If the evidence from acceptable medical sources is insufficient to establish the existence of an impairment or contains a material conflict, undertake additional development (e.g., recontact medical sources, order a CE), per DI 22505.008 and DI 22510.001.

After development is complete, decide the nature of the child's impairment(s) based on all the evidence of record.

Do not establish the existence of an impairment(s) on the basis of information from a source(s) that is not an acceptable medical source (although such information may be valuable when assessing the severity of an impairment(s).

Example 1: A school psychologist, who is the only source of evidence, concludes that the claimant, a 9-year-old child, has a developmental reading disorder. Based on the school psychologist's report and on the child's parents' statements, the DDS medical consultant/psychological consultant (MC/PC) believes that the child's more significant impairment may be a disruptive behavior disorder. The MC/PC cannot establish that a disruptive behavior disorder exists because the record does not include medical evidence about the disruptive behavior disorder from an acceptable medical source. (Per DI 22505.003A, a school psychologist is an acceptable medical source only with respect to intellectual disability, learning disabilities, and borderline intellectual functioning.) The DDS should not establish the existence of a disruptive behavior disorder without additional evidence from an acceptable medical source.

Example 2: A CE provider indicates that a child was somewhat oppositional in the test situation, but the provider does not provide sufficient medical evidence to establish the existence of an oppositional defiant disorder (ODD). It would be incorrect to combine anecdotal information with reports from the child's parent and teacher to conclude that the child has ODD. Recontact with the CE provider is required.

Example 3: A psychological evaluation indicates that a 10-year-old child has full scale, verbal, and performance IQs in the low 60's, but the report does not discuss deficits of adaptive functioning nor does it provide a diagnosis of intellectual disability. The consultant cannot be recontacted for clarification. However, the child's parent describes activities typical of mild intellectual disability. In this case, the DDS should not establish the existence of intellectual disability without additional evidence about adaptive functioning from an acceptable medical source.