Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 71: What is the term for the condition in which a person intentionally causes physical symptoms in another individual under their care?

A. Overly anxious parenting
B. Conversion disorder
C. Hypochondriasis
D. Munchausen syndrome by proxy (Correct Answer)

Explanation: **Explanation:** **Munchausen syndrome by proxy (MSBP)**, now clinically referred to in the DSM-5 as **Factitious Disorder Imposed on Another**, is a form of child abuse. In this condition, a caregiver (usually the mother) deliberately fabricates, exaggerates, or induces physical or psychological symptoms in a person under their care (usually a child) to gain attention or sympathy for themselves. The primary motivation is the "sick role by proxy" rather than external incentives like financial gain. **Analysis of Options:** * **Overly anxious parenting:** This involves excessive worry about a child's health without the intentional induction of symptoms or deception. * **Conversion disorder (Functional Neurological Symptom Disorder):** This involves neurological symptoms (like paralysis or seizures) that are *unintentional* and arise from psychological distress, not external fabrication. * **Hypochondriasis (Illness Anxiety Disorder):** This is a preoccupation with having a serious illness based on a misinterpretation of bodily symptoms; it is not characterized by the intentional production of symptoms in others. **Clinical Pearls for NEET-PG:** * **The Perpetrator:** Usually has a background in healthcare or extensive medical knowledge and appears remarkably calm despite the child's "mysterious" illness. * **The Victim:** Symptoms typically improve or disappear when the child is separated from the caregiver (e.g., during hospitalization with strict supervision). * **Warning Signs:** Multisystem involvement, symptoms that occur only in the caregiver's presence, and a history of "doctor shopping." * **Legal Obligation:** If MSBP is suspected, the immediate priority is the safety of the child, followed by mandatory reporting to child protective services.

Question 72: A patient with an IQ of 30 will be diagnosed with which of the following?

A. Mild intellectual disability
B. Moderate intellectual disability
C. Severe intellectual disability (Correct Answer)
D. Profound intellectual disability

Explanation: **Explanation:** Intellectual Disability (ID), formerly known as Mental Retardation, is characterized by deficits in intellectual and adaptive functioning. According to the ICD-10 and DSM-IV classifications, the severity of ID is categorized based on the Intelligence Quotient (IQ) score. **Why Option C is Correct:** A patient with an **IQ of 30** falls into the **Severe Intellectual Disability** category. This range is defined as an **IQ of 20–34**. Individuals in this group typically have very limited communication skills and require significant support for daily self-care activities, often living in supervised settings. **Analysis of Incorrect Options:** * **A. Mild ID (IQ 50–69):** These individuals are "educable." They can reach an academic level of approximately 6th grade and can live independently with minimal support. * **B. Moderate ID (IQ 35–49):** These individuals are "trainable." They can acquire primary communication skills and perform semi-skilled work under supervision (reaching a 2nd-grade academic level). * **D. Profound ID (IQ < 20):** These individuals have minimal sensorimotor functioning and require constant supervision and 24-hour nursing care. **NEET-PG High-Yield Pearls:** 1. **DSM-5 Update:** While IQ scores are still used, the DSM-5 emphasizes **adaptive functioning** (conceptual, social, and practical domains) rather than IQ scores alone to determine the level of support required. 2. **Most Common Type:** Mild ID is the most common, accounting for approximately 85% of cases. 3. **Borderline Intelligence:** Refers to an IQ range of **70–79**. 4. **Commonest Genetic Cause:** Down Syndrome (Trisomy 21) is the most common overall; Fragile X Syndrome is the most common inherited cause.

Question 73: Specific Learning Disability involves which of the following?

A. Writing
B. Reading
C. Mathematical skills
D. All of the above (Correct Answer)

Explanation: **Explanation:** Specific Learning Disorder (SLD) is a neurodevelopmental disorder characterized by persistent difficulties in learning and using academic skills, despite normal intelligence and adequate instruction. According to the **DSM-5**, SLD is a single overarching diagnosis with specifiers for deficits in three primary domains: 1. **Reading (Dyslexia):** The most common form, involving difficulties with word reading accuracy, reading rate/fluency, and reading comprehension. 2. **Writing (Dysgraphia):** Involves challenges with spelling accuracy, grammar, punctuation, and clarity or organization of written expression. 3. **Mathematics (Dyscalculia):** Involves problems with number sense, memorization of arithmetic facts, accurate calculation, and math reasoning. Since SLD encompasses impairments in all three areas—reading, writing, and mathematics—**Option D (All of the above)** is the correct answer. Options A, B, and C are incorrect only because they represent individual components of the broader disorder rather than the complete clinical spectrum. **High-Yield Clinical Pearls for NEET-PG:** * **IQ Requirement:** By definition, the child’s academic performance must be significantly below what is expected for their chronological age and **average IQ** (usually a discrepancy of >2 standard deviations). * **Age of Onset:** Symptoms typically become apparent during early school years when academic demands increase. * **Comorbidity:** SLD is frequently comorbid with **ADHD** (approx. 20-25% overlap). * **Diagnosis:** It is a clinical diagnosis, but standardized achievement tests (like the NIMHANS battery in India) are used for confirmation. * **Management:** The mainstay of treatment is **Remedial Education** (Individualized Education Program - IEP); pharmacological intervention is only used for comorbid conditions like ADHD.

Question 74: Who proposed the stage of industry versus inferiority?

A. Erikson (Correct Answer)
B. Lorenz
C. Freud
D. Bleuler

Explanation: **Explanation:** The correct answer is **Erikson**. Erik Erikson proposed the **Theory of Psychosocial Development**, which consists of eight stages from infancy to late adulthood. **Industry vs. Inferiority** is the **fourth stage**, occurring during the school-age years (approximately **6 to 12 years**). During this period, children focus on mastering academic and social skills. Success leads to a sense of **competence**, while failure or lack of encouragement results in feelings of inadequacy and inferiority. **Analysis of Incorrect Options:** * **Lorenz (Konrad Lorenz):** An ethologist known for the concept of **Imprinting** (the rapid learning process in newborn animals). * **Freud (Sigmund Freud):** Proposed the **Psychosexual Stages of Development** (Oral, Anal, Phallic, Latent, and Genital). The "Industry vs. Inferiority" stage corresponds to Freud’s **Latency stage**. * **Bleuler (Eugen Bleuler):** A Swiss psychiatrist who coined the term **"Schizophrenia"** and described the **4 A’s** (Ambivalence, Autism, Affective blunting, and Associative looseness). **High-Yield Clinical Pearls for NEET-PG:** * **Virtue of this stage:** The successful resolution of Industry vs. Inferiority results in the virtue of **Competence**. * **Stages Mnemonic:** **T**rust vs. Mistrust (Infancy), **A**utonomy vs. Shame (Toddler), **I**nitiative vs. Guilt (Preschool), **I**ndustry vs. Inferiority (School-age), **I**dentity vs. Role Confusion (Adolescence). * **Adolescence Stage:** "Identity vs. Role Confusion" is the most frequently asked stage in exams regarding teenage behavior.

Question 75: In autism spectrum disorder, which of the following is identified as the first biomarker?

A. Decreased brain volume in children less than 4 years
B. Reduced latency of sleep
C. Increased level of serotonin in the platelets (Correct Answer)
D. Increased levels of dopamine

Explanation: **Explanation:** The correct answer is **C. Increased level of serotonin in the platelets.** **Understanding the Concept:** Hyperserotonemia (elevated whole-blood or platelet serotonin levels) was the first biochemical marker identified in Autism Spectrum Disorder (ASD), discovered by Schain and Freedman in 1961. It remains one of the most robust and consistently replicated biological findings in psychiatry, present in approximately **one-third (30%)** of children with ASD. While its exact pathophysiological role is still being researched, it is thought to relate to altered serotonin transporter (SERT) function or synthesis during early neurodevelopment. **Analysis of Incorrect Options:** * **Option A:** In ASD, there is typically an **increased** brain volume (macrocephaly) and accelerated head circumference growth in children under 4 years, rather than a decrease. This is due to a lack of synaptic pruning. * **Option B:** Sleep disturbances are common in ASD, but they are characterized by **increased** sleep latency (difficulty falling asleep) and frequent nocturnal awakenings, not reduced latency. * **Option C:** While dopamine dysregulation is implicated in many neurodevelopmental disorders (like ADHD), there is no consistent evidence identifying increased dopamine as a primary or "first" biomarker for ASD. **NEET-PG High-Yield Pearls:** * **M-CHAT (Modified Checklist for Autism in Toddlers):** The most commonly used screening tool (done at 18–24 months). * **Gold Standard Diagnosis:** ADOS (Autism Diagnostic Observation Schedule) and ADI-R. * **Core Triad (DSM-5):** 1. Deficits in social communication/interaction; 2. Restricted, repetitive patterns of behavior/interests. * **Best Prognostic Factor:** The presence of communicative speech by age 5 and a higher IQ.

Question 76: Which of the following drugs can be used for ADHD in a 9-year-old boy with no medical conditions?

A. Methylphenidate
B. Dexamphetamine
C. Clonidine
D. All of the above (Correct Answer)

Explanation: **Explanation:** Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. Pharmacotherapy is a mainstay of treatment for children aged 6 years and older. **Why "All of the above" is correct:** The management of ADHD involves both stimulant and non-stimulant medications. * **Methylphenidate and Dexamphetamine (Stimulants):** These are considered **first-line** pharmacological treatments. They work by increasing the synaptic concentration of dopamine and norepinephrine in the prefrontal cortex by blocking their reuptake. * **Clonidine (Non-stimulant):** This is a centrally acting **alpha-2 adrenergic agonist**. While often used as a second-line agent or as an adjunct to stimulants (especially when there are comorbid tics, aggression, or sleep disturbances), it is FDA-approved and clinically effective for ADHD in children. **Analysis of Options:** * **A & B (Stimulants):** Highly effective for core ADHD symptoms. Methylphenidate is the most commonly prescribed stimulant in India. * **C (Clonidine):** Useful for patients who do not tolerate stimulants or have comorbid conditions. Another similar alpha-2 agonist used is **Guanfacine**. **High-Yield Clinical Pearls for NEET-PG:** * **First-line treatment (General):** Stimulants (Methylphenidate > Amphetamines). * **First-line Non-stimulant:** **Atomoxetine** (a selective norepinephrine reuptake inhibitor). It is preferred if there is a history of substance abuse or severe anxiety. * **Side Effects of Stimulants:** Insomnia, decreased appetite, weight loss, and potential growth retardation (monitor height/weight). * **Cardiac Screening:** Always screen for a family history of sudden cardiac death or arrhythmias before starting stimulants. * **Behavioral Therapy:** Always recommended alongside pharmacotherapy (Multimodal treatment).

Question 77: All of the following are types of temperament EXCEPT?

A. Slow to warm
B. Easy
C. Difficult
D. Unpredictable (Correct Answer)

Explanation: **Explanation:** The concept of temperament refers to the innate, biologically based behavioral style of a child. The most widely accepted classification comes from the **New York Longitudinal Study (NYLS)** conducted by **Thomas and Chess**. They identified nine dimensions of temperament, which cluster into three primary types. **Why "Unpredictable" is the correct answer:** "Unpredictable" is not a recognized category in the Thomas and Chess classification. While temperament involves patterns of biological regularity (rhythmicity), the term used to describe children with irregular patterns is "Difficult," not "Unpredictable." **Analysis of Incorrect Options:** * **Easy (40% of children):** These children are characterized by regularity in biological functions, positive approach to new stimuli, high adaptability to change, and a predominantly cheerful mood. * **Difficult (10% of children):** These children show irregularity in biological functions (e.g., sleep/hunger), withdrawal from new stimuli, slow adaptability, and frequent intense negative emotional expressions (crying/fretting). * **Slow to warm up (15% of children):** These children show low activity levels and initial withdrawal from new stimuli. They adapt slowly but eventually respond positively with repeated exposure. *Note: About 35% of children do not fit neatly into these three categories.* **High-Yield Clinical Pearls for NEET-PG:** * **Goodness of Fit:** This is the most important clinical concept related to temperament. It refers to the compatibility between the child’s temperament and the expectations/demands of their environment (parents). * **Dimensions:** Thomas and Chess identified **9 dimensions**: Activity level, Rhythmicity, Approach/Withdrawal, Adaptability, Threshold of responsiveness, Intensity of reaction, Quality of mood, Distractibility, and Attention span/Persistence. * Temperament is considered a precursor to adult **personality**.

Question 78: The Lovaas-based Model is which type of intervention used in Autistic Spectrum Disorders?

A. Educational intervention
B. Cognitive and behavioral intervention
C. Early Intensive behavioral and developmental intervention (Correct Answer)
D. Social Skills training

Explanation: ### Explanation **Correct Answer: C. Early Intensive behavioral and developmental intervention** The **Lovaas Model**, developed by Dr. Ivar Lovaas, is the foundational framework for **Applied Behavior Analysis (ABA)**. It is classified as an **Early Intensive Behavioral Intervention (EIBI)**. The core concept relies on the principle that children with Autism Spectrum Disorder (ASD) can make significant developmental gains if intervention is started early (typically before age 4), is intensive (30–40 hours per week), and is one-on-one. It utilizes "Discrete Trial Training" to break down complex skills into small, teachable steps, using positive reinforcement to shape behavior and improve cognitive and language functions. **Why other options are incorrect:** * **A. Educational intervention:** While the Lovaas model is used in educational settings, "Educational intervention" is a broad term. EIBI is a specific clinical sub-type of behavioral therapy. * **B. Cognitive and behavioral intervention:** Cognitive Behavioral Therapy (CBT) requires a level of meta-cognition (thinking about one's thoughts) that is usually not applicable to the early developmental stages of non-verbal or severely autistic young children. * **D. Social Skills training:** This is a component of ASD management but is usually a targeted intervention for older children or those with "High-Functioning Autism" (formerly Asperger’s) rather than a comprehensive early developmental model. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** ABA/Lovaas-based EIBI is considered the gold standard for early autism management. * **M-CHAT:** The most common screening tool for ASD (used at 18 and 24 months). * **Diagnosis:** ASD is characterized by two domains: 1. Deficits in social communication/interaction and 2. Restricted, repetitive patterns of behavior (DSM-5). * **Pharmacotherapy:** No drug treats the core symptoms of ASD. **Risperidone** and **Aripiprazole** are FDA-approved only for treating irritability and aggression associated with Autism.

Question 79: Poor scholastic performance is not associated with which of the following conditions?

A. Specific Learning Disorder (SLD)
B. Attention Deficit Hyperactivity Disorder (ADHD)
C. Pica (Correct Answer)
D. Anxiety

Explanation: **Explanation:** Poor scholastic performance is a multifactorial issue in child psychiatry, often stemming from cognitive, behavioral, or emotional disturbances. **Why Pica is the Correct Answer:** **Pica** is an eating disorder characterized by the persistent ingestion of non-nutritive, non-food substances (e.g., clay, chalk, paint) for at least one month. While it may be associated with nutritional deficiencies (like iron or zinc) or intellectual disability, Pica itself is a **behavioral feeding disorder** and does not inherently impair the cognitive or psychological processes required for academic learning. Therefore, it is not primarily associated with poor scholastic performance. **Analysis of Incorrect Options:** * **Specific Learning Disorder (SLD):** This is a neurodevelopmental disorder (e.g., Dyslexia, Dyscalculia) where a child has specific difficulties in reading, writing, or math despite normal intelligence. It is the most direct cause of poor scholastic performance. * **ADHD:** Characterized by inattention, hyperactivity, and impulsivity. Inattention leads to difficulty following instructions, finishing tasks, and staying organized, directly impacting academic grades. * **Anxiety:** Emotional disorders like Generalized Anxiety or School Phobia can lead to "cognitive interference," where the child's preoccupation with worry reduces concentration and memory, leading to a decline in school performance. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause** of poor scholastic performance is **Intellectual Disability (ID)**, followed by SLD and ADHD. * **SLD Diagnosis:** Requires a persistent difficulty for at least **6 months** despite targeted interventions. * **Pica Association:** Frequently seen in children with Autism Spectrum Disorder (ASD) and Intellectual Disability; always screen for **Lead Poisoning** and **Iron Deficiency Anemia**.

Question 80: What is the IQ range for a child with profound mental retardation?

A. 20-34
B. 35-49
C. 50-69
D. <20 (Correct Answer)

Explanation: **Explanation:** Intellectual Disability (ID), formerly known as Mental Retardation, is classified based on Intelligence Quotient (IQ) scores. According to the ICD-10 and DSM-IV criteria, **Profound Mental Retardation** is defined by an **IQ score of less than 20**. Children in this category have significant cognitive impairments, often requiring constant supervision and 24-hour nursing care for basic activities of daily living. **Analysis of Options:** * **Option D (<20): Correct.** This represents the "Profound" category. These individuals often have associated neurological conditions and limited communication skills. * **Option A (20-34): Incorrect.** This range defines **Severe** Mental Retardation. These individuals can often be trained in elementary self-care and habit formation. * **Option B (35-49): Incorrect.** This range defines **Moderate** Mental Retardation. They are considered "trainable" and can perform semi-skilled work under supervision. * **Option C (50-69): Incorrect.** This range defines **Mild** Mental Retardation. They are considered "educable" and constitute the majority (approx. 85%) of the ID population. **High-Yield NEET-PG Clinical Pearls:** 1. **Most Common Type:** Mild Mental Retardation (IQ 50-69) is the most common form. 2. **Borderline Intelligence:** Refers to an IQ range of **70-79**. 3. **Assessment Tools:** In children, the **Binet-Kamat Test** and **Malin’s Intelligence Scale for Indian Children (MISIC)** are frequently used in India. 4. **Clinical Feature:** The most common cause of preventable intellectual disability worldwide is **Iodine deficiency**, while the most common inherited cause is **Fragile X Syndrome**.

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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