Child Disability Payment decision making guide
Element 1: Does the individual have a severe mental impairment?
6. To meet this criterion, the individual must have both (CDP regs, reg. 13(7)):
- a severe impairment of intelligence
- a severe impairment of social functioning.
This must result from either (CDP regs, reg. 13(7)):
- a state of arrested development caused by a failure of the individual’s brain to grow or develop in the way typically expected
- a deficiency in the functionality of the brain caused by its incomplete physical development.
Whether a child has “severe impairment of intelligence and social functioning” should be treated as a single test and all the evidence considered as a whole. This is described in subsection “What is severe impairment of social functioning?” below in more detail.
What is severe mental impairment of intelligence?
An IQ of 55 or less is generally accepted as a “severe impairment of intelligence”. However, for children and young people, the individual’s IQ is likely to be only a minor factor in assessing whether the individual has a severe impairment of intelligence. An IQ score alone is likely to give a misleading impression, because an IQ test is designed to be as independent of social context as possible. An individual with a reduced IQ will likely have had a referral to a paediatrician or other specialist. Case managers must be careful not to refuse an application because an individual has not been referred to a specialist, as there may be reasons for this.
Children and young people with a severe impairment of intelligence are likely to receive any of the following:
- specialised schooling and supervision of all activities
- intensive support service provided by support workers
- Intensive 1:1 support in a mainstream school/nursery.
To understand whether the individual has a ‘severe impairment of intelligence’ the case manager should consider:
- supporting information
- advice via a clinical case discussion, if necessary
in addition to the application or review form.
The case manager should consider the individual’s ‘useful intelligence’ e.g. their degree of judgment in relation to everyday living. This will include whether the individual:
- has an understanding of the impact of their behaviour
- can understand the risk of danger or hazards
- has met key milestones in their development
- is educated in a specialist school
- has no awareness of where they are or of what time it is
- experiences short and long-term memory difficulties.
This list is not exhaustive.
Case managers should not consider any factor in isolation. It is also important to consider the child or young person’s age. This is particularly true for very young children. They may show any one of the above behaviours because of their age rather than because of a disability.
What is severe impairment of social functioning?
Social functioning is what a person can do with their intelligence. For example, some children and young people can:
- relate to other people
- perform basic social skills
once they are shown how to do them. However, individuals who have a severe impairment of social functioning, as a result of arrested development, or deficiency in the functionality of the brain due to incomplete physical development of the brain may not be able to do these things because of their disability. They may alternatively only be able to acquire a few basic social skills after being shown how to perform them.
It is rare to see impairment of intelligence without an impairment in social functioning. This means there is crossover for considerations for both severe impairment of intelligence and social functioning. This includes an individual’s inability to understand danger or the impact of their behaviour.
An individual may have a severe impairment of social functioning if they either:
- are unable or have limited ability to speak, such as only being able to communicate by gesturing, using simple signs or making sounds
- are unable to read or write, or have very limited ability to read or write
- have either limited or no understanding of the impact of their behaviour on others
- have either limited or no ability to understand danger or hazards, such as eating dangerous objects or touching hot objects
- have not been toilet trained by an age when most children will have been
- cannot engage in play or co-operation with others
- behave violently and injure themselves or others.
This list is not exhaustive.
Case managers should not consider any factor in isolation. It is also important to consider the child or young person’s age. This is particularly the case for very young children. The children may show any one of the above behaviours because of their age rather than because of a disability.
If the case manager is unable to reach a determination based on the application or review form and the available supporting information, they should seek input of a practitioner through the case discussion process.
What is causing the severe impairment of intelligence and social functioning?
After they have established that the individual has a severe impairment of intelligence and social functioning, the case manager must determine if these conditions result from either (CDP regs, reg. 13(7)):
- a state of arrested development as a result of a failure of the individual’s brain to grow or develop in the way normally expected, or
- a deficiency in the functionality of the brain as a result of its incomplete physical development.
In order to meet this test, the information provided by the individual or in supporting information does not have to confirm a physical defect in the brain. This means that it is not required for the individual to provide results of a brain scan or any other relevant tests. The fact that an individual has not had a scan does not mean that this test cannot be met. An individual may be awaiting further tests. It may also be the case that further tests would unnecessarily distress the individual.
There are also a number of congenital conditions present at birth that impact on the proper development of the brain in the womb and following birth, that may be documented in the individual’s supporting information.
There may be cases where there is no information from a professional to confirm an individual’s incomplete physical development of the brain. Case managers should still consider the information provided by the individual, as well as any other forms supporting information. For more detail on supporting information please see the Gathering Supporting Information chapter. Case managers should use the balance of probabilities to make a determination.
Case managers should consult a practitioner within Social Security Scotland through the case discussion process if supporting information is unclear or incomplete.
Arrested development
Arrested development (CDP regs, reg. 13(7)(a)) is separate from incomplete physical development (CDP regs, reg. 13(7)(b)) of the brain. Therefore, it may apply in cases involving arrested emotional or functional development which has a physical cause.
Common conditions where an individual might meet the criteria for arrested development are:
- trauma / neglect / sexual abuse
- when an individual has a diagnosis of an attachment disorder like Reactive Attachment Disorder or Disinhibited Social Engagement Disorder
- global developmental delay
- in some cases, neurodevelopmental conditions, such as Autism Spectrum Condition and/or ADHD
- some severe cases of mental illness.
This list is not exhaustive.
Case managers should be aware that there is no automatic, condition-based entitlement to CDP. Case managers should always consider the individual’s circumstances and level of needs holistically and base their decision on whether or not the individual meets all three elements of the severe mental impairment and severe behavioural difficulties test, as set out in this chapter.
Whether or not an individual who has one of the conditions listed has arrested development of the brain needs to be considered on a case-by-case basis. For example, just because an individual has experienced trauma doesn’t mean their development will be arrested. However, severe cases of abuse/trauma can affect how an individual’s brain forms and functions.
Sarah is 3 years old. Her development is substantially delayed across several domains and she is suspected of having autism. Sarah is non-verbal and she does not appear to be able to understand or comply with adult instruction. Sarah’s only way of communicating is by pointing, or by leading an adult to what she wants. When adults are unable to correctly interpret Sarah’s needs, she will become very distressed. When Sarah is extremely distressed, she will engage in self-injurious behaviours like banging her head against a wall.
Sarah is still in nappies full-time and she is not displaying any readiness for toileting training. Her gross and fine motor skills are also delayed. For example, Sarah frequently trips or falls when walking and she is unable to do up fastenings. Sarah does not seem interested in others and she prefers solitary play. The brains of people with autism are different compared to individuals without the condition. Therefore Sarah’s suspected autism, combined with her global developmental delay, would indicate that Sarah’s development is arrested.
Deficiency in the functionality of the brain due to incomplete physical development of the brain
Incomplete physical development of the brain involves a failure of the brain to grow properly and focuses on the fact that the brain is not functioning as expected.
Conditions which indicate the brain has not developed as expected include:
- lissencephaly
- microgyria
- holoprosencephaly.
This list is not exhaustive.
Case managers should be aware that there is no automatic, condition-based entitlement to CDP. Case managers should always consider the individual’s circumstances and level of needs holistically and base their decision on whether or not the individual meets all three elements of the severe mental impairment and severe behavioural difficulties test, as set out in this chapter.
Joey is 3 years old. He was born with a condition which means his brain did not develop as expected before his birth. His condition is known as agenesis of the corpus callosum. His parents apply for CDP on his behalf.
Joey’s application form and the supporting information submitted by his parents outline multiple areas of complex needs in relation to his bodily functions.
The case manager recognises that this is a condition which has affected the physical development of Joey's brain. They therefore request a clinical case discussion to explore this further and understand the condition’s longer-term impact on Joey's needs.
The practitioner confirms the impact of the condition on Joey's brain development. They explain that the impact is substantial and that Joey’s level of needs will most likely be long-term.