Abstract
This paper used Social Security Administration program data from 2005 to 2019 to examine national- and state-level changes in the number of new adult supplemental security income (SSI) awardees on the autism spectrum relative to awardees with intellectual disability and other mental health disorders. We identified three main findings: the number of autistic awards increased between 2005 and 2019 when awards for all other mental health disorders declined; roughly nine out of every 10 autistic adult awardees were between ages 18–25 years; there was variation in the growth of autistic awards across states. These findings support the need to consider geographic and age differences in SSI program participation among autistic adults and determine the underlying causes.
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SSA uses the Listing of Impairments (Listings) – a codified guide of eligible medical conditions – to determine whether the applicant meets criteria for a physical or mental health impairment. There are 11 categories of mental disorders within the Listings that can qualify a claimant for SSI benefits: neurocognitive disorders; schizophrenia spectrum and other psychotic disorders; depressive, bipolar and related disorders; intellectual disorder; anxiety and obsessive–compulsive disorders; somatic symptom and related disorders; personality and impulse-control disorders; autism spectrum disorder; neurodevelopmental disorders; eating disorders; and trauma- and stressor-related disordersAdministration, S. S. (2014). Disability Evaluation Under Social Security, Listing of Impairments—Adult Listings (Part A). https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm.
Social security claims representatives document the primary disability that qualifies an individual to receive SSI benefits. There is also a position for a SSA field office staff member to record a secondary disability, though this is often not required for disability determination. That said, the classification of primary versus secondary impairments is susceptible to the subjectivity of claims representatives and may be driven in part by which diagnosis is more sufficient to establish benefit. Because of the strident rules for proof of disability documentation required to qualify for SSI, a person who has a primary or secondary impairment of autism very likely has autism. However, there may be people who receive SSI and have autism, but do not have it listed as an impairment in their SSA record.
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Acknowledgments
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under UJ2MC31073: Maternal and Health-ASD Transitions Research Project. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Funding
This research was also supported by the Organization for Autism Research (OAR), Inc. Applied Research Grant, under the title “Usage Trends and Characteristics of SSI Recipients on the Autism Spectrum.”
The findings and conclusions are solely those of the authors and do not represent the views of the Social Security Administration.
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KA conceived of the study and drafted the manuscript; JH conducted data analysis, and contributed to the conceptualization of the design and the implications of the findings and revised the manuscript critically for important intellectual content; DW, JB, AR, JR and PS contributed to the conceptualization of the design and the implications of the findings and revised the manuscript critically for important intellectual content.
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Anderson, K.A., Hemmeter, J., Wittenburg, D. et al. National and State Trends in autistic Adult Supplemental Security Income Awardees: 2005–2019. J Autism Dev Disord 52, 3547–3559 (2022). https://doi.org/10.1007/s10803-021-05215-1
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DOI: https://doi.org/10.1007/s10803-021-05215-1