DSM-5 On Autism Spectrum Disorders

     I had earlier posted an excerpt on Disruptive Mood Dysregulation Disorder from the newly issued Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the so-called Bible of psychiatry. It's not at all clear what Social Security will do with that new diagnostic criteria which will greatly reduce the diagnosis of bipolar disorder in children and adolescents but it is not the only part of DSM-5 which may bring about changes in disability determinations at Social Security. The DSM-5 also does away with the diagnostic category of Asperger's Syndrome, opting instead for a solitary diagnosis of Autism Spectrum Disorder. I'm doubting that this change will make much difference but here is the language from DSM-5:

Autism Spectrum Disorder 299.00

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
     1. Deficits in social-emotional reciprocity, ranging, tor example, from abnormal social approach and tailure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
     2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
     3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

     Specify current severity:
          Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

    1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
     2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
     3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
     4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

     Specify current severity:
          Severity is based on social communication impairments and restricted, repetitive
patterns of behavior (see Table 2).

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by Intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbjd diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM·IV diagnosis of autistic disorder. Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

OMB Clears Proposed Regs On Objecting To Video Hearings

     After nearly five months of review, the Office of Management and Budget (OMB) has cleared proposed new regulations concerning objecting to video hearings. This proposal was submitted while Michael Astrue was still Commissioner. OMB is part of the White House. OMB has to clear any regulatory proposal made by any agency. Five months is a very long time for one of Social Security's proposals to stay under review at OMB. I would guess that OMB identified this proposal as significant and possibly controversial. OMB's website indicates that there was some change made in the proposed rule while it was under review. Here is Social Security's original summary of the proposal:

We propose to revise our rules to protect the integrity of our programs and to address public concerns regarding the removal of an administrative law judge's name from the Notice of Hearing and other prehearing notices. To accomplish both objectives, these proposed rules state that we will provide an individual with notice that his or her hearing may be held by video teleconferencing and that he or she has an opportunity to object to appearing by video teleconferencing within 30 days of the notice. We have also made changes that allow us to determine that claimant will appear via video teleconferencing if a claimant changes residences while his or her request for hearing is pending. We anticipate these changes will increase the integrity of our programs with minimal impact on the public and result in more efficient administration of our program. 

     We should know soon how this proposal ended up, since it will probably be published in the Federal Register in the next week or two. Note that Social Security will not be publishing a final rule at this time. They will only be publishing a Notice of Proposed Rule-Making (NPRM). The public will get a chance to review the NPRM and comment on it. It will be many months at least before anything becomes final.
     My opinion is that under a rule such as described above many attorneys will advise their clients to refuse video hearings. The main reason that attorneys now advise their clients to accept video hearings is to avoid delay. It's not like we think that a video hearing is just as good as an in-person hearing. If the decision to refuse a video hearing can be made well before any hearing is scheduled, there should be no reason for additional delay associated with asking for an in person hearing. If this goes forward, things may not work out in the way that Social Security expects.
     Also, if a Social Security claimant moves from North Carolina to Minnesota while his or her request for hearing is pending, why does he or she abandon their right to an in person hearing?

Online Crooks Going After Online Accounts

     From WPTV:

A new kind of Social Security scam has left local beneficiaries wondering where their money is.

Pills and bills eat up Patricia Bell's monthly Social Security check.
"Without Social Security, we'd have nothing," said Bell, 71, of Okeechobee.
When she got a letter in the mail saying she had created an online account on Social Security's website, she called her son.
"Right then, I stopped, I said, I didn't do this," said Bell.
But someone had, stealing her personal information, including her Social Security number.
"I have no idea how they did that, " said Bell.
A crook used Social Security's new online system to change her direct deposit information.
They redirected her $1,200 check to themselves. ...

Nationwide, 36,000 have fallen victim since May of 2011. 

     This will only get bigger and bigger. Social Security management needs to face the facts. The online accounts are way too susceptible to fraud. This is probably becoming a cottage industry in places like China or Nigeria. I believe that all you need is access to credit reports and that's not that difficult. Identify an older person using the credit reports, use the information from the older person's credit report to open an account Social Security account in the person's name, divert one month's benefits to a bank account you control and withdraw the money using an ATM. If you're overseas, what's your risk?

A Top Ten List

     The right is really getting invested in the idea that fraud is rampant in Social Security's disability programs. The National Review has posted its Top Ten List of the most outrageous disability cheaters of the past year.

Legislation Proposed

     From a press release:

U.S. Senators Tom Coburn, M.D. (R-OK), Jeff Flake (R-AZ), Angus King (I-ME), and Joe Manchin (D-WV) introduced the Reducing Overlapping Payments Act, which aims to protect the Social Security Disability Insurance and Unemployment Insurance programs by reducing overlapping benefits. The bill requires the Social Security Administration (SSA) to suspend Disability Insurance (DI) benefits  during any month in which a recipient also collects Unemployment Insurance (UI) benefits, while also ensuring the SAA [SSA?] has the necessary information to identify overlapping DI and UI payments. According to the Government Accountability Office (GAO), in fiscal year 2010 over 117,000 individuals received more than $850 million in overlapping payments. 

Was Social Security Originally Designed In A Racist Way?

     Brad Plummer writes in the Washington Post about an argument that the Social Security Act as originally passed was designed to exclude most African-American workers. This was supposedly done to gain the support of Southern Democrats in the Congress. This was accomplished by excluding agricultural workers and maids, the most important occupations for African-Americans in the South at the time.
     The counter-argument is that agricultural workers and maids were excluded for reasons of administrative feasibility and that Southerners in Congress at the time expressed no strong views on the subject.

Criticism For "Unfit For Work"

     Trudy Lieberman, writing in the Columbia Journalism Review, takes a belated look at NPR's "Unfit For Work" series and finds it lacking. Lieberman primarily criticizes "Unfit For Work" for suggesting that it's easy to get on Social Security disability benefits. Lieberman writes in conclusion that "Unfit For Work":

... did a disservice to an important safety net crucial to the survival of some of the sickest people around. It could have been a useful service had it explained what disability benefits are — social insurance, not welfare. And that the Social Security program has encountered funding shortfalls 11 times before, and these were always fixed by reallocating payroll tax revenues among the trust funds to account for demographic shifts. As the eight former Social Security commissioners put it in their letter, Social Security actuaries predicted similar action would be needed in 2016, and “they were right on target.”

Calling Social Security

     From the Hartford Courant:

There comes a time in every baby boomer's life when he or she must deal with the Social Security Administration. This is not cause for alarm.

Once you get to speak to a representative, you will find them pleasant and helpful. The trick is getting to a representative. I don't mean to be discouraging, but it is easier to get Barack on the line. ...

There was a time in a bureaucratic galaxy far, far away when you could dial up your local Social Security office and speak to a local human being. Not anymore.

Now, all calls are automatically switched to a central location where an annoying micro-chippie does everything in her power to keep you from speaking with an actual person.

To begin the process you must select a language, be made aware there is a website, and understand that your call may be recorded for training purposes (um, training purposes)?
Does this mean recorded calls are being used to train the computer generated beings answering the phone? I've rather suspected this was the case for a while now. I mean, has anyone else noticed how the micro-chippies are quicker to cop an attitude these days, and even get a little huffy when you swear at them?

Anyway, after the virtual representative is finished aggravating you, she passes you along to another virtual representative who tells you the wait time for a human representative is 15 minutes, or you can call back (this is where the swearing comes in.) ...

Suddenly, there is a real person on the line who will be glad to help but first has a few questions to make sure you are who you say you are.

Age? Address? Social Security number?

How much does your mother-in-law weigh?

What brand of whiskey did your third grade teacher drink at recess? ...