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PS10.1,PS11.1 | Developmental Psychiatry — Practice Quiz
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A 7-year-old boy is referred by his class teacher because he frequently leaves his seat, interrupts classmates, and cannot wait his turn during games. His mother reports that at home he is constantly on the go, loses his belongings, and rarely completes homework before switching to another activity. These behaviours have been present since he was 4 years old and occur in school, at home, and at the playground. There are no features of language delay or unusual repetitive behaviours. Which diagnostic criterion set best fits this presentation?
Correct. DSM-5 requires ADHD symptoms to be present for at least 6 months, in at least 2 settings, with several symptoms present before age 12 years. The age criterion shifted from 'before age 7' (DSM-IV) to 'before age 12' in DSM-5.
DSM-5 ADHD: ≥6 symptoms (inattentive and/or hyperactive-impulsive), duration ≥6 months, onset of several symptoms before age 12, impairment in ≥2 settings. IQ requirement is NOT a criterion for ADHD.
DSM-5 ADHD criteria require a minimum 6-month duration, impairment in at least 2 settings, and symptom onset before 12 years of age. Note that DSM-IV used an age-7 cutoff; DSM-5 extended this to age 12.
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A 5-year-old girl is brought by her parents who are concerned that she does not make eye contact, rarely initiates conversation, and seems unaware of other children's emotions. She has an extensive vocabulary but speaks in a monotone and uses phrases she has heard on television without apparent understanding of their context. She insists on the same route to school every day and becomes extremely distressed if her routine is altered. She lines up her toy cars in a specific order for hours each day. Which of the following best describes her core diagnostic features according to DSM-5?
Correct. DSM-5 ASD requires (1) persistent deficits in social communication and social interaction across multiple contexts, AND (2) restricted, repetitive patterns of behaviour, interests, or activities. Both domains must be present.
DSM-5 ASD: two core domains required — (A) social communication/interaction deficits and (B) restricted/repetitive behaviours. Symptoms must be present in early developmental period (though may not fully manifest until later). Intellectual ability can range from profound disability to superior IQ.
ASD in DSM-5 is defined by two core domains: social communication/interaction deficits AND restricted/repetitive behaviours. The vignette illustrates both: poor eye contact and pragmatic language difficulties (domain 1) plus rigid routines and stereotyped play (domain 2).
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Parents of a 9-year-old boy with confirmed ADHD ask about first-line pharmacological treatment. The child attends a government school and the family has limited resources. Which medication should be recommended?
Correct. Methylphenidate (a stimulant) is the first-line pharmacological agent for ADHD. It is a dopamine and norepinephrine reuptake inhibitor that reduces inattention and hyperactivity. It is included on the WHO Essential Medicines List for ADHD in children.
ADHD pharmacotherapy: stimulants (methylphenidate, amphetamine salts) are first-line. Atomoxetine (non-stimulant, SNRI) is second-line or when stimulants are contraindicated. Always combine with behavioural interventions and psychoeducation.
Methylphenidate is the first-line drug for ADHD. Risperidone is an antipsychotic used for severe behavioural disturbance but not first-line. Fluoxetine is an SSRI for depression/OCD. Valproate is an anticonvulsant/mood stabiliser with no role in ADHD management.
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A child psychiatrist diagnoses a 10-year-old boy with both ADHD and Autism Spectrum Disorder. His parents express surprise, saying they were told the two diagnoses cannot coexist. Which of the following correctly describes the current diagnostic guidance?
Correct. DSM-IV had an exclusion criterion — ASD diagnosis precluded ADHD diagnosis. DSM-5 (2013) explicitly removed this exclusion and permits concurrent diagnosis of both conditions. This reflects accumulated evidence that ADHD and ASD commonly co-occur.
Key DSM-5 change: concurrent ADHD+ASD diagnosis is now permitted. Studies show 30-50% of children with ASD meet criteria for ADHD. ICD-11 similarly allows co-diagnosis. This is a common exam trap — always apply the classification system being tested (DSM-5 vs DSM-IV).
DSM-IV prohibited ASD+ADHD dual diagnosis (ASD was an exclusion criterion for ADHD). DSM-5 removed this exclusion — both diagnoses may be given concurrently when criteria for each are independently met.
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A mother asks about proven pharmacological treatment for her 8-year-old daughter who has been diagnosed with Autism Spectrum Disorder (level 1, no intellectual disability). She wants to know if there is a medication that corrects the underlying autism. Which response is most accurate?
Correct. There is no pharmacological treatment that reverses or corrects core ASD symptoms (social-communication deficits, restricted/repetitive behaviours). The primary intervention is behavioural — structured behavioural therapy, speech/language therapy, and occupational therapy. Medications are used only for specific comorbidities (e.g., risperidone/aripiprazole for severe irritability/aggression; methylphenidate for comorbid ADHD).
ASD management is behavioural-first: Applied Behaviour Analysis (ABA), Early Start Denver Model, speech-language therapy, occupational therapy, psychoeducation. No medication corrects core ASD. FDA-approved drugs (risperidone, aripiprazole) target irritability/aggression only.
No drug treats core ASD. Behavioural intervention (ABA, ESDM, speech therapy, OT) is the mainstay. Risperidone and aripiprazole are approved (FDA) for irritability/aggression in ASD — not for core social deficits. Methylphenidate helps comorbid ADHD, not core ASD.
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A 14-year-old boy is brought by his parents for evaluation. Psychometric testing reveals a full-scale IQ of 58. He is described as being able to perform basic self-care (dressing, feeding) with supervision, communicate in short sentences, and count money for simple purchases, though he cannot manage a bank account or understand complex social norms. He attends a special education school. According to DSM-5, what severity level of Intellectual Disability Disorder does this presentation most likely represent?
Correct. Mild IDD (DSM-5): IQ approximately 50-69 (historical/indicative range). The key DSM-5 principle is severity is graded by adaptive functioning, not IQ alone. Mild IDD is characterised by: conceptual deficits (academic difficulties), social deficits (immature social interactions), and practical deficits (needs support for complex daily tasks but can perform basic self-care). This boy's profile — basic self-care with supervision, limited communication, partial practical skills — fits mild IDD.
DSM-5 IDD severity grading is adaptive-function-based (not IQ-based). Historical IQ bands: mild ~50-69, moderate ~35-49, severe ~20-34, profound <20. Always describe the adaptive functioning profile (conceptual, social, practical domains) in addition to IQ.
DSM-5 bases IDD severity on adaptive functioning across three domains (conceptual, social, practical). Mild IDD (IQ ~50-69): can perform basic self-care with supervision, communicate in simple sentences, handle simple transactions. This is distinct from moderate IDD (IQ ~35-49) where adaptive deficits are more pronounced.
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A 3-year-old boy born to a 42-year-old mother presents with hypotonia, flat nasal bridge, upward-slanting palpebral fissures, a single palmar crease, and a small mouth with a protruding tongue. He has a ventricular septal defect detected on echocardiography. His developmental milestones are significantly delayed. Which of the following is the most likely genetic aetiology of his Intellectual Disability?
Correct. This is a classic presentation of Down syndrome (Trisomy 21): advanced maternal age (risk increases with maternal age), characteristic facial features (upward-slanting eyes, flat nasal bridge, protruding tongue), single palmar crease, hypotonia, and associated congenital heart disease (ASD/VSD in ~40-50%). Down syndrome is the most common chromosomal cause of IDD.
Down syndrome (Trisomy 21) — key associations: advanced maternal age, characteristic facies, hypotonia, single palmar crease, cardiac defects (ASD/VSD), atlantoaxial instability, early Alzheimer's risk. Fragile X (X-linked, affects males mainly, macroorchidism, large ears). PKU (treatable with phenylalanine-free diet). Fetal alcohol syndrome (FASD): no characteristic chromosomal abnormality, prenatal alcohol exposure history.
The combination of advanced maternal age, dysmorphic facial features (upward-slanting palpebral fissures, flat nasal bridge, protruding tongue), single palmar crease, hypotonia, and congenital heart disease is pathognomonic of Down syndrome (Trisomy 21). This is the most common chromosomal cause of intellectual disability.
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The parents of a 12-year-old girl with moderate Intellectual Disability Disorder ask whether medications can improve her intellectual functioning. She is currently stable without any psychiatric comorbidity. Which of the following is the most appropriate counselling statement?
Correct. There is no pharmacological treatment that reverses intellectual disability. Management is multidisciplinary and supportive: special education, occupational therapy, speech-language therapy, social skills training, and family support. Pharmacotherapy may be used for specific comorbid psychiatric conditions (anxiety, ADHD, aggression, depression) but does not improve intellectual functioning per se.
IDD management is multidisciplinary: early intervention (speech therapy, OT, PT), special education, life-skills training, family counselling, and vocational rehabilitation. Prevention is key: antenatal screening, genetic counselling, neonatal PKU screening, immunisation, and folic acid supplementation. No pharmacotherapy improves core intellectual functioning.
No drug reverses intellectual disability. The cornerstone of IDD management is multidisciplinary rehabilitation — special education, speech/OT/PT, behavioural support, social skills training, and family counselling. Medications are used only for psychiatric comorbidities, not to improve IQ.
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According to DSM-5, which of the following is required for a diagnosis of Intellectual Disability Disorder?
Correct. DSM-5 requires ALL THREE criteria for IDD: (1) significant deficits in intellectual functioning (IQ ~≤70), (2) significant deficits in adaptive functioning (conceptual, social, and/or practical domains), AND (3) onset during the developmental period. IQ alone is insufficient — adaptive functioning deficits must co-occur.
DSM-5 IDD diagnostic triad: (1) Intellectual deficits (IQ approximately ≤70 on standardised testing), (2) Adaptive behaviour deficits in at least one of three domains — conceptual (academic), social (interpersonal), or practical (self-care, work, safety), and (3) Onset during developmental period (before age 18 in DSM-5, or more broadly 'during development' in ICD-11).
DSM-5 IDD requires three concurrent criteria: intellectual deficits (IQ ~≤70) + adaptive functioning deficits (conceptual/social/practical domains) + onset during developmental period. IQ alone does not make the diagnosis — a person with IQ 65 but no adaptive impairment would not qualify.
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