Developmental Assessment — MCQs

10 questions

All of the following are classified under Pervasive Developmental Disorders except?

A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from

Which of the following is not a known cause of neuroregression in children?

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 two year old girl child is brought to the out patient with features of hand wringing stereotype movements, impaired language and communication development, breath holding spells, poor social skills and deceleration of head growth after 6 months of age. The most likely diagnosis is –

Which of the following conditions is least likely to be associated with intellectual disability?

A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?

Which is not a feature of ADHD?

Which among the following are defence mechanisms adopted when an individual is faced with problems or failures? I. Rationalization II. Regression III. Projection IV. Replacement Select the correct answer using the code given below :

Q10

Which of the following is not a central characteristic of childhood autism?

Developmental Assessment Indian Medical PG Practice Questions and MCQs

Question 1: All of the following are classified under Pervasive Developmental Disorders except?

A. Childhood Disintegrative Disorder
B. Down Syndrome (Correct Answer)
C. Asperger Syndrome
D. Rett Syndrome

Explanation: ***Down Syndrome*** - **Down syndrome** is a **chromosomal disorder** (Trisomy 21) causing intellectual disability and distinctive physical features, not a pervasive developmental disorder. - Pervasive developmental disorders (PDDs) are characterized by difficulties in **social interaction**, **communication**, and repetitive behaviors, which are distinct from the genetic origin of Down syndrome. *Childhood Disintegrative Disorder* - **Childhood disintegrative disorder** (CDD) is a rare PDD characterized by a significant loss of previously acquired skills in multiple developmental areas after at least two years of normal development. - It involves severe regression in social, communication, and motor skills, aligning with the criteria for a PDD. *Asperger Syndrome* - **Asperger syndrome** was previously classified as a PDD, characterized by difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. - Individuals with Asperger syndrome typically have average or above-average intelligence and no significant delay in language development. *Rett Syndrome* - **Rett syndrome** is a neurodevelopmental disorder classified as a PDD, almost exclusively affecting females, characterized by normal early development followed by a period of regression. - It involves the loss of purposeful hand movements, development of stereotypical hand movements, and severe impairments in language and motor skills.

Question 2: A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from

A. Examination anxiety
B. Lack of interest in studies
C. Intellectual disability
D. Specific learning disability (Correct Answer)

Explanation: ***Specific learning disability*** - Difficulty in expressing himself in **writing** and **frequent spelling mistakes** are hallmark features of a **specific learning disability** affecting written expression (**dysgraphia**). - These academic skill deficits are the primary presenting features and indicate a **specific learning disorder** as per DSM-5 criteria. - The inability to follow instructions and difficulty waiting for turns suggest **comorbid ADHD**, which occurs in 30-50% of children with learning disabilities. - When both conditions coexist, the **learning disability** is typically identified first in school-aged children through academic difficulties, making it the most likely primary diagnosis in this clinical scenario. *Examination anxiety* - Examination anxiety manifests as psychological distress **specifically during test situations** (nervousness, worry, physical symptoms like sweating or rapid heartbeat). - It does not explain **persistent difficulties** with writing, spelling, following instructions, or impulse control across multiple settings (school and play). - The symptoms described occur in everyday activities, not just during examinations. *Lack of interest in studies* - Lack of interest or motivation leads to **poor effort** and **disengagement**, but not to specific skill deficits like spelling mistakes or writing difficulties. - Children with low motivation can typically perform adequately when interested, unlike those with learning disabilities who struggle despite effort. - This option doesn't account for the **impulsivity** (cannot wait for turn) which suggests a neurobiological basis rather than motivational issues. *Intellectual disability* - Intellectual disability involves **global cognitive impairment** affecting all areas of functioning with IQ typically below 70. - The pattern described shows **specific deficits** in writing and spelling (academic skills) alongside behavioral regulation issues, rather than pervasive intellectual limitations. - Children with intellectual disability would show broader developmental delays across multiple domains (communication, self-care, social skills), not just circumscribed learning and behavioral difficulties.

Question 3: Which of the following is not a known cause of neuroregression in children?

A. Vitamin B12 deficiency
B. Ataxia telangiectasia
C. ADHD (Correct Answer)
D. Wilson's disease

Explanation: ***ADHD*** - **Attention-deficit/hyperactivity disorder (ADHD)** is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity. It is **not** a cause of neuroregression. - While ADHD can impact cognitive and behavioral functioning, it does not involve a loss of previously acquired developmental milestones or skills. *Wilson's disease* - **Wilson's disease** is an inherited disorder that causes **copper accumulation** in organs, particularly the liver and brain. - Neurological symptoms, including **neuroregression**, can occur due to copper toxicity in the central nervous system. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can lead to neurological complications such as **subacute combined degeneration** of the spinal cord and peripheral neuropathy. - In children, severe or prolonged deficiency can impair brain development and lead to **developmental regression**. *Ataxia telangiectasia* - **Ataxia telangiectasia** is a rare, neurodegenerative, inherited disease that affects multiple body systems. - It is characterized by progressive **cerebellar ataxia**, leading to **neuroregression** and intellectual disability over time.

Question 4: 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 5: A two year old girl child is brought to the out patient with features of hand wringing stereotype movements, impaired language and communication development, breath holding spells, poor social skills and deceleration of head growth after 6 months of age. The most likely diagnosis is –

A. Rett's syndrome (Correct Answer)
B. Asperger's syndrome
C. Fragile x–syndrome
D. Colorado syndrome

Explanation: ***Rett's syndrome*** - The constellation of **hand-wringing stereotype movements**, language impairment, poor social skills, and **deceleration of head growth** after 6 months of age in a female child is highly characteristic of Rett's syndrome. - This neurodevelopmental disorder is almost exclusively seen in girls and is caused by a mutation in the **MECP2 gene**. *Asperger's syndrome* - Asperger's syndrome (now part of **Autism Spectrum Disorder**) typically presents with difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. - However, it does not usually involve **seizures, loss of purposeful hand use, or acquired microcephaly**, which are key features of Rett's syndrome. *Fragile x–syndrome* - Fragile X syndrome is a genetic condition causing intellectual disability, most commonly in males, characterized by a **long face, prominent jaw and ears**, and **macroorchidism** (large testicles) in post-pubertal males. - It does not specifically feature the unique hand stereotypes or decelerated head growth seen in Rett's syndrome. *Colorado syndrome* - **Colorado syndrome** is not a recognized medical diagnosis for such a clinical presentation. - The symptoms described do not align with any known neurological or developmental disorder named "Colorado syndrome."

Question 6: Which of the following conditions is least likely to be associated with intellectual disability?

A. Cretinism
B. Birth asphyxia
C. Hypopituitarism (Correct Answer)
D. Down syndrome

Explanation: ***Hypopituitarism*** - This condition primarily affects **growth** and **metabolism** due to deficiencies in pituitary hormones but typically does not directly cause intellectual disability unless severe complications arise or it is a component of a larger syndrome affecting brain development. - While it can lead to developmental delays if growth hormone is deficient, it's less directly linked to intrinsic intellectual impairment compared to the other options. *Cretinism* - This is a condition of **severe congenital hypothyroidism** that, if untreated, leads to profoundly impaired physical and mental development. - Adequate thyroid hormone is crucial for normal brain development, and its absence results in irreversible intellectual disability. *Birth asphyxia* - Refers to a lack of oxygen to the brain around the time of birth, which can cause **hypoxic-ischemic encephalopathy (HIE)**. - HIE can lead to significant and permanent brain damage, often resulting in cerebral palsy and intellectual disability. *Down syndrome* - This genetic disorder, caused by a **trisomy of chromosome 21**, is characterized by a range of physical features and a varying degree of intellectual disability. - Intellectual disability is a universal feature of Down syndrome, though its severity can differ between individuals.

Question 7: A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?

A. Specific learning disability
B. Intellectual disability
C. Sibling Rivalry
D. Autism Spectrum Disorder (Correct Answer)

Explanation: ***Autism Spectrum Disorder*** - The child's delayed speech, **restricted interests** (spinning objects), lack of social engagement, and difficulty interacting with other children are classic symptoms of **Autism Spectrum Disorder (ASD)**. - Normal developmental milestones in other areas, such as motor skills, differentiate ASD from global developmental delays. - The **triad of impairments** includes social communication deficits, restricted interests, and repetitive behaviors, all evident in this case. *Specific learning disability* - This diagnosis typically presents with difficulties in specific academic areas like reading, writing, or math in a child with otherwise average intelligence. - It is generally diagnosed after school entry (age 6-7 years) when academic demands increase. - It doesn't explain the **social communication deficits** and **restricted, repetitive behaviors** seen in this case. *Intellectual disability* - This condition involves significant limitations in both intellectual functioning and adaptive behavior, with onset during the developmental period. - While delayed speech can be a feature, the child's otherwise **normal developmental milestones** in motor and other domains argue against a global intellectual deficit. - The **restricted interests** and social deficits are more characteristic of ASD than intellectual disability alone. *Sibling Rivalry* - This refers to competition or animosity between siblings, often manifesting as behavioral problems or attention-seeking from parents. - It is a normal developmental phenomenon, not a psychiatric disorder. - It does not account for the core symptoms described, such as **delayed speech**, **restricted interests** (fascination with spinning objects), or a pervasive disinterest in social interaction.

Question 8: 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 9: Which among the following are defence mechanisms adopted when an individual is faced with problems or failures? I. Rationalization II. Regression III. Projection IV. Replacement Select the correct answer using the code given below :

A. I, III and IV
B. I, II and III (Correct Answer)
C. I, II and IV
D. II, III and IV

Explanation: ***I, II and III*** - **Rationalization**, **Regression**, and **Projection** are all classic defense mechanisms described in psychoanalytic theory. - These mechanisms are unconscious strategies used by the **ego** to reduce anxiety and protect the self from unacceptable thoughts or feelings, particularly when an individual faces problems or failures. *I, III and IV* - This option correctly identifies Rationalization and Projection, but incorrectly includes **Replacement**. - While "replacement" might refer to a form of **displacement** in some contexts, it is not a standard, recognized defense mechanism in the classic psychoanalytic framework. *I, II and IV* - This option correctly identifies Rationalization and Regression, but incorrectly includes **Replacement**. - **Replacement** is not a standard defense mechanism; instead, individuals might experience **displacement** where feelings are redirected to a safer target. *II, III and IV* - This option includes Regression and Projection, but misses **Rationalization** while incorrectly including **Replacement**. - **Rationalization** is a very common defense mechanism involving creating logical but false justifications for actions or beliefs.

Question 10: Which of the following is not a central characteristic of childhood autism?

A. Callous and unemotional traits (Correct Answer)
B. Impaired communication
C. Restricted, repetitive behaviour
D. Impaired social interaction

Explanation: ***Callous and unemotional traits*** - While some individuals with autism may struggle with empathy, **callous and unemotional traits** are not a core diagnostic feature of autism spectrum disorder (ASD); they are more commonly associated with conditions like **conduct disorder** or **antisocial personality disorder**. - **Emotional dysregulation** and **difficulty recognizing others' emotions** are common in autism, but this differs from a pervasive pattern of callousness. *Impaired communication* - **Impaired verbal and nonverbal communication** is a fundamental diagnostic criterion for autism spectrum disorder, ranging from absent speech to difficulties with conversations and understanding social cues. - This can manifest as problems with **initiating or maintaining conversations**, **lack of eye contact**, and **unusual tone of voice**. *Restricted, repetitive behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** are a core diagnostic feature of ASD. - Examples include **stereotyped motor movements**, **insistence on sameness**, **highly restricted or fixated interests**, and **unusual sensory sensitivities**. *Impaired social interaction* - **Persistent deficits in social communication and social interaction** across multiple contexts are defining characteristics of autism. - This includes difficulties with **social-emotional reciprocity**, **nonverbal communication**, and **developing, maintaining, and understanding relationships**.

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