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3 National-Level Trends in the SSI Program for Children with Mental Disorders, 20042013
Pages 71-90

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From page 71...
... . The quantitative overview provided in this chapter of the SSI disability benefits program for children with mental disorders provides context for the rest of the report in two ways. First, it demonstrates the relative size of the SSI program for children in the United States and the proportion of SSI benefits administered to youth that are based on disability due to mental disorders.
From page 72...
... under-18 population that received SSI disability benefits increased from 1.35 to 1.8 percent. However, as the number of children receiving SSI benefits increased, the proportion of SSI children who were recipients of SSI benefits due to the 10 major mental disorders gradually decreased, from 54.38 percent in 2004 to 49.51 percent in 2013.
From page 73...
... Child Population Receiving Year SSI Recipients Disorders Other Disorders Mental Disorders Population SSI Benefits 2004 993,127 540,051 453,076 54.38% 73,297,735 1.35% 2005 1,036,498 562,402 474,096 54.26% 73,523,669 1.41% 2006 1,078,977 577,091 501,886 53.49% 73,757,714 1.46% 2007 1,121,017 583,947 537,070 52.09% 74,019,405 1.51% 2008 1,153,844 587,618 566,226 50.93% 74,104,602 1.56% 2009 1,199,788 600,115 599,673 50.02% 74,134,167 1.62% 2010 1,239,269 615,772 623,497 49.69% 74,119,556 1.67% 2011 1,277,122 631,602 645,520 49.46% 73,902,222 1.73% 2012 1,311,861 647,555 664,306 49.36% 73,708,179 1.78% 2013 1,321,681 654,370 667,311 49.51% 73,585,872 1.80% SOURCES: SSA, 2014; U.S. Census Bureau, 2014; unpublished data set provided by the Social Security Administration (SSA)
From page 74...
... under-18 populaƟon receiving SSI benefits for all 0.20% condiƟons excluding the 10 major mental disorders 0.00% 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year FIGURE 3-2  Percentage of the U.S. under-18 population that received SSI benefits, 2004–2013.
From page 75...
... . Similarly, the percentage of child allowances attributable to the 10 major mental disorders did not increase over that time period.
From page 76...
... Child Initial Adjudicative 10 Major Mental Other Mental the 10 Major Under-18 Population Allowed Year Level Disorders Disorders Mental Disorders Population SSI Disability Benefits 2004 179,240 93,401 85,839 52.11% 73,297,735 0.24% 2005 175,944 90,554 85,390 51.47% 73,523,669 0.24% 2006 167,521 83,707 83,814 49.97% 73,757,714 0.23% 2007 164,943 80,465 84,478 48.78% 74,019,405 0.22% 2008 174,634 85,447 89,187 48.93% 74,104,602 0.24% 2009 187,854 91,739 96,115 48.84% 74,134,167 0.25% 2010 196,831 97,778 99,053 49.68% 74,119,556 0.27% 2011 197,473 98,571 98,902 49.92% 73,902,222 0.27% 2012 189,080 93,132 95,948 49.26% 73,708,179 0.26% 2013 171,574 84,307 87,267 49.14% 73,585,872 0.23% SOURCES: U.S. Census Bureau, 2014; unpublished data set provided by the SSA.
From page 77...
... Summary of Aggregate Review of 10 Major Mental Disorders Figure 3-3 shows the number of initial allowances, initial determinations, and recipients for the 10 major mental disorders from 2004 to 2013. The number of children who were receiving SSI benefits for the 10 major mental disorders continuously increased over that decade, while the
From page 78...
... SOURCES: SSA, 2006, 2013b. 700,000 Number of Allowances, Determinations, and 600,000 500,000 400,000 Allowances Recipients DeterminaƟons 300,000 Recipients 200,000 100,000 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year FIGURE 3-3  Initial allowances, initial determinations, and recipient trends for 10 major mental disorders, 2004–2013.
From page 79...
... The total number of allowances resulting from successful appeals is not known to the committee and is thought to be relatively small. Figure 3-4 shows the percentages of children in the United States who received SSI benefits for the major mental disorders and were allowed SSI benefits for the major mental disorders at the initial level.
From page 80...
... The remaining seven mental disorders do not exhibit any trends of similar magnitude, although the number of allowances does appear to have decreased over that time 35,000 AƩenƟon deficit hyperacƟvity disorder 30,000 AuƟsƟc disorders and developmental disorders Intellectual disability 25,000 Number of Allowances Mood disorders for children 20,000 Learning disorder 15,000 Organic mental disorders OpposiƟonal defiant 10,000 disorders Anxiety related disorders 5,000 Borderline intellectual funcƟoning 0 Conduct disorders 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year FIGURE 3-5 Number of allowances for major mental disorders for all children under 18, at the initial level, 2004–2013. SOURCE: Unpublished data set provided by the SSA.
From page 81...
... However, as previously noted, only 140,000 AƩenƟon deficit hyperacƟvity disorder 120,000 AuƟsƟc disorders and developmental disorders Mood disorders for 100,000 children Number of Determinations Learning disorder 80,000 Intellectual disability 60,000 OpposiƟonal defiant disorders Anxiety related disorders 40,000 Borderline intellectual funcƟoning 20,000 Organic mental disorders Conduct disorders 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year FIGURE 3-6 Number of determinations for the major mental disorders for all children under 18, at the initial level, 2004–2013. SOURCE: Unpublished data set provided by the SSA.
From page 82...
... The allowance rate of organic mental disorders decreased from 87.12 percent in 2004 to 56.6 percent in 2013, which may have been related to an overall decrease in the recognition of the diagnostic category by mental health professionals. Overall, the combined yearly allowance rate for the 10 major mental disorders decreased from 52 percent in 2004 to 43 percent in 2013.
From page 83...
... TABLE 3-5  Percentage of Determinations for the Major Mental Disorders for All Children Under 18, at the Initial Level, 2004–2013 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 ADHD 42.10% 43.21% 44.13% 44.65% 45.63% 46.10% 47.17% 48.36% 48.66% 47.75% LD 13.74% 13.54% 12.99% 12.53% 11.53% 10.81% 10.41% 9.97% 9.49% 9.36% Mood 9.76% 10.02% 10.26% 10.62% 10.56% 10.62% 10.91% 10.58% 10.26% 10.22% ID 12.80% 11.60% 10.56% 9.48% 9.12% 8.80% 7.86% 6.93% 6.16% 6.03% ASD 4.97% 5.48% 6.38% 7.26% 8.59% 9.43% 9.65% 10.41% 11.55% 12.49% BIF 6.35% 5.80% 5.36% 4.95% 4.28% 3.91% 3.64% 3.09% 2.88% 2.79% ODD 3.59% 3.53% 3.48% 3.55% 3.53% 3.40% 3.33% 3.53% 3.76% 4.01% CD 2.61% 2.63% 2.62% 2.68% 2.50% 2.41% 2.32% 2.20% 2.11% 1.94% Anxiety 2.06% 2.04% 2.12% 2.15% 2.18% 2.26% 2.34% 2.54% 2.70% 2.84% Organic 2.02% 2.14% 2.09% 2.12% 2.08% 2.26% 2.37% 2.39% 2.43% 2.57% SOURCE: Unpublished data set provided by the SSA.
From page 84...
... One of the two exceptions to the trend was the number of ID recipients, which decreased from 215,709 in 2004 to 120,248 in 2013. Overall, as shown in Figure 3-9, the combined number of recipients for the 10 major mental disorders increased each year during the 10-year period, growing from 540,051 recipients to 654,370.
From page 85...
... 250,000 AƩenƟon deficit hyperacƟvity disorder AuƟsƟc disorders and developmental disorders 200,000 Intellectual disability Mood disorders for children Number of Recipients 150,000 Learning disorder Organic mental disorders 100,000 OpposiƟonal defiant disorders Borderline intellectual 50,000 funcƟoning Anxiety related disorders Conduct disorders 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year FIGURE 3-9  Number of recipients for the major mental disorders for all children under 18, at the initial level, 2004–2013. SOURCE: Unpublished data set provided by the SSA.
From page 86...
... From 2009 to 2013 the numbers of allowances that functionally equaled the listings exceeded the number of allowances that met the listings. Combined with the observation that allowance rates are decreasing, these trends may indicate that the children who are being determined for the SSI benefits on the basis of the major mental disorders are less severely impaired and may not have supporting evidence that meet the listings criteria.
From page 87...
... allowances by regulation basis can vary considerably among the individual mental disorder categories. Figure 3-11 shows the percentage of initial allowances for ID by regulation basis for all children under age 18 from 2004 to 2013.
From page 88...
... 100% 90% 80% Percentage of Allowances 70% 60% FuncƟonally Equals 50% Meets LisƟngs 40% Medical Equals 30% Other 20% 10% 0% 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year FIGURE 3-12 Percent of initial allowances for ADHD by regulation basis, 2004–2013. SOURCE: Unpublished data set provided by the SSA.
From page 89...
... children who were recipients of SSI disability benefits for the 10 major mental disorders grew from 0.74 percent in 2004 to 0.89 percent in 2013. • Among the children who applied for SSI, the proportion whose SSI applications were allowed (i.e., met the SSI disability criteria)
From page 90...
... As a consequence, it is not possible to precisely identify the pool of children who are SSI recipients based on a specific mental disorder. That said, the committee concluded that the data contained in this report for each of the 10 major childhood mental disorders are the best available approximation of specific diagnosis prevalence in the SSI beneficiary population.


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