Child and Adolescent Psychiatry

Child and Adolescent Psychiatry Indian Medical PG Question 1: 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)

Child and Adolescent Psychiatry 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.

Child and Adolescent Psychiatry Indian Medical PG Question 2: Attention deficit hyperactivity disorder is characterized by-

• A. Impulsivity
• B. Poor attention
• C. Hyperactivity
• D. All of the options (Correct Answer)

Child and Adolescent Psychiatry Explanation: ***All of the options*** - **Attention deficit hyperactivity disorder (ADHD)** is characterized by a persistent pattern of **inattention and/or hyperactivity-impulsivity** that interferes with functioning or development. - All three features—**impulsivity**, **inattention (poor attention)**, and **hyperactivity**—represent the core symptom domains of ADHD according to **DSM-5** criteria. - ADHD presentations can vary: **predominantly inattentive**, **predominantly hyperactive-impulsive**, or **combined presentation** (most common). **The Three Core Features:** **Impulsivity** - Acting without thinking or considering consequences - Difficulty waiting turns or delaying gratification - Interrupting or intruding on others - Making hasty decisions without forethought **Inattention (Poor Attention)** - Difficulty sustaining attention in tasks or play - Easily distracted by extraneous stimuli - Forgetfulness in daily activities - Poor organization and time management - Frequently loses things necessary for tasks **Hyperactivity** - Excessive motor activity and restlessness - Fidgeting, squirming, or inability to remain seated - Running or climbing inappropriately (in children) - Feeling internally restless (in adults) - Talking excessively *Why individual options alone are incomplete:* While each symptom domain can be prominent in different ADHD presentations, the disorder is comprehensively **characterized by all three core symptom clusters**, making "All of the options" the most accurate and complete answer.

Child and Adolescent Psychiatry Indian Medical PG 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

Child and Adolescent Psychiatry 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.

Child and Adolescent Psychiatry Indian Medical PG 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

Child and Adolescent Psychiatry 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.

Child and Adolescent Psychiatry Indian Medical PG Question 5: Stimulant drugs are primarily given to children for the treatment of:

• A. Speech developmental disorder
• B. Conduct disorder
• C. ADHD (Correct Answer)
• D. Pervasive disorder

Child and Adolescent Psychiatry Explanation: ***ADHD*** - Stimulant medications like **methylphenidate** and **amphetamine** are first-line treatments for attention-deficit/hyperactivity disorder (ADHD) in children. - They work by increasing the levels of **dopamine** and **norepinephrine** in the brain, improving focus and reducing impulsivity. *Speech developmental disorder* - This disorder primarily involves difficulties with **language production** or comprehension. - Treatment typically focuses on **speech therapy** and educational interventions, not stimulant medications. *Conduct disorder* - This condition involves persistent patterns of **antisocial behavior**, aggression, and violations of rules. - While therapy is the primary treatment, if there are co-occurring symptoms of ADHD, stimulants might be used to address those specific symptoms, but aren't a direct treatment for conduct disorder itself. *Pervasive disorder* - This term is an older term for what is now known as **autism spectrum disorder (ASD)**. - There is no evidence that stimulant medications are effective for the core symptoms of ASD, and they might exacerbate some behavioral symptoms.

Child and Adolescent Psychiatry Flashcard 1 of 5

Question: _____ disorder is a childhood disorder characterized by severe and recurrent temper outbursts out of proportion to a situation lasting for more than 1 year, without symptoms for not more than 3 months

Answer: Disruptive mood dysregulation

Child and Adolescent Psychiatry Flashcard 2 of 5

Question: _____ is a type of pervasive developmental disorder characterized by difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests

Answer: Asperger's syndrome

Child and Adolescent Psychiatry Flashcard 3 of 5

Question: _____ syndrome is also known as childhood disintegrative disorder

Answer: Heller

Child and Adolescent Psychiatry Flashcard 4 of 5

Question: _____ syndrome is characterised by the failure to develop an attachment with a parental figure and a preoccupation with inanimate objects.

Answer: Kanner

Child and Adolescent Psychiatry Flashcard 5 of 5

Question: The developmental age of child suffering from reactive attachment disorder is atleast _____ months

Answer: 9