Autism Spectrum Disorders — MCQs
Infantile autism is characterized by:
A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?
A 3-year-old child with delayed speech development, prefers to play alone and is not making friends. The likely diagnosis is
Which of the following is a CORE diagnostic criterion of autistic spectrum disorder according to DSM-5?
A child with pervasive developmental disorder will have all of the following except:
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 ?
Autism is characterized by all except -
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 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 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:
Autism Spectrum Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Infantile autism is characterized by:
- A. Only language development delays
- B. Hyperactivity and attention deficits
- C. Intellectual disability in all cases
- D. Social communication deficits and restricted, repetitive behaviors (Correct Answer)
Explanation: ***Social communication deficits and restricted, repetitive behaviors*** - **Infantile autism**, now part of **Autism Spectrum Disorder (ASD)**, is primarily characterized by persistent deficits in **social communication and social interaction**. - Another core characteristic is the presence of **restricted, repetitive patterns of behavior, interests, or activities**, which can include repetitive movements, adherence to routines, or fixated interests. *Only language development delays* - While **language delays** are common in ASD, they are not the sole defining feature; **social communication deficits** encompass much more than just delayed speech. - Focusing solely on language delays would miss other critical diagnostic criteria like **social interaction impairments** and **repetitive behaviors**. *Hyperactivity and attention deficits* - **Hyperactivity** and **attention deficits** are symptoms more commonly associated with conditions like **Attention-Deficit/Hyperactivity Disorder (ADHD)**. - Although these can co-occur with ASD, they are not primary diagnostic criteria for **autism** itself. *Intellectual disability in all cases* - While a significant proportion of individuals with ASD also have an **intellectual disability**, it is not present in all cases. - Many individuals with ASD have average or above-average intellectual abilities.
Question 2: A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?
- A. Specific learning disability
- B. Intellectual disability
- C. Sibling Rivalry
- D. Autism Spectrum Disorder (Correct Answer)
Explanation: ***Autism Spectrum Disorder*** - The child's delayed speech, **restricted interests** (spinning objects), lack of social engagement, and difficulty interacting with other children are classic symptoms of **Autism Spectrum Disorder (ASD)**. - Normal developmental milestones in other areas, such as motor skills, differentiate ASD from global developmental delays. - The **triad of impairments** includes social communication deficits, restricted interests, and repetitive behaviors, all evident in this case. *Specific learning disability* - This diagnosis typically presents with difficulties in specific academic areas like reading, writing, or math in a child with otherwise average intelligence. - It is generally diagnosed after school entry (age 6-7 years) when academic demands increase. - It doesn't explain the **social communication deficits** and **restricted, repetitive behaviors** seen in this case. *Intellectual disability* - This condition involves significant limitations in both intellectual functioning and adaptive behavior, with onset during the developmental period. - While delayed speech can be a feature, the child's otherwise **normal developmental milestones** in motor and other domains argue against a global intellectual deficit. - The **restricted interests** and social deficits are more characteristic of ASD than intellectual disability alone. *Sibling Rivalry* - This refers to competition or animosity between siblings, often manifesting as behavioral problems or attention-seeking from parents. - It is a normal developmental phenomenon, not a psychiatric disorder. - It does not account for the core symptoms described, such as **delayed speech**, **restricted interests** (fascination with spinning objects), or a pervasive disinterest in social interaction.
Question 3: 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 4: Which of the following is a CORE diagnostic criterion of autistic spectrum disorder according to DSM-5?
- A. Impaired communication (Correct Answer)
- B. Impaired imagination
- C. Language developmental delay
- D. Vision problems
Explanation: ***Impaired communication*** - Deficits in **social communication and social interaction** are one of the two core diagnostic criteria for Autism Spectrum Disorder (ASD) in DSM-5. - This includes deficits in social-emotional reciprocity, nonverbal communicative behaviors, and developing/maintaining relationships. - Communication impairments are essential for diagnosis and must be present across multiple contexts. *Impaired imagination* - While restricted, repetitive patterns of behavior (which can include rigid thinking patterns) are the second core criterion, "impaired imagination" is not specifically listed as a core diagnostic criterion in DSM-5. - Imaginative play deficits may be present but fall under the broader category of restricted/repetitive behaviors, not as a standalone core criterion. *Language developmental delay* - Language delay is **not a core diagnostic criterion** in DSM-5 for ASD. - DSM-5 explicitly states that ASD can occur with or without accompanying language impairment. - When present, language delay is noted as a specifier, not a required criterion. *Vision problems* - Vision problems are not a characteristic feature of Autism Spectrum Disorder. - Any vision issues in individuals with ASD are co-occurring conditions unrelated to the core diagnostic features.
Question 5: 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 6: 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 7: Autism is characterized by all except -
- A. Language problems
- B. Depression (Correct Answer)
- C. Stereotyped behavior
- D. Lack of social play in child
Explanation: ***Depression*** - While individuals with **autism spectrum disorder (ASD)** may experience higher rates of anxiety and depression as co-occurring conditions, **depression** itself is not a core diagnostic symptom used to characterize autism. - The diagnostic criteria for autism focus on deficits in social communication and interaction, and restricted, repetitive patterns of behavior, interests, or activities. *Language problems* - **Language problems** are a hallmark feature of autism, ranging from delayed speech development to unusual patterns of speech like **echolalia** or difficulty with **conversational reciprocity**. - These communication difficulties are a direct component of the core diagnostic criteria for autism spectrum disorder. *Stereotyped behavior* - **Stereotyped behaviors**, such as repetitive motor movements (e.g., hand flapping, rocking), repetitive use of objects, or insistence on sameness, are a defining characteristic of autism. - These behaviors fall under the diagnostic criteria of **restricted, repetitive patterns of behavior, interests, or activities**. *Lack of social play in child* - A significant **lack of social play** (e.g., imaginative play, cooperative play) and difficulty with social interaction is a core diagnostic feature of autism, particularly evident in childhood. - This symptom reflects the impairment in **social communication and interaction** central to the diagnosis of autism spectrum disorder.
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 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 10: 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.
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