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Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulations6419112.00C, the first sentence of 112.00C2.introductory text 112.00C2.b.,112.00C2.c., the heading of 112.00C2.d.,112.00C4 and the undesignatedparagraph under it, and 112.02B2.c.introductory text to read as follows:Appendix 1 to Subpart P—Listing ofImpairments* * * * *Part B* * * * *103.00 Respiratory SystemA. * * ** * * * ** * * Even if a child does not showthat his or her impairment meets thecriteria of these listings, the child mayhave an impairment(s) that is medicallyor functionally equivalent in severity toone of the listed impairments. * * ** * * * *It must be remembered that theselistings are only examples of commonrespiratory disorders that are severeenough to find a child disabled. Whena child has a medically determinableimpairment that is not listed, animpairment that does not meet therequirements of a listing, or acombination of impairments no one ofwhich meets the requirements of alisting, we will make a determinationwhether the child’s impairment(s) ismedically or functionally equivalent inseverity to the criteria of a listing. (See§§ 404.1526, 416.926, and 416.926a.)* * * * *104.00 Cardiovascular SystemA. Introduction* * * * ** * * Even though a child who doesnot receive treatment may not be able toshow an impairment that meets thecriteria of these listings, the child mayhave an impairment(s) that is medicallyor functionally equivalent in severity toone of the listed impairments.Indeed, it must be remembered thatthese listings are only examples ofcommon cardiovascular disorders thatare severe enough to find a childdisabled. When a child has a medicallydeterminable impairment that is notlisted, an impairment that does not meetthe requirements of a listing, or acombination of impairments no one ofwhich meets the requirements of alisting, we will make a determinationwhether the child’s impairment(s) ismedically or functionally equivalent inseverity to the criteria of a listing. (See§§ 404.1526, 416.926, and 416.926a.)* * * * *C. Treatment and Relationship Status* * * * ** * * (See § 404.1594 or § 416.994a,as appropriate, for our rules on medicalimprovement and whether anindividual is no longer disabled.)112.00 Mental DisordersA. * * ** * * * *It must be remembered that theselistings are only examples of commonmental disorders that are severe enoughto find a child disabled. When a childhas a medically determinableimpairment that is not listed, animpairment that does not meet therequirements of a listing, or acombination of impairments no one ofwhich meets the requirements of alisting, we will make a determinationwhether the child’s impairment(s) ismedically or functionally equivalent inseverity to the criteria of a listing. (See§§ 404.1526, 416.926, and 416.926a.)* * ** * * * *C. * * * The functional areas that weconsider are: Motor function; cognitive/communicative function; socialfunction; personal function; andconcentration, persistence, or pace.* * *1. * * *2. Preschool children (age 3 toattainment of age 6). For the age groupsincluding preschool children throughadolescence, the functional areas usedto measure severity are: (a) Cognitive/communicative function, (b) socialfunction, (c) personal function, and (d)deficiencies of concentration,persistence, or pace resulting infrequent failure to complete tasks in atimely manner. * * *a. * * *b. Social function. Social functioningrefers to a child’s capacity to form andmaintain relationships with parents,other adults, and peers. Socialfunctioning includes the ability to getalong with others (e.g., family members,neighborhood friends, classmates,teachers). Impaired social functioningmay be caused by inappropriateexternalized actions (e.g., running away,physical aggression—but not selfinjuriousactions, which are evaluatedin the personal area of functioning), orinappropriate internalized actions (e.g.,social isolation, avoidance ofinterpersonal activities, mutism). Itsseverity must be documented in termsof intensity, frequency, and duration,and shown to be beyond what might bereasonably expected for age. Strength insocial functioning may be documentedby such things as the child’s ability torespond to and initiate social interactionwith others, to sustain relationships,and to participate in group activities.Cooperative behaviors, consideration forothers, awareness of others’ feelings,and social maturity, appropriate to achild’s age, also need to be considered.Social functioning in play and schoolmay involve interactions with adults,including responding appropriately topersons in authority (e.g., teachers,coaches) or cooperative behaviorsinvolving other children. Socialfunctioning is observed not only athome but also in preschool programs.c. Personal function. Personalfunctioning in preschool childrenpertains to self-care; i.e., personal needs,health, and safety (feeding, dressing,toileting, bathing; maintaining personalhygiene, proper nutrition, sleep, healthhabits; adhering to medication ortherapy regimens; following safetyprecautions). Development of self-careskills is measured in terms of the child’sincreasing ability to help himself/herselfand to cooperate with others in takingcare of these needs. Impaired ability inthis area is manifested by failure todevelop such skills, failure to use them,or self-injurious actions. This functionmay be documented by a standardizedtest of adaptive behavior or by a carefuldescription of the full range of self-careactivities. These activities are oftenobserved not only at home but also inpreschool programs.d. Concentration, persistence, or pace.* * ** * * * *4. Adolescents (age 12 to attainmentof age 18). Functional criteria parallel tothose for primary school children(cognitive/communicative; social;personal; and concentration,persistence, or pace) are the measure ofseverity for this age group. Testinginstruments appropriate to adolescentsshould be used where indicated.Comparable findings of disruption ofsocial function must consider thecapacity to form appropriate, stable, andlasting relationships. If information isavailable about cooperative workingrelationships in school or at part-time orfull-time work, or about the ability towork as a member of a group, it shouldbe considered when assessing thechild’s social functioning. Markedlyimpoverished social contact, isolation,withdrawal, and inappropriate orbizarre behavior under the stress ofsocializing with others also constitutecomparable findings. (Note that selfinjuriousactions are evaluated in thepersonal area of functioning.)a. Personal functioning in adolescentspertains to self-care. It is measured in