Child and Adolescent Psychiatry Practice Questions

Q: A 6-year-old boy is observed to be peculiar by his teacher. Children attempt to play with him but his response is to either ignore them or get angry at their advances. This response in someone with autism might best be described as which of the following?

Lack of social reciprocity. ***Lack of social reciprocity*** - This describes the **difficulty in engaging in the give-and-take of social interaction**, where an individual struggles to respond appropriately to social cues or initiations from others. - The boy's actions of ignoring or getting angry at children's advances directly reflect a fundamental challenge in **reciprocal social communication**, a core diagnostic criterion for autism spectrum disorder. *Obsessional thinking* - This refers to **recurrent and persistent thoughts, urges, or images** that are intrusive and unwanted, which is a key feature of obsessive-compulsive disorder. - While individuals with autism may have **restricted interests or repetitive behaviors**, this option does not directly explain the observed social interaction difficulties. *Stereotyped behavior* - This involves **repetitive motor movements, use of objects, or speech** (e.g., hand flapping, rigid adherence to routines), which is a common characteristic of autism. - While a feature of autism, it doesn't specifically address the **social interaction component** of ignoring or reacting angrily to peers. *Poor language development* - This refers to delays or deficits in the acquisition and use of receptive or expressive language, manifesting as difficulty with vocabulary, grammar, or forming sentences. - While **communication deficits** are common in autism, the scenario specifically highlights difficulties in **social interaction**, not primarily the *structure* or *comprehension* of language itself.

Q: A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?

Autism Spectrum Disorder. ***Autism Spectrum Disorder*** - The child's delayed speech, **restricted interests** (spinning objects), lack of social engagement, and difficulty interacting with other children are classic symptoms of **Autism Spectrum Disorder (ASD)**. - Normal developmental milestones in other areas, such as motor skills, differentiate ASD from global developmental delays. - The **triad of impairments** includes social communication deficits, restricted interests, and repetitive behaviors, all evident in this case. *Specific learning disability* - This diagnosis typically presents with difficulties in specific academic areas like reading, writing, or math in a child with otherwise average intelligence. - It is generally diagnosed after school entry (age 6-7 years) when academic demands increase. - It doesn't explain the **social communication deficits** and **restricted, repetitive behaviors** seen in this case. *Intellectual disability* - This condition involves significant limitations in both intellectual functioning and adaptive behavior, with onset during the developmental period. - While delayed speech can be a feature, the child's otherwise **normal developmental milestones** in motor and other domains argue against a global intellectual deficit. - The **restricted interests** and social deficits are more characteristic of ASD than intellectual disability alone. *Sibling Rivalry* - This refers to competition or animosity between siblings, often manifesting as behavioral problems or attention-seeking from parents. - It is a normal developmental phenomenon, not a psychiatric disorder. - It does not account for the core symptoms described, such as **delayed speech**, **restricted interests** (fascination with spinning objects), or a pervasive disinterest in social interaction.

Q: Severe intellectual disability means IQ in the range of:

20-35. ***Correct Option: 20-35*** - An **IQ score** in the range of **20-35** is internationally recognized as the diagnostic criterion for **severe intellectual disability** according to **ICD-11** and **DSM-5**. - Individuals in this range require substantial support for daily living and adaptive functioning. - They may acquire basic self-care skills with intensive training but need continuous supervision. *Incorrect Option: 35-50* - This **IQ range** corresponds to **moderate intellectual disability**, where individuals typically achieve kindergarten to second-grade academic skills. - They often require supervision but can achieve some degree of independence in supported environments. *Incorrect Option: <20* - An **IQ score** below **20** categorizes an individual with **profound intellectual disability**. - This level is associated with severe impairments in adaptive functioning and communication, requiring intensive 24-hour support. *Incorrect Option: 50-70* - This **IQ range** signifies **mild intellectual disability**, which is the most common category. - Individuals may function independently with appropriate support and often achieve up to a sixth-grade academic level.

Q: All are feature of Autistic disorder EXCEPT:

Third person hallucination. ***Third person hallucination*** - **Third-person hallucinations** are a feature of psychotic disorders like **schizophrenia**, where a patient hears voices discussing them in the third person. - They are **not a diagnostic criterion** for **Autistic Disorder**, which primarily involves deficits in social communication and restricted, repetitive behaviors. *Usually appears by 2-3 years of age* - The onset of **Autistic Disorder** is typically identified in early childhood, often becoming apparent between **12 and 24 months of age**, or by 2-3 years, as key developmental milestones are missed or behaviors emerge. - Parents may notice delays in **language development**, lack of social interaction, or unusual play patterns during this period. *Co-occurring intellectual disability in majority of cases* - A significant proportion of individuals diagnosed with **Autistic Spectrum Disorder** have co-occurring **intellectual disability** (intellectual developmental disorder). - Current estimates suggest approximately **30-40%** of individuals with autism have intellectual disability, though this varies depending on diagnostic criteria and population studied. - Many individuals with autism have **average or above-average intelligence**, and some demonstrate exceptional abilities in specific domains. *Absent social smile* - An **absent or delayed social smile** can be an early indicator of **Autistic Disorder**, as it reflects a lack of reciprocal social interaction. - Difficulty engaging in **joint attention** and responding to social cues are core features of the disorder, and lack of social smiling is an early manifestation.

Q: Infantile autism is characterized by -

Impaired Neurobehavioural development. ***Impaired Neurobehavioural development*** - **Infantile autism**, now referred to as **Autism Spectrum Disorder (ASD)**, is fundamentally characterized by significant impairments in **social interaction**, **communication**, and the presence of **restricted, repetitive patterns of behavior, interests, or activities**. These are core neurobehavioral deficits. - These impairments manifest early in development and significantly impact a child's ability to learn, play, and form relationships, highlighting compromised neurobehavioral development. *Impaired folate level* - While some research has explored the role of **folate metabolism** in ASD, a primary diagnostic criterion or universal characteristic of infantile autism is not an impaired folate level. - Folate deficiency is not a direct cause or defining feature of the neurodevelopmental pathology of autism, though nutritional factors can influence overall health. *Impaired vision* - **Impaired vision** is not a characteristic feature or diagnostic criterion for infantile autism. Children with ASD typically have normal vision, although some may have sensory sensitivities impacting their visual processing. - Visual deficits, when present in children with ASD, are usually co-occurring conditions rather than a direct component of the autism diagnosis itself. *All of the options* - This option is incorrect because while **impaired neurobehavioral development** is central to autism, **impaired folate levels** and **impaired vision** are not universal or defining characteristics. - The core diagnostic criteria for ASD focus on social communication deficits and restricted behaviors, not on these specific biological markers or sensory deficits.

Q: A 3-year-old child with delayed speech development, prefers to play alone and is not making friends. The likely diagnosis is

Autism. ***Autism*** - **Delayed speech development**, a preference for playing alone, and difficulty making friends are classic diagnostic criteria for **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. *Specific learning disability* - A specific learning disability primarily affects academic skills (e.g., **reading, writing, arithmetic**) in individuals with otherwise average intelligence. - While it can impact social interactions due to frustration or self-esteem issues, its core features are not primarily related to delayed speech or intrinsic difficulties in social engagement. *Rett's syndrome* - Rett's syndrome is a rare **neurodevelopmental disorder** that almost exclusively affects females and is caused by mutations in the MECP2 gene. - It is characterized by initial normal development followed by a regression of skills, including **purposeful hand movements**, speech, and gait, often presenting with stereotypic hand-wringing. - The clinical presentation here shows early developmental concerns without regression, making ASD more likely. *ADHD* - **Attention-deficit/hyperactivity disorder (ADHD)** is characterized by symptoms of **inattention, hyperactivity, and impulsivity**. - While children with ADHD may have difficulty with social interactions due to impulsivity or inattention, delayed speech development and a consistent preference for solitary play are not primary diagnostic features.

Q: 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?

Autism. ***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.

Q: Asperger's syndrome is a -

Developmental delay. **Developmental delay** - Asperger's syndrome, now considered part of **autism spectrum disorder (ASD)**, is characterized by significant difficulties in **social interaction** and nonverbal communication, alongside restricted and repetitive patterns of behavior, interests, and activities. - These characteristics manifest as a **developmental delay** in social and emotional milestones, though language development is typically unimpaired. *Metabolic disorder* - A **metabolic disorder** involves problems with chemical reactions in the body that break down food, produce energy, or eliminate waste products. - Asperger's syndrome is a **neurodevelopmental condition**, not an issue of metabolic dysfunction, and does not involve errors in metabolism. *Neuromuscular disease* - A **neuromuscular disease** affects the nerves that control voluntary muscles or the muscles themselves, leading to problems with movement, balance, and coordination. - Asperger's syndrome primarily affects **social communication and behavior**, with motor deficits being secondary or co-occurring rather than defining the primary diagnosis. *Degenerative disorder* - A **degenerative disorder** involves the progressive breakdown or loss of function of cells, tissues, or organs over time, often related to aging or disease processes. - Asperger's syndrome is a **lifelong neurodevelopmental condition** present from early childhood, not a progressive deterioration of neurological function.

Q: A child finds difficulty in spelling and reading, otherwise their IQ is normal, interacts well with parents and friends. Vision is normal. What is the most probable diagnosis of the condition?

Dyslexia. ***Dyslexia*** - This condition is characterized by **difficulties with accurate and/or fluent word recognition** and poor spelling and decoding abilities despite normal intelligence and adequate educational opportunities. - The child's **normal IQ** and good social interaction, coupled with specific issues in spelling and reading, strongly indicate dyslexia. *ADHD* - **Attention Deficit Hyperactivity Disorder** primarily presents with persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. - While academic difficulties can occur, the primary presenting problem is usually not confined to reading and spelling but rather a broader difficulty in attention or impulse control. *Autism* - **Autism Spectrum Disorder** is characterized by persistent deficits in social communication and social interaction across multiple contexts, and restricted, repetitive patterns of behavior, interests, or activities. - The child's ability to **interact well with parents and friends** makes autism an unlikely diagnosis, as deficits in social reciprocity are a hallmark feature. *Asperger syndrome* - Formerly a distinct diagnosis, **Asperger syndrome** is now considered part of the Autism Spectrum Disorder. Like autism, it involves difficulties in social interaction and communication. - Despite often having normal or above-average intelligence, individuals with Asperger syndrome typically exhibit **significant social awkwardness** and repetitive behaviors, which are not described in the child's presentation.

Q: Which is not a feature of ADHD?

Dyslexia. ***Dyslexia*** - While individuals with **ADHD** may have comorbid learning disabilities, **dyslexia** itself is a specific learning disorder primarily characterized by difficulties with accurate and/or fluent word recognition, and poor spelling and decoding abilities, not a core feature of ADHD. - Dyslexia can occur alongside ADHD, but it is a distinct condition with its own diagnostic criteria and is not considered a symptom or feature of ADHD. *Impulsiveness* - **Impulsiveness** is a core diagnostic criterion for ADHD, particularly in the **hyperactive-impulsive presentation**, where individuals often act without thinking or have difficulty awaiting their turn. - This can manifest as blurting out answers, interrupting others, or engaging in risky behaviors. *Hyperactivity* - **Hyperactivity** is a hallmark symptom of ADHD, especially in childhood, and is reflected in excessive motor activity, fidgeting, restlessness, and difficulty staying seated. - This symptom can persist into adulthood, although it may present as an internal sense of restlessness rather than overt physical movement. *Inattention* - **Inattention** is a primary diagnostic feature of ADHD, characterized by difficulty sustaining attention, easily being distracted, making careless mistakes, and problems with organization. - This aspect of ADHD can significantly impair academic, occupational, and social functioning.

Question 1

A 6-year-old boy is observed to be peculiar by his teacher. Children attempt to play with him but his response is to either ignore them or get angry at their advances. This response in someone with autism might best be described as which of the following?

Accepted Answer

Lack of social reciprocity

Answer

Obsessional thinking

Answer

Stereotyped behavior

Answer

Poor language development

Question 2

A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?

Accepted Answer

Autism Spectrum Disorder

Answer

Specific learning disability

Answer

Intellectual disability

Answer

Sibling Rivalry

Question 3

Severe intellectual disability means IQ in the range of:

Accepted Answer

20-35

Answer

35-50

Answer

<20

Answer

50-70

Question 4

All are feature of Autistic disorder EXCEPT:

Accepted Answer

Third person hallucination

Answer

Usually appears by 2-3 years of age

Answer

Co-occurring intellectual disability in majority of cases

Answer

Absent social smile

Question 5

Infantile autism is characterized by -

Accepted Answer

Impaired Neurobehavioural development

Answer

Impaired folate level

Answer

Impaired vision

Answer

All of the options

Question 6

A 3-year-old child with delayed speech development, prefers to play alone and is not making friends. The likely diagnosis is

Accepted Answer

Autism

Answer

Specific learning disability

Answer

Rett's syndrome

Answer

ADHD

Question 7

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?

Accepted Answer

Autism

Answer

Conduct disorder

Answer

Social phobia

Answer

ADHD

Question 8

Asperger's syndrome is a -

Accepted Answer

Developmental delay

Answer

Metabolic disorder

Answer

Neuromuscular disease

Answer

Degenerative disorder

Question 9

A child finds difficulty in spelling and reading, otherwise their IQ is normal, interacts well with parents and friends. Vision is normal. What is the most probable diagnosis of the condition?

Accepted Answer

Dyslexia

Answer

ADHD

Answer

Autism

Answer

Asperger syndrome

Question 10

Which is not a feature of ADHD?

Accepted Answer

Dyslexia

Answer

Impulsiveness

Answer

Hyperactivity

Answer

Inattention

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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