Autism Spectrum Disorders — MCQs
A 3-year-old child with delayed speech development, prefers to play alone and is not making friends. The likely diagnosis is
In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-
A 2.5 year old boy is brought by the parents because of the concern that he is not developing appropriately. Child often is unable to engage with others using eye contact and does not play with other children. He continuously bangs his head against the wall and remains confined to himself most of the time. What is the most likely diagnosis?
An 11 year old female patient has come for a routine dental examination. She gives a history of epileptic episodes. General examination also reveals lack of eye contact, poor co-ordination, non-communicative, poor muscle tone, drooling, hyperactive knee jerk and strabismus. Which of the following techniques is contraindicated in the management of this child ?
Most reliable predictor of autism in 18-month-olds is:
A child with pervasive developmental disorder will have all of the following except:
Most reliable predictor of autism in 18-month-olds is:
Child starts speaking short sentences by the age of :
A 5-year-old child refuses to sleep in his bed, claiming there are monsters in his closet and that he has bad dreams. The parents allow him to sleep with them in their bed to avoid the otherwise inevitable screaming fit. The parents note that the child sleeps soundly, waking only at sunrise. Which sleep disturbance is most consistent with this history?
A child guidance clinic is most helpful in all of the following conditions except:
Autism Spectrum Disorders Indian Medical PG Practice Questions and MCQs
Question 1: A 3-year-old child with delayed speech development, prefers to play alone and is not making friends. The likely diagnosis is
- A. Autism (Correct Answer)
- B. Specific learning disability
- C. Rett's syndrome
- D. ADHD
Explanation: ***Autism*** - **Delayed speech development**, a preference for playing alone, and difficulty making friends are classic diagnostic criteria for **Autism Spectrum Disorder (ASD)**. - ASD is characterized by persistent deficits in **social communication and social interaction** across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities. *Specific learning disability* - A specific learning disability primarily affects academic skills (e.g., **reading, writing, arithmetic**) in individuals with otherwise average intelligence. - While it can impact social interactions due to frustration or self-esteem issues, its core features are not primarily related to delayed speech or intrinsic difficulties in social engagement. *Rett's syndrome* - Rett's syndrome is a rare **neurodevelopmental disorder** that almost exclusively affects females and is caused by mutations in the MECP2 gene. - It is characterized by initial normal development followed by a regression of skills, including **purposeful hand movements**, speech, and gait, often presenting with stereotypic hand-wringing. - The clinical presentation here shows early developmental concerns without regression, making ASD more likely. *ADHD* - **Attention-deficit/hyperactivity disorder (ADHD)** is characterized by symptoms of **inattention, hyperactivity, and impulsivity**. - While children with ADHD may have difficulty with social interactions due to impulsivity or inattention, delayed speech development and a consistent preference for solitary play are not primary diagnostic features.
Question 2: In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-
- A. Disturbances of intellectual development
- B. Disturbance of social interaction
- C. Disturbances of communication (Correct Answer)
- D. Restricted, repetitive patterns of behaviour
Explanation: ***Disturbances of communication*** - In DSM-5 and proposed ICD-11, **communication deficits** are now subsumed under the broader category of **social communication deficits**. - This change reflects the understanding that communication difficulties in ASD are primarily related to their social function rather than being a separate, general communication disorder. *Disturbances of intellectual development* - While many individuals with ASD also have **intellectual disabilities**, this has never been a core diagnostic criterion for autism itself. - **Intellectual development** is considered a co-occurring condition rather than a defining feature of the spectrum. *Disturbance of social interaction* - **Deficits in social interaction** remain a core diagnostic criterion for autism spectrum disorder in both DSM-5 and ICD-11. - This domain emphasizes difficulties with **social-emotional reciprocity**, nonverbal communicative behaviors, and developing social relationships. *Restricted, repetitive patterns of behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** also remain a core diagnostic criterion in both diagnostic systems. - This includes a range of symptoms such as **stereotyped motor movements**, insistence on sameness, and highly restricted fixated interests.
Question 3: A 2.5 year old boy is brought by the parents because of the concern that he is not developing appropriately. Child often is unable to engage with others using eye contact and does not play with other children. He continuously bangs his head against the wall and remains confined to himself most of the time. What is the most likely diagnosis?
- A. Conduct disorder
- B. Social phobia
- C. Autism (Correct Answer)
- D. ADHD
Explanation: ***Autism*** - The child's lack of **eye contact**, inability to **play with other children**, and repetitive self-stimulatory behavior (banging head) are classic signs of **autism spectrum disorder (ASD)**. - ASD is characterized by persistent deficits in **social communication** and **social interaction** across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities. *Conduct disorder* - Characterized by a repetitive and persistent pattern of behavior in which the **basic rights of others** or major age-appropriate **societal norms or rules are violated**. - Symptoms include aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules, which are not described in this case. *Social phobia* - Involves an intense, persistent fear of social or performance situations where the individual fears **embarrassment** or **humiliation**. - While there is social avoidance, it is driven by fear of negative evaluation rather than a fundamental inability to engage socially or repetitive behaviors. *ADHD* - Primarily defined by persistent patterns of **inattention** and/or **hyperactivity-impulsivity** that interfere with functioning or development. - While children with ADHD may have social difficulties, the core symptoms of lack of eye contact, repetitive behaviors, and profound social engagement deficits are not typical of ADHD.
Question 4: An 11 year old female patient has come for a routine dental examination. She gives a history of epileptic episodes. General examination also reveals lack of eye contact, poor co-ordination, non-communicative, poor muscle tone, drooling, hyperactive knee jerk and strabismus. Which of the following techniques is contraindicated in the management of this child ?
- A. Conscious sedation
- B. Aversive conditioning (Correct Answer)
- C. Pedi-Wrap
- D. Papoose Board
Explanation: ***Aversive conditioning*** - Aversive conditioning involves using **unpleasant stimuli** to reduce undesirable behaviors. This technique is ethically questionable and generally **contraindicated in pediatric dentistry**, especially for a child with complex needs like epilepsy and developmental delays, as it can cause significant distress and fear. - Given the patient's **epileptic episodes** and other neurological signs, any technique that could induce stress or fear might **trigger seizures** or exacerbate behavioral issues. *Conscious sedation* - **Conscious sedation** can be a useful technique for managing patients with special needs, including those with epilepsy, by reducing anxiety and improving cooperation during dental procedures. - While careful anesthetic consideration is required due to her **epileptic history**, it is not inherently contraindicated and can be safely administered with proper monitoring. *Pedi-Wrap* - The **Pedi-Wrap** is a type of **physical restraint** used to ensure patient safety and cooperation during dental treatment by limiting movement. - For a child with **poor co-ordination** and **poor muscle tone**, physical restraints can be a necessary tool to prevent injury during procedures. *Papoose Board* - A **Papoose Board** is another form of **physical restraint** designed to stabilize a child during dental treatment, similar to a Pedi-Wrap. - This technique is often used for pediatric patients who cannot cooperate due to age, developmental challenges, or medical conditions, which aligns with the description of this patient.
Question 5: Most reliable predictor of autism in 18-month-olds is:
- A. Language delay
- B. Poor eye contact
- C. Repetitive behaviors
- D. No pretend play (Correct Answer)
Explanation: ***No pretend play*** - The **absence of pretend play** is a significant early indicator of autism spectrum disorder (ASD) in toddlers, as it reflects deficits in **social imagination** and symbolic thought. - This symptom is often more specific and reliable for predicting ASD at 18 months than other common developmental delays. *Language delay* - While **language delay** is a common feature of autism, it can also be present in other developmental delays, making it less specific as a sole predictor. - Many children without autism may experience transient language delays that resolve with time or intervention. *Poor eye contact* - **Poor eye contact** is a known sign of autism, but it can be variable in presentation and is not as universally predictive as deficits in social play at this age. - Other conditions or even normal variations in temperament can cause inconsistent eye contact. *Repetitive behaviors* - **Repetitive behaviors** are characteristic of autism but may not be fully established or clearly identifiable as atypical in their severity or frequency in all 18-month-olds with ASD. - Some repetitive behaviors are typical in early development, so distinguishing pathological forms requires careful assessment.
Question 6: A child with pervasive developmental disorder will have all of the following except:
- A. Stereotyped behaviour
- B. Reduced social interaction
- C. Poor language skills
- D. Impaired cognition (Correct Answer)
Explanation: ***Impaired cognition*** - While some individuals with **pervasive developmental disorders (PDDs)** may have comorbid intellectual disability, **impaired cognition is not a universal or defining characteristic** of PDDs. - Many individuals with PDDs, particularly those with **Asperger's syndrome**, have **average or above-average intelligence**. - Intelligence quotient (IQ) varies widely across the autism spectrum, making cognitive impairment a non-essential feature. *Stereotyped behaviour* - **Stereotyped and repetitive behaviors** (e.g., hand flapping, rocking, rigid adherence to routines) are a **core diagnostic criterion** for PDDs, including autism spectrum disorder. - These behaviors are part of the **restricted, repetitive patterns of behavior, interests, or activities** domain in diagnostic criteria. *Reduced social interaction* - Significant **deficits in social interaction and communication** are a **hallmark feature** of PDDs. - This manifests as difficulty with reciprocal social communication, impaired ability to interpret social cues, and challenges in forming age-appropriate peer relationships. *Poor language skills* - **Communication impairments**, including poor language skills, are a **common feature** of PDDs, especially in classical autism. - This can include delayed speech development, unusual language patterns (e.g., **echolalia**, pronoun reversal), or complete absence of verbal communication in severe cases.
Question 7: Most reliable predictor of autism in 18-month-olds is:
- A. No pretend play (Correct Answer)
- B. Language delay
- C. Repetitive behaviors
- D. Poor eye contact
Explanation: ***No pretend play*** - The absence of **symbolic play** or **pretend play** is a significant early indicator of autism spectrum disorder (ASD) in toddlers. - This reflects a core deficit in **social imagination** and understanding of others' perspectives often seen in ASD. *Language delay* - While **language delay** is a common feature in children with ASD, it is not the most specific or reliable predictor on its own at 18 months, as many children without ASD can also experience language delays. - It can also be associated with other developmental issues, making it less specific than lack of pretend play. *Repetitive behaviors* - **Repetitive behaviors**, such as hand flapping or rocking, are characteristic of ASD but often become more prominent and easier to identify at a slightly later age than 18 months. - At this early age, these behaviors may be subtle and less consistently observed compared to deficits in pretend play. *Poor eye contact* - **Poor eye contact** is a recognized symptom of ASD, reflecting difficulties in social interaction. - However, it can be variable and influenced by temperament and other factors, making it less universally reliable as the single best predictor at 18 months compared to the fundamental disruption in social communication represented by absent pretend play.
Question 8: Child starts speaking short sentences by the age of :
- A. 15 months
- B. 12 months
- C. 24 months (Correct Answer)
- D. 36 months
Explanation: ***24 months*** - By **24 months (2 years old)**, children typically begin to combine two or more words into **short sentences** and use about 50 words or more. - They also start to follow simple instructions and point to named objects and pictures. *15 months* - At **15 months**, children usually say a few words and can point to show what they want, but **short sentences** are not yet typical. They might use gestures more often. - Their vocabulary is still developing and usually consists of single words like "mama" or "dada." *12 months* - At **12 months (1 year old)**, most children are just starting to say their first words and are primarily communicating through gestures and sounds. - They are generally not forming combinations of words into sentences at this stage. *36 months* - By **36 months (3 years old)**, children have more advanced language skills, using **3-4 word sentences**, understanding most of what they hear, and having a vocabulary of several hundred words. - This age represents a more mature stage of language development than the initial formation of short sentences.
Question 9: A 5-year-old child refuses to sleep in his bed, claiming there are monsters in his closet and that he has bad dreams. The parents allow him to sleep with them in their bed to avoid the otherwise inevitable screaming fit. The parents note that the child sleeps soundly, waking only at sunrise. Which sleep disturbance is most consistent with this history?
- A. Night terrors
- B. Nightmares
- C. Learned behavior (Correct Answer)
- D. Obstructive sleep apnea
Explanation: **Explanation:** The correct answer is **Learned behavior** (specifically, a conditioned sleep-onset association). **1. Why Learned Behavior is Correct:** The child’s refusal to sleep in his own bed and the subsequent "screaming fits" are forms of **limit-setting sleep disorder**. By allowing the child to sleep in their bed to avoid a tantrum, the parents are providing **positive reinforcement** for the behavior. The child has "learned" that protesting leads to the desired outcome (sleeping with parents). A key diagnostic clue here is that the child **sleeps soundly** once the condition (sleeping with parents) is met, which distinguishes this from primary sleep disorders. **2. Why Other Options are Incorrect:** * **Night Terrors (Sleep Terrors):** These occur during NREM (Stage N3) sleep. The child typically appears terrified, screams, and is inconsolable, but remains asleep and has **no memory** of the event. This child is awake and making "claims" about monsters to stay with parents. * **Nightmares:** While the child mentions "bad dreams," nightmares occur during REM sleep and typically cause the child to wake up *during* the night in a state of fear. This child’s primary issue is the **struggle at bedtime** (sleep onset), and he sleeps soundly once in the parents' bed. * **Obstructive Sleep Apnea (OSA):** OSA presents with snoring, gasping, restless sleep, and daytime hyperactivity. It does not manifest as behavioral resistance to sleeping alone. **Clinical Pearls for NEET-PG:** * **Night Terrors vs. Nightmares:** Night terrors occur in the first third of the night (NREM), with no recall. Nightmares occur in the later part of the night (REM), with vivid recall. * **Management of Learned Behavior:** The treatment of choice is **behavioral modification** (e.g., "graduated extinction" or "controlled crying") and establishing a consistent bedtime routine. * **Developmental Milestone:** Fears of "monsters" or the dark are developmentally normal for a 5-year-old, but the *persistence* and the parental *reaction* turn it into a behavioral sleep disturbance.
Question 10: A child guidance clinic is most helpful in all of the following conditions except:
- A. Bed wetting
- B. Cerebral palsy
- C. Squint (Correct Answer)
- D. School adjustment problems
Explanation: ### Explanation **Correct Option: C (Squint)** **Why Squint is the Correct Answer:** A **Child Guidance Clinic (CGC)** is a specialized multi-disciplinary facility designed to manage emotional, behavioral, and psychological disorders in children. **Squint (Strabismus)** is a purely physical/anatomical ophthalmological condition involving the misalignment of the eyes. It requires surgical or optical correction by an ophthalmologist, not psychological intervention. Therefore, it falls outside the scope of a CGC. **Analysis of Incorrect Options:** * **Bed wetting (Enuresis):** This is a common behavioral/developmental disorder. While it can have organic causes, it is frequently associated with emotional stress or developmental delays, making it a classic case for CGC management (behavioral therapy, counseling). * **Cerebral Palsy (CP):** Although CP is a motor disorder, children with CP often suffer from associated cognitive impairments, learning disabilities, and emotional/behavioral challenges. A CGC provides the necessary psychological support and rehabilitation guidance for these comorbid conditions. * **School adjustment problems:** These include school phobia, learning disabilities (Dyslexia), and ADHD. These are core areas of focus for a CGC, involving psychologists and social workers to improve the child’s social and academic functioning. **High-Yield Clinical Pearls for NEET-PG:** * **CGC Team:** Typically consists of a **Child Psychiatrist** (Leader), Clinical Psychologist, Educational Psychologist, and Psychiatric Social Worker. * **Primary Goal:** Early detection and treatment of maladjustment and personality disorders to prevent adult mental illness. * **Common Indications:** Habit disorders (thumb sucking, nail-biting), conduct disorders (lying, stealing), and emotional disorders (anxiety, temper tantrums).
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