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Listing 112.00 Mental Disorders

A. Introduction: The structure of the mental disorders listings for children under age 18 parallels the structure for the mental disorders listings for adults but is modified to reflect the presentation of mental disorders in children. It must be remembered that these listings are only examples of common mental disorders that are severe enough to find a child disabled. When a child has a medically determinable impairment that is not listed, an impairment that does not meet the requirements of a listing, or a combination of impairments no one of which meets the requirements of a listing, we will make a determination whether the child's impairment(s) is medically or functionally equivalent in severity to the criteria of a listing. (See Secs. 404.1526, 416.926, and 416.926a.)

The listings for mental disorders in children are arranged in diagnostic categories:

There are significant differences between the listings for adults and the listings for children. There are disorders found in children that have no real analogy in adults; hence, the differences in the diagnostic categories for children. The presentation of mental disorders in children, particularly the very young child, may be subtle and of a character different from the signs andsymptoms found in adults. For example, findings such as separation anxiety, failure to mold or bond with the parents, or withdrawal may serve as findingscomparable to findings that mark mental disorders in adults. The activitiesappropriate to children, such as learning, growing, playing, maturing, and school adjustment, are also different from the activities appropriate to theadult and vary widely in the different childhood stages.

Each listing begins with an introductory statement that describes the disorder or disorders addressed by the listing. This is followed (except in listings 112.05 and 112.12) by medical findings (paragraph A criteria), which, if satisfied, lead to an assessment of impairment-related functional limitations(paragraph B criteria). An individual will be found to have a listed impairment when the criteria of both paragraphs A and B of the listed impairment aresatisfied.

The purpose of the criteria in paragraph A is to substantiate medically the presence of a particular mental disorder. Specific symptoms and signs under any of the listings 112.02 through 112.12 cannot be considered in isolation from the description of the mental disorder contained at the beginning of each listing category. Impairments should be analyzed or reviewed under the mental category(ies) indicated by the medical findings.

Paragraph A of the listings is a composite of medical findings which are used to substantiate the existence of a disorder and may or may not be appropriatefor children at specific developmental stages. However, a range of medical findings is included in the listings so that no age group is excluded. Forexample, in listing 112.02A7, emotional lability and crying would beinappropriate criteria to apply to older infants and toddlers, age 1 toattainment of age 3; whereas in 112.02A1, developmental arrest, delay, orregression are appropriate criteria for older infants and toddlers. Wheneverthe adjudicator decides that the requirements of paragraph A of a particularmental listing are satisfied, then that listing should be applied regardless ofthe age of the child to be evaluated.

The purpose of the paragraph B criteria is to describe impairment-relatedfunctional limitations which are applicable to children. Standardized tests ofsocial or cognitive function and adaptive behavior are frequently available andappropriate for the evaluation of children and, thus, such tests are included inthe paragraph B functional parameters. The functional restrictions in paragraphB must be the result of the mental disorder which is manifested by the medicalfindings in paragraph A.

We have not included separate C criteria for listings 112.03 and 112.06, asare found in the adult listings, because for the most part we do not believethat categories like residual schizophrenia or agoraphobia are commonly found inchildren. However, in unusual cases where these disorders are found in childrenand are comparable to the severity and duration found in adults, the adult12.03C and 12.06C criteria may be used for evaluation of the cases.

The structure of the listings for Mental Retardation (112.05) and Developmental and Emotional Disorders of Newborn and Younger Infants (112.12) is different from that of the other mental disorders. Listing 112.05 (Mental Retardation) contains six sets of criteria, any one of which, if satisfied, will result in a finding that the child's impairment meets the listing. Listing 112.12 (Developmental and Emotional Disorders of Newborn and Younger Infants)contains five criteria, any one of which, if satisfied, will result in a finding that the infant's impairment meets the listing.

It must be remembered that these listings are examples of common mental disorders which are severe enough to find a child disabled. When a child has amedically determinable impairment that is not listed or a combination of impairments no one of which meets a listing, we will make a medical equivalencydetermination. (See Secs. 404.1526 and 416.926.) This determination can be especially important in older infants and toddlers (age 1 to attainment of age3), who may be too young for identification of a specific diagnosis, yet demonstrate serious functional limitations. Therefore, the determination ofequivalency is necessary to the evaluation of any child's case when the child does not have an impairment that meets a listing.

B. Need for Medical Evidence.

C. Assessment of Severity: In childhood cases, as with adults, severity is measured according to the functional limitations imposed by the medically determinable mental impairment.

D. Documentation: The presence of a mental disorder in a child must be documented on the basis of reports from acceptable sources of medical evidence.

E. Effect of Hospitalization or Residential Placement.

F. Effects of Medication: Attention must be given to the effect of medication on the child's signs, symptoms, and ability to function.

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