Child and Adolescent Psychiatry Practice Questions

Q: Language function is preserved in which of the following conditions?

Asperger's syndrome. **Explanation:** The core distinction between **Asperger’s Syndrome** and other Autism Spectrum Disorders (ASD) lies in the preservation of early language development and cognitive function. 1. **Asperger’s Syndrome (Correct Answer):** According to DSM-IV and ICD-10 criteria, Asperger’s is characterized by significant impairment in social interaction and restricted, repetitive patterns of behavior. However, there is **no clinically significant general delay in language** (e.g., single words are used by age 2, communicative phrases by age 3). While social pragmatics (the "give and take" of conversation) may be impaired, basic language functions like grammar and vocabulary are preserved. 2. **Why other options are incorrect:** * **Autism (Classical/Kanner’s):** Characterized by a significant delay or total lack of spoken language development. Even when speech is present, it is often idiosyncratic or echolalic. * **Rett Syndrome:** A neurodevelopmental disorder (primarily in girls, MECP2 mutation) characterized by a period of normal development followed by a **loss of purposeful hand skills and acquired spoken language.** * **Tourette Syndrome:** This is a tic disorder. While it involves vocal tics (coprolalia, palilalia), it is not primarily a disorder of language acquisition or social communication in the same category as ASD. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Update:** Asperger’s Syndrome is no longer a standalone diagnosis; it has been folded into the broader category of **Autism Spectrum Disorder (ASD)**. However, exams often still use the older terminology. * **"Little Professors":** Children with Asperger’s often speak in a pedantic, overly formal manner about specific niche interests. * **IQ:** In Asperger’s, the **Verbal IQ** is typically higher than the Performance IQ. * **Rett Syndrome Hallmark:** Hand-wringing or "hand-washing" stereotypies.

Q: Heller's syndrome is characterized by regression of milestones after how many years?

2 years. **Explanation:** **Heller’s Syndrome**, also known as **Childhood Disintegrative Disorder (CDD)**, is a rare condition characterized by a period of normal development followed by a significant loss of previously acquired skills. 1. **Why Option B is Correct:** According to the **ICD-10 and DSM-IV criteria**, the diagnosis of Heller’s Syndrome requires a period of **at least 2 years** of normal development (including age-appropriate verbal/non-verbal communication, social relationships, and motor skills) before the onset of regression. The regression typically occurs between the ages of 2 and 10 years. 2. **Why Other Options are Incorrect:** * **Option A (1 year) & D (6 months):** These are incorrect because regression occurring before age 2 is more characteristic of **Autism Spectrum Disorder (ASD)** or specific metabolic/neurological disorders. * **Option C (3 years):** While regression often happens after age 3, the diagnostic threshold/minimum requirement is specifically **2 years** of normal development. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Features:** Loss of skills must occur in at least two of the following areas: expressive/receptive language, social skills, bowel/bladder control, play, or motor skills. * **Prognosis:** The prognosis for Heller’s Syndrome is generally **worse** than that of Autism, as the loss of skills is often permanent and severe. * **Gender:** It is significantly more common in **males**. * **DSM-5 Update:** In the DSM-5, Heller’s Syndrome is no longer a distinct diagnosis and has been folded into the broader category of **Autism Spectrum Disorder (ASD)**. However, it is still frequently tested under its classical name in postgraduate exams.

Q: A patient has an IQ of 60. What degree of intellectual disability is this classified as?

Mild intellectual disability. **Explanation:** Intellectual Disability (ID) is classified based on Intelligence Quotient (IQ) scores, typically measured using standardized tests like the Wechsler Adult Intelligence Scale (WAIS). According to the ICD-10 and DSM-IV criteria (which remain high-yield for exams), the classification is as follows: * **Mild ID (IQ 50–70):** This is the most common type (approx. 85% of cases). These individuals are considered "educable," can achieve academic skills up to a 6th-grade level, and can live independently with minimal support. Since the patient’s IQ is 60, **Option D** is the correct classification. **Analysis of Incorrect Options:** * **Moderate ID (IQ 35–49):** These individuals are "trainable." They can acquire communication skills and perform unskilled or semi-skilled work under supervision but usually require supervised living. * **Severe ID (IQ 20–34):** These individuals have very limited communication skills and require significant assistance with activities of daily living (ADLs). * **Profound ID (IQ <20):** This group requires 24-hour nursing care and constant supervision due to limited sensorimotor functioning. **NEET-PG High-Yield Pearls:** 1. **Diagnosis:** Diagnosis requires deficits in both **intellectual functioning** (IQ <70) and **adaptive functioning** (social, conceptual, and practical skills) with onset during the developmental period. 2. **Most Common Cause:** The most common genetic cause of ID is **Down Syndrome**, while the most common inherited cause is **Fragile X Syndrome**. 3. **Epidemiology:** Mild ID is the most prevalent subtype. 4. **DSM-5 Shift:** Note that DSM-5 now emphasizes **adaptive functioning** over IQ scores alone to determine the severity of the disability.

Q: What is the IQ level typically observed in individuals with profound mental retardation?

Below 20-25. **Explanation:** The classification of Intellectual Disability (ID), formerly known as Mental Retardation, is based on the Intelligence Quotient (IQ) score. According to the ICD-10 and DSM-IV classifications, **Profound Mental Retardation** is defined by an **IQ level below 20 or 25**. Individuals in this category require constant supervision and 24-hour care, as they possess minimal sensorimotor functioning and very limited communication skills. **Analysis of Options:** * **Option A (Below 20-25): Correct.** This range represents the "Profound" category. These individuals often have associated neurological conditions and a mental age of less than 3 years. * **Option B (25-40): Incorrect.** This range corresponds to **Severe Mental Retardation**. These individuals can be trained in basic self-care (e.g., toileting) but usually require a highly supervised living environment. * **Option C (40-55): Incorrect.** This range corresponds to **Moderate Mental Retardation**. These individuals are considered "trainable"; they can acquire communication skills and perform semi-skilled work under supervision. * **Option D (55-70): Incorrect.** This range corresponds to **Mild Mental Retardation**. This is the most common type (approx. 85%). These individuals are "educable" and can achieve social and vocational adequacy with some support. **High-Yield NEET-PG Pearls:** * **Most Common Type:** Mild Mental Retardation (IQ 50-70). * **Educable:** Mild ID; **Trainable:** Moderate ID. * **Assessment Tools:** Binet-Kamat Test and Vineland Social Maturity Scale (VSMS) are frequently used in India. * **DSM-5 Update:** Note that DSM-5 now emphasizes **adaptive functioning** (conceptual, social, and practical domains) rather than just IQ scores to determine the severity of Intellectual Disability.

Q: Which of the following statements is false regarding childhood autism?

It represents a type of childhood neurotic disorder.. **Explanation:** The correct answer is **D**. Childhood Autism (Autism Spectrum Disorder) is classified as a **Neurodevelopmental Disorder**, not a neurotic disorder. Neurotic disorders (like anxiety or OCD) typically involve intact reality testing and are often reactions to stress, whereas neurodevelopmental disorders are characterized by impairments in the growth and development of the brain or central nervous system. **Analysis of Options:** * **Option A (True):** Many children with autism exhibit **"Savant Syndrome,"** where they possess isolated, remarkable talents in specific areas such as mental calculation, music, or memory, despite overall cognitive impairments. * **Option B (True):** Modern psychiatry has debunked the "Refrigerator Mother" theory. It is now well-established that autism is a **biological/genetic condition**; parental upbringing, attitude, or lack of warmth do not cause the disorder. * **Option C (True):** Impairment in communication and social interaction are core features. A **delayed social smile** (normally appearing at 2 months) and delayed or absent speech are classic early warning signs. **Clinical Pearls for NEET-PG:** * **Core Triad:** 1. Impaired social interaction, 2. Impaired communication, 3. Restricted, repetitive patterns of behavior/interests. * **Age of Onset:** Symptoms must be present in the **early developmental period** (typically recognized before age 3). * **M-CHAT:** The most commonly used screening tool for toddlers. * **Pharmacotherapy:** While behavioral therapy (ABA) is mainstay, **Risperidone and Aripiprazole** are FDA-approved for irritability and aggression in autism.

Question 1

Which of the following diagnostic criteria, when observed in a school-aged child, are suggestive of inattention (attention deficit)?

Accepted Answer

Easily distracted by extraneous stimuli and does not seem to listen when spoken to directly

Answer

Fidgets with hands or squirms in seat and is easily distracted by extraneous stimuli

Answer

Fidgets with hands or squirms in seat and has difficulty awaiting turn

Answer

Fidgets with hands or squirms in seat, is easily distracted by extraneous stimuli, has difficulty awaiting turn, and does not seem to listen when spoken to directly

Question 2

Language function is preserved in which of the following conditions?

Accepted Answer

Asperger's syndrome

Answer

Autism

Answer

Rett syndrome

Answer

Tourette syndrome

Question 3

Which of the following is NOT a possible outcome or course of ADHD?

Accepted Answer

Schizophrenia

Answer

Alcoholism

Answer

Mood Disorder

Answer

Antisocial behavior

Question 4

Heller's syndrome is characterized by regression of milestones after how many years?

Accepted Answer

2 years

Answer

1 year

Answer

3 years

Answer

6 months

Question 5

What is the current accepted term for 'mental retardation'?

Accepted Answer

Intellectual disability

Answer

Mental block

Answer

Intelligence deficit

Answer

Mental disability

Question 6

Which of the following is true about Autism Spectrum Disorder?

Accepted Answer

Persistent hallucination

Answer

Persistent delusion

Answer

Incoordinate social interaction

Answer

Defective reciprocal interaction

Question 7

A patient has an IQ of 60. What degree of intellectual disability is this classified as?

Accepted Answer

Mild intellectual disability

Answer

Severe intellectual disability

Answer

Profound intellectual disability

Answer

Moderate intellectual disability

Question 8

What is the IQ level typically observed in individuals with profound mental retardation?

Accepted Answer

Below 20-25

Answer

25-40

Answer

40-55

Answer

55-70

Question 9

Which of the following statements is false regarding childhood autism?

Accepted Answer

It represents a type of childhood neurotic disorder.

Answer

An isolated area of talent may be remarkably developed.

Answer

Parental attitude and behavior do not contribute to it.

Answer

Emergence of speech and social smile is often delayed.

Question 10

Conduct disorder in a child manifests with all of the following except:

Accepted Answer

Decreased head circumference

Answer

Disregard for the rights of others

Answer

Lack of concern for authority

Answer

Backwardness in studies

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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