FI L ED U.S. COURT OF APPEAL S EL EVENTHCI RCUI T SEPTEMBER 3, 2010 J OHN L EY CL ERK [DO NOT PUBLISH] IN THE U

NITED STATE S COURT OF APPEALS FOR THE ELE VENTH CIRCUIT

__ __ __ __ __ __ __ __ __ __ __ __ No. 1 0- 10 42 8 Non -Arg um en t Ca le nd ar

__ __ __ __ __ __ __ __ __ __ __ __ D.C. Dock etNo. 2 :0 9- cv -0 07 46 -J FG ALICE MUHAMM AD, o.b .o. T.I.M., ll ll ll ll ll ll ll ll ll ll l Pl ai nt iff -Ap pe ll an t, vers us COMM ISSI ONER OF SOCIAL SECURITY, ll ll ll ll ll ll ll ll ll ll l Defen da nt -Ap pe ll ee.

__ __ __ __ __ __ __ __ __ __ __ __ App eal fro m

th e Uni te d S ta te s Di st ric t Co urt forth e North ernDis tri ctof Al ab am a

__ __ __ __ __ __ __ __ __ __ __ __ (Sep te m be r 3, 2 01 0) Befo re EDMONDSON, MARTIN an d F AY, Circ ui t J ud ge s. PER CURI AM: Ali ce M uh amm ad , on be ha lf o f he r m in orso n, T.I.M., ap pe al s fr om th edi st ric t co urt’s o rd er af firm in g t he So ci al Secu rit y Co m m is si on er’s (“ Co m m is si on er”) de ni al of T.I.M .’ s ap pl ic at io n fo r di sabi li ty ins ur an ce b en efi ts , pu rs ua ntto 42 U.S.C. § 4 05 (g ). Muha m m adarg ue s tha t the di st ric t co urt erredin affi rm in g t he Co m

m is si on er’s d eci si on , bec au se : (1 ) subs ta nt ia l ev id en ce d idno t supp ort the Adm in is tra ti ve Law Ju dg e’s (“ ALJ”) de ci si on no t t o a cco rdsubs ta nt ia l weig htto th e o pi ni on s o f Dr. AlaaElref ai , T.I.M.’ s t reat in g p sychi atris t; an d (2 ) subs ta nt ia l ev id en ce d idno t s up po rt t he ALJ’s de te rm in at io n t ha t T.I.M’s im pa irments di d n otfun ct io na ll y equa l an im

pa irment l is te d i n 2 0 C .F.R. § 4 04 , Subp artP, ap pe nd ix I, an d t ha t T.I.M. thu s was no t d is ab le d. Fo r th e rea so ns setforthbe lo w, we affi rm . I. InNov em

be r 20 06 , Mu ha m

m adfil edanap pl ic at io n fo r di sabi li ty ben efi ts on be ha lf o f he r si x- y ear- ol d c hi ld , T.I.M. Muh amm adid en ti fie d T.I.M.’s di sabl in g c on di ti onas ADHD. The C omm is si on er d en ie d the ap pl ic at io n, an d Mu ha m m adreque st eda he ari ng be fo re an ALJ. The ALJ co nduc te d ahe ari ng in Octo be r 20 08 . Duri ng th e h eari ng , Mu ha m m adtes ti fie d t ha t T.I.M. h adatt en de d t he fir stgra de , andcu rren tl y was i n th e se co ndgra de , at Ep ic Elem en ta ry Sch oo l (“ Epi c”). Mu ha m m adex pl ai ne d t ha t T.I.M.’s sch oo l p erfo rm an ce h adim pr ov eddu rin g t he sec on d g rad e b ecau se he 2was enro ll edin sp eci al educ at io n c la ss es . As a s pe ci al -educ at io n s tu de nt , T.I.M.

rece iv edin di vi du al iz edatt en ti onfro m two or t hr ee t each ers , andpa rti ci pa te d i n a m od ifi edcu rri cu lu m

with areduc edwork lo ad . T.I.M. recen tl y ha d re cei ve d t hr ee A’ s an d t wo B’s i n h is rep ort ca rd . Muh amm adexpl ai ne d t ha t T.I.M.’s b eh av io r du rin g t he sec on d g rad e h adva rie d, an d t ha t h e h ad“up s an d d own s,” b utth at T.I.M.’s be ha vi orwas “be tt er” t ha n i t h adbe endu rin g the pre vi ou s ac ad em ic y ear. Mu ha m m adfurth er t es ti fie d t ha t the in di vi du al iz edatt en ti on in th e sp eci al educ at io n p ro gr am

ha d i m pr ov edT.I.M.’ s ab il ity

to st ay “ on tas k” in th e cl as sr oo m . Muh amm adhe lp edT.I.M. with h is ho m ewo rk , andha d n ot ic edth at T.I.M. ha d d iff

ic ul ty retai ni ng or r ecal li ng in fo rm at io n t ha t h e rec en tl y ha d rev ie wed . T.I.M. wou ldno t co m pl et e h is ho m ewo rkif M uh amm adlef t h im by hi m se lf, a nd , as ares ul t, s he ha d t o s itwith h im un ti l h e co m

pl et edhi s h om ewo rk . T.I.M. sa w Dr. Elrefa i, wh o wo rk edat West ernMen ta l Hea lt h C en te r (“ W es te rn ”), twi ce a year, an d s aw co un se lo rs at West ernon ce ev ery on e to two m on th s. The ev id en ce re fle ct edth at , inNov em be r 20 06 , Mu ha m

m adco m pl et eda fu nc ti on rep ort, i n wh ic h s he rep orte d t ha t T.I.M. d idno t ex pe rie nc e an y li m it at io n in hi s ab il it y

to co m m un ic at e with o th ers ( i.e. , hav in g aco nv ers at io n, t el li ng a st ory , andus in g c om

pl et e se nt en ces ). She rep orte d t ha t T.I.M.’s i m pa irment li m it edhi s ab il it y

to un de rs ta ndan d u se in fo rm at io n t ha t h e h adlea rn ed , bu t tha t 3T.I.M. was abl e to reci te nu m be rs , def in e co m m on word s, as k fo r th e m ean in g o f a wor d, an d u nd ers ta nda jok e. Mu ha m m adals o re po rte d t ha t T.I.M.’s i m pa irment affe ct edhi s b eh av io r wit h o th ers . She als o s ta te d, h owe ve r, th atT.I.M. was

“ lo vi ng ,” sh owe d a ffec ti on to wardot he rs , enjo y edbe in g wi thot he r ch il dr enhi s ag e, an d e njo y edpl ay in g b oardga m es an d g am es su ch as t ag , hi de -an d- se ek , and

“pr et en d” ga m es . Muh amm adex pl ai ne d t ha t, al th ou gh T.I.M. was “ ve ry sm art ,” it was di ffi cu ltforhi m

to foc us , andhi s at te nt io n s pa n e ndur edforon ly a min ut e. The reco rdals o i nc lu de d atea ch er que st io nn ai re, wh ic h Vo tu ra Ma ck , T.I.M.’s ki nd erg art entea ch er atSo ut h Ham pt on Elem en ta ry

Sch oo l (“ So ut h Ham pt on ”) co m

pl et edin Jan ua ry

20 07 . Res po nd in g t o que st io ns co nc ern in g T.I.M.’s ab il it y

to acqui re an d u se in fo rm at io n, M ackrep orte d t ha t T.I.M. h ad“ no pr ob le m ” wit h c om

pr eh en di ng ora l i ns tru ct io ns , un de rs tand in g v oc ab ul ary, co m pl et in g m ath p ro bl em s, u nd ers ta nd in g a ndparti ci pa ti ng incla ss di sc us si on s, le arn in g n ew m at eri al , recal li ng m at eri al th athe pre vi ou sl y ha d l earn ed , and ap pl y in g p ro bl em -s ol vi ng sk il ls in cla ss di sc us si on s. T.I.M. h ada “ sl ig ht pr ob le m ” wit h re ad in g a ndco m pr eh en di ng writ te n m at eri al , pro vi di ng org an iz ed or al ex pl an at io ns an d a de qu at e d es cri pt io ns , andex pr es si ng id eas in writ te n fo rm . Res po nd in g t o que st io ns reg ard in g T.I.M.’s ab il it y to att en d a ndco m

pl et e ta sk s, M ackrep orte d t ha t T.I.M. h adno pro bl em with c arrying ou t s in gl e-s te p 4in st ru ct io ns , or c om pl et in g h is workwitho utm ak in g c arel es s m is ta ke s. He h ada sl ig htpro bl em

with p ay in g a tt en ti onwhen sp ok ento di rect ly, su st ai ni ng att en ti on du rin g p la y

or s po rts act iv it ie s, an d c arrying ou t m ul ti -s te p i ns tru ct io ns . Mack fu rth er re po rte d t ha t T.I.M. h ad“ anob vi ou s p ro bl em ” wit h m ai nt ai ni ng foc us whi le ch an gi ng fro m

on e act iv it y

to an ot he r, an d wo rk in g a t a r eas on ab le pa ce. T.I.M. ha d a“ se rio us pro bl em ” wit h m ai nt ai ni ng th e fo cu s n eces sa ry to fin is h a n as si gn edtas k, co m

pl et in g s ch oo lwo rkan d h om ewo rk , andwork in g wi th ou t di st ract in g h im se lf o r ot he rs . Inth e ev al ua ti on , Mackals o a ns weredqu es ti on s co nc ern in g T.I.M.’s ab il it y to in te ractwith a ndrel at e to ot he rs . Mackrep orte d tha t T.I.M. h adno pro bl em with p lay in g c oo pe rat iv el y with o th er ch il dr en , m ak in g a ndke ep in g fr ie nd s, se ek in g a tt en ti on ap pr op ria te ly, rel at in g e xp eri en ces an d t el li ng st or ie s, in te rp ret in g fa ci al expr es si on s an d b od y lan gu ag e, an d u si ng ad equa te vo cab ul ary an d g ramm ar i n e ve ry day co nv ers at io n. T.I.M. h ada sl ig htpro bl em with res pe ct in g a ndob ey in g a du lt s i n aut ho rit y . T.I.M. hadanob vi ou s p ro bl em with ex pr es si ng an ge r ap pr op ria te ly, ha nd li ng fru st rat io n, as ki ng forpe rm is si on in an ap pr op ria te m an ne r, an d u si ng lan gu ag e ap pr op ria te to th e si tu at io n andth e li st en er. Mac k s pe ci fie d t ha t T.I.M. s om et im es ki ck edan d c ur se d wh enask edto pe rfo rm a ta sk , andth at , whi le he was abl e to workin de pe nd en tl y , he was te d t im e 5by no t s ta y in g o n t as k.

Ina se pa rat e fo rm

ad dr es si ng T.I.M.’ s b eh av io r atsch oo l, Ma ckrep orte d th at , bet weenAug us t an d No ve m be r 20 06 , T.I.M. “ co ns ta nt ly” lefthi s s eatan d m ov edfro m

de skto de sk . T.I.M. call edMac k n am es on ce a wee k, an d h adki ck ed he r. Mackals o re po rte d t ha t, as of M ay 20 07 , T.I.M.’ s b eh av io r ha d “ de fin it e[l y ]” im pr ov ed , andth athe ha d a“ba d wee k” on ly onc e a m on th . T.I.M.’ s k in de rg art en rep ort ca rdsh owe d t ha t h e rec ei ve d g rad es of “ ex cel le nt ” o r “ sa ti sf act ory ” in all cat eg or ie s. Ina rep ort en ti tl ed“ In di vi du al iz edEdu cat io n P ro gr am ,” (“ IEP”), wh ic h was co m pl et edaft er T.I.M. fi ni sh edth e fi rs t g rad e, Epi c st aff re po rte d t ha t, dur in g t he fir stgra de , T.I.M. hadrece iv edsev eral di sc ip li nary writ e-ups . He di sp la y ed ag gr es si on to wardot he rs by kic ki ng hi s t each er an d e ng ag in g i n fr eque ntna m ecal li ng . He freque nt ly lefthi s s eatin th e cl as sr oo m , us ed“ug ly” lan gu ag e to ward pe ers an d h is tea ch er, an d h addi ffi cu lt y st ay in g o n t as k. Du rin g t hi s s ch oo l year, T.I.M. rece iv edanav erag e g rad e o f “ F” i n l an gu ag e art s, a “ D” inread in g, an d a

“ D” in m ath. He re cei ve d a n a ve rag e g rad e o f “ A” in m us ic , ph y si cal educ at io n, sc ie nc e, an d s oc ia l s tu di es . At th e en d o f th e fi rs t g rad e, T.I.M. co ul d re adon ly a few wo rd s, an d e xp eri en ceddi ffi cu lt y with m ath a ndwrit te n wo rk , des pi te th e fac t th athe ha d re cei ve d the ass is ta nc e o f a tut or . Stan da rd iz edach ie ve m en t t es ti ng 6sh owe d t ha t T.I.M.’s ab il it y in m athe m at ic al reas on in g a ndread in g co m pr eh en si on was a t the lo w endof t he av erag e ran ge , andth athi s b as ic read in g ab il it y was wi th in th e av erag e ran ge . T.I.M.’ s l is te ni ng co m pr eh en si on was b el ow av erag e. Due t o h is de fic ie ntgra de s an d b eh av io ral pro bl em s, T.I.M. was tra ns ferr edto sp eci al educ at io n c la ss es . T.I.M.’s m ed ic al reco rd s s ho wedth at , inth e fal l o f 20 06 , Muha m m ad so ug httre at m en t fo r T.I.M. atW es te rn . A Decem be r 20 06 tre at m en t p la n s ho wed th atT.I.M. ha d b een di ag no se d wi th ADHD, andth athe expe rie nc ededuc at io na l pr ob le m s. Th e tr eat m en t p lan a ls o n ot edth atMu ha m m adha d s ta te d t o West ern st aff tha t s he ho pe d t ha t T.I.M.’s treat m en t wo ul d e nabl e h im to “be m or e fo cu se d” an d “ pa y

att en ti on ,” an d d ecre as e h is hypera ct iv it y . The treat m en t p la n in cl ud edT.I.M.’ s g lo ba l as se ss m en t fu nc ti on in g s co re (“ GAF”) o f 52 , whi ch was as so ci at edwith “ m od erat e” d iff ic ul ty in s oc ia l an d s ch oo l fu nc ti on in g. InFeb ru ary 20 07 , Dr. Tho m as Bo ll , Ph.D., ex am in edT.I.M. at t he reque st of th e Co m m is si on er. Bo ll ob se rv edth atT.I.M. “ was ab le to pro vi de reas on ab le am ou nt s o f in fo rm at io n,” an d m ai nt ai ne d g oo d e y e co nt act . Duri ng th e ex am in at io n, T.I.M. “ te nd [ed ] to bo un ce i n h is ch ai r,” an d, af te r a s ho rt t im e, be cam e “ m od erat el y

di st ract ab le , andwand eredab ou t the roo m pl ay in g wi th ob jects .” Bo ll fou ndth atT.I.M.’ s s pe ech , con ve rs at io n, an d arti cu la ti on were 7ad equa te an d n orm al , th athi s t ho ug htpro ces se s an d a ch ie ve m en t o f

de ve lo pm en ta l m il es to ne s wer e n orm al , andth atT.I.M. di d n otsu fferco nf us io n o r ha ve “ lo os e as so ci at io ns .” In a dd it io n, Bo ll de te rm in edth atT.I.M.’ s t ho ug ht co nt en t was no rm al , andth athi s af fectan d m oo d wer e n orm al , no ti ng th e ab se nc e of an xi ety or m oo d s win gs . Bol l n ot edth at , whi le T.I.M. ha d “ so m e d is rupt io n” with h is co nc en tra ti on , per si st en ce, an d p ace, h is “ ap pe aran ce, b eh av io r, le ve l o f act iv it ie s, i nt eres ts an d abi li ty to re la te to ot he rs is no rm al .” Bo ll sp eci fie d t ha t, i n m ak in g the fin di ng s d es cri be d abo ve , he h adco ns id eredno t o nl y hi s p ers on al ob se rv at io ns , bu t al so T.I.M.’ s m ed ic al reco rd s. T.I.M.’s reco rd s fu rth er s ho wedth at , betweenNov em be r 20 06 an d Decem be r 20 07 , Dr. Elrefa i ch an ge d T.I.M.’s p res cri pt io n s ev eral ti m es , no ti ng th atso m e p res cri pt io ns were i ne ffec ti ve . In Dec em be r 20 07 , Dr. Elrefa i pr es cri be d F oc al in forT.I.M., no ti ng th atth is m ed ic at io n “ worke d fi ne .” Bet weenth e en d o f Decem be r 20 07 an d M ay

20 08 , T.I.M.’ s p res cri pt io n re m ai ne d st ab le . Betwe enJan ua ry

an d Dec em

be r of 20 07 , Jam es W ag ne r, a ch il d t he rap is t atW es te rn , no te d tha t T.I.M.’s b eh av io r atsch oo l v ari ed . In J anuary an d F eb ru ary 20 07 , W ag ne r no te d tha t T.I.M.’s b eh av io r ha d i m pr ov ed , andth athe ha d re cei ve d a g oo d g rad e in co nduc t. InMay 200 7, Wagn er n ot edth atT.I.M. was “ do in g well ,” an d t ha t, wh il e T.I.M. st il l ex pe rie nc edbe ha vi or al pro bl em s, the se pro bl em s 8ha d d ecre as ed . At th e en d o f Aug us t 2 00 7, Wagn er n ot edth atT.I.M. was “ do in g

well ov eral l,” t ha t h e was no t ag gr es si ve , andth atth ere wer e n o re po rte d i ss ue s with h is be ha vi orat s ch oo l. Als o i n Au gu st20 07 , W ag ne r wro te a le tt er t o Ep ic co nc ern in g T.I.M.’s treat m en t, i n wh ic h h e n ot edth atT.I.M.’ s m os t re cen t GAF sc or e was 62 , whi chwas a ss oc ia te d wi th m il d s ym pt om s an d “ so m e” p ro bl em s with s ch oo l fu nc ti on in g. InDecem be r 20 07 , ho wev er, Wagn er re po rte d t ha t Mu ha m m adha d d es cri be d T.I.M.’s b eh av io r atsch oo l as “un co nt ro ll ab le .” Nev erthe le ss , inMarc h a ndJu ne 20 08 , a li cen se d p ro fes si on al co un se lo r at W es te rnno te d t ha t T.I.M. h adm ad e p ro gr es s t owa rdth e o bjec ti ve s o ut li ne d i n h is tre at m en t p la n. InAug us t 2 00 8, Dr. Elr efai co m pl et edanev al ua ti on , inwhi ch he op in ed th atT.I.M. ha d m ark edli m it at io ns in th e are as of a cqui rin g a ndus in g in fo rm at io n, at te nd in g a ndco m pl et in g t as ks , andin te ract in g wi th an d re la ti ng to ot he rs . The ALJ d en ie d b en efi ts . The ALJ fo un d t ha t T.I.M. h adth e fo ll owi ng se ve re i m pa irments : (1 ) ADHD; an d (2 ) a s pe ci fic lea rn in g d is ab il it y . The ALJ al so fou nd , ho wev er, tha t T.I.M. d idno t h av e anim pa irment o r co m

bi na ti on of im pa irments th atm et , m ed ic al ly equ al ed , or fu nc ti on al ly equ al edanim pa irment li st edin th e fed eral reg ul at io ns at 2 0 C .F.R. § 4 04 , Sub pa rt P , app en di x 1 , andth at 9T.I.M. th us was n otdi sabl ed . The ALJ e xp la in edth at , inev al ua ti ng th e ex te ntof

T.I.M.’s li m it at io ns , he f

ou ndth atMac k’s ev al ua ti onwas “ hi gh ly pro ba ti ve ” o f T.I.M.’s “ tru e fu nc ti on in g” be cau se , inhe r pr of es si on al cap aci ty, Mac k h adclo se co nt actwith T.I.M. o ve r th e co ur se of asch oo l year an d was ab le to ob se rv e h im in bo th acad em ic an d s oc ia l s et ti ng s. Th e ALJ ch arac te riz edMac k’s s ta te m en ts in he r ev al ua ti on as s ta ti ng th atT.I.M. ha d o nl y a sl ig htpro bl em

in th e are a o f acqui rin g a ndus in g i nf

orm at io n, an d m od erat e p ro bl em s i n t he area s o f at te nd in g an d c om pl et in g t as ks an d i nt erac ti ng with o th ers . The ALJ a ls o n ot edth at , inMay 20 07 , Mackrep orte d t ha t T.I.M.’s b eh av io r ha d i m pr ov ed . The ALJ ev al ua te d the ex te ntof T.I.M .’ s l im it at io ns in each of t he si x

“ do m ai ns ” o f fu nc ti on in g s etforth in 20 C.F.R. § 41 6.9 26 a(g )-(l ). The ALJfou nd th atT.I.M. ha d s om e, bu t “ le ss th anm ark ed ,” li m it at io ns in th e fo ll owi ng do m ai ns : (1 ) acqui rin g a ndus in g i nf orm at io n; (2) att en di ng an d c om pl et in g t as ks ; an d (3 ) in te ract in g wi than d re la ti ng to othe rs . In s up po rt o f th es e fi nd in gs , th e ALJ rel ie d h eav il y

on Mac k’s ev al ua ti on an d Dr. Bo ll ’s rep ort. The ALJ n ot ed th atT.I.M. ha d re cei ve d d efi ci en t g rad es in m ath, l an gu ag e art s, an d re ad in g du rin g t he fir stgra de , bu t al so no te d t ha t s ta nd ard iz edach ie ve m en t t es ti ng ha d sh own th atT.I.M.’ s ab il ity in th es e are as was wi th in th e av erag e ran ge , andth at T.I.M. ha d re cei ve d s at is fact ory gra de s dur in g k in de rg art enan d s eco ndgra de . In

10ad di ti on , th e ALJ n ot edth atm ed ic at io n, al on g wi th T.I.M.’ s p art ic ip at io n i n a

sp eci al educ at io n p ro gr am , hadim pr ov edhi s p erfo rm an ce atsch oo l, an d t ha t T.I.M.’s GAF sco re h adin crea se d t o 6 2 b y Aug us t 2 00 7. Ad dr es si ng th e fi na l th ree d om ai ns of f

un ct io ni ng , th e ALJ d et erm in edth atT.I.M. ha d n o l im it at io ns in hi s ab il it ie s t o m ov e an d m an ip ul at e o bjec ts , care f orhi m se lf, o r in hi s g en eral ph y si cal he al th . Bas edon th e ab ov e, th e ALJ co nc lu de d t ha t T.I.M.’s i m pa irments di d n ot fu nc ti on al ly equ al a li st edim pa irment, b ecau se he di d n otsu fferfro m ex tre m e li m it at io ns inan y

of the si x d om ai ns of f

un ct io ni ng , no r di d h e su fferfro m m ark ed li m it at io ns inat l eas t two o f th es e si x d om ai ns . The ALJ a ckno wled ge d t ha t Dr. Elre fai ha d o pi ne d tha t T.I.M. s uf fere d fr om

m ark edli m it at io ns in th e d om ai ns of acqui rin g a ndus in g i nf

orm at io n, at te nd in g a ndco m pl et in g t as ks , andin te ract in g with a ndrel at in g t o o th ers . The ALJ d is co un te d Dr. El refa i’s o pi ni on s b ecau se he fo un d tha t the se op in io ns co nf li ct edwith West ern ’s un de rlyin g t reatm en t n ot es reg ard in g T.I.M., T.I.M.’s i m pr ov edGAF sco re, T.I.M.’s im pr ov edbe havi oran d sc ho ol pe rfo rm an ce, Ma ck ’s eva lu at io n, an d M uh amm ad ’s tes ti m on y . The ALJ ad di ti on al ly fou ndth atDr. Elref ai saw T.I.M. o nl y

twi ce a year, an d t ha t the se vi si ts were “pr im ari ly for ren ewin g h is pre sc rip ti on s.” Acc or di ng ly, th e ALJ co nc lu de d t ha t Dr. Elr efai ’s op in io ns were n ot“ well -s up po rte d” by the reco rd . 11Mu ha m

m ad ’s reque stforrev ie w of t he ALJ’s de ci si on was d en ie d b y th e App eal s Co un ci l. Mu ha m m adsubs eque nt ly file d aco m pl ai ntinth e d is tri ctco urt, al le gi ng th at th e ALJ’s d eci si on was n otsupp orte d b y subs ta nt ia l ev id en ce. The Co m m is si on er an swe red , reque st in g t ha t the co urt af firm th e d en ia l o f be ne fit s. Th e d is tri ctco urt en te redanord er af

firm in g t he Co m

m is si on er’s jud gm en t, s ta ti ng th atitha d rev ie wedth e rec or d, an d fo un d t ha t the ALJ’s de ci si on s wer e supp orte d b y subs ta nt ia l ev id en ce. 

### I I . Inrev ie win g a n ALJ ’s dec is io n t o d is co un t the op in io n o f a treat in g ph y si ci an , we con si de r whe th er the de ci si onis supp orte d b y subs ta nt ia l ev id en ce. Se e Phi ll ip s v. Ba rn ha rt , 35 7 F .3d12 32 , 12 41 (11 th Cir . 20 04 ). “ The tes ti m on y of a tr eat in g p hysic ia n m

us t o rd in ari ly be g iv ensubs ta nt ia l o r co ns id erab le weig ht un le ss go odcau se is sh own to th e co nt rary.” Mac Gre go r v. Bo wen , 78 6 F .2d 10 50 , 10 53 (11 th Cir . 19 86 ). An ALJ i s re qu ire d t o s pe ci fy “ wha t wei gh t i s g iv en to a tr eat in g p hysic ia n’s o pi ni on an d any reaso n fo r gi vi ng itno weig ht .” Id
. ; se e al so 20 C.F.R. § 41 6.9 27 (d )(2 ). An ALJ m us t h av e “ go odcau se ” to di sc ou ntth e op in io n o f a treat in g p hysic ia n. Phi ll ip s , 35 7 F .3dat 1 24 0. “ ‘[G] oo d c au se ’ ex is ts whe n the : (1 ) tr eat in g p hysic ia n’s o pi ni on was n otbo ls te redby the ev id en ce; 12(2 ) ev id en ce s up po rte d aco nt rary fin di ng ; o r (3 ) tr eat in g p hysic ia n’s o pi ni on was

co nc lu so ry

or i nc on si st en t wi th th e d oc to r’s own m ed ic al reco rd s.” Id
. at12 40 -4 1.

“ A tre at in g p hysic ia n’s re po rt m ay be di sc ou nt edwhenitis no t ac co m pani edby ob jecti ve m ed ic al ev id en ce.” Cr aw fo rd v. Co mm’r o

f S oc . Sec
. , 36 3 F .3d11 55 , 11 59 (11 th Cir . 20 04 ). Whe n d et erm in in g t he weig htto acco rdto a tr eat in g p hysic ia n’s o pi ni on , an ALJ s ho ul d c on si de r, am on g o th er thi ng s, the freque nc y with wh ic h t he ph y si ci an ex am in es th e p at ie nt , as wel l as th e dur at io n a ndna tu re o f th e d oc to r-p at ie nt rel at io ns hi p. 2 0 C .F.R. § 4 16 .92 7( d) (2 )(i )-(i i). When ev al ua ti ng th e ev id en ce, the ALJ m ay co ns id er d at a p ro vi de d b y no n- m ed ic al so ur ces su chas e du cat io na l pe rs on ne l, i nc lu di ng sch oo l t each ers . 20 C.F.R. § 41 6.9 13 (d )(2 ). Here, s ub st an ti al ev id en ce s up po rts th e ALJ’s d eci si on to di sc ou ntDr. Elre fai ’s op in io ns th atT.I.M. ha d m ark edli m it at io ns in th e d om ai ns of a cqui rin g an d u si ng in fo rm at io n, at te nd in g a ndco m pl et in g t as ks , andin te ract in g wi th an d rel at in g t o o th ers . Alth ou gh Dr. Elref ai was T.I.M.’s treat in g p sychi atris t, the ALJ ha d g oo d c au se to di sc ou nthi s o pi ni on s b ecau se th e ev id en ce s up po rte d afin di ng co nt rary to Dr. Elr efai ’s con cl us io ns . Se e Phi ll ip s , 35 7 F .3dat 1 24 0- 41 . Sp eci fic al ly, T.I.M.’s im pr ov edGAF sco re o f 62 , hi s k in de rg art enan d s eco nd
gr ad e rep ort ca rd s, h is av erag e-ra ng e sc or es on st an da rd iz edach ie ve m en t t es ts , 13Dr. Bo ll ’s rep ort, Ma ck ’s eva lu at io n re sp on se s, an d M uh amm ad ’s st at em en ts in

th e 2 00 6 fu nc ti on rep ort co nf li ct edwith Dr. El refa i’s o pi ni on th atT.I.M. ha d m ark edli m it at io ns inhi s ab il it y to acqui re an d u se in fo rm at io n. Inad di ti on , Dr. Elrefa i’s o pi ni on th atT.I.M. ha d m ark edli m it at io ns in hi s ab il it y to in te ractwith a ndrel at e to ot he rs was a ls o c on tra di ct edby Mack ’s ev al ua ti on , inwhi ch sh e rep orte d t ha t T.I.M. h adno tro ub le in m ak in g a nd ke ep in g fr ie nd s, p la y in g c oo pe rat iv el y with o th er ch il dr en , or t el li ng st or ie s. Mo reo ve r, in th e func ti onrep ort, Mu ha m m adha d d es cri be d T.I.M. a s “ lo vi ng ,” an d h adrep orte d t ha t T.I.M. en joy edbe in g wi th ot he r ch il dr enhi s ag e an d p la y in g ga m es su ch as h id e-an d- se ek . Dr. Bol l fo un d t ha t T.I.M.’s ab il it y to rel at e to ot he rs was “ no rm al .” Whi le Dr. Elref

ai op in edth atT.I.M. ha d m ark edli m it at io ns in hi s ab il it y to at te ndan d c om

pl et e a t as k, thi s o pi ni on was s om ewh atco nt rad ic te d b y T.I.M.’ s tre at m en t n ot es fro m

W es te rn , whi ch in di cat edth at , as o f Mar chan d J un e o f 20 08 , he ha d m ad e p ro gr es s t owa rdach ie vi ng th e g oa l o f in crea si ng hi s ab il it y to rem ai n fo cu se d o n atas k. In ad di ti on , W ag ne r rep orte d tha t T.IM.’s b eh av io r la rg el y ha d im pr ov eddu rin g m os t o f 20 07 . Dr. Elrefa i’s o pi ni on als o c on fli ct ed , to a cert ai n ex te nt , with T.I.M.’s i m

pr ov edGAF sco re o f 62 , andMu ha m m ad ’s tes ti m on y

th at T.I.M.’s be ha vi orat s ch oo l h adim pr ov ed . 14Acco rd in gl y , whi le Dr. Elref ai ’s op in io ns were co ns is te ntwith s om e o f th e ev id en ce, s uc h a s T.I.M.’s p oo r gr ad es an d u nrul y be ha vi ordu rin g the fir stgra de , an d M uh amm ad ’s tes ti m on y th atsh e h adto si t wi th T.I.M. inord er fo r hi m to co m pl et e h is ho m ewo rk , th e rec or d a ls o i nc lu de d s ub st an ti al ev id en ce tha t supp orte d c on cl us io ns co nt rary to Dr. Elr efai ’s con cl us io ns th atT.I.M. ha d m ark edli m it at io ns insev eral do m ai ns . Se e Phi ll ip s , 35 7 F .3dat 1 24 0- 41 . Mo reo ve r, in hi s re po rt, Dr. El refa i d idno t s pe ci fy whatev id en ce h e h ad co ns id eredin form in g h is op in io ns , no r di d h e o fferan y ex pl an at io n o r po in t t o ob jecti ve m ed ic al ev id en ce i n s up po rt o f hi s co nc lu si on s t ha t T.I.M. h adm ark ed li m it at io ns insev eral do m ai ns . Accor di ng ly, Dr. Elref ai ’s rep ort was co nc lu so ry in na tu re. Se e Phi ll ip s , 35 7 F .3dat 1 24 0- 41 ; Cr aw fo rd , 36 3 F .3dat 1 15 9. In ad di ti on , whi le Dr. Elref

ai was T.I.M.’s treat in g p hysic ia n, the reco rdsh ows th at he ex am in edT.I.M. ap pr ox im at el y twi ce a year. Acco rd in gl y , subs ta nt ia l ev id en ce s up po rte d t he ALJ’s de ci si on to di sc ou ntDr. Elref ai ’s op in io ns . II I. W e rev ie w de no vo th e d is tri ctco urt’s d et erm in at io n o f whe th er s ub st an ti al ev id en ce s up po rts th e ALJ’s d eci si on . W il so n v . Barnh ar t , 28 4 F .3d12 19 , 12 21 (1 1t h C ir. 2 00 2) . “ The [ALJ]’ s fa ctua l fi nd in gs are co nc lu si ve if s up po rte d b y subs ta nt ia l ev id en ce.” Id
. 15An i nd iv idua l u nd er the ag e o f 18 is co ns id eredto be di sabl edif h e h as a

“ m ed ic al ly det erm in ab le ph y si cal or m en ta l i m pa irment, wh ic h re su lt s i n m ark ed an d s ev ere f

un ct io na l l im it at io ns , and. . . whi ch ha s l as te d o r can be ex pe ct edto la stfora co nt in uo us pe rio d o f no t l es s t han 1 2 m on th s.” 4 2 U.S.C. § 1 38 2c (a)( 3) (C)( i). “ Fed eral reg ul at io ns setforth th e p ro ces s b y whi ch th e SSA de te rm in es if ach il d i s d is ab le d a ndth ereb y eli gi bl e fo r di sabi li ty ben efi ts .” Sh in n ex r el . Sh in n v . Comm’r

of So c. Se c. , 39 1 F .3d12 76 , 12 78 (11 th Cir . 20 04 ). As pa rt o f th is pro ces s, the ALJ m us t d et erm in e whe th er the ch il d h as a m ed ic al ly de te rm in ab le im

pa irment t ha t i s s ev ere. Sh in n , 39 1 F .3dat 1 27 8; 20 C.F.R. § 4 16 .92 4( c). If the ch il d h as a se ve re i m pa irment, t he ALJ n ex t d et erm in es whet he r th e im pa irment “ cau se s m ark edan d s ev ere fu nc ti on al li m it at io ns forth e ch il d.” Sh in n , 39 1 F .3dat 1 27 8 (quo ti ng 20 C.F.R. § 41 6.9 24 (d )). Thi s d et erm in at io n i s m ad e b as edup on a co ns id erat io n o f th e Lis ti ng of I m pa irments , whi ch is in cl ud ed in 20 C.F.R. § 40 4, Subp artP, ap pe nd ix 1. Sh in n , 39 1 F .3dat 1 27 8; 20 C.F.R. § 4 16 .92 5( a). A ch il d’s i m pa irment i s re co gn iz edas c au si ng “ m ark edan d s ev ere fu nc ti on al li m it at io ns if t ho se li m it at io ns m eet , m ed ic al ly equ al , or fu nc ti on al ly equa l” anim

pa irment d es cri be d i n t he Lis ti ng of I m pa irments . Sh in n , 39 1 F .3dat 12 79 (qu ot at io n a ndalt erat io ns om it te d) ; 2 0 C .F.R. § 4 16 .92 4( d) . If a ch il d’s 16im

pa irment d oe s n otm eetor m ed ic al ly equ al a li st edim pa irment, a n ALJ m ay

st il l fin d t ha t the ch il d i s d is ab le d i f hi s i m pa irment f

un ct io na ll y

equa ls a li st ed im pa irment. Sh in n , 39 1 F .3dat 1 27 9. In d et erm in in g wh ethe r a ch il d’s i m pa irment f

un ct io na ll y

equa ls a li st ed im pa irment, a n ALJ m

us t co ns id er the ex te ntto whi ch th e im pa irment l im it s t he ch il d’s ab il it y

to fun ct io n i n t he fol lo win g s ix “ do m ai ns ” o f li fe: (1) acqui rin g a nd us in g i nf orm at io n; (2) att en di ng an d c om pl et in g t as ks ; (3 ) in te ract in g a ndrel at in g with o th ers ; (4 ) m ov in g abo utan d m an ip ul at in g o bjec ts ; (5 ) car in g fo r on es el f; an d (6 ) he al th an d p hysic al well -b ei ng . Sh in n , 39 1 F .3dat 1 27 9; 20 C.F.R. § 4 16 .92 6a (b )(1 ). A chi ld ’s im pa irment f

un ct io na ll y

equa ls a li st edim

pa irment, an d t hu s co ns ti tu te s a d is ab il it y , if the ch il d’s l im it at io ns are “ m ark ed ” in two of th e si x l ife do m ai ns , or i f th e ch il d’s l im it at io ns are “ ex tre m e” i n o ne of t he si x do m ai ns . Sh in n , 39 1 F .3dat 1 27 9; 20 C.F.R. § 41 6.9 26 a(d ). Fed eral reg ul at io ns setforth be nc hm ark s t ha t ch il dr enof n orm al fun ct io ni ng sh ou ldha ve ach ie ve d a t a c ert ai n a ge . Sh in n , 39 1 F .3dat 1 27 9; 20 C.F.R. § 4 16 .92 6a (g )-(l ). Thes e reg ul at io ns pro vi de th at , inth e d om ai n o f acqui rin g a nd us in g i nf orm at io n, a c hi ldbe twee n t he ag es of 6 an d 1 2 s ho ul d b e ab le to lea rnto read , writ e, co m

pl et e m athe m at ic s p ro bl em s, an d d is cu ss hi st ory an d s ci en ce. 2 0 C.F.R. § 41 6.9 26 a(g )(2 )(i v) . Chi ld renof t hi s ag e al so sh ou ldbe ab le to 17de m on st rat e wha t the y ha ve lea rn edth ro ug h o ral an d wri tt enwork , andus e wha t th ey ha ve lea rn edin gro up workan d c la ss di sc us si on s. In ad di ti on , a ch il d be twee n the ag es of 6 an d 1 2 s ho ul d b e ab le to us e anin crea si ng ly com pl ex vo cab ul ary to sh are i nf

orm at io n, as k que st io ns , andex pr es s i de as . Id
. The reg ul at io ns furth er p ro vi de th atth e d om ai n o f at te nd in g a ndco m pl et in g ta sk s ex am in es a ch il d’s ab il it y to foc us hi s at te nt io n o n a ct iv it ie s, an d fi ni sh act iv it ie s atanap pr op ria te pa ce. 2 0 C .F.R. § 4 16 .92 6a (h ). In t hi s d om ai n, a c hi ld be twee n the ag es of 6 an d 1 2 s ho ul d b e ab le to “ fo cu s [h is ] at te nt io n i n ava rie ty of si tu at io ns in ord er t o fo ll ow d ire ct io ns , rem em be r an d o rg an iz e [h is ] sc ho ol m at eri al s, an d c om

pl et e cl as sr oo m

an d h om ewo rkass ig nm en ts .” 20 C.F.R. § 4 16 .92 6a (h )(2 )(i v) . In ad di ti on , th e ch il d s ho ul d b e ab le to tra ns it io n b etween act iv it ie s wi th ou t d is tra ct io n, s ta y in pl ace wh enap pr op ria te , andsu st ai n h is at te nt io n wel l en ou gh to readby him se lf o r co m pl et e a h ou se ho ldch or e. Id
. The fed eral reg ul at io ns expl ai n t ha t the do m ai n o f in te ract in g a ndrel at in g with o th ers ad dr es se s a c hi ld ’s abi li ty to i ni ti at e an d s us ta in em ot io na l co nn ect io ns with o th ers , dev el op an d u se ap pr op ria te lan gu ag e, co op erat e wit h o th ers , com pl y with ru le s, an d re sp on d t o c rit ic is m . 20 C.F.R. § 41 6.9 26 a(i ). In t hi s d om ai n, a ch il d b etweenth e ag es of 6 an d 1 2 s ho ul d b e ab le to de ve lo p l as ti ng fri en ds hi ps with h is pe ers , exp res s h is id eas an d t el l s to rie s, an d b eg in to un de rs ta ndho w to 18work i n agro up to so lv e a p ro bl em . 20 C.F.R. § 41 6.9 26 a(i )(2 )(i v) .

The reg ul at io ns pro vi de th ata ch il d’s l im it at io n i s “ m ark ed ” whe re i t i s

“ m or e th anm od erat e,” b ut“ le ss th anex tre m e.” 2 0 C .F.R. § 4 16 .92 6a (e)( 2) (i) . A m ark edim

pa irment “ se rio us ly” in te rfer es with ach il d’s “ ab il it y to in de pe nd en tl y in it ia te , su st ai n, o r co m

pl et e act iv it ie s.” Id
. An “ ex tre m e” l im it at io n i s a li m it at io n t ha t i s “ m or e th anm ark ed ,” an d “ in te rfer es ve ry ser io us ly w ith [t he ch il d’s] abi li ty to i nd ep en de nt ly ini ti at e, su st ai n, o r co m pl et e act iv it ie s.” 2 0 C .F.R. § 4 16 .92 6a (e)( 3) (i) . In d et erm in in g wh ethe r a ch il d h as “ m ark ed ” o r “ ex tre m e” li m it at io ns ina do m ai n, an ALJ sh ou ldco ns id er h ow t he ch il d p erfo rm s i n a supp orti ve set ti ng , as wel l as th e eff ect s o f m ed ic at io n o r ot he r tr eat m en t. 2 0 C.F.R. § 41 6.9 26 a(a) . Here, s ub st an ti al ev id en ce s up po rts th e ALJ’s d et erm in at io n t ha t T.I.M. i s no t d is ab le d, as he di d n otsu fferex tre m e li m it at io ns in an y on e o f th e si x do m ai ns , or m ark edli m it at io ns in at l eas t two o f th e si x d om ai ns . Firs t, subs ta nt ia l ev id en ce s up po rts th e ALJ’s d et erm in at io n t ha t T.I.M. h adles s- th an m ark edli m it at io ns inth e d om ai n o f acqui rin g a ndus in g i nf orm at io n. Se e W

il so n , 28 4 F .3dat 1 22 1; 20 C.F.R. § 41 6.9 26 a(g )(2 )(i v) . Whi le T.I.M. rece iv edde fic ie nt gr ad es in read in g, l an gu ag e art s, an d m ath dur in g t he fir stgra de , he r ecei ve d A’s in sci en ce an d s oc ia l s tu di es , andhi s s ta nd ard iz edach ie ve m en t s co res refl ect ed 19th athi s ab il it y in read in g c om

pr eh en si on an d m athe m at ic al reas on in g fe ll withi n th e av erag e ran ge . Mackrep orte d t ha t T.I.M. h ad“ no pro bl em ” wit h l earn in g ne w m at eri al an d re cal li ng m at eri al th athe pre vi ou sl y ha d l earn ed , andT.I.M.’ s ki nd erg art engra de s wer e “ ex cel le nt ” an d “ sa ti sf act ory .” In c om

pl et in g t he ch il d fu nc ti on rep ort, Mu ha m

m adde sc rib edT.I.M. as “ ve ry sm art ,” an d re po rte d t ha t T.I.M. co ul d d efi ne co m

m on word s, as k fo r th e m ean in g o f a wo rd , and un de rs ta nda jok e. Mo reo ve r, Dr. Bo ll fou ndth atT.I.M.’ s t ho ug htpro ces se s an d de ve lo pm en ta l m il es to ne s wer e n orm al . Subs ta nt ia l ev id en ce al so supp orte d t he ALJ’s de te rm in at io n t ha t T.I.M. h ad le ss -th an -m ark edli m it at io ns in th e d om ai n o f in te ract in g wi th an d re la ti ng to ot he rs . W

il so n , 28 4 F .3dat 1 22 1; 20 C.F.R. § 41 6.9 26 a(i )(2 )(i v) . Mackob se rv ed th atT.I.M. ha d “ no pro bl em ” wit h m ak in g a ndke ep in g fr ie nd s, re la ti ng ex pe rie nc es an d t el li ng st or ie s, an d i nt erp ret in g fa ci al ex pr es si on s an d b od y la ng ua ge . Thes e o bs erv at io ns were co ns is te ntwith Dr. Bo ll ’s op in io n t ha t T.I.M.’s ab il it y

to rel at e to ot he rs was n orm al , as wel l as with M uh amm ad ’s st at em en ts th atT.I.M. en

joy edbe in g wi thot he r ch il dr enhi s ag e an d p la y in g ga m es with o th er ch il dr en . Whi le T.I.M. m an ife st edbe ha vi or al pro bl em s s uc h a s ki ck in g a ndna m e-ca ll in g dur in g k in de rg art enan d fi rs t g rad e, Mu ha m m adtes ti fie d th atT.I.M.’ s b eh av io r ha d i m pr ov eddu rin g t he sec on d g rad e. Inad di ti on ,

20T.I.M.’s GAF sco re h adim pr ov edto 62 by Aug us t 2 00 7, i nd ic at in g t ha t h is ab il it y to in te ractwith o th ers in anap pr op ria te m an ne r ha d i m pr ov ed . Altho ug h t he ev id en ce i nd ic at es th atT.I.M. ha d am or e se rio us pro bl em in th e d om ai n o f at te nd in g a ndco m pl et in g t as ks th anhe ha d i n o th er d om ai ns , subs ta nt ia l ev id en ce s up po rts th e ALJ’s d eci si on th atT.I.M.’ s l im it at io ns inth is do m ai n wer e le ss -th an -m ark ed , parti cu larly in l ig htof t he factth atth e ALJ was pe rm it te d t o c on si de r th e im pr ov em en ts effe ct edby T .I.M.’s m ed ic at io n a ndhi s pa rti ci pa ti on in a sp eci al -educ at io n p ro gr am . Se e W il so n , 28 4 F .3dat 1 22 1; 20 C.F.R. § 41 6.9 26 a(a) , (h) (2 )(i v) . As no te d abo ve , T.I.M.’ s GAF s co re h ad im pr ov edto 62 by Aug us t 2 00 7. Dr. Bo ll fou ndth at , whi le T.I.M. was

“ m od erat el y

di st ract ab le ,” th ere was on ly “ so m e d is rupt io n” in T.I.M.’ s co nc en tra ti on an d p ace, a ndhi s b eh av io r an d a ct iv it y lev el s wer e n orm al . In ad di ti on , T.I.M.’ s t reat m en t re co rd s fr om W es te rnrefl ectth at , inMarc h 2 00 8 a nd Ju ne 20 08 , T.I.M. hadm ad e p ro gr es s t owa rdth e g oa ls setforthin hi s t reat m en t pl an , su chas i m

pr ov in g h is ab il it y

to co nc en tra te an d m ai nt ai n fo cu s. Wagn er no te d t ha t, dur in g t he m ajor it y of 2 00 7, T.I.M.’s b eh av io r sh owe d s ig ni fic an t im pr ov em en t. Thi s was co ns is te ntwith M ack ’s op in io n tha t m ed ic at io n c au se d T.I.M.’s be ha vi orto im

pr ov e b y May 200 7. Fi na ll y , we no te th at , eve n i f subs ta nt ia l ev id en ce d idno t s up po rt t he ALJ’s 21de te rm in at io n t ha t T.I.M. h adles s- th an -m ark edli m it at io ns in th e d om ai n o f

at te nd in g a ndco m

pl et in g t as ks , any suc h e rro r was ha rm le ss . Se e Dio ri o v . Heckl er , 72 1 F .2d72 6, 7 28 (11 th Cir . 19 83 ) (h ol di ng th at , alt ho ug h t he ALJ m ad e va rio us erro rs , th es e err or s wer e h arm le ss be cau se th ey ul ti m at el y

were i rrel ev an t to th e d en ia l o f th e cl ai m an t’s ap pl ic at io n fo r di sabi li ty ben efi ts ). Even if T.I.M.’s li m it at io ns inth is do m ai n wer e m ark ed , he s ti ll wou ldno t b e d is ab le d b ecau se he di d n otha ve m ark edli m it at io ns in at l eas t o ne ad di ti on al do m ai n. Se e S hi nn , 39 1 F.3 d a t 1 27 9; 20 C.F.R. § 41 6.9 26 a(d ). Altho ug h am in orcla im an t i s d is ab le d i f he ha s ex tre m e li m it at io ns in on ly one do m ai n, the ev id en ce d es cri be d abo ve de m on st rat es th atT.I.M.’ s l im it at io ns in th e d om ai n o f at te nd in g a ndco m pl et in g ta sk s wer e n otex tre m e. Se e S hi nn , 39 1 F .3dat 1 27 9; 20 C.F.R. § 41 6.9 26 a(d ). Acco rd in gl y , eve n i f th e ALJ erredin ev al ua ti ng T.I.M.’ s l im it at io ns inth is do m ai n, s ub st an ti al ev id en ce s ti ll wou ldsupp ort h is ul ti m at e d et erm in at io n t ha t T.I.M. was n otdi sabl ed . AFFIRMED.

22