Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 21: A 4-year-old boy interrupts his mother every time she talks on the phone. The family pediatrician recommends that whenever the child interrupts her, the mother should pay no attention to him. What type of behavioral strategy has the pediatrician recommended?

A. Intermittent reinforcement
B. Non-reinforcement (Correct Answer)
C. Positive reinforcement
D. Negative reinforcement

Explanation: ### Explanation The pediatrician has recommended **Non-reinforcement** (also known as **Extinction**). **1. Why Non-reinforcement is correct:** In behavioral psychology, reinforcement is anything that increases the likelihood of a behavior. For a child seeking attention, even a mother’s scolding or "stop it" acts as positive reinforcement because it provides the attention the child craves. By "paying no attention," the mother removes the reinforcing stimulus. When a previously reinforced behavior is no longer followed by a reinforcing consequence, the behavior eventually decreases and stops. This process is called extinction or non-reinforcement. **2. Why the other options are incorrect:** * **Intermittent reinforcement (A):** This involves reinforcing a behavior only some of the time. This is the most powerful way to maintain a behavior and makes it very resistant to extinction. If the mother ignored the child sometimes but gave in others, she would be using this. * **Positive reinforcement (C):** This involves adding a rewarding stimulus (e.g., a candy or praise) following a behavior to increase its frequency. * **Negative reinforcement (D):** This involves the **removal of an aversive (unpleasant) stimulus** to increase a behavior. A common example is a child cleaning their room to stop their mother’s nagging. It is often confused with punishment, but its goal is to *increase* a desired behavior. **3. Clinical Pearls for NEET-PG:** * **Extinction Burst:** When non-reinforcement is first applied, the undesired behavior often temporarily increases in intensity or frequency before it begins to decline. Parents should be warned about this "burst" so they don't give up. * **Reinforcement vs. Punishment:** Reinforcement (Positive or Negative) always aims to **increase** a behavior. Punishment always aims to **decrease** a behavior. * **Time-out:** This is a form of "Negative Punishment" (removal of a positive reinforcer for a specific period).

Question 22: What is the drug of choice for attention deficit disorder with hyperactivity?

A. Chlorpromazine
B. Clonidine
C. Imipramine
D. Methylphenidate (Correct Answer)

Explanation: **Explanation:** **Attention-Deficit/Hyperactivity Disorder (ADHD)** is primarily characterized by a deficiency in dopamine and norepinephrine neurotransmission within the prefrontal cortex. **1. Why Methylphenidate is the Correct Answer:** Methylphenidate is a **central nervous system (CNS) stimulant** and is considered the **first-line drug of choice** for ADHD. It works by blocking the reuptake of dopamine and norepinephrine (NDRI), thereby increasing their availability in the synaptic cleft. This enhances executive function, improves attention span, and reduces impulsivity and hyperactivity. **2. Why the Other Options are Incorrect:** * **Chlorpromazine:** This is a typical antipsychotic (dopamine antagonist). It is used for schizophrenia or acute psychosis; in ADHD, it would likely worsen cognitive symptoms and cause sedation. * **Clonidine:** An alpha-2 adrenergic agonist. While used as an *adjunct* or second-line treatment (especially if there are comorbid tics or aggression), it is not the primary drug of choice. * **Imipramine:** A tricyclic antidepressant (TCA). It is considered a third-line option due to its side effect profile (cardiotoxicity) and is generally reserved for cases where stimulants are ineffective or contraindicated. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Blocks Dopamine Transporter (DAT) and Norepinephrine Transporter (NET). * **Side Effects:** The most common side effects are **insomnia and anorexia** (appetite suppression). Long-term use requires monitoring of height and weight due to potential **growth retardation**. * **Non-Stimulant Alternative:** **Atomoxetine** is the preferred non-stimulant (selective NRI) if there is a risk of substance abuse or if stimulants are not tolerated. * **Diagnosis:** Symptoms must be present for at least **6 months** in **two or more settings** (e.g., home and school) before age 12.

Question 23: Mild Mitral Regurgitation (MR) has which of the following features?

A. Present in 5-10% of the population.
B. Increased incidence in low socioeconomic groups.
C. Presents within the first 2 years of life. (Correct Answer)
D. Has a genetic background.

Explanation: **Explanation:** In the context of Child Psychiatry, **Mental Retardation (MR)**—now clinically referred to as **Intellectual Disability (ID)**—is classified based on IQ levels. **Mild MR** (IQ range 50–69) accounts for approximately 85% of all cases of intellectual disability. **Why Option C is Correct:** While the functional deficits of Mild MR may become more apparent during school years (due to academic challenges), the underlying neurodevelopmental delay **presents within the first 2 years of life**. Early developmental milestones, such as speech and motor skills, are often delayed, even if the delay is subtle. According to diagnostic criteria (DSM-5/ICD-11), the onset must occur during the **developmental period**, and signs are typically observable in early childhood. **Analysis of Incorrect Options:** * **Option A:** Mild MR does not occur in 5-10% of the general population. The overall prevalence of Intellectual Disability is estimated at approximately **1-3%** of the population. * **Option B:** While severe MR is equally distributed across social classes, **Mild MR** actually shows a **higher incidence in low socioeconomic groups** due to factors like malnutrition, lack of stimulation, and poor prenatal care. The option states "increased incidence," but the question asks for a defining feature; more importantly, the link to social class is an epidemiological association, not a clinical diagnostic feature. * **Option D:** Unlike Severe MR (which often has clear genetic causes like Down Syndrome or Fragile X), Mild MR is more frequently associated with **environmental and psychosocial factors** rather than a specific, identifiable genetic background. **High-Yield Clinical Pearls for NEET-PG:** * **Mild MR (IQ 50-69):** "Educable" group. Can achieve social and vocational adequacy with support. * **Moderate MR (IQ 35-49):** "Trainable" group. Can perform supervised semi-skilled work. * **Severe MR (IQ 20-34):** Often associated with neurological deficits. * **Profound MR (IQ <20):** Requires constant supervision and nursing care.

Question 24: Who proposed the concept of intimacy versus isolation in psychosocial development?

A. Erik Erikson (Correct Answer)
B. Eugen Bleuler
C. Sigmund Freud
D. Konrad Lorenz

Explanation: **Explanation:** **Erik Erikson** (Option A) is the correct answer. He proposed the **Theory of Psychosocial Development**, which consists of eight stages spanning from infancy to late adulthood. Each stage is characterized by a specific psychosocial crisis. **Intimacy vs. Isolation** is the sixth stage, typically occurring during young adulthood (ages 18 to 40). During this period, the major developmental task is forming intimate, loving relationships with others. Success leads to the virtue of **Love**, while failure results in loneliness and emotional isolation. **Analysis of Incorrect Options:** * **Eugen Bleuler (Option B):** A Swiss psychiatrist famous for coining the term "Schizophrenia" and defining its "4 As" (Association, Affect, Ambivalence, and Autism). * **Sigmund Freud (Option C):** The founder of psychoanalysis who proposed the **Psychosexual** stages of development (Oral, Anal, Phallic, Latency, and Genital), focusing on libidinal energy rather than social interaction. * **Konrad Lorenz (Option D):** An ethologist known for his work on **Imprinting** and attachment in animals (specifically geese), which laid the groundwork for later attachment theories. **High-Yield Clinical Pearls for NEET-PG:** * **Erikson’s Stages (First 5):** 1. Trust vs. Mistrust (Infancy - Virtue: Hope) 2. Autonomy vs. Shame/Doubt (Early Childhood - Virtue: Will) 3. Initiative vs. Guilt (Preschool - Virtue: Purpose) 4. Industry vs. Inferiority (School age - Virtue: Competence) 5. **Identity vs. Role Confusion** (Adolescence - Virtue: Fidelity) — *Most frequently asked stage.* * Erikson’s theory is unique because it emphasizes that personality development continues throughout the entire lifespan, unlike Freud’s theory which concludes at puberty.

Question 25: Which of the following tic disorders may be diagnosed even if the onset is after 18 years of age?

A. Tourette's disorder
B. Chronic motor or vocal tic disorder
C. Transient tic disorder
D. Tic disorder not otherwise specified (Correct Answer)

Explanation: In child and adolescent psychiatry, the classification of tic disorders is primarily based on the **DSM-5** and **ICD-10/11** criteria. ### **Explanation of the Correct Answer** For the primary tic disorders (Tourette’s, Chronic, and Provisional/Transient), a mandatory diagnostic criterion is that the **onset must occur before the age of 18 years**. If a patient develops tics for the first time after age 18, it cannot be classified under these specific categories. Instead, it is classified as **Tic Disorder Not Otherwise Specified (NOS)** (or "Other Specified/Unspecified Tic Disorder" in DSM-5). This category is reserved for clinical presentations that do not meet the full criteria for a specific tic disorder, including cases with late-age onset or atypical presentations. ### **Why Other Options are Incorrect** * **A. Tourette's Disorder:** Requires both multiple motor tics and at least one vocal tic to be present for >1 year, with onset strictly **before age 18**. * **B. Chronic Motor or Vocal Tic Disorder:** Requires either motor or vocal tics (but not both) for >1 year, with onset strictly **before age 18**. * **C. Transient (Provisional) Tic Disorder:** Characterized by single or multiple motor and/or vocal tics for <1 year, with onset strictly **before age 18**. ### **High-Yield NEET-PG Pearls** * **Age of Onset:** The peak age for tic onset is **4–6 years**; severity typically peaks at **10–12 years**. * **Gender:** Tic disorders are significantly more common in **males** (approx. 3:1 ratio). * **Comorbidities:** The most common comorbidities with Tourette’s are **ADHD** (most common) and **OCD**. * **Treatment:** The first-line behavioral therapy is **CBIT** (Comprehensive Behavioral Intervention for Tics). Pharmacotherapy includes alpha-2 agonists (Clonidine) or antipsychotics (Risperidone, Haloperidol).

Question 26: Language function is preserved in which of the following conditions?

A. Autism
B. Asperger's syndrome (Correct Answer)
C. Rett syndrome
D. Tourette syndrome

Explanation: **Explanation:** The core distinction between **Asperger’s Syndrome** and other Autism Spectrum Disorders (ASD) lies in the preservation of early language development and cognitive function. 1. **Asperger’s Syndrome (Correct Answer):** According to DSM-IV and ICD-10 criteria, Asperger’s is characterized by significant impairment in social interaction and restricted, repetitive patterns of behavior. However, there is **no clinically significant general delay in language** (e.g., single words are used by age 2, communicative phrases by age 3). While social pragmatics (the "give and take" of conversation) may be impaired, basic language functions like grammar and vocabulary are preserved. 2. **Why other options are incorrect:** * **Autism (Classical/Kanner’s):** Characterized by a significant delay or total lack of spoken language development. Even when speech is present, it is often idiosyncratic or echolalic. * **Rett Syndrome:** A neurodevelopmental disorder (primarily in girls, MECP2 mutation) characterized by a period of normal development followed by a **loss of purposeful hand skills and acquired spoken language.** * **Tourette Syndrome:** This is a tic disorder. While it involves vocal tics (coprolalia, palilalia), it is not primarily a disorder of language acquisition or social communication in the same category as ASD. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Update:** Asperger’s Syndrome is no longer a standalone diagnosis; it has been folded into the broader category of **Autism Spectrum Disorder (ASD)**. However, exams often still use the older terminology. * **"Little Professors":** Children with Asperger’s often speak in a pedantic, overly formal manner about specific niche interests. * **IQ:** In Asperger’s, the **Verbal IQ** is typically higher than the Performance IQ. * **Rett Syndrome Hallmark:** Hand-wringing or "hand-washing" stereotypies.

Question 27: Which of the following is NOT a possible outcome or course of ADHD?

A. Schizophrenia (Correct Answer)
B. Alcoholism
C. Mood Disorder
D. Antisocial behavior

Explanation: **Explanation:** Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity. While many symptoms may improve with age, ADHD often persists into adulthood and is associated with various psychiatric comorbidities. **Why Schizophrenia is the Correct Answer:** There is **no established causal link or direct progression** from ADHD to Schizophrenia. Schizophrenia is a psychotic disorder with a distinct pathophysiology involving dopaminergic pathways (mesolimbic/mesocortical) different from those primarily implicated in ADHD (prefrontal cortex/executive dysfunction). While a patient with ADHD can theoretically develop Schizophrenia, it is not considered a standard "outcome" or "course" of the disorder. **Analysis of Incorrect Options:** * **Alcoholism (Substance Use Disorders):** Individuals with ADHD are at a significantly higher risk for substance abuse, often as a form of "self-medication" for impulsivity and emotional dysregulation. * **Mood Disorders:** There is a high comorbidity between ADHD and Major Depressive Disorder or Bipolar Disorder. Chronic frustration and functional impairment often lead to secondary mood disturbances. * **Antisocial Behavior:** ADHD is a known precursor to **Conduct Disorder** in childhood, which frequently progresses to **Antisocial Personality Disorder (ASPD)** in adulthood. This is often referred to as the "Externalizing Pathway." **High-Yield Clinical Pearls for NEET-PG:** * **The Rule of Thirds:** Approximately 1/3 of ADHD cases remit by adulthood, 1/3 persist with symptoms, and 1/3 develop significant comorbidities (like ASPD). * **Most Common Comorbidity:** Oppositional Defiant Disorder (ODD) is the most frequent comorbid condition. * **Drug of Choice:** Methylphenidate (Psychostimulant) is the first-line treatment. Atomoxetine (Non-stimulant) is used if there is a risk of substance abuse or tics. * **Adult ADHD:** In adults, hyperactivity often decreases, but **inattention and impulsivity** remain the predominant symptoms.

Question 28: Concerning attention deficit hyperactivity disorder, which of the following statements is true?

A. Impulsive behavior is a feature.
B. It has a higher incidence in tic disorders.
C. It may respond to treatment with stimulants such as amphetamine.
D. All the above. (Correct Answer)

Explanation: **Explanation:** Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. * **Option A (Impulsive behavior):** This is one of the three core symptom domains of ADHD (Inattention, Hyperactivity, and Impulsivity). Impulsivity often manifests as blurting out answers, difficulty waiting for a turn, or interrupting others. * **Option B (Higher incidence in tic disorders):** There is a strong clinical and genetic association between ADHD and Tic disorders (including Tourette Syndrome). Approximately 30-60% of children with Tourette Syndrome also have ADHD, making it a common comorbidity. * **Option C (Response to stimulants):** Psychostimulants are the first-line pharmacological treatment for ADHD. They work by increasing synaptic levels of dopamine and norepinephrine in the prefrontal cortex. Common examples include **Methylphenidate** (most common) and **Amphetamines**. **Why "All the above" is correct:** Since impulsive behavior is a diagnostic criterion, tic disorders are a frequent comorbidity, and stimulants are the gold-standard treatment, all statements are clinically accurate. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Requires symptoms to be present before the **age of 12 years** and occur in **two or more settings** (e.g., home and school). * **Gender:** More common in **males** (approx. 3:1 ratio). * **First-line Non-Pharmacological Rx:** Behavioral therapy (especially for preschool-aged children). * **Non-stimulant alternative:** **Atomoxetine** (a Selective Norepinephrine Reuptake Inhibitor) is used if stimulants are contraindicated or if there is a risk of substance abuse. * **Side effects of Stimulants:** Insomnia, decreased appetite, and potential growth retardation (requires monitoring).

Question 29: Heller's syndrome is characterized by regression of milestones after how many years?

A. 1 year
B. 2 years (Correct Answer)
C. 3 years
D. 6 months

Explanation: **Explanation:** **Heller’s Syndrome**, also known as **Childhood Disintegrative Disorder (CDD)**, is a rare condition characterized by a period of normal development followed by a significant loss of previously acquired skills. 1. **Why Option B is Correct:** According to the **ICD-10 and DSM-IV criteria**, the diagnosis of Heller’s Syndrome requires a period of **at least 2 years** of normal development (including age-appropriate verbal/non-verbal communication, social relationships, and motor skills) before the onset of regression. The regression typically occurs between the ages of 2 and 10 years. 2. **Why Other Options are Incorrect:** * **Option A (1 year) & D (6 months):** These are incorrect because regression occurring before age 2 is more characteristic of **Autism Spectrum Disorder (ASD)** or specific metabolic/neurological disorders. * **Option C (3 years):** While regression often happens after age 3, the diagnostic threshold/minimum requirement is specifically **2 years** of normal development. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Features:** Loss of skills must occur in at least two of the following areas: expressive/receptive language, social skills, bowel/bladder control, play, or motor skills. * **Prognosis:** The prognosis for Heller’s Syndrome is generally **worse** than that of Autism, as the loss of skills is often permanent and severe. * **Gender:** It is significantly more common in **males**. * **DSM-5 Update:** In the DSM-5, Heller’s Syndrome is no longer a distinct diagnosis and has been folded into the broader category of **Autism Spectrum Disorder (ASD)**. However, it is still frequently tested under its classical name in postgraduate exams.

Question 30: What is the current accepted term for 'mental retardation'?

A. Mental block
B. Intelligence deficit
C. Intellectual disability (Correct Answer)
D. Mental disability

Explanation: ### Explanation **Correct Answer: C. Intellectual disability** The term **Intellectual Disability (ID)** is the current, internationally accepted clinical term replacing "Mental Retardation." This change was formalized to reduce the social stigma associated with the previous terminology and to align with the **DSM-5** (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) and **ICD-11** (International Classification of Diseases). The diagnosis of Intellectual Disability is no longer based solely on an IQ score below 70; it now requires deficits in both **intellectual functioning** (reasoning, problem-solving) and **adaptive functioning** (failure to meet developmental and sociocultural standards for personal independence and social responsibility) that begin during the developmental period. **Analysis of Incorrect Options:** * **A. Mental block:** This is a psychological term referring to an inability to recall information or a temporary suppression of thought processes, often due to anxiety or trauma; it is not a developmental disorder. * **B. Intelligence deficit:** While descriptive of the condition, this is not a standardized medical or diagnostic term used in clinical practice. * **D. Mental disability:** This is a broad, non-specific term that could encompass any psychiatric disorder or cognitive impairment; it lacks the diagnostic specificity required for ID. **High-Yield Clinical Pearls for NEET-PG:** * **Rosa’s Law (2010):** The US federal law that initiated the official shift from "mental retardation" to "intellectual disability." * **Severity Levels:** In DSM-5, severity (Mild, Moderate, Severe, Profound) is determined by **adaptive functioning** rather than IQ scores alone. * **Most Common Cause:** The most common inherited cause of ID is **Fragile X Syndrome**, while the most common genetic (chromosomal) cause is **Down Syndrome**. * **IQ Range for Mild ID:** 50–70 (Educable); represents about 85% of cases.

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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