Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program (2016)

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Appendix G Summary of Mental Disorders and Disabilities Among Low-Income Children In 2013, the Social Security Administration’s Office of Disability Policy requested that the Institute of Medicine (IOM) convene a consensus com- mittee to identify past and current trends with the prevalence and per- sistence of mental disorders for the general U.S. population under age 18; compare those trends with trends in the Social Security Income (SSI) childhood disability population; and provide an overview of the current status of the diagnosis and treatment of mental disorders and the levels of impairment associated with these disorders in the U.S. population under age 18 (see Box G-1 for the committee’s statement of task). This study was con- ducted at the same time that the study of the Committee on the Evaluation of the Supplemental Security Income (SSI) Disability Program for Children with Speech Disorders and Language Disorders was under way. While the two studies had related statements of task, they entailed separate commit- tees, meetings, and report review processes. The report of the Committee on the Evaluation of the Supplemental Security Income Disability Program for Children with Mental Disorders— Mental Disorders and Disabilities Among Low-Income Children—was released in September 2015. Box G-2 provides the report’s key conclusions. The full text of the report can be found online at http://www.nap.edu/ catalog/21780. 275 

276 SPEECH AND LANGUAGE DISORDERS IN CHILDREN BOX G-1 Statement of Task The task order objective is to: •  dentify pasta and current trendsb in the prevalence and persistence of I mental disordersc for the general U.S. population under age 18, and compare those trends to trends in the SSI childhood disability population. •  rovide an overview of the current status of the diagnosis and treatment P of mental disorders, and the levels of impairment, in the U.S. population under age 18. To accomplish this objective, the committee shall: 1.  ompare the national trends in the number of children with mental C disorders under age 18 with the trends in the number of children receiving SSI on the basis of mental disorders, and describe the possible factors that may contribute to any differences between the two groups. 2.  Identify current professional standards of pediatric and adolescent mental health care and identify the kinds of care documented or reported to be received by children in the SSI childhood disability population. To perform the above activities, the committee shall do the following with respect to the two child populations: 1. Identify national trends in the prevalence of mental disorders in children; and assess factors that influence these trends (for example, increased awareness or improved diagnosis). 2. Identify the average age of onset and the gender distribution; and assess the levels of impairment within age groups. 3.  ssess how age, development, and gender may play a role in the A progression of some mental disorders. 4. Identify common comorbidities among pediatric mental disorders. 5. Identify which mental disorders are most amenable to treatment; and as- sess typical or average time required for improvement in mental disorder to manifest following diagnosis and treatment. 6. Identify professionally accepted standards of care (such as diagnostic evaluation and assessment, treatment planning and protocols, medica- tion management,d and behavioral and educational interventions) for children with mental disorders. a For at least the past 10 years. bIn context of current trends in child health and development, and in pediatric and adolescent medicine. c Including disorders such as attention deficit hyperactivity disorder, autism and other developmental disorders, intellectual disability, learning disorders, and mood and conduct disorders. d Including appropriateness of how medications are being prescribed. 

APPENDIX G 277 BOX G-2 Key Conclusions 1.  Information about trends in the rates of mental disorders, and the dis- ability associated with mental disorders, among children in the United States is limited. In addition, it is difficult to directly compare these trends to trends in the number of allowances and recipients* of SSI benefits for child mental disorders. Information about the severity, comorbidities, treatment, outcomes, and other characteristics (including race and ethnic- ity) of children who are SSI recipients is also limited. 2.  While the number of children allowed (that is new beneficiaries of) SSI benefits for mental disorders has fluctuated from year to year between 2004 to 2013, over the 10-year period, the percentage of poor children who are allowed SSI benefits for mental disorders has decreased. 3.  After taking child poverty into account, the increase in the percentage of poor children receiving SSI benefits for mental disorders (from 1.88 per- cent in 2004 to 2.09 percent in 2013) is consistent with and proportionate to trends in prevalence of mental disorders among children in the general population. 4.  The trend in child poverty was a major factor affecting trends observed in the SSI program for children with mental disorders during the study period. Increases in numbers of children applying for and receiving SSI benefits on the basis of mental health diagnoses are strongly tied to increasing rates of childhood poverty because more children with mental health disorders become financially eligible for the program when poverty rates increase. 5.  Better data about diagnoses, comorbidities, severity of impairment, and treatment, with a focus on trends in these characteristics, is necessary to inform improvements to the SSI program for children. The expansion of data collection and analytical capacities to obtain critical information about SSI allowances for, and recipients with mental disorders should be given consideration by the SSA and related stakeholders. 6.  Important policy issues identified during this study, but outside of the scope of this committee’s statement of task, include improving methods for the evaluation of impairment and disability in children, effects of SSI benefits for children on family income and work, and state to state varia- tion within the SSI program. Further investigation of these topics, building on the findings and conclusions of this report, could provide expert policy advice on how to improve the SSI program for children. * An allowance is determination by the disability determination service, an administrative law judge, or the Appeals Council that an applicant meets the medical definition of disability under the law. A recipient is an individual who receives SSI benefits.