New NAS report finds drop in percentage of children allowed SSI benefits for mental disorders

September 15, 2015

CONTACT: Barbara Wolfe (wolfe@lafollette.wisc.edu)

MADISON—In response to concern over trends in the growth of the proportion of children allowed federal Supplemental Security Income (SSI) program benefits for disabling mental disorders, a National Academies of Sciences, Engineering, and Medicine (NAS) committee studied the issue and issued a report September 9.

The committee's principal task was to identify trends in the number of children diagnosed with mental disorders in the United States and compare those trends with the number of children who receive SSI benefits for mental disorders.

Because both poverty and having a severe disability are SSI program eligibility criteria and because poverty can be both a risk factor and a consequence of disability, the task of comparing disability trends in the SSI population to trends in the general population was complicated.

Over the decades since the SSI children's program was founded in 1972, the proportion of children receiving SSI benefits for a mental, emotional, or behavioral disorder has grown, and for the past decade roughly equaled the proportion of children receiving benefits for a physical disability.

Parents who care for children who are severely disabled face costs and employment limitations that are widely acknowledged. In addition, family poverty magnifies the occurrence and severity of disability. For these reasons, breaking the cycle of poverty and disability is one of the goals of the childhood SSI program.

There are about 73.6 million children under age 18 living in the United States, and approximately 1.8 percent of them, or 1.3 million children, receive monthly SSI benefits. In 2012, the annual federal payments for children with disabilities through the SSI program totaled approximately $9.9 billion, an expenditure that makes up 5.5 percent of all disability benefits provided to U.S. citizens by the SSA.

Despite the relatively small expenditure and participation rate of the SSI program for children, there has been keen interest in the growth, effectiveness, accuracy, and sustainability of the SSI program for children. In response, the Social Security Administration commissioned the NAS study.

Authors of the resulting report, Mental Disorders and Disabilities Among Low-Income Children, including Barbara Wolfe and Maureen Durkin of the University of Wisconsin–Madison, found that despite the increase in benefits, many families with a child who has a disabling mental disorder are likely not supported by SSI benefits. Key conclusions are as follows:

  • Information about trends in the rates of mental disorders among U.S. children is limited. In addition, it is difficult to directly compare these trends to trends in the number of allowances and recipients of SSI benefits for child mental disorders.
  • Over the 10-year period from 2004 to 2013, the percentage of children who were allowed SSI benefits for mental disorders decreased, though the number receiving these benefits increased.
  • After taking trends in child poverty into account, the increase in the percentage of children receiving SSI benefits for mental disorders is consistent with and proportionate to trends in the percentage of mental disorders among children in the general population.
  • Better data about mental disorders is necessary to inform improvements in the SSI program for children. Data collection should be expanded.
  • The study identified important policy issues that should be addressed in future studies, including improving methods for evaluating impairment and disability in children, understanding the effects of SSI benefits for children on family income and work, and state-to-state variation with the SSI program.
Figure: Comparing trends in child poverty and the number of children applying for and receiving new disability benefits from the SSI program. Source National Academies of Sciences, Engineering, Medicine

Note: The 10 selected mental disorders are as follows: attention deficit hyperactivity disorder, autism spectrum disorder, intellectual disability, mood disorders (depression and bipolar disorder), learning disorder, organize mental disorders, oppositional defiant disorder, conduct disorder, anxiety related disorders, and borderline intellectual function.

NAS committee members and report coauthors from the University of Wisconsin–Madison are Barbara Wolfe, the Richard A. Easterlin Professor of Public Affairs, Economics, and Population Health Sciences and an executive committee member and former director of the Institute for Research on Poverty; and Maureen Durkin, Professor of Population Health Sciences and of Pediatrics, Waisman Center Investigator, Vice-Chair of the Department of Population and Health Sciences, and Director of the Population and Health Graduate Program.

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—Deborah Johnson, deborah.johnson@wisc.edu, (608) 262-7779