Social Security Administration.
Notice of Social Security Ruling (SSR).
We are giving notice of SSR 09–4p. This SSR consolidates information from our regulations, training materials, and question-and-answer documents about the functional equivalence domain of “Attending and completing tasks.” It also explains our policy about that domain.
Janet Truhe, Office of Disability Programs, Social Security Administration, 6401 Security Boulevard, Baltimore, MD 21235–6401, (410) 965–1020.
Although 5 U.S.C. 552(a)(1) and (a)(2) do not require us to publish this SSR, we are doing so under 20 CFR 402.35(b)(1).
SSRs make available to the public precedential decisions relating to the Federal old-age, survivors, disability, supplemental security income, special veterans benefits, and black lung benefits programs. SSRs may be based
Although SSRs do not have the same force and effect as statutes or regulations, they are binding on all components of the Social Security Administration. 20 CFR 402.35(b)(1).
This SSR will be in effect until we publish a notice in the
As we explain in greater detail in SSR 09–1p, we always evaluate the “whole child” when we make a finding regarding functional equivalence, unless we can otherwise make a fully favorable determination or decision.
(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, and
(6) Health and physical well-being.
To functionally equal the listings, an impairment(s) must be of listing-level severity; that is, it must result in “marked” limitations in two domains of functioning or an “extreme” limitation in one domain.
In the domain of “Attending and completing tasks,” we consider a child's ability to focus and maintain attention, and to begin, carry through, and finish activities or tasks. We consider the child's ability to initiate and maintain attention, including the child's alertness and ability to focus on an activity or task despite distractions, and to perform tasks at an appropriate pace. We also consider the child's ability to change focus after completing a task and to avoid impulsive thinking and acting. Finally, we evaluate a child's ability to organize, plan ahead, prioritize competing tasks, and manage time.
The ability to attend and to complete tasks develops throughout childhood, evolving from an infant's earliest response to stimuli, such as light, sound, and movement, to an adolescent's completion of academic requirements. Over time, this evolution can be seen in the steady development of a child's ability to attend and to complete increasingly complex tasks. For example:
• Newborns or young infants gaze at human faces or moving objects, and listen in the direction of a human voice.
• Toddlers engage in activities that interest them, such as listening to a story.
• Preschool children engage in uninterrupted periods of play, such as putting a puzzle together.
• School-age children focus long enough to do classwork and homework.
• Adolescents may perform part-time work requiring sustained attention to assigned duties that must be completed on time.
As in any domain, when we evaluate a child's limitations in the domain of “Attending and completing tasks,” we consider how appropriately, effectively, and independently the child functions compared to children of the same age who do not have impairments. For example, a teacher may report that a child “pays attention well with frequent prompting.” The need for frequent prompting demonstrates that the child is not paying attention as appropriately, effectively, or independently as children of the same age who do not have impairments. Despite the fact that the child is paying attention with prompting, this child is not functioning well in this domain.
The domain of “Attending and completing tasks” covers only the mental aspects of task completion; such as the mental pace that a child can maintain to complete a task.
• Children with attention-deficit/hyperactivity disorder (AD/HD) whose primary difficulty is
• Children with AD/HD whose primary difficulty is
Although we more often see limitations in this domain in connection with mental disorders, a physical impairment(s) can also affect a child's mental ability to attend and to complete tasks. For example, pain caused by a musculoskeletal disorder can distract a child and interfere with the child's ability to concentrate and to complete assignments on time. Medications that affect concentration or interfere with other mental processes, such as some medications for seizure disorders, may also affect a child's ability to attend and to complete tasks.
Some children with impairments can attend to some tasks, but not to all tasks in all settings. Such children may exhibit “hyperfocus,” an intense focus on things that interest them, such as video games, but be limited in their ability to focus on other tasks. These kinds of limitations in the domain of “Attending and completing tasks” are common in children with AD/HD and autistic spectrum disorders (ASD). For example, some children with ASD may be distracted by, or become fixated on, everyday sounds (such as the hum of an air conditioner) that children without impairments can easily ignore. Children with autism may become fixated on parts of an object (such as the wheels on a toy truck) rather than on the more obvious and primary use of the object. Children with Asperger's disorder (one type of ASD), may hyperfocus on a single area of interest and have difficulty discussing or paying attention to any other subject. These children may appear to function well, or even better than other children, in the area of hyperfocus, but may be very limited in some other tasks and settings.
As with limitations in any domain, we do not consider a limitation in the domain of “Attending and completing tasks” unless it results from a medically determinable impairment(s). However, while it is common for all children to experience some difficulty attending and completing tasks from time to time, a child who has significant but unexplained problems in this domain may have an impairment(s) that was not alleged or has not yet been diagnosed. In such cases, adjudicators should pursue any indications that an impairment(s) may be present.
In the domain of “Attending and completing tasks,” we consider the mental aspects of a child's ability to focus, maintain attention, and complete age-appropriate tasks throughout the day. In addition, because the ability to attend and to complete tasks is involved in nearly everything a child does, an impairment(s) that affects this ability may cause limitations in other domains.
For example, school-age children with AD/HD may have limitations in multiple domains. The effects of inattention and hyperactivity can impede the learning process and affect competence in many areas of life. These effects can result in limitations in the domain of “Acquiring and using information”; for example, by undermining academic performance. They may also have effects in the domain of “Interacting and relating with others”; for example, children with AD/HD may interrupt others in conversation or have difficulty taking turns during play activities. They may also cause limitations in the domain of “Caring for yourself”; for example, when a child risks personal safety by not stopping and thinking before doing something.
Therefore, as in any case, we evaluate the effects of a child's impairment(s), including the effects of medication or other treatment and therapies, in all relevant domains. Rating the limitations caused by a child's impairment(s) in each and every domain that is affected is
While there is a wide range of normal development, most children follow a typical course as they grow and mature. To assist adjudicators in evaluating a child's impairment-related limitations in the domain of “Attending and completing tasks,” we provide the following examples of typical functioning drawn from our regulations, training, and case reviews. These examples are not all-inclusive, and
• Shows sensitivity to environment by responding to various stimuli (for example, light, touch, temperature, movement).
• Stops activity when voices or other sounds are heard.
• Begins to notice and gaze at various moving objects, including people and toys.
• Listens to family conversations and plays with people and toys for progressively longer periods of time.
• Wants to change activities frequently, but gradually expands interest in continuing an interaction or a game.
• Attends to things of interest (for example, looking at picture books, listening to stories).
• Has adequate attention to complete some tasks independently (for example, putting a toy away).
• Demonstrates sustained attention (for example, building with blocks, helping to put on clothes).
• Pays attention when spoken to directly.
• Sustains attention to play and learning activities.
• Concentrates on activities like putting puzzles together or completing art projects.
• Focuses long enough to complete many activities independently (for example, getting dressed, eating).
• Takes turns and changes activities when told by a caregiver or teacher that it is time to do something else.
• Plays contentedly and independently without constant supervision.
• Focuses attention in a variety of situations in order to follow directions, completes school assignments, and remembers and organizes school-related materials.
• Concentrates on details and avoids making careless mistakes.
• Changes activities or routines without distracting self or others.
• Sustains attention well enough to participate in group sports, read alone, and complete family chores.
• Completes a transition task without extra reminders or supervision (for example, changing clothes after gym or going to another classroom at the end of a lesson).
• Pays attention to increasingly longer presentations and discussions.
• Maintains concentration while reading textbooks.
• Plans and completes long-range academic projects independently.
• Organizes materials and manages time in order to complete school assignments.
• Maintains attention on tasks for extended periods of time, and is not unduly distracted by or distracting to peers in a school or work setting.
To further assist adjudicators in evaluating a child's impairment-related limitations in the domain of “Attending and completing tasks,” we also provide the following examples of some of the limitations we consider in this domain. These examples are drawn from our regulations and training. They are not the only examples of limitations in this domain, nor do they necessarily describe a “marked” or an “extreme” limitation.
In addition, the examples below may or may not describe limitations depending on the expected level of functioning for a given child's age. For example, a toddler would not be expected to be able to play a game or stay on another task for an hour, but a teenager would.
• Is easily startled, distracted, or overreactive to everyday sounds.
• Is slow to focus on or fails to complete activities that interest the child.
• Gives up easily on tasks that are within the child's capabilities.
• Repeatedly becomes sidetracked from activities or frequently interrupts others.
• Needs extra supervision to stay on task.
• Cannot plan, manage time, or organize self in order to complete assignments or chores.