Social-emotional development US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Social-emotional development. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Social-emotional development US Medical PG Question 1: A mother brings her 4-year-old son to his pediatrician. Over the last eight months, her son has been exhibiting several "odd" behaviors. Most importantly, he repeatedly says that he is playing games with a friend named "Steven," though she is certain that he does not exist. She has often found him acting out magical scenarios as though someone else is present, when no one is there. What is the most likely diagnosis in this patient?
- A. Schizophreniform disorder
- B. Schizophrenia
- C. Developmental delay
- D. Schizoid personality disorder
- E. Normal development (Correct Answer)
Social-emotional development Explanation: ***Normal development***
- It is **normal for children** between the ages of 3-7 to have **imaginary friends** or engage in imaginary play, which supports **creativity** and **social development**.
- There is no indication of distress, functional impairment, or other diagnostic criteria for a mental disorder, making this a typical developmental phenomenon.
*Schizophreniform disorder*
- This disorder is characterized by symptoms of schizophrenia lasting **between 1 and 6 months**; the child's age makes a diagnosis of schizophrenia or schizophreniform disorder highly unlikely.
- While it involves psychotic symptoms such as **hallucinations** or **delusions**, the described behaviors of an imaginary friend and magical thinking are not psychotic in a 4-year-old.
*Schizophrenia*
- Schizophrenia is rare in children and typically involves more pervasive and severe symptoms such as **prominent delusions**, **frank hallucinations**, **disorganized speech**, and **negative symptoms** causing significant functional impairment.
- The behavior described is consistent with a normal developmental stage, not the severe and persistent psychotic symptoms required for a schizophrenia diagnosis.
*Developmental delay*
- Developmental delay implies a significant lag in reaching developmental milestones across various domains (e.g., cognitive, social, motor).
- The child's behaviors are within the range of **typical development** for imaginary play, and there is no information to suggest a global delay in other areas.
*Schizoid personality disorder*
- This is a personality disorder typically diagnosed in **adulthood**, characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of emotional expression.
- This child's behavior of having an imaginary friend suggests active engagement in a form of social interaction and creativity, which contradicts the features of social detachment seen in schizoid personality disorder.
Social-emotional development US Medical PG Question 2: A 6-month-old boy is brought to the physician for a well-child examination. The boy was born at term, and the pregnancy was complicated by prolonged labor. There is no family history of any serious illnesses. He can sit upright but needs help to do so and cannot roll over from the prone to the supine position. He can grasp his rattle and can transfer it from one hand to the other. He babbles. He cries if anyone apart from his parents holds him or plays with him. He touches his own reflection in the mirror. Vital signs are within normal limits. He is at the 40th percentile for head circumference, 30th percentile for length, and 40th percentile for weight. Physical examination reveals no abnormalities. Which of the following developmental milestones is delayed in this infant?
- A. Gross motor (Correct Answer)
- B. Fine motor
- C. Social
- D. Language
- E. Cognitive
Social-emotional development Explanation: ***Gross motor***
- The infant can sit upright with help but **cannot roll over** from prone to supine, which is typically achieved by 4-5 months.
- While he can pull himself to stand (an advanced skill for his age), the inability to roll over indicates a delay in fundamental **gross motor development**.
*Fine motor*
- The infant can grasp his rattle and **transfer it from one hand to the other**, which is an appropriate fine motor skill for a 6-month-old.
- This demonstrates adequate **hand-eye coordination** and manipulation abilities.
*Social*
- The infant **cries if anyone apart from his parents holds or plays with him**, indicating **stranger anxiety**, which is a normal social development milestone for this age.
- This shows appropriate attachment and social discrimination.
*Language*
- The infant **babbles**, which is a typical language milestone for a 6-month-old, indicating early vocalization and speech development.
- This suggests that his pre-linguistic skills are emerging as expected.
*Cognitive*
- The infant **touches his own reflection in the mirror**, which is a normal cognitive behavior for a 6-month-old, showing an interest in faces and self-recognition (even if not full understanding).
- This also encompasses the ability to transfer objects, demonstrating **object permanence** and problem-solving skills.
Social-emotional development US Medical PG Question 3: A 4-year-old boy is brought to the physician by his parents because of concerns about his behavior during the past year. His parents report that he often fails to answer when they call him and has regular unprovoked episodes of crying and screaming. At kindergarten, he can follow and participate in group activities, but does not follow his teacher's instructions when these are given to him directly. He is otherwise cheerful and maintains eye contact when spoken to but does not respond when engaged in play. He gets along well with friends and family. He started walking at the age of 11 months and can speak in two-to-three-word phrases. He often mispronounces words. Which of the following is the most likely diagnosis?
- A. Selective mutism
- B. Hearing impairment (Correct Answer)
- C. Conduct disorder
- D. Specific-learning disorder
- E. Autistic spectrum disorder
Social-emotional development Explanation: ***Hearing impairment***
- The child's inconsistent response to being called, failure to follow direct instructions, and unprovoked crying and screaming, despite maintaining eye contact and having normal social interactions, are all suggestive of a **hearing impairment**.
- His delayed and unusual speech patterns (two-to-three-word phrases, mispronouncing words) for his age further points to **auditory processing difficulties** due to hearing loss.
*Selective mutism*
- This condition involves a consistent failure to speak in specific social situations where speaking is expected, despite speaking in other situations. The child's issue is with comprehending and responding to speech, not with speaking itself.
- The behavior observed (not responding to calls or direct instructions) is more indicative of an inability to hear rather than a choice not to speak.
*Conduct disorder*
- Conduct disorder is characterized by a persistent pattern of behavior that violates the rights of others and major societal norms appropriate for the individual's age.
- The child's symptoms do not include aggression, destruction of property, deceitfulness, or serious rule violations and he gets along well with friends and family.
*Specific-learning disorder*
- A specific learning disorder involves difficulties with academic skills, despite normal intelligence. While he has speech difficulties, he can participate in group activities, and there is no information about his academic performance.
- The primary concern here is his inability to respond to auditory input, which precedes and likely causes any potential learning difficulties rather than being a learning disorder itself.
*Autistic spectrum disorder*
- Autism spectrum disorder is characterized by persistent deficits in social communication and social interaction across multiple contexts, and restricted, repetitive patterns of behavior, interests, or activities.
- This child maintains eye contact, is cheerful, gets along well with friends and family, and can participate in group activities, which argues against significant **social communication deficits** typical of autism.
Social-emotional development US Medical PG Question 4: A 6-month-old girl presents to an outpatient office for a routine physical. She can sit momentarily propped on her hands, babbles with consonants, and transfers objects hand to hand. The pediatrician assures the parents that their daughter has reached appropriate developmental milestones. Which additional milestone would be expected at this stage in development?
- A. Separation anxiety
- B. Showing an object to her parents to share her interest in that object
- C. Starts to share
- D. Engaging in pretend play
- E. Stranger anxiety (Correct Answer)
Social-emotional development Explanation: ***Stranger anxiety***
- **Stranger anxiety** typically develops around **6–9 months** of age, peaking at **9–12 months**.
- This milestone aligns with the infant's increasing ability to distinguish familiar caregivers from unfamiliar individuals.
*Separation anxiety*
- **Separation anxiety** typically develops later, usually around **9–12 months** of age.
- It involves distress when a primary caregiver leaves, which is distinct from fear of strangers.
*Showing an object to her parents to share her interest in that object*
- **Joint attention**, where a child actively gestures or shows objects to share interest, typically emerges around **9–12 months**.
- This milestone requires more advanced social and cognitive development than expected at 6 months.
*Starts to share*
- The concept of **sharing** and reciprocal play develops later in toddlerhood, typically around **18 months to 2 years**.
- This involves understanding social give-and-take, which is too complex for a 6-month-old.
*Engaging in pretend play*
- **Pretend play** or symbolic play typically begins around **12–18 months** of age.
- It involves using objects or actions to represent something else and requires more advanced cognitive and imaginative skills.
Social-emotional development US Medical PG Question 5: During subject selection for an infant neurological development study, a child is examined by the primary investigator. She is at the 80th percentile for length and weight. She has started crawling. She looks for dropped objects. She says mama and dada non-specifically. She can perform the pincer grasp. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental age?
- A. Pulls up to stand (Correct Answer)
- B. Says at least 1 word clearly
- C. Turns pages in a book
- D. Points to 3 body parts
- E. Engages in pretend play
Social-emotional development Explanation: ***Pulls up to stand***
- The child is reported to be crawling, performing a **pincer grasp**, and babbling "mama" and "dada" non-specifically, which suggests an age of **8-10 months**. Pulling to stand is a typical motor milestone expected around **9-11 months of age**.
- This milestone aligns with the gross motor development progressing from crawling to standing with support before independent walking.
*Says at least 1 word clearly*
- While "mama" and "dada" are spoken non-specifically, a child typically starts saying their **first meaningful word** around **12 months of age**.
- The described child's language development is consistent with an age where babbling is prominent, but specific, meaningful words are still developing.
*Turns pages in a book*
- This fine motor skill, especially turning multiple pages independently, is usually achieved around **12-18 months of age**, requiring more advanced dexterity than a pincer grasp alone.
- The child described is likely younger, based on other developmental markers like non-specific "mama/dada."
*Points to 3 body parts*
- Pointing to body parts on command indicates a higher level of receptive language and cognitive understanding, a skill typically emerging around **15-18 months of age**.
- The current language skills are more indicative of a younger infant who does not yet demonstrate this level of comprehension.
*Engages in pretend play*
- Engaging in **pretend play**, such as feeding a doll or talking on a toy phone, is a cognitive and social milestone typically observed in toddlers, starting around **18-24 months of age**.
- The behaviors described in the question indicate an earlier developmental stage, preceding symbolic play.
Social-emotional development US Medical PG Question 6: A 3-year-old boy is brought in by his mother because she is concerned that he has been “acting differently recently”. She says he no longer seems interested in playing with his friends from preschool, and she has noticed that he has stopped making eye contact with others. In addition, she says he flaps his hands when excited or angry and only seems to enjoy playing with objects that he can place in rows or rigid patterns. Despite these behaviors, he is meeting his language goals for his age (single word use). The patient has no significant past medical history. He is at the 90th percentile for height and weight for his age. He is afebrile and his vital signs are within normal limits. A physical examination is unremarkable. Which of the following is the most likely diagnosis in this patient?
- A. Pervasive developmental disorder, not otherwise specified
- B. Autism spectrum disorder (Correct Answer)
- C. Rett’s disorder
- D. Childhood disintegrative disorder
- E. Asperger’s disorder
Social-emotional development Explanation: ***Autism spectrum disorder***
- This patient exhibits **persistent deficits in social communication and social interaction** (e.g., lack of interest in friends, poor eye contact) and **restricted, repetitive patterns of behavior, interests, or activities** (e.g., hand flapping, lining up objects). These are the core diagnostic criteria for **autism spectrum disorder (ASD)**.
- The symptoms are presenting in **early childhood** (age 3) and are causing **clinically significant impairment** in social, occupational, or other important areas of current functioning, consistent with an ASD diagnosis.
*Pervasive developmental disorder, not otherwise specified*
- This diagnosis was previously used when a child met some, but not all, criteria for autistic disorder or when there was atypical presentation. However, under **DSM-5**, these conditions are now unified under the single diagnosis of **Autism Spectrum Disorder**.
- Its usage has been largely superseded by the broader diagnosis of **Autism Spectrum Disorder** in the DSM-5.
*Rett’s disorder*
- **Rett's disorder** primarily affects **females** and is characterized by a period of normal development followed by a loss of acquired hand skills, severe intellectual disability, and characteristic hand-wringing movements. This patient is a male and does not exhibit these specific features.
- Patients typically experience **regression** in language and motor skills after normal early development, which is not described in this case, and they develop **microcephaly**.
*Childhood disintegrative disorder*
- This diagnosis involves a **marked regression** in multiple areas of functioning (social, communication, motor) after at least **2 years of normal development**.
- The patient's mother notes recent changes, but there is no indication of previous normal development followed by significant loss of skills across multiple domains after age 2, which differentiates it from the insidious onset of ASD symptoms.
*Asperger’s disorder*
- **Asperger’s disorder** was characterized by **significant difficulties in social interaction** and **restricted, repetitive patterns of behavior**, but with **no clinically significant delay in language or cognitive development**.
- In **DSM-5**, Asperger's disorder is no longer a distinct diagnosis and is now subsumed under the umbrella of **Autism Spectrum Disorder**, which better reflects the spectrum of symptom severity.
Social-emotional development US Medical PG Question 7: A 4-year-old girl is brought to the pediatrician by her parents after her mother recently noticed that other girls of similar age talk much more than her daughter. Her mother reports that her language development has been abnormal and she was able to use only 5–6 words at the age of 2 years. Detailed history reveals that she has never used her index finger to indicate her interest in something. She does not enjoy going to birthday parties and does not play with other children in her neighborhood. The mother reports that her favorite “game” is to repetitively flex and extend the neck of a doll, which she always keeps with her. She is sensitive to loud sounds and starts screaming excessively when exposed to them. There is no history of delayed motor development, seizures, or any other major illness; perinatal history is normal. When she enters the doctor’s office, the doctor observes that she does not look at him. When he gently calls her by her name, she does not respond to him and continues to look at her doll. When the doctor asks her to look at a toy on his table by pointing a finger at the toy, she looks at neither his finger nor the toy. The doctor also notes that she keeps rocking her body while in the office. Which of the following is an epidemiological characteristic of the condition the girl is suffering from?
- A. There has been a steady decline in prevalence in the United States over the last decade.
- B. There is an increased risk if the mother smoked during pregnancy.
- C. There is an increased risk with low prenatal maternal serum vitamin D level.
- D. There is an increased incidence if the mother gives birth before 25 years of age.
- E. This condition is 4 times more common in boys than girls. (Correct Answer)
Social-emotional development Explanation: **_This condition is 4 times more common in boys than girls._**
- The clinical presentation, including **impaired social interaction** (not looking at the doctor, not responding to her name, not playing with other children, not enjoying parties), **communication deficits** (delayed language, lack of pointing), **repetitive behaviors** (flexing doll's neck, body rocking) and **sensory sensitivities** (screaming at loud sounds), is highly suggestive of **Autism Spectrum Disorder (ASD)**.
- **ASD** is indeed diagnosed approximately four times more often in boys than in girls, making this a characteristic epidemiological feature.
*There has been a steady decline in prevalence in the United States over the last decade.*
- The **prevalence of ASD** has actually been **steadily increasing** in the United States and globally over the last few decades, partly due to increased awareness, improved diagnostic criteria, and better screening.
- This statement is contrary to current epidemiological trends for **ASD**.
*There is an increased risk if the mother smoked during pregnancy.*
- While maternal smoking during pregnancy is linked to other developmental issues like **ADHD** and **premature birth**, a definitive, strong, and consistent causal link to a significantly increased risk of **ASD** has not been established.
- Research on environmental risk factors for **ASD** is ongoing, but maternal smoking is not a primary, well-established epidemiological characteristic.
*There is an increased risk with low prenatal maternal serum vitamin D level.*
- Some studies suggest a potential association between low prenatal maternal vitamin D levels and an increased risk of **ASD**, but this link is **not yet definitively established** and requires further research to confirm causation.
- It is considered a potential risk factor, but not a widely accepted or strong epidemiological characteristic for the condition.
*There is an increased incidence if the mother gives birth before 25 years of age.*
- The risk of **ASD** has been more consistently associated with **advanced parental age** (both maternal and paternal), not with younger maternal age.
- Studies generally indicate a **higher risk for children born to older parents**, making this statement inaccurate.
Social-emotional development US Medical PG Question 8: A 2-year-old girl is brought to the physician by her mother for a well-child examination. She is at the 55th percentile for height and the 40th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. She is able to follow simple commands, such as “close your eyes, then stick out your tongue,” but she is unable to follow 3-step commands. She knows approximately 75 words, and half of her speech is understandable. She can say 2-word phrases, and she is able to name many parts of the body. Assuming normal development, which of the following milestones would be expected in a patient this age?
- A. Hops on one foot
- B. Engages in role-playing
- C. Separates easily from parents
- D. Pedals a tricycle
- E. Builds a tower of 6 cubes (Correct Answer)
Social-emotional development Explanation: ***Builds a tower of 6 cubes***
- At 2 years old, children typically develop fine motor skills enabling them to stack **6 to 7 cubes** to build a tower, demonstrating good hand-eye coordination.
- This milestone aligns well with the described cognitive development, such as following multi-step commands and early language acquisition.
*Hops on one foot*
- **Hopping on one foot** is a gross motor skill usually achieved later, typically around **4 years of age**.
- A 2-year-old child is more likely to be developing skills like running, jumping with two feet, or walking up and down stairs.
*Engages in role-playing*
- While toddlers engage in **imitative play**, true imaginative **role-playing** with complex scenarios and multiple characters typically develops later, around **3 years of age or older**.
- At 2, play is often more focused on mimicking observed actions.
*Separates easily from parents*
- At 2 years old, many children are still experiencing **separation anxiety**, especially in unfamiliar situations.
- **Easy separation** from parents is a milestone typically achieved later as children develop more independence and social confidence, often closer to 3 or 4 years of age.
*Pedals a tricycle*
- **Pedaling a tricycle** requires coordinated gross motor skills, balance, and cognitive understanding that are typically developed around **3 years of age**.
- A 2-year-old may be able to sit on a tricycle and push with their feet, but not yet pedal efficiently.
Social-emotional development US Medical PG Question 9: A 3-month-old girl with an immunodeficiency syndrome has been hospitalized for 1 month due to a severe pulmonary infection. Her family came to visit her daily in the beginning of her hospital stay; however, since their car broke down they have been unable to visit for the last 2 weeks. While the infection has now been resolved with proper treatment and supportive care, the girl's nurse is concerned that the patient is becoming increasingly withdrawn. Specifically, the nurse has noticed that since the family has stopped visiting, the girl seems to shy away from contact and sometimes even becomes unresponsive to verbal or visual cues. Which of the following is most likely true about this infant's condition?
- A. The condition can be diagnosed in adults if it lasts > 6 months
- B. The condition is significantly more common in boys
- C. The condition is exclusively seen in girls
- D. The condition should be reported to state authorities
- E. The condition is reversible (Correct Answer)
Social-emotional development Explanation: ***The condition is reversible***
- The infant is exhibiting symptoms of **anaclitic depression** or **hospitalism**, characterized by withdrawal, unresponsiveness, and lack of social engagement due to prolonged separation from primary caregivers.
- This condition is often **reversible** with proper intervention, such as reuniting the infant with their primary caregivers and providing supportive care.
*The condition can be diagnosed in adults if it lasts > 6 months*
- **Anaclitic depression** is a specific diagnosis primarily observed in **infants and young children** who experience prolonged separation from their primary attachment figures.
- While adults can experience depression, the specific symptom profile and etiological factors for anaclitic depression are distinct and not applied to adult diagnoses.
*The condition is significantly more common in boys*
- There is **no significant gender predilection** for anaclitic depression; it affects both boys and girls equally who experience similar environmental stressors.
- The development of this condition is primarily linked to the quality and consistency of early attachment relationships, not gender.
*The condition is exclusively seen in girls*
- **Anaclitic depression** is not exclusive to girls; it can affect **any infant** who experiences prolonged separation from their primary caregivers and lack of consistent emotional support.
- The case description only specifies a girl, but this does not imply gender exclusivity.
*The condition should be reported to state authorities*
- While the family's inability to visit is concerning, the infant's symptoms are best described as a consequence of **hospitalization and separation from caregivers**, not necessarily direct child abuse or neglect requiring state intervention.
- The focus should be on therapeutic interventions like facilitating family visits and providing consistent nursing care, rather than immediately involving child protective services.
Social-emotional development US Medical PG Question 10: A male child is presented at the pediatric clinic for a well-child visit by his mother who reports previously normal developmental milestones. The child was born at 40 weeks with no complications during pregnancy or birth. The mother notes that the infant is able to sit without support. He is able to feed himself crackers and pureed food. He is constantly shaking his toy teddy bear but is able to stop when the mother says 'no'. Which of the following indicate the most likely language milestone the child presents with?
- A. Two-word combinations
- B. Saying words such as apple and cat, though limited to around 4 different words
- C. Able to say his first and last name
- D. Cooing
- E. Babbling (Correct Answer)
Social-emotional development Explanation: ***Babbling***
- The developmental milestones described (sitting without support, feeding himself, responding to "no") are consistent with an infant around **6-9 months of age**.
- **Babbling** (e.g., "bababa", "dadada") is the primary language milestone expected at this age, as infants begin to experiment with sounds.
*Two-word combinations*
- This milestone typically emerges around **18-24 months of age**, when infants start to combine words like "more milk" or "mama up."
- The child's overall developmental stage, especially his motor skills, suggests he is significantly younger than the age at which two-word combinations are expected.
*Saying words such as apple and cat, though limited to around 4 different words*
- Saying a few distinct words usually occurs around **12-18 months of age**, after a period of extensive babbling.
- The child's other milestones place him in an earlier developmental period.
*Able to say his first and last name*
- Knowing and saying one's first and last name is a more advanced language and cognitive skill, typically seen in children around **2-3 years of age**.
- This milestone is far beyond the developmental stage indicated by the child's motor and social skills.
*Cooing*
- **Cooing**, characterized by vowel sounds like "ooh" and "aah," is an early vocalization skill typically observed in infants aged **2-4 months**.
- The child's ability to sit unsupported, feed himself, and respond to commands indicates a more advanced developmental stage than cooing.
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