Child and Adolescent Psychiatry — MCQs

A 2.5 year old boy is brought by the parents because of the concern that he is not developing appropriately. Child often is unable to engage with others using eye contact and does not play with other children. He continuously bangs his head against the wall and remains confined to himself most of the time. What is the most likely diagnosis?

Q206

Asperger's syndrome is a -

Q207

A child finds difficulty in spelling and reading, otherwise their IQ is normal, interacts well with parents and friends. Vision is normal. What is the most probable diagnosis of the condition?

Q208

Which is not a feature of ADHD?

Q209

An adolescent school girl complains of dropping objects from hands, it gets precipitated during morning and during exams. There is no history of loss of consciousness and her cousin sister has been diagnosed with epilepsy. EEG was suggestive of epileptic spikes. What is the diagnosis?

Q210

Which of the following is a criterion for diagnosing Autism Spectrum Disorder?

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 201: Best therapy suited to teach daily life skill to a mentally challenged child:

A. Contingency management (Correct Answer)
B. Cognitive reconstruction
C. Self instruction
D. CBT (Cognitive behavior therapy)

Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.

Question 202: All are feature of Autistic disorder EXCEPT:

A. Usually appears by 2-3 years of age
B. Co-occurring intellectual disability in majority of cases
C. Absent social smile
D. Third person hallucination (Correct Answer)

Explanation: ***Third person hallucination*** - **Third-person hallucinations** are a feature of psychotic disorders like **schizophrenia**, where a patient hears voices discussing them in the third person. - They are **not a diagnostic criterion** for **Autistic Disorder**, which primarily involves deficits in social communication and restricted, repetitive behaviors. *Usually appears by 2-3 years of age* - The onset of **Autistic Disorder** is typically identified in early childhood, often becoming apparent between **12 and 24 months of age**, or by 2-3 years, as key developmental milestones are missed or behaviors emerge. - Parents may notice delays in **language development**, lack of social interaction, or unusual play patterns during this period. *Co-occurring intellectual disability in majority of cases* - A significant proportion of individuals diagnosed with **Autistic Spectrum Disorder** have co-occurring **intellectual disability** (intellectual developmental disorder). - Current estimates suggest approximately **30-40%** of individuals with autism have intellectual disability, though this varies depending on diagnostic criteria and population studied. - Many individuals with autism have **average or above-average intelligence**, and some demonstrate exceptional abilities in specific domains. *Absent social smile* - An **absent or delayed social smile** can be an early indicator of **Autistic Disorder**, as it reflects a lack of reciprocal social interaction. - Difficulty engaging in **joint attention** and responding to social cues are core features of the disorder, and lack of social smiling is an early manifestation.

Question 203: Infantile autism is characterized by -

A. Impaired Neurobehavioural development (Correct Answer)
B. Impaired folate level
C. Impaired vision
D. All of the options

Explanation: ***Impaired Neurobehavioural development*** - **Infantile autism**, now referred to as **Autism Spectrum Disorder (ASD)**, is fundamentally characterized by significant impairments in **social interaction**, **communication**, and the presence of **restricted, repetitive patterns of behavior, interests, or activities**. These are core neurobehavioral deficits. - These impairments manifest early in development and significantly impact a child's ability to learn, play, and form relationships, highlighting compromised neurobehavioral development. *Impaired folate level* - While some research has explored the role of **folate metabolism** in ASD, a primary diagnostic criterion or universal characteristic of infantile autism is not an impaired folate level. - Folate deficiency is not a direct cause or defining feature of the neurodevelopmental pathology of autism, though nutritional factors can influence overall health. *Impaired vision* - **Impaired vision** is not a characteristic feature or diagnostic criterion for infantile autism. Children with ASD typically have normal vision, although some may have sensory sensitivities impacting their visual processing. - Visual deficits, when present in children with ASD, are usually co-occurring conditions rather than a direct component of the autism diagnosis itself. *All of the options* - This option is incorrect because while **impaired neurobehavioral development** is central to autism, **impaired folate levels** and **impaired vision** are not universal or defining characteristics. - The core diagnostic criteria for ASD focus on social communication deficits and restricted behaviors, not on these specific biological markers or sensory deficits.

Question 204: A 3-year-old child with delayed speech development, prefers to play alone and is not making friends. The likely diagnosis is

A. Autism (Correct Answer)
B. Specific learning disability
C. Rett's syndrome
D. ADHD

Explanation: ***Autism*** - **Delayed speech development**, a preference for playing alone, and difficulty making friends are classic diagnostic criteria for **Autism Spectrum Disorder (ASD)**. - ASD is characterized by persistent deficits in **social communication and social interaction** across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities. *Specific learning disability* - A specific learning disability primarily affects academic skills (e.g., **reading, writing, arithmetic**) in individuals with otherwise average intelligence. - While it can impact social interactions due to frustration or self-esteem issues, its core features are not primarily related to delayed speech or intrinsic difficulties in social engagement. *Rett's syndrome* - Rett's syndrome is a rare **neurodevelopmental disorder** that almost exclusively affects females and is caused by mutations in the MECP2 gene. - It is characterized by initial normal development followed by a regression of skills, including **purposeful hand movements**, speech, and gait, often presenting with stereotypic hand-wringing. - The clinical presentation here shows early developmental concerns without regression, making ASD more likely. *ADHD* - **Attention-deficit/hyperactivity disorder (ADHD)** is characterized by symptoms of **inattention, hyperactivity, and impulsivity**. - While children with ADHD may have difficulty with social interactions due to impulsivity or inattention, delayed speech development and a consistent preference for solitary play are not primary diagnostic features.

Question 205: A 2.5 year old boy is brought by the parents because of the concern that he is not developing appropriately. Child often is unable to engage with others using eye contact and does not play with other children. He continuously bangs his head against the wall and remains confined to himself most of the time. What is the most likely diagnosis?

A. Conduct disorder
B. Social phobia
C. Autism (Correct Answer)
D. ADHD

Explanation: ***Autism*** - The child's lack of **eye contact**, inability to **play with other children**, and repetitive self-stimulatory behavior (banging head) are classic signs of **autism spectrum disorder (ASD)**. - ASD is characterized by persistent deficits in **social communication** and **social interaction** across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities. *Conduct disorder* - Characterized by a repetitive and persistent pattern of behavior in which the **basic rights of others** or major age-appropriate **societal norms or rules are violated**. - Symptoms include aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules, which are not described in this case. *Social phobia* - Involves an intense, persistent fear of social or performance situations where the individual fears **embarrassment** or **humiliation**. - While there is social avoidance, it is driven by fear of negative evaluation rather than a fundamental inability to engage socially or repetitive behaviors. *ADHD* - Primarily defined by persistent patterns of **inattention** and/or **hyperactivity-impulsivity** that interfere with functioning or development. - While children with ADHD may have social difficulties, the core symptoms of lack of eye contact, repetitive behaviors, and profound social engagement deficits are not typical of ADHD.

Question 206: Asperger's syndrome is a -

A. Metabolic disorder
B. Developmental delay (Correct Answer)
C. Neuromuscular disease
D. Degenerative disorder

Explanation: **Developmental delay** - Asperger's syndrome, now considered part of **autism spectrum disorder (ASD)**, is characterized by significant difficulties in **social interaction** and nonverbal communication, alongside restricted and repetitive patterns of behavior, interests, and activities. - These characteristics manifest as a **developmental delay** in social and emotional milestones, though language development is typically unimpaired. *Metabolic disorder* - A **metabolic disorder** involves problems with chemical reactions in the body that break down food, produce energy, or eliminate waste products. - Asperger's syndrome is a **neurodevelopmental condition**, not an issue of metabolic dysfunction, and does not involve errors in metabolism. *Neuromuscular disease* - A **neuromuscular disease** affects the nerves that control voluntary muscles or the muscles themselves, leading to problems with movement, balance, and coordination. - Asperger's syndrome primarily affects **social communication and behavior**, with motor deficits being secondary or co-occurring rather than defining the primary diagnosis. *Degenerative disorder* - A **degenerative disorder** involves the progressive breakdown or loss of function of cells, tissues, or organs over time, often related to aging or disease processes. - Asperger's syndrome is a **lifelong neurodevelopmental condition** present from early childhood, not a progressive deterioration of neurological function.

Question 207: A child finds difficulty in spelling and reading, otherwise their IQ is normal, interacts well with parents and friends. Vision is normal. What is the most probable diagnosis of the condition?

A. ADHD
B. Autism
C. Asperger syndrome
D. Dyslexia (Correct Answer)

Explanation: ***Dyslexia*** - This condition is characterized by **difficulties with accurate and/or fluent word recognition** and poor spelling and decoding abilities despite normal intelligence and adequate educational opportunities. - The child's **normal IQ** and good social interaction, coupled with specific issues in spelling and reading, strongly indicate dyslexia. *ADHD* - **Attention Deficit Hyperactivity Disorder** primarily presents with persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. - While academic difficulties can occur, the primary presenting problem is usually not confined to reading and spelling but rather a broader difficulty in attention or impulse control. *Autism* - **Autism Spectrum Disorder** is characterized by persistent deficits in social communication and social interaction across multiple contexts, and restricted, repetitive patterns of behavior, interests, or activities. - The child's ability to **interact well with parents and friends** makes autism an unlikely diagnosis, as deficits in social reciprocity are a hallmark feature. *Asperger syndrome* - Formerly a distinct diagnosis, **Asperger syndrome** is now considered part of the Autism Spectrum Disorder. Like autism, it involves difficulties in social interaction and communication. - Despite often having normal or above-average intelligence, individuals with Asperger syndrome typically exhibit **significant social awkwardness** and repetitive behaviors, which are not described in the child's presentation.

Question 208: Which is not a feature of ADHD?

A. Impulsiveness
B. Hyperactivity
C. Dyslexia (Correct Answer)
D. Inattention

Explanation: ***Dyslexia*** - While individuals with **ADHD** may have comorbid learning disabilities, **dyslexia** itself is a specific learning disorder primarily characterized by difficulties with accurate and/or fluent word recognition, and poor spelling and decoding abilities, not a core feature of ADHD. - Dyslexia can occur alongside ADHD, but it is a distinct condition with its own diagnostic criteria and is not considered a symptom or feature of ADHD. *Impulsiveness* - **Impulsiveness** is a core diagnostic criterion for ADHD, particularly in the **hyperactive-impulsive presentation**, where individuals often act without thinking or have difficulty awaiting their turn. - This can manifest as blurting out answers, interrupting others, or engaging in risky behaviors. *Hyperactivity* - **Hyperactivity** is a hallmark symptom of ADHD, especially in childhood, and is reflected in excessive motor activity, fidgeting, restlessness, and difficulty staying seated. - This symptom can persist into adulthood, although it may present as an internal sense of restlessness rather than overt physical movement. *Inattention* - **Inattention** is a primary diagnostic feature of ADHD, characterized by difficulty sustaining attention, easily being distracted, making careless mistakes, and problems with organization. - This aspect of ADHD can significantly impair academic, occupational, and social functioning.

Question 209: An adolescent school girl complains of dropping objects from hands, it gets precipitated during morning and during exams. There is no history of loss of consciousness and her cousin sister has been diagnosed with epilepsy. EEG was suggestive of epileptic spikes. What is the diagnosis?

A. Juvenile myoclonic epilepsy (Correct Answer)
B. Benign rolandic epilepsy
C. Atypical absence
D. Choreo-athetoid epilepsy

Explanation: ***Juvenile myoclonic epilepsy*** - This diagnosis is supported by the patient's age (adolescent), the **myoclonic jerks** (dropping objects), precipitation in the morning or with stress (exams), and a family history of epilepsy. - The **EEG showing epileptic spikes** further confirms the diagnosis, as **polyspike-wave discharges** are characteristic. *Benign rolandic epilepsy* - Typically presents with **nocturnal seizures** involving facial and pharyngeal muscles, often with speech arrest and salivation. - While it occurs in childhood, it is usually outgrown by adolescence and does not typically manifest as dropping objects or with morning precipitation. *Atypical absence* - Characterized by **brief staring spells with altered consciousness**, but usually with more pronounced motor phenomena than typical absence seizures. - However, the prominent myoclonic jerks and the familial history described here are more consistent with JME. *Choreo-athetoid epilepsy* - This is not a recognized epilepsy syndrome; choreoathetosis refers to a type of **movement disorder** characterized by involuntary, jerky, writhing movements. - While movement disorders can be associated with some forms of epilepsy, the primary presentation described does not fit this classification.

Question 210: Which of the following is a criterion for diagnosing Autism Spectrum Disorder?

A. Abnormalities in socialization
B. Abnormalities in language development
C. Cognitive dysfunction
D. Restricted patterns of behavior & interest (Correct Answer)

Explanation: ***Restricted patterns of behavior & interest*** - This is one of the **two core diagnostic criteria** for Autism Spectrum Disorder (ASD) according to DSM-5, specifically addressing **Domain B** of the diagnostic criteria. - These patterns include **stereotyped or repetitive motor movements, use of objects, or speech**, insistence on sameness, highly **restricted and fixated interests** that are abnormal in intensity or focus, and **hyper- or hyporeactivity to sensory input** or unusual interest in sensory aspects of the environment. - This is a **mandatory diagnostic requirement** along with deficits in social communication and interaction. *Abnormalities in socialization* - While deficits in **social communication and social interaction** are indeed the other core diagnostic criterion (**Domain A** in DSM-5), this option as phrased is less specific. - The DSM-5 specifically requires deficits across multiple contexts: **social-emotional reciprocity**, **nonverbal communicative behaviors** used for social interaction, and **developing, maintaining, and understanding relationships**. - Both social deficits and restricted/repetitive behaviors are required for ASD diagnosis, making both fundamental criteria. *Abnormalities in language development* - In DSM-5, **language delay is no longer a separate diagnostic criterion** for ASD as it was in previous editions. - Communication deficits in ASD are now conceptualized specifically as deficits in **social communication**, not general language development. - Language abnormalities may be present but are not required for diagnosis, and many individuals with ASD have age-appropriate formal language skills. *Cognitive dysfunction* - **Intellectual disability is NOT a diagnostic criterion** for ASD, though it may co-occur in some individuals. - ASD is diagnosed based on **behavioral and developmental characteristics** in social communication and restricted/repetitive behaviors, independent of cognitive level. - Individuals with ASD can have intellectual abilities ranging from intellectual disability to above-average intelligence.

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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