Child and Adolescent Psychiatry Practice Questions

Q: A 10-year-old child presents with persistent restlessness, inattentiveness to studies, and a strong preference for outdoor play. The parents are highly concerned. What is the most appropriate next step in management?

Comprehensive evaluation by a qualified professional. ***Comprehensive evaluation by a qualified professional*** - The combination of **persistent restlessness**, **inattentiveness to studies**, and strong preference for outdoor play at age 10 could indicate a **developmental or behavioral disorder**, such as **ADHD**. - A qualified professional (e.g., pediatrician, child psychologist, psychiatrist) can conduct a thorough evaluation to differentiate between normal childhood behavior and potential underlying conditions, and determine appropriate interventions. *It is a normal behaviour* - While many children are active and enjoy outdoor play, **persistent restlessness** and **inattentiveness affecting studies** are not always normal and can be signs of an underlying issue. - Ignoring these symptoms as entirely normal could delay necessary intervention for conditions that impact a child's development and academic performance. *Needs change in environment* - While environmental factors can influence behavior, assuming that a simple change in environment will resolve persistent restlessness and inattentiveness may overlook a **biological or neurodevelopmental component**. - Environmental changes might be part of a broader management plan, but they are unlikely to be the sole solution without a clear understanding of the root cause. *It is a serious illness requiring medical treatment* - While the symptoms could be indicative of a condition that might require medical intervention, premature labeling as a "serious illness" without an evaluation or directly jumping to medical treatment without a diagnosis is inappropriate. - The first step is always **diagnosis** to determine the presence, nature, and severity of any potential condition.

Q: A 13-year-old boy is brought by his parents with history of frequent fighting at school, disciplinary problems, stealing money, assaulting his batchmates and being weak in studies. What is the most appropriate diagnosis for this child:

Conduct disorder. ***Conduct disorder*** - This diagnosis is strongly indicated by the child's pattern of **aggressive behavior** (assaulting batchmates), **coercion/theft** (stealing money), and frequent **rule-breaking** (fighting, disciplinary problems). - These actions represent a persistent disregard for societal norms and the rights of others, characteristic of **conduct disorder** in a 13-year-old. *Attention deficit hyperactivity disorder* - While children with **ADHD** may have disciplinary problems due to impulsivity and inattention, the hallmark features of **aggression** and **theft** are not primary symptoms. - The core symptoms of ADHD are problems with **inattention, hyperactivity**, and **impulsivity**, which are not the central focus of this presentation. *Autism* - **Autism spectrum disorder** is characterized by persistent deficits in **social communication and interaction**, and **restricted, repetitive patterns of behavior**. - The described behaviors of fighting, stealing, and assaulting are not typical manifestations of autism. *Nothing abnormal (teenage phenomenon)* - While some behavioral changes are normal during adolescence, a consistent pattern of **assault, theft, and severe disciplinary problems** goes beyond normal teenage rebellion. - These behaviors indicate a significant underlying issue requiring professional intervention, not just a passing phase.

Q: Scholastic performance is impaired in all of the following, except :

PICA. ***PICA*** - Pica is an eating disorder characterized by the **compulsive consumption of non-nutritive substances** (e.g., dirt, paint, hair). - While it can be associated with developmental disorders or nutritional deficiencies, pica itself does not directly impair scholastic performance in the way neurodevelopmental or psychological conditions do. *Anxiety* - **High levels of anxiety** can significantly interfere with a student's ability to focus, concentrate, and retain information in academic settings. - Test anxiety, social anxiety, and generalized anxiety can lead to poor performance, even in individuals with strong cognitive abilities. *Specific Learning Disability (SLD)* - SLD is a **neurodevelopmental disorder** that specifically impairs learning in areas like reading (dyslexia), writing (dysgraphia), or mathematics (dyscalculia). - This directly impacts a student's ability to acquire and apply academic skills, leading to impaired scholastic performance. *Attention Deficit Hyperactivity Disorder (ADHD)* - ADHD is characterized by **persistent patterns of inattention, hyperactivity, and/or impulsivity** that interfere with functioning or development. - These core symptoms directly impact a student's ability to pay attention in class, complete assignments, and organize schoolwork, leading to impaired scholastic performance.

Q: Which of the following is not a typical core feature of hyperkinetic disorder?

Bradykinesia. ***Bradykinesia*** - **Bradykinesia**, meaning **slow movement**, is characteristic of **hypokinetic** (reduced movement) disorders, such as Parkinson's disease, not hyperkinetic disorders. - Hyperkinetic disorders, like ADHD, are defined by excessive and rapid movements, along with impulsivity and inattention. *Aggressive outburst* - **Aggressive outbursts** can be a feature of hyperkinetic disorder, particularly in children and adolescents struggling with **impulsivity** and difficulty regulating emotions. - While not a primary diagnostic criterion, it is a common behavioral comorbidity associated with the disorder. *Soft neurological signs* - **Soft neurological signs** (e.g., clumsiness, minor coordination difficulties, poor fine motor skills) are frequently observed in individuals with hyperkinetic disorder. - These signs suggest minor neurological dysfunction and are consistent with neurodevelopmental conditions like ADHD. *Decreased attention span* - A **decreased attention span** (inattention) is a core diagnostic feature of **hyperkinetic disorder** (ADHD), alongside hyperactivity and impulsivity. - Individuals struggle to sustain focus, are easily distracted, and often have difficulty completing tasks.

Q: Which of the following is not a central characteristic of childhood autism?

Callous and unemotional traits. ***Callous and unemotional traits*** - While some individuals with autism may struggle with empathy, **callous and unemotional traits** are not a core diagnostic feature of autism spectrum disorder (ASD); they are more commonly associated with conditions like **conduct disorder** or **antisocial personality disorder**. - **Emotional dysregulation** and **difficulty recognizing others' emotions** are common in autism, but this differs from a pervasive pattern of callousness. *Impaired communication* - **Impaired verbal and nonverbal communication** is a fundamental diagnostic criterion for autism spectrum disorder, ranging from absent speech to difficulties with conversations and understanding social cues. - This can manifest as problems with **initiating or maintaining conversations**, **lack of eye contact**, and **unusual tone of voice**. *Restricted, repetitive behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** are a core diagnostic feature of ASD. - Examples include **stereotyped motor movements**, **insistence on sameness**, **highly restricted or fixated interests**, and **unusual sensory sensitivities**. *Impaired social interaction* - **Persistent deficits in social communication and social interaction** across multiple contexts are defining characteristics of autism. - This includes difficulties with **social-emotional reciprocity**, **nonverbal communication**, and **developing, maintaining, and understanding relationships**.

Q: Chronological age 10 years, mental age 4 years. What is that person classified as?

Moderate intellectual disability. ***Moderate intellectual disability*** - A person with a chronological age of 10 years and a mental age of 4 years has an **IQ of 40** (mental age/chronological age x 100), which falls within the range for moderate intellectual disability (IQ 35-49). - Individuals with moderate intellectual disability often require **supervision** in daily living and can achieve some degree of **social and vocational skills**. *Mild intellectual disability* - This classification is typically associated with an **IQ range of 50-69**. - Individuals with mild intellectual disability can usually achieve basic academic skills up to a **sixth-grade level** and live independently with minimal support. *Severe intellectual disability* - This classification is generally associated with an **IQ range of 20-34**. - Individuals with severe intellectual disability require significant **support and supervision** for most daily activities and may have very limited communication skills. *Profound intellectual disability* - This classification is associated with an **IQ below 20**. - Individuals with profound intellectual disability require constant **intensive support and supervision** for all aspects of daily living.

Q: All of the following are disruptive, impulse control and conduct disorders except:

Munchausen syndrome. ***Munchausen syndrome*** - This is an older term for **factitious disorder imposed on self**, where an individual feigns or induces illness to assume the sick role. - It is classified under **somatic symptom and related disorders**, not disruptive, impulse control, and conduct disorders. *Conduct disorder* - This disorder is 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. - It is explicitly listed as a **disruptive, impulse control, and conduct disorder** in the DSM-5. *Oppositional defiant disorder* - This involves a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months. - It is a primary diagnosis within the category of **disruptive, impulse control, and conduct disorders**. *Intermittent explosive disorder* - Characterized by recurrent behavioral outbursts representing a failure to control aggressive impulses, often disproportionate to the provocation. - This disorder is a core example of an **impulse control disorder** within the disruptive, impulse control, and conduct disorders section of the DSM-5.

Q: Kaspar Hauser syndrome is due to:

Psychosocial causes. ***Psychosocial causes*** - **Kaspar Hauser Syndrome** refers to growth failure, particularly in children under 3 years old, caused by severe psychosocial deprivation and emotional neglect. - While these children may present with symptoms such as **short stature, delayed bone age, and poor appetite**, these are secondary to the severe emotional and social stressors they experience. *Growth hormone insensitivity* - **Growth hormone insensitivity** (Laron syndrome) results from a defect in the growth hormone receptor, leading to **low IGF-1 levels** despite normal or high growth hormone levels. - This condition is primarily genetic and not attributed to environmental or psychosocial factors. *Growth hormone deficiency* - **Growth hormone deficiency** is a medical condition where the body does not produce enough growth hormone, leading to short stature and delayed development. - While it directly causes growth failure, it is a primary endocrine disorder, not linked to the psychosocial deprivation seen in Kaspar Hauser syndrome. *Constitutional delayed growth* - **Constitutional delayed growth** is a common variant of normal growth pattern where a child is shorter than average but follows a normal growth curve after a slow start. - This is a benign condition and does not involve severe psychosocial deprivation; children eventually catch up to normal adult height.

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

Applied Behavior Analysis (ABA). **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.

Q: A child having IQ of 25 falls in which category?

Dependent. ***Dependent (Severe to Profound Intellectual Disability)*** - An IQ of 25 falls into the category of **severe intellectual disability** by modern DSM-5 criteria (IQ 20-34), which was historically classified under the **"Dependent"** category. - The older classification system used the term **"Dependent"** to describe individuals with severe to profound intellectual disability (typically IQ <35) who require extensive support in all areas of daily living. - Individuals in this range require **continuous supervision and care** for basic daily activities. *Needs life support* - This term refers to severe physical/medical conditions requiring technological intervention (ventilators, feeding tubes, etc.) to sustain life, not to cognitive classification. - While some individuals with severe intellectual disability may have co-occurring medical conditions, an IQ score alone does not determine need for life support systems. *Educable* - The **"Educable"** category corresponds to **mild intellectual disability** with an **IQ range of 50-70**. - These individuals can achieve academic skills up to approximately 6th-grade level and can live semi-independently or independently with appropriate support. - This term is now largely replaced by "mild intellectual disability" in modern classification. *Trainable* - The **"Trainable"** category refers to **moderate intellectual disability** with an **IQ range of 35-49**. - These individuals can learn self-care skills and simple vocational tasks with supervision but typically do not progress beyond 2nd-grade academic level. - This term is now largely replaced by "moderate intellectual disability" in modern classification.

Question 1

A 10-year-old child presents with persistent restlessness, inattentiveness to studies, and a strong preference for outdoor play. The parents are highly concerned. What is the most appropriate next step in management?

Accepted Answer

Comprehensive evaluation by a qualified professional

Answer

It is a normal behaviour

Answer

Needs a change in environment

Answer

It is a serious illness requiring medical treatment

Question 2

A 13-year-old boy is brought by his parents with history of frequent fighting at school, disciplinary problems, stealing money, assaulting his batchmates and being weak in studies. What is the most appropriate diagnosis for this child:

Accepted Answer

Conduct disorder

Answer

Attention deficit hyperactivity disorder

Answer

Autism

Answer

Nothing abnormal (teenage phenomenon)

Question 3

Scholastic performance is impaired in all of the following, except :

Accepted Answer

PICA

Answer

Anxiety

Answer

Specific Learning Disability (SLD)

Answer

Attention Deficit Hyperactivity Disorder (ADHD)

Question 4

Which of the following is not a typical core feature of hyperkinetic disorder?

Accepted Answer

Bradykinesia

Answer

Aggressive outburst

Answer

Soft neurological signs

Answer

Decreased attention span

Question 5

Which of the following is not a central characteristic of childhood autism?

Accepted Answer

Callous and unemotional traits

Answer

Impaired communication

Answer

Restricted, repetitive behaviour

Answer

Impaired social interaction

Question 6

Chronological age 10 years, mental age 4 years. What is that person classified as?

Accepted Answer

Moderate intellectual disability

Answer

Mild intellectual disability

Answer

Severe intellectual disability

Answer

Profound intellectual disability

Question 7

All of the following are disruptive, impulse control and conduct disorders except:

Accepted Answer

Munchausen syndrome

Answer

Conduct disorder

Answer

Oppositional defiant disorder

Answer

Intermittent explosive disorder

Question 8

Kaspar Hauser syndrome is due to:

Accepted Answer

Psychosocial causes

Answer

Growth hormone insensitivity

Answer

Growth hormone deficiency

Answer

Constitutional delayed growth

Question 9

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

Accepted Answer

Applied Behavior Analysis (ABA)

Answer

Cognitive Behavioral Therapy (CBT)

Answer

Social skills training

Answer

Self-instructional training

Question 10

A child having IQ of 25 falls in which category?

Accepted Answer

Dependent

Answer

Needs life support

Answer

Educable

Answer

Trainable

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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