Child and Adolescent Psychiatry Practice Questions

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

Conduct disorder. ***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.

Q: 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. ***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.

Q: Which of the following is not seen in autism?

Abnormal dermatoglyphics. ***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.

Q: 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?

Oppositional defiant disorder. **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.

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

Disturbances of communication. ***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.

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

Down Syndrome. ***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.

Q: Autism is characterized by all except -

Depression. ***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.

Q: 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?

Specific learning disability. ***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.

Question 1

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

Accepted Answer

Conduct disorder

Answer

Selective mutism

Answer

Binge eating disorder

Answer

Separation anxiety disorder

Question 2

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:

Accepted Answer

Autism

Answer

ADHD

Answer

Depression

Answer

Bipolar disorder

Question 3

Which of the following is not seen in autism?

Accepted Answer

Abnormal dermatoglyphics

Answer

1/3rd patients have intellectual disability

Answer

Poor eye contact

Answer

Language is impaired

Question 4

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?

Accepted Answer

Oppositional defiant disorder

Answer

Conduct disorder

Answer

Autism spectrum disorder

Answer

Attention deficit hyperactivity disorder

Question 5

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:

Accepted Answer

An autistic child

Answer

A child with intellectual disability

Answer

First dental appointment anxieties of a 4 year old child

Answer

A child with a chronic seizure disorder

Question 6

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

Accepted Answer

Disturbances of communication

Answer

Disturbances of intellectual development

Answer

Disturbance of social interaction

Answer

Restricted, repetitive patterns of behaviour

Question 7

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

Accepted Answer

Respond similarly to typically developing children of the same mental age

Answer

All of the options

Answer

Respond inconsistently

Answer

Can be managed in ways similar to typically developing children

Question 8

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

Accepted Answer

Down Syndrome

Answer

Childhood Disintegrative Disorder

Answer

Asperger Syndrome

Answer

Rett Syndrome

Question 9

Autism is characterized by all except -

Accepted Answer

Depression

Answer

Language problems

Answer

Stereotyped behavior

Answer

Lack of social play in child

Question 10

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?

Accepted Answer

Specific learning disability

Answer

Intellectual disability

Answer

Examination anxiety

Answer

Lack of interest in studies

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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