Disinhibited Social Engagement Disorder — MCQs

10 questions

A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?

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

Best therapy suited to teach daily life skills to a child with intellectual disability:

A 2.5 year old boy is brought by the parents because of the concern that he is not developing appropriately. Child often is unable to engage with others using eye contact and does not play with other children. He continuously bangs his head against the wall and remains confined to himself most of the time. What is the most likely diagnosis?

A child with pervasive developmental disorder will have all of the following except:

Best therapy suited to teach daily life skill to a mentally challenged child:

Ganser syndrome is classified under which of the following disorders?

Most reliable predictor of autism in 18-month-olds is:

Negative symptoms of schizophrenia are all except:-

Q10

Which is not a feature of ADHD?

Disinhibited Social Engagement Disorder Indian Medical PG Practice Questions and MCQs

Question 1: A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?

A. Conduct disorder
B. Oppositional defiant disorder (Correct Answer)
C. Autism spectrum disorder
D. Attention deficit hyperactivity disorder

Explanation: **Oppositional defiant disorder** - The boy's behaviors of **not following rules**, arguing with teachers and students, and **provoking parents** are characteristic features of ODD. - ODD is defined by a pattern of **angry/irritable mood**, argumentative/defiant behavior, or vindictiveness. *Conduct disorder* - Conduct disorder involves more serious violations of the **rights of others** or major **societal norms**, such as aggression towards people or animals, destruction of property, deceitfulness, or theft. - The scenario describes defiant and argumentative behavior, not the severe actions typical of conduct disorder. *Autism spectrum disorder* - ASD is characterized by persistent deficits in **social communication and interaction** across multiple contexts, and **restricted, repetitive patterns of behavior, interests, or activities.** - The provided symptoms do not align with the core diagnostic criteria for autism spectrum disorder. *Attention deficit hyperactivity disorder* - ADHD involves a persistent pattern of **inattention** and/or **hyperactivity-impulsivity** that interferes with functioning or development. - While some defiant behavior can coexist with ADHD, the primary presentation here is one of opposition and defiance, not predominantly inattention or hyperactivity.

Question 2: 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 3: Best therapy suited to teach daily life skills to a child with intellectual disability:

A. Applied Behavior Analysis (ABA) (Correct Answer)
B. Cognitive Behavioral Therapy (CBT)
C. Social skills training
D. Self-instructional training

Explanation: **Applied Behavior Analysis (ABA)** - **ABA** is a highly structured, evidence-based therapy that focuses on teaching specific skills by breaking them down into smaller steps and using **positive reinforcement**. - It is particularly effective for children with intellectual disabilities in acquiring **adaptive daily living skills**, communication, and social behaviors. *Cognitive Behavioral Therapy (CBT)* - **CBT** primarily targets changing negative thought patterns and behaviors, requiring a level of abstract reasoning that may be challenging for children with significant intellectual disabilities. - While it can be adapted, its core methods rely on cognitive processes that might not be the most direct approach for teaching basic daily life skills to a mentally challenged child. *Social skills training* - **Social skills training** focuses specifically on improving social interactions and communication within social contexts. - While important for overall development, it is a subcomponent of broader skill development and may not directly address all aspects of **daily living skills** in a comprehensive manner. *Self-instructional training* - **Self-instructional training** involves teaching individuals to guide themselves through tasks using internal speech or self-talk, which relies on a child's ability to internalize and follow complex verbal instructions. - This approach might be too cognitively demanding for a child with significant developmental delays when the primary goal is mastering basic, functional daily life skills.

Question 4: A 2.5 year old boy is brought by the parents because of the concern that he is not developing appropriately. Child often is unable to engage with others using eye contact and does not play with other children. He continuously bangs his head against the wall and remains confined to himself most of the time. What is the most likely diagnosis?

A. Conduct disorder
B. Social phobia
C. Autism (Correct Answer)
D. ADHD

Explanation: ***Autism*** - The child's lack of **eye contact**, inability to **play with other children**, and repetitive self-stimulatory behavior (banging head) are classic signs of **autism spectrum disorder (ASD)**. - ASD is characterized by persistent deficits in **social communication** and **social interaction** across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities. *Conduct disorder* - Characterized by a repetitive and persistent pattern of behavior in which the **basic rights of others** or major age-appropriate **societal norms or rules are violated**. - Symptoms include aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules, which are not described in this case. *Social phobia* - Involves an intense, persistent fear of social or performance situations where the individual fears **embarrassment** or **humiliation**. - While there is social avoidance, it is driven by fear of negative evaluation rather than a fundamental inability to engage socially or repetitive behaviors. *ADHD* - Primarily defined by persistent patterns of **inattention** and/or **hyperactivity-impulsivity** that interfere with functioning or development. - While children with ADHD may have social difficulties, the core symptoms of lack of eye contact, repetitive behaviors, and profound social engagement deficits are not typical of ADHD.

Question 5: A child with pervasive developmental disorder will have all of the following except:

A. Stereotyped behaviour
B. Reduced social interaction
C. Poor language skills
D. Impaired cognition (Correct Answer)

Explanation: ***Impaired cognition*** - While some individuals with **pervasive developmental disorders (PDDs)** may have comorbid intellectual disability, **impaired cognition is not a universal or defining characteristic** of PDDs. - Many individuals with PDDs, particularly those with **Asperger's syndrome**, have **average or above-average intelligence**. - Intelligence quotient (IQ) varies widely across the autism spectrum, making cognitive impairment a non-essential feature. *Stereotyped behaviour* - **Stereotyped and repetitive behaviors** (e.g., hand flapping, rocking, rigid adherence to routines) are a **core diagnostic criterion** for PDDs, including autism spectrum disorder. - These behaviors are part of the **restricted, repetitive patterns of behavior, interests, or activities** domain in diagnostic criteria. *Reduced social interaction* - Significant **deficits in social interaction and communication** are a **hallmark feature** of PDDs. - This manifests as difficulty with reciprocal social communication, impaired ability to interpret social cues, and challenges in forming age-appropriate peer relationships. *Poor language skills* - **Communication impairments**, including poor language skills, are a **common feature** of PDDs, especially in classical autism. - This can include delayed speech development, unusual language patterns (e.g., **echolalia**, pronoun reversal), or complete absence of verbal communication in severe cases.

Question 6: Best therapy suited to teach daily life skill to a mentally challenged child:

A. Contingency management (Correct Answer)
B. Cognitive reconstruction
C. Self instruction
D. CBT (Cognitive behavior therapy)

Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.

Question 7: Ganser syndrome is classified under which of the following disorders?

A. OCD
B. Conversion disorder
C. Dissociative disorder (Correct Answer)
D. Schizoid personality disorder

Explanation: ***Dissociative disorder*** - Ganser syndrome is characterized by a "passing-off" behavior, where the individual gives **approximate or nonsensical answers** to simple questions, often associated with other dissociative symptoms. - While historically difficult to classify, contemporary understanding places it within the spectrum of dissociative disorders due to its features of an altered state of consciousness and a detachment from reality. *OCD* - **Obsessive-compulsive disorder (OCD)** involves recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). - Ganser syndrome does not typically present with the classic symptom profile of obsessions and compulsions. *Conversion disorder* - **Conversion disorder** involves neurological symptoms (e.g., paralysis, blindness, seizures) that are not consistent with neurological disease and are often preceded by psychological stress. - While both involve psychological factors, Ganser syndrome is distinct in its presentation of "answers" that are close but incorrect, rather than physical symptoms. *Schizoid personality disorder* - **Schizoid personality disorder** is characterized by a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. - This disorder primarily affects social functioning and emotional expression, which is different from the specific cognitive and behavioral pattern seen in Ganser syndrome.

Question 8: Most reliable predictor of autism in 18-month-olds is:

A. Language delay
B. Poor eye contact
C. Repetitive behaviors
D. No pretend play (Correct Answer)

Explanation: ***No pretend play*** - The **absence of pretend play** is a significant early indicator of autism spectrum disorder (ASD) in toddlers, as it reflects deficits in **social imagination** and symbolic thought. - This symptom is often more specific and reliable for predicting ASD at 18 months than other common developmental delays. *Language delay* - While **language delay** is a common feature of autism, it can also be present in other developmental delays, making it less specific as a sole predictor. - Many children without autism may experience transient language delays that resolve with time or intervention. *Poor eye contact* - **Poor eye contact** is a known sign of autism, but it can be variable in presentation and is not as universally predictive as deficits in social play at this age. - Other conditions or even normal variations in temperament can cause inconsistent eye contact. *Repetitive behaviors* - **Repetitive behaviors** are characteristic of autism but may not be fully established or clearly identifiable as atypical in their severity or frequency in all 18-month-olds with ASD. - Some repetitive behaviors are typical in early development, so distinguishing pathological forms requires careful assessment.

Question 9: Negative symptoms of schizophrenia are all except:-

A. Apathy
B. Anhedonia
C. Over activity (Correct Answer)
D. Alogia

Explanation: ***Over activity*** - **Overactivity** is a manifestation of disorganized or positive symptoms in schizophrenia, such as **agitation** or purposeless movements, rather than a deficiency. - While it can occur in schizophrenia, it represents an excess or distortion of normal function, distinguishing it from **negative symptoms** which reflect a reduction or absence of typical behaviors. *Apathy* - **Apathy**, or avolition, is a core negative symptom characterized by a **lack of motivation** and an inability to initiate or persist in goal-directed activities. - Patients with apathy often show diminished interest in daily activities and personal care. *Anhedonia* - **Anhedonia** is a negative symptom defined by the **inability to experience pleasure** from activities that are usually enjoyable. - This can include a loss of interest in social interactions, hobbies, and other rewarding experiences. *Alogia* - **Alogia**, or poverty of speech, is a negative symptom characterized by a **reduction in the quantity and fluency of speech**. - Individuals with alogia may provide brief, empty responses and exhibit long pauses during conversation.

Question 10: 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.

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