Child and Adolescent Psychiatry Practice Questions

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

50-70. **Explanation:** Intellectual Disability (ID), formerly known as Mental Retardation, is characterized by significant limitations in both intellectual functioning (IQ) and adaptive behavior. According to the **ICD-10 classification**, the IQ range for **Mild Mental Retardation is 50 to 70**. **Why Option B is correct:** Mild ID (IQ 50-70) constitutes the largest segment of the affected population (approx. 85%). These individuals are considered **"Educable."** They can typically achieve academic skills up to a 6th-grade level and can live independently in the community with minimal support. **Analysis of Incorrect Options:** * **Option A (Less than 50):** This encompasses Moderate (35-49), Severe (20-34), and Profound (<20) ID. Individuals with Moderate ID are "Trainable," while those with Severe/Profound ID require constant supervision. * **Option C (70-100):** An IQ of 71-84 is classified as **Borderline Intellectual Functioning**. An IQ of 90-110 is considered "Average." * **Option D (Greater than 100):** This represents average to superior intelligence and does not fall under the spectrum of intellectual disability. **High-Yield Clinical Pearls for NEET-PG:** * **Classification (ICD-10):** * **Mild:** 50–70 (Educable) * **Moderate:** 35–49 (Trainable) * **Severe:** 20–34 (Survival words/Basic habits) * **Profound:** < 20 (Total supervision) * **DSM-5 Update:** The DSM-5 has shifted the focus from IQ scores alone to **adaptive functioning** (conceptual, social, and practical domains) to determine the severity of Intellectual Disability. * **Most Common Genetic Cause:** Down Syndrome (Trisomy 21). * **Most Common Inherited Cause:** Fragile X Syndrome.

Q: Which of the following statements is not true regarding autistic disorder?

Vision problems. **Explanation:** Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by a triad of impairments: social interaction, communication, and restricted/repetitive patterns of behavior. **Why "Vision Problems" is the correct answer:** Vision problems are **not** a diagnostic feature or a core clinical manifestation of autism. While children with autism may exhibit atypical visual behaviors (such as avoiding eye contact, looking at objects from the corners of their eyes, or being hypersensitive to light), their actual visual acuity and ocular anatomy are typically normal. **Analysis of Incorrect Options:** * **Option A (Impaired social interaction and communication):** This is the hallmark of ASD. It includes a lack of social-emotional reciprocity, poor non-verbal communication (e.g., lack of pointing), and difficulty developing and maintaining relationships. * **Option B (Impaired imagination and imaginative play):** Children with autism often show a lack of varied, spontaneous make-believe play or social imitative play. They tend to play with toys in a repetitive or ritualistic manner (e.g., lining up cars instead of "driving" them). * **Option C (Language developmental delay):** Delay in, or total lack of, the development of spoken language is a common feature. Even when speech is present, it is often characterized by echolalia (repetition of words) or idiosyncratic use of language. **High-Yield Clinical Pearls for NEET-PG:** * **Age of Onset:** Symptoms must be present in the early developmental period (typically recognized before age 3). * **M-CHAT:** The Modified Checklist for Autism in Toddlers is the most common screening tool used between 16–30 months. * **Associated Features:** 70% of cases are associated with Intellectual Disability; 25% develop Seizures. * **Prognosis:** The best predictors of long-term outcome are the **level of IQ** and the **development of communicative language** by age 5.

Q: For a definitive diagnosis of mental retardation, a reduced level of intellectual functioning should be seen along with what?

Impaired adaptive functioning. To diagnose **Intellectual Disability (ID)**—formerly known as Mental Retardation—the presence of a low Intelligence Quotient (IQ) alone is insufficient. According to both the **DSM-5** and **ICD-11**, a definitive diagnosis requires deficits in two core domains: 1. **Intellectual Functioning:** Deficits in mental abilities such as reasoning, problem-solving, and abstract thinking (typically an **IQ score < 70**). 2. **Adaptive Functioning:** Failure to meet developmental and sociocultural standards for personal independence and social responsibility. This refers to how well a person navigates daily life (e.g., communication, self-care, and social skills). ### Why the other options are incorrect: * **A & B (Motor Skills & Speech):** While delays in motor development and speech are common clinical presentations in children with ID, they are not mandatory diagnostic criteria. They are often considered "associated features" or symptoms of the underlying condition rather than the defining diagnostic pillar. * **C (Academic Difficulties):** While individuals with ID almost always face academic challenges, "academic difficulty" is a broad term. It can be caused by Specific Learning Disorders (e.g., Dyslexia) or ADHD in children with normal IQ. Therefore, it is not specific enough for a diagnosis of ID. ### NEET-PG High-Yield Pearls: * **DSM-5 Change:** The severity of ID is now determined by **adaptive functioning** (conceptual, social, and practical domains) rather than IQ scores alone. * **Age of Onset:** Deficits must manifest during the **developmental period** (typically before age 18). * **Most Common Cause:** The most common preventable cause is **Fetal Alcohol Syndrome**; the most common inherited cause is **Fragile X Syndrome**; the most common chromosomal cause is **Down Syndrome**. * **IQ Ranges (Old Classification):** Mild (50-70), Moderate (35-49), Severe (20-34), Profound (<20).

Q: A 15-year-old boy is brought to a child psychiatrist by his mother, who reports that he has been performing poorly in school and has failed twice in 7th class. She further reports that he does not follow the instructions of teachers and does not obey his parents. He frequently gets into fights with other children and often gets injured in brawls. Three times, he has been caught stealing money from his father's purse. Last week, he was also seen smoking with older students in front of his school. What is the most likely diagnosis?

Conduct disorder. ### Explanation The clinical presentation of this 15-year-old boy—characterized by a repetitive and persistent pattern of behavior that violates the basic rights of others and major age-appropriate societal norms—is classic for **Conduct Disorder (CD)**. **Why Conduct Disorder is correct:** According to DSM-5/ICD-11, CD involves behaviors in four main categories: aggression to people/animals (fights, brawls), destruction of property, deceitfulness or theft (stealing money), and serious violations of rules (truancy, smoking, academic failure). This patient exhibits aggression, theft, and defiance of authority, fitting the diagnosis perfectly. **Why the other options are incorrect:** * **Antisocial Personality Disorder (ASPD):** While the behaviors are similar, ASPD cannot be diagnosed in individuals under **18 years of age**. If the behavior persists beyond 18, the diagnosis may shift from CD to ASPD. * **Attention-Deficit Hyperactivity Disorder (ADHD):** While ADHD often co-occurs with CD and involves poor school performance, it is primarily characterized by inattention, hyperactivity, and impulsivity, rather than deliberate violation of social norms or physical aggression. * **Oppositional Defiant Disorder (ODD):** ODD involves a pattern of angry/irritable mood and argumentative/defiant behavior. However, ODD **does not** include the more severe behaviors seen here, such as physical aggression (brawls), theft, or serious rule-breaking. **Clinical Pearls for NEET-PG:** * **Age Cut-off:** Conduct Disorder is for <18 years; ASPD is for ≥18 years. * **Progression:** ODD often progresses to CD, which may eventually progress to ASPD in adulthood. * **Subtypes:** CD is classified into **Childhood-onset** (symptoms before age 10; worse prognosis) and **Adolescent-onset** (symptoms after age 10). * **Callous-Unemotional Traits:** A specifier for CD indicating a lack of remorse or empathy, often predicting more severe outcomes.

Q: A 6-year-old boy does not show any interest in other children and ignores adults other than his parents. He spends hours lining up his toy cars or spinning their wheels. He rarely uses speech to communicate and remains confined to himself. If his routine is disturbed, he becomes restless. Which of the following disorders is the child most likely suffering from?

Autism. ### Explanation The clinical presentation describes a classic case of **Autism Spectrum Disorder (ASD)**. The diagnosis is based on a triad of core deficits: 1. **Impaired Social Interaction:** The child shows no interest in peers and ignores adults (social detachment). 2. **Communication Deficits:** He rarely uses speech to communicate and remains "confined to himself." 3. **Restricted, Repetitive Patterns of Behavior:** This is evidenced by "lining up toy cars," "spinning wheels" (stereotyped movements/interests), and "insistence on sameness" (restlessness when routine is disturbed). #### Why other options are incorrect: * **Social Phobia:** Characterized by an intense fear of being scrutinized or judged in social situations. Unlike Autism, children with social phobia usually have normal social development and communication skills but are inhibited by anxiety. * **Intellectual Disability (ID):** While ID often co-occurs with Autism, ID alone presents with global developmental delays in both cognitive and adaptive functioning. It does not inherently involve the specific repetitive behaviors or the profound lack of social reciprocity seen here. * **ADHD:** Primarily characterized by inattention, hyperactivity, and impulsivity. While ADHD children may struggle socially due to impulsivity, they do not typically exhibit the ritualistic behaviors or the lack of social-emotional reciprocity characteristic of Autism. #### High-Yield Clinical Pearls for NEET-PG: * **Age of Onset:** Symptoms must be present in the **early developmental period** (typically recognized before age 3). * **Gender Ratio:** More common in **males** (approx. 4:1). * **Prognostic Factors:** The best predictors of long-term outcome are **IQ level** and the **development of communicative language** by age 5. * **Associated Findings:** 25% of children with ASD develop **seizures** by adolescence. Macrocephaly is sometimes noted.

Q: Which of the following diseases is seen only in females?

Rett's disease. **Explanation:** **Correct Answer: C. Rett’s disease** **Rett’s disease** is a neurodevelopmental disorder caused by a mutation in the **MECP2 gene** located on the **X chromosome**. It is seen almost exclusively in females. In males, the mutation is typically lethal in utero or results in severe neonatal encephalopathy because they lack a second X chromosome to compensate for the defect. **Clinical Presentation:** Children with Rett's syndrome typically show normal development for the first 6–18 months, followed by a period of regression. A hallmark clinical sign is the loss of purposeful hand movements, replaced by **stereotypical hand-wringing or "hand-washing" movements**. Other features include microcephaly, ataxia, and loss of social engagement. **Analysis of Incorrect Options:** * **A. Autism & B. Asperger’s Syndrome:** Both are part of the Autism Spectrum Disorder (ASD). These conditions are significantly **more common in males** (ratio of approximately 4:1). * **D. Cotard Disease:** Also known as "Walking Corpse Syndrome," this is a rare neuropsychiatric delusion where the patient believes they are dead, putrefying, or have lost their internal organs. It is not gender-specific and can occur in both males and females, usually associated with severe depression or schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **MECP2 Gene:** The most common genetic cause of Rett's syndrome. * **Hand-wringing:** The most characteristic "spotter" sign in exams. * **Deceleration of head growth:** Leads to acquired microcephaly. * **ICD-10/DSM-5:** While previously categorized separately, Rett's is now often differentiated from ASD due to its specific genetic etiology and progressive neurological decline.

Q: Regression of milestones is seen in all except?

Kleine-Levin syndrome. **Explanation:** The core concept in this question is distinguishing between **neurodevelopmental regression** (loss of previously acquired skills) and **episodic sleep disorders**. **Why Option D is Correct:** **Kleine-Levin Syndrome (KLS)**, also known as "Sleeping Beauty Syndrome," is a rare sleep disorder characterized by **episodic hypersomnia** (sleeping up to 20 hours a day), hyperphagia (compulsive eating), and hypersexuality. Crucially, patients are neurologically and behaviorally normal between episodes. It does **not** involve a permanent loss or regression of developmental milestones. **Why the other options are incorrect:** * **Childhood Disintegrative Disorder (Heller’s Syndrome):** Characterized by normal development for at least 2 years, followed by a **marked regression** in multiple areas of functioning (language, social skills, motor skills, and bladder/bowel control) before age 10. * **Rett Syndrome:** Primarily affects females (X-linked dominant, MECP2 mutation). After a period of normal development (6–18 months), there is a **regression** in purposeful hand movements (replaced by stereotyped hand-wringing), head growth (microcephaly), and social engagement. * **Landau-Kleffner Syndrome (LKS):** Also known as "Acquired Epileptic Aphasia." It involves a sudden or gradual **loss of language skills** (regression) in a child who previously spoke normally, associated with abnormal EEG findings during sleep. **High-Yield Clinical Pearls for NEET-PG:** * **Rett Syndrome:** Look for the keyword "hand-wringing movements" and "loss of purposeful hand skills." * **LKS:** The hallmark is "word deafness" or auditory verbal agnosia in a child. * **KLS:** Remember the triad: **Hypersomnia, Hyperphagia, and Hypersexuality.** It typically affects adolescent males. * **Regression** in a child always warrants an urgent neurological workup to rule out metabolic or neurodegenerative disorders.

Q: All of the following are examples of 'specific learning disability' EXCEPT?

Dysphoria. ### Explanation **Specific Learning Disorder (SLD)** is a neurodevelopmental disorder characterized by persistent difficulties in learning and using academic skills, which are significantly below the expected level for the individual's age. According to DSM-5, SLD is a single diagnosis with specifiers for deficits in reading, writing, and mathematics. **Why Dysphoria is the Correct Answer:** **Dysphoria** is not a learning disability. It is a clinical term describing a profound state of unease, dissatisfaction, or anxiety. It is a common symptom in mood disorders (like Depression), Gender Dysphoria, or Premenstrual Dysphoric Disorder (PMDD). It relates to **affect/emotion**, not cognitive academic processing. **Analysis of Incorrect Options:** * **Dyslexia (Option A):** The most common SLD. It involves impairment in **reading**, specifically difficulties with word recognition, decoding, and spelling. * **Dysgraphia (Option B):** An SLD involving impairment in **written expression**. It manifests as poor handwriting, incorrect grammar/punctuation, and poor organization of written ideas. * **Dyscalculia (Option C):** An SLD involving impairment in **mathematics**. It includes difficulties mastering number sense, number facts, or accurate calculation. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** SLD is usually diagnosed during formal schooling years. A key diagnostic criterion is that the difficulties must persist for at least **6 months** despite targeted interventions. * **IQ vs. Achievement:** Children with SLD typically have a **normal or high IQ**, but their academic achievement is significantly lower than their intellectual potential. * **Comorbidity:** The most common comorbid condition with SLD is **ADHD** (Attention-Deficit/Hyperactivity Disorder). * **Management:** Treatment is primarily educational (Remedial Education) rather than pharmacological.

Question 1

What is the IQ range for mild mental retardation?

Accepted Answer

50-70

Answer

Less than 50

Answer

70-100

Answer

Greater than 100

Question 2

Which of the following statements is not true regarding autistic disorder?

Accepted Answer

Vision problems

Answer

Impaired social interaction and communication

Answer

Impaired imagination and imaginative play

Answer

Language developmental delay

Question 3

For a definitive diagnosis of mental retardation, a reduced level of intellectual functioning should be seen along with what?

Accepted Answer

Impaired adaptive functioning

Answer

Impaired motor skills

Answer

Impaired speech

Answer

Academic difficulties

Question 4

A 15-year-old boy is brought to a child psychiatrist by his mother, who reports that he has been performing poorly in school and has failed twice in 7th class. She further reports that he does not follow the instructions of teachers and does not obey his parents. He frequently gets into fights with other children and often gets injured in brawls. Three times, he has been caught stealing money from his father's purse. Last week, he was also seen smoking with older students in front of his school. What is the most likely diagnosis?

Accepted Answer

Conduct disorder

Answer

Antisocial personality disorder

Answer

Attention-deficit hyperactivity disorder

Answer

Oppositional defiant disorder

Question 5

A 6-year-old boy does not show any interest in other children and ignores adults other than his parents. He spends hours lining up his toy cars or spinning their wheels. He rarely uses speech to communicate and remains confined to himself. If his routine is disturbed, he becomes restless. Which of the following disorders is the child most likely suffering from?

Accepted Answer

Autism

Answer

Social phobia

Answer

Intellectual disability

Answer

ADHD

Question 6

A 6-year-old boy presents with complaints of hyperactivity, excessive shoulder shrugging, throat clearing, and eye blinking. During examination, he is not cooperative, uses obscene words, and runs around in the consultation room. What is the most probable diagnosis?

Accepted Answer

Attention deficit hyperactivity disorder with Tic disorder

Answer

Tic disorder

Answer

Psychomotor seizures

Answer

Childhood psychosis

Question 7

An eleven-month-old boy is so restless that his classmates are unable to concentrate. He is hardly ever in his seat and roams around the hall. He has difficulty playing quietly. What is the most likely diagnosis?

Accepted Answer

Attention-deficit hyperactivity disorder

Answer

Conduct disorder

Answer

Depressive disorder

Answer

Schizophrenia

Question 8

Which of the following diseases is seen only in females?

Accepted Answer

Rett's disease

Answer

Autism

Answer

Asperger's syndrome

Answer

Cotard disease

Question 9

Regression of milestones is seen in all except?

Accepted Answer

Kleine-Levin syndrome

Answer

Childhood disintegrative disorder

Answer

Rett syndrome

Answer

Landau-Kleffner syndrome

Question 10

All of the following are examples of 'specific learning disability' EXCEPT?

Accepted Answer

Dysphoria

Answer

Dyslexia

Answer

Dysgraphia

Answer

Dyscalculia

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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