Child and Adolescent Psychiatry — MCQs

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:

Q166

In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-

Q167

In treating children with intellectual disabilities, one generally finds that they:

Q168

All of the following are classified under Pervasive Developmental Disorders except?

Q169

Autism is characterized by all except -

Q170

A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes. He passes his examination with poor marks. However, his mathematical ability and social adjustment are appropriate for his age. Which of the following is the most likely diagnosis?

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 161: Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?

A. Selective mutism
B. Conduct disorder (Correct Answer)
C. Binge eating disorder
D. Separation anxiety disorder

Explanation: ***Conduct disorder*** - **Untreated ADHD**, marked by impulsivity and difficulty with emotional regulation, significantly increases the risk of developing **conduct disorder** in adolescence. - Adolescents with untreated ADHD may struggle with following rules, exhibiting aggressive behaviors, and engaging in antisocial acts, which are hallmarks of conduct disorder. *Selective mutism* - This is an **anxiety disorder** characterized by a child's consistent failure to speak in specific social situations where there is an expectation for speaking despite speaking in other situations. - While it can co-occur with ADHD, it is not a direct consequence of untreated ADHD and involves distinct psychological mechanisms. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, often accompanied by a sense of loss of control. - While there is a higher prevalence of eating disorders in individuals with ADHD, it is not a primary or direct developmental risk from untreated ADHD in adolescence. *Separation anxiety disorder* - This disorder involves **excessive fear or anxiety** concerning separation from home or from attachment figures, beyond what is expected for the individual's developmental level. - While it can co-occur with ADHD, it is not a direct developmental risk that emerges from untreated ADHD in adolescence.

Question 162: 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 163: Which of the following is not seen in autism?

A. 1/3rd patients have intellectual disability
B. Poor eye contact
C. Abnormal dermatoglyphics (Correct Answer)
D. Language is impaired

Explanation: ***Abnormal dermatoglyphics*** - **Abnormal dermatoglyphics** (fingerprint patterns) are not a characteristic feature of autism spectrum disorder. - While dermatoglyphics can be altered in some genetic syndromes, they are not consistently found or used as a diagnostic marker for autism. *1/3rd patients have intellectual disability* - Approximately **one-third (30-40%) of individuals with autism** have co-occurring intellectual disability (ID with IQ <70). - This comorbidity impacts the level of support and interventions required. - The prevalence has decreased over time due to improved diagnostic criteria and recognition of high-functioning autism. *Poor eye contact* - **Poor eye contact** is a cardinal feature and a key diagnostic criterion for autism spectrum disorder. - It reflects difficulties in social communication and interaction, a core deficit in autism. *Language is impaired* - **Language impairment** is a common feature of autism, ranging from delayed language development to complete absence of speech in some cases. - Challenges in both receptive and expressive language are characteristic, affecting social communication. - However, not all individuals with autism have language impairment, particularly those with high-functioning autism or Asperger's syndrome.

Question 164: 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 165: 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 166: In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-

A. Disturbances of intellectual development
B. Disturbance of social interaction
C. Disturbances of communication (Correct Answer)
D. Restricted, repetitive patterns of behaviour

Explanation: ***Disturbances of communication*** - In DSM-5 and proposed ICD-11, **communication deficits** are now subsumed under the broader category of **social communication deficits**. - This change reflects the understanding that communication difficulties in ASD are primarily related to their social function rather than being a separate, general communication disorder. *Disturbances of intellectual development* - While many individuals with ASD also have **intellectual disabilities**, this has never been a core diagnostic criterion for autism itself. - **Intellectual development** is considered a co-occurring condition rather than a defining feature of the spectrum. *Disturbance of social interaction* - **Deficits in social interaction** remain a core diagnostic criterion for autism spectrum disorder in both DSM-5 and ICD-11. - This domain emphasizes difficulties with **social-emotional reciprocity**, nonverbal communicative behaviors, and developing social relationships. *Restricted, repetitive patterns of behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** also remain a core diagnostic criterion in both diagnostic systems. - This includes a range of symptoms such as **stereotyped motor movements**, insistence on sameness, and highly restricted fixated interests.

Question 167: In treating children with intellectual disabilities, one generally finds that they:

A. All of the options
B. Respond similarly to typically developing children of the same mental age (Correct Answer)
C. Respond inconsistently
D. Can be managed in ways similar to typically developing children

Explanation: ***Respond similarly to typically developing children of the same mental age*** - Children with **intellectual disabilities** often demonstrate cognitive and behavioral patterns that align with the developmental stage of neurotypical children who share their **mental age**, rather than their chronological age. - This principle is fundamental in designing **educational and therapeutic interventions**, as it suggests that learning approaches effective for younger neurotypical children can be adapted for children with intellectual disabilities at a similar developmental level. *All of the options* - This option is incorrect because not all listed statements are accurate; specifically, the idea that they respond inconsistently is a generalization that does not capture the nuanced understanding of intellectual disability. - While there are various approaches to care and education, the most accurate statement regarding their response patterns is linked to their mental age, making this overarching "all of the options" choice invalid. *Can be managed in ways similar to typically developing children* - While children with intellectual disabilities can indeed respond to structured environments and behavioral interventions, this statement is less precise than comparing their responses to their mental age. - The effectiveness of management approaches often needs to be adapted to their specific cognitive and developmental levels, which are better characterized by mental age. *Respond inconsistently* - This generalization is often inaccurate, as many children with intellectual disabilities, given appropriate support and tailored teaching methods, can demonstrate consistent learning and behavioral patterns. - Inconsistency might stem more from ill-suited interventions or environmental stressors rather than an inherent characteristic of intellectual disability itself.

Question 168: 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 169: 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 170: A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes. He passes his examination with poor marks. However, his mathematical ability and social adjustment are appropriate for his age. Which of the following is the most likely diagnosis?

A. Specific learning disability (Correct Answer)
B. Intellectual disability
C. Examination anxiety
D. Lack of interest in studies

Explanation: ***Specific learning disability*** - The boy's difficulties specifically in **writing** and **spelling** despite age-appropriate mathematical ability and social adjustment are characteristic of a **specific learning disorder**. - These disorders affect specific academic skills like **dysgraphia** (writing) or **dysorthographia** (spelling) while other cognitive functions remain intact. *Intellectual disability* - This condition involves significant limitations in **both intellectual functioning** (e.g., reasoning, problem-solving) and **adaptive behavior** (e.g., conceptual, social, practical skills). - The boy's appropriate **mathematical ability** and **social adjustment** argue against a diagnosis of intellectual disability. *Examination anxiety* - While examination anxiety can lead to poor test performance, it typically affects performance across various subjects due to **stress** and **panic**, rather than specific difficulties in writing or spelling. - It would not explain a fundamental difficulty in **expressing himself in writing** regardless of the context. *Lack of interest in studies* - Lack of interest might lead to poor academic performance, but it doesn't typically manifest as specific difficulties with **writing and spelling mechanics** while other cognitive abilities are preserved. - A student lacking interest might simply not try, but usually wouldn't have a fundamental inability to perform the task if motivated.

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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