Attention Deficit Hyperactivity Disorder — MCQs
A 10-year-old child presents with persistent restlessness, inattentiveness to studies, and a strong preference for outdoor play. The parents are highly concerned. What is the most appropriate next step in management?
Attention deficit hyperactivity disorder is characterized by-
All of the following are used to improve attention deficit in children, except which of the following?
A 10-year-old child presents with symptoms of hyperactivity and inattention. How should the parents be advised regarding potential treatment options?
Which of the following conditions is least likely to be associated with intellectual disability?
Which of the following is not seen in a hyperkinetic child?
A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?
All are used in attention deficit hyperactivity disorder (ADHD) except:
Which of the following is not a typical core feature of hyperkinetic disorder?
A 9-year-old child is found to be restless. He is hyperactive, and his teacher complains that he does not listen to teaching in the class, disturbs other students, and also shows less interest in playing. The likely diagnosis is:
Attention Deficit Hyperactivity Disorder Indian Medical PG Practice Questions and MCQs
Question 1: A 10-year-old child presents with persistent restlessness, inattentiveness to studies, and a strong preference for outdoor play. The parents are highly concerned. What is the most appropriate next step in management?
- A. It is a normal behaviour
- B. Needs a change in environment
- C. Comprehensive evaluation by a qualified professional (Correct Answer)
- D. It is a serious illness requiring medical treatment
Explanation: ***Comprehensive evaluation by a qualified professional*** - The combination of **persistent restlessness**, **inattentiveness to studies**, and strong preference for outdoor play at age 10 could indicate a **developmental or behavioral disorder**, such as **ADHD**. - A qualified professional (e.g., pediatrician, child psychologist, psychiatrist) can conduct a thorough evaluation to differentiate between normal childhood behavior and potential underlying conditions, and determine appropriate interventions. *It is a normal behaviour* - While many children are active and enjoy outdoor play, **persistent restlessness** and **inattentiveness affecting studies** are not always normal and can be signs of an underlying issue. - Ignoring these symptoms as entirely normal could delay necessary intervention for conditions that impact a child's development and academic performance. *Needs change in environment* - While environmental factors can influence behavior, assuming that a simple change in environment will resolve persistent restlessness and inattentiveness may overlook a **biological or neurodevelopmental component**. - Environmental changes might be part of a broader management plan, but they are unlikely to be the sole solution without a clear understanding of the root cause. *It is a serious illness requiring medical treatment* - While the symptoms could be indicative of a condition that might require medical intervention, premature labeling as a "serious illness" without an evaluation or directly jumping to medical treatment without a diagnosis is inappropriate. - The first step is always **diagnosis** to determine the presence, nature, and severity of any potential condition.
Question 2: Attention deficit hyperactivity disorder is characterized by-
- A. Impulsivity
- B. Poor attention
- C. Hyperactivity
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Attention deficit hyperactivity disorder (ADHD)** is characterized by a persistent pattern of **inattention and/or hyperactivity-impulsivity** that interferes with functioning or development. - All three features—**impulsivity**, **inattention (poor attention)**, and **hyperactivity**—represent the core symptom domains of ADHD according to **DSM-5** criteria. - ADHD presentations can vary: **predominantly inattentive**, **predominantly hyperactive-impulsive**, or **combined presentation** (most common). **The Three Core Features:** **Impulsivity** - Acting without thinking or considering consequences - Difficulty waiting turns or delaying gratification - Interrupting or intruding on others - Making hasty decisions without forethought **Inattention (Poor Attention)** - Difficulty sustaining attention in tasks or play - Easily distracted by extraneous stimuli - Forgetfulness in daily activities - Poor organization and time management - Frequently loses things necessary for tasks **Hyperactivity** - Excessive motor activity and restlessness - Fidgeting, squirming, or inability to remain seated - Running or climbing inappropriately (in children) - Feeling internally restless (in adults) - Talking excessively *Why individual options alone are incomplete:* While each symptom domain can be prominent in different ADHD presentations, the disorder is comprehensively **characterized by all three core symptom clusters**, making "All of the options" the most accurate and complete answer.
Question 3: All of the following are used to improve attention deficit in children, except which of the following?
- A. Cognitive enhancement therapy
- B. Cognitive behavioral therapy
- C. Cognitive remediation therapy
- D. Flooding (Correct Answer)
Explanation: ***Flooding*** - **Flooding** is a behavioral therapy technique used to treat phobias and anxiety disorders by exposing an individual to a feared stimulus without avoidance. It is not used to improve attention deficit. - This method is based on the principle of **extinction** and habituation, aiming to reduce the anxiety response to previously feared situations. *Cognitive enhancement therapy* - **Cognitive enhancement therapy** (CET) focuses on improving cognitive functions like attention, memory, and social cognition, often used in conditions like schizophrenia. - It involves structured exercises and group activities designed to strengthen **neurocognitive abilities**. *Cognitive behavioral therapy* - **Cognitive behavioral therapy** (CBT) helps individuals identify and change problematic thought patterns and behaviors that contribute to their difficulties. - While not directly targeted at attention deficit, CBT techniques can help children with ADHD manage **disruptive behaviors**, improve organizational skills, and develop coping strategies. *Cognitive remediation therapy* - **Cognitive remediation therapy** (CRT) is a behavioral training intervention designed to improve cognitive skills, including attention, working memory, and executive functions. - It uses targeted exercises and strategies to enhance **neurocognitive performance**, often applicable in conditions like ADHD and schizophrenia.
Question 4: A 10-year-old child presents with symptoms of hyperactivity and inattention. How should the parents be advised regarding potential treatment options?
- A. Medical evaluation and possible medication may be necessary. (Correct Answer)
- B. This behavior is typical for children of this age.
- C. Consider behavioral therapy as a first step.
- D. Adjusting the child's environment may help.
Explanation: ***Medical evaluation and possible medication may be necessary*** - **Medical evaluation is essential** to properly diagnose ADHD and rule out other conditions causing hyperactivity and inattention symptoms - For a **10-year-old child** (school-age), current guidelines support **pharmacological treatment** as first-line therapy, either alone or in combination with behavioral interventions - **Methylphenidate** and other stimulants have strong evidence for efficacy in school-age children with ADHD - Parents should be advised that proper diagnosis through medical evaluation is the first step, followed by evidence-based treatment which may include medication, behavioral therapy, or both depending on severity *Consider behavioral therapy as a first step* - While behavioral therapy is an important component of ADHD management, it should not delay or replace medical evaluation - For school-age children with ADHD, behavioral therapy alone may be insufficient, especially for moderate to severe symptoms - Current **AAP guidelines** recommend medication as first-line for children 6+ years, with behavioral therapy as an adjunct or for mild cases - This option assumes a diagnosis has already been made, which is premature when the child is just "presenting with symptoms" *This behavior is typical for children of this age* - While some activity and inattention is developmentally normal, persistent and significant symptoms that impair functioning require evaluation - Dismissing these symptoms as "typical" could delay diagnosis and intervention for **ADHD** - A proper assessment is needed to distinguish normal developmental variation from a clinical disorder *Adjusting the child's environment may help* - Environmental modifications (structured routines, reduced distractions) are helpful adjuncts to treatment - However, these alone are typically insufficient for managing clinically significant ADHD symptoms - Environmental adjustments should be part of a comprehensive treatment plan that includes proper medical evaluation and evidence-based interventions
Question 5: Which of the following conditions is least likely to be associated with intellectual disability?
- A. Cretinism
- B. Birth asphyxia
- C. Hypopituitarism (Correct Answer)
- D. Down syndrome
Explanation: ***Hypopituitarism*** - This condition primarily affects **growth** and **metabolism** due to deficiencies in pituitary hormones but typically does not directly cause intellectual disability unless severe complications arise or it is a component of a larger syndrome affecting brain development. - While it can lead to developmental delays if growth hormone is deficient, it's less directly linked to intrinsic intellectual impairment compared to the other options. *Cretinism* - This is a condition of **severe congenital hypothyroidism** that, if untreated, leads to profoundly impaired physical and mental development. - Adequate thyroid hormone is crucial for normal brain development, and its absence results in irreversible intellectual disability. *Birth asphyxia* - Refers to a lack of oxygen to the brain around the time of birth, which can cause **hypoxic-ischemic encephalopathy (HIE)**. - HIE can lead to significant and permanent brain damage, often resulting in cerebral palsy and intellectual disability. *Down syndrome* - This genetic disorder, caused by a **trisomy of chromosome 21**, is characterized by a range of physical features and a varying degree of intellectual disability. - Intellectual disability is a universal feature of Down syndrome, though its severity can differ between individuals.
Question 6: Which of the following is not seen in a hyperkinetic child?
- A. Left-right disorientation (Correct Answer)
- B. Decreased attention span
- C. Aggressive outbursts
- D. Soft neurological signs
Explanation: ***Left to right disorientation*** - **Left-right disorientation** is a sign of **developmental coordination disorder** or other specific learning difficulties, not a core symptom of hyperkinesis (ADHD). - Hyperkinetic children primarily exhibit symptoms related to **inattention**, **hyperactivity**, and **impulsivity**. *Decreased attention span* - A **decreased attention span** is a cardinal feature of **Attention-Deficit/Hyperactivity Disorder (ADHD)**, which is synonymous with hyperkinesis in children. - Children with ADHD often struggle with sustaining focus on tasks, leading to difficulties in academic and social settings. *Aggressive outbursts* - **Aggressive outbursts** and **irritability** can be associated features of hyperkinetic disorder, particularly in children who also experience **oppositional defiant disorder** or **conduct disorder** as comorbidities. - Impulsivity and difficulty with emotional regulation can contribute to these behaviors. *Soft neurological signs* - **Soft neurological signs** (e.g., poor coordination, minor motor deficits, abnormal reflexes) are more frequently observed in children with **hyperkinetic disorder** compared to neurotypical children. - These signs indicate subtle neurological dysfunction that is not localized or severe enough to be classified as a distinct neurological disorder.
Question 7: A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?
- A. Conduct disorder
- B. Oppositional defiant disorder (Correct Answer)
- C. Autism spectrum disorder
- D. Attention deficit hyperactivity disorder
Explanation: **Oppositional defiant disorder** - The boy's behaviors of **not following rules**, arguing with teachers and students, and **provoking parents** are characteristic features of ODD. - ODD is defined by a pattern of **angry/irritable mood**, argumentative/defiant behavior, or vindictiveness. *Conduct disorder* - Conduct disorder involves more serious violations of the **rights of others** or major **societal norms**, such as aggression towards people or animals, destruction of property, deceitfulness, or theft. - The scenario describes defiant and argumentative behavior, not the severe actions typical of conduct disorder. *Autism spectrum disorder* - ASD is characterized by persistent deficits in **social communication and interaction** across multiple contexts, and **restricted, repetitive patterns of behavior, interests, or activities.** - The provided symptoms do not align with the core diagnostic criteria for autism spectrum disorder. *Attention deficit hyperactivity disorder* - ADHD involves a persistent pattern of **inattention** and/or **hyperactivity-impulsivity** that interferes with functioning or development. - While some defiant behavior can coexist with ADHD, the primary presentation here is one of opposition and defiance, not predominantly inattention or hyperactivity.
Question 8: All are used in attention deficit hyperactivity disorder (ADHD) except:
- A. Dextro-amphetamine
- B. Methylphenidate
- C. Phenobarbitone (Correct Answer)
- D. Atomoxetine
Explanation: ***Phenobarbitone*** - **Phenobarbitone** (phenobarbital) is a **barbiturate** primarily used as an **anticonvulsant** and for sedation. - It works as a **CNS depressant** and would worsen, not improve, symptoms of ADHD, which include inattention, hyperactivity, and impulsivity. - **Not indicated** for ADHD management and may cause sedation, cognitive impairment, and paradoxical hyperactivity in children. *Dextro-amphetamine* - **Dextro-amphetamine** is a **stimulant medication** commonly used in ADHD. - It works by increasing levels of **dopamine** and **norepinephrine** in the brain, improving focus and reducing hyperactivity. - Approved for ADHD treatment in both children and adults. *Methylphenidate* - **Methylphenidate** is a **stimulant** widely prescribed for ADHD and considered a first-line treatment. - It acts as a **norepinephrine-dopamine reuptake inhibitor**, thereby increasing the availability of these neurotransmitters. - Available in immediate-release and extended-release formulations. *Atomoxetine* - **Atomoxetine** is a **non-stimulant** selective norepinephrine reuptake inhibitor (SNRI) used for ADHD. - It is particularly useful in patients who cannot tolerate stimulants or have comorbid anxiety disorders. - Preferred when there is concern about substance abuse or tic disorders.
Question 9: Which of the following is not a typical core feature of hyperkinetic disorder?
- A. Aggressive outburst
- B. Soft neurological signs
- C. Bradykinesia (Correct Answer)
- D. Decreased attention span
Explanation: ***Bradykinesia*** - **Bradykinesia**, meaning **slow movement**, is characteristic of **hypokinetic** (reduced movement) disorders, such as Parkinson's disease, not hyperkinetic disorders. - Hyperkinetic disorders, like ADHD, are defined by excessive and rapid movements, along with impulsivity and inattention. *Aggressive outburst* - **Aggressive outbursts** can be a feature of hyperkinetic disorder, particularly in children and adolescents struggling with **impulsivity** and difficulty regulating emotions. - While not a primary diagnostic criterion, it is a common behavioral comorbidity associated with the disorder. *Soft neurological signs* - **Soft neurological signs** (e.g., clumsiness, minor coordination difficulties, poor fine motor skills) are frequently observed in individuals with hyperkinetic disorder. - These signs suggest minor neurological dysfunction and are consistent with neurodevelopmental conditions like ADHD. *Decreased attention span* - A **decreased attention span** (inattention) is a core diagnostic feature of **hyperkinetic disorder** (ADHD), alongside hyperactivity and impulsivity. - Individuals struggle to sustain focus, are easily distracted, and often have difficulty completing tasks.
Question 10: A 9-year-old child is found to be restless. He is hyperactive, and his teacher complains that he does not listen to teaching in the class, disturbs other students, and also shows less interest in playing. The likely diagnosis is:
- A. Attention deficit hyperkinetic child (Correct Answer)
- B. Delirium
- C. Cerebral palsy
- D. Mania
Explanation: ***Attention deficit hyperkinetic child*** - The child's symptoms of **restlessness**, **hyperactivity**, difficulty listening, disturbing others, and lack of interest in play are classic indicators of **Attention-Deficit/Hyperactivity Disorder (ADHD)**, specifically the hyperactive-impulsive and inattentive presentations. - The persistence and pervasiveness of these behaviors across multiple settings (home and school) during childhood are key diagnostic features for ADHD. *Delirium* - **Delirium** is characterized by an **acute disturbance in attention and cognition**, with a fluctuating course, and often presents with disorientation, hallucinations, or altered consciousness. - It typically has an **acute onset** and is often linked to a medical condition, substance intoxication, or withdrawal, which is not suggested by the chronic behavioral pattern described. *Cerebral palsy* - **Cerebral palsy (CP)** is a permanent, non-progressive neurological disorder that primarily affects **movement, muscle tone, and posture**. - While CP can be associated with cognitive and behavioral issues, its defining feature is motor impairment, which is not mentioned as a primary concern here. *Mania* - **Mania** in children, part of Bipolar Disorder, involves periods of abnormally and persistently **elevated, expansive, or irritable mood**, increased energy, and goal-directed activity. - While hyperactivity can be present, manic episodes typically involve more pronounced mood disturbances, grandiosity, decreased need for sleep, and rapid speech, which are not described in this case.
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