The Case OF Emmanuel

The Case OF Emmanuel

Diagnosis

After an analysis of the case presentation, I suggest that the best diagnosis for Emmanuel is a social communication disorder. With this diagnosis, however, the possibility of intellectual impairment is disqualified. Thus, the diagnosis can be written as 315.39 Social (Pragmatic) Communication Disorder, without intellectual impairment.

Support for the Diagnosis

The persistent difficulties in the utilization of verbal and nonverbal methods of communication exhibited by the patient point to this diagnosis. This is further supported by functional limitations in effective communication, participation in social gatherings, poor academic performance, hardship in social relationships, and the onset of independent symptoms early in the developmental period. The fact that the patient has an above-average intellectual ability ut poor grades in school presents perfect evidence for the current diagnosis. The history of struggling wit peer-to-peer interactions since pre-school, hardships in taking directions, and the need to be guided by someone, missing conventional social cues, rare conversation with peers, and behavioral changes are crucial in this. These directly point to early-onset, difficulty in understanding unclearly stated instruction, inability to effectively use verbal and non-verbal cues, poor academic achievement, social relationship deficits, poor communication, and impaired ability to change communication to match context, respectively. It is vital to note that he has been relatively healthy throughout.

Differential Diagnosis and Elimination

At first, four possible diagnoses were listed. These included 315.8 Global Development Delay, 315.39 Social (Pragmatic) Communication Disorder, 299.00 Autism Spectrum Disorder, and 307.9 Unspecified Communication Disorder (Ronne, Johnson & Bernstein, 2017). Te diagnosis of GDD was based on Emanuel’s young age while the suspecting of Autism as due to difficulty in social interaction. The presentation of impaired social functioning pointed to an unspecified communication disorder. However, these could be dropped for reasons. Firstly GDD could be dropped based on the fact that it is only expected at ages below five years, yet Emmanuel is eight years old. Secondly, Autism could be dropped on the basis of lack of restricted, repetitive patterns of behavior. Finally, Unspecified Communication Disorder can be eliminated because the client meets the full criteria for a Social Communication disorder.

Other DSM-5 Criteria

Besides the listed criteria, two other DSM-5 criteria are still considerable. The deficits present, firstly, cannot be explained by low abilities. Structural language and cognitive scores could not be used because the diagnosis for the selected disorder can only be made above the age of 4 years (Swineford, Thurm, Baird, Wetherby & Swedo, 2014). However, although the diminished abilities were first noted at pre-school (range of age below four years), the referral was only made at the age of 8 years. Additionally, the case history reveals no restricted patterns of behavior, a requirement that is central to the diagnosis of Social Communication disorder.

References

Ronne, E., Johnson, M., & Bernstein, R. (2017). DSM 5 Medical Coding. Newburyport: BarCharts, Inc.

Swineford, L., Thurm, A., Baird, G., Wetherby, A., & Swedo, S. (2014). Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category. Journal Of Neurodevelopmental Disorders, 6(1). doi: 10.1186/1866-1955-6-41