Child and Adolescent Psychiatry Practice Questions

Q: A 10-year-old child with a mental age of 2 years will have an IQ level of?

20. ### Explanation **1. Understanding the Correct Answer (A):** The Intelligence Quotient (IQ) is calculated using the classic formula developed by William Stern: **IQ = (Mental Age / Chronological Age) × 100** In this case: * **Mental Age (MA):** 2 years * **Chronological Age (CA):** 10 years * **Calculation:** (2 / 10) × 100 = **20** According to the ICD-10 and DSM classifications, an IQ of 20 falls at the boundary of **Severe Mental Retardation (IQ 20–34)** and **Profound Mental Retardation (IQ < 20)**. **2. Why Other Options are Incorrect:** * **Option B (30):** This would require a mental age of 3 years (3/10 × 100). This falls under Severe Mental Retardation. * **Option C (50):** This would require a mental age of 5 years (5/10 × 100). This is the cutoff for Moderate Mental Retardation (IQ 35–49). * **Option D (70):** This would require a mental age of 7 years (7/10 × 100). An IQ of 70 is the traditional cutoff for Mild Mental Retardation (IQ 50–70). **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Classification of Intellectual Disability (ICD-10):** * **Mild (IQ 50–70):** "Educable"; can reach 6th-grade level; most common (85%). * **Moderate (IQ 35–49):** "Trainable"; can reach 2nd-grade level; performs supervised tasks. * **Severe (IQ 20–34):** Can learn basic self-care and survival words. * **Profound (IQ < 20):** Requires constant supervision; minimal verbal skills. * **Most Common Cause:** The most common genetic cause of intellectual disability is **Down Syndrome**, while the most common inherited cause is **Fragile X Syndrome**. * **Assessment:** In children, the **Vineland Social Maturity Scale (VSMS)** and **Binet-Kamat Test (BKT)** are frequently used in Indian clinical settings to assess Social Quotient (SQ) and IQ.

Q: A boy with an IQ of 62 will come under which category of intellectual disability?

Mild intellectual disability. **Explanation:** Intellectual Disability (ID) is characterized by deficits in intellectual functioning (reasoning, problem-solving, planning) and adaptive functioning. According to the ICD-10 and DSM-IV classifications, the severity of ID is primarily categorized based on Intelligence Quotient (IQ) scores. **Why the correct answer is right:** * **Mild Intellectual Disability (IQ 50–69):** An IQ of 62 falls squarely within this range. Individuals in this category are often referred to as "educable." They can usually acquire academic skills up to the 6th-grade level, achieve social and vocational adequacy with some support, and live independently in the community. **Why the incorrect options are wrong:** * **Moderate Intellectual Disability (IQ 35–49):** These individuals are "trainable." They can perform supervised unskilled or semi-skilled work and usually achieve an academic level of the 2nd grade. * **Severe Intellectual Disability (IQ 20–34):** These individuals have very limited communication skills and require significant supervision for self-care and safety. * **Normal Intellectual Functioning (IQ 90–109):** An IQ of 62 is significantly below the average range (85–115) and the threshold for "Borderline Intellectual Functioning" (IQ 70–79). **High-Yield Clinical Pearls for NEET-PG:** * **Profound ID:** IQ < 20. Requires constant nursing care and supervision. * **Most Common Type:** Mild ID accounts for approximately **85%** of all cases of intellectual disability. * **Diagnosis:** Under DSM-5, the severity of ID is now determined by **adaptive functioning** (conceptual, social, and practical domains) rather than IQ scores alone, though IQ remains a vital clinical marker. * **Commonest Genetic Cause:** Down Syndrome (Trisomy 21). * **Commonest Inherited Cause:** Fragile X Syndrome.

Q: Which of the following statements is true regarding Attention Deficit Hyperactivity Disorder (ADHD)?

It is more frequently seen in boys.. ### Explanation **Correct Answer: B. It is more frequently seen in boys.** **1. Why Option B is Correct:** Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. Epidemiological studies consistently show a higher prevalence in males compared to females, with a ratio typically cited between **3:1 and 4:1** in clinical samples. Boys are more likely to present with externalizing symptoms like hyperactivity and impulsivity, which often leads to earlier referral and diagnosis. **2. Why the Other Options are Incorrect:** * **Option A:** According to DSM-5 criteria, several inattentive or hyperactive-impulsive symptoms must be present **before age 12**. Symptoms do not start after age ten; they are developmental in nature and typically manifest in early childhood. * **Option C:** ADHD is not exclusively a childhood disorder. While hyperactivity may decrease with age, symptoms of inattention and impulsivity **persist into adulthood** in approximately 50–60% of cases (Adult ADHD). * **Option D:** ADHD is characterized by **hyperactivity**, not hypoactivity. The core triad of symptoms includes **Inattention, Hyperactivity, and Impulsivity**. **3. High-Yield Clinical Pearls for NEET-PG:** * **Neurobiology:** Associated with dysfunction in the **Prefrontal Cortex** and imbalances in **Dopamine and Norepinephrine** pathways. * **Drug of Choice (DOC):** **Methylphenidate** (a CNS stimulant). It acts by blocking the reuptake of dopamine and norepinephrine. * **Non-stimulant alternative:** **Atomoxetine** (Selective Norepinephrine Reuptake Inhibitor), often used if there is a history of substance abuse or tics. * **Common Comorbidities:** Oppositional Defiant Disorder (ODD), Conduct Disorder, and Specific Learning Disorders.

Q: Attention-Deficit/Hyperactivity Disorder (ADHD) in childhood is associated with an increased risk of which of the following disorders later in life?

Alcoholism. ### Explanation **Correct Option: B. Alcoholism** ADHD is a neurodevelopmental disorder characterized by executive dysfunction, impulsivity, and emotional dysregulation. Longitudinal studies consistently show that children with ADHD are at a significantly higher risk for **Substance Use Disorders (SUD)**, including alcoholism, in adolescence and adulthood. * **Mechanism:** Impulsivity and the tendency for "self-medication" to manage symptoms of restlessness or poor focus contribute to this risk. Additionally, ADHD often co-occurs with **Conduct Disorder (CD)**; the presence of comorbid CD further escalates the risk of developing antisocial personality disorder and severe substance abuse later in life. **Analysis of Incorrect Options:** * **A. Schizophrenia:** While both are neurodevelopmental in origin, there is no direct causal link or significant longitudinal association suggesting ADHD leads to Schizophrenia. * **C. Dissociative Disorder:** These disorders are typically rooted in severe childhood trauma (e.g., abuse) rather than the neurobiological pathways of ADHD. * **D. Intellectual Disability (ID):** ID is a concurrent neurodevelopmental condition. ADHD does not *cause* ID later in life; rather, they may coexist as comorbidities from early childhood. **High-Yield Clinical Pearls for NEET-PG:** * **Most common comorbidity in ADHD:** Oppositional Defiant Disorder (ODD). * **Prognosis:** Approximately 50–60% of cases persist into adulthood (Adult ADHD), where symptoms of hyperactivity often transition into internal restlessness. * **Treatment of Choice:** Stimulants (e.g., **Methylphenidate**) are first-line. Non-stimulants like **Atomoxetine** (a selective NRI) are preferred if there is a high risk of substance abuse. * **Gender:** More common in boys (approx. 3:1 ratio).

Q: Which of the following autistic spectrum disorders carries a good prognosis?

Asperger's syndrome. **Explanation:** The prognosis of Autism Spectrum Disorders (ASD) is primarily determined by two factors: **Intellectual ability (IQ)** and **Language development**. **Asperger’s Syndrome (Correct Option):** Asperger’s syndrome is characterized by social impairment and restricted interests, but it is distinguished by the **absence of clinically significant delays in language or cognitive development**. Because these individuals have normal to high IQs and functional communication skills, they have the best prognosis among the listed disorders, often achieving independent living and employment. **Incorrect Options:** * **Childhood Autism:** Typically involves significant delays in language and social interaction. About 50-70% of cases are associated with intellectual disability (IQ < 70), leading to a more guarded prognosis compared to Asperger’s. * **Rett’s Disease:** A progressive neurodevelopmental disorder (primarily in females, linked to the *MECP2* gene) characterized by a period of normal development followed by loss of purposeful hand skills, deceleration of head growth, and severe intellectual disability. It has a **poor prognosis**. * **Heller’s Syndrome (Childhood Disintegrative Disorder):** Involves a dramatic loss of previously acquired skills (language, social, motor) after at least 2 years of normal development. It carries a **very poor prognosis** as the regression is often permanent and severe. **NEET-PG High-Yield Pearls:** * **DSM-5 Update:** All these categories (except Rett's) are now merged under the single umbrella of **Autism Spectrum Disorder (ASD)**. * **Best Prognostic Indicators:** High IQ and the presence of communicative speech by age 5–7 years. * **Rett’s Syndrome:** Look for "hand-wringing" stereotypies and its X-linked dominant inheritance pattern. * **Kanner’s Syndrome:** Another name for Early Infantile Autism.

Q: Rett's syndrome is characterized by?

Regression of language and motor milestones. **Explanation:** **Rett’s Syndrome** is a unique neurodevelopmental disorder primarily affecting females (X-linked dominant inheritance, usually due to a mutation in the **MECP2 gene**). It is characterized by a period of normal early development (6–18 months) followed by a distinct **regression of milestones**, particularly in language and motor skills. * **Why Option A is correct:** The hallmark of Rett’s syndrome is the loss of previously acquired purposeful hand skills and spoken language. This is replaced by stereotypical, repetitive hand movements (e.g., **hand-wringing**, clapping, or washing motions) and gait abnormalities (ataxia). * **Why Option B is incorrect:** While some behavioral irritability exists, hyperactivity is not the defining feature. In fact, patients often develop social withdrawal and "autistic-like" features during the regression phase. * **Why Option C is incorrect:** Children with Rett’s syndrome often face growth failure, including low weight and height, as the disease progresses. * **Why Option D is incorrect:** Rett’s syndrome is classically associated with **acquired microcephaly** (deceleration of head growth), not macrocephaly. Macrocephaly is more commonly associated with certain types of Autism Spectrum Disorders or metabolic storage diseases. **High-Yield Clinical Pearls for NEET-PG:** * **Genetics:** Mutation in the **MECP2 gene** on the X chromosome. It is usually lethal in males. * **Key Sign:** **Hand-wringing stereotypes** are the most characteristic diagnostic clue. * **Respiratory Signs:** Episodes of hyperventilation followed by apnea (breath-holding spells) are common. * **Seizures:** Up to 80% of patients develop epilepsy. * **ICD/DSM Classification:** Previously classified under Pervasive Developmental Disorders (PDD), it is now recognized as a distinct genetic neurological entity.

Q: Which of the following is NOT characteristic of autism?

Onset after 6 years of age. **Explanation:** Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and restricted, repetitive patterns of behavior. **Why Option A is the Correct Answer:** According to the **DSM-5 criteria**, symptoms of autism must be present in the **early developmental period** (typically before **3 years of age**). While symptoms may not become fully manifest until social demands exceed limited capacities, an onset after 6 years of age is inconsistent with a diagnosis of ASD. If a child develops normally until age 6 and then regresses, clinicians must investigate other neurological or degenerative conditions. **Analysis of Incorrect Options:** * **Option B (Repetitive behavior):** This is a core diagnostic criterion. It includes stereotyped motor movements (e.g., hand flapping), insistence on sameness, and highly restricted, fixated interests. * **Option C (Delayed language development):** Communication deficits are hallmark features. This includes a total lack of speech, delayed speech, or "echolalia" (meaningless repetition of words). * **Option D (Severe deficit in social interaction):** This is the "social triad" deficit, including poor eye contact, lack of social-emotional reciprocity, and inability to develop peer relationships. **High-Yield Clinical Pearls for NEET-PG:** * **M-CHAT (Modified Checklist for Autism in Toddlers):** The most commonly used screening tool (usually at 18 and 24 months). * **Male to Female Ratio:** Approximately 4:1. * **Associated Findings:** Macrocephaly is often noted in early childhood; about 30% of cases are associated with Epilepsy. * **Treatment:** Behavioral therapy (Applied Behavior Analysis - ABA) is the mainstay. Pharmacotherapy (e.g., Risperidone) is used only for associated irritability or aggression.

Q: PANDAS are associated with which of the following infections?

Streptococcus. **Explanation:** **PANDAS** stands for **Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections**. **Why Streptococcus is correct:** The core pathophysiology involves an autoimmune response following an infection with **Group A Beta-Hemolytic Streptococcus (GABHS)**, such as strep throat or scarlet fever. It is hypothesized that antibodies produced against the streptococcal bacteria cross-react with host tissues in the **basal ganglia** through a mechanism known as **molecular mimicry** (similar to the mechanism in Sydenham’s chorea). This triggers a sudden, dramatic onset or "flare-up" of obsessive-compulsive disorder (OCD) symptoms or tic disorders in children. **Why other options are incorrect:** * **Pseudomonas, Staphylococcus, and Neisseria:** While these are common human pathogens, they are not associated with the specific molecular mimicry involving the basal ganglia that characterizes PANDAS. There is no clinical evidence linking these bacteria to the acute-onset neuropsychiatric syndrome defined by the PANDAS criteria. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Criteria:** Symptoms must appear between age 3 and puberty, have an episodic (relapsing-remitting) course, and show a temporal relationship with GABHS infection (confirmed by positive throat culture or elevated Anti-streptolysin O [ASO] titers). * **Key Symptoms:** Sudden onset OCD, tics, emotional lability, irritability, and often "clumsiness" or hyperactivity. * **Differential Diagnosis:** Must be distinguished from **Sydenham’s Chorea** (a major Jones criterion for Rheumatic Fever), which also involves the basal ganglia but presents with characteristic purposeless movements. * **PANS:** A broader category called Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is used when the trigger is not necessarily Streptococcal (can be other infections or environmental factors).

Question 1

A 10-year-old child with a mental age of 2 years will have an IQ level of?

Accepted Answer

20

Answer

30

Answer

50

Answer

70

Question 2

A boy with an IQ of 62 will come under which category of intellectual disability?

Accepted Answer

Mild intellectual disability

Answer

Moderate intellectual disability

Answer

Severe intellectual disability

Answer

Normal intellectual functioning

Question 3

Eye blinking or throat-clearing noises are observed in an otherwise healthy 8-year-old boy. For the description above, select the most likely diagnosis.

Accepted Answer

Transient tic disorder of childhood

Answer

Tourette syndrome

Answer

Sydenham chorea

Answer

Dystonia

Question 4

Which of the following statements is true regarding Attention Deficit Hyperactivity Disorder (ADHD)?

Accepted Answer

It is more frequently seen in boys.

Answer

Symptoms start after ten years of age.

Answer

Symptoms never continue into adulthood.

Answer

It is characterized by hypoactivity of the child.

Question 5

Attention-Deficit/Hyperactivity Disorder (ADHD) in childhood is associated with an increased risk of which of the following disorders later in life?

Accepted Answer

Alcoholism

Answer

Schizophrenia

Answer

Dissociative disorder

Answer

Intellectual disability

Question 6

Which of the following autistic spectrum disorders carries a good prognosis?

Accepted Answer

Asperger's syndrome

Answer

Childhood autism

Answer

Rett's disease

Answer

Heller's syndrome

Question 7

Rett's syndrome is characterized by?

Accepted Answer

Regression of language and motor milestones

Answer

Hyperactive child

Answer

Normal weight

Answer

Macrocephaly

Question 8

Which of the following is NOT characteristic of autism?

Accepted Answer

Onset after 6 years of age

Answer

Repetitive behaviour

Answer

Delayed language development

Answer

Severe deficit in social interaction

Question 9

PANDAS are associated with which of the following infections?

Accepted Answer

Streptococcus

Answer

Pseudomonas

Answer

Staphylococcus

Answer

Neisseria

Question 10

Which of the following is the most significant component of a behavioral program developed to help a mother deal with a child having oppositional defiant disorder?

Accepted Answer

Positive reinforcement

Answer

Punishment

Answer

School suspension

Answer

Strict parenting

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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