child psychopathology final

A 13-year-old girl presents to the school counselor reporting persistent excessive worry about school performance for the past 4 months, daily stomachaches on school days, avoidance of lunchtime with peers, and a 5-lb weight loss due to eating less around others. Which broad diagnostic domain best captures this clinical picture?

Internalizing disorders

A 9-year-old boy has been referred for behavioral problems: he frequently shoves and hits classmates during recess, intentionally breaks classroom materials when frustrated, loudly interrupts the teacher, and refuses to follow classroom rules despite repeated warnings. Which cluster best describes these behaviors?

Externalizing symptoms

A 16-year-old adolescent develops severe social anxiety and disordered eating after moving to a community where social media and peer groups emphasize thinness and appearance, and where family members frequently comment on weight and dieting. Which etiological perspective most directly accounts for these influences?

Sociocultural

A 12-year-old boy shows classic signs of bipolar disorder (mood swings with mania and depression) and neuroimaging suggests atypical white matter development; family history shows bipolar disorder in a first-degree relative. Which etiological model is most supported by these findings?

Neurobiological

In Ainsworth’s Strange Situation, a toddler who explores toys while the caregiver is present, shows mild distress when the caregiver briefly leaves, and is readily comforted and returns to play when the caregiver returns is best described as having which attachment style?

Secure attachment

During the Strange Situation, an infant alternates between approaching the caregiver and suddenly freezing, displays contradictory behaviors (e.g., moving toward caregiver but averting gaze), and shows signs of fear. Which attachment classification best fits this pattern?

Disorganized attachment

A clinician uses a diagnostic manual that requires a patient to meet every single listed criterion exactly (no partial matches are allowed) before assigning the diagnosis. This diagnostic framework is an example of which approach?

Categorical diagnostic model

A different clinician applies a diagnostic rule that allows for heterogeneous presentations: the patient must meet a specified number of symptoms from a list (for example, 5 out of 9) and the clinician accepts multiple symptom combinations as valid. This is best described as which diagnostic approach?

Prototypical

A school psychologist implements a program to increase a socially anxious child’s participation at recess using token economies, shaping, and graded exposure (structured, behavioral tasks). Which therapeutic orientation best describes these interventions?

Behavioral therapy

In therapy, a clinician works with a 14-year-old to identify automatic thoughts such as “I always fail,” test the evidence for these beliefs, and restructure them into more accurate statements. Which type of therapy is being used?

Cognitive therapy (CBT)

A 10-year-old child functions academically roughly at the 3rd-grade level, requires minimal supports in daily life, and is able to form friendships and live in the community as an adult. According to severity classifications, this profile most closely fits:

Mild intellectual disability

A 5-year-old with significant delays in motor and language milestones, multiple congenital anomalies, and a lifelong need for supervision and assistance with feeding and mobility is most consistent with which level of intellectual disability?

Severe ID

An infant with profound developmental delays, extremely limited communication, inability to feed or dress independently, and major biological problems that were evident in the first year of life is most appropriately labeled as:

Profound ID

A 4-year-old avoids eye contact, does not engage in back-and-forth play, flaps her hands when excited, and fixates on lining up toy cars in a very specific order. Which diagnosis is most consistent with this clinical picture?

Autism Spectrum Disorder (ASD)

A 13-year-old adolescent reports hearing voices that comment on his actions and has developed social withdrawal and declining academic performance over the past 9 months, with no early childhood social-communication deficits or restricted interests. Which diagnosis should be considered first?

Schizophrenia

A child with mild intellectual disability typically is identified during elementary school, can acquire social and some vocational skills, and may live independently with supports. Which of the following functional outcomes is most consistent with mild ID?

Can live in the community and hold jobs with minimal supports

Moderate intellectual disability is usually recognized by preschool age and children commonly perform supervised semi-skilled work as adults. This severity classification corresponds roughly to mental ages of:

8–9 years

When intellectual disability has a clear organic or biological cause (e.g., genetic syndrome, prenatal exposure), it is most commonly associated with which severity level?

Severe

A child must demonstrate persistent deficits in social communication across multiple contexts (e.g., difficulty with social-emotional reciprocity, nonverbal communicative behaviors) in order to meet criteria for:

Autism Spectrum Disorder (ASD)

Repetitive body movements (stimming), insistence on sameness, and highly restricted interests are core characteristics of which diagnosis?

Autism Spectrum Disorder (ASD)

An adolescent presenting with auditory hallucinations (voices), delusional thoughts, marked disorganization in speech and behavior, and social occupational decline for 7 months meets criteria most consistent with:

Schizophrenia (duration + positive symptoms)

A child who has difficulty sounding out words (phonological decoding), confuses similar sight words (e.g., “who,” “what,” “said”), and is unable to read fluently so comprehension is poor is most likely to be diagnosed with:

Reading disorder (dyslexia)

A 5th grader produces short, poorly organized essays, frequently omits punctuation, and has extremely messy, hard-to-read handwriting caused in part by poor fine-motor coordination. Which learning disorder matches these problems?

Writing disorder (dysgraphia)

A student who consistently misaligns columns when adding multi-digit numbers, has trouble with time concepts and place value, and cannot efficiently memorize basic arithmetic facts would most likely be diagnosed with:

Math disorder (dyscalculia)

A seven-year-old who frequently fidgets, leaves his seat during lessons, climbs on furniture inappropriately, blurts out answers before questions are completed, and has difficulty playing quietly meets criteria primarily for which ADHD presentation?

Predominantly hyperactive

A child who has persistent difficulty sustaining attention to tasks, frequently makes careless mistakes at schoolwork, loses homework and other items, and appears “spacey” during instructions most closely matches which ADHD presentation?

Predominantly inattentive

A 15-year-old who has repeatedly started physical fights, set fires, and shown little remorse after harming others, with evidence of callous–unemotional traits, is most consistent with:

Conduct disorder

Oppositional defiant disorder (ODD) is classified as mild when symptoms occur in one setting, moderate when in two settings, and severe when symptoms are present in three or more settings (e.g., home, school, with peers). If a child displays persistent defiance at home and at school but behaves appropriately with peers, this is:

Moderate ODD

Callous–unemotional traits (e.g., lack of guilt or empathy, shallow affect) in youth are most predictive of which long-term diagnosis or outcome?

Conduct disorder and more severe antisocial outcomes

The Behavioral Inhibition System (BIS) is thought to underlie sensitivity to punishment, novel situations, and nonreward; a high BIS is associated with:

Increased anxiety and avoidance tendencies

A 15-year-old presents with two weeks of markedly decreased interest in previously enjoyed activities, persistent irritability, insomnia, poor concentration, significant decline in academic performance, and impaired social functioning. According to DSM criteria for children

adolescents, which diagnosis fits best?

A 12-year-old reports chronic feelings of sadness, low energy, low self-esteem, and irritability for the past 14 months with no discrete major depressive episodes of 2+ weeks’ severity. Which diagnosis is most consistent with this chronic course?

Persistent depressive disorder (PDD; dysthymia)

A child experiencing a severe depressive episode reports hearing accusatory voices saying “you’re worthless” that are temporally linked to the depressed mood and remit when mood improves. Which statement best describes these symptoms?

Mood-congruent psychotic features occurring only during depressive episodes (MDD with psychotic features)

Which of the following is the key diagnostic distinction between psychotic symptoms associated with schizophrenia versus those associated with mood disorders like MDD or bipolar disorder?

Psychotic symptoms in schizophrenia occur independently of mood and are usually present across time, whereas mood disorders have psychosis only during mood episodes

Compared to adults, children with major depressive disorder more commonly present with which of the following affective states?

Predominant irritability rather than reported sadness

A 10-year-old refuses to attend the school talent show despite loving music at home because they fear humiliation and negative evaluation by classmates. This pattern of excessive fear and avoidance in social situations best meets criteria for which disorder?

Social anxiety disorder (social phobia)

For a diagnosis of social anxiety disorder in children and adolescents, the fear or avoidance of social situations must be persistent for at least how long?

6 months

A high-school student is terrified of public speaking and faints at the thought of presenting a paper. Their fear is limited strictly to performances and does not apply to other social situations. Which subtype of social anxiety disorder does this describe?

Performance-only social anxiety

A child speaks freely and loudly at home with family members but has stopped speaking completely in the classroom setting for more than one school month while understanding and using the language otherwise. What is the most likely diagnosis?

Selective mutism

A child repeatedly experiences intrusive, unwanted thoughts that they have contaminated their hands, and they feel compelled to wash them repeatedly to “prevent illness.” The repetitive hand washing performed to reduce anxiety is best classified as which of the following?

A compulsion (ritualized behavior)

Which of the following best describes an obsession in obsessive–compulsive disorder (OCD)?

Recurrent, persistent, intrusive thoughts, urges, or images that are unwanted and cause distress

OCD is diagnosed when obsessions and/or compulsions are time-consuming or cause clinically significant distress or impairment. The DSM commonly uses what minimum daily time burden as a guideline for “time-consuming”?

More than 1 hour/day

A sudden episode of intense fear that peaks within minutes and involves palpitations, shortness of breath, chest pain, and fear of dying would best be labeled:

A panic attack

For the diagnosis of panic disorder, the DSM requires that the panic attack be followed by at least one month of which of the following?

Fear or concern about additional attacks or significant maladaptive change in behavior related to the attacks

When anxious, a child often shows autonomic signs such as increased heart rate, dilated pupils, and faster breathing. Which autonomic branch is primarily responsible for these “fight-or-flight” responses?

Sympathetic nervous system

Which physiological changes are typical of sympathetic activation during acute anxiety? (Select the best single answer.)

Increased heart rate and respiration, dilated pupils, blood shunting to muscles

Children who have chronic anxiety often have difficulty activating their parasympathetic response. Which set of functions is associated with parasympathetic activation?

Rest-and-digest: decreased heart rate, increased digestion, pupil constriction

A 9-year-old witnesses a severe car crash in which a family member is badly injured. According to DSM criteria, this constitutes what type of qualifying criteria for a PTSD diagnosis?

Direct exposure to life-threatening event

A child repeatedly relives a traumatic event through involuntary, distressing memories and flashbacks that seem to recreate the original experience. These symptoms are categorized as:

Intrusion symptoms

Persistent and purposeful avoidance of internal or external reminders of the trauma (e.g., refusing to ride in cars or avoiding places that look like the accident site) are best classified clinically as:

Avoidance symptoms

To meet full PTSD diagnostic criteria (DSM-5) in school-age children and adolescents, trauma-related symptoms must persist for a minimum duration of:

1 month

A child exposed to a single traumatic event develops symptoms across intrusion, dissociation, and arousal categories that begin immediately after the trauma and persist for 10 days. Which diagnosis is most appropriate?

Acute Stress Disorder

Acute stress disorder requires a certain number of symptoms drawn from categories including intrusion, negative mood, dissociation, avoidance, and arousal. The DSM specifies that the presence of how many symptoms across the categories is required?

9 symptoms across categories

Adjustment disorder is diagnosed when emotional or behavioral symptoms develop in response to an identifiable stressor and occur within what time window following the onset of the stressor?

Within 3 months

A teenager develops significant anxiety, insomnia, and social withdrawal beginning two months after parental divorce (a non-life-threatening stressor), with impairment in school and peer relationships. The most fitting diagnosis is:

Adjustment disorder with anxiety

Which of the following treatments is considered the evidence-based first-line psychosocial treatment for PTSD in children and adolescents, particularly when trauma processing is required?

Trauma-focused cognitive behavioral therapy (TF-CBT) with cognitive restructuring and trauma narrative exposure

Which treatment approach is most central to treating non-trauma anxiety disorders (e.g., specific phobia, social anxiety) in youth?

Exposure therapy (graded in vivo or imaginal exposure) often combined with CBT

For obsessive–compulsive disorder in children, the gold-standard behavioral treatment involves:

Exposure and response prevention (ERP), where the child confronts feared stimuli and refrains from rituals

When assessing trauma exposure in young children (age 6 and under), clinicians should remember that one manifestation of exposure is repetitive play in which themes or aspects of the traumatic event are reenacted — this behavior is best interpreted as:

A possible sign of trauma-related intrusion or re-experiencing in young children

According to DSM guidelines, repeated exposure to traumatic material through electronic media (e.g., watching graphic news coverage) qualifies as a Criterion A traumatic exposure for PTSD in most cases. Is this true or false?

False — indirect exposure via electronic media does not generally qualify unless work-related and repeated (e.g., first responders)

An 18-month-old in foster care is observed to approach and readily go off with unfamiliar adults, show overly familiar verbal and physical behavior with strangers, and rarely check back with a caregiver for reassurance. The most fitting diagnosis is:

Disinhibited Social Engagement Disorder (DSED)

A child who is persistently emotionally withdrawn, rarely seeks comfort from caregivers when distressed, shows limited positive affect, and has a history of severe neglect or insufficient care would most likely be diagnosed with:

Reactive Attachment Disorder (RAD)

For RAD diagnosis, the insufficient care or patterns of caregiving that contributed to the disorder must have occurred before which age threshold is the diagnostic literature most concerned with?

Before age 5 years (symptoms evident before age 5)

Disinhibited Social Engagement Disorder (DSED) requires a minimum developmental age for diagnosis such that the child is at least able to interact socially in expected ways — commonly the DSM indicates a minimum developmental age of:

9 months

DSED’s pattern of indiscriminate friendliness and lack of boundaries is commonly associated with greater long-term risk of:

Conduct problems, poor peer relationships, and increased risk-taking (externalizing outcomes)

A 16-year-old consistently falls asleep after midnight (often around 2 a.m.) and cannot awaken for a 7 a.m. school start time despite sleeping well once asleep. The adolescent reports no problem staying asleep or frequent awakenings. Which sleep disorder best captures this pattern?

Circadian rhythm sleep–wake disorder (delayed sleep phase)

A 10-year-old reports difficulties falling asleep each night, daytime fatigue, problems concentrating in class, mood irritability, and significant impairment in school functioning. Which disorder best fits the overall sleep complaint and daytime consequences?

Insomnia disorder

A child awakens from sleep screaming, is easily consoled, remembers a vivid dream in detail, and is able to describe the dream content the next morning. This episode is most consistent with:

Nightmare disorder

A preschooler abruptly screams and thrashes in bed at night, has pronounced autonomic arousal (rapid heart rate, sweating), is very difficult to awaken, and has little or no recall of the event the next morning. This clinical picture best matches:

Night terrors

Pediatric obstructive sleep apnea (OSA) is commonly associated with which of the following anatomical or medical contributors in children?

Adenotonsillar hypertrophy (enlarged tonsils/adenoids) obstructing upper airway

For nocturnal enuresis in school-age children (bedwetting), evidence-based first-line behavioral management includes which intervention(s)?

Enuresis alarm paired with behavioral interventions and positive reinforcement

A 15-year-old female intentionally restricts caloric intake, maintains a body weight significantly below expected for age and height (BMI in underweight range), has an intense fear of gaining weight, and exhibits extreme body-image distortion about her size. Which eating disorder diagnosis does this most closely match?

Anorexia nervosa (restricting type)

A 17-year-old engages in recurrent episodes of binge eating followed by inappropriate compensatory behaviors (self-induced vomiting, laxative misuse), reports shame and secrecy about the binges, but body weight remains within the normal range. Which diagnosis is most appropriate?

Bulimia nervosa

A 4-year-old is extremely limited in the variety of foods accepted, avoids many textures and smells, fails to gain weight appropriately (deceleration of weight gain), and does not exhibit concerns about body shape or weight. Which feeding

eating disorder best describes this pattern?

Which of the following statements correctly highlights a primary clinical difference between ARFID and anorexia nervosa in children?

ARFID involves avoidance or restriction due to sensory or fear-of-choking concerns without preoccupation with body weight, whereas anorexia involves body-image disturbance and weight-loss behaviors aimed at thinness

A parent of a 9-year-old with oppositional and defiant behaviors begins using Parent Management Training (PMT) strategies. They implement consistent positive reinforcement for appropriate behaviors, use clear and specific commands (“Please put your shoes in the bin”), set predictable consequences for rule-breaking, and practice active ignoring of minor attention-seeking behaviors. Which core behavioral principle underlying PMT best explains why this approach reduces disruptive behavior?

Increasing positive parent–child interactions and reinforcing desired behaviors while systematically reducing reinforcement for negative behaviors