Intellectual Developmental Disorder — MCQs
Porencephaly is due to -
All of the following are classified under Pervasive Developmental Disorders except?
Which of the following is a CORE diagnostic criterion of autistic spectrum disorder according to DSM-5?
A 7-year-old girl presents with difficulties in writing and spelling, while her overall intelligence is normal. What is the most likely diagnosis?
A child finds difficulty in spelling and reading, otherwise their IQ is normal, interacts well with parents and friends. Vision is normal. What is the most probable diagnosis of the condition?
Best therapy suited to teach daily life skill to a mentally challenged child:
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 child with pervasive developmental disorder will have all of the following except:
ADHD in childhood can lead to which of the following in the future?
The diagrammatic representation of the karyotype of an individual indicates a specific genetic abnormality. What is the diagnosis?
Intellectual Developmental Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Porencephaly is due to -
- A. Trauma
- B. Dandy-Walker syndrome
- C. Cerebral infarction (Correct Answer)
- D. Fetal alcohol syndrome
Explanation: ***Cerebral infarction*** - **Porencephaly** is a rare neurological disorder characterized by a **cyst or cavity within the cerebral hemisphere** that is usually communicating with the ventricular system. - It results from the **destruction of brain tissue due to a focal cerebral injury**, most commonly caused by **ischemic events** (e.g., cerebral infarction) or **hemorrhage** during fetal development or early infancy [1]. *Trauma* - While trauma can cause brain injury, **porencephaly** specifically refers to tissue destruction and cavity formation, often distinguished from the immediate and direct tissue damage seen in acute traumatic brain injuries [1]. - Trauma typically leads to **hematomas, contusions, or diffuse axonal injury**, rather than the characteristic fluid-filled cysts of porencephaly. *Dandy-Walker syndrome* - **Dandy-Walker syndrome** involves a congenital malformation of the cerebellum and the fluid-filled spaces around it, specifically characterized by **enlargement of the fourth ventricle** and **absence of the cerebellar vermis** [2]. - It is a **developmental brain anomaly**, not typically associated with focal destructive lesions like those seen in porencephaly. *Fetal alcohol syndrome* - **Fetal alcohol syndrome (FAS)** is a group of birth defects caused by maternal alcohol consumption during pregnancy, leading to characteristic facial features, growth deficits, and **central nervous system abnormalities** [3]. - While FAS can cause brain damage including **microcephaly** and **cortical malformations**, the characteristic cysts of porencephaly are not a primary feature. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1260-1261. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 718-719. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 717-718.
Question 2: All of the following are classified under Pervasive Developmental Disorders except?
- A. Childhood Disintegrative Disorder
- B. Down Syndrome (Correct Answer)
- C. Asperger Syndrome
- D. Rett Syndrome
Explanation: ***Down Syndrome*** - **Down syndrome** is a **chromosomal disorder** (Trisomy 21) causing intellectual disability and distinctive physical features, not a pervasive developmental disorder. - Pervasive developmental disorders (PDDs) are characterized by difficulties in **social interaction**, **communication**, and repetitive behaviors, which are distinct from the genetic origin of Down syndrome. *Childhood Disintegrative Disorder* - **Childhood disintegrative disorder** (CDD) is a rare PDD characterized by a significant loss of previously acquired skills in multiple developmental areas after at least two years of normal development. - It involves severe regression in social, communication, and motor skills, aligning with the criteria for a PDD. *Asperger Syndrome* - **Asperger syndrome** was previously classified as a PDD, characterized by difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. - Individuals with Asperger syndrome typically have average or above-average intelligence and no significant delay in language development. *Rett Syndrome* - **Rett syndrome** is a neurodevelopmental disorder classified as a PDD, almost exclusively affecting females, characterized by normal early development followed by a period of regression. - It involves the loss of purposeful hand movements, development of stereotypical hand movements, and severe impairments in language and motor skills.
Question 3: 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 4: A 7-year-old girl presents with difficulties in writing and spelling, while her overall intelligence is normal. What is the most likely diagnosis?
- A. Dyslexia
- B. Intellectual disability
- C. Dysphonia
- D. Specific learning disorder affecting writing (Correct Answer)
Explanation: ***Specific learning disorder affecting writing*** - This diagnosis aligns with documented difficulties in **writing and spelling** despite **normal overall intelligence**. - Formerly known as **dysgraphia**, it specifically impacts the motor and cognitive aspects of written expression. *Dyslexia* - Primarily affects **reading abilities**, with challenges in **decoding and phonological processing**. - While it can co-occur with writing difficulties, the primary presentation here emphasizes writing and spelling. *Intellectual disability* - Characterized by significant limitations in both **intellectual functioning** and **adaptive behavior**. - The descriptor "normal overall intelligence" directly rules out intellectual disability. *Dysphonia* - Refers to a **disorder of the voice**, affecting its quality, pitch, or loudness. - This condition is related to speech production and has no direct involvement with difficulties in writing or spelling.
Question 5: A child finds difficulty in spelling and reading, otherwise their IQ is normal, interacts well with parents and friends. Vision is normal. What is the most probable diagnosis of the condition?
- A. ADHD
- B. Autism
- C. Asperger syndrome
- D. Dyslexia (Correct Answer)
Explanation: ***Dyslexia*** - This condition is characterized by **difficulties with accurate and/or fluent word recognition** and poor spelling and decoding abilities despite normal intelligence and adequate educational opportunities. - The child's **normal IQ** and good social interaction, coupled with specific issues in spelling and reading, strongly indicate dyslexia. *ADHD* - **Attention Deficit Hyperactivity Disorder** primarily presents with persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. - While academic difficulties can occur, the primary presenting problem is usually not confined to reading and spelling but rather a broader difficulty in attention or impulse control. *Autism* - **Autism Spectrum Disorder** is characterized by persistent deficits in social communication and social interaction across multiple contexts, and restricted, repetitive patterns of behavior, interests, or activities. - The child's ability to **interact well with parents and friends** makes autism an unlikely diagnosis, as deficits in social reciprocity are a hallmark feature. *Asperger syndrome* - Formerly a distinct diagnosis, **Asperger syndrome** is now considered part of the Autism Spectrum Disorder. Like autism, it involves difficulties in social interaction and communication. - Despite often having normal or above-average intelligence, individuals with Asperger syndrome typically exhibit **significant social awkwardness** and repetitive behaviors, which are not described in the child's presentation.
Question 6: Best therapy suited to teach daily life skill to a mentally challenged child:
- A. Contingency management (Correct Answer)
- B. Cognitive reconstruction
- C. Self instruction
- D. CBT (Cognitive behavior therapy)
Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.
Question 7: 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 8: 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 9: ADHD in childhood can lead to which of the following in the future?
- A. Intellectual changes
- B. Alcoholism
- C. Antisocial behaviour
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - Childhood ADHD is associated with an increased risk of developing various long-term negative outcomes, including **substance use disorders** (like alcoholism), **antisocial behaviors**, and impacts on **academic and occupational functioning** which can be broadly termed intellectual or cognitive impacts. - The inattentiveness, impulsivity, and hyperactivity characteristic of ADHD can disrupt normal development, leading to difficulties in social interactions, educational attainment, and emotional regulation, all contributing to these wider issues. *Intellectual changes* - While ADHD does not directly cause an intellectual disability, it can significantly impact **academic performance**, executive function, and the ability to apply learned knowledge, leading to what might be perceived as intellectual challenges or underachievement. - Difficulties with sustained attention, organization, and impulse control can hinder learning processes and the acquisition of new skills, influencing cognitive development and application. *Alcoholism* - Individuals with ADHD, particularly those with untreated or poorly managed symptoms, have a significantly **higher risk of developing substance use disorders**, including alcoholism. - The impulsive nature and difficulty with self-regulation often seen in ADHD can contribute to engaging in risky behaviors, including substance experimentation and dependence, as a form of self-medication or coping mechanism. *Antisocial behaviour* - ADHD, especially when comorbid with **oppositional defiant disorder (ODD)** or **conduct disorder (CD)**, is a significant risk factor for the development of antisocial behaviors and later antisocial personality disorder. - Impulsivity, poor emotional regulation, and difficulties understanding consequences can predispose individuals with ADHD to violate social norms and engage in aggressive or non-compliant actions.
Question 10: The diagrammatic representation of the karyotype of an individual indicates a specific genetic abnormality. What is the diagnosis?
- A. Angelman syndrome
- B. Cri du Chat syndrome
- C. DiGeorge syndrome
- D. Prader-Willi syndrome (Correct Answer)
Explanation: ***Prader-Willi syndrome*** - The karyotype shows an abnormality on **chromosome 15**, which is consistent with Prader-Willi syndrome caused by **deletion of 15q11-q13** inherited from the **paternal** chromosome or **maternal uniparental disomy**. - While PWS deletions are typically **submicroscopic**, larger deletions can occasionally be visible on standard karyotyping, particularly when they represent **class I deletions** that are more extensive and involve additional chromosomal material beyond the typical PWS critical region. *Angelman syndrome* - Although Angelman syndrome also involves **chromosome 15q11-q13 deletion**, it results from **maternal** deletion or **paternal uniparental disomy**, and presents with distinctly different clinical features. - Clinical presentation includes **severe intellectual disability**, **ataxia**, **seizures**, **absent speech**, and **inappropriate laughter** (happy demeanor), which differs significantly from the PWS phenotype. *DiGeorge syndrome* - DiGeorge syndrome is caused by **deletion of chromosome 22q11.2**, not chromosome 15 as shown in the karyotype. - Clinical features include **cardiac defects** (conotruncal abnormalities), **thymic hypoplasia**, **parathyroid hypoplasia** (hypocalcemia), **cleft palate**, and characteristic facial features (CATCH-22 syndrome). *Cri du Chat syndrome* - This syndrome results from **deletion of chromosome 5p** (short arm of chromosome 5), not chromosome 15 as indicated in the karyotype. - Characteristic features include **high-pitched cry** resembling a cat's meow in infancy, **intellectual disability**, **microcephaly**, and **distinctive facial features**.
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