Child and Adolescent Psychiatry Practice Questions

Q: An IQ score of 35-47 is classified according to WHO as which of the following?

Moderate mental retardation. ### Explanation The classification of Intellectual Disability (formerly Mental Retardation) is a high-yield topic for NEET-PG, primarily based on the **ICD-10** criteria by the WHO. The classification is determined by the Intelligence Quotient (IQ) score, which reflects an individual’s cognitive ability relative to their age group. **1. Why the Correct Answer is Right:** According to the WHO (ICD-10), **Moderate Mental Retardation** is defined by an IQ range of **35 to 49**. Individuals in this category typically achieve a mental age of 6 to 9 years. They can usually acquire simple communication and manual skills but require varying degrees of support to live and work in the community. **2. Analysis of Incorrect Options:** * **A. Mild Mental Retardation (IQ 50–69):** This is the most common type (85%). These individuals are "educable" and can reach a mental age of 9 to 12 years. * **C. Severe Mental Retardation (IQ 20–34):** These individuals are "trainable" in basic self-care but require significant supervision. Their mental age corresponds to 3 to 6 years. * **D. Profound Mental Retardation (IQ < 20):** This is the most severe form. Individuals have very limited communication and require 24-hour nursing care. Their mental age is below 3 years. **3. Clinical Pearls for NEET-PG:** * **Formula:** $IQ = \frac{\text{Mental Age (MA)}}{\text{Chronological Age (CA)}} \times 100$. * **DSM-5 Update:** The DSM-5 has replaced the term "Mental Retardation" with **Intellectual Disability** and emphasizes **adaptive functioning** (conceptual, social, and practical domains) over IQ scores alone for determining the severity level. * **Most Common Cause:** The most common genetic cause of intellectual disability is **Down Syndrome**, while the most common inherited cause is **Fragile X Syndrome**.

Q: A boy exhibits selective mutism, refusing to speak at school but speaking normally in other environments. His IQ assessment is normal. What is the most likely diagnosis?

Selective mutism. ### Explanation **1. Why Selective Mutism is Correct:** Selective Mutism (SM) is characterized by a consistent failure to speak in specific social situations (e.g., school) despite speaking in other situations (e.g., at home). According to DSM-5/ICD-11 criteria, this behavior must persist for at least **one month** (not limited to the first month of school) and interfere with educational or social communication. The child’s normal IQ and ability to speak in comfortable settings rule out global developmental or language delays. It is fundamentally considered an **anxiety disorder**. **2. Why the Other Options are Incorrect:** * **ADHD:** Presents with a persistent pattern of inattention, hyperactivity, and impulsivity. It does not typically involve a refusal to speak in specific settings. * **Autism Spectrum Disorder (ASD):** While children with ASD may have communication deficits, these are pervasive across all settings. ASD also involves restricted, repetitive patterns of behavior and impaired social reciprocity, which are absent here. * **Dyslexia:** This is a specific learning disorder characterized by difficulties with word recognition, decoding, and spelling. It affects reading ability, not the physiological or psychological intent to speak. **3. NEET-PG High-Yield Pearls:** * **Comorbidity:** The most common comorbid condition with Selective Mutism is **Social Anxiety Disorder**. * **Treatment:** The first-line treatment is **Behavioral Therapy** (e.g., stimulus fading, shaping). Pharmacotherapy (SSRIs like Fluoxetine) is reserved for refractory cases. * **Age of Onset:** Usually before age 5, but often only diagnosed when the child enters the school environment. * **Rule Out:** Always ensure the mutism is not due to a lack of knowledge of the spoken language or a communication disorder (e.g., stuttering).

Q: What is true about autism?

Starts before 2–3 years of age. **Explanation:** **Autism Spectrum Disorder (ASD)** is a neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, along with restricted, repetitive patterns of behavior. **Why Option C is Correct:** According to DSM-5 and ICD-10 criteria, symptoms of autism must be present in the **early developmental period**. While the diagnosis may sometimes be made later when social demands exceed limited capacities, the core developmental delays typically manifest **before 3 years of age**. Parents often notice signs such as lack of social smiling or poor eye contact as early as 12–18 months. **Analysis of Incorrect Options:** * **Option A:** Autism has **no correlation with socioeconomic status**. It affects children across all economic, racial, and social backgrounds equally. * **Option B:** **Impaired communication** is a hallmark of ASD. This includes delayed speech, lack of "joint attention," inability to sustain conversations, and literal/pedantic language. * **Option D:** Autism is significantly **more common in boys** than girls, with a male-to-female ratio of approximately **4:1**. **High-Yield Clinical Pearls for NEET-PG:** * **M-CHAT (Modified Checklist for Autism in Toddlers):** The most commonly used screening tool (validated for ages 16–30 months). * **Earliest Sign:** Lack of joint attention (e.g., not pointing to objects of interest). * **Associated Findings:** Macrocephaly (in some cases), seizures (25% of cases), and "Savant" skills (exceptional memory or musical talent in a minority). * **Gold Standard Diagnosis:** Clinical evaluation using ADOS (Autism Diagnostic Observation Schedule).

Q: A 13-year-old boy is often aggressive, argues with parents and teachers, and has a history of frequent lying and stealing money at home. He frequently runs away from class to play. What is the most likely diagnosis?

Conduct disorder. ### Explanation The correct diagnosis is **Conduct Disorder (CD)**. This condition is characterized by a repetitive and persistent pattern of behavior in which the **basic rights of others** or major age-appropriate societal norms/rules are violated. **Why Conduct Disorder is correct:** The patient exhibits key diagnostic criteria for CD: 1. **Aggression:** Arguing and aggressive behavior. 2. **Deceitfulness or Theft:** Frequent lying and stealing money. 3. **Serious Violation of Rules:** Running away from class (truancy). In children under 18, the combination of antisocial behavior (stealing/lying) and aggression points directly to CD. If these behaviors persist after age 18, the diagnosis shifts to Antisocial Personality Disorder. **Why the other options are incorrect:** * **Oppositional Defiant Disorder (ODD):** While ODD involves irritability and defiance toward authority figures, it **does not** typically include aggression toward people/animals, destruction of property, or a pattern of theft and deceit. CD is essentially a more severe progression of ODD. * **Autism & Pervasive Developmental Disorder (PDD):** These are neurodevelopmental disorders characterized by impairments in social communication, restricted interests, and repetitive behaviors. They do not primarily manifest as intentional rule-breaking or predatory aggression. **High-Yield Clinical Pearls for NEET-PG:** * **The "Triad":** CD is often associated with the "MacDonald Triad" (enuresis, fire-setting, and cruelty to animals), though this is no longer a formal diagnostic requirement. * **Progression:** ODD → Conduct Disorder (pre-18 years) → Antisocial Personality Disorder (post-18 years). * **Comorbidity:** CD is highly comorbid with **ADHD** and Substance Use Disorders. * **Treatment:** Multi-systemic therapy and parent management training are first-line; pharmacotherapy (like Risperidone) is used only for severe aggression.

Q: Which of the following is NOT a cardinal feature of ADHD?

Temper Tantrums. **Explanation:** Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of behavior that interferes with functioning or development. According to the **DSM-5** and **ICD-11** criteria, the diagnosis is based on three core (cardinal) symptom domains: 1. **Inattention (Option A):** Manifests as difficulty sustaining focus, wandering off tasks, lack of persistence, and being disorganized. 2. **Hyperactivity (Option C):** Refers to excessive motor activity (fidgeting, tapping, or talkativeness) that is not appropriate for the setting. 3. **Impulsivity (Option B):** Refers to hasty actions that occur in the moment without forethought (e.g., interrupting others, inability to wait for a turn). **Temper Tantrums (Option D)** are not a cardinal feature of ADHD. While children with ADHD may exhibit emotional dysregulation or low frustration tolerance, frequent temper tantrums are more characteristic of **Oppositional Defiant Disorder (ODD)** or **Disruptive Mood Dysregulation Disorder (DMDD)**. Although ODD is a common comorbidity in children with ADHD, it remains a distinct clinical entity. **High-Yield Clinical Pearls for NEET-PG:** * **Age of Onset:** Symptoms must be present before **12 years of age** (DSM-5). * **Pervasiveness:** Symptoms must be present in **two or more settings** (e.g., home and school). * **Drug of Choice:** **Methylphenidate** (a CNS stimulant) is the first-line pharmacological treatment. * **Non-Stimulant Option:** **Atomoxetine** (Selective Norepinephrine Reuptake Inhibitor) is used if stimulants are contraindicated or cause side effects. * **Most Common Comorbidity:** Oppositional Defiant Disorder (ODD).

Q: All of the following regarding Autistic Spectrum Disorder are true EXCEPT?

More common in girls. **Explanation:** **Autism Spectrum Disorder (ASD)** is a neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, alongside restricted, repetitive patterns of behavior. **Why Option D is the correct answer (The "Except"):** Autism Spectrum Disorder is significantly **more common in boys** than in girls. Epidemiological data consistently shows a male-to-female ratio of approximately **4:1**. Therefore, the statement that it is more common in girls is factually incorrect. **Analysis of other options:** * **A. Defective communication:** This is a core diagnostic criterion. Children with ASD often have delayed speech, lack of social-emotional reciprocity, and difficulty understanding non-verbal cues (e.g., eye contact, gestures). * **B. Absent separation anxiety:** Unlike neurotypical children, children with ASD often lack "stranger anxiety" or "separation anxiety" because they lack the social-emotional attachment and "joint attention" typically seen in early development. They may appear indifferent to the presence or absence of parents. * **C. Impaired concentration:** Children with ASD frequently exhibit poor attention spans for tasks that do not interest them, though they may show "hyper-focus" on specific, restricted interests. **High-Yield Clinical Pearls for NEET-PG:** * **Kanner’s Syndrome:** The historical term for "Early Infantile Autism." * **Key Features:** Social isolation ("autistic aloneness"), insistence on sameness (rituals), and delayed language. * **Prognosis:** The best predictors of long-term outcome are **IQ (above 70)** and the **development of communicative language** by age 5–7. * **Treatment:** Behavioral interventions (Applied Behavior Analysis - ABA) are mainstay; Risperidone/Aripiprazole are FDA-approved for irritability/aggression in ASD.

Q: When behavioral therapy fails in the management of enuresis, what is the pharmacological drug of choice?

Imipramine. **Explanation:** **Enuresis** (bedwetting) is defined as involuntary voiding of urine into bed or clothes in children aged 5 years or older. While **behavioral therapy** (specifically the Enuresis Alarm) is the first-line treatment with the highest long-term success rate, pharmacological intervention is indicated when behavioral methods fail or when rapid short-term improvement is needed. **Why Imipramine is the Correct Answer:** **Imipramine**, a Tricyclic Antidepressant (TCA), is the pharmacological drug of choice when behavioral therapy fails. Its efficacy in enuresis is attributed to a triple mechanism of action: 1. **Anticholinergic effect:** It increases bladder capacity by relaxing the detrusor muscle. 2. **Alpha-adrenergic stimulation:** It increases internal sphincter tone. 3. **Alteration of sleep-arousal patterns:** It lightens the depth of sleep, allowing the child to wake up when the bladder is full. **Analysis of Incorrect Options:** * **A. Phenytoin:** An antiepileptic drug used for seizures; it has no role in bladder control or enuresis management. * **B. Diazepam & D. Alprazolam:** These are Benzodiazepines. While they are used for anxiety or sleep disorders, they can actually worsen enuresis by deepening sleep and causing muscle relaxation, making it harder for the child to wake up to void. **High-Yield Clinical Pearls for NEET-PG:** * **First-line non-pharmacological treatment:** Enuresis Alarm (Bell and Pad). * **Alternative Drug:** **Desmopressin (DDAVP)**, an ADH analogue, is also frequently used (especially for sleepovers) as it reduces urine production at night. * **Safety Warning:** Imipramine has a narrow therapeutic index; overdose can lead to fatal cardiac arrhythmias (QT prolongation). * **Relapse Rate:** Pharmacological treatments have a higher relapse rate compared to behavioral therapy once the drug is discontinued.

Q: Which of the following is NOT an associated co-morbid condition in children with hyperkinetic attention deficit disorder?

Elimination disorder. **Explanation:** Attention Deficit Hyperactivity Disorder (ADHD), or Hyperkinetic Disorder, is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. It is highly comorbid, with approximately **60-80%** of affected children having at least one other psychiatric or developmental condition. **Why Elimination Disorder is the correct answer:** While children with ADHD may occasionally have higher rates of nocturnal enuresis due to developmental delays or sleep issues, **Elimination Disorders (Enuresis and Encopresis)** are not formally recognized as standard associated comorbidities in major diagnostic classifications (DSM-5/ICD-11) for ADHD. In the context of this competitive exam question, it is the "least likely" association compared to the other three well-established comorbidities. **Analysis of Incorrect Options:** * **Anxiety Disorder:** Up to 25-35% of children with ADHD have a co-occurring anxiety disorder. The constant struggle with executive dysfunction often leads to performance anxiety and social stress. * **Sleep Disorder:** Sleep disturbances (delayed sleep onset, restless leg syndrome, and disordered breathing) are found in about 50% of ADHD cases. * **Language Disorder:** ADHD is frequently associated with Communication Disorders and Specific Learning Disorders (SLD). There is a significant overlap between ADHD and difficulties in expressive language and reading (Dyslexia). **High-Yield Clinical Pearls for NEET-PG:** * **Most common comorbidity:** Oppositional Defiant Disorder (ODD) is the most frequent (approx. 50%). * **Gender Ratio:** More common in boys (approx. 3:1). * **Neurobiology:** Associated with dysfunction in the **Prefrontal Cortex** and neurotransmitter imbalances in **Dopamine and Norepinephrine**. * **Drug of Choice:** Methylphenidate (Psychostimulant). Non-stimulant alternative: Atomoxetine.

Q: What is the IQ range for moderate mental retardation?

50-35. **Explanation:** Mental Retardation (now clinically referred to as **Intellectual Disability**) is categorized based on Intelligence Quotient (IQ) scores. According to the ICD-10 classification, **Moderate Mental Retardation** corresponds to an **IQ range of 35–49 (often rounded to 35–50)**. Individuals in this category are considered "trainable"; they can acquire communication skills and perform semi-skilled work under supervision but usually require support to live independently. **Analysis of Options:** * **Option A (90–70):** This range represents **Borderline Intelligence**. It is not classified as mental retardation, though individuals may face significant learning challenges. * **Option B (70–50):** This is **Mild Mental Retardation** (Educable). It is the most common type (85% of cases). These individuals can achieve academic skills up to the 6th-grade level. * **Option C (50–35):** **Correct.** This defines **Moderate Mental Retardation**. * **Option D (35–20):** This is **Severe Mental Retardation**. These individuals may learn to talk and can be trained in basic self-care (e.g., toileting) but require a highly structured environment. (IQ <20 is classified as Profound). **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Genetic (Down Syndrome is the most common chromosomal cause; Fragile X is the most common inherited cause). * **Assessment Tool:** In children, the **Binet-Kamat Test** or **VSMS** (Vineland Social Maturity Scale) are frequently used in India. * **The "Rule of 15":** A quick way to remember the ranges is to subtract 15 points for each level starting from 70 (70-55 Mild, 55-40 Moderate, 40-25 Severe), though the ICD-10 ranges (70-50-35-20) are the standard for exams.

Question 1

All of the following are true about autism spectrum disorder except:

Accepted Answer

Two-thirds of individuals with autism have intellectual disability.

Answer

Language development is typically impaired.

Answer

Abnormal dermatoglyphics are a common feature.

Answer

Poor eye contact is a characteristic symptom.

Question 2

An IQ score of 35-47 is classified according to WHO as which of the following?

Accepted Answer

Moderate mental retardation

Answer

Mild mental retardation

Answer

Severe mental retardation

Answer

Profound mental retardation

Question 3

A boy exhibits selective mutism, refusing to speak at school but speaking normally in other environments. His IQ assessment is normal. What is the most likely diagnosis?

Accepted Answer

Selective mutism

Answer

Attention-deficit/hyperactivity disorder (ADHD)

Answer

Autism spectrum disorder

Answer

Dyslexia

Question 4

What is true about autism?

Accepted Answer

Starts before 2–3 years of age

Answer

Occurs in high economic strata

Answer

Normal communication

Answer

More common in girls

Question 5

A 13-year-old boy is often aggressive, argues with parents and teachers, and has a history of frequent lying and stealing money at home. He frequently runs away from class to play. What is the most likely diagnosis?

Accepted Answer

Conduct disorder

Answer

Oppositional defiant disorder

Answer

Autism

Answer

Pervasive developmental disorder

Question 6

Which of the following is NOT a cardinal feature of ADHD?

Accepted Answer

Temper Tantrums

Answer

Inattention

Answer

Impulsivity

Answer

Hyperactivity

Question 7

All of the following regarding Autistic Spectrum Disorder are true EXCEPT?

Accepted Answer

More common in girls

Answer

Defective communication

Answer

Absent separation anxiety

Answer

Impaired concentration

Question 8

When behavioral therapy fails in the management of enuresis, what is the pharmacological drug of choice?

Accepted Answer

Imipramine

Answer

Phenytoin

Answer

Diazepam

Answer

Alprazolam

Question 9

Which of the following is NOT an associated co-morbid condition in children with hyperkinetic attention deficit disorder?

Accepted Answer

Elimination disorder

Answer

Anxiety disorder

Answer

Sleep disorder

Answer

Language disorder

Question 10

What is the IQ range for moderate mental retardation?

Accepted Answer

50-35

Answer

90-70

Answer

70-50

Answer

35-20

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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