Child and Adolescent Psychiatry — MCQs
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Development of attraction in young girls towards their father is called:
A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?
A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from
All are true about Tourette syndrome, EXCEPT :
Stimulant drugs are primarily given to children for the treatment of:
Attention deficit hyperactivity disorder is characterized by-
Coprolalia is seen in:
The hyperkinetic disorder is characterised by all, except-
A 10-year-old child has been restless, unable to sit still in class, frequently interrupting others, and unable to complete homework for the past 8 months. Teachers report similar inattentive and hyperactive behaviors at school. Academic performance has declined significantly. The parents are extremely distressed. What would you advise as the initial management?
A 10-year-old child presents with persistent restlessness, inattentiveness to studies, and a strong preference for outdoor play. The parents are highly concerned. What is the most appropriate next step in management?
Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs
Question 181: Development of attraction in young girls towards their father is called:
- A. Oedipus complex
- B. Attraction complex
- C. Electra complex (Correct Answer)
- D. There are no such attractions that exist
Explanation: ***Electra complex*** - The **Electra complex** describes a girl's psychosexual desire for her father and rivalry with her mother, according to **analytical psychology**. - This concept is considered a female counterpart to the **Oedipus complex** originally proposed by **Sigmund Freud** for male children. *Oedipus complex.* - The **Oedipus complex** refers to a boy's desire for his mother and rivalry with his father. - This term specifically applies to **males**, so it does not describe a girl's attraction to her father. *Attraction complex.* - **"Attraction complex"** is not a recognized psychological term or Freudian concept. - This option lacks a specific, established meaning within psychological theory. *There are no such attractions that exist.* - While the **validity of psychosexual developmental theories** is debated, the concept of such attractions (like the Electra complex) exists within psychological literature. - Denying the existence of these theoretical constructs is incorrect given their historical and theoretical significance in psychology.
Question 182: A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?
- A. Autism
- B. Selective mutism (Correct Answer)
- C. Expressive language disorder
- D. School phobia
Explanation: ***Selective mutism*** - This condition is characterized by a **consistent failure to speak in specific social situations** (e.g., school) despite speaking in other situations (e.g., at home with close family). - The child's **appropriate participation in class activities** and use of alternative communication methods (gestures, drawings) are typical features. *Autism* - Children with autism spectrum disorder often exhibit **deficits in social-emotional reciprocity** and may have **restricted, repetitive patterns of behavior or interests**. - While they may have communication challenges, the selective nature of the mutism and otherwise appropriate social engagement in the classroom argue against autism. *Expressive language disorder* - This disorder involves difficulty **producing spoken language**, regardless of the setting. - The fact that the child speaks normally at home suggests her expressive language abilities are intact, making this diagnosis unlikely. *School phobia* - School phobia, now often referred to as **school refusal**, is characterized by symptoms of anxiety or panic when attending or anticipating school. - While the child might be anxious, her ability to participate in class activities and communicate nonverbally suggests the primary issue is not an avoidance of school itself but a selective inability to speak.
Question 183: A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from
- A. Examination anxiety
- B. Lack of interest in studies
- C. Intellectual disability
- D. Specific learning disability (Correct Answer)
Explanation: ***Specific learning disability*** - Difficulty in expressing himself in **writing** and **frequent spelling mistakes** are hallmark features of a **specific learning disability** affecting written expression (**dysgraphia**). - These academic skill deficits are the primary presenting features and indicate a **specific learning disorder** as per DSM-5 criteria. - The inability to follow instructions and difficulty waiting for turns suggest **comorbid ADHD**, which occurs in 30-50% of children with learning disabilities. - When both conditions coexist, the **learning disability** is typically identified first in school-aged children through academic difficulties, making it the most likely primary diagnosis in this clinical scenario. *Examination anxiety* - Examination anxiety manifests as psychological distress **specifically during test situations** (nervousness, worry, physical symptoms like sweating or rapid heartbeat). - It does not explain **persistent difficulties** with writing, spelling, following instructions, or impulse control across multiple settings (school and play). - The symptoms described occur in everyday activities, not just during examinations. *Lack of interest in studies* - Lack of interest or motivation leads to **poor effort** and **disengagement**, but not to specific skill deficits like spelling mistakes or writing difficulties. - Children with low motivation can typically perform adequately when interested, unlike those with learning disabilities who struggle despite effort. - This option doesn't account for the **impulsivity** (cannot wait for turn) which suggests a neurobiological basis rather than motivational issues. *Intellectual disability* - Intellectual disability involves **global cognitive impairment** affecting all areas of functioning with IQ typically below 70. - The pattern described shows **specific deficits** in writing and spelling (academic skills) alongside behavioral regulation issues, rather than pervasive intellectual limitations. - Children with intellectual disability would show broader developmental delays across multiple domains (communication, self-care, social skills), not just circumscribed learning and behavioral difficulties.
Question 184: All are true about Tourette syndrome, EXCEPT :
- A. Motor tics
- B. Associated with OCD
- C. Neuroleptics are used in the treatment
- D. More common in females (Correct Answer)
Explanation: ***More common in females*** - **Tourette syndrome** is significantly **more common in males** than in females, with a male-to-female ratio of approximately 3-4:1. - The prevalence and severity of tics are generally higher in males. *Motor tics* - **Motor tics** are a **defining characteristic** of Tourette syndrome, encompassing a wide range of movements such as blinking, head jerking, or shoulder shrugging. - For a diagnosis of Tourette syndrome, both **multiple motor tics** and at least one vocal tic must be present. *Associated with OCD* - **Obsessive-compulsive disorder (OCD)** is a **frequently co-occurring condition** in individuals with Tourette syndrome, often more impairing than the tics themselves. - The association is thought to stem from shared underlying neurobiological mechanisms involving the **basal ganglia** and **cortico-striato-thalamo-cortical circuits**. *Neuroleptics are used in the treatment* - **Neuroleptics**, particularly **dopamine receptor blockers** (e.g., haloperidol, risperidone, aripiprazole), are often used to reduce the severity and frequency of tics in Tourette syndrome. - These medications help by modulating **dopaminergic activity** in the brain, which is implicated in tic generation.
Question 185: Stimulant drugs are primarily given to children for the treatment of:
- A. Speech developmental disorder
- B. Conduct disorder
- C. ADHD (Correct Answer)
- D. Pervasive disorder
Explanation: ***ADHD*** - Stimulant medications like **methylphenidate** and **amphetamine** are first-line treatments for attention-deficit/hyperactivity disorder (ADHD) in children. - They work by increasing the levels of **dopamine** and **norepinephrine** in the brain, improving focus and reducing impulsivity. *Speech developmental disorder* - This disorder primarily involves difficulties with **language production** or comprehension. - Treatment typically focuses on **speech therapy** and educational interventions, not stimulant medications. *Conduct disorder* - This condition involves persistent patterns of **antisocial behavior**, aggression, and violations of rules. - While therapy is the primary treatment, if there are co-occurring symptoms of ADHD, stimulants might be used to address those specific symptoms, but aren't a direct treatment for conduct disorder itself. *Pervasive disorder* - This term is an older term for what is now known as **autism spectrum disorder (ASD)**. - There is no evidence that stimulant medications are effective for the core symptoms of ASD, and they might exacerbate some behavioral symptoms.
Question 186: Attention deficit hyperactivity disorder is characterized by-
- A. Impulsivity
- B. Poor attention
- C. Hyperactivity
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Attention deficit hyperactivity disorder (ADHD)** is characterized by a persistent pattern of **inattention and/or hyperactivity-impulsivity** that interferes with functioning or development. - All three features—**impulsivity**, **inattention (poor attention)**, and **hyperactivity**—represent the core symptom domains of ADHD according to **DSM-5** criteria. - ADHD presentations can vary: **predominantly inattentive**, **predominantly hyperactive-impulsive**, or **combined presentation** (most common). **The Three Core Features:** **Impulsivity** - Acting without thinking or considering consequences - Difficulty waiting turns or delaying gratification - Interrupting or intruding on others - Making hasty decisions without forethought **Inattention (Poor Attention)** - Difficulty sustaining attention in tasks or play - Easily distracted by extraneous stimuli - Forgetfulness in daily activities - Poor organization and time management - Frequently loses things necessary for tasks **Hyperactivity** - Excessive motor activity and restlessness - Fidgeting, squirming, or inability to remain seated - Running or climbing inappropriately (in children) - Feeling internally restless (in adults) - Talking excessively *Why individual options alone are incomplete:* While each symptom domain can be prominent in different ADHD presentations, the disorder is comprehensively **characterized by all three core symptom clusters**, making "All of the options" the most accurate and complete answer.
Question 187: Coprolalia is seen in:
- A. Delirium
- B. Alcoholic intoxication
- C. Mania
- D. Tourette's syndrome (Correct Answer)
Explanation: ***Tourette's syndrome*** - **Coprolalia**, the involuntary utterance of obscene words, occurs in only **10-15%** of individuals with Tourette's syndrome, despite being commonly portrayed in popular media as a defining feature. - Tourette's syndrome is primarily characterized by **motor and vocal tics**, with coprolalia being just one possible but **uncommon vocal tic manifestation**. *Delirium* - Delirium is characterized by an **acute disturbance in attention and awareness**, often fluctuating, and is not typically associated with coprolalia. - Common symptoms include **disorientation**, perceptual disturbances like hallucinations, and agitation, but not specific vocal tics. *Alcoholic intoxication* - While alcohol intoxication can lead to disinhibition and impaired judgement, it does not specifically cause involuntary verbal tics like **coprolalia**. - Symptoms usually include **slurred speech**, ataxia, and altered mood or behavior. *Mania* - Mania is characterized by an **elevated or irritable mood**, increased energy, and goal-directed activity, sometimes with pressured speech and racing thoughts. - While speech can be rapid and expansive, it does not usually involve involuntary obscene utterances like **coprolalia**.
Question 188: The hyperkinetic disorder is characterised by all, except-
- A. Hallucinations (Correct Answer)
- B. Distractibility
- C. Impulsivity
- D. Hyperactivity
Explanation: ***Hallucinations*** - **Hallucinations** are perceptual disturbances and are not a defining characteristic of hyperkinetic disorders (also known as Attention-Deficit/Hyperactivity Disorder or ADHD). - While other psychiatric conditions can co-occur with ADHD, **hallucinations** themselves indicate a different primary diagnosis or a more complex clinical picture. *Distractibility* - **Distractibility** is a core symptom of hyperkinetic disorders, reflecting an inability to maintain focus on a single task or stimulus. - This symptom contributes significantly to impaired academic, occupational, and social functioning. *Impulsivity* - **Impulsivity** is a key feature of hyperkinetic disorders, characterized by acting without forethought or consideration of consequences. - This can manifest as blurting out answers, interrupting others, or engaging in risky behaviors. *Hyperactivity* - **Hyperactivity** is a hallmark symptom, involving excessive motor activity that is often out of proportion to the situation. - This can include fidgeting, squirming, difficulty remaining seated, and excessive talking.
Question 189: A 10-year-old child has been restless, unable to sit still in class, frequently interrupting others, and unable to complete homework for the past 8 months. Teachers report similar inattentive and hyperactive behaviors at school. Academic performance has declined significantly. The parents are extremely distressed. What would you advise as the initial management?
- A. Behaviour therapy (Correct Answer)
- B. It is a normal behaviour
- C. Needs change in environment
- D. It is a serious illness that requires medical treatment
Explanation: ***Behaviour therapy*** - The child's symptoms of **persistent restlessness**, **inattention**, **hyperactivity**, and **impulsivity** occurring in **multiple settings** (home and school) for **>6 months** with **functional impairment** (declining academic performance) meet the criteria for **Attention-Deficit/Hyperactivity Disorder (ADHD)**. - **Behavioral therapy**, including parent training and school-based interventions, is the **first-line treatment for ADHD** in children, especially for those under 12 years with mild to moderate symptoms. - Behavioral interventions include positive reinforcement, structured routines, organizational skills training, and contingency management. - According to **AAP guidelines**, behavioral therapy should be initiated before or alongside medication in school-aged children. *It is a normal behaviour* - While some level of activity and desire to play is developmentally appropriate, the **duration (8 months)**, **pervasiveness across multiple settings** (home and school), and **significant functional impairment** (academic decline) clearly distinguish this from normal childhood behavior. - Normal developmental exuberance does not cause persistent difficulties requiring teacher intervention or academic performance decline. *It is a serious illness that requires medical treatment* - ADHD is a **neurodevelopmental disorder** but **behavioral therapy is the first-line intervention** for school-aged children with ADHD before considering pharmacotherapy. - Medication (stimulants like methylphenidate or atomoxetine) is typically reserved for moderate to severe cases, or when behavioral interventions alone are insufficient. - Immediate medication without behavioral intervention is not the standard initial approach for this age group. *Needs change in environment* - While **environmental modifications** (structured routines, reduced distractions, clear expectations) are important **components of behavioral therapy**, they alone are insufficient without comprehensive behavioral intervention strategies. - A simple "change in environment" without structured therapeutic approaches and parent/teacher training will not adequately address ADHD symptoms.
Question 190: A 10-year-old child presents with persistent restlessness, inattentiveness to studies, and a strong preference for outdoor play. The parents are highly concerned. What is the most appropriate next step in management?
- A. It is a normal behaviour
- B. Needs a change in environment
- C. Comprehensive evaluation by a qualified professional (Correct Answer)
- D. It is a serious illness requiring medical treatment
Explanation: ***Comprehensive evaluation by a qualified professional*** - The combination of **persistent restlessness**, **inattentiveness to studies**, and strong preference for outdoor play at age 10 could indicate a **developmental or behavioral disorder**, such as **ADHD**. - A qualified professional (e.g., pediatrician, child psychologist, psychiatrist) can conduct a thorough evaluation to differentiate between normal childhood behavior and potential underlying conditions, and determine appropriate interventions. *It is a normal behaviour* - While many children are active and enjoy outdoor play, **persistent restlessness** and **inattentiveness affecting studies** are not always normal and can be signs of an underlying issue. - Ignoring these symptoms as entirely normal could delay necessary intervention for conditions that impact a child's development and academic performance. *Needs change in environment* - While environmental factors can influence behavior, assuming that a simple change in environment will resolve persistent restlessness and inattentiveness may overlook a **biological or neurodevelopmental component**. - Environmental changes might be part of a broader management plan, but they are unlikely to be the sole solution without a clear understanding of the root cause. *It is a serious illness requiring medical treatment* - While the symptoms could be indicative of a condition that might require medical intervention, premature labeling as a "serious illness" without an evaluation or directly jumping to medical treatment without a diagnosis is inappropriate. - The first step is always **diagnosis** to determine the presence, nature, and severity of any potential condition.
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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