Child and Adolescent Psychiatry Practice Questions

Q: A 13-year-old boy is brought by his parents with history of frequent fighting at school, disciplinary problems, stealing money, assaulting his batchmates and being weak in studies. What is the most appropriate diagnosis for this child:

Conduct disorder. ***Conduct disorder*** - This diagnosis is strongly indicated by the child's pattern of **aggressive behavior** (assaulting batchmates), **coercion/theft** (stealing money), and frequent **rule-breaking** (fighting, disciplinary problems). - These actions represent a persistent disregard for societal norms and the rights of others, characteristic of **conduct disorder** in a 13-year-old. *Attention deficit hyperactivity disorder* - While children with **ADHD** may have disciplinary problems due to impulsivity and inattention, the hallmark features of **aggression** and **theft** are not primary symptoms. - The core symptoms of ADHD are problems with **inattention, hyperactivity**, and **impulsivity**, which are not the central focus of this presentation. *Autism* - **Autism spectrum disorder** is characterized by persistent deficits in **social communication and interaction**, and **restricted, repetitive patterns of behavior**. - The described behaviors of fighting, stealing, and assaulting are not typical manifestations of autism. *Nothing abnormal (teenage phenomenon)* - While some behavioral changes are normal during adolescence, a consistent pattern of **assault, theft, and severe disciplinary problems** goes beyond normal teenage rebellion. - These behaviors indicate a significant underlying issue requiring professional intervention, not just a passing phase.

Q: Scholastic performance is impaired in all of the following, except :

PICA. ***PICA*** - Pica is an eating disorder characterized by the **compulsive consumption of non-nutritive substances** (e.g., dirt, paint, hair). - While it can be associated with developmental disorders or nutritional deficiencies, pica itself does not directly impair scholastic performance in the way neurodevelopmental or psychological conditions do. *Anxiety* - **High levels of anxiety** can significantly interfere with a student's ability to focus, concentrate, and retain information in academic settings. - Test anxiety, social anxiety, and generalized anxiety can lead to poor performance, even in individuals with strong cognitive abilities. *Specific Learning Disability (SLD)* - SLD is a **neurodevelopmental disorder** that specifically impairs learning in areas like reading (dyslexia), writing (dysgraphia), or mathematics (dyscalculia). - This directly impacts a student's ability to acquire and apply academic skills, leading to impaired scholastic performance. *Attention Deficit Hyperactivity Disorder (ADHD)* - ADHD is characterized by **persistent patterns of inattention, hyperactivity, and/or impulsivity** that interfere with functioning or development. - These core symptoms directly impact a student's ability to pay attention in class, complete assignments, and organize schoolwork, leading to impaired scholastic performance.

Q: Which of the following is not a typical core feature of hyperkinetic disorder?

Bradykinesia. ***Bradykinesia*** - **Bradykinesia**, meaning **slow movement**, is characteristic of **hypokinetic** (reduced movement) disorders, such as Parkinson's disease, not hyperkinetic disorders. - Hyperkinetic disorders, like ADHD, are defined by excessive and rapid movements, along with impulsivity and inattention. *Aggressive outburst* - **Aggressive outbursts** can be a feature of hyperkinetic disorder, particularly in children and adolescents struggling with **impulsivity** and difficulty regulating emotions. - While not a primary diagnostic criterion, it is a common behavioral comorbidity associated with the disorder. *Soft neurological signs* - **Soft neurological signs** (e.g., clumsiness, minor coordination difficulties, poor fine motor skills) are frequently observed in individuals with hyperkinetic disorder. - These signs suggest minor neurological dysfunction and are consistent with neurodevelopmental conditions like ADHD. *Decreased attention span* - A **decreased attention span** (inattention) is a core diagnostic feature of **hyperkinetic disorder** (ADHD), alongside hyperactivity and impulsivity. - Individuals struggle to sustain focus, are easily distracted, and often have difficulty completing tasks.

Q: Which of the following is not a central characteristic of childhood autism?

Callous and unemotional traits. ***Callous and unemotional traits*** - While some individuals with autism may struggle with empathy, **callous and unemotional traits** are not a core diagnostic feature of autism spectrum disorder (ASD); they are more commonly associated with conditions like **conduct disorder** or **antisocial personality disorder**. - **Emotional dysregulation** and **difficulty recognizing others' emotions** are common in autism, but this differs from a pervasive pattern of callousness. *Impaired communication* - **Impaired verbal and nonverbal communication** is a fundamental diagnostic criterion for autism spectrum disorder, ranging from absent speech to difficulties with conversations and understanding social cues. - This can manifest as problems with **initiating or maintaining conversations**, **lack of eye contact**, and **unusual tone of voice**. *Restricted, repetitive behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** are a core diagnostic feature of ASD. - Examples include **stereotyped motor movements**, **insistence on sameness**, **highly restricted or fixated interests**, and **unusual sensory sensitivities**. *Impaired social interaction* - **Persistent deficits in social communication and social interaction** across multiple contexts are defining characteristics of autism. - This includes difficulties with **social-emotional reciprocity**, **nonverbal communication**, and **developing, maintaining, and understanding relationships**.

Q: A 15-year-old boy presented with day dreaming and decline in school performance. The likely possibility is?

Typical absence seizure. ***Typical absence seizure*** - This presentation of **daydreaming** and **decline in school performance** is characteristic of typical absence seizures, which involve brief episodes of impaired consciousness without loss of postural tone. - These seizures are common in childhood and adolescence, often manifesting as staring spells that can be mistaken for inattention. *Atonic seizure* - An atonic seizure involves a **sudden loss of muscle tone**, leading to a sudden drop or fall, which is not described here. - While it can cause brief loss of consciousness, the primary feature is the motor event. *Myoclonic seizure* - Myoclonic seizures are characterized by **sudden, brief, jerking movements** of a muscle or muscle group. - They are typically very brief and do not involve the sustained staring spell or impaired awareness described. *Atypical absence seizure* - Atypical absence seizures have a **more gradual onset and offset** than typical absence seizures, and may be associated with more noticeable motor signs and less complete loss of awareness. - Daydreaming and decline in school performance are classic for typical, not atypical, absence seizures.

Q: A child is not eating vegetables. His mother starts giving a chocolate each time he finishes vegetables in the diet. This method comes under which of the following?

Operant conditioning. ***Operant conditioning*** - This is a type of learning in which a **behavior is strengthened (or weakened)** by the consequence that follows. - Giving a chocolate (a **positive reinforcement**) after eating vegetables increases the likelihood that the child will eat vegetables again. *Social training* - This broadly refers to teaching appropriate social behaviors and norms, often through observation and instruction. - While the interaction occurs in a social context, the specific mechanism described (reward for a behavior) fits more precisely into operant conditioning. *Negative reinforcement* - This involves the **removal of an aversive stimulus** to increase a behavior. - For example, if a child eats vegetables to *stop* nagging, that would be negative reinforcement; receiving a desirable item like chocolate is positive. *Classical conditioning* - This involves associating a **neutral stimulus with an unconditioned stimulus** to elicit a conditioned response. - An example would be if a bell (neutral stimulus) was rung every time food was presented (unconditioned stimulus), eventually the bell alone would make the child salivate (conditioned response).

Q: Kaspar Hauser syndrome is due to:

Psychosocial causes. ***Psychosocial causes*** - **Kaspar Hauser Syndrome** refers to growth failure, particularly in children under 3 years old, caused by severe psychosocial deprivation and emotional neglect. - While these children may present with symptoms such as **short stature, delayed bone age, and poor appetite**, these are secondary to the severe emotional and social stressors they experience. *Growth hormone insensitivity* - **Growth hormone insensitivity** (Laron syndrome) results from a defect in the growth hormone receptor, leading to **low IGF-1 levels** despite normal or high growth hormone levels. - This condition is primarily genetic and not attributed to environmental or psychosocial factors. *Growth hormone deficiency* - **Growth hormone deficiency** is a medical condition where the body does not produce enough growth hormone, leading to short stature and delayed development. - While it directly causes growth failure, it is a primary endocrine disorder, not linked to the psychosocial deprivation seen in Kaspar Hauser syndrome. *Constitutional delayed growth* - **Constitutional delayed growth** is a common variant of normal growth pattern where a child is shorter than average but follows a normal growth curve after a slow start. - This is a benign condition and does not involve severe psychosocial deprivation; children eventually catch up to normal adult height.

Q: Best therapy suited to teach daily life skills to a child with intellectual disability:

Applied Behavior Analysis (ABA). **Applied Behavior Analysis (ABA)** - **ABA** is a highly structured, evidence-based therapy that focuses on teaching specific skills by breaking them down into smaller steps and using **positive reinforcement**. - It is particularly effective for children with intellectual disabilities in acquiring **adaptive daily living skills**, communication, and social behaviors. *Cognitive Behavioral Therapy (CBT)* - **CBT** primarily targets changing negative thought patterns and behaviors, requiring a level of abstract reasoning that may be challenging for children with significant intellectual disabilities. - While it can be adapted, its core methods rely on cognitive processes that might not be the most direct approach for teaching basic daily life skills to a mentally challenged child. *Social skills training* - **Social skills training** focuses specifically on improving social interactions and communication within social contexts. - While important for overall development, it is a subcomponent of broader skill development and may not directly address all aspects of **daily living skills** in a comprehensive manner. *Self-instructional training* - **Self-instructional training** involves teaching individuals to guide themselves through tasks using internal speech or self-talk, which relies on a child's ability to internalize and follow complex verbal instructions. - This approach might be too cognitively demanding for a child with significant developmental delays when the primary goal is mastering basic, functional daily life skills.

Q: A 6-year-old boy is observed to be peculiar by his teacher. Children attempt to play with him but his response is to either ignore them or get angry at their advances. This response in someone with autism might best be described as which of the following?

Lack of social reciprocity. ***Lack of social reciprocity*** - This describes the **difficulty in engaging in the give-and-take of social interaction**, where an individual struggles to respond appropriately to social cues or initiations from others. - The boy's actions of ignoring or getting angry at children's advances directly reflect a fundamental challenge in **reciprocal social communication**, a core diagnostic criterion for autism spectrum disorder. *Obsessional thinking* - This refers to **recurrent and persistent thoughts, urges, or images** that are intrusive and unwanted, which is a key feature of obsessive-compulsive disorder. - While individuals with autism may have **restricted interests or repetitive behaviors**, this option does not directly explain the observed social interaction difficulties. *Stereotyped behavior* - This involves **repetitive motor movements, use of objects, or speech** (e.g., hand flapping, rigid adherence to routines), which is a common characteristic of autism. - While a feature of autism, it doesn't specifically address the **social interaction component** of ignoring or reacting angrily to peers. *Poor language development* - This refers to delays or deficits in the acquisition and use of receptive or expressive language, manifesting as difficulty with vocabulary, grammar, or forming sentences. - While **communication deficits** are common in autism, the scenario specifically highlights difficulties in **social interaction**, not primarily the *structure* or *comprehension* of language itself.

Q: A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?

Autism Spectrum Disorder. ***Autism Spectrum Disorder*** - The child's delayed speech, **restricted interests** (spinning objects), lack of social engagement, and difficulty interacting with other children are classic symptoms of **Autism Spectrum Disorder (ASD)**. - Normal developmental milestones in other areas, such as motor skills, differentiate ASD from global developmental delays. - The **triad of impairments** includes social communication deficits, restricted interests, and repetitive behaviors, all evident in this case. *Specific learning disability* - This diagnosis typically presents with difficulties in specific academic areas like reading, writing, or math in a child with otherwise average intelligence. - It is generally diagnosed after school entry (age 6-7 years) when academic demands increase. - It doesn't explain the **social communication deficits** and **restricted, repetitive behaviors** seen in this case. *Intellectual disability* - This condition involves significant limitations in both intellectual functioning and adaptive behavior, with onset during the developmental period. - While delayed speech can be a feature, the child's otherwise **normal developmental milestones** in motor and other domains argue against a global intellectual deficit. - The **restricted interests** and social deficits are more characteristic of ASD than intellectual disability alone. *Sibling Rivalry* - This refers to competition or animosity between siblings, often manifesting as behavioral problems or attention-seeking from parents. - It is a normal developmental phenomenon, not a psychiatric disorder. - It does not account for the core symptoms described, such as **delayed speech**, **restricted interests** (fascination with spinning objects), or a pervasive disinterest in social interaction.

Question 1

A 13-year-old boy is brought by his parents with history of frequent fighting at school, disciplinary problems, stealing money, assaulting his batchmates and being weak in studies. What is the most appropriate diagnosis for this child:

Accepted Answer

Conduct disorder

Answer

Attention deficit hyperactivity disorder

Answer

Autism

Answer

Nothing abnormal (teenage phenomenon)

Question 2

Scholastic performance is impaired in all of the following, except :

Accepted Answer

PICA

Answer

Anxiety

Answer

Specific Learning Disability (SLD)

Answer

Attention Deficit Hyperactivity Disorder (ADHD)

Question 3

Which of the following is not a typical core feature of hyperkinetic disorder?

Accepted Answer

Bradykinesia

Answer

Aggressive outburst

Answer

Soft neurological signs

Answer

Decreased attention span

Question 4

Which of the following is not a central characteristic of childhood autism?

Accepted Answer

Callous and unemotional traits

Answer

Impaired communication

Answer

Restricted, repetitive behaviour

Answer

Impaired social interaction

Question 5

A 15-year-old boy presented with day dreaming and decline in school performance. The likely possibility is?

Accepted Answer

Typical absence seizure

Answer

Atonic seizure

Answer

Myoclonic seizure

Answer

Atypical absence seizure

Question 6

A child is not eating vegetables. His mother starts giving a chocolate each time he finishes vegetables in the diet. This method comes under which of the following?

Accepted Answer

Operant conditioning

Answer

Social training

Answer

Negative reinforcement

Answer

Classical conditioning

Question 7

Kaspar Hauser syndrome is due to:

Accepted Answer

Psychosocial causes

Answer

Growth hormone insensitivity

Answer

Growth hormone deficiency

Answer

Constitutional delayed growth

Question 8

Best therapy suited to teach daily life skills to a child with intellectual disability:

Accepted Answer

Applied Behavior Analysis (ABA)

Answer

Cognitive Behavioral Therapy (CBT)

Answer

Social skills training

Answer

Self-instructional training

Question 9

A 6-year-old boy is observed to be peculiar by his teacher. Children attempt to play with him but his response is to either ignore them or get angry at their advances. This response in someone with autism might best be described as which of the following?

Accepted Answer

Lack of social reciprocity

Answer

Obsessional thinking

Answer

Stereotyped behavior

Answer

Poor language development

Question 10

A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?

Accepted Answer

Autism Spectrum Disorder

Answer

Specific learning disability

Answer

Intellectual disability

Answer

Sibling Rivalry

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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