Page 15 - Delaware Medical Journal - March/April 2019
P. 15
CASE REPORT
of a conversation. On the other hand,
he displayed poor ability to understand social cues, had awkward eye contact, and had inappropriate speech intonation his behavior and speech according to
his audience and environment. His underlying SCD became more apparent when his disruptive mood dysregulation disorder symptoms were controlled by medications.
Separation anxiety can be present at the age of 3 in normally developed children. It is more commonly present in children who have had disruptions in caregivers, as is mood dysregulation. Observations noting the patient’s clinging to household members show he had some level of trust in them, although his attachments to them may have not been fully secure. A lack
of secure attachment to caregivers is likely to impact attachments and social relationships with those outside the family. It is also not uncommon for patients with SCD to have a family history pertinent for autism.5
It is clinically relevant to diagnose a child appropriately with ASD or SCD. This is because expectations, testing, treatment, and prognosis will be different based on the diagnosis and individual. According to the Child Mind Institute,
known. It is presumed that speech and language therapy designed to improve language pragmatics will greatly assist these children, along with social skills 6 The Social Communication randomized controlled trial of a social communication intervention aimed
on this at www.psych-sci.manchester. ac.uk/scip. This is an individualized intervention approach that targets development in three areas: social
understanding and social interaction; verbal and nonverbal pragmatic skills, including conversation; and language processing, including narrative, inferencing, and developing word knowledge.7
Unlike SCD, ASD has an extensive and established treatment regimen. This includes Applied Behavior Analysis, psychotropic medications for symptom control, behavior and communication therapies, highly structured educational programs, family therapies, social skills training, and occupational therapy.8 According to The Center for Autism, “Applied Behavior Analysis (ABA) is the application of the principles of learning and motivation from Behavior Analysis, and the procedures and technology derived from those principles, to the
Many decades of research have validated 9 Although long-term prognosis for SCD is not well known as it is a relatively new diagnosis, improvement with treatment is expected, similar to ASD.6
TAKE-HOME MESSAGE
It is important and clinically relevant
for a child with SCD to be diagnosed correctly, as the appropriate treatment may greatly improve the functionality of the child in the long run. Young children with SCD can present with multiple psychiatric comorbidities, which can have overlapping symptoms. Comorbidities must be treated to ensure a proper underlying diagnosis of SCD. Although there are similarities between ASD and SCD, there are also important differences.
TABLE 1
MEDICATIONS
BEHAVIORAL INTERVENTIONS
1. Haldol 7.5 mg POBID daily for mood
2. Depakote ER 500 mg PO BID for mood
3. Cogentin 1 mg PO BID for EPS prophylaxis
4. Vivanse 40 mg PO daily for ADHD
5. Vistaril 25 mg PO BID for anxiety
1. Speech therapy
2. Social skills groups - 45 minutes five times a week to help express feelings in an appropriate manner
3. Individual counseling - one hour per week to identify trauma and how it has affected patient
4. Art therapy - 45 minutes five times a week to express negative experiences nonverbally
5. Family counseling - one hour per week
6. Case management - one hour per month
TABLE 2
OBJECTIVES:
ACHIEVED RESULTS
Participation in psychiatric evaluations in order to identify symptoms and needed medication
30%
Participation in therapy sessions
40%
Use of appropriate social skills in the classroom
20%
To practice being an arm’s length away from peers
30%
To be able to hold a reciprocal conversation with staff and peers
20%
Reduction in anger outbursts
30%
Del Med J | March/April 2019 | Vol. 91 | No. 2
63
