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Globe Editorial

Mislabeling kids as ADHD? Investigate federal rules

May 29, 2011

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GOOD INTENTIONS have gone awry in the federal program that gives cash benefits to families of disabled children, and a comprehensive assessment of the program’s weaknesses is the first step toward fixing it. Given the strong possibility that children are being misclassified as disabled to make their families eligible for checks of up to $700 a month, Congress should happily pay the $10 million or so needed to fund a study of the program by the well-regarded Institute of Medicine. And then it should quickly implement any changes based on the institute’s findings before more children are misclassified.

As the Globe’s Patricia Wen documented in a series in December, the $10 billion-a-year Supplemental Security Income program, which was originally meant for families of children with such disabilities as Down syndrome or cerebral palsy, has long since expanded to cover such mental conditions as attention-deficit disorder. In 1990, 8 percent of the poor children on SSI had qualified because of mental, learning, or behavioral disorders; in 2009, more than half did.

To some degree, the change reflects an acknowledgment that certain mental disabilities can strain a family just as physical ones do. But it also suggests that, in an era of stagnant wages and dead-end jobs, many poor families are looking to SSI less to defray expenses associated with a child’s disability than to help make ends meet more generally.

SSI has clearly given some hard-up parents a strong financial incentive to seek federal aid by having their children classified as disabled — and in some cases to get drugs prescribed. “To get the check,’’ one regretful mother told the Globe, “you’ve got the medicate the child.’’ The program has also made some ostensibly disabled teens reluctant to seek work for fear of jeopardizing their families’ benefits. “If I work and I get a certain amount,’’ one teen lamented, “then they’ll take money away from my mom.’’

But teens, including teens with diagnosed disabilities, learn useful skills from paying jobs. In this way and others, when SSI becomes a substitute for other benefits, it has deeply distorting effects on the families who receive it.

Some advocates for the poor defend the current system as a substitute for welfare, the only recourse for some needy families. But the damage done to children who are misclassified as mentally ill is incalculable: Some linger in special ed classes when they are capable of accelerated work; others come to believe themselves to be impaired when no such impairment exists.

The numbers alone suggest that too many low-income children are being classified with attention deficits and other disorders that are diagnosed in relatively subjective ways; nationwide, 199,904 children received SSI benefits in 2009 because of ADHD, and 155,023 more received them for speech delays. Anecdotal evidence goes further, suggesting that some families, encouraged by disreputable lawyers and doctors, have coached their children in behaviors that can get them diagnosed with ADHD. When claims are rejected, families go to court. According to Social Security Administration commissioner Michael J. Astrue, a whopping $1.5 billion per year in SSI benefits are withheld to cover the legal fees of families who sue to get benefits after having been rejected.

The Institute of Medicine can help establish just how severe the weaknesses of the program are, and what might realistically be done to make it work better. In an ideal world, SSI benefits might be restricted so that they pay only for services that help children cope with or overcome their disabilities. But Astrue contends that his agency lacks the ability to administer benefits at that level of individual detail. Already, the growing numbers of cases appear to have overwhelmed the system. The Globe reported that disability evaluators don’t meet children face to face when their families apply — and then fail to monitor children closely as they grow.

Advocates for low-income families and people with disabilities should support Astrue’s request for an investigation by the Institute of Medicine, and not only because the overuse of disability checks is a provocation to budget-cutters who’d just as soon scrap children’s SSI altogether. Worse yet, it’s a disservice to children who are being nudged toward disability diagnoses — and in many cases drugs — that are unneeded, and doing far more harm than good.