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
Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulations6427emotional cues (e.g., facial expressions,vocal tone changes).(D) Responsiveness to stimuli (birth toattainment of age 1): Your ability orinability to form patterns of selfregulation,i.e., to recognize internalcues (e.g., hunger, pain), and to organizeexternal experiences (e.g., light, sound,temperature, movement), and to regulateyour reactions to them (e.g., brighteningin response to sights and sounds,enjoying being touched or stroked orheld, enjoying gentle movement inspace (‘‘rock-a-bye-baby’’)).(ii) Older infants and toddlers (age 1to attainment of age 3): Children in thisage group are evaluated in terms of threeareas of development. The following aregeneral descriptions of developmenttypical of this age group.(A) Cognitive/communicativedevelopment (age 1 to attainment of age3): Your ability or inability tounderstand by responding toincreasingly complex requests,instructions, and questions; to refer toyourself and things around you bypointing and eventually by naming; toform concepts and to solve simpleproblems through purposefulexperimentation (e.g., disassemblingtoys), imitation (immediate anddelayed), and constructive play (e.g.,putting things in and out of containers,building with blocks, exploring spaces);to demonstrate your knowledge ofobjects, actions, and situations you haveencountered through pretend playactivities; to spontaneouslycommunicate your wishes or needs byusing gestures, an increasing number ofintelligible words, and eventuallygrammatically correct simple sentencesand questions with increasingly richand broad vocabulary.(B) Motor development (age 1 toattainment of age 3): Your ability orinability to move in your environmentusing your body with steadilyincreasing dexterity and independencefrom support by others, and yourincreasing ability to manipulate smallobjects and to use your hands to do, orto get, something that you want or need.(C) Social development (age 1 toattainment of age 3): Your ability orinability to exhibit normal dependenceupon, and intimacy with, your primarycaregivers, as well as increasingindependence from them; to initiate andrespond to a variety of emotional cues;to regulate and organize emotions andbehaviors. Your ability or inability to beinterested in initiating and maintaininginteractions with others, first duringbrief, yet frequent encounters, andgradually increasing to longer, sustainedones. Your ability or inability to showinterest in, initially watch, then playalongside, and eventually interact withsimilarly aged peers.(iii) Preschool children (age 3 toattainment of age 6). Children in thisage group are evaluated in terms of fiveareas of development. The following aregeneral descriptions of developmenttypical of this age group.(A) Cognitive/communicativedevelopment (age 3 to attainment of age6): Your ability or inability to learn,understand, and solve problems throughintuition, perception, verbal andnonverbal reasoning, and theapplication of acquired knowledge; yourability or inability to retain and recallinformation, images, events, andprocedures during the process ofthinking (as in the development ofreadiness skills for formal learning (e.g.,learning letters, shapes, colors) andskills for daily living (e.g., putting toysin proper places)). Your ability orinability to communicate by expressingyour needs, feelings, and preferences; bytelling, requesting, predicting, andrelating information; by describingactions and functions; by providingexplanations; by following and givingdirections; and by engaging inconversation in a spontaneous,interactive, and increasingly intelligiblemanner, using increasingly complexvocabulary and grammar.(B) Motor development (age 3 toattainment of age 6): Your ability orinability to move and use your arms andlegs in increasingly more intricate andcoordinated activity, and your ability orinability to use your hands withincreasing coordination to manipulatesmall objects during play (e.g., drawing,using building blocks, constructingpuzzles) and physically related dailyactivities other than self-care (seePersonal area).(C) Social development (age 3 toattainment of age 6): Your ability orinability to initiate social exchanges, toorganize and regulate your emotionsand behaviors, and to respond to yoursocial environment through appropriateand increasingly complex interactions,such as showing affection, sharing, andhelping; your ability to relate tocaregivers with increasingindependence, to choose your ownfriends, and to play cooperatively withother children, one-at-a-time or in agroup.(D) Personal development (age 3 toattainment of age 6): Your ability orinability to help yourself and tocooperate with others in taking care ofyour personal needs, health, and safety(e.g., bathing, dressing, maintainingsleep habits, crossing the street with anadult).(E) Concentration, persistence, orpace (age 3 to attainment of age 6): Yourability or inability to engage in anactivity, and to sustain the activity fora period of time at a reasonable pace(e.g., playing a simple board game).(iv) School-age children (age 6 toattainment of age 12). Children in thisage group are evaluated in terms of fiveareas of functioning. The following aregeneral descriptions of functioningtypical of this age group.(A) Cognitive/communicativefunctioning (age 6 to attainment of age12): Your ability or inability to learn,understand, and solve problems throughintuition, perception, verbal andnonverbal reasoning, and theapplication of acquired knowledge; theability to retain and recall information,images, events, and procedures duringthe process of thinking, as in formallearning situations (e.g., reading, classdiscussions) and in daily living (e.g.,telling time, making change). Yourability or inability to comprehend andproduce language (e.g., vocabulary,grammar) in order to communicate insocial conversation (e.g., to expressfeelings, meet needs, seek information,describe events, share stories), and inlearning situations (e.g., to exchangeinformation and ideas with peers andfamily or with groups such as yourschool classes) in a spontaneous,interactive, sustained, and intelligiblemanner, using increasingly complexvocabulary and grammar.(B) Motor functioning (age 6 toattainment of age 12): Your ability orinability to use fine and gross motorskills in order to engage in the physicalactivities involved in normal mobility,school work, play, physical education,sports, and other physically relateddaily activities other than self-care (seePersonal area).(C) Social functioning (age 6 toattainment of age 12): Your ability orinability to play alone, with anotherchild, and in a group; to initiate anddevelop friendships; to respond to yoursocial environments throughappropriate and increasingly complexinterpersonal behaviors, such asempathizing with others and toleratingdifferences; and to relate appropriatelyto individuals and in group situations(e.g., siblings, parents or caregivers,peers, teachers, school classes,neighborhood groups).(D) Personal functioning (age 6 toattainment of age 12): Your ability orinability to help yourself and tocooperate with others in taking care ofyour personal needs, health, and safety(e.g., eating, dressing, maintainingpersonal hygiene, following safetyprecautions).
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