Child and Adolescent Psychiatry Practice Questions

Q: What age range does the Phallic/Oedipal stage of Freud's theory correspond to?

3-6 years. The correct answer is **B. 3-6 years**. ### **Explanation of the Correct Answer** Sigmund Freud’s Psychoanalytic Theory of Psychosexual Development proposes that personality develops through five distinct stages, each focused on an erogenous zone. The **Phallic Stage** occurs between **3 to 6 years** of age. During this period, the child’s libido is focused on the genitals. This stage is clinically significant for the development of the **Oedipus complex** (in boys) and the **Electra complex** (in girls), where the child experiences unconscious sexual desire for the opposite-sex parent and rivalry with the same-sex parent. Resolution occurs through **identification** with the same-sex parent, leading to the formation of the **Superego**. ### **Analysis of Incorrect Options** * **A. 0-1 year (Oral Stage):** The focus is on the mouth (sucking, biting). Fixation here leads to oral-aggressive or oral-passive traits (e.g., smoking, overeating). * **C. 2-3 years (Anal Stage):** The focus is on toilet training and bladder/bowel control. Fixation leads to "Anal Retentive" (obsessive/organized) or "Anal Expulsive" (messy/reckless) personalities. * **D. 6-12 years (Latency Stage):** Sexual impulses are suppressed; the child focuses on social skills, hobbies, and peer relationships. ### **High-Yield NEET-PG Pearls** * **Sequence:** Oral → Anal → Phallic → Latency → Genital (Mnemonic: **O**ld **A**ge **P**eople **L**ove **G**rapes). * **Castration Anxiety:** A key feature of the Phallic stage in boys, where they fear the father will punish them for their feelings toward the mother. * **Penis Envy:** The corresponding concept in girls during the Phallic stage. * **Fixation:** If a child’s needs are not met or overindulged at a stage, they may remain "stuck," manifesting as specific psychiatric traits in adulthood.

Q: A boy exhibits selective mutism, refusing to speak at school but speaking normally in other environments. His IQ assessment is normal. What is the most likely diagnosis?

Selective mutism. ### Explanation **1. Why Selective Mutism is Correct:** Selective Mutism (SM) is characterized by a consistent failure to speak in specific social situations (e.g., school) despite speaking in other situations (e.g., at home). According to DSM-5/ICD-11 criteria, this behavior must persist for at least **one month** (not limited to the first month of school) and interfere with educational or social communication. The child’s normal IQ and ability to speak in comfortable settings rule out global developmental or language delays. It is fundamentally considered an **anxiety disorder**. **2. Why the Other Options are Incorrect:** * **ADHD:** Presents with a persistent pattern of inattention, hyperactivity, and impulsivity. It does not typically involve a refusal to speak in specific settings. * **Autism Spectrum Disorder (ASD):** While children with ASD may have communication deficits, these are pervasive across all settings. ASD also involves restricted, repetitive patterns of behavior and impaired social reciprocity, which are absent here. * **Dyslexia:** This is a specific learning disorder characterized by difficulties with word recognition, decoding, and spelling. It affects reading ability, not the physiological or psychological intent to speak. **3. NEET-PG High-Yield Pearls:** * **Comorbidity:** The most common comorbid condition with Selective Mutism is **Social Anxiety Disorder**. * **Treatment:** The first-line treatment is **Behavioral Therapy** (e.g., stimulus fading, shaping). Pharmacotherapy (SSRIs like Fluoxetine) is reserved for refractory cases. * **Age of Onset:** Usually before age 5, but often only diagnosed when the child enters the school environment. * **Rule Out:** Always ensure the mutism is not due to a lack of knowledge of the spoken language or a communication disorder (e.g., stuttering).

Q: A 13-year-old boy is often aggressive, argues with parents and teachers, and has a history of frequent lying and stealing money at home. He frequently runs away from class to play. What is the most likely diagnosis?

Conduct disorder. ### Explanation The correct diagnosis is **Conduct Disorder (CD)**. This condition is characterized by a repetitive and persistent pattern of behavior in which the **basic rights of others** or major age-appropriate societal norms/rules are violated. **Why Conduct Disorder is correct:** The patient exhibits key diagnostic criteria for CD: 1. **Aggression:** Arguing and aggressive behavior. 2. **Deceitfulness or Theft:** Frequent lying and stealing money. 3. **Serious Violation of Rules:** Running away from class (truancy). In children under 18, the combination of antisocial behavior (stealing/lying) and aggression points directly to CD. If these behaviors persist after age 18, the diagnosis shifts to Antisocial Personality Disorder. **Why the other options are incorrect:** * **Oppositional Defiant Disorder (ODD):** While ODD involves irritability and defiance toward authority figures, it **does not** typically include aggression toward people/animals, destruction of property, or a pattern of theft and deceit. CD is essentially a more severe progression of ODD. * **Autism & Pervasive Developmental Disorder (PDD):** These are neurodevelopmental disorders characterized by impairments in social communication, restricted interests, and repetitive behaviors. They do not primarily manifest as intentional rule-breaking or predatory aggression. **High-Yield Clinical Pearls for NEET-PG:** * **The "Triad":** CD is often associated with the "MacDonald Triad" (enuresis, fire-setting, and cruelty to animals), though this is no longer a formal diagnostic requirement. * **Progression:** ODD → Conduct Disorder (pre-18 years) → Antisocial Personality Disorder (post-18 years). * **Comorbidity:** CD is highly comorbid with **ADHD** and Substance Use Disorders. * **Treatment:** Multi-systemic therapy and parent management training are first-line; pharmacotherapy (like Risperidone) is used only for severe aggression.

Q: Which of the following is NOT a cardinal feature of ADHD?

Temper Tantrums. **Explanation:** Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of behavior that interferes with functioning or development. According to the **DSM-5** and **ICD-11** criteria, the diagnosis is based on three core (cardinal) symptom domains: 1. **Inattention (Option A):** Manifests as difficulty sustaining focus, wandering off tasks, lack of persistence, and being disorganized. 2. **Hyperactivity (Option C):** Refers to excessive motor activity (fidgeting, tapping, or talkativeness) that is not appropriate for the setting. 3. **Impulsivity (Option B):** Refers to hasty actions that occur in the moment without forethought (e.g., interrupting others, inability to wait for a turn). **Temper Tantrums (Option D)** are not a cardinal feature of ADHD. While children with ADHD may exhibit emotional dysregulation or low frustration tolerance, frequent temper tantrums are more characteristic of **Oppositional Defiant Disorder (ODD)** or **Disruptive Mood Dysregulation Disorder (DMDD)**. Although ODD is a common comorbidity in children with ADHD, it remains a distinct clinical entity. **High-Yield Clinical Pearls for NEET-PG:** * **Age of Onset:** Symptoms must be present before **12 years of age** (DSM-5). * **Pervasiveness:** Symptoms must be present in **two or more settings** (e.g., home and school). * **Drug of Choice:** **Methylphenidate** (a CNS stimulant) is the first-line pharmacological treatment. * **Non-Stimulant Option:** **Atomoxetine** (Selective Norepinephrine Reuptake Inhibitor) is used if stimulants are contraindicated or cause side effects. * **Most Common Comorbidity:** Oppositional Defiant Disorder (ODD).

Q: All of the following regarding Autistic Spectrum Disorder are true EXCEPT?

More common in girls. **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 D is the correct answer (The "Except"):** Autism Spectrum Disorder is significantly **more common in boys** than in girls. Epidemiological data consistently shows a male-to-female ratio of approximately **4:1**. Therefore, the statement that it is more common in girls is factually incorrect. **Analysis of other options:** * **A. Defective communication:** This is a core diagnostic criterion. Children with ASD often have delayed speech, lack of social-emotional reciprocity, and difficulty understanding non-verbal cues (e.g., eye contact, gestures). * **B. Absent separation anxiety:** Unlike neurotypical children, children with ASD often lack "stranger anxiety" or "separation anxiety" because they lack the social-emotional attachment and "joint attention" typically seen in early development. They may appear indifferent to the presence or absence of parents. * **C. Impaired concentration:** Children with ASD frequently exhibit poor attention spans for tasks that do not interest them, though they may show "hyper-focus" on specific, restricted interests. **High-Yield Clinical Pearls for NEET-PG:** * **Kanner’s Syndrome:** The historical term for "Early Infantile Autism." * **Key Features:** Social isolation ("autistic aloneness"), insistence on sameness (rituals), and delayed language. * **Prognosis:** The best predictors of long-term outcome are **IQ (above 70)** and the **development of communicative language** by age 5–7. * **Treatment:** Behavioral interventions (Applied Behavior Analysis - ABA) are mainstay; Risperidone/Aripiprazole are FDA-approved for irritability/aggression in ASD.

Q: A reluctant child, forced to bring sugar from a shop, spills half of it on the way. This is an example of:

Passive aggression. **Explanation:** The correct answer is **Passive aggression (Option B)**. This behavior is a classic example of a defense mechanism where an individual expresses underlying hostility or resentment toward an authority figure or a task in an indirect, non-confrontational manner. In this scenario, the child is "reluctant" (indicating internal resistance) and "forced" (indicating external pressure). Instead of refusing the task directly (active disobedience), the child complies but performs the task inefficiently or destructively by spilling the sugar. This allows the child to vent frustration and "punish" the requester while maintaining a facade of compliance. In psychiatry, this is often associated with **Passive-Aggressive Personality Disorder** (now categorized under "Other Specified Personality Disorders" in DSM-5), characterized by procrastination, stubbornness, and intentional inefficiency. **Why other options are incorrect:** * **Hysteria (A):** Now referred to as Conversion Disorder or Dissociative Disorder, this involves physical symptoms (like paralysis or seizures) or sensory loss without a neurological cause, usually triggered by psychological conflict. * **Disobedience (C):** This is a direct, overt refusal to follow rules or commands. The child would have simply said "No" or refused to go to the shop. * **Active aggression (D):** This involves direct, overt harmful behavior, such as throwing the sugar at the person who asked or shouting in anger. **High-Yield Clinical Pearls for NEET-PG:** * **Defense Mechanism:** Passive aggression is considered an **immature defense mechanism**. * **Key Features:** Look for "intentional forgetfulness," "procrastination," "sullenness," and "learned helplessness" in clinical vignettes. * **Management:** In a clinical setting, the best approach is to encourage the patient to express their feelings directly and assertively rather than through indirect actions.

Question 1

All of the following are true about autism spectrum disorder except:

Accepted Answer

Two-thirds of individuals with autism have intellectual disability.

Answer

Language development is typically impaired.

Answer

Abnormal dermatoglyphics are a common feature.

Answer

Poor eye contact is a characteristic symptom.

Question 2

Down syndrome is now commonly referred to as which of the following?

Accepted Answer

Suboptimal development

Answer

Oligophrenia

Answer

Cognitive impairment

Answer

Intellectual disability

Question 3

Which drug is not effective in treating pediatric acute mania?

Accepted Answer

Oxcarbazepine

Answer

Lithium

Answer

Divalproex

Answer

Carbamazepine

Question 4

What age range does the Phallic/Oedipal stage of Freud's theory correspond to?

Accepted Answer

3-6 years

Answer

0-1 year

Answer

2-3 years

Answer

6-12 years

Question 5

A boy exhibits selective mutism, refusing to speak at school but speaking normally in other environments. His IQ assessment is normal. What is the most likely diagnosis?

Accepted Answer

Selective mutism

Answer

Attention-deficit/hyperactivity disorder (ADHD)

Answer

Autism spectrum disorder

Answer

Dyslexia

Question 6

A 13-year-old boy is often aggressive, argues with parents and teachers, and has a history of frequent lying and stealing money at home. He frequently runs away from class to play. What is the most likely diagnosis?

Accepted Answer

Conduct disorder

Answer

Oppositional defiant disorder

Answer

Autism

Answer

Pervasive developmental disorder

Question 7

Which of the following is NOT a cardinal feature of ADHD?

Accepted Answer

Temper Tantrums

Answer

Inattention

Answer

Impulsivity

Answer

Hyperactivity

Question 8

All of the following regarding Autistic Spectrum Disorder are true EXCEPT?

Accepted Answer

More common in girls

Answer

Defective communication

Answer

Absent separation anxiety

Answer

Impaired concentration

Question 9

Which of the following features of conduct disorder is more commonly seen in boys compared to girls?

Accepted Answer

Physical aggression

Answer

Running away from home

Answer

Emotional bullying

Answer

High-risk sexual behavior

Question 10

A reluctant child, forced to bring sugar from a shop, spills half of it on the way. This is an example of:

Accepted Answer

Passive aggression

Answer

Hysteria

Answer

Disobedience

Answer

Active aggression

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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