San Pedro College

Graduate School Studies

Department of Psychology

Case no. 02
A CASE REPORT ON
INTELLECTUAL ABILITIES AND COMMUNICATION DISORDER
(Level A)

A Course Requirement on
Advance Abnormal Psychology
Master of Science in Clinical Psychology

Submitted by:
MICHAEL JOHN P. CANOY, RPm

Submitted to:
DR. ORENCITA V. LOZADA, RP, RGC, CSCLP
Professor

A.Y. 2019-2020
Michael John P. Canoy, RPm MS in Psychology

CLINICAL PROFILE

I. PURPOSE OF EVALUATION
This undertaking was originally meant to screen and assess evidences of underlying
physical, mental, and psychological dysfunctions of the client. This will provide plausible
information that will serve as a basis for full clinical diagnosis, case management and further
therapeutic interventions. This document is endorsed for educational purposes only and will be
submitted as a course requirement for PSY504 - Advanced Abnormal Psychology in the
Graduate School Program of the Psychology Department of San Pedro College, Davao City.

II. IDENTIFYING INFORMATION

a. Demographic Profile
Name: Clifford
Age: 13 Years Old
Gender: Male
Educational Attainment: Currently at 7th Grade
Religion: Not Specified
Ethnicity: Not Specified

b. Medical History
Medical

Clifford met Clifford met all of his motor milestones on time, always showed an
interest in his peers, and liked “all the typical little boy stuff—cars, trains, planes, video
games, and so on”; however, his mother laments, “Clifford almost always seemed to be
running a step behind.” He received speech therapy from preschool until third grade,
because of both his delayed use of language and his difficulties with sibilant “s” or “sh”
sounds.

Psychiatric

It was not clearly specified that Clifford received any psychiatric evaluation and
history however it is noted that he received speech therapy from preschool until third
 Michael John P. Canoy, RPm MS in Psychology

grade, because of both his delayed use of language and his difficulties with sibilant “s” or
“sh” sounds.

c. Family Background
Family Dynamics
Relationship Age/Status Occupation Medical History Psychiatric Remarks
History
Father Age was not Not Specified Not Specified Not Specified For further
mentioned in assessment to
the case gain more
information
Mother Age was not Not Specified Not Specified Not Specified For further
mentioned in assessment to
the case gain more
information
Sibling/s Not Specified Not Specified Not Specified Not Specified For further
assessment to
gain more
information

d. Psycho-emotional-social History
Early Development Stage
Clifford met all of his motor milestones on time, always showed an interest in his
peers, and liked “all the typical little boy stuff—cars, trains, planes, video games, and so
on”; however, his mother laments, “Clifford almost always seemed to be running a step
behind.” Clifford talked late, and although he had a handful of single words by age 18
months, he did not really begin to string words together until he was approaching his
third birthday.

Middle School Age

Michael John P. Canoy, RPm MS in Psychology

As a middle school student, Clifford continues to have some difficulties with

verbal communication. He talks loudly, despite frequent reminders to use his “indoor
voice,” and when in a small group setting, he will talk over the conversations of other
kids, sometimes on topics that are largely irrelevant to the group’s conversational context.
Although his academic performance has always been on grade level, his teachers
and parents describe him as “a little bit immature” and as “a late bloomer.” Math is
Clifford’s favorite subject, and he is fascinated by all computer-related things. He loves
video games, especially those of the action and first-person shooter genres. He is a huge
basketball fan and follows his favorite professional and college teams religiously. He
used to play on his school recreational team but quit last year, complaining, “I spend so
much time on the bench, and then the coach and the other kids are always yelling at me,
‘Pass the ball!’ when it’s finally my turn on the court!”
Clifford has never had many close friends. Children spends time usually share of
interest in video games and online activities, while Clifford refers to kids who are merely
online contacts as his “friends.” He used to spend more time playing outdoors with other
children in the neighborhood, but these interactions are now mostly limited to “shooting
hoops” in Clifford’s driveway, and even these “games” often end in shouting matches
and hurt feelings.
Despite his social difficulties, Clifford’s mother and teacher both note that
Clifford is not a “mean” kid. He wants to have friends and sometimes goes out of his way
to try to do nice things for others; unfortunately, his efforts often fall flat. He does not
seem to be able to read others’ body language or nonverbal cues, and his mother will
joke, “Subtle is not a word in Clifford’s vocabulary.” He frequently comes across as
insensitive to the feelings of his peers, pointing out their failings and inadequacies and
mistakes, even in public settings, without stopping to think about the impact his words
might have.
Clifford has a difficult time in social interactions with others. He is unable to
communicate with his friends in conversation, often “talking over” them about topics that
are not relevant to the context of the conversation. He cannot modulate his conversational
tone (he talks loudly despite the teacher’s reminders to use his “indoor voice,” and he
often sounds very formal and pedantic). He will talk on and on without regard to others
Michael John P. Canoy, RPm MS in Psychology

involved in the conversation and will say things that are hurtful. He is unable to read
body language or nonverbal cues in interacting with others, and he is very poor at
understanding things like puns or double entendre that depend on context for their
interpretation

III. REASON FOR REFERRAL

Prior to the referral, some communication and social difficulties were already seen by every
significant person in Clifford’s life. These severe problems in social communication interfere
especially with his peer group interactions and cause impairment in social functioning. He was
also able to have speech therapy from his preschool time until his third grade. Nonetheless, we
will still be evaluating the client for the presence of specific symptoms that may classify to
Intellectual Disabilities and Communication Disorders and the possibility of other comorbid
disorders. We may also identify specific treatment for should there be a specific diagnosis
presented.

IV. PROBLEMS AND SYMPTOMS

Identifying Data and Presenting Conflict
 He elicited underdevelopment in talking
 He cannot modulate his conversational tone and talks loudly even with
instruction of doing otherwise
 Often communicates with others with topics that are irrelevant or incongruent to
the group’s conversational context
 Difficulties in social relationship that leads to his minimal number of friends
 Clifford has a difficult time in social interactions with others for he does not seem
to be able to read others’ body language or nonverbal cues.
 Being insensitive to other’s feelings. He is not likely to realize when his words or
actions have crossed a line, and he repeats the same social gaffes time and time
again.

V. CONTRIBUTORY AND CAUSAL FACTORS

Michael John P. Canoy, RPm MS in Psychology

Although contributory factors and/or causal factors were not fully stipulated in the
case, the diagnostician in training is looking into possibility that these difficulties may
involve hereditary factors such as DNA or genes from the parents or in their family
genealogy. If there is a medical history in the family genealogy with Autism Spectrum
disorder, Communication Disorder, Language Disorder, or Specific Learning Disorder,
it may also be a contributory factor in the difficulties experienced by the client. A family
history of autism spectrum disorder, communication disorders, or specific learning
disorder appears to increase the risk for social (pragmatic) communication disorder. With
that being said, the diagnostician in training needs to have a further evaluation and
observation to have a clear picture of the case. This may include, making a genogram,
biological checking of the parents’ DNA and other in-depth interview that can provide
relevant data pertaining Clifford’s concerns.

VI. MENTAL EXAMINATION

The diagnostician in training conducted a Mental Status Examination to Sam and
found out the following based on the data collected:

Appearance
 The client doesn’t look physically unkept nor untidy
 Clothing is also not messy nor dirty
 There is no unusual physical characteristics

Behavior
 Posture is not seen as slumped
 There is also no rigidity in his body posture
 His posture doesn’t appear to be atypical nor inappropriate
 In his facial expressions, he doesn’t show any anxiety, fear, nor apprehension
 His facial expression doesn’t suggest anger and hostility
 There is no seen decreased in variability of expression
 There is a marked inappropriateness and bizarreness in his facial expression
especially when talking about things he likes doing
Michael John P. Canoy, RPm MS in Psychology

 Sometimes, there is dominance especially when he talk on and on without regard

to others involved in the conversation
 Submissiveness and overly compliant is not present to the client
 Provocative behaviors are also not present
 There is also no suspicious behavior being shown
 Client is not uncooperative as well

Feeling (affect/mood)
 There is a marked inappropriateness to client’s thought content since he doesn’t
blend with the context of the group’s conversation
 There is instability to client’s mood and affect
 Euphoria and elation is present to the client especially when talking about his
gaming activities
 There is no anger, hostility shown by the client
 There is no fear, anxiety and apprehension shown by the client
 There were no signs of depression and sadness however his tantrums may indicate
sadness

Perception
 There were no data in the case that can infer whether the client is experiencing
Illusions
 There were no data in the case that can infer whether the client is experiencing
Auditory hallucinations
 There were no data in the case that can infer whether the client is experiencing
visual hallucinations
Comments: Needs further evaluation

Thinking
 There is no impairment in his level of consciousness
 There is also no impairment with his attention
Michael John P. Canoy, RPm MS in Psychology

 Impairment in calculation ability is not present with the client

 There is also no impairment in his intelligence as has achieved developmental
milestones that his age requires except his social skills and communication skills
 Sam doesn’t show disorientation to person
 He also doesn’t show any disorientation to place
 The client did not show any disorientation to time
 There is no data showing whether the client is showing difficulty in
acknowledging the presence of psychological disorder
 Blaming others for his difficulties was not present
 There is marked impairment in managing the client’s daily living activities such
as his inability to find many friends or to blend in social contexts.
 Occasionally, the client shows impairment in his ability to make reasonable
decisions
 Impaired immediate recall was not present
 Impaired recent memory was also not present
 Impaired remote memory was also not present
 Obsessions were not present with the client
 Compulsions were also not present
 There were no signs of phobias
 Depersonalization is not present with the client
 There were also no suicidal and homicidal idealization with the client
 Delusions are not present with the client
 There were also no ideas of reference nor ideas of influence
 The client also doesn’t show disturbance in association of thoughts
 Decreased and increased flow of thoughts were not seen

Although there were tendencies and other difficulties seen with the client especially in social
and communication skills, further evaluation and assessments are needed for a more holistic
and definitive diagnosis.
 Michael John P. Canoy, RPm MS in Psychology

VII. CASE OVERVIEW

Clifford, a 13-year old client, has difficulties involving social interaction as well
as communication. During the lifespan of Clifford these difficulties were seen by his
mother as well as his teacher. Some professional help and interventions were given to
Clifford such as having a speech therapy from preschool until his third grade. As Clifford
is growing up, these difficulties are even more eminent and are not congruent to the
acquired skills or behavior his age should require. These severe problems in social
communication interfere especially with his peer group interactions and cause
impairment in social functioning. Thus, further evaluation and observation is needed in
order to objectively know Clifford’s condition as well as provide him the suitable
intervention.

VIII. PRELIMINARY DIAGNOSIS

Based on the information provided and thorough evaluation of the data, the
symptoms and history of the client have fully met the criteria of
Social (Pragmatic) Communication Disorder 315.39 (F80.89)
Note: The color red indicates that the presented fact(s) is present in the case. The color
green means that it is evident in the case, however, it is not directly stated. The color
blue, on the other hand, means that it is not present in the case but is probable which will
be given a remark “for further observation”

Social (Pragmatic) Communication Disorder 315.39 (F80.89)

DIAGNOSTIC CRITERIA PRESENTED FACTS

A. Persistent difficulties in the social use Persistent difficulties in the social use of
of verbal and nonverbal verbal and nonverbal communication as
communication as manifested by all of manifested by all the following symptoms as
the following: presented below:

1. Deficits in using communication for He talks loudly, despite frequent reminders to

social purposes, such as greeting and use his “indoor voice”
Michael John P. Canoy, RPm MS in Psychology

sharing information, in a manner that At times he sounds a bit pedantic, especially

is appropriate for the social context. when talking about his gaming activities, a
topic he frequently brings to the fore.

2. Impairment of the ability to change When in a small group setting, he will talk
communication to match context or over the conversations of other kids,
the needs of the listener, such as sometimes on topics that are largely irrelevant
speaking differently in a classroom to the group’s conversational context.
than on a playground, talking
differently to a child than to an adult,
and avoiding use of overly formal
language.

When he gets excited about a topic, like his

3. Difficulties following rules
for favorite basketball team clinching the division
conversation and storytelling, such as title, he will talk on and on without even
taking turns in
conversation, seeming to pause for breath and can be quite
rephrasing when misunderstood, and difficult to follow.
knowing how to use verbal and He does not seem to be able to read others’
nonverbal signals to regulate body language or nonverbal cues.
interaction.

He has difficulty in understanding subtle

4. Difficulties understanding what is not thoughts as her mother sometimes joke,
explicitly stated (e.g., making “Subtle is not a word in Clifford’s
inferences) and nonliteral or vocabulary.”
ambiguous meanings of language Many of his peers’ jokes go over his head,
(e.g., idioms, humor, metaphors, especially puns and double entendre.
multiple meanings that depend on the Clifford typically will, with prompting,
context for interpretation). apologize and appear to be genuinely sorry,
Michael John P. Canoy, RPm MS in Psychology

but in the absence of outside intervention, he

is not likely to realize when his words or
actions have crossed a line, and he repeats the
same social gaffes time and time again.

B. The deficits result in functional His severe problems in social

limitations in effective communication interfere especially with
communication, social participation,
his peer group interactions and cause
social relationships, academic
impairment in social functioning (he has
achievement, or occupational
few close friends and considers some
performance, individually or in
combination.
kids he only knows online to be his
friends).
To some extents these difficulties lead for him
to hurt other individual’s feelings without him
even knowing
C. The onset of the symptoms is in the Difficulties were observed from age 18
early developmental period (but months until the present.
deficits may not become fully
manifest until social communication
demands exceed limited capacities).
D. The symptoms are not attributable to Although it was not clearly stated in the case,
another medical or neurological it is eminent that the client these difficulties
condition or to low abilities in the are not better explained by autism spectrum
domains of word structure and disorder, intellectual disability (intellectual
grammar, and are not better explained developmental disorder), global
by autism spectrum disorder, developmental delay, or another mental
intellectual disability (intellectual disorder for his difficulties doesn’t meet the
developmental disorder), global criteria for these said other disorders. Thus,
developmental delay, or another needs further evaluation and data garthering
mental disorder. procedures.
Justification Fully satisfied. The diagnostic criteria for
Michael John P. Canoy, RPm MS in Psychology

Social (Pragmatic) Communication Disorder

is fully met.

IX. DIAGNOSTIC FEATURES

Social (pragmatic) communication disorder is characterized by a primary
difficulty with pragmatics, or the social use of language and communication, as
manifested by deficits in understanding and following social rules of verbal and
nonverbal communication in naturalistic contexts, changing language according to the
needs of the listener or situation, and following rules for conversations and storytelling.
The deficits in social communication result in functional limitations in effective
communication, social participation, development of social relationships, academic
achievement, or occupational performance. The deficits are not better explained by low
abilities in the domains of structural language or cognitive ability.
As stated in the case, several criteria of the disorder were fully met by the client
involving difficulties in social communication and social interaction. Clifford has
difficulties in using social use of verbal and nonverbal while interacting with his friends
or playmates as stated in the previous sections (Criterion A). Often, these difficulties lead
to quarrel and hurting of feelings. Also, Clifford barges in with other individuals and
converse with them with topics that are irrelevant or incongruent to the group’s
conversational context (Criterion B). These difficulties were present during his early
years and was only began to string words together until was approaching his 3rd birthday
and are still present even in his middle school age (Criterion C). These difficulties limits
him to perform competencies that are expected to his age. Other behaviors that are
supposed to let him do daily functioning were also affected due to these difficulties,
however his difficulties are not better explained by autism spectrum disorder, intellectual
disability (intellectual developmental disorder), global developmental delay, or another
mental disorder for his difficulties doesn’t meet the criteria for these said other disorders
(Criterion D).
Michael John P. Canoy, RPm MS in Psychology

X. ASSOCIATED FEATURES
The most common associated feature of social (pragmatic) communication
disorder is language impairment, which is characterized by a history of delay in reaching
language milestones, and historical, if not current, structural language problems (see
''Language Disorder" earlier in this chapter). Individuals with social communication
deficits may avoid social interactions. Attention-deficit/hyperactivity disorder (ADHD),
behavioral problems, and specific learning disorders are also more common among
affected individuals.

Most of which mentioned above were reported to be experienced by the client

such as his difficulties in conversing verbally and non-verbally. Although other disorders
such as ADHD, Specific Learning Disorders, and other behavioral problems are more
common to see with Clifford’s symptoms, his case is better explained and fitted to Social
(Pragmatic) Communication Disorder.

XI. ETIOLOGY AND PREVALENCE

Prevalence

Precise estimates of the incidence and prevalence of social communication

disorder have been difficult to determine because many investigations draw on varied
populations and employ inconsistent or ambiguous definitions of the disorder. Moreover,
with the relatively recent expansion of the DSM-5 (APA, 2013) to include the new
diagnostic category of Social (Pragmatic) Communication Disorder, it will be necessary
to examine and evaluate the validity of the criteria for that disorder prior to estimating
prevalence (Swineford, Thurm, Baird, Wetherby, & Swedo, 2014).

A population estimate based on a community sample of more than 1,300

kindergarteners suggests that pragmatic language impairment occurs in about 7.5% of
children and affects more boys than girls by a ratio of 2.6:1.0 (Ketelaars, Cuperus, van
Daal, Jansonius, & Verhoeven, 2009).

Higher prevalence rates (23%–33%) have been noted in individuals with language
disorders (Botting, Crutchley, & Conti-Ramsden, 1998; Ketelaars et al., 2009).
 Michael John P. Canoy, RPm MS in Psychology

Given that social communication problems co-occur with a number of other

disorders, additional data on incidence and prevalence may be available for those
conditions with other defining symptoms and characteristics.

XII. DEVELOPMENT AND COURSE

Because social (pragmatic) communication depends on adequate developmental
progress in speech and language, diagnosis of social (pragmatic) communication disorder
is rare among children younger than 4 years. By age 4 or 5 years, most children should
possess adequate speech and language abilities to permit identification of specific deficits
in social communication. Milder forms of the disorder may not become apparent until
early adolescence, when language and social interactions become more complex. The
outcome of social (pragmatic) communication disorder is variable, with some children
improving substantially over time and others continuing to have difficulties persisting
into adulthood. Even among those who have significant improvements, the early deficits
in pragmatics may cause lasting impairments in social relationships and behavior and also
in acquisition of other related skills, such as written expression.

XIII. RISK AND PROGNOSTIC FACTORS

Genetic and physiological

A family history of autism spectrum disorder, communication disorders, or specific
learning disorder appears to increase the risk for social (pragmatic) communication
disorder.

XIV. DIFFERENTIAL DAGNOSIS

Autism spectrum disorder. Clifford fails to reveal any evidence of restricted/repetitive

patterns of behavior, interests, or activities in his lifespan thus this diagnosis should be
ruled out.
Attention-deficit/hyperactivity disorder. Clifford did not show any pattern of
inattention and/or hyperactivity-impulsivity that interferes with functioning or
development thus, this diagnosis can also be ruled out.
 Michael John P. Canoy, RPm MS in Psychology

Social anxiety disorder (social phobia). Clifford individual has never had effective
social communication however, this social communication skills was developed
appropriately and are not utilized because of anxiety, fear, or distress about social
interactions thus, this diagnosis can also be ruled out.

Intellectual disability (intellectual developmental disorder) and global

developmental delay. There were no records of deficits in intellectual functions, such as
reasoning, problem solving, planning, abstract thinking, judgment, academic learning,
and learning from experience, confirmed by both clinical assessment and individualized,
standardized intelligence testing. Thus, this diagnosis is ruled out

XV. TREATMENT PLAN

LONG-TERM GOALS THERAPEUTIC INTERVENTION
1. Accept the need for and actively cooperate with Educate the client’s parents and family
speech therapy. members about the maturation process in
individuals with social (pragmatic)
communication disorder and the challenges that
this process presents.
Assign the parents to view videotapes that add
knowledge to their child’s condition
2. Improve the expressive and receptive language Social Skills Groups—an intervention that uses
abilities to the level of capability. instruction, role play, and feedback to teach
ways of interacting appropriately with peers.
Groups typically consist of two to eight
individuals with social communication disorder
and a teacher or adult facilitator. Social skills
groups can be used across a wide range of ages,
including school-age children and adults.
3. Achieve mastery of the expected speech sounds Therapy sessions with professionals that
that are appropriate for the age and dialect specializes in speech and language. Continual
practices at home is also suggested.
4. Eliminate stuttering; speak fluently and at a Therapy sessions with professionals that
 Michael John P. Canoy, RPm MS in Psychology

normal rate on a regular, consistent basis specializes in speech and language. Continual
practices at home is also suggested. Role-
playing can also be an intervention
5. Develop an awareness and acceptance of Conduct family therapy sessions to provide the
speech/language problems so that there is parents and siblings with the opportunity to
consistent participation in discussions in the peer share and work through their feelings pertaining
group, school, or social settings. to the client’s condition.
Educate the client’s parents and family
members about the maturation process in
individuals with social (pragmatic)
communication disorder and the challenges that
this process presents.

6. Parents establish realistic expectations of their Allowing parents to have in-depth knowledge
child’s speech/language abilities about this son’s conditions as well as proper
treatment and realistic prognosis.

SHORT-TERM GOALS THERAPEUTIC INTERVENTION

Complete a speech/language evaluation to determine Refer the client for a speech/ language
eligibility for special education services. evaluation to assess the presence of a disorder
and determine his/her eligibility for special
education services.
Complete neuropsychological testing Arrange for a neurological examination or
neuropsychological evaluation to rule out the
presence of organic factors that may contribute
to the client’s speech/language problem
Comply with a psychoeducational evaluation Arrange for a psychoeducational evaluation to
assess the client’s intellectual abilities and rule
out the presence of other possible learning
disorders.
Attend speech and language therapy sessions. Refer the client to a speech/language
pathologist for ongoing services to improve
his/her speech and language abilities.
Complete psychological testing Arrange for psychological testing to determine
 Michael John P. Canoy, RPm MS in Psychology

whether emotional factors or Attention-Deficit/

Hyperactivity Disorder (ADHD) are interfering
with the client’s speech/language development
Comply fully with the recommendations offered by Consult with the parents, teachers, and other
the assessment(s) and individualized educational appropriate school officials about designing
planning committee effective learning programs, classroom
assignments, or interventions that build on the
client’s strengths and compensate for
weaknesses.
Comply with the move to an appropriate alternative Consult with parents, school officials, and
residential placement setting. mental health professionals about the need to
place the client in an alternative residential
setting (e.g., foster care, group home, residential
program)
Provide behavioral, emotional, and attitudinal Assess for the severity of the level of
information toward an assessment of specifiers impairment to the client’s functioning to
relevant to a DSM diagnosis, the efficacy of treatment, determine appropriate level of care (e.g., the
and the nature of the therapy relationship behavior noted creates mild, moderate, severe,
or very severe impairment in social, relational,
vocational, or occupational endeavors);
continuously assess this severity of impairment
as well as the efficacy of treatment (e.g., the
client no longer demonstrates severe
impairment but the presenting problem now is
causing mild or moderate impairment.

Assess the client’s home, school, and

community for pathogenic care (e.g., persistent
disregard for the child’s emotional needs or
physical needs, repeated changes in primary
caregivers, limited opportunities for stable
attachments, persistent harsh punishment or
 Michael John P. Canoy, RPm MS in Psychology

other grossly inept parenting).

Increase the frequency of appropriate, self-initiated Actively build the level of trust with the client
verbalizations toward the therapist, family members, through frequent attention and interest,
and others. unconditional positive regard, and warm
acceptance to facilitate improved
communication.

Parents maintain regular communication with teachers Encourage the parents to maintain regular
and speech/language pathologist communication with the client’s teachers and
the speech/language pathologist to help
facilitate speech/language development.
Parents verbalize increased knowledge and Educate the parents about the signs and
understanding of autism spectrum disorders. symptoms of the client’s social (pragmatic)
communication disorder

Challenge the parents’ denial surrounding the

client’s speech/ language problem so that the
parents cooperate with the recommendations
regarding placement and interventions for the
client
Parents increase the time spent with the client in Ask the parents to have the client read to them
activities that build and facilitate social for 15 minutes four times weekly and then ask
communication improvement. the client to retell the story to build his/her
vocabulary, using a reward system to maintain
the client’s interest and motivation
Parents increase social support network. Refer the client’s parents to a support group for
parents of children with the same concerns.
Improve the lines of communication in the family Teach effective communication skills (e.g.,
system. active listening, reflecting feelings, “I
statements”) to facilitate the client’s
speech/social development.
Increase the frequency of positive interactions with Encourage family members to regularly include
parents and other family members the client in structured work or play activities
 Michael John P. Canoy, RPm MS in Psychology

for 20 minutes each day.

Instruct the parents to sing songs (e.g., nursery
rhymes, lullabies, popular hits, songs related to
client’s interests) with the client to help
establish a closer parent-child bond and
increase verbalizations in home environment.
Encourage detached parents to increase their
involvement in the client’s daily life, leisure
activities, or schoolwork
Increase the frequency of social contacts with peers Consult with the client’s parents and teachers
about increasing the frequency of his social
contacts with peers (working with student aide
in class, attending Sunday school, participating
in Special Olympics, refer to summer camp).

XVI. REFERENCES

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: Author

Botting, N., Crutchley, A., & Conti-Ramsden, G. (1998). Educational transitions of 7-year old
children with SLI in language units: A longitudinal study. International Journal of
Language & Communication Disorders, 33, 177–197.
Jongsma, A. E. Jr. (2014). The Child Psychotherapy Treatment Planner. 5th Edition, 425-434
Jongsma, A. E. Jr. (2014). The Child Psychotherapy Treatment Planner. 4th Edition, 305-312
 Michael John P. Canoy, RPm MS in Psychology

Ketelaars, M. P., Cuperus, J. M., van Daal, J., Jansonius, K. & Verhoeven, L. (2009). Screening
for pragmatic language impairment: The potential of the Children’s Communication
Checklist. Research in Developmental Disabilities, 30, 952–960.
Swineford, L. B., Thurm, A., Baird, G., Wetherby, A. M., & Swedo, S. (2014). Social
(pragmatic) communication disorder: A research review of this new DSM-5 diagnostic
category. Journal of Neurodevelopmental Disorders, 6, 41.

XVII. ATTACHMENTS
CASE STUDY

REPORTER: KATRINA VALLES

TOPIC: Intellectual Abilities and Communication Disorder

Clifford, age 13, is in seventh grade at his local middle school. Although his academic
performance has always been on grade level, his teachers and parents describe him as “a little bit
immature” and as “a late bloomer.” Clifford met all of his motor milestones on time, always
showed an interest in his peers, and liked “all the typical little boy stuff—cars, trains, planes,
Michael John P. Canoy, RPm MS in Psychology

video games, and so on”; however, his mother laments, “Clifford almost always seemed to be
running a step behind.” Clifford talked late, and although he had a handful of single words by
age 18 months, he did not really begin to string words together until he was approaching his third
birthday. He received speech therapy from preschool until third grade, because of both his
delayed use of language and his difficulties with sibilant “s” or “sh” sounds.

Even as a middle school student, Clifford continues to have some difficulties with verbal
communication. He talks loudly, despite frequent reminders to use his “indoor voice,” and when
in a small group setting, he will talk over the conversations of other kids, sometimes on topics
that are largely irrelevant to the group’s conversational context. At times he sounds a bit
pedantic, especially when talking about his gaming activities, a topic he frequently brings to the
fore. When he gets excited about a topic, like his favorite basketball team clinching the division
title, he will talk on and on without even seeming to pause for breath and can be quite difficult to
follow.

Math is Clifford’s favorite subject, and he is fascinated by all computer-related things. He

loves video games, especially those of the action and first-person shooter genres. He is a huge
basketball fan and follows his favorite professional and college teams religiously. He used to
play on his school recreational team but quit last year, complaining, “I spend so much time on
the bench, and then the coach and the other kids are always yelling at me, ‘Pass the ball!’ when
it’s finally my turn on the court!”

Clifford has never had many close friends. Children spends time usually share of interest
in video games and online activities, while Clifford refers to kids who are merely online contacts
as his “friends.” He used to spend more time playing outdoors with other children in the
neighbourhood, but these interactions are now mostly limited to “shooting hoops” in Clifford’s
driveway, and even these “games” often end in shouting matches and hurt feelings.

Despite his social difficulties, Clifford’s mother and teacher both note that Clifford is not
a “mean” kid. He wants to have friends and sometimes goes out of his way to try to do nice
things for others; unfortunately, his efforts often fall flat. He does not seem to be able to read
others’ body language or nonverbal cues, and his mother will joke, “Subtle is not a word in
Michael John P. Canoy, RPm MS in Psychology

Clifford’s vocabulary.” He frequently comes across as insensitive to the feelings of his peers,
pointing out their failings and inadequacies and mistakes, even in public settings, without
stopping to think about the impact his words might have. He teases others with comments that he
believes to be jokes but that are sometimes hurtful. On the other hand, many of his peers’ jokes
go over his head, especially puns and double entendre. If an adult calmly points out to him that
he has hurt another child’s feelings, Clifford typically will, with prompting, apologize and appear
to be genuinely sorry, but in the absence of outside intervention, he is not likely to realize when
his words or actions have crossed a line, and he repeats the same social gaffes time and time
again.

Clifford has a difficult time in social interactions with others. He is unable to

communicate with his friends in conversation, often “talking over” them about topics that are not
relevant to the context of the conversation. He cannot modulate his conversational tone (he talks
loudly despite the teacher’s reminders to use his “indoor voice,” and he often sounds very formal
and pedantic). He will talk on and on without regard to others involved in the conversation and
will say things that are hurtful. He is unable to read body language or nonverbal cues in
interacting with others, and he is very poor at understanding things like puns or double entendre
that depend on context for their interpretation. These severe problems in social communication
interfere especially with his peer group interactions and cause impairment in social functioning
(he has few close friends and considers some kids he only knows online to be his friends).