tutions, 81.5 percent were ambulatory, and the number confined to their homes (10.5 percent) approximated the national average of 10.6 percent (table 5).

Information presently available for study is not conclusive, but there appears to be a positive relationship between whether the parent of a disabled child beneficiary is dead and whether or not that beneficiary is in an institution. In 32 States the proportion of applicants who were institutionalized when they applied for benefits exceeded the proportion who applied in the Nation

as a whole (26.2 percent). In 23 States the proportion of beneficiaries in current-payment status on December 31, 1964, who were entitled on the wage record of a deceased parent was greater than for the United States (50 percent). Twenty of these latter were among the 31 States that comprised the first group.

DIAGNOSES

The abnormalities that were severe enough to qualify these applicants for benefits were typical

of the mental, emotional, and physical disorders that 20 or more years ago severely crippled babies and young children and usually lasted throughout their lives. These are conditions that do not necessarily end in early death but often extend into the upper reaches of adulthood.

In each year since 1957, about 9 out of 10 of the applicants who qualified for benefits had severe psychological and neurological conditions (table 6). The proportion with primary diagnoses in the group with mental, psychoneurotic, and

personality disorders increased from 47.4 percen in 1957 to 65.7 percent in 1963, while the pro portion with diseases of the nervous system and sense organs declined from 38.8 to 24.5 percent

Within and between these broad classifications there has also been considerable change in th proportions with specific conditions. Those, fo example, with a primary diagnosis of menta deficiency made up 45 percent of the total i 1957 and 52 percent in 1963, and the proportion with cerebral spastic infantile paralysis decline

from 15 percent in 1957 to 4 percent in 1963. For the cerebral palsied who were not mentally deficient, the decline was from 32 to 10 percent. Persons with schizophrenic disorders (dementia praecox) as a primary cause of disability increased as a proportion from 1.5 percent in 1957 to 7 percent in 1963.

The degree of importance that should be assigned to these measures of increase or decrease can only be conjectured since the differences may be the result of one or several factors: refinement of diagnostic techniques over the years, improvement in disease classification, or in increased recognition of the fact that psychoneurological and personality disorders may accompany mental retardation and, in fact, may be the primary cause of disability in persons previously classified as "mentally deficient."

The 20,000 beneficiaries with primary diagnoses outside the two major disease groups are no less important and their disabilities no less disabling. Their problems are of serious import to themselves, their families, and their communities, where their need for services, often protective, is constant and the cost of services, when available, often prohibitive. For many of them the fact that they are alive today is, no doubt, the result of advances in medical knowledge and therapy. In years past they might not have lived long enough to be included, as an adult, in a social insurance. program. In order of their numerical significance. were persons handicapped as a result of poliomyelitis (3,619), infectious encephalitis (1,168), and congenital syphilis (578); the endocrine diseases, myxoedema and cretinism, which have mental deficiency as a sequel (1,942); muscular dystrophy and similar diseases (1,428); rheumatoid arthritis and allied conditions (1,048); and a miscellany of congenital malformations (5,527).o

Those newly awarded benefits ranged in age from 18 to 65 and over. About half were over age 30 and 1 in 10 was aged 45 or older.

In each year since 1957 new entrants to the rolls were slightly younger than the ones who became beneficiaries the year before. At the same time, those receiving benefits at the end of each year were, as a group, a little older by a few months than in the preceding year-their median ages were 34.5 and 36.5 in 1964. In general, the women were older by about 2 years. The tabulation that follows gives the median age for men and women whose application for disability benefits was allowed in each of the years 1957-64.

1 For 1957, 1958, and 1959 allowances, age on birthday in year of application; for 1960 and 1961 allowances, age in year of allowance.

More than one-fourth (26.6 percent) of those who were awarded benefits in 1964 were aged 1819, a fact that emphasizes the role played by the OASDHI program in helping to identify in early adulthood these specially disabled people,

as well as the role it could possibly play in identifying severely handicapped children before they reach age 18. An estimated 4,000-5,000 of the 5,415 persons aged 18 or 19 who were awarded childhood disability benefits in 1964 had received benefits before age 18 as dependents. They had not, of course, been previously identified in beneficiary records as "disabled" dependents. To what extent might earlier identification. have led to reduction of the disabilities of some of these people who became severely handicapped at early ages?

The proportion aged 60 and over among those receiving benefits at the end of each year has grown from 0.4 percent in 1957 to 1.6 percent in 1964 (table 7), and their number has risen from 122 to 3,037. Of the latter, 793 were aged 65 and over. Unlike disabled-worker beneficiaries who are transferred from the rolls of the disabled to the rolls of the retired when they reach age 65, there is no upper limit to the age at which an adult with a childhood disability receives his benefit.

Total...

Failed to meet medical standards for disability...

Met medical standards for disability but able to engage in substantial gainful activity..

Failed to furnish suflicient evidence.

Not disabled before age 18.
Other..

35,682 100.0 39.4 22.4 23.7

CHANGES IN BENEFIT STATUS

Only 10 percent of those awarded benefits in the 8 years 1957-64 had been removed from the benefit rolls by December 31, 1964. Six percent had died and about 1 percent had experienced such improvement in their physical and mental condition that they no longer met the disability requirements for benefits. About 2 percent married and thus became ineligible.

Total.....

groups.

Although for most of these applicants their conditions were not as severe as among the beneficiaries, it is a realistic assumption that many were handicapped enough to be limited in the degree to which they could go about the activities of daily living. Except for a few, they had not worked. Nevertheless, the group was younger and the conditions were less severe than for the beneficiaries. In most years since 1957, as with applicants who qualified for benefits, the proportion with denials who were under age 35 has grown larger but at a more accelerated pace than for beneficiaries (table 10).

This group can be expected, therefore, to have in it a sizable proportion of members with some potential for rehabilitation, vocational and

Missouri. Montana..

1 Does not include 1,515 persons who failed to qualify for benefits in 1963 because they were not disabled before age 18 (1,335), were able to engage in substantial gainful activity although they met medical standards for disability (90), and for other reasons (90).

otherwise. The extent to which this potential can be exploited and directed toward a higher level of self-sufficiency than now obtains will depend on the circumstances of the individual applicant's environment as well as on the nature of his physical or mental abnormality. These applicants were distributed throughout the United States, with every State represented, in personal circumstances at least made no easier because of the financial and social demands resulting from long-term chronic conditions (table 11). In addition, they had varying exposures to supportive and therapeutic resources, education, training, and job opportunities.