One aspect of my job is to represent impoverished people in Social Security Disability hearings. Representing the children is what I love most.

Many people wonder why a child would seek disability benefits. Particularly for kids with mental health issues, some think that being found disabled by the federal government means that the child is labeled and stigmatized for life. I look at it differently.

Even though there are laws that are supposed to ensure that children with special needs get the appropriate services at school, the reality is that services are expensive, and many school districts resist providing them. Nearly all of my clients are in need of special education services, but I would say that only 1/3 of them are getting any kind of services. Many get none. Many need more than they are getting now. So one big advantage to being found disabled due to a learning problem or a behavioral problem is that it is harder for the school to deny the child’s eligibility for special services. These services can make a huge difference in the child’s future.

Most of my child clients have been diagnosed with ADHD. However, their symptoms are extreme: sudden mood swings, unexplained bouts of violence and rage, difficulties learning and remembering, as well as the typical hyperactivity. Often, their behavior and concentration seem unaffected by the medications prescribed for ADHD. The judges before whom I represented some of these children would issue decisions in which they blamed the mother for not giving the child his or her medication, because, they believed, there is no way these symptoms would persist if she had.

It seemed odd to me that so many mothers would be so forgetful or negligent, so I did some research. I learned that lead poisoning causes all of those symptoms, rage and sudden mood swings in particular. Lead poisoning cannot be treated with medication, or, it turns out, at all*. The US Centers for Disease Control recently revised its criteria for when blood lead levels are considered to have poisoned the child. A year ago, a blood level of 10 micrograms per deciliter of blood was considered “of concern.” Now it is 5 micrograms, and in fact, the CDC states that there is NO safe level of lead in the blood for anyone; lead stays in the child’s body forever, in the bones and teeth.

At every hearing, I provide the judge with numerous articles from medical journals about the impact of lead poisoning on a child’s mood, behavior and learning ability. So far, I have met with zero success in convincing the judges that this is something they should factor into their evaluation of the child’s symptoms. They continue to rule that the child has not been properly medicated. I will continue trying to educate the judges, and appealing the decisions when my clients are denied benefits.

That brings me to another challenge in this type of work. Most of the Social Security Disability judges are middle class or upper middle class people, who have had an abundance of opportunities and significant education. It seems hard for some of them to understand the challenges of living in poverty and to remember that it’s not a lifestyle choice. Often, these families are impoverished because of a family history of significant disabilities over many generations which were never adequately treated, or because the child I represent keeps getting suspended or expelled and the parent can’t maintain a job if he has to leave work three times a week to collect his kid from school.

The hearings take about 30 minutes. The judge has to eyeball the child and figure out what’s going on in that brief time, which is impossible, in my view. I provide reams of school and medical records as evidence, but that face to face meeting between the child and the judge is key. Thanks to television, my little clients understand that judges are important people whom they need to respect. Kids who are scribbling with markers on the ceiling while swinging from the light fixture in the waiting room before a hearing will come into the courtroom, fold their hands and say, “Yes, your honor,” “No, your honor,” with nary a wiggle or an outburst. A lawyer has to prepare her clients for the hearing, but it’s difficult to instruct an 8-year-old to do his best to act up the way he normally does at home and at school!

I keep trying to find ways to get the message to the judges that my clients face many obstacles in life even before we get to their learning disabilities or mental health issues. It isn’t just a matter of knowing the law; an advocate for the poor also has to navigate the huge gulf between the life circumstances of the applicant for benefits and those of the person who gets to decide his or her eligibility. These challenges are what make the work so interesting. I love doing it.

I’d love to hear from anyone who tries to bridge cultural/social divides in their work.  Any ideas to share?  

*Except in cases of extremely high levels, where chelation therapy may be used.

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