Diagnosing Social Communication Disorder (SCD) in Multicultural Individuals: A Case Study. (30th August 2019)

• Record Type: Journal Article
• Authors: Jain, D; Cohen, M J; Fredrick-Keniston, A
• Is Part Of: Archives of clinical neuropsychology. Volume 34:Number 7(2019)
• Page Start: 1288
• Page End: 1288
• Publication Date: 2019-08-30
• Subjects: Clinical neuropsychology -- Periodicals; 616.805
• DOI: 10.1093/arclin/acz029.55
• Languages: English
• ISSNs: 0887-6177

Abstract

Abstract: Objective: Explore the impact of culture, developmental stage, and cognitive functioning in a possible diagnosis of SCD. Case Description: A 12-year-old South Asian, bilingual/bicultural adolescent male (X) presented with concerns regarding his executive and social functioning skills. His medical history was notable for craniosynostosis - successfully treated with craniofacial surgery at age 1 - and a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD), combined presentation. Diagnostic Impressions and Outcomes: X demonstrated superior intellectual performance with some inefficiencies in cognitive processing. Challenges with social interaction were not observed over the course of testing but his mother reported difficulties understanding pragmatic aspects of communication (sexual innuendos in double entendres) and recognizing when conversation had moved to a different topic. He kept a small social circle and preferred the company of older children. Discussion: In conceptualizing X's difficulties with social pragmatics, we must keep in mind the socio-cultural context in which he is growing up. He is the son of immigrant parents with South Asian roots. He is at an adolescent developmental stage where he is beginning to explore his individual identity while navigating the differing mores between his South Asian home culture and his American host culture. Therefore, responding to sexual innuendos may be a decision that is fraught with cultural angst over what is appropriate in one context but not the other. His gifted abilities and ADHD may make it difficult for him to remain engaged in the classroom or with similar-aged peers who don't challenge his intellectual proclivities. His ADHD may also explain his difficulty in recognizing when the topic of conversation has changed. In deciding whether to assign a diagnosis of SCD, it is important to remember these cultural and developmental factors which could explain his difficulties in a normalizing way. These factors should also inform potential therapeutic recommendations.