SSR 09-3p: Title XVI: Determining Childhood Disability – The Functional Equivalence Domain of “Acquiring and Using Information”

Effective Date: March 19, 2009 Publication

Date: February 17, 2009 Federal Register Vol. 74, No. 30, page

7511

POLICY INTERPRETATION RULING

Purpose:

This SSR consolidates information

from our regulations, training materials, and question-and-answer

documents about the functional equivalence domain of “Acquiring

and using information.” It also explains our policy about that

domain.

Citations:

Sections 1614(a)(3) , 1614(a)(4) , and 1614(c) of the Social

Security Act, as amended; Regulations No. 4, subpart P,

appendix 1 ; and Regulations No. 16, subpart I, sections 416.902 , 416.906 , 416.909 , 416.923 , 416.924 , 416.924a , 416.924b , 416.925 , 416.926 , 416.926a , and 416.994a .

Introduction:

As we explain in greater detail in SSR 09-1p, we always evaluate the

“whole child” when we make a finding regarding functional

equivalence, unless we can otherwise make a fully favorable

determination or decision. [6] We focus first on the child’s activities, and evaluate how

appropriately, effectively, and independently the child functions

compared to children of the same age who do not have impairments. 20 CFR 416.926a(b) and (c) . We consider what

activities the child cannot do, has difficulty doing, needs help doing,

or is restricted from doing because of the impairment(s). 20 CFR 416.926a(a) . Activities are everything a child does at home, at school, and in

the community, 24 hours a day, 7 days a week. [7]

We next evaluate the effects of a child’s impairment(s) by

rating the degree to which the impairment(s) limits functioning in six

“domains.” Domains are broad areas of functioning

intended to capture all of what a child can or cannot do. We use the

following six domains:

(1) Acquiring and using information,

(2) Attending and completing tasks,

(3) Interacting and relating with others,

(4) Moving about and manipulating objects,

(5) Caring for yourself, and

the degree to which the impairment(s) limits functioning in six

“domains.” Domains are broad areas of functioning

intended to capture all of what a child can or cannot do. We use the

following six domains:

(1) Acquiring and using information,

(2) Attending and completing tasks,

(3) Interacting and relating with others,

(4) Moving about and manipulating objects,

(5) Caring for yourself, and

(6) Health and physical well-being.

20 CFR

416.926a(b)(1) . [8]

To functionally equal the listings, an impairment(s) must be of

listing-level severity; that is, it must result in "marked"

limitations in two domains of functioning or an "extreme"

limitation in one domain. [9] 20 CFR 416.926a(a) .

Policy Interpretation

General

In the domain of “Acquiring and using information,” we

consider a child’s ability to learn information and to think

about and use the information.

Children acquire and use information at all ages for many different

purposes. For example:

- An infant shakes a rattle and learns that it will produce

noise.

- A toddler learns how to play simple games.

- An older child learns how to read and do arithmetic, which enables

the child to act more independently, such as to make a purchase.

- A teenager may learn the rules and mechanics for driving a car.

Accordingly, this domain considers more than just assessments of

cognitive ability as measured by intelligence tests, academic

achievement instruments, or grades in school.

to play simple games.

- An older child learns how to read and do arithmetic, which enables

the child to act more independently, such as to make a purchase.

- A teenager may learn the rules and mechanics for driving a car.

Accordingly, this domain considers more than just assessments of

cognitive ability as measured by intelligence tests, academic

achievement instruments, or grades in school.

Learning and thinking begin at birth. In early infancy, children

learn primarily by exploring their world through the senses (sight,

sound, taste, touch, and smell), but also through movement and

imitation. As they go on to engage in play, children learn about

concepts (for example, “color,” “shape,”

“size,” and “weight”). As they learn that

people, objects, and activities have names, they begin to understand

that names are words, and words are symbols that “stand

for” what is named. Over time, this understanding of concepts

and symbols prepares children for using language to learn and think.

Eventually, they are expected to learn to read, write, and do

arithmetic, as well as to acquire new information--not only in school,

but at home and in the community.

Throughout the learning process, children have to think about and use

the information they have learned. Thinking involves being able to

perceive relationships (for example, over/under and near/far), reason,

and make logical choices. Children may do these things by thinking in

pictures, words, or both. For example, children may solve problems by

watching and imitating what other people do (thinking in pictures), or

by internally “talking” their way through them (thinking in

words). Eventually, children should be able to use language to think

about the world, understand others, and express themselves. As they

learn more complex language, children should be able to combine ideas to

solve problems and perform more complex tasks.

ems by

watching and imitating what other people do (thinking in pictures), or

by internally “talking” their way through them (thinking in

words). Eventually, children should be able to use language to think

about the world, understand others, and express themselves. As they

learn more complex language, children should be able to combine ideas to

solve problems and perform more complex tasks.

Both mental and physical impairments can affect a child’s

ability to acquire and use information. In addition to mental

retardation and learning disorders, many other mental disorders can

cause limitations in the domain of “Acquiring and using

information.” For example, children with anxiety disorders may be

so fearful about failing that they cannot perform learning-related

tasks at school, such as taking tests or making presentations. Physical

impairments, such as speech and hearing disorders, may affect a

child’s ability to learn, especially in the classroom. Other

impairments that frequently have effects in this domain include, but are

not limited to, traumatic brain injury, cerebral palsy, and

meningitis.

As with limitations in any domain, we do not consider a limitation in

the domain of “Acquiring and using information” unless it

results from a medically determinable impairment(s). However, while it

is common for all children to experience some difficulty acquiring and

using information from time to time, a child who has significant but

unexplained problems in this domain may have an impairment(s) that was

not alleged or has not yet been diagnosed. In such cases, adjudicators

should pursue any indications that an impairment(s) may be present.

[10] Preschool and school evidence

while it

is common for all children to experience some difficulty acquiring and

using information from time to time, a child who has significant but

unexplained problems in this domain may have an impairment(s) that was

not alleged or has not yet been diagnosed. In such cases, adjudicators

should pursue any indications that an impairment(s) may be present.

[10] Preschool and school evidence

Because much of a preschool or school-age child’s learning

takes place in a school setting, preschool and school records are often

a significant source of information about limitations in the domain of

“Acquiring and using information.” Poor grades or

inconsistent academic performance are among the more obvious indicators

of a limitation in this domain provided they result from a medically

determinable mental or physical impairment(s). Other indications in

school records that a mental or physical impairment(s) may be

interfering with a child’s ability to acquire and use information

include, but are not limited to:

- Special education services, such as assignment of a personal

aide who helps the child with classroom activities in a regular

classroom, remedial or compensatory teaching methods for academic

subjects, or placement in a self-contained classroom.

- Related services to help the child benefit from special

education, such as occupational, physical, or speech/language therapy,

or psychological and counseling services.

- Other accommodations made for the child’s

impairment(s), both inside and outside the classroom, such as front-row

seating in the classroom, more time to take tests, having tests read to

the student, or after-school tutoring.

elated services to help the child benefit from special

education, such as occupational, physical, or speech/language therapy,

or psychological and counseling services.

- Other accommodations made for the child’s

impairment(s), both inside and outside the classroom, such as front-row

seating in the classroom, more time to take tests, having tests read to

the student, or after-school tutoring.

The kind, level, and frequency of special education, related

services, or other accommodations a child receives can provide helpful

information about the severity of the child’s impairment(s).

However, the lack of such indicators does not necessarily mean that a

child has no limitations in this domain. For various reasons, some

children’s limitations may go unnoticed until well along in their

schooling, or the children may not receive the services that they

need. [11] Therefore, when we

assess a child’s abilities in any of the domains, we must compare

the child’s functioning to the functioning of same-age children

without impairments based on all relevant evidence in the case

record.

Although we consider formal school evidence (such as grades and

aptitude and achievement test scores) in determining the severity of a

child’s limitations in this domain, we do not rely solely on such

measures. We also consider evidence about the child’s ability to

learn and think from medical and other non-medical sources (including

the child, if the child is old enough to provide such information), and

we assess limitations in this ability in all settings, not just in

school.

As already noted, we do not consider a limitation in acquiring and

using information unless it results from a medically determinable

impairment(s). Therefore, we do not consider limitations that are

associated with academic underachievement by a student who does not

have a physical or mental impairment that accounts for the limitations.

Effects in other domains

settings, not just in

school.

As already noted, we do not consider a limitation in acquiring and

using information unless it results from a medically determinable

impairment(s). Therefore, we do not consider limitations that are

associated with academic underachievement by a student who does not

have a physical or mental impairment that accounts for the limitations.

Effects in other domains

Children who have limitations in the domain of “Acquiring and

using information” may also have limitations in other domains.

For example, mental impairments that affect a child’s ability to

learn may also affect a child’s ability to attend or to complete

tasks. In such cases, we evaluate limitations in both the domains of

“Acquiring and using information” and “Attending and

completing tasks.” Also, children who have language impairments

often have limitations in both the domains of “Acquiring and

using information” and “Interacting and relating with

others.”

Children who have physical impairments that affect motor functioning,

which we evaluate in the domain of “Moving about and manipulating

objects,” may also have limitations in the domain of

“Acquiring and using information.” Symptoms associated with

a physical impairment(s), such as generalized or localized pain, may

interfere with a child’s ability to concentrate (an effect that we

evaluate in the domain of “Attending and completing

tasks”), and this will often also have effects on the

child’s ability in the domain of “Acquiring and using

information.” Lastly, some medications for physical impairments

may affect mental functioning, interfering with a child’s ability

to pay attention, remember, or follow directions. We consider these

effects in the domains of “Acquiring and using

information,” “Attending and completing tasks,” or

both.

s will often also have effects on the

child’s ability in the domain of “Acquiring and using

information.” Lastly, some medications for physical impairments

may affect mental functioning, interfering with a child’s ability

to pay attention, remember, or follow directions. We consider these

effects in the domains of “Acquiring and using

information,” “Attending and completing tasks,” or

both.

Therefore, as in any case, we evaluate the effects of a

child’s impairment(s), including the effects of medication or

other treatment and therapies, in all relevant domains. Rating the

limitations caused by a child’s impairment(s) in each and every

domain that is affected is not “double-weighting” of

either the impairment(s) or its effects. Rather, it recognizes the

particular effects of the child’s impairment(s) in all domains

involved in the child’s limited activities. [12]

Examples of typical functioning in the domain of

“Acquiring and using information”

While there is a wide range of normal development, most children

follow a typical course as they grow and mature. To assist

adjudicators in evaluating a child’s impairment-related

limitations in the domain of “Acquiring and using

information,” we provide the following examples of typical

functioning drawn from our regulations, training, and case reviews.

These examples are not all-inclusive, and adjudicators are not required

to develop evidence about each of them. They are simply a frame of

reference for determining whether children are functioning typically for

their age with respect to acquiring and using information.

Newborns and young infants (birth to attainment of

age 1)

- Shows interest in and explores the environment (for example,

reaches for a toy).

- Engages in random actions that eventually become purposeful (for

example, shakes a rattle).

- Begins to recognize and anticipate routine situations and events

(for example, smiles at the sight of a stroller).

pect to acquiring and using information.

Newborns and young infants (birth to attainment of

age 1)

- Shows interest in and explores the environment (for example,

reaches for a toy).

- Engages in random actions that eventually become purposeful (for

example, shakes a rattle).

- Begins to recognize and anticipate routine situations and events

(for example, smiles at the sight of a stroller).

- Begins to recognize and attach meaning to everyday sounds (for

example, the telephone).

- Begins to recognize and respond to familiar words (for example, own

name, the name of a family member, or the word for a favorite toy or

activity).

Older infants and toddlers (age 1 to attainment

of age 3)

- Learns how objects go together in different ways.

- Learns through pretending that actions can represent real

things.

- Understands that words represent people, things, places, and

activities.

- Refers to self and things by pointing and eventually naming.

- Learns concepts and solves simple problems by purposeful

experimentation (for example, taking a toy apart), imitation,

constructive play (for example, building with blocks), and pretend play

activities.

- Makes simple choices between two things.

- Responds to increasingly complex instructions and questions.

- Produces an increasing number of words and grammatically correct

simple sentences and questions.

Preschool children (age 3 to attainment of age

6)

- Develops readiness skills needed for learning to read (for example,

listening to stories, rhyming words, or matching letters).

- Develops readiness skills needed for learning to do math (for

example, counting, sorting, or building with blocks). [13]

- Develops readiness skills needed for learning to write (for

example, coloring, painting, copying shapes, or using scissors).

- Uses words to ask questions, give answers, describe things, provide

explanations, and tell stories.

- Follows several unrelated directions (for example, “Put your

toy in the box and get your coat on.”).

or

example, counting, sorting, or building with blocks). [13]

- Develops readiness skills needed for learning to write (for

example, coloring, painting, copying shapes, or using scissors).

- Uses words to ask questions, give answers, describe things, provide

explanations, and tell stories.

- Follows several unrelated directions (for example, “Put your

toy in the box and get your coat on.”).

- Begins to understand the order of daily routines (for example,

breakfast before lunch).

- Begins to understand and remember own accomplishments.

- Begins to understand increasingly complex concepts (for example,

“time” as in yesterday, today, and tomorrow).

School-age children (age 6 to attainment of age

12)

- Learns to read, write, and do simple arithmetic.

- Becomes interested in new subjects and activities (for example,

science experiments and stories from history).

- Demonstrates learning by producing oral and written projects,

solving arithmetic problems, taking tests, doing group work, and

entering into class discussions.

- Applies learning in daily activities at home and in the community

(for example, reading street signs, telling time, and making

change).

- Uses increasingly complex language (vocabulary and grammar) to

share information, ask questions, express ideas, and respond to the

opinions of others.

Adolescents (age 12 to attainment of age 18)

- Continues to demonstrate learning in academic assignments (for

example, in composition, during classroom discussion, and by school

laboratory experiments).

- Applies learning in daily situations without assistance (for

example, going to the store, getting a book from the library, or using

public transportation).

- Comprehends and expresses simple and complex ideas using

increasingly complex language in academic and daily living

situations.

- Learns to apply knowledge in practical ways that will help in

employment (for example, carrying out instructions, completing a job

application, or being interviewed by a potential employer).

ore, getting a book from the library, or using

public transportation).

- Comprehends and expresses simple and complex ideas using

increasingly complex language in academic and daily living

situations.

- Learns to apply knowledge in practical ways that will help in

employment (for example, carrying out instructions, completing a job

application, or being interviewed by a potential employer).

- Plans ahead for future activities.

- Begins realistic occupational planning.

Examples of limitations in the domain of

“Acquiring and using information”

To further assist adjudicators in evaluating a child’s

impairment-related limitations in the domain of “Acquiring and

using information,” we also provide the following examples of some

of the limitations we consider in this domain. These examples are

drawn from our regulations and training. They are not the only

limitations in this domain, nor do they necessarily describe a

“marked” or an “extreme” limitation.

In addition, the examples below may or may not describe limitations

depending on the expected level of functioning for a given child’s

age. For example, a toddler would not be expected to be able to read,

but a teenager would. [14]

- Does not demonstrate an understanding of words that describe

concepts such as space, size, or time (for example, inside/outside,

big/little, morning/night).

- Cannot rhyme words or the sounds in words.

- Has difficulty remembering what was learned in school the day

before.

- Does not use language appropriate for age.

- Is not developing “readiness skills” the same as peers

(for example, learning to count, reciting ABCs, scribbling).

- Is not reading, writing, or doing arithmetic at appropriate grade

level.

- Has difficulty comprehending written or oral directions.

- Struggles with following simple instructions.

- Talks only in short, simple sentences.

- Has difficulty explaining things.

Effective date:

This SSR is effective on March 19, 2009

Cross-References:

or example, learning to count, reciting ABCs, scribbling).

- Is not reading, writing, or doing arithmetic at appropriate grade

level.

- Has difficulty comprehending written or oral directions.

- Struggles with following simple instructions.

- Talks only in short, simple sentences.

- Has difficulty explaining things.

Effective date:

This SSR is effective on March 19, 2009

Cross-References:

SSR 09-1p , Title XVI:

Determining Childhood Disability Under the Functional Equivalence Rule

--The "Whole Child" Approach; SSR 09-2p , Title: Determining

Childhood Disability — Documenting a Child's Impairment-Related

Limitations; SSR 09-4p , Title XVI:

Determining Childhood Disability — The Functional Equivalence

Domain of “Attending and Completing Tasks”; SSR 09-5p , Title XVI: Determining

Childhood Disability — “Interacting and Relating with

Others”; SSR 09-6p , Title

XVI: Determining Childhood Disability — The Functional Equivalence

Domain of “Moving About and Manipulating Objects”; SSR 09-7p , Title XVI: Determining

Childhood Disability — The Functional Equivalence Domain of

“Caring for Yourself”; SSR

09-8p , Title XVI: Determining Childhood Disability — The

Functional Equivalence Domain of “Health and Physical

Well-Being”; SSR 98-1p , Title

XVI: Determining Medical Equivalence in Childhood Disability Claims When

a Child Has Marked Limitations in Cognition and Speech; and Program

Operations Manual System (POMS) DI 25225.030, DI 25225.035, DI

25225.040, DI 25225.045, DI 25225.050, and DI 25225.055.

[1] The definition of

disability in section 1614(a)(3)(C) of the

Social Security Act (the Act) applies to any “individual”

who has not attained age 18. In this SSR, we use the word

"child" to refer to any such person, regardless of whether

the person is considered a "child" for purposes of the SSI

program under section 1614(c) of the Act.

5.040, DI 25225.045, DI 25225.050, and DI 25225.055.

[1] The definition of

disability in section 1614(a)(3)(C) of the

Social Security Act (the Act) applies to any “individual”

who has not attained age 18. In this SSR, we use the word

"child" to refer to any such person, regardless of whether

the person is considered a "child" for purposes of the SSI

program under section 1614(c) of the Act.

[2] For simplicity, we

refer in this SSR only to initial claims for benefits. However, the

policy interpretations in this SSR also apply to continuing disability

reviews of children under section 1614(a)(4) of the Act and 20 CFR 416.994a .

[3] We use the term

“impairment(s)” in this SSR to refer to an “impairment

or a combination of impairments.”

[4] The impairment(s) must

also satisfy the duration requirement in section 1614(a)(3)(A) of the

Act; that is, it must be expected to result in death, or must have

lasted or be expected to last for a continuous period of not less than

12 months.

[5] For each major body

system, the listings describe impairments we consider severe enough to

cause “marked and severe functional limitations.” 20 CFR 416.925(a) ; 20 CFR part 404, subpart P, appendix 1 .

[6] See SSR 09-1p , Title XVI: Determining

Childhood Disability Under the Functional Equivalence Rule – The

“Whole Child” Approach.

[7] However, some children

have chronic physical or mental impairments that are characterized by

episodes of exacerbation (worsening) and remission (improvement);

therefore, their level of functioning may vary considerably over time.

To properly evaluate the severity of a child’s limitations

in functioning, as described in the following paragraphs, we must

consider any variations in the child’s level of functioning to

determine the impact of the chronic illness on the child’s

ability to function longitudinally; that is, over time. For more

information about how we evaluate the severity of a child’s

limitations, see SSR 09-1p

operly evaluate the severity of a child’s limitations

in functioning, as described in the following paragraphs, we must

consider any variations in the child’s level of functioning to

determine the impact of the chronic illness on the child’s

ability to function longitudinally; that is, over time. For more

information about how we evaluate the severity of a child’s

limitations, see SSR 09-1p .

For a comprehensive discussion of how we document a child’s

functioning, including evidentiary sources, see SSR 09-2p , Title XVI: Determining

Childhood Disability – Documenting a Child’s

Impairment-Related Limitations.

[8] For the first five

domains, we describe typical development and functioning using five age

categories: Newborns and young infants (birth to attainment of age 1);

older infants and toddlers (age 1 to attainment of age 3); preschool

children (age 3 to attainment of age 6); school-age children (age 6 to

attainment of age 12); and adolescents (age 12 to attainment of age

18). We do not use age categories in the sixth domain because that

domain does not address typical development and functioning, as we

explain in SSR 09-8p , Title XVI:

Determining Childhood Disability – The Functional Equivalence

Domain of “Health and Physical Well-Being.”

[9] See 20 CFR 416.926a(e) for

definitions of the terms “marked” and “extreme.”

[10] For this domain,

early intervention records can be an important source of information

for children from birth to the attainment of age 3. For more

information about how we consider early intervention, preschool, school,

and other evidence, see SSRs

09-1p and 09-2p .

ain of “Health and Physical Well-Being.”

[9] See 20 CFR 416.926a(e) for

definitions of the terms “marked” and “extreme.”

[10] For this domain,

early intervention records can be an important source of information

for children from birth to the attainment of age 3. For more

information about how we consider early intervention, preschool, school,

and other evidence, see SSRs

09-1p and 09-2p .

[11] See 20 CFR

416.924a(b)(7)(iv) , which states that “[t]he fact that you do

or do not receive special education services does not, in itself,

establish your actual limitations or abilities. Children are placed in

special education settings, or are included in regular classrooms (with

or without accommodation), for many reasons that may or may not be

related to the level of their impairments.”

[12] For more

information about how we rate limitations, including their interactive

and cumulative effects, see SSR

09-1p .

[13] When building with

blocks, a child is learning mathematical concepts such as

“size” and “volume.”

[14] See 20 CFR 416.924b .