Child and Adolescent Psychiatry Practice Questions

Q: Which one of the following is not a Pervasive Developmental Disorder?

Conduct disorder. **Explanation:** **Pervasive Developmental Disorders (PDD)** are a group of conditions characterized by delays in the development of multiple basic functions, including socialization and communication. According to the **ICD-10** and **DSM-IV** classifications, PDDs include Autistic disorder, Asperger’s disorder, Rett’s disorder, Childhood Disintegrative Disorder (CDD), and PDD-Not Otherwise Specified (PDD-NOS). **Why Conduct Disorder is the correct answer:** **Conduct Disorder** is not a PDD; it is classified as a **Disruptive Behavior Disorder**. It is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms are violated (e.g., aggression to people/animals, destruction of property, deceitfulness, or theft). **Why the other options are incorrect:** * **Autistic Disorder:** The prototypical PDD involving impairments in social interaction, communication, and restricted/repetitive behaviors. * **Asperger’s Disorder:** A PDD characterized by social impairment and restricted interests, but notably **without** significant delays in language or cognitive development. * **Rett’s Disorder:** A PDD primarily affecting females (X-linked dominant, *MECP2* gene mutation), characterized by a period of normal development followed by loss of purposeful hand skills and the development of stereotypic "hand-wringing" movements. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Update:** In the newer DSM-5, the term "Pervasive Developmental Disorder" has been replaced by **Autism Spectrum Disorder (ASD)**, which now encompasses Autism, Asperger’s, and CDD. * **Rett Syndrome** is now considered a separate genetic/neurological disorder in DSM-5 rather than being part of the Autism Spectrum. * **Conduct Disorder** in a child is a strong predictor of **Antisocial Personality Disorder** after the age of 18.

Q: Which of the following conditions is seen predominantly in females?

Rett syndrome. **Explanation:** **Rett Syndrome (Option B)** is the correct answer because it is an X-linked dominant neurodevelopmental disorder caused by a mutation in the **MECP2 gene**. It is seen almost exclusively in **females**. In males, the mutation is typically lethal in utero or results in severe neonatal encephalopathy, as they lack a second X chromosome to compensate for the defect. **Clinical Features of Rett Syndrome:** * Initial normal development for the first 6–18 months. * Subsequent regression of language and motor skills. * **Pathognomonic sign:** Purposeful hand movements are replaced by repetitive, stereotypic **"hand-wringing"** or "hand-washing" motions. * Deceleration of head growth (acquired microcephaly). **Analysis of Incorrect Options:** * **Autism (Option A) & Asperger Syndrome (Option C):** Both are part of the Autism Spectrum Disorders (ASD). ASD shows a strong **male predominance**, with a male-to-female ratio of approximately 4:1. * **Cornelia de Lange Syndrome (Option D):** This is a genetic multisystem malformation syndrome characterized by facial dysmorphism (synophrys/monobrow), limb defects, and intellectual disability. It affects males and females **equally**. **High-Yield Clinical Pearls for NEET-PG:** * **MECP2 mutation** on the X chromosome is the hallmark of Rett Syndrome. * It was previously classified under Pervasive Developmental Disorders (PDD) in DSM-IV but is now considered a distinct genetic neurological entity. * **Differential Diagnosis:** If a child presents with "hand-wringing" and "regression of milestones" after a period of normalcy, always suspect Rett Syndrome.

Q: An IQ score between 70-75 denotes which of the following intellectual functioning levels?

Borderline intellectual functioning. **Explanation:** The classification of intellectual functioning is primarily based on the Intelligence Quotient (IQ) score, with a mean of 100 and a standard deviation (SD) of 15. **1. Why Borderline Intellectual Functioning is correct:** Borderline Intellectual Functioning (BIF) describes a range of intelligence that falls between average cognitive ability and intellectual disability. According to the DSM-5 and ICD-10, this corresponds to an **IQ score of 70 to 79** (roughly 1 to 2 standard deviations below the mean). Individuals in this range often struggle with complex academic tasks but do not meet the full diagnostic criteria for an Intellectual Disability (ID). **2. Analysis of Incorrect Options:** * **Mild Intellectual Disability (IQ 50–69):** This is the most common form of ID (85%). These individuals are "educable" and can achieve academic skills up to the 6th-grade level. * **Moderate Intellectual Disability (IQ 35–49):** These individuals are "trainable." They can perform supervised tasks and achieve academic skills up to the 2nd-grade level. * **Normal Intelligence (IQ 90–109):** This represents the average range where the majority of the population resides. **3. High-Yield Clinical Pearls for NEET-PG:** * **Intellectual Disability (ID) Criteria:** Diagnosis requires deficits in both **intellectual functioning** (IQ <70) and **adaptive functioning** (conceptual, social, and practical domains) with onset during the developmental period. * **IQ Ranges (ICD-10):** * **Mild:** 50–69 * **Moderate:** 35–49 * **Severe:** 20–34 * **Profound:** <20 * **Most Common Cause of ID:** Genetic (Down Syndrome is the most common chromosomal cause; Fragile X is the most common inherited cause). * **Binet-Simon Scale:** The first formal scale to measure intelligence.

Q: Nowadays, Down syndrome is referred to as:

Submental disorder. **Explanation:** The terminology used to describe intellectual and developmental disabilities has evolved significantly to reduce stigma and improve clinical accuracy. In modern psychiatric and medical nomenclature, Down syndrome is classified under the umbrella of **Submental disorders** (or sub-average mental functioning). This term reflects the cognitive impairment and intellectual disability (ID) characteristic of the condition, where the Intelligence Quotient (IQ) is typically below 70, accompanied by deficits in adaptive functioning. **Analysis of Options:** * **A. Submental disorder (Correct):** This is the current preferred clinical descriptor for conditions involving intellectual deficits. It aligns with the classification of Down syndrome as a primary cause of intellectual disability. * **B. Oligophrenia:** This is an archaic term (derived from Greek, meaning "few mind") formerly used to describe intellectual disability. While historically accurate, it is no longer used in modern clinical practice or the DSM-5/ICD-11. * **C. Madness:** This is a non-medical, derogatory lay term historically used for psychosis or severe mental illness. It lacks clinical validity. * **D. Mentally unstable:** This is a vague, non-diagnostic term often used to describe mood lability or personality disorders, rather than the stable, developmental cognitive impairment seen in Down syndrome. **Clinical Pearls for NEET-PG:** * **Genetics:** Most common cause of genetic intellectual disability; 95% of cases are due to **Trisomy 21 (Nondisjunction)**. * **Cytogenetics:** 4% are due to **Robertsonian Translocation** (usually 14;21), and 1% are **Mosaicism**. * **Psychiatric Comorbidity:** Increased risk of ADHD, Autism Spectrum Disorder, and early-onset **Alzheimer’s disease** (due to the APP gene on chromosome 21). * **Screening:** First-trimester screening includes nuchal translucency (increased) and PAPP-A (decreased).

Q: A 6-year-old child with a history of birth asphyxia has poor communication, slow mental and physical growth, social withdrawal, limited interests, and becomes agitated when disturbed. What is the most likely diagnosis?

Autistic disorder. ### Explanation The clinical presentation described is characteristic of **Autistic Disorder** (now part of Autism Spectrum Disorder - ASD). The diagnosis is based on a triad of impairments: 1. **Social Impairment:** Social withdrawal and poor communication. 2. **Communication Deficits:** Slow mental growth and poor verbal/non-verbal interaction. 3. **Restricted/Repetitive Behaviors:** Limited interests and agitation when routines are disturbed (insistence on sameness). Birth asphyxia is a known prenatal/perinatal risk factor for neurodevelopmental delays, including ASD. **Analysis of Incorrect Options:** * **Hyperkinetic Disorder / ADHD (Options A & C):** These are characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. While children with ADHD may have social difficulties, they do not typically exhibit the profound deficits in social communication or the "insistence on sameness" seen in Autism. * **Schizophrenia (Option D):** Childhood-onset schizophrenia is rare before age 13. It presents with hallucinations, delusions, and thought disorders rather than the developmental delays in social and motor milestones described here. **Clinical Pearls for NEET-PG:** * **Age of Onset:** Symptoms of ASD must be present in the early developmental period (typically recognized by age 3). * **Kanner’s Syndrome:** An older term for classic Autistic Disorder. * **Key Sign:** Lack of "joint attention" (e.g., not pointing to objects of interest) is a major early red flag. * **Comorbidity:** Intellectual disability is present in approximately 70% of cases, though "High-functioning Autism" (formerly Asperger’s) presents with normal IQ and language.

Q: Which of the following subtypes of ADHD is common in girls?

Inattentive Type. **Explanation:** Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. According to the DSM-5, ADHD is classified into three main presentations: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and Combined type. **Why Inattentive Type is correct:** Epidemiological studies consistently show that while ADHD is more frequently diagnosed in boys (who often present with disruptive, externalizing behaviors), the **Inattentive Type** is the most common presentation in **girls**. Girls often exhibit "internalizing" symptoms such as daydreaming, difficulty following instructions, and academic underachievement rather than physical restlessness. Because these symptoms are less disruptive in a classroom setting, girls are frequently diagnosed later in life compared to boys. **Analysis of Incorrect Options:** * **A & B (Hyperactive/Impulsive Types):** These symptoms are characterized by "externalizing" behaviors (fidgeting, running, interrupting). These are significantly more common in **boys**. * **D (Autistic Type):** This is not a subtype of ADHD. Autism Spectrum Disorder (ASD) is a separate neurodevelopmental diagnosis, though it can be comorbid with ADHD. **High-Yield Clinical Pearls for NEET-PG:** * **Male to Female Ratio:** Approximately 3:1 in clinical samples (though the gap narrows in adulthood). * **Age of Onset:** Symptoms must be present before **age 12** (DSM-5 criteria). * **Setting:** Symptoms must be present in **two or more settings** (e.g., home and school). * **First-line Treatment:** Psychostimulants (e.g., **Methylphenidate**) are the gold standard. Non-stimulant options include **Atomoxetine** (a selective NE reuptake inhibitor).

Q: Coprolalia is an important symptom for which of the following disorders?

Tourette's disorder. **Explanation:** **Tourette’s Disorder (Correct Answer):** Tourette’s Disorder is a neurodevelopmental condition characterized by the presence of **multiple motor tics** and at least **one vocal tic** for a duration of more than one year, with onset before age 18. **Coprolalia**, the involuntary utterance of socially taboo or obscene words, is a classic (though not mandatory) symptom of Tourette’s, occurring in approximately 10–15% of cases. It arises due to a failure of inhibitory control in the cortico-striato-thalamo-cortical (CSTC) circuits. **Incorrect Options:** * **Anxiety Disorder:** While anxiety can exacerbate tics, it does not manifest as coprolalia. Anxiety disorders typically present with excessive worry, autonomic hyperactivity, or avoidance behaviors. * **Avoidant Personality Disorder:** This is a Cluster C personality disorder characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. It involves no motor or vocal tics. * **Stereotypic Movement Disorder:** This involves repetitive, driven, and non-functional motor behavior (e.g., hand waving, body rocking). Unlike tics, these movements are rhythmic and lack the "premonitory urge" and vocal components like coprolalia. **Clinical Pearls for NEET-PG:** * **Diagnostic Criteria:** Both motor and vocal tics must be present for >1 year for a diagnosis of Tourette’s. * **Associated Comorbidities:** The most common comorbidities are **ADHD** (most common) and **OCD**. * **Treatment:** First-line behavioral therapy is **CBIT** (Comprehensive Behavioral Intervention for Tics). Pharmacotherapy includes Alpha-2 agonists (Clonidine/Guanfacine) or atypical antipsychotics (Risperidone/Aripiprazole). * **Related terms:** **Copropraxia** (involuntary obscene gestures) and **Echolalia** (repeating others' words) are also seen in Tourette’s.

Question 1

Which one of the following is not a Pervasive Developmental Disorder?

Accepted Answer

Conduct disorder

Answer

Autistic disorder

Answer

Asperger's disorder

Answer

Rett's disorder

Question 2

Which of the following conditions is also known as "minimal brain dysfunction syndrome"?

Accepted Answer

Attention-Deficit/Hyperactivity Disorder (ADHD)

Answer

Dyslexia

Answer

Intellectual Disability

Answer

Down Syndrome

Question 3

A 4-year-old girl who stas school has never shown much interest in interacting with others. She has never used many words, which her parents attribute to her isolation as an only child. She has always done best with a strict schedule and does not tolerate changes well. Other children attempt to play with her, but her response is to either ignore them or get angry at their advances. How can the patient described be best distinguished from Rett disorder?

Accepted Answer

Absence of a period of normal development

Answer

Social difficulties

Answer

Lack of language development

Answer

Evidence of mental retardation

Question 4

A 7-year-old child exhibits conservative behavior, has difficulty playing quietly with peers, and struggles with organization. The child also interrupts others in school and is easily distracted. Which of the following is the likely diagnosis?

Accepted Answer

Attention deficit hyperactivity disorder

Answer

Learning disorder

Answer

Autistic disorder

Answer

Conduct disorder

Question 5

Which of the following conditions is seen predominantly in females?

Accepted Answer

Rett syndrome

Answer

Autism

Answer

Asperger syndrome

Answer

Cornelia de Lange syndrome

Question 6

An IQ score between 70-75 denotes which of the following intellectual functioning levels?

Accepted Answer

Borderline intellectual functioning

Answer

Mild intellectual disability

Answer

Moderate intellectual disability

Answer

Normal intelligence

Question 7

Nowadays, Down syndrome is referred to as:

Accepted Answer

Submental disorder

Answer

Oligophrenia

Answer

Madness

Answer

Mentally unstable

Question 8

A 6-year-old child with a history of birth asphyxia has poor communication, slow mental and physical growth, social withdrawal, limited interests, and becomes agitated when disturbed. What is the most likely diagnosis?

Accepted Answer

Autistic disorder

Answer

Hyperkinetic disorder

Answer

Attention deficit disorder

Answer

Schizophrenia

Question 9

Which of the following subtypes of ADHD is common in girls?

Accepted Answer

Inattentive Type

Answer

Hyperactive Type

Answer

Impulsive Type

Answer

Autistic Type

Question 10

Coprolalia is an important symptom for which of the following disorders?

Accepted Answer

Tourette's disorder

Answer

Anxiety disorder

Answer

Avoidant personality disorder

Answer

Stereotypic movement disorder

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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