Child and Adolescent Psychiatry — MCQs
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IQ is commonly categorized as:
Which neurodevelopmental disorder is characterized by impaired social interaction, impaired verbal and nonverbal communication, and restricted and repetitive behavior?
Which of the following childhood disorders typically improves with increasing age?
Tourette syndrome is characterized by which of the following?
Who proposed the psychosocial stages of development?
What are the education criteria for intellectual disability?
A child between 2-4 years of age exhibiting certain behaviours indicates:
Which of the following is true about autism?
An IQ between 50-70 indicates which level of intellectual disability?
What is the current term for mental retardation as defined by the American Association on Intellectual and Developmental Disabilities?
Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs
Question 1: IQ is commonly categorized as:
- A. Mild intellectual disability (Correct Answer)
- B. Moderate intellectual disability
- C. Severe intellectual disability
- D. Profound intellectual disability
Explanation: **Explanation:** Intellectual Disability (ID) is classified based on Intelligence Quotient (IQ) scores, which measure cognitive functioning. According to the ICD-10 and DSM-5 criteria, the categorization is as follows: * **Mild Intellectual Disability (IQ 50–70):** This is the correct answer. Individuals in this category constitute about 85% of the ID population. They are considered "educable," usually achieving up to a 6th-grade academic level and can live independently with minimal support. * **Moderate Intellectual Disability (IQ 35–49):** These individuals are "trainable." They can acquire communication skills and perform semi-skilled work under supervision but rarely progress beyond 2nd-grade academic levels. * **Severe Intellectual Disability (IQ 20–34):** These individuals have very limited communication skills and require significant supervision and support for self-care and daily activities. * **Profound Intellectual Disability (IQ <20):** This group requires 24-hour nursing care and constant supervision. They often have associated neurological conditions. **High-Yield Clinical Pearls for NEET-PG:** 1. **Borderline Intelligence:** Refers to an IQ range of **71–84**. 2. **Average IQ:** The mean IQ is **100**, with a standard deviation of 15. 3. **Diagnosis:** Diagnosis of ID requires both an IQ below 70 and significant deficits in **adaptive functioning** (conceptual, social, and practical domains) manifesting before age 18. 4. **Most Common Cause:** The most common genetic cause of ID is **Down Syndrome**, while the most common inherited cause is **Fragile X Syndrome**. The most common preventable cause is **Fetal Alcohol Syndrome**.
Question 2: Which neurodevelopmental disorder is characterized by impaired social interaction, impaired verbal and nonverbal communication, and restricted and repetitive behavior?
- A. Autism (Correct Answer)
- B. Anxiety disorder
- C. Antisocial personality disorder
- D. Paranoid schizophrenia
Explanation: ### Explanation **Correct Option: A. Autism (Autism Spectrum Disorder - ASD)** Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder defined by a classic "triad" of impairments (as per DSM-IV) or two core domains (as per DSM-5). The diagnosis is based on: 1. **Persistent deficits in social communication and social interaction:** This includes difficulty with social-emotional reciprocity, nonverbal communicative behaviors (e.g., eye contact, gestures), and developing/maintaining relationships. 2. **Restricted, repetitive patterns of behavior, interests, or activities:** This includes stereotyped motor movements (e.g., hand flapping), insistence on sameness, and highly fixated interests. **Why Incorrect Options are Wrong:** * **B. Anxiety disorder:** Characterized by excessive fear or worry and physical symptoms of autonomic arousal; it does not inherently involve deficits in social communication or repetitive motor behaviors. * **C. Antisocial personality disorder:** A Cluster B personality disorder characterized by a pervasive pattern of disregard for, and violation of, the rights of others. It is diagnosed only after age 18. * **D. Paranoid schizophrenia:** A psychotic disorder characterized by delusions and hallucinations. While social withdrawal occurs, it lacks the early developmental onset and specific repetitive behavioral patterns of ASD. **High-Yield Clinical Pearls for NEET-PG:** * **Age of Onset:** Symptoms must be present in the **early developmental period** (typically recognized by age 2–3). * **Screening Tool:** **M-CHAT** (Modified Checklist for Autism in Toddlers) is commonly used. * **Prognosis:** The best predictors of long-term outcome are **IQ** and **communicative language development** by age 5. * **Associated Condition:** Approximately 30% of children with ASD develop **Seizures/Epilepsy**. * **Gender:** More common in **males** (approx. 4:1 ratio).
Question 3: Which of the following childhood disorders typically improves with increasing age?
- A. Conduct disorder
- B. Emotional problems
- C. Temper tantrum (Correct Answer)
- D. Sleep disorder
Explanation: **Explanation:** **Correct Option: C. Temper tantrum** Temper tantrums are considered a **normal developmental phase** in young children, typically peaking between the ages of **2 and 4 years**. They occur because toddlers have limited verbal skills to express frustration and a developing sense of autonomy. As the child’s language skills improve, emotional regulation matures, and social coping mechanisms develop, these episodes naturally decrease in frequency and intensity. Therefore, temper tantrums typically improve and resolve with increasing age. **Analysis of Incorrect Options:** * **A. Conduct Disorder:** This is a repetitive and persistent pattern of behavior where the basic rights of others or major age-appropriate societal norms are violated. Without intervention, it often persists into adulthood, frequently evolving into **Antisocial Personality Disorder**. * **B. Emotional Problems:** Conditions like childhood anxiety or depression do not follow a predictable pattern of improvement with age. In many cases, untreated childhood emotional disorders can worsen or predispose the individual to chronic psychiatric morbidity in adulthood. * **C. Sleep Disorders:** While some issues like night terrors may resolve, many childhood sleep disorders (e.g., insomnia, sleep apnea, or delayed sleep phase) can persist or change in presentation rather than simply improving as a rule of maturation. **High-Yield Pearls for NEET-PG:** * **Breath-holding spells:** Another common behavioral phenomenon in toddlers (6 months to 2 years) that also typically improves with age. * **Red Flag:** If temper tantrums persist beyond age 5, are unusually frequent (multiple times a day), or involve self-harm, they may indicate underlying ADHD, ODD, or Autism Spectrum Disorder. * **Management:** The primary management for simple temper tantrums is **anticipatory guidance** and **behavioral extinction** (ignoring the behavior while ensuring the child's safety).
Question 4: Tourette syndrome is characterized by which of the following?
- A. Attention deficit disorder
- B. Tics (Correct Answer)
- C. Autism spectrum disorder
- D. Intellectual disability
Explanation: **Explanation:** **Tourette Syndrome (TS)** is a neurodevelopmental disorder primarily characterized by the presence of **multiple motor tics and at least one vocal (phonic) tic** that have persisted for more than one year, with an onset before age 18. Tics are sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations. This makes **Option B** the definitive diagnostic feature. **Analysis of Incorrect Options:** * **Option A (ADHD):** While ADHD is the **most common comorbidity** associated with Tourette Syndrome (occurring in about 60% of cases), it is not a defining characteristic of the syndrome itself. * **Option C (Autism Spectrum Disorder):** ASD involves deficits in social communication and restricted, repetitive patterns of behavior. While both are neurodevelopmental, they are distinct clinical entities. * **Option D (Intellectual Disability):** Most individuals with Tourette Syndrome have a normal range of intelligence. ID is not a feature or a common association of the disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Criteria:** Multiple motor + ≥1 vocal tic; duration >1 year; onset <18 years. * **Common Comorbidities:** ADHD (most common), followed by Obsessive-Compulsive Disorder (OCD). * **Premonitory Urge:** Patients often describe an uncomfortable sensory urge (like an itch) that is relieved by performing the tic. * **Coprolalia:** The involuntary utterance of obscene words occurs in only about 10-15% of cases (often overemphasized in exams). * **Treatment:** * First-line non-pharmacological: **CBIT** (Comprehensive Behavioral Intervention for Tics). * Pharmacological: Alpha-2 agonists (Clonidine, Guanfacine) or Antipsychotics (Haloperidol, Pimozide, Risperidone).
Question 5: Who proposed the psychosocial stages of development?
- A. Erikson (Correct Answer)
- B. Bleuler
- C. Freud
- D. Lorenz
Explanation: **Explanation:** **Erik Erikson** proposed the **Psychosocial Theory of Development**, which suggests that personality develops in a predetermined order through **eight stages** from infancy to adulthood. Unlike Freud’s focus on psychosexual stages, Erikson emphasized the impact of social experience and conscious thought. Each stage is characterized by a "psychosocial crisis" (e.g., Trust vs. Mistrust) that serves as a turning point in development. **Analysis of Incorrect Options:** * **B. Eugen Bleuler:** A Swiss psychiatrist known for coining the term **"Schizophrenia"** and defining its "4 As" (Association, Affect, Ambivalence, and Autism). * **C. Sigmund Freud:** The father of psychoanalysis who proposed the **Psychosexual stages of development** (Oral, Anal, Phallic, Latency, and Genital). * **D. Konrad Lorenz:** An ethologist famous for his work on **Imprinting** and the "Critical Period" in animal behavior, which influenced attachment theory. **High-Yield Clinical Pearls for NEET-PG:** * **Stage 1 (0–1 yr):** Trust vs. Mistrust (Virtue: **Hope**). * **Stage 5 (12–18 yrs):** Identity vs. Role Confusion (Virtue: **Fidelity**). This is the most frequently tested stage in adolescent psychiatry. * **Stage 8 (Late Adulthood):** Integrity vs. Despair (Virtue: **Wisdom**). * **Key Distinction:** Freud’s theory ends at adolescence, whereas Erikson’s theory covers the **entire lifespan**.
Question 6: What are the education criteria for intellectual disability?
- A. Mild (Correct Answer)
- B. Moderate
- C. Severe
- D. Profound
Explanation: **Explanation:** Intellectual Disability (ID) is classified into four levels of severity based on IQ scores and adaptive functioning. The term **"Educable"** is specifically associated with **Mild Intellectual Disability**. 1. **Mild ID (IQ 50–70):** This group constitutes about 85% of the ID population. These individuals are considered **"Educable"** because they can acquire academic skills up to approximately the 6th-grade level. With appropriate support, they can live independently and maintain semi-skilled or unskilled jobs. 2. **Moderate ID (IQ 35–49):** These individuals are classified as **"Trainable."** They can acquire communication and basic health/safety skills but rarely progress beyond 2nd-grade academic levels. They require supervised living and sheltered workshops. 3. **Severe ID (IQ 20–34):** These individuals have very limited communication and poor motor development. They require significant supervision and can only perform simple tasks under close oversight. 4. **Profound ID (IQ <20):** These individuals require 24-hour nursing care and constant supervision. They often have associated neurological conditions and minimal sensorimotor functioning. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Shift:** Diagnosis is now based on **adaptive functioning** (conceptual, social, and practical domains) rather than IQ scores alone. * **Most Common Cause:** Genetic (Down Syndrome is the most common genetic cause; Fragile X is the most common inherited cause). * **Prevention:** Phenylketonuria (PKU) is a treatable cause of ID if dietary restrictions are started early. * **Memory Aid:** * Mild = Educable (6th grade) * Moderate = Trainable (2nd grade) * Severe/Profound = Dependent/Custodial care
Question 7: A child between 2-4 years of age exhibiting certain behaviours indicates:
- A. Antisocial behaviour
- B. Testing parental attitudes (Correct Answer)
- C. As an adventure
- D. Oppositionalism
Explanation: ***Testing parental attitudes*** - Children aged 2-4 years engage in **normal developmental testing** to understand **boundaries** and **parental responses**, which is crucial for learning social rules. - This behavior represents **healthy exploration** of limits and helps establish **secure attachment** through consistent parental guidance. *Antisocial behaviour* - **Antisocial personality disorder** cannot be diagnosed before age **18 years** and requires persistent pattern of violating others' rights. - True antisocial behavior involves **lack of empathy** and **remorse**, which are not developmentally appropriate concerns in toddlers. *As an adventure* - While toddlers are naturally **curious** and **exploratory**, challenging behaviors at this age are primarily about **limit-testing** rather than seeking adventure. - Adventure-seeking would involve **positive exploration** without the oppositional component typical of boundary-testing behaviors. *Oppositionalism* - **Oppositional Defiant Disorder** requires persistent pattern lasting at least **6 months** with significant impairment in functioning. - Normal developmental opposition in 2-4 year olds is **transient** and **situational**, unlike the pervasive pattern required for clinical diagnosis.
Question 8: Which of the following is true about autism?
- A. Occurs in high economic strata.
- B. Characterized by normal communication.
- C. Starts before 2-3 years of age. (Correct Answer)
- D. More common in girls.
Explanation: **Explanation:** Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, alongside restricted, repetitive patterns of behavior. **Why Option C is Correct:** According to both ICD-10 and DSM-5 criteria, the onset of symptoms must occur in the **early developmental period**. Typically, features become evident before the age of **3 years**. While some children show signs in infancy (e.g., lack of eye contact), others may undergo a "regressive" phase where they lose previously acquired language or social skills between 15–24 months. **Why the Other Options are Incorrect:** * **Option A:** Historically, it was falsely believed that autism was linked to "refrigerator mothers" or high socioeconomic status. Modern research confirms that ASD occurs across **all socioeconomic, racial, and ethnic groups**. * **Option B:** Impaired communication is a **hallmark** of autism. This includes delayed speech, lack of "joint attention," inability to understand non-verbal cues (gestures/facial expressions), and echolalia. * **Option D:** ASD is significantly **more common in boys** than girls, with a reported ratio of approximately **4:1**. **High-Yield Clinical Pearls for NEET-PG:** * **Kanner’s Syndrome:** The historical term for "Early Infantile Autism." * **Core Triad:** Impaired social interaction, impaired communication, and restricted/repetitive interests. * **Best Prognostic Factor:** The presence of communicative speech by age 5 and a higher IQ. * **Associated Sign:** "Hand-flapping" or "toe-walking" (stereotypical movements). * **Screening Tool:** M-CHAT (Modified Checklist for Autism in Toddlers).
Question 9: An IQ between 50-70 indicates which level of intellectual disability?
- A. Mild intellectual disability (Correct Answer)
- B. Moderate intellectual disability
- C. Severe intellectual disability
- D. Profound intellectual disability
Explanation: **Explanation:** Intellectual Disability (ID), formerly known as mental retardation, is characterized by deficits in intellectual functions (reasoning, problem-solving, planning) and adaptive functioning. According to the ICD-10 and DSM-5 classifications, the severity of ID is categorized based on IQ scores. **Why the correct answer is right:** * **Mild Intellectual Disability (IQ 50–70):** This is the most common type, accounting for about 85% of the ID population. Individuals in this category are considered "educable." They can usually acquire academic skills up to the 6th-grade level and achieve social and vocational skills adequate for minimum self-support, though they may need guidance during unusual social or economic stress. **Why the incorrect options are wrong:** * **Moderate Intellectual Disability (IQ 35–49):** These individuals are considered "trainable." They can acquire communication skills and perform unskilled or semi-skilled work under supervision but rarely progress beyond 2nd-grade academic levels. * **Severe Intellectual Disability (IQ 20–34):** These individuals have very limited communication skills and require significant support and supervision for activities of daily living. * **Profound Intellectual Disability (IQ < 20):** These individuals have minimal sensorimotor functioning and require 24-hour nursing care and constant supervision. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of ID:** Genetic factors (Down Syndrome is the most common chromosomal cause; Fragile X is the most common inherited cause). * **Assessment Tools:** Binet-Kamat Test (BKT) and Malin’s Intelligence Scale for Indian Children (MISIC) are frequently used in India. * **DSM-5 Shift:** While IQ scores are still used, the DSM-5 emphasizes **adaptive functioning** (conceptual, social, and practical domains) rather than IQ score alone to determine the level of support required.
Question 10: What is the current term for mental retardation as defined by the American Association on Intellectual and Developmental Disabilities?
- A. Feeble mindedness
- B. Madness
- C. Intellectual disability (Correct Answer)
- D. Mentally unstable
Explanation: **Explanation:** The correct answer is **Intellectual disability (ID)**. This shift in terminology reflects a global move toward less stigmatizing and more descriptive clinical language. **Why Intellectual Disability is correct:** The American Association on Intellectual and Developmental Disabilities (AAIDD) and the **DSM-5** officially replaced the term "Mental Retardation" with "Intellectual Disability." This diagnosis is characterized by deficits in both **intellectual functioning** (reasoning, problem-solving, IQ < 70) and **adaptive functioning** (failure to meet developmental and sociocultural standards for personal independence) that begin during the developmental period. **Analysis of Incorrect Options:** * **A. Feeble-mindedness:** This is an archaic, derogatory term used in the early 20th century. It lacks clinical precision and is no longer used in medical literature. * **B. Madness:** This is a colloquial, non-medical term historically used to describe psychosis or severe mental illness, not intellectual impairment. * **C. Mentally unstable:** This is a vague, non-clinical descriptor often used by the public to describe mood swings or personality disorders; it is not a formal psychiatric diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **ICD-11 Update:** The ICD-11 uses the term **"Disorders of Intellectual Development."** * **Severity Levels:** In DSM-5, the severity (Mild, Moderate, Severe, Profound) is determined by **adaptive functioning** rather than IQ scores alone. * **Most Common Cause:** The most common genetic cause of ID is **Down Syndrome**, while the most common *inherited* cause is **Fragile X Syndrome**. * **IQ Range for Mild ID:** 50–70 (Educable); represents about 85% of cases.
Practice by Chapter
Normal Child Development
Practice Questions
Intellectual Developmental Disorder
Practice Questions
Autism Spectrum Disorders
Practice Questions
Attention-Deficit/Hyperactivity Disorder
Practice Questions
Conduct Disorder
Practice Questions
Oppositional Defiant Disorder
Practice Questions
Anxiety Disorders in Children
Practice Questions
Depression in Children and Adolescents
Practice Questions
Psychosis in Children and Adolescents
Practice Questions
Learning Disorders
Practice Questions
Child Abuse and Neglect
Practice Questions
Family Therapy Approaches
Practice Questions
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