Child and Adolescent Psychiatry Practice Questions

Q: In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-

Disturbances of communication. ***Disturbances of communication*** - In DSM-5 and proposed ICD-11, **communication deficits** are now subsumed under the broader category of **social communication deficits**. - This change reflects the understanding that communication difficulties in ASD are primarily related to their social function rather than being a separate, general communication disorder. *Disturbances of intellectual development* - While many individuals with ASD also have **intellectual disabilities**, this has never been a core diagnostic criterion for autism itself. - **Intellectual development** is considered a co-occurring condition rather than a defining feature of the spectrum. *Disturbance of social interaction* - **Deficits in social interaction** remain a core diagnostic criterion for autism spectrum disorder in both DSM-5 and ICD-11. - This domain emphasizes difficulties with **social-emotional reciprocity**, nonverbal communicative behaviors, and developing social relationships. *Restricted, repetitive patterns of behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** also remain a core diagnostic criterion in both diagnostic systems. - This includes a range of symptoms such as **stereotyped motor movements**, insistence on sameness, and highly restricted fixated interests.

Q: All are recognised features of Tourette's syndrome, EXCEPT:

Ataxia. ***Ataxia*** - **Ataxia** refers to impaired coordination and balance due to neurological dysfunction, which is not a characteristic feature of **Tourette's syndrome**. - Tourette's syndrome is a **neurodevelopmental disorder** primarily characterized by tics, not motor incoordination. *Coprolalia* - **Coprolalia**, the involuntary utterance of obscene words or socially inappropriate phrases, is a classic though uncommon feature of Tourette's syndrome. - It is a specific type of **vocal tic** seen in a subset of individuals with the condition. *Motor Tics* - **Motor tics**, such as blinking, head jerking, shoulder shrugging, or more complex movements, are a core diagnostic criterion for Tourette's syndrome. - For diagnosis, both multiple motor tics and at least one vocal tic must be present at some point during the illness. *Predominantly affects males* - **Tourette's syndrome** is more prevalent in males than in females, with a male-to-female ratio typically ranging from 3:1 to 4:1. - This demographic pattern is a recognized epidemiological feature of the disorder.

Q: Which of the following is true about Intellectual Disability (Mental Retardation):

Antenatal factor can cause mental retardation. ***Antenatal factor can cause mental retardation*** - Many causes of **intellectual disability** (ID) are due to events or conditions that occur during the **prenatal period**, affecting fetal brain development. - Examples include genetic disorders like **Down syndrome**, intrauterine infections (rubella, CMV, toxoplasmosis), maternal substance abuse, and exposure to teratogens. - This is the **correct answer**. *Severe MR is IQ <20* - According to most diagnostic criteria, **severe intellectual disability** is typically defined by an **IQ score between 20-34** (DSM-5) or 20-39 (ICD-10). - An IQ score below 20 is generally classified as **profound intellectual disability**, not severe. *More common in female than male* - **Intellectual disability** is generally found to be **more common in males than in females** (approximately 1.3-1.6:1 ratio). - This male predominance is observed across various levels of severity and is partly attributed to X-linked genetic disorders (e.g., Fragile X syndrome). *All of the options* - Since only the first option (antenatal factors) is correct, and the other two options are incorrect, this option cannot be true.

Q: In treating children with intellectual disabilities, one generally finds that they:

Respond similarly to typically developing children of the same mental age. ***Respond similarly to typically developing children of the same mental age*** - Children with **intellectual disabilities** often demonstrate cognitive and behavioral patterns that align with the developmental stage of neurotypical children who share their **mental age**, rather than their chronological age. - This principle is fundamental in designing **educational and therapeutic interventions**, as it suggests that learning approaches effective for younger neurotypical children can be adapted for children with intellectual disabilities at a similar developmental level. *All of the options* - This option is incorrect because not all listed statements are accurate; specifically, the idea that they respond inconsistently is a generalization that does not capture the nuanced understanding of intellectual disability. - While there are various approaches to care and education, the most accurate statement regarding their response patterns is linked to their mental age, making this overarching "all of the options" choice invalid. *Can be managed in ways similar to typically developing children* - While children with intellectual disabilities can indeed respond to structured environments and behavioral interventions, this statement is less precise than comparing their responses to their mental age. - The effectiveness of management approaches often needs to be adapted to their specific cognitive and developmental levels, which are better characterized by mental age. *Respond inconsistently* - This generalization is often inaccurate, as many children with intellectual disabilities, given appropriate support and tailored teaching methods, can demonstrate consistent learning and behavioral patterns. - Inconsistency might stem more from ill-suited interventions or environmental stressors rather than an inherent characteristic of intellectual disability itself.

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

Down Syndrome. ***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.

Q: Autism is characterized by all except -

Depression. ***Depression*** - While individuals with **autism spectrum disorder (ASD)** may experience higher rates of anxiety and depression as co-occurring conditions, **depression** itself is not a core diagnostic symptom used to characterize autism. - The diagnostic criteria for autism focus on deficits in social communication and interaction, and restricted, repetitive patterns of behavior, interests, or activities. *Language problems* - **Language problems** are a hallmark feature of autism, ranging from delayed speech development to unusual patterns of speech like **echolalia** or difficulty with **conversational reciprocity**. - These communication difficulties are a direct component of the core diagnostic criteria for autism spectrum disorder. *Stereotyped behavior* - **Stereotyped behaviors**, such as repetitive motor movements (e.g., hand flapping, rocking), repetitive use of objects, or insistence on sameness, are a defining characteristic of autism. - These behaviors fall under the diagnostic criteria of **restricted, repetitive patterns of behavior, interests, or activities**. *Lack of social play in child* - A significant **lack of social play** (e.g., imaginative play, cooperative play) and difficulty with social interaction is a core diagnostic feature of autism, particularly evident in childhood. - This symptom reflects the impairment in **social communication and interaction** central to the diagnosis of autism spectrum disorder.

Q: A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes. He passes his examination with poor marks. However, his mathematical ability and social adjustment are appropriate for his age. Which of the following is the most likely diagnosis?

Specific learning disability. ***Specific learning disability*** - The boy's difficulties specifically in **writing** and **spelling** despite age-appropriate mathematical ability and social adjustment are characteristic of a **specific learning disorder**. - These disorders affect specific academic skills like **dysgraphia** (writing) or **dysorthographia** (spelling) while other cognitive functions remain intact. *Intellectual disability* - This condition involves significant limitations in **both intellectual functioning** (e.g., reasoning, problem-solving) and **adaptive behavior** (e.g., conceptual, social, practical skills). - The boy's appropriate **mathematical ability** and **social adjustment** argue against a diagnosis of intellectual disability. *Examination anxiety* - While examination anxiety can lead to poor test performance, it typically affects performance across various subjects due to **stress** and **panic**, rather than specific difficulties in writing or spelling. - It would not explain a fundamental difficulty in **expressing himself in writing** regardless of the context. *Lack of interest in studies* - Lack of interest might lead to poor academic performance, but it doesn't typically manifest as specific difficulties with **writing and spelling mechanics** while other cognitive abilities are preserved. - A student lacking interest might simply not try, but usually wouldn't have a fundamental inability to perform the task if motivated.

Q: What is the definition of Autism Spectrum Disorder (ASD)?

A neurodevelopmental disorder characterized by difficulties in social interaction, communication, and restricted and repetitive behavior. ***A neurodevelopmental disorder characterized by difficulties in social interaction, communication, and restricted and repetitive behavior*** - This definition accurately describes **Autism Spectrum Disorder (ASD)**, which is fundamentally characterized by challenges in **social communication and interaction**, alongside **restricted, repetitive patterns of behavior, interests, or activities** [1]. - These core characteristics differentiate autism from other developmental or psychiatric conditions [2]. *Most severely handicapping condition* - While autism can be significantly impairing for some individuals, describing it as the "most severely handicapping condition" is an **overgeneralization** and not a diagnostic definition. - The **severity of autism** varies widely, and many individuals with ASD lead fulfilling lives with appropriate support. *Chronic recurrent and Paraxysmal changes in neurologic function* - This description is more indicative of conditions like **epilepsy** or other neurological disorders involving sudden, episodic changes. - Autism is a **persistent neurodevelopmental disorder**, not characterized by recurrent paroxysmal neurological changes [3]. *Incapacitating communication and emotional problem* - While **communication and emotional challenges** are central to autism, this description is incomplete and lacks the crucial component of **restricted and repetitive behaviors** [1]. - It also uses the strong term "incapacitating," which may not apply to all individuals on the spectrum.

Q: A 10-year-old child has a mental age of 4 years, suggesting significantly impaired adaptive functioning. This most likely indicates which level of intellectual disability?

Moderate. ***Moderate*** - Mental age (4 years) ÷ Chronological age (10 years) × 100 = **IQ of 40** - IQ of 40 falls within the **moderate intellectual disability range (IQ 35-49)** - Individuals with moderate intellectual disability require **moderate support and supervision** in daily activities, have limited academic potential (typically 2nd-4th grade level), but can achieve some independence in structured settings *Mild* - Mild intellectual disability corresponds to **IQ 50-70** - The calculated IQ of 40 is **below this threshold**, ruling out mild intellectual disability - Individuals with mild ID can typically achieve **6th grade academic skills** and functional independence with minimal support *Severe* - Severe intellectual disability is characterized by **IQ 20-34** - An IQ of 40 is **above this range**, ruling out severe intellectual disability - Individuals with severe ID require extensive support and have very limited communication abilities *Profound* - Profound intellectual disability is defined as **IQ below 20** - An IQ of 40 is **significantly higher** than this range - Individuals with profound ID require constant care and have minimal cognitive and adaptive functioning

Question 1

A mother and her 4 year old son are seated alone in
a reception area with the child staring off into space,
rocking and constantly twisting a strand of hair about
his fingers. Upon entry of another person, the child
begins to beat his fist against the side of his face and
behaves as though he does not hear his mother speaking
to him. This behavior is most characteristic of:

Accepted Answer

An autistic child

Answer

A child with intellectual disability

Answer

First dental appointment anxieties of a 4 year old child

Answer

A child with a chronic seizure disorder

Question 2

In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-

Accepted Answer

Disturbances of communication

Answer

Disturbances of intellectual development

Answer

Disturbance of social interaction

Answer

Restricted, repetitive patterns of behaviour

Question 3

All are recognised features of Tourette's syndrome, EXCEPT:

Accepted Answer

Ataxia

Answer

Coprolalia

Answer

Motor Tics

Answer

Predominantly affects males

Question 4

Which of the following is true about Intellectual Disability (Mental Retardation):

Accepted Answer

Antenatal factor can cause mental retardation

Answer

Severe MR is IQ <20

Answer

More common in female than male

Answer

All of the options

Question 5

In treating children with intellectual disabilities, one generally finds that they:

Accepted Answer

Respond similarly to typically developing children of the same mental age

Answer

All of the options

Answer

Respond inconsistently

Answer

Can be managed in ways similar to typically developing children

Question 6

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

Accepted Answer

Down Syndrome

Answer

Childhood Disintegrative Disorder

Answer

Asperger Syndrome

Answer

Rett Syndrome

Question 7

Autism is characterized by all except -

Accepted Answer

Depression

Answer

Language problems

Answer

Stereotyped behavior

Answer

Lack of social play in child

Question 8

A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes. He passes his examination with poor marks. However, his mathematical ability and social adjustment are appropriate for his age. Which of the following is the most likely diagnosis?

Accepted Answer

Specific learning disability

Answer

Intellectual disability

Answer

Examination anxiety

Answer

Lack of interest in studies

Question 9

What is the definition of Autism Spectrum Disorder (ASD)?

Accepted Answer

A neurodevelopmental disorder characterized by difficulties in social interaction, communication, and restricted and repetitive behavior

Answer

Most severely handicapping condition

Answer

Chronic recurrent and Paraxysmal changes in neurologic function

Answer

Incapacitating communication and emotional problem

Question 10

A 10-year-old child has a mental age of 4 years, suggesting significantly impaired adaptive functioning. This most likely indicates which level of intellectual disability?

Accepted Answer

Moderate

Answer

Mild

Answer

Severe

Answer

Profound

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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