Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 221: A 10-year-old child has a mental age of 4 years. How is this condition classified?

A. Severe intellectual disability
B. Moderate intellectual disability (Correct Answer)
C. No intellectual disability
D. Above average intelligence

Explanation: ***Moderate intellectual disability*** - A 10-year-old child with a **mental age of 4 years** has an **IQ of 40** (mental age/chronological age * 100), which falls within the range for **moderate intellectual disability** (IQ 35-49). - Individuals with moderate intellectual disability often require considerable support in daily life and may have limited academic progress beyond the second-grade level. *Severe intellectual disability* - This classification applies to individuals with an **IQ typically below 35**, which is lower than calculated for this child. - People with severe intellectual disability typically require **extensive support** in all areas of functioning. *No intellectual disability* - This would be incorrect as the child's mental age is significantly lower than their chronological age, indicating a **significant developmental delay**. - No intellectual disability implies an IQ of 70 or above, which is not the case here. *Above average intelligence* - This is incorrect; the child's mental age is **significantly below their chronological age**, indicating intellectual impairment, not enhanced cognitive abilities. - Above-average intelligence would imply a mental age greater than or equal to their chronological age, and typically an **IQ above 110**.

Question 222: What are the homes called where children are placed under the care of doctors and psychiatrists?

A. Foster care homes
B. Youth detention centers
C. Child mental health clinics
D. Residential treatment facilities (Correct Answer)

Explanation: ***Residential treatment facilities*** - These facilities provide structured, live-in therapeutic environments where children and adolescents receive comprehensive psychiatric and medical care. - They are staffed by a multidisciplinary team including **psychiatrists**, psychologists, social workers, and nurses. *Foster care homes* - Foster care involves placing children with temporary families, usually due to neglect or abuse, focusing on a family-like setting rather than intensive medical or psychiatric care. - While foster children may receive mental health services, the homes themselves are not clinical environments. *Youth detention centers* - These facilities are for children and adolescents who have committed crimes and are awaiting trial or serving sentences. - While mental health services may be provided, their primary purpose is correctional, not therapeutic. *Child mental health clinics* - These clinics offer outpatient services, including diagnosis, therapy, and medication management, but do not provide residential care. - Children attend appointments and then return home, unlike the live-in care provided in residential facilities.

Question 223: A 10-year-old child presents with symptoms of hyperactivity and inattention. How should the parents be advised regarding potential treatment options?

A. Medical evaluation and possible medication may be necessary. (Correct Answer)
B. This behavior is typical for children of this age.
C. Consider behavioral therapy as a first step.
D. Adjusting the child's environment may help.

Explanation: ***Medical evaluation and possible medication may be necessary*** - **Medical evaluation is essential** to properly diagnose ADHD and rule out other conditions causing hyperactivity and inattention symptoms - For a **10-year-old child** (school-age), current guidelines support **pharmacological treatment** as first-line therapy, either alone or in combination with behavioral interventions - **Methylphenidate** and other stimulants have strong evidence for efficacy in school-age children with ADHD - Parents should be advised that proper diagnosis through medical evaluation is the first step, followed by evidence-based treatment which may include medication, behavioral therapy, or both depending on severity *Consider behavioral therapy as a first step* - While behavioral therapy is an important component of ADHD management, it should not delay or replace medical evaluation - For school-age children with ADHD, behavioral therapy alone may be insufficient, especially for moderate to severe symptoms - Current **AAP guidelines** recommend medication as first-line for children 6+ years, with behavioral therapy as an adjunct or for mild cases - This option assumes a diagnosis has already been made, which is premature when the child is just "presenting with symptoms" *This behavior is typical for children of this age* - While some activity and inattention is developmentally normal, persistent and significant symptoms that impair functioning require evaluation - Dismissing these symptoms as "typical" could delay diagnosis and intervention for **ADHD** - A proper assessment is needed to distinguish normal developmental variation from a clinical disorder *Adjusting the child's environment may help* - Environmental modifications (structured routines, reduced distractions) are helpful adjuncts to treatment - However, these alone are typically insufficient for managing clinically significant ADHD symptoms - Environmental adjustments should be part of a comprehensive treatment plan that includes proper medical evaluation and evidence-based interventions

Question 224: Which of the following is a CORE diagnostic criterion of autistic spectrum disorder according to DSM-5?

A. Impaired communication (Correct Answer)
B. Impaired imagination
C. Language developmental delay
D. Vision problems

Explanation: ***Impaired communication*** - Deficits in **social communication and social interaction** are one of the two core diagnostic criteria for Autism Spectrum Disorder (ASD) in DSM-5. - This includes deficits in social-emotional reciprocity, nonverbal communicative behaviors, and developing/maintaining relationships. - Communication impairments are essential for diagnosis and must be present across multiple contexts. *Impaired imagination* - While restricted, repetitive patterns of behavior (which can include rigid thinking patterns) are the second core criterion, "impaired imagination" is not specifically listed as a core diagnostic criterion in DSM-5. - Imaginative play deficits may be present but fall under the broader category of restricted/repetitive behaviors, not as a standalone core criterion. *Language developmental delay* - Language delay is **not a core diagnostic criterion** in DSM-5 for ASD. - DSM-5 explicitly states that ASD can occur with or without accompanying language impairment. - When present, language delay is noted as a specifier, not a required criterion. *Vision problems* - Vision problems are not a characteristic feature of Autism Spectrum Disorder. - Any vision issues in individuals with ASD are co-occurring conditions unrelated to the core diagnostic features.

Question 225: Which of the following is commonly associated with encopresis?

A. Low socioeconomic status
B. Child with developmental delays (Correct Answer)
C. History of trauma
D. Severe emotional disturbances

Explanation: ***Child with developmental delays*** - **Developmental delays** are strongly associated with encopresis, including intellectual disability, autism spectrum disorder, and other neurodevelopmental conditions. - These children often have **delayed toilet training**, reduced awareness of bowel sensations, and difficulty establishing regular bowel habits. - **Chronic constipation** is more common in developmentally delayed children due to reduced mobility, dietary issues, and behavioral factors. - Encopresis in this population is often **secondary to functional constipation** with overflow incontinence. *History of trauma* - While trauma (physical or sexual abuse) can be associated with encopresis in some cases, it is **not the most common association**. - Trauma may lead to psychological distress and toileting avoidance, but represents a **minority of encopresis cases**. - Most cases of encopresis are related to **chronic constipation** rather than psychological trauma. *Low socioeconomic status* - Socioeconomic factors are **indirect associations** that may affect access to healthcare and early intervention. - Not a direct or primary cause of encopresis itself. - Lower priority compared to developmental and physiological factors. *Severe emotional disturbances* - Emotional disturbances can be **both a cause and consequence** of encopresis, but are not the most common association. - Often develop as a **secondary effect** due to social stigma, embarrassment, and punishment related to soiling. - Primary encopresis (never achieved continence) vs. secondary encopresis (loss of continence) may have different psychological profiles.

Question 226: Characterized by chronic, multiple tics, what is the condition?

A. Parkinson's disease
B. Wilson's disease
C. Shy-Drager syndrome
D. Tourette's syndrome (Correct Answer)

Explanation: ***Tourette's syndrome*** - This syndrome is defined by **multiple motor tics** and at least one **vocal tic** that persist for more than one year. - Tics in Tourette's syndrome are typically **sudden**, rapid, recurrent, nonrhythmic **movements** or vocalizations. *Parkinson's disease* - Characterized by **tremor at rest**, **bradykinesia**, **rigidity**, and postural instability. - While it involves movement disorders, it does not typically present with the characteristic tics seen in Tourette's. *Wilson's disease* - An **autosomal recessive disorder** causing excessive copper accumulation in the liver, brain, and other organs. - Manifestations include **hepatic dysfunction**, neurologic symptoms like **tremor** and **dystonia**, and **Kayser-Fleischer rings**, not tics. *Shy-Drager syndrome* - This is an older term for **multiple system atrophy (MSA)**, a progressive neurodegenerative disorder. - It primarily affects the **autonomic nervous system**, leading to **orthostatic hypotension**, cerebellar ataxia, and parkinsonism, but not tics.

Question 227: Minimal brain dysfunction (a historical term from the 1960s-70s) is most commonly associated with which of the following conditions?

A. Down's syndrome
B. Attention Deficit Hyperactivity Disorder (ADHD) (Correct Answer)
C. Learning Disabilities
D. Autism Spectrum Disorder

Explanation: ***Attention Deficit Hyperactivity Disorder (ADHD)*** - **Minimal brain dysfunction (MBD)** was an older, broad diagnostic term for a constellation of neurological impairments, with attention and behavioral issues forming a significant part. - The symptoms described as MBD, particularly problems with **attention, impulsivity, and hyperactivity**, overlap significantly with the modern diagnostic criteria for ADHD. *Learning Disabilities* - While **learning disabilities** were sometimes considered under the umbrella of MBD, the term primarily focused on difficulties with attention and behavior, not exclusively on academic skill deficits. - Learning disabilities specifically describe difficulties in acquiring and using listening, speaking, reading, writing, reasoning, or mathematical abilities. *Down's syndrome* - **Down's syndrome** is a genetic disorder caused by an extra copy of chromosome 21, leading to distinct physical features and intellectual disability. - This condition has a clear genetic etiology and distinct clinical features that do not align with the historical concept of **minimal brain dysfunction**. *Autism Spectrum Disorder* - **Autism Spectrum Disorder (ASD)** is characterized by persistent deficits in social communication and interaction, and restricted, repetitive patterns of behavior, interests, or activities. - While MBD was a broad term, the core diagnostic features of ASD are distinct from the primary focus of hyperactivity and inattention that defined much of what was once called MBD.

Question 228: A 6-year-old child who does not communicate well, has slow mental and physical growth, does not interact with people, has limited interests, and becomes easily agitated if disturbed, is diagnosed with which of the following?

A. Hyperkinetic child
B. Autistic Disorder (Correct Answer)
C. Mixed Receptive-Expressive Language Disorder
D. Attention Deficit Disorder

Explanation: ***Autistic Disorder*** - The constellation of symptoms including **poor communication**, **limited social interaction**, **restricted interests**, and **agitation upon disturbance** are hallmark features of **Autistic Disorder**. - **Slow mental and physical growth** can be associated, though not a diagnostic criterion, further supporting a pervasive developmental disorder. *Hyperkinetic child* - This term is often used synonymously with **Attention-Deficit/Hyperactivity Disorder (ADHD)**, which primarily involves issues with **inattention, hyperactivity, and impulsivity**. - While agitation can occur, the central features of **social and communication deficits** and **restricted interests** are not typical of hyperkinetic disorder. *Attention Deficit Disorder* - **Attention Deficit Disorder (ADD)**, now often referred to as **ADHD predominantly inattentive presentation**, is characterized by difficulties with **focus, organization, and attention**. - It does not typically present with severe deficits in **social interaction**, **communication**, or the presence of **restricted, repetitive behaviors** as described. *Mixed Receptive -Expressive Language Disorder* - This disorder is specifically characterized by difficulties in both **understanding (receptive)** and **producing (expressive) language**. - While the child does not communicate well, the additional symptoms of **poor social interaction**, **limited interests**, and **agitation to change** are not explained solely by a language disorder.

Question 229: All of the following are used to improve attention deficit in children, except which of the following?

A. Cognitive enhancement therapy
B. Cognitive behavioral therapy
C. Cognitive remediation therapy
D. Flooding (Correct Answer)

Explanation: ***Flooding*** - **Flooding** is a behavioral therapy technique used to treat phobias and anxiety disorders by exposing an individual to a feared stimulus without avoidance. It is not used to improve attention deficit. - This method is based on the principle of **extinction** and habituation, aiming to reduce the anxiety response to previously feared situations. *Cognitive enhancement therapy* - **Cognitive enhancement therapy** (CET) focuses on improving cognitive functions like attention, memory, and social cognition, often used in conditions like schizophrenia. - It involves structured exercises and group activities designed to strengthen **neurocognitive abilities**. *Cognitive behavioral therapy* - **Cognitive behavioral therapy** (CBT) helps individuals identify and change problematic thought patterns and behaviors that contribute to their difficulties. - While not directly targeted at attention deficit, CBT techniques can help children with ADHD manage **disruptive behaviors**, improve organizational skills, and develop coping strategies. *Cognitive remediation therapy* - **Cognitive remediation therapy** (CRT) is a behavioral training intervention designed to improve cognitive skills, including attention, working memory, and executive functions. - It uses targeted exercises and strategies to enhance **neurocognitive performance**, often applicable in conditions like ADHD and schizophrenia.

Question 230: A child is asked to bring sugar from a shop but spills half of it on the way. This behavior is an example of:

A. Emotional outburst
B. Refusal to comply
C. Confrontational behavior
D. Accidental behavior (Correct Answer)

Explanation: ***Accidental behavior*** - The spilling of half the sugar was unintentional and not done with any malicious intent or conscious decision to disobey. - This behavior falls under the category of **unintended actions** or mistakes, which are common in children due to developing motor skills and attention spans. *Emotional outburst* - An emotional outburst would typically involve a sudden, intense display of feelings such as anger, frustration, or sadness, often accompanied by crying, screaming, or throwing objects. - There is no indication here of such an emotional display; the spilling was presented as an event, not a reaction driven by strong emotions. *Refusal to comply* - Refusal to comply implies a deliberate choice to not follow an instruction or command. - The child was asked to bring sugar and was presumably attempting to do so, indicating an intention to comply rather than refuse. *Confrontational behavior* - Confrontational behavior involves openly hostile or aggressive actions directed at another person, often challenging authority or expressing direct opposition. - Spilling sugar accidentally does not represent a direct challenge or act of hostility towards an authority figure.

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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