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6426 Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulationsappropriately only in the areas of motordevelopment or motor functioning. Inothers, the effects will be more global.If you have a physical impairment(s)that causes a functional limitation(s) notaddressed solely in the area of motordevelopment or motor functioning, wewill consider the effects of yourimpairment in all relevant areas inwhich you have limitations from theimpairment(s). A physicalimpairment(s) may cause limitations inany or all of the areas of developmentor functioning.(2) Other considerations. When weassess your functioning, we willconsider all information in your caserecord that can help us determine theeffect of your impairment(s) on yourphysical and mental functioning. Wewill consider the nature of yourimpairment(s), your age, your ability tobe tested given your age, and otherrelevant factors (see §§ 416.924a through416.924c). We will consider whetherany help that you need from others toenable you to do any particular activity(e.g., dressing) is appropriate to yourage.(3) Definitions of ‘‘marked’’ and‘‘extreme’’ limitations—(i) Markedlimitation means—(A) Whenstandardized tests are used as themeasure of functional abilities, a validscore that is two standard deviations ormore below the norm for the test (butless than three standard deviations); or(B) For children from birth toattainment of age 3, functioning at morethan one-half but not more than twothirdsof chronological age; or(C) For children from age 3 toattainment of age 18, ‘‘more thanmoderate’’ and ‘‘less than extreme.’’Marked limitation may arise whenseveral activities or functions arelimited or even when only one islimited as long as the degree oflimitation is such as to interfereseriously with the child’s functioning.(ii) Extreme limitation means— (A)When standardized tests are used as themeasure of functional abilities, a validscore that is three standard deviations ormore below the norm for the test; or(B) For children from birth toattainment of age 3, functioning at onehalfchronological age or less; or(C) For children from birth toattainment of age 18, no meaningfulfunctioning in a given area. There maybe extreme limitation when severalactivities or functions are limited oreven when only one is limited.(4) Areas of development orfunctioning. The following are the areasof development or functioning that maybe addressed in a finding of functionalequivalence.(i) Cognition/communication: Theability or inability to learn, understand,and solve problems through intuition,perception, verbal and nonverbalreasoning, and the application ofacquired knowledge; the ability to retainand recall information, images, events,and procedures during the process ofthinking. The ability or inability tocomprehend and produce language (e.g.,vocabulary and grammar) in order tocommunicate (e.g., to respond, as inanswering questions, followingdirections, acknowledging thecomments of others; to request, as indemanding action, meeting needs,seeking information, requestingclarification, initiating interaction; tocomment, as in sharing information,expressing feelings, and ideas,providing explanations, describingevents, maintaining interaction, usinghearing that is adequate forconversation, and using speech(articulation, voice, and fluency) that isintelligible.(ii) Motor: The ability or inability touse gross and fine motor skills to relateto the physical environment and serveone’s physical purposes. It involvesgeneral mobility, balance, and theability to perform age-appropriatephysical activities involved in play,physical education, sports, andphysically related daily activities otherthan self-care (see Personal area).(iii) Social: The ability or inability toform and maintain relationships withother individuals and with groups; e.g.,parents, siblings, neighborhoodchildren, classmates, teachers. Ability ismanifested in responding to andinitiating social interaction with others,sustaining relationships, andparticipating in group activities. Itinvolves cooperative behaviors,consideration for others, awareness ofothers’ feelings, and social maturityappropriate to a child’s age. Ability isalso manifested in the absence ofinappropriate externalized actions (e.g.,running away, physical aggression—butnot self-injurious actions, which areevaluated in the personal area offunctioning), and the absence ofinappropriate internalized actions (e.g.,social isolation, avoidance ofinterpersonal activities, mutism). Socialfunctioning in play, school, and worksituations may involve interactions withadults, including respondingappropriately to persons in authority(e.g., teachers, coaches, employers) orcooperative behaviors involving otherchildren.(iv) Responsiveness to stimuli (birth toage 1 only): The ability or inability torespond appropriately to stimulation(visual, auditory, tactile, vestibular,proprioceptive).(v) Personal (age 3 to age 18 only):The ability or inability to help yourselfand to cooperate with others in takingcare of your personal needs, health, andsafety (e.g., feeding, dressing, toileting,bathing; maintaining personal hygiene,proper nutrition, sleep, health habits;adhering to medication or therapyregimens; following safety precautions).(vi) Concentration, persistence, orpace (age 3 to age 18 only): The abilityor inability to attend to, and sustainconcentration on, an activity or task,such as playing, reading, or practicing asport, and the ability to perform theactivity or complete the task at areasonable pace.(5) Descriptions for specific agegroups—(i) Newborns and young infants(birth to attainment of age 1) Childrenin this age group are evaluated in termsof four areas of development. Thefollowing are general descriptions ofdevelopment typical of this age group.(A) Cognitive/communicativedevelopment (birth to attainment of age1): Your ability or inability to showinterest in, and actively seek interactionwith, your environment, first randomly,then through trial-and-error, and finallywith deliberate and purposeful intent.Your ability or inability to firstrecognize, and then attach meaning to,routine situations and events andgradually to everyday sounds andeventually to familiar words. Yourability or inability to vocalize, bothimitatively and spontaneously, usingvowels and later consonants, first inisolation, and then in increasinglylonger babbling strings.(B) Motor development (birth toattainment of age 1): Your ability orinability to explore and manipulate yourenvironment by moving your body andby using your hands; e.g., byincreasingly controlling position andmovement of head, sitting with support,creeping or crawling, pulling tostanding position, walking with handheld, standing alone briefly, wavingsmall rattle, reaching for or graspingobjects, transferring toys, picking upsmall objects, attempting to scribble.(C) Social development (birth toattainment of age 1): Your ability orinability to form and maintain intimaterelationships, and to respond to, andeventually initiate reciprocalinteractions with, your primarycaregivers (e.g., through games such aspat-a-cake, peek-a-boo, so big). Yourability or inability to begin to regulatethe behavior of others throughintentional behavior (e.g., gestures,vocalizations). Your ability or inabilityto recognize and produce a variety of