Child and Adolescent Psychiatry Practice Questions

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

Methylphenidate. **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.

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

Erik Erikson. **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.

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

Tic disorder not otherwise specified. 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).

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

Asperger's syndrome. **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.

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

All the above.. **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).

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

2 years. **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 1

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?

Accepted Answer

Non-reinforcement

Answer

Intermittent reinforcement

Answer

Positive reinforcement

Answer

Negative reinforcement

Question 2

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

Accepted Answer

Methylphenidate

Answer

Chlorpromazine

Answer

Clonidine

Answer

Imipramine

Question 3

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

Accepted Answer

Presents within the first 2 years of life.

Answer

Present in 5-10% of the population.

Answer

Increased incidence in low socioeconomic groups.

Answer

Has a genetic background.

Question 4

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

Accepted Answer

Erik Erikson

Answer

Eugen Bleuler

Answer

Sigmund Freud

Answer

Konrad Lorenz

Question 5

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

Accepted Answer

Tic disorder not otherwise specified

Answer

Tourette's disorder

Answer

Chronic motor or vocal tic disorder

Answer

Transient tic disorder

Question 6

Language function is preserved in which of the following conditions?

Accepted Answer

Asperger's syndrome

Answer

Autism

Answer

Rett syndrome

Answer

Tourette syndrome

Question 7

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

Accepted Answer

Schizophrenia

Answer

Alcoholism

Answer

Mood Disorder

Answer

Antisocial behavior

Question 8

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

Accepted Answer

All the above.

Answer

Impulsive behavior is a feature.

Answer

It has a higher incidence in tic disorders.

Answer

It may respond to treatment with stimulants such as amphetamine.

Question 9

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

Accepted Answer

2 years

Answer

1 year

Answer

3 years

Answer

6 months

Question 10

What is the current accepted term for 'mental retardation'?

Accepted Answer

Intellectual disability

Answer

Mental block

Answer

Intelligence deficit

Answer

Mental disability

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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