Evaluating Disability for Children

Domains of Functioning

The Social Security Administration created the term “Domains of Functioning” for children who are disabled that do not meet or equal the requirements of a listing, which would be found in the Social Security’s “blue book” under the section Childhood Listings (Part B).

The Domains of Functioning refers to six categories (known as domains) that each evaluates a different area of functioning important in everyday life. Here are the 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
6.      Health and Physical Well-being

Marked and Extreme Limitations

In order for an impairment to equal the listings through the domains of functioning, the impairment must cause severe (marked) limitations that affect at least two of the six domains of functioning or an extreme limitation that affects at least one domain. The difference between a marked and extreme limitation is described below.

Marked Limitation – is a limitation that severely interferes with a child’s ability to engage in activities related to a domain of functioning. A marked limitation is more severe than a moderate limitation and is less severe than an extreme limitation.

Extreme Limitation – is a limitation that very seriously interferes with a child’s ability to engage in activities related to a domain of functioning. An extreme limitation is rather rare and is only given to the worst limitations.

The Six Domains of Functioning

Acquiring and Using Information

This domain considers how well a child can learn and acquire information as well as their ability to utilize the information. From birth, children start learning and acquiring information through exploring the world and receiving formal education by attending school. As they grow up, children should adapt and acquire skills in communication, arithmetic, reading, writing, and reasoning through their experiences. These skills should progress with complexity as they age and eventually can be utilized in a workplace or community environment.

A child may have a marked or extreme limitation if:

The Child cannot show understanding of works related to size, space, or time
The Child is unable to rhyme words
The Child has difficulty remembering important concepts learned the day beforehand
The Child has difficulty solving math or arithmetic problems
The Child talks in simple, short sentence and has trouble explaining what they mean

Attending and Completing Tasks

This domain evaluates a child’s ability to focus and maintain attention as well as their ability to begin, continue, and complete activities at a normal pace for their age. Typically, a child should be able to regulate alertness, filter out distractions, and maintain focus on a task or activity. While attending school, these abilities are critical for a child to effectively follow instructions, keep organized, and complete assignments.

A child may have a marked or extreme limitation if:
The Child is easily startled, distracted or overreacts to touch, sounds, or movements
The Child is slow to focus on, or unable to finish activities of interest
The Child frequently becomes sidetracked from activities or repeatedly interrupts other
The Child becomes frustrated easily and gives up on tasks
The Child requires additional supervision to maintain engagement in an activity

Interacting and Relating to Others

This domain focuses on a child’s ability to connect and cooperate with others, abide by rules or restrictions, respond to authority or criticism, respect the possessions of others, and develop a sense of community. A child should develop close personal relationships with family and friends and work cooperatively with other children in school or the community. A child should also understand and respect social rules in various environments such as what is behavior is acceptable at home compared to being in public at a grocery store.

A child may have a marked or extreme limitation if:

The Child does not reach out to be picked up by his or her guardians
The Child has no close friends of the same age
The Child avoids contact with others including people they know
The Child has problems with adequate fluency when speaking
The Child has difficulty engaging in activities with rules (such as board games or sports)
The Child has difficulty with communication; The Child struggles with expressing emotions, continuing a conversation, or asking for help

Moving About and Manipulating Objects

This domain involves how well a child can move his or her body from one location to another and how The Child moves and manipulates objects. These movements are known as “gross” and “fine” motor skills and are described below.

Gross and Fine Motor Skills

Gross motor skills involve movement and coordination of the limbs (arms and legs) and other large body parts while fine motor skills refer to the movement and coordination of smaller body parts such as the hands, fingers, wrists, feet, ankles and toes. Gross motor skills include movements such as running, kneeling, bending, and crawling. Fine motor skills include movements such as grasping, gripping, and writing.

The physical capabilities of a child depend on his or her age. A 6-year-old is not expected to have the same complex motor skills as a 16-year-old. As children age, they should develop more complex motor skills appropriate for their age. Below are some examples of limitations for this domain.

A child may have a marked or extreme limitation if:

The Child experiences sensory loss, muscle weakness, or joint stiffness
The Child has difficulty keeping balance, climbing stairs, or maintaining organized locomotion
The Child has trouble with coordinating gross motor movement
The Child has trouble with fine motor movement
The Child has difficulty with complex finger or hand movements
The Child has poor hand-eye coordination while using scissors or a pencil

Caring for Self

This domain evaluates how well a child is able to take care of him or herself. This includes a child’s ability to meet his or her emotional and physical wants and needs as well as how the child deals with changes in his or her environment. As children grow, they should learn to understand how to regulate themselves independently and take care of their own personal needs, possessions, health, and safety (appropriate for their age).

A child may have a marked or extreme limitation if:

The Child repeatedly places inedible objects in his or her month
The Child consistently engages in self-soothing activities exhibiting developmental regression
The Child is unable to dress or bathe properly for his or her age
The Child often engages in self-harming behavior or disregards safety rules
The Child does not seek out activities of interest
The Child has disturbed sleeping and eating patterns

Health and Physical Well-Being

This domain considers the cumulative physical effects of the child’s impairment(s) and its associated medications or treatments that are not considered in the “Caring for Self” domain. Physical and mental disabilities can have physical effects that vary in severity and can inhibit a child’s ability to perform activities effectively or independently. The medication a child takes for his or her disability may potentially create physical side effects that interfere with daily activities.

A child may have a marked or extreme limitation if:

The Child needs intensive medical care to maintain health and well-being
The Child physical limitations manifested from treatments, medication, or surgeries
The Child has generalized symptoms caused by his or her condition such as dizziness, lethargy, weakness, agitation, or psychomotor retardation