Child and Adolescent Psychiatry Practice Questions

Q: ADHD in childhood can lead to which of the following in the future?

All of the options. ***All of the options*** - Childhood ADHD is associated with an increased risk of developing various long-term negative outcomes, including **substance use disorders** (like alcoholism), **antisocial behaviors**, and impacts on **academic and occupational functioning** which can be broadly termed intellectual or cognitive impacts. - The inattentiveness, impulsivity, and hyperactivity characteristic of ADHD can disrupt normal development, leading to difficulties in social interactions, educational attainment, and emotional regulation, all contributing to these wider issues. *Intellectual changes* - While ADHD does not directly cause an intellectual disability, it can significantly impact **academic performance**, executive function, and the ability to apply learned knowledge, leading to what might be perceived as intellectual challenges or underachievement. - Difficulties with sustained attention, organization, and impulse control can hinder learning processes and the acquisition of new skills, influencing cognitive development and application. *Alcoholism* - Individuals with ADHD, particularly those with untreated or poorly managed symptoms, have a significantly **higher risk of developing substance use disorders**, including alcoholism. - The impulsive nature and difficulty with self-regulation often seen in ADHD can contribute to engaging in risky behaviors, including substance experimentation and dependence, as a form of self-medication or coping mechanism. *Antisocial behaviour* - ADHD, especially when comorbid with **oppositional defiant disorder (ODD)** or **conduct disorder (CD)**, is a significant risk factor for the development of antisocial behaviors and later antisocial personality disorder. - Impulsivity, poor emotional regulation, and difficulties understanding consequences can predispose individuals with ADHD to violate social norms and engage in aggressive or non-compliant actions.

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

Impaired cognition. ***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.

Q: A child is suspected of having an autistic disorder. All areTRUE about autism, EXCEPT:

Child is able to interact. ***Child is able to interact*** - Autism Spectrum Disorder (ASD) is characterized by **persistent deficits in social communication and social interaction**. - Children with autism typically have difficulty with **social reciprocity**, such as initiating or responding to social interactions, and often show limited interest in interacting with peers. - This statement is **FALSE** about autism, making it the correct answer to this EXCEPT question. *Repetitive behavior is seen* - **Restricted, repetitive patterns of behavior, interests, or activities** are a core diagnostic criterion for ASD. - This can manifest as **stereotyped or repetitive motor movements**, use of objects, or speech, as well as insistence on sameness or highly restricted, fixed interests. *Language is not well developed* - Many individuals with ASD experience **delays or difficulties in language development**, ranging from a complete lack of spoken language to difficulties with conversational skills and understanding nuances of speech. - While some may develop advanced vocabulary, their **pragmatic language skills** (social use of language) are often impaired. *Symptoms appear between 18-24 months* - Symptoms of ASD often become noticeable between **12 and 24 months** of age, though this can vary. - Early signs can sometimes be observed before 12 months, and in some cases, symptoms may not become clear until **social demands exceed limited capacities** in later childhood. - The typical age of symptom recognition is indeed in this developmental period.

Q: A 16-year-old male is found to have a mental age of 9 years on I.Q. testing. He has -

Mild intellectual disability. ***Mild intellectual disability*** - A mental age of 9 years in a 16-year-old corresponds to an **IQ range of 50-69**, which falls under the definition of **mild intellectual disability**. - Individuals in this category typically achieve a **sixth-grade academic level** and can often live independently with appropriate support. *Profound intellectual disability* - This is characterized by an **IQ below 20**, meaning a mental age significantly lower than 9 years, even for a child. - Individuals require **constant supervision** and have very limited communication and motor skills. *Severe intellectual disability* - This category is associated with an **IQ of 20-34**, corresponding to a mental age typically below 6 years. - Individuals often have **minimal communication skills** and require daily supervision. *Moderate intellectual disability* - This is defined by an **IQ of 35-49**, which would result in a mental age significantly lower than 9 years for a 16-year-old. - Individuals can develop some communication and self-care skills but generally need **substantial support** throughout their lives.

Q: According to DSM 5 criteria, all are true about ADHD except:

For diagnoses, symptoms should be present before 7 years. ***For diagnoses, symptoms should be present before 7 years*** - This statement is **INCORRECT** according to DSM-5 criteria - DSM-IV required symptoms before **7 years of age**, but DSM-5 **revised** this requirement - DSM-5 now requires symptoms to be present before **12 years of age** - This is the **correct answer** for this EXCEPT question as it is the false statement *Adult ADHD symptoms are similar to children* - This statement is generally TRUE - Core symptoms of **inattention, hyperactivity, and impulsivity** persist into adulthood - However, manifestations change: hyperactivity in adults often presents as **restlessness** or internal feeling of being "on edge" rather than overt physical activity - The similarity in core symptoms makes this statement true *Symptoms should be present in more than one setting* - This statement is TRUE per DSM-5 criteria - Symptoms must be present in **two or more settings** (e.g., home, school, work, with friends) - This criterion ensures symptoms reflect a **pervasive pattern** rather than situational behavior - This is a key requirement for ADHD diagnosis *For diagnoses, symptoms should be present before 12 years* - This statement is TRUE and reflects current DSM-5 criteria - Several **inattentive or hyperactive-impulsive symptoms** must be present before **12 years of age** - This updated age criterion (changed from 7 in DSM-IV) allows for later recognition of symptoms - This helps differentiate ADHD from conditions with adult onset

Q: Autism is characterised by all EXCEPT

High intelligence. ***High intelligence*** - While some individuals with autism may have **savant skills** or average to above-average intelligence, high intelligence is **not a defining or universal characteristic** of autism spectrum disorder. - Autism is a **developmental disorder** primarily defined by challenges in social communication and interaction, and restrictive, repetitive behaviors, rather than intelligence level. *Motor abnormalities* - **Motor abnormalities**, such as clumsiness, gait disturbances, and problems with fine motor skills, are frequently observed in individuals with autism. - These can include **hypotonia**, **dyspraxia**, and repetitive motor mannerisms. *Unusual gestures* - **Unusual or repetitive gestures**, also known as **stereotypies** (e.g., hand-flapping, body rocking), are a common characteristic of autism spectrum disorder. - These gestures are part of the **restricted, repetitive patterns of behavior, interests, or activities** criterion for diagnosis. *Less eye contact* - **Reduced or atypical eye contact** is a hallmark characteristic of autism, reflecting difficulties in social communication and interaction. - This is often one of the **earliest recognized signs** in children with autism, indicating challenges in non-verbal communication.

Q: According to the DSM-5 criteria for Autism Spectrum Disorder, which of the following is required for diagnosis in children?

Persistent deficits in social communication and interaction. ***Persistent deficits in social communication and interaction*** - This is a **core diagnostic criterion** for Autism Spectrum Disorder (ASD) according to DSM-5, encompassing difficulties in social-emotional reciprocity, nonverbal communicative behaviors, and developing/maintaining relationships. - These deficits must be present across **multiple contexts** and not better explained by other conditions. *Language delay before age 2* - While language delay is common in ASD, it is **not a mandatory diagnostic criterion** in the DSM-5; some individuals with ASD may have typical or even advanced language skills. - The focus has shifted from specific language milestones to broader **social communication deficits**. *Presence of seizure disorder* - **Seizures** are a co-occurring medical condition that can affect individuals with ASD, but they are absolutely **not a diagnostic criterion** for the disorder itself. - The presence of a seizure disorder suggests comorbidity, not a defining feature of autism. *Intellectual disability* - **Intellectual disability** frequently co-occurs with ASD (approximately 30-50% of cases), but it is **not a required criterion** for diagnosis. - Many individuals with ASD have average or above-average intellectual abilities.

Q: A 7-year-old girl presents with difficulties in writing and spelling, while her overall intelligence is normal. What is the most likely diagnosis?

Specific learning disorder affecting writing. ***Specific learning disorder affecting writing*** - This diagnosis aligns with documented difficulties in **writing and spelling** despite **normal overall intelligence**. - Formerly known as **dysgraphia**, it specifically impacts the motor and cognitive aspects of written expression. *Dyslexia* - Primarily affects **reading abilities**, with challenges in **decoding and phonological processing**. - While it can co-occur with writing difficulties, the primary presentation here emphasizes writing and spelling. *Intellectual disability* - Characterized by significant limitations in both **intellectual functioning** and **adaptive behavior**. - The descriptor "normal overall intelligence" directly rules out intellectual disability. *Dysphonia* - Refers to a **disorder of the voice**, affecting its quality, pitch, or loudness. - This condition is related to speech production and has no direct involvement with difficulties in writing or spelling.

Q: Autism is characterised by-

Pervasive social and communication problem. ***Pervasive social and communication problem*** - **Autism Spectrum Disorder (ASD)** is fundamentally characterized by persistent deficits in **social communication** and social interaction across multiple contexts. - This includes impairments in social-emotional reciprocity, nonverbal communicative behaviors, and developing/maintaining relationships. - Individuals with ASD also exhibit restricted, repetitive patterns of behavior, interests, or activities, which constitute the second core diagnostic criterion. *Mainly due to hypothalamic damage* - While brain differences are noted in ASD, **hypothalamic damage** is not identified as the primary or main cause. - ASD is a complex neurodevelopmental disorder with diverse etiologies involving multiple brain regions and neural networks, not solely linked to hypothalamic pathology. *Biological causation* - While ASD has a significant **biological basis**, including genetic and neurobiological factors, this statement is too broad and vague to characterize the disorder. - The defining features of autism relate specifically to **social communication impairments** and **restricted/repetitive behaviors**, not just general biological causes. *Metabolic disease* - ASD is not categorized as a primary **metabolic disease**. It is classified as a neurodevelopmental disorder. - Although some metabolic abnormalities can co-occur with or influence certain aspects of the disorder in a subset of individuals, the primary diagnostic criteria do not classify ASD as a metabolic disorder.

Question 1

ADHD in childhood can lead to which of the following in the future?

Accepted Answer

All of the options

Answer

Intellectual changes

Answer

Alcoholism

Answer

Antisocial behaviour

Question 2

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

Accepted Answer

Impaired cognition

Answer

Stereotyped behaviour

Answer

Reduced social interaction

Answer

Poor language skills

Question 3

A child is suspected of having an autistic disorder. All areTRUE about autism, EXCEPT:

Accepted Answer

Child is able to interact

Answer

Repetitive behavior is seen

Answer

Language is not well developed

Answer

Symptoms appear between 18-24 months

Question 4

A 16-year-old male is found to have a mental age of 9 years on I.Q. testing. He has -

Accepted Answer

Mild intellectual disability

Answer

Profound intellectual disability

Answer

Severe intellectual disability

Answer

Moderate intellectual disability

Question 5

Infantile autism is characterized by:

Accepted Answer

Social communication deficits and restricted, repetitive behaviors

Answer

Only language development delays

Answer

Hyperactivity and attention deficits

Answer

Intellectual disability in all cases

Question 6

According to DSM 5 criteria, all are true about ADHD except:

Accepted Answer

For diagnoses, symptoms should be present before 7 years

Answer

Adult ADHD symptoms are similar to children

Answer

Symptoms should be present in more than one setting

Answer

For diagnoses, symptoms should be present before 12 years

Question 7

Autism is characterised by all EXCEPT

Accepted Answer

High intelligence

Answer

Motor abnormalities

Answer

Unusual gestures

Answer

Less eye contact

Question 8

According to the DSM-5 criteria for Autism Spectrum Disorder, which of the following is required for diagnosis in children?

Accepted Answer

Persistent deficits in social communication and interaction

Answer

Language delay before age 2

Answer

Presence of seizure disorder

Answer

Intellectual disability

Question 9

A 7-year-old girl presents with difficulties in writing and spelling, while her overall intelligence is normal. What is the most likely diagnosis?

Accepted Answer

Specific learning disorder affecting writing

Answer

Dyslexia

Answer

Intellectual disability

Answer

Dysphonia

Question 10

Autism is characterised by-

Accepted Answer

Pervasive social and communication problem

Answer

Mainly due to hypothalamic damage

Answer

Biological causation

Answer

Metabolic disease

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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