Page 13 - Delaware Medical Journal - March/April 2019
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CASE REPORT
can adapt styles of speech they deem appropriate for their audience.1
Social communication and pragmatic
in standardized ways. This is due to standardized testing being unable to fully capture social communication problems that may arise on a daily basis where rules of interaction are less transparent and differ, and cultural variation is present. Communication behaviors include eye contact, affect, turn taking, conversation interruptions, humor, questioning, challenging, debating, relationship to
the other, politeness, intonations, and other nonverbal cues. Unlike structural aspects of language (e.g., vocabulary or grammar), there are also far fewer normative data for such behaviors.2
DSM-5 and ICD-11 will require that children with social (pragmatic) communication disorder (SCD) do not and repetitive interests and behaviors (RRIBs). Literature has at times been SCD show evidence of RRIBs. Reisinger, Cornish, and Fombonne3 compared children with autism spectrum disorder (ASD) and children with SCD on the Autism Diagnostic Observation Schedule (ADOS) and the Social Communication Questionnaire (SCQ). They found that
the groups could be distinguished by the severity of social and communication measures of RRIB. On the other hand, children with SCD as a group were less likely to display RRIBs, according to Bishop and Norbury, who used similar methods.4 According to the studies, the majority of children with SCD were rated as having speech abnormalities associated with autism and used stereotyped language. Due to changes in the DSM-5
criteria for ASD, these subjects could now be considered for the diagnosis of ASD. of stereotyped language as an RRIB. sensory interests in ASD. Few studies have measured RRIBs in typically developing children and children with SCD. This can be complicating because even if children with SCD may not exhibit enough RRIBs to meet the threshold for ASD, they may exhibit higher RRIBs relative to their typically developing counterparts. Hence, according to Reisinger et al., it may not be possible to distinguish ASD and SCD on the basis of
Furthermore, the DSM-5 explicitly states that when an individual shows impairment in social communication and social interactions, but does not show restricted and repetitive behavior or interests, criteria for SCD, instead of ASD, may
may have comorbidities like attention
disruptive behavior problems, language
They may also avoid social interactions.5
CASE PRESENTATION
A 10-year-old biracial male was brought to a residential treatment facility
for the treatment of his behavioral issues regarding increased violence
and aggression. He was given several diagnoses in the past, which included bipolar disorder, disruptive mood dysregulation disorder, intermittent explosive disorder, ADHD, and ASD. Upon psychiatric review of symptoms, the patient denied symptoms of depression, psychosis, and suicidal/homicidal ideations; however, he reported feeling angry most of the time. Based on the history provided by his family, he had
home and school. The most pertinent behavioral issues included refusal to
do his chores, physical aggression, his face, and recurrent verbal threats
to kill himself. The patient had a
history of recent hospitalization at an weeks due to worsening of his clinical symptoms. During that admission, he required frequent physical restraints for exhibiting severe agitation and self- injurious behavior. One week after his discharge from the psychiatric hospital, his maladaptive behavior returned. This included self-injurious behavior and threats to harm his family, which led to his admission to the residential treatment facility.
With regards to developmental history,
he was born full-term following an unremarkable pregnancy and delivery. He achieved motor and language milestones within age-appropriate limits. His family mother’s reported history of bipolar disorder and a diagnosis of ASD not made until adulthood. It is also important to note that he was raised in a single-parent home with the absence of his father. There has been instability in caregiving, with a substantial portion of his care provided
by his maternal grandparents. The patient started displaying severe temper tantrums at the age of 2 during which he was engaged in self-injury, scratching, biting, and banging of his head. At age 3, he had socialization and communication delays. His eye contact was poor, and
he was very sensitive to loud noises.
He was also found to be obsessed with particular TV shows. As he grew older, he was unable to care for his basic needs and required reminders by his family to eat and to clean himself. He was noticed to be clinging to people in his household.
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