Review Test
Directions: Each o th e n u m bered item s or in com p lete statem en ts in th is section is ollowed by
an swers or by com p letion s o th e statem en t. Select th e one lettered an swer or com p letion th at
is best in each case.
Questions 1 and 2
Questions 4–7
Sin ce th e age o 8, a 15-year-old girl with n orm al in telligen ce an d social skills h as sh own a
n u m ber o rep etitive m otor m ovem en ts. Sh e
recen tly h as begu n to h ave ou tbu rsts in wh ich
sh e cu rses an d sh rieks. Wh en asked i sh e can
con trol th e vocalization s an d m ovem en ts sh e
says, “For a sh ort tim e on ly; it is like h oldin g
you r breath —even tu ally you h ave to let it
ou t.” Med ical evalu ation is u n rem arkab le.
A 9-year-old boy with norm al intelligence requently gets into trouble at school because he
blurts out answers, interrupts the teacher, disturbs the other students, and cannot seem to sit
still in class. He also requently injures him sel
during play and rarely sits through an entire m eal
at hom e. His siblings say that he is “a real pest.”
However, the child does his schoolwork well and
behaves well when he is alone with his tutor.
1. Th is ch ild is sh owin g eviden ce o
(A) au tism sp ectru m d isorder (ASD)
(B) Rett’s syn d rom e
(C) atten tion -de icit/ h yp eractivity disord er
4. Th e best exp lan ation or th is ch ild’s
beh avior is
(D) Tou rette’s disorder
(E) selective m u tism
(A)
(B)
(C)
(D)
(E)
2. Th e m ost e ective m an agem en t o th e
5. Which o the ollowin g is m ost closely
u n wan ted vocalization s an d m ovem en ts is
involved in the etiology o this child’s problem ?
(A)
(B)
(C)
(D)
(E)
(A)
(B)
(C)
(D)
(E)
(ADHD)
an an tip sych otic
an an tid ep ressan t
am ily th erapy
a stim u lan t
in dividu al p sych oth erapy
op p osition al d e ian t d isord er
ADHD
social d i icu lties in th e am ily
con d u ct d isord er
typ ical age-ap p rop riate beh avior
Food allergy
Im p rop er diet
Neu rologic dys u n ction
Excessive p u n ish m en t
Excessive len ien cy
3. A 4-year-old ch ild wh o h as n ever sp oken
6. O th e ollowin g, th e m ost e ective
volun tarily shows n o in terest in or con n ection
to his p aren ts, oth er adu lts, or oth er ch ildren .
Medical exam in ation an d otological testin g
are u n rem arkable. Th e ch ild’s m oth er tells
th e doctor that he persisten tly turn s on the
taps to watch th e water run n in g an d th at h e
scream s an d struggles ercely when she tries
to dress h im . Which o th e ollowin g disorders
best ts this clin ical picture?
m an agem en t or th is ch ild is
(A)
(B)
(C)
(D)
(E)
164
ASD
Rett’s syn d rom e
ADHD
Tou rette’s disorder
Selective m u tism
(A)
(B)
(C)
(D)
(E)
an an tip sych otic
an an tid ep ressan t
am ily th erapy
a stim u lan t
in dividu al p sych oth erapy
7. Th is boy is at a h igh er risk th an oth er
ch ildren to d evelop wh ich o th e ollowin g
disord ers?
(A)
(B)
(C)
(D)
(E)
Tou rette’s disorder
Sep aration an xiety disorder
Bip olar d isord er
Con du ct disorder
Sch izop h ren ia
Chapter 15
8. A ter startin g rst grade, a 7-year-old boy
o ten com p lain s o eelin g ill an d re u ses
to go to sch ool. Th ere are n o m edical
n din gs. At h om e, th e ch ild is ap p rop riately
in teractive with h is p aren ts an d, wh en
rien ds visit, h e p lays well with th em . At rst
h is p aren ts let h im stay at h om e, bu t th ey
are b ecom in g in creasin gly con cern ed th at
h e is allin g beh in d in h is sch oolwork. Th e
p aren ts wan t to h ire a h om e tu tor or th e
ch ild. Wh at is th e p ed iatrician’s n ext step in
m an agem en t?
(A) Advise th e p aren ts to go to sch ool with
(B)
(C)
(D)
(E)
th e ch ild an d, over days, grad u ally
decrease th e tim e th ey sp en d th ere.
Advise th e p aren ts to allow th e ch ild to
stay at h om e u n til h e in d icates th at h e is
com ortable sep aratin g rom th e p aren ts.
Advise th e p aren ts to ign ore th e sch ool
re u sal, brin g th e ch ild to sch ool, an d tell
h im wh at tim e th ey will p ick h im u p.
Reassu re th e p aren ts th at h irin g a h om e
tu tor or th e cu rren t sch ool year is best
or th e ch ild.
Prescrib e an an tian xiety agen t or th e
ch ild to b e given on ly on sch ool days.
9. A 9-year-old b oy with n orm al in telligen ce
h as a h istory o gh tin g with oth er ch ildren
an d catch in g an d tortu rin g b irds, squ irrels,
an d rabb its. Wh en asked wh y h e en gages
in th is beh avior, h e says, “It’s ju st u n .”
Develop m en tal h istory an d m edical
exam in ation are u n rem arkable. Th e b est
explan ation o th is ch ild’s b eh avior is
(A)
(B)
(C)
(D)
(E)
op p osition al d e ian t d isord er
ADHD
social d i icu lties in th e am ily
con d u ct d isord er
typ ical age-ap p rop riate beh avior
Psychiatric Disorders in Children
165
Questions 10 and 11
Con cern ed p a ren ts o a 7-yea r-old b oy
b rin g th eir ch ild to th e p ed ia tricia n or
eva lu a tio n . Th ey n o te th a t ever sin ce h e
wa s an in a n t, th eir so n h a s n ever wa n ted
to b e h eld , cries wh en ever h e is b a th ed , a n d
b ecom es very u p set wh en h is d a ily rou tin e
is ch a n ged in an y way. Alth ou gh th e ch ild
ca n n o t yet rea d , h is p aren ts rem a rk th at
h e ca n id en ti y th e sta te o o rigin o a n y
ca r licen se p late a n d a lm o st exclu sively
p la ys with rep licas o car licen se p la tes. Th e
ch ild’s sp ea ks in co m p lete sen ten ces a n d
h a s a go od vo cab u la ry, b u t h is b eh avior
seem s od d a n d h e d oes n ot m a ke eye con ta ct wh en sp oken to. Med ica l evalu a tio n is
u n rem a rka b le.
10. As an adolescen t, th is boy is likely to h ave
th e m ost di cu lty in wh ich o th e ollowin g
areas?
(A)
(B)
(C)
(D)
(E)
Payin g atten tion in sch ool
Con cen tratin g on relevan t stim u li
Carin g or p ets
Makin g rien ds
Con trollin g h is activity level
11. Th e m ajor ch aracteristic th at su ggests
th at th is ch ild h as Level 1 rath er th an Level 3
au tism sp ectru m disorder is th at th is ch ild
does not sh ow
(A)
(B)
(C)
(D)
(E)
restricted in terests
sp ecial abilities
ocu s on keep in g u p rou tin es
p roblem s in p eer relation sh ip s
lan gu age delay
12. Th e p aren ts an d teach er o a 7-yearold boy n ote th at h e requ en tly sh ru gs
h is sh ou ld ers. O ten h e b lin ks h is eyes
excessively an d, at oth er tim es, sh ou ts ou t
word s or n o reason . In adu lth ood, th is ch ild
is at risk to develop wh ich o th e ollowin g
con dition s?
(A)
(B)
(C)
(D)
(E)
A seizu re disord er
Obsessive–com p u lsive disorder
Con du ct disorder
Sch izop h ren ia
ASD
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BRS Behavioral Science
13. Th e p aren ts o a 10-year-old ch ild rep ort
th at th e ch ild is still wettin g th e b ed . Th e
ch ild is very u p set ab ou t th is b ecau se h e
wou ld like to go away to su m m er cam p b u t is
a raid th at h e will wet th e bed th ere as well.
Ph ysical exam in ation is u n rem arkab le an d
th e ch ild is oth erwise develop in g typ ically
or his age. Beh avioral in terven tion s su ch as
lim itin g f u ids b e ore b ed an d th e b ell an d
p ad ap p aratu s h ave n ot been e ective. At
th is tim e, wh ich o th e ollowin g is th e b est
ch oice or p h arm acologic m an agem en t o
en uresis in th is ch ild?
(A)
(B)
(C)
(D)
(E)
Im ip ram in e
Diazep am
Desm op ressin acetate
Acetam in op h en
Asp irin
14. Th e p aren ts o an 8-year-old boy rep ort
th at h is beh avior at h om e is p rob lem atic. He
re u ses to d o h is ch ores an d o ten gh ts with
h is 6-year-old broth er an d 11-year-old sister.
His teach ers rep ort th at h e is well beh aved
at sch ool, is workin g at th e exp ected level,
an d gets alon g well with th e oth er ch ildren .
Medical exam in ation is u n rem arkable. Th e
m ost likely exp lan ation or th is p ictu re is
(A)
(B)
(C)
(D)
(E)
op p osition al d e ian t d isord er
atten tion -de icit/ h yp eractivity disord er
social d i icu lties in th e am ily
con d u ct d isord er
typ ical age-ap p rop riate beh avior
An swers an d Exp lan ation s
Typical Board Question
The answer is A. Th is 2-year-old ch ild is sh owin g typ ical beh avior or h er age. Two-year-old ch ildren can n ot b e exp ected to p ay atten tion or m ore th an a ew m in u tes at a tim e, do n ot yet
p lay coop eratively with oth er ch ildren , an d com m on ly are relu ctan t to sh are th eir toys (see also
Ch ap ter 1). ADHD, con d u ct d isord er, an d op p osition al d e ian t disord er can be d i icu lt to distin gu ish rom n orm ative beh avior in ch ildren u n der age 4 years.
1. The answer is D. 2. The answer is A. Th is girl is m ost likely to h ave Tou rette’s disorder, a
ch ron ic n eu rologic con d ition with beh avioral m an i estation s su ch as u n wan ted m otor
activity an d vocalization s. Th e vocalization s an d m otor tics can be con trolled on ly brie ly
an d th en th ey m u st be exp ressed. ASD an d Rett’s syn drom e are develop m en tal disorders
o ch ildh ood th at are ch aracterized by abn orm al social in teraction an d sp eech . ADHD
in volves n orm al develop m en t o sp eech an d social in teraction bu t di icu lty p ayin g
atten tion or sittin g still. Selective m u tism in volves volu n tary absen ce or decrease in
sp eakin g in social situ ation s. Th e m ost e ective m an agem en t or Tou rette’s disorder is
an tip sych otic m ed ication , su ch as halop eridol. Th ere is n o eviden ce th at an tidep ressan ts
or stim u lan ts are h elp u l or con trol o m otor or vocal tics. Psych oth erapy can h elp p atien ts
with Tou rette’s disorder deal with the social p roblem s th eir disorder m ay cau se, bu t is n ot
th e m ost e ective m an agem en t or th e sym p tom s o th e d isorder.
3. The answer is A. Th is ch ild, wh o h as n ever sp oken volu n tarily an d wh o sh ows n o in terest
in or con n ection to h is p aren ts, oth er adu lts, or oth er ch ildren desp ite n orm al h earin g,
p robably h as ASD. He tu rn s on th e tap to watch th e water ru n n in g becau se, as with m an y
ch ild ren with ASD, rep etitive m otion calm s h im . An y ch an ge in h is en viron m en t, su ch as
bein g d ressed , lead s to in ten se discom ort, stru gglin g, an d scream in g (see also an swer to
Qu estion 1).
4. The answer is B. 5. The answer is C. 6. The answer is D. 7. The answer is D. Th is 9-yearold boy wh o gets in to trou ble at sch ool becau se h e distu rbs th e teach er an d th e oth er
stu d en ts, h as b eh avioral di icu lties at h om e an d with sib lin gs, an d can n ot seem to sit still
is sh owin g eviden ce o ADHD (see also an swer to Qu estion 1). Ch ildren with ADHD can
o ten learn well wh en th ere are ew distraction s (e.g., alon e with a tu tor). Ch ildren with
con du ct d isorder sh ow b eh avior th at violates social n orm s (e.g., stealin g). In con trast,
ch ild ren with ADHD h ave trou ble con trollin g th eir beh avior bu t do n ot in ten tion ally cau se
h arm . Ch ildren with op p osition al de ian t disorder h ave p roblem s dealin g with au th ority
igu res bu t n ot with oth er ch ildren or an im als. ADHD is believed to resu lt rom n eu rologic
dys u n ction . Alth ou gh an ecdotal eviden ce h as been p u t orward, scien ti ic stu dies h ave
n ot revealed an association between ADHD an d eith er im p rop er diet (e.g., excessive su gar
in take) or ood allergy (e.g., to arti icial colors or lavors). Th e disorder also is n ot a resu lt
o p aren tin g style (e.g., excessive p u n ish m en t or len ien cy). However, in part becau se o
th eir di icu lt beh avior, ch ild ren with ADHD are m ore likely to b e p h ysically ab u sed by
p aren ts. Th e m ost e ective m an agem en t or ch ildren with ADHD is u se o cen tral n ervou s
system stim u lan ts in clu d in g m eth ylp h en id ate (Ritalin ), an d d extroam p h etam in e su l ate
(Dexedrin e). Lith iu m is u sed to treat bip olar disorder, an tidep ressan ts are u sed p rim arily
to treat dep ression , an d sedatives are u sed p rim arily to treat an xiety. Wh ile p sych oth erapy
m ay h elp th e p aren ts an d ch ild deal with th e b eh avioral sym p tom s, it is n ot th e m ost
e ective m an agem en t sin ce th e disorder is based on n eu rologic dys u n ction . Ch ildren with
ADHD are at h igh er risk th an oth er ch ild ren or op p osition al d e ian t d isord er an d con d u ct
disorder.
167
168
BRS Behavioral Science
8. The answer is A. Th is ch ild is sh owin g evid en ce o sep aration an xiety d isorder. By th e age
o 3 to 4 years ch ild ren sh ou ld be able to sp en d som e tim e away rom p aren ts in a sch ool
settin g. Th e p ed iatrician’s b est recom m en dation is or th e p aren ts to go to sch ool with th e
ch ild an d , over days, grad u ally d ecrease th e tim e th ey sp en d th ere. Allowin g th e ch ild to
stay at h om e or h irin g a h om e tu tor will ju st in crease th e ch ild’s d i icu lty sep aratin g rom
h is p aren ts. Ph arm acologic th erapy is n ot th e irst ch oice in th e m an agem en t o th is ch ild.
9. The answer is D. Th is ch ild is sh owin g evid en ce o con d u ct disord er. Ch ild ren with th is
disord er h ave little or n o con cern or oth ers or or an im als (e.g., th is ch ild in ds tortu rin g
an im als “ u n”) (see also an swer to Qu estion 4).
10. The answer is D. 11. The answer is E. Th is ch ild wh o d oes n ot wan t to b e h eld , cries wh en
h is en viron m en t is ch an ged (e.g., when bath ed), an d does n ot m ake eye con tact is likely to
h ave ASD. Ch ild ren with ASD h ave great di icu lty with in terp erson al relation s. Problem s
with atten tion an d con cen tration are m ore ch aracteristic o ADHD. Ch ild ren with con du ct
d isord er ten d to h ave p oor sel -con trol an d to break societal ru les. Hyp eractivity m ay
b e p resen t bu t is n ot sp eci ically associated with ASD. Th e m ajor ch aracteristic th at
d i eren tiates Level 1 rom Level 3 au tism sp ectru m disorder is th at in th e latter bu t n ot in
th e orm er, th ere is develop m en tal lan gu age delay an d th is ch ild sh ows relatively n orm al
lan gu age develop m en t, restricted or u n u su al in terests (h ere, in ten se ocu s on state licen se
p lates), sp ecial ab ilities, ocu s on keep in g u p rou tin es an d p roblem s in p eer relation sh ip s
are ch aracteristic o all levels o au tism sp ectru m disorder.
12. The answer is B. Th is ch ild wh o sh ows eviden ce o Tou rette’s disorder is at risk to develop
obsessive–com p u lsive d isord er (OCD) in adu lth ood. Both disorders in volve dys u n ction o
th e cau date n u cleu s. Seizu re disorders, con du ct disorder, sch izop h ren ia, an d ASD are n ot
p articu larly associated with Tou rette’s disorder (see also an swer to Qu estion 1).
13. The answer is C. Th e best ch oice or th e p h arm acologic m an agem en t o b edwettin g in an
older ch ild su ch as th is is d esm op ressin acetate. Im ip ram in e is also u se u l in m an agin g
en u resis b u t h as m ore sid e e ects. Diazep am (a b en zod iazep in e), u sed to treat an xiety,
an d acetam in op h en an d asp irin , u sed in th e m an agem en t o m in or p ain , are n ot u se u l in
m an agin g en u resis.
14. The answer is C. Th e m ost likely exp lan ation or wh y th is ch ild m isbeh aves at h om e bu t
n ot at sch ool is that th ere are social di icu lties in th e am ily, or exam p le, p roblem s in th e
relation sh ip between th e m oth er an d ath er. In con trast, ch ildren with con du ct disorder
sh ow beh avior th at violates social n orm s (e.g., stealin g), ch ildren with ADHD h ave trou ble
con trollin g th eir beh avior, an d ch ildren with op p osition al de ian t disorder h ave p roblem s
dealin g with au th ority igu res. In th ese d isorders, beh avioral d i icu lties typ ically are
p resen t both at h om e an d at sch ool.