Children living in poverty are more likely to have mental health problems, and their conditions are more likely to be severe. Of the approximately 1.3 million children who were recipients of Supplemental Security Income (SSI) disability benefits in 2013, about 50% were disabled primarily due to a mental disorder. An increase in the number of children who are recipients of SSI benefits due to mental disorders has been observed through several decades of the program beginning in 1985 and continuing through 2010. Nevertheless, less than 1% of children in the United States are recipients of SSI disability benefits for a mental disorder.

At the request of the Social Security Administration, Mental Disorders and Disability Among Low-Income Children compares national trends in the number of children with mental disorders with the trends in the number of children receiving benefits from the SSI program, and describes the possible factors that may contribute to any differences between the two groups. This report provides an overview of the current status of the diagnosis and treatment of mental disorders, and the levels of impairment in the U.S. population under age 18. The report focuses on 6 mental disorders, chosen due to their prevalence and the severity of disability attributed to those disorders within the SSI disability program: attention-deficit/hyperactivity disorder, oppositional defiant disorder/conduct disorder, autism spectrum disorder, intellectual disability, learning disabilities, and mood disorders. While this report is not a comprehensive discussion of these disorders, Mental Disorders and Disability Among Low-Income Children provides the best currently available information regarding demographics, diagnosis, treatment, and expectations for the disorder time course - both the natural course and under treatment.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE TO EVALUATE THE SUPPLEMENTAL SECURITY INCOME DISABILITY PROGRAM FOR CHILDREN WITH MENTAL DISORDERS
• Reviewers
• Preface
• Acknowledgments
• Acronyms and Abbreviations
• Summary
  • NATIONAL TRENDS IN THE SSI PROGRAM FOR CHILDREN WITH DISABILITIES
  • STATE-TO-STATE VARIATION OBSERVED IN THE SSI PROGRAM FOR CHILDREN WITH MENTAL DISORDERS
  • POVERTY AND CHILDHOOD DISABILITY
  • CLINICAL CHARACTERISTICS OF MENTAL DISORDERS IN CHILDREN
  • PREVALENCE OF MENTAL DISORDERS IN CHILDREN
  • PREVALENCE AND TREATMENT OF MENTAL DISORDERS IN CHILDREN ENROLLED IN MEDICAID
• I. Background and Context of the Supplemental Security Income Disability Benefit Program for Children
  • 1. Introduction
    • BACKGROUND
    • STUDY CHARGE, SCOPE, AND APPROACH
    • References
  • 2. The SSI Program for Children
    • PURPOSE AND HISTORY OF THE SSI PROGRAM FOR CHILDREN
    • KEY TERMS AND DEFINITIONS
    • REQUIREMENTS FOR SSI ELIGIBILITY
    • THE APPEALS PROCESS, SUSPENSIONS AND TERMINATIONS, AND RECURRING REVIEWS
    • DESCRIPTION OF SSI DATA
    • INTERPRETATION AND USE OF SSI DATA FOR PREVALENCE TRENDS
    • SUMMARY
    • FINDINGS
    • CONCLUSIONS
    • References
  • 3. National-Level Trends in the SSI Program for Children with Mental Disorders, 2004–2013
    • AGGREGATE REVIEW OF 10 MAJOR MENTAL DISORDERS
    • REVIEW OF INDIVIDUAL MAJOR MENTAL DISORDERS
    • FINDINGS
    • CONCLUSIONS
    • REFERENCES
  • 4. State Variation in the SSI Program for Children
    • STATE VARIATION IN THE RATES OF REPORTED MENTAL HEALTH DISORDERS
    • STATE-TO-STATE VARIATION IN 2013
    • CHANGE IN STATE-SPECIFIC DETERMINATION RATES IN CHILDREN IN LOW-INCOME HOUSEHOLDS BETWEEN 2004 AND 2013
    • SUMMARY OF STATE VARIATIONS IN 2013
    • FINDING
    • CONCLUSION
    • REFERENCES
  • 5. Poverty and Childhood Disability
    • CHILDHOOD POVERTY
    • CHILDHOOD DISABILITY
    • FINDINGS
    • CONCLUSIONS
    • REFERENCES
• II. Clinical Characteristics of Selected Mental Disorders
  • 6. Clinical Characteristics of Attention Deficit Hyperactivity Disorder
    • DIAGNOSIS AND ASSESSMENT
    • DEMOGRAPHIC FACTORS AND DURATION OF THE DISORDER
    • COMORBIDITIES
    • FUNCTIONAL IMPAIRMENT
    • TREATMENT AND OUTCOMES
    • FINDINGS
    • REFERENCES
  • 7. Clinical Characteristics of Oppositional Defiant Disorder and Conduct Disorder
    • DIAGNOSIS AND ASSESSMENT
    • DEMOGRAPHIC FACTORS AND DURATION OF THE DISORDER
    • COMORBIDITIES
    • FUNCTIONAL IMPAIRMENT
    • TREATMENT AND OUTCOMES
    • REFERENCES
  • 8. Clinical Characteristics of Autism Spectrum Disorder
    • DIAGNOSIS AND ASSESSMENT
    • DEMOGRAPHIC FACTORS AND DURATION OF THE DISORDER
    • COMORBIDITIES
    • FUNCTIONAL IMPAIRMENT
    • TREATMENT AND OUTCOMES
    • FINDINGS
    • REFERENCES
  • 9. Clinical Characteristics of Intellectual Disabilities
    • DIAGNOSIS AND ASSESSMENT
    • DEMOGRAPHIC FACTORS AND DURATION OF THE DISORDER
    • COMORBIDITIES
    • FUNCTIONAL IMPAIRMENT
    • TREATMENT AND OUTCOMES
    • FINDINGS
    • REFERENCES
  • 10. Clinical Characteristics of Learning Disabilities
    • DIAGNOSIS AND ASSESSMENT
    • DEMOGRAPHIC FACTORS AND DURATION OF THE DISORDER
    • COMORBIDITIES
    • FUNCTIONAL IMPAIRMENT
    • TREATMENT AND OUTCOMES
    • FINDINGS
    • REFERENCES
  • 11. Clinical Characteristics of Mood Disorders
    • DEPRESSION
    • PEDIATRIC BIPOLAR DISORDER
    • FINDINGS
    • REFERENCES
• III. Prevalence of Selected Mental Disorders
  • 12. Prevalence of Attention Deficit Hyperactivity Disorder
    • ESTIMATES OF ADHD PREVALENCE AND PREVALENCE TRENDS FROM THE GENERAL POPULATION
    • TRENDS IN THE RATES OF ADHD AMONG SSI AND MEDICAID POPULATIONS
    • DISCUSSION
    • FINDINGS
    • CONCLUSIONS
    • REFERENCES
  • 13. Prevalence of Oppositional Defiant Disorder and Conduct Disorder
    • ESTIMATES OF ODD AND CD PREVALENCE AND PREVALENCE TRENDS FROM THE GENERAL POPULATION
    • TRENDS IN THE RATES OF ODD AND CD AMONG SSI AND MEDICAID POPULATIONS
    • DISCUSSION
    • FINDINGS
    • CONCLUSION
    • REFERENCES
  • 14. Prevalence of Autism Spectrum Disorder
    • ESTIMATES OF AUTISM PREVALENCE AND PREVALENCE TRENDS FROM THE GENERAL POPULATION
    • POTENTIAL EXPLANATIONS FOR THE RISING PREVALENCE OF AUTISM
    • TRENDS IN THE PREVALENCE OF ASD AMONG SSI AND MEDICAID POPULATIONS
    • DISCUSSION
    • REFERENCES
  • 15. Prevalence of Intellectual Disabilities
    • ESTIMATES OF INTELLECTUAL DISABILITY PREVALENCE AND PREVALENCE TRENDS FROM THE GENERAL POPULATION
    • TRENDS IN THE RATES OF INTELLECTUAL DISABILITY AMONG SSI AND MEDICAID POPULATIONS
    • DISCUSSION
    • FINDINGS
    • CONCLUSION
    • REFERENCES
  • 16. Prevalence of Learning Disabilities
    • ESTIMATES OF LEARNING DISABILITY PREVALENCE AND PREVALENCE TRENDS FROM THE GENERAL POPULATION
    • TRENDS IN THE RATES OF LEARNING DISABILITY AMONG SSI AND MEDICAID POPULATIONS
    • DISCUSSION
    • FINDINGS
    • CONCLUSIONS
    • REFERENCES
  • 17. Prevalence of Mood Disorders
    • ESTIMATES OF DEPRESSION PREVALENCE AND PREVALENCE TRENDS FROM THE GENERAL POPULATION
    • ESTIMATES OF BIPOLAR DISORDER PREVALENCE AND PREVALENCE TRENDS FROM THE GENERAL POPULATION
    • TRENDS IN THE RATES OF MOOD DISORDERS AMONG SSI AND MEDICAID POPULATIONS
    • DISCUSSION
    • FINDINGS
    • CONCLUSION
    • REFERENCES
• IV. Medicaid Analytic eXtract Study
  • 18. Medicaid Analytic eXtract Study
    • STUDY DESIGN AND METHODS
    • 10-YEAR TRENDS IN THE PREVALENCE OF COMMON CHILD MENTAL DISORDERS AMONG CHILDREN ENROLLED IN MEDICAID
    • COMORBIDITY
    • MENTAL DISORDERS BY RACE AND ETHNICITY
    • TREATMENT
    • CONCLUSIONS
    • FINDINGS
    • REFERENCES
• Appendixes
  • Appendix A. Deeming Eligibility Chart for Children
  • Appendix B. SSA Childhood Mental Disorders Listing of Impairments
  • Appendix C. 5 The Listing of Impairments—Overview
  • Appendix D. Surveys and Surveillance Systems That Collect Data on Mental Disorders Among Children
  • Appendix E. Initial Allowance, Initial Determination, Allowance Rate, and Recipient Data for 10 Major Mental Disorders
  • Appendix F. Medicaid Analytic eXtract Methods
  • Appendix G. Medicaid Analytic eXtract Results
  • Appendix H. Committee and Consultant Biographies

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2015. Mental disorders and disabilities among low-income children. Washington, DC: The National Academies Press.