Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 101: All of the following are true about autism spectrum disorder except:

A. Two-thirds of individuals with autism have intellectual disability. (Correct Answer)
B. Language development is typically impaired.
C. Abnormal dermatoglyphics are a common feature.
D. Poor eye contact is a characteristic symptom.

Explanation: **Explanation:** Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and restricted, repetitive patterns of behavior. **1. Why Option A is the correct answer (The "Except"):** Historically, it was believed that the majority of children with autism had intellectual disability (ID). However, with improved screening and the inclusion of "High-Functioning Autism" (formerly Asperger’s) into the spectrum, current data shows that only about **30–40% (one-third)** of individuals with ASD have a co-occurring intellectual disability (IQ < 70). Therefore, the statement that "two-thirds" have ID is outdated and incorrect. **2. Analysis of other options:** * **Option B (Language impairment):** While not required for a diagnosis under DSM-5, language delay or atypical language (echolalia, pronoun reversal) is a hallmark feature in a significant majority of clinical cases. * **Option C (Dermatoglyphics):** Research has consistently shown that children with ASD often exhibit abnormal dermatoglyphic patterns (fingerprints and palmar creases), suggesting a disturbance in ectodermal development during the first trimester. * **Option D (Poor eye contact):** This is a cardinal sign of impaired social-emotional reciprocity and is one of the earliest red flags for ASD. **Clinical Pearls for NEET-PG:** * **M-CHAT:** The most commonly used screening tool for toddlers (16–30 months). * **Gold Standard Diagnosis:** ADOS (Autism Diagnostic Observation Schedule) and ADI-R. * **Prognosis:** The two best predictors of long-term prognosis are **IQ** and **communicative language** development by age 5. * **Associated Findings:** Increased head circumference (macrocephaly) is often noted in early childhood.

Question 102: Down syndrome is now commonly referred to as which of the following?

A. Suboptimal development (Correct Answer)
B. Oligophrenia
C. Cognitive impairment
D. Intellectual disability

Explanation: **Explanation:** The correct answer is **Suboptimal development**. This terminology reflects a shift in clinical and educational psychology toward more descriptive, less stigmatizing language. While Down syndrome is a genetic condition (Trisomy 21) characterized by intellectual deficits, modern classifications often use "suboptimal development" to describe the deviation from the expected developmental trajectory in these children. **Analysis of Options:** * **Suboptimal development (Correct):** This is the preferred contemporary term used in various academic and clinical contexts to describe the developmental delays and cognitive limitations associated with Down syndrome, focusing on the process of development rather than just the end-state deficit. * **Oligophrenia (Incorrect):** This is an archaic term (literally meaning "few mind") previously used to describe intellectual disability. It is no longer used in modern clinical practice due to its derogatory connotations. * **Cognitive impairment (Incorrect):** While individuals with Down syndrome do have cognitive impairment, this is a broad symptom found in many conditions (like dementia or delirium) and is not the specific "new name" or categorical label for the condition itself. * **Intellectual disability (Incorrect):** This is the formal diagnostic term used in the DSM-5 and ICD-11 to replace "Mental Retardation." While Down syndrome is a *cause* of intellectual disability, the question specifically asks for the descriptive term now commonly associated with the condition's developmental profile. **High-Yield Clinical Pearls for NEET-PG:** * **Most common chromosomal cause** of intellectual disability: Down syndrome (Trisomy 21). * **Most common inherited cause** of intellectual disability: Fragile X syndrome. * **Cytogenetics:** 95% are due to meiotic non-disjunction, 4% due to Robertsonian translocation, and 1% due to mosaicism. * **Psychiatric Comorbidity:** Individuals with Down syndrome have a significantly higher risk of developing **early-onset Alzheimer’s disease** (often by age 40-50) due to the overexpression of the APP gene on chromosome 21.

Question 103: Which drug is not effective in treating pediatric acute mania?

A. Lithium
B. Divalproex
C. Oxcarbazepine (Correct Answer)
D. Carbamazepine

Explanation: **Explanation:** The management of pediatric bipolar disorder (PBD) requires medications with robust evidence for efficacy in acute mania. While several mood stabilizers and atypical antipsychotics are effective, **Oxcarbazepine** has consistently failed to demonstrate superiority over placebo in randomized controlled trials (RCTs) for pediatric acute mania. **Why Oxcarbazepine is the Correct Answer:** Oxcarbazepine is a keto-derivative of carbamazepine. Although it is effective as an anticonvulsant, multiple double-blind, placebo-controlled studies have shown it is **ineffective** for treating acute manic or mixed episodes in children and adolescents (ages 7-17). Therefore, it is not recommended as a first-line or even adjunctive treatment for this indication. **Analysis of Incorrect Options:** * **A. Lithium:** This is the "Gold Standard" and is FDA-approved for the treatment of acute mania and maintenance in children aged 12 and older (often used off-label in younger children). * **B. Divalproex (Valproate):** It is a first-line mood stabilizer frequently used in pediatric mania, especially for mixed episodes or rapid cycling, supported by clinical guidelines and open-label trials. * **D. Carbamazepine:** While less commonly used than Lithium or Valproate due to drug-drug interactions and side effects, it has shown efficacy in treating manic symptoms in pediatric populations and is considered a viable alternative. **High-Yield NEET-PG Pearls:** * **First-line for Pediatric Mania:** Lithium, Quetiapine, Risperidone, and Aripiprazole. * **FDA Approval:** Lithium is approved for ages ≥7 (maintenance/acute) and several atypical antipsychotics (e.g., Asenapine, Risperidone) are approved for ages ≥10. * **Oxcarbazepine Side Effect:** Monitor for **hyponatremia**, though it occurs less frequently than with carbamazepine. * **Key Distinction:** Do not confuse Carbamazepine (effective) with Oxcarbazepine (ineffective) in the context of pediatric bipolar disorder.

Question 104: What age range does the Phallic/Oedipal stage of Freud's theory correspond to?

A. 0-1 year
B. 3-6 years (Correct Answer)
C. 2-3 years
D. 6-12 years

Explanation: 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.

Question 105: 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?

A. Selective mutism (Correct Answer)
B. Attention-deficit/hyperactivity disorder (ADHD)
C. Autism spectrum disorder
D. Dyslexia

Explanation: ### 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).

Question 106: 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?

A. Conduct disorder (Correct Answer)
B. Oppositional defiant disorder
C. Autism
D. Pervasive developmental disorder

Explanation: ### 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.

Question 107: Which of the following is NOT a cardinal feature of ADHD?

A. Inattention
B. Impulsivity
C. Hyperactivity
D. Temper Tantrums (Correct Answer)

Explanation: **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).

Question 108: All of the following regarding Autistic Spectrum Disorder are true EXCEPT?

A. Defective communication
B. Absent separation anxiety
C. Impaired concentration
D. More common in girls (Correct Answer)

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 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.

Question 109: Which of the following features of conduct disorder is more commonly seen in boys compared to girls?

A. Running away from home
B. Emotional bullying
C. High-risk sexual behavior
D. Physical aggression (Correct Answer)

Explanation: **Explanation:** Conduct Disorder (CD) is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms are violated. While the core diagnostic criteria are the same for both genders, the **phenotypic expression** differs significantly between boys and girls. **1. Why Physical Aggression is Correct:** Epidemiological studies and the DSM-5 indicate that boys with Conduct Disorder are more likely to exhibit **overt, confrontational behaviors**. This includes physical aggression, fighting, cruelty to animals, and property destruction (e.g., vandalism or fire-setting). This "externalizing" profile is a hallmark of the male presentation of the disorder. **2. Analysis of Incorrect Options:** * **Running away from home (A):** This is a non-aggressive, status violation. While seen in both genders, it is statistically more frequent in girls as part of a "covert" symptom profile. * **Emotional bullying (B):** Girls tend to engage in **relational aggression** rather than physical violence. This includes social exclusion, spreading rumors, and emotional manipulation. * **High-risk sexual behavior (C):** While seen in severe cases of CD in both genders, it is more commonly associated with the female presentation of the disorder, often alongside substance use. **Clinical Pearls for NEET-PG:** * **Gender Ratio:** Conduct Disorder is significantly more common in boys (approx. 3:1 to 4:1). * **Progression:** Conduct Disorder is the childhood precursor to **Antisocial Personality Disorder** (diagnosed only after age 18). * **The "Callous-Unemotional" Trait:** This specifier indicates a worse prognosis and a higher risk of adult psychopathy. * **Comorbidity:** Highly associated with ADHD and Substance Use Disorders. * **Treatment:** Multi-systemic therapy (MST) and Parent Management Training (PMT) are the mainstays; pharmacotherapy is reserved for comorbid aggression or ADHD.

Question 110: A reluctant child, forced to bring sugar from a shop, spills half of it on the way. This is an example of:

A. Hysteria
B. Passive aggression (Correct Answer)
C. Disobedience
D. Active aggression

Explanation: **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.

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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