Attention-Deficit/Hyperactivity Disorder — MCQs
Which of the following drugs are used in the treatment of Attention-Deficit Hyperactivity Disorder (ADHD)?
All of the following are used to improve attention deficit in children, except which of the following?
All are used in attention deficit hyperactivity disorder (ADHD) except:
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 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:
Which of the following is not a typical core feature of hyperkinetic disorder?
The 4AT is a screening tool for detection of delirium. Which THREE of the following parameters listed below are included in the 4AT tool? I. Alertness II. Apnoea III. Abbreviated Mental Test (AMT4) IV. Attention Select the correct answer using the code given below:
A mother and her 4 year old son are seated alone in a reception area with the child staring off into space, rocking and constantly twisting a strand of hair about his fingers. Upon entry of another person, the child begins to beat his fist against the side of his face and behaves as though he does not hear his mother speaking to him. This behavior is most characteristic of:
A 6 year old child who does not interact with other children of his age group and prefers playing alone with repetitive behaviors, is likely to be suffering from:
A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from
Attention-Deficit/Hyperactivity Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following drugs are used in the treatment of Attention-Deficit Hyperactivity Disorder (ADHD)?
- A. Atomoxetine
- B. Dexmethylphenidate
- C. Methylphenidate
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Atomoxetine**, **dexmethylphenidate**, and **methylphenidate** are all approved and commonly used medications for managing Attention-Deficit Hyperactivity Disorder (ADHD) [1]. - They represent different classes or formulations of drugs targeting neurotransmitter systems involved in ADHD. *Atomoxetine* - This is a **selective norepinephrine reuptake inhibitor** used for ADHD. - It is a **non-stimulant** option, often preferred for patients who do not tolerate stimulants or have co-existing anxiety disorders. *Dexmethylphenidate* - This is the **dextro-isomer** of methylphenidate, and it is a **central nervous system (CNS) stimulant** [1]. - It is known for its **potency** and faster onset of action due to only containing the active isomer. *Methylphenidate* - This is a **CNS stimulant** medication that works by blocking the reuptake of norepinephrine and dopamine [1]. - It is available in various formulations (short-acting, intermediate-acting, long-acting) to suit individual patient needs [1].
Question 2: 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 3: 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 4: 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 5: 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.
Question 6: 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 7: The 4AT is a screening tool for detection of delirium. Which THREE of the following parameters listed below are included in the 4AT tool? I. Alertness II. Apnoea III. Abbreviated Mental Test (AMT4) IV. Attention Select the correct answer using the code given below:
- A. I, III and IV (Correct Answer)
- B. I, II and IV
- C. I, II and III
- D. II, III and IV
Explanation: ***I, III and IV*** - The 4AT screening tool specifically includes **Alertness**, **AMT4 (Abbreviated Mental Test)**, and **Attention** as key parameters for detecting delirium. - The **AMT4** component assesses **cognitive function**, while **Alertness** and **Attention** evaluate the patient's state of consciousness and focus. *I, II and IV* - This option incorrectly includes **Apnoea**. While apnoea is a significant medical condition, it is not a direct parameter in the **4AT delirium screening tool**. - The 4AT focuses on cognitive and neurological signs of delirium, not respiratory patterns. *I, II and III* - This option also incorrectly includes **Apnoea** as one of the parameters in the 4AT tool. - The 4AT is designed to assess **delirium**, which primarily manifests through altered mental status, rather than respiratory issues. *II, III and IV* - This option is incorrect as it includes **Apnoea** and omits **Alertness**, which is a fundamental component of the **4AT delirium screening tool**. - **Alertness** is crucial for evaluating the patient's level of consciousness, a primary sign of delirium.
Question 8: A mother and her 4 year old son are seated alone in a reception area with the child staring off into space, rocking and constantly twisting a strand of hair about his fingers. Upon entry of another person, the child begins to beat his fist against the side of his face and behaves as though he does not hear his mother speaking to him. This behavior is most characteristic of:
- A. A child with intellectual disability
- B. First dental appointment anxieties of a 4 year old child
- C. An autistic child (Correct Answer)
- D. A child with a chronic seizure disorder
Explanation: ***An autistic child*** - The behavior described, including **rocking**, **twisting hair**, **staring off into space**, **self-injurious behavior** (beating fist against face), and **unresponsiveness to verbal cues**, are classic signs of **autism spectrum disorder**. - **Autism** is characterized by difficulties in social interaction and communication, and restricted or repetitive patterns of behavior, interests, or activities. *A child with intellectual disability* - While children with intellectual disability may exhibit some repetitive behaviors or difficulties with social interaction, the combination of **intense self-stimulatory behaviors**, **unresponsiveness to name**, and **self-injurious conduct** points more specifically to autism. - **Intellectual disability** primarily involves limitations in intellectual functioning and adaptive behavior across multiple domains, which is a broader diagnosis than the specific pattern of behaviors seen here. *First dental appointment anxieties of a 4 year old child* - **Anxiety** in a dental setting typically manifests as fear, crying, resistance to examination, or clinging to a parent, but not typically as the **repetitive self-stimulatory behaviors** or **unresponsiveness** described. - The behaviors seen, such as constant rocking and twisting hair, precede the arrival of the new person (which could be the dentist or assistant), indicating a baseline behavior beyond acute situational anxiety. *A child with a chronic seizure disorder* - A **seizure disorder** might present with altered consciousness or repetitive movements, but these would typically be paroxysmal and not a persistent pattern of behavior like **rocking**, **staring into space**, and **unresponsiveness** that improves with the removal of external stimuli or changes in internal state. - The described behaviors are more indicative of a **neurodevelopmental disorder** affecting social communication and behavior regulation, rather than epileptic activity.
Question 9: A 6 year old child who does not interact with other children of his age group and prefers playing alone with repetitive behaviors, is likely to be suffering from:
- A. ADHD
- B. Autism (Correct Answer)
- C. Depression
- D. Bipolar disorder
Explanation: ***Autism*** - Difficulties in **social interaction** and **communication**, along with **repetitive behaviors** and restricted interests, are core diagnostic features of **Autism Spectrum Disorder (ASD)**. - The child's preference for playing alone and lack of interaction with peers are hallmark signs of **social deficits** in ASD. *ADHD* - **Attention-Deficit/Hyperactivity Disorder (ADHD)** primarily involves difficulties with **inattention**, **hyperactivity**, and **impulsivity**. - While children with ADHD may struggle socially, repetitive behaviors and a complete lack of interest in peer interaction are not typical primary symptoms. *Depression* - **Depression** in children often presents with **sadness**, **loss of interest** in previously enjoyed activities, changes in sleep or appetite, and irritability. - Social withdrawal in depression is usually due to low mood or anhedonia, rather than a fundamental difficulty in social understanding or a preference for repetitive play. *Bipolar disorder* - **Bipolar disorder** in children involves distinct episodes of **mania** (elevated mood, increased energy, decreased need for sleep) and **depression**. - The symptoms described do not align with the characteristic mood swings and episodic nature of bipolar disorder.
Question 10: A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from
- A. Examination anxiety
- B. Lack of interest in studies
- C. Intellectual disability
- D. Specific learning disability (Correct Answer)
Explanation: ***Specific learning disability*** - Difficulty in expressing himself in **writing** and **frequent spelling mistakes** are hallmark features of a **specific learning disability** affecting written expression (**dysgraphia**). - These academic skill deficits are the primary presenting features and indicate a **specific learning disorder** as per DSM-5 criteria. - The inability to follow instructions and difficulty waiting for turns suggest **comorbid ADHD**, which occurs in 30-50% of children with learning disabilities. - When both conditions coexist, the **learning disability** is typically identified first in school-aged children through academic difficulties, making it the most likely primary diagnosis in this clinical scenario. *Examination anxiety* - Examination anxiety manifests as psychological distress **specifically during test situations** (nervousness, worry, physical symptoms like sweating or rapid heartbeat). - It does not explain **persistent difficulties** with writing, spelling, following instructions, or impulse control across multiple settings (school and play). - The symptoms described occur in everyday activities, not just during examinations. *Lack of interest in studies* - Lack of interest or motivation leads to **poor effort** and **disengagement**, but not to specific skill deficits like spelling mistakes or writing difficulties. - Children with low motivation can typically perform adequately when interested, unlike those with learning disabilities who struggle despite effort. - This option doesn't account for the **impulsivity** (cannot wait for turn) which suggests a neurobiological basis rather than motivational issues. *Intellectual disability* - Intellectual disability involves **global cognitive impairment** affecting all areas of functioning with IQ typically below 70. - The pattern described shows **specific deficits** in writing and spelling (academic skills) alongside behavioral regulation issues, rather than pervasive intellectual limitations. - Children with intellectual disability would show broader developmental delays across multiple domains (communication, self-care, social skills), not just circumscribed learning and behavioral difficulties.
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