neurodevelopmental disorders

Which of the following is not required for a DSM-5 diagnosis of intellectual dis ability (intellectual developmental disorder)?

A. Full-scale IQ below 70.

B. Deficits in intellectual functions confirmed by clinical assessment.

C. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility.

D. Symptom onset during the developmental period.

E. Deficits in intellectual functions confirmed by individualized, standardized intelligence testing.

A. Full-scale IQ below 70.

A 7-year-old boy in second grade displays significant delays in his ability to reason, solve problems, and learn from his experiences. He has been slow to develop reading, writing, and mathematics skills in school. All through devel opment, these skills lagged behind peers, although he is making slow progress. These deficits significantly impair his ability to play in an age-appropriate manner with peers and to begin to acquire independent skills at home. He re quires ongoing assistance with basic skills (dressing, feeding, and bathing him self; doing any type of schoolwork) on a daily basis. Which of the following diagnoses best fits this presentation?

A. Childhood-onset major neurocognitive disorder.

B. Specific learning disorder.

C. Intellectual disability (intellectual developmental disorder).

D. Communication disorder.

E. Autism spectrum disorder

C. Intellectual disability (intellectual developmental disorder).

A 7-year-old boy in second grade displays significant delays in his ability to reason, solve problems, and learn from his experiences. He has been slow to develop reading, writing, and mathematics skills in school. All through devel opment, these skills lagged behind peers, although he is making slow progress. These deficits significantly impair his ability to play in an age-appropriate manner with peers and to begin to acquire independent skills at home. He re quires ongoing assistance with basic skills (dressing, feeding, and bathing him self; doing any type of schoolwork) on a daily basis. What is the appropriate severity rating for this patient’s current presentation?

A. Mild.

B. Moderate.

C. Severe.

D. Profound.

E. Cannot be determined without an IQ score

B. Moderate.

Which of the following statements about intellectual disability (intellectual de velopmental disorder) is false?

A. Individuals with intellectual disability have deficits in general mental abil ities and impairment in everyday adaptive functioning compared with age and gender-matched peers from the same linguistic and sociocultural group.

B. For individuals with intellectual disability, the full-scale IQ score is a valid assessment of overall mental abilities and adaptive functioning, even if sub test scores are highly discrepant.

C. Individuals with intellectual disability may have difficulty in managing their behavior, emotions, and interpersonal relationships and in maintaining motivation in the learning process.

D. Intellectual disability is generally associated with an IQ that is 2 standard deviations from the population mean, which equates to an IQ score of about 70 or below ( 5 points).

E. Assessment procedures for intellectual disability must take into account factors that may limit performance, such as sociocultural background, na tive language, associated communication/language disorder, and motor or sensory handicap.

B. For individuals with intellectual disability, the full-scale IQ score is a valid assessment of overall mental abilities and adaptive functioning, even if sub test scores are highly discrepant.

Which of the following statements about the diagnosis of intellectual disability (intellectual developmental disorder) is false?

A. An individual with an IQ of less than 70 would receive the diagnosis if there were no significant deficits in adaptive functioning.

B. An individual with an IQ above 75 would not meet diagnostic criteria even if there were impairments in adaptive functioning.

C. In forensic assessment, severe deficits in adaptive functioning might allow for a diagnosis with an IQ above 75.

D. Adaptive functioning must take into account the three domains of conceptual, social, and practical functioning.

E. The specifiers mild, moderate, severe, and profound are based on IQ scores.

E. The specifiers mild, moderate, severe, and profound are based on IQ scores.

Which of the following is not a diagnostic feature of intellectual disability (intellectual developmental disorder)?

A. A full-scale IQ of less than 70.

B. Inability to perform complex daily living tasks (e.g., money management, medical decision making) without support.

C. Gullibility, with naivet in social situations and a tendency to be easily led by others.

D. Lack of age-appropriate communication skills for social and interpersonal functioning.

E. All of the above are diagnostic features of intellectual disability.

A. A full-scale IQ of less than 70.

Which of the following statements about adaptive functioning in the diagnosis of intellectual disability (intellectual developmental disorder) is true?

A. Adaptive functioning is based on an individual’s IQ score.

B. “Deficits in adaptive functioning” refers to problems with motor coordination.

C. At least two domains of adaptive functioning must be impaired to meet Criterion B for the diagnosis of intellectual disability.

D. Adaptive functioning in intellectual disability tends to improve over time, although the threshold of cognitive capacities and associated developmental disorders can limit it.

E. Individuals diagnosed with intellectual disability in childhood will typi cally continue to meet criteria in adulthood even if their adaptive function ing improves.

D. Adaptive functioning in intellectual disability tends to improve over time, although the threshold of cognitive capacities and associated developmental disorders can limit it.

Which of the following statements about development of and risk factors for intellectual disability (intellectual developmental disorder) is true?

A. Intellectual developmental disorder should not be diagnosed in the presence of a known genetic syndrome, such as Lesch-Nyhan or Prader-Willi syndrome.

B. Etiologies are confined to perinatal and postnatal factors and exclude pre natal events.

C. In severe acquired forms of intellectual developmental disorder, onset may be abrupt following an illness (e.g., meningitis) or head trauma occurring during the developmental period.

D. When intellectual disability results from a loss of previously acquired cognitive skills, as in severe traumatic brain injury (TBI), only the TBI diagnosis is assigned.

E. Prenatal, perinatal, and postnatal etiologies of intellectual developmental disorder are demonstrable in approximately 33% of cases.

C. In severe acquired forms of intellectual developmental disorder, onset may be abrupt following an illness (e.g., meningitis) or head trauma occurring during the developmental period.

Which of the following statements about the developmental course of intellectual disability (intellectual developmental disorder) is true?

A. Delayed motor, language, and social milestones are not identifiable until af ter the first 2 years of life.

B. Intellectual disability caused by an illness (e.g., encephalitis) or by head trauma occurring during the developmental period would be diagnosed as a neurocognitive disorder, not as intellectual disability (intellectual developmental disorder).

C. Intellectual disability is always nonprogressive.

D. Major neurocognitive disorder may co-occur with intellectual developmental disorder.

E. Even if early and ongoing interventions throughout childhood and adulthood lead to improved adaptive and intellectual functioning, the diagnosis of intellectual disability would continue to apply.

D. Major neurocognitive disorder may co-occur with intellectual developmental disorder.

The DSM-5 diagnosis of intellectual developmental disorder includes severity specifiers—Mild, Moderate, Severe, and Profound—with which to indicate the level of supports required in various domains of adaptive functioning. Which of the following features would not be characteristic of an individual with a “Severe” level of impairment?

A. The individual generally has little understanding of written language or of concepts involving numbers, quantity, time, and money.

B. The individual’s spoken language is quite limited in terms of vocabulary and grammar.

C. The individual requires support for all activities of daily living, including meals, dressing, bathing, and toileting.

D. In adulthood, the individual may be able to sustain competitive employment in a job that does not emphasize conceptual skills.

E. The individual cannot make responsible decisions regarding the well-being of self or others.

D. In adulthood, the individual may be able to sustain competitive employment in a job that does not emphasize conceptual skills.

A 10-year-old boy with a history of dyslexia, who is otherwise developmentally normal, is in a skateboarding accident in which he experiences severe traumatic brain injury. This results in significant global intellectual impairment (with a persistent reading deficit that is more pronounced than his other newly acquired but stable deficits, along with a full-scale IQ of 75). There is mild impairment in his adaptive functioning such that he requires support in some areas of functioning. He is also displaying anxious and depressive symptoms in response to his accident and hospitalization. What is the least likely diagnosis?

A. Intellectual disability (intellectual developmental disorder).

B. Traumatic brain injury.

C. Specific learning disorder.

D. Major neurocognitive disorder due to traumatic brain injury.

E. Adjustment disorder

D. Major neurocognitive disorder due to traumatic brain injury.

In which of the following situations would a diagnosis of global developmental delay be inappropriate?

A. The patient is a child who is too young to fully manifest specific symptoms or to complete requisite assessments.

B. The patient, a 7-year-old boy, has a full-scale IQ of 65 and severe impairment in adaptive functioning.

C. The patient’s scores on psychometric tests suggest intellectual disability (intellectual developmental disorder), but there is insufficient information about the patient’s adaptive functional skills.

D. The patient’s impaired adaptive functioning suggests intellectual develop mental disorder, but there is insufficient information about the level of cog nitive impairment measured by standardized instruments.

E. The patient’s cognitive and adaptive impairments suggest intellectual de velopmental disorder, but there is insufficient information about age at on set of the condition.

B. The patient, a 7-year-old boy, has a full-scale IQ of 65 and severe impairment in adaptive functioning.

Which of the following statements about global developmental delay is true?

A. The diagnosis is typically made in children younger than 5 years of age.

B. The etiology can usually be determined.

C. The prevalence is estimated to be between 0.5% and 2%.

D. The condition is progressive.

E. The condition does not generally occur with other neurodevelopmental dis orders

A. The diagnosis is typically made in children younger than 5 years of age.

A 3-year-old girl with a history of lead exposure and a seizure disorder demonstrates substantial delays across multiple domains of functioning, including communication, learning, attention, and motor development, which limit her ability to interact with same-age peers and require substantial support in all activities of daily living at home. Unfortunately, her mother is an extremely poor historian, and the child has received no formal psychological or learning evaluation to date. She is about to be evaluated for readiness to attend preschool. What is the most appropriate diagnosis?

A. Major neurocognitive disorder.

B. Developmental coordination disorder.

C. Autism spectrum disorder.

D. Global developmental delay.

E. Specific learning disorder.

D. Global developmental delay.

A 5-year-old boy has difficulty making friends and problems with initiating and sustaining back-and-forth conversation; reading social cues; and sharing his feelings with others. He makes good eye contact, has normal speech into nation, displays facial gestures, and has a range of affect that generally seems appropriate to the situation. He demonstrates an interest in trains that seems abnormal in intensity and focus, and he engages in little imaginative or symbolic play. Which of the following diagnostic requirements for autism spectrum disorder are not met in this case?

A. Deficits in social-emotional reciprocity.

B. Deficits in nonverbal communicative behaviors used for social interaction.

C. Deficits in developing and maintaining relationships.

D. Restricted, repetitive patterns of behavior, interests, or activities as manifested by symptoms in two of the specified four categories.

E. Symptoms with onset in early childhood that cause clinically significant impairment.

B. Deficits in nonverbal communicative behaviors used for social interaction.

Which of the following statements about the development and course of au tism spectrum disorder (ASD) is false?

A. Symptoms of ASD are typically recognized during the second year of life (12–24 months of age).

B. Symptoms of ASD are usually not noticeable until 5–6 years of age or later.

C. First symptoms frequently involve delayed language development, often accompanied by lack of social interest or unusual social interactions.

D. ASD is not a degenerative disorder, and it is typical for learning and compensation to continue throughout life.

E. Because many normally developing young children have strong preferences and enjoy repetition, distinguishing restricted and repetitive behaviors that are diagnostic of ASD can be difficult in preschoolers

B. Symptoms of ASD are usually not noticeable until 5–6 years of age or later.

Which of the following was a criterion symptom for autistic disorder in DSM IV that was eliminated from the diagnostic criteria for autism spectrum disor der in DSM-5?

A. Stereotyped or restricted patterns of interest.

B. Stereotyped and repetitive motor mannerisms.

C. Inflexible adherence to routines.

D. Persistent preoccupation with parts of objects.

E. None of the above

D. Persistent preoccupation with parts of objects.

A 7-year-old girl presents with a history of normal language skills (vocabulary and grammar intact) but is unable to use language in a socially pragmatic manner to share ideas and feelings. She has never made good eye contact, and she has difficulty reading social cues. Consequently, she has had difficulty making friends, which is further complicated by her being somewhat obsessed with cartoon characters, which she repetitively scripts. She tends to excessively smell objects. Because she insists on wearing the same shirt and shorts every day, regardless of the season, getting dressed is a difficult activity. These symptoms date from early childhood and cause significant impairment in her functioning. What diagnosis best fits this child’s presentation?

A. Asperger’s disorder.

B. Autism spectrum disorder.

C. Pervasive developmental disorder not otherwise specified (NOS).

D. Social (pragmatic) communication disorder.

E. Rett syndrome.

B. Autism spectrum disorder.

A 15-year-old boy has a long history of nonverbal communication deficits. As an infant he was unable to follow someone else directing his attention by pointing. As a toddler he was not interested in sharing events, feelings, or games with his parents. From school age into adolescence, his speech was odd in tonality and phrasing, and his body language was awkward. What do these symptoms represent?

A. Stereotypies.

B. Restricted range of interests.

C. Developmental regression.

D. Prodromal schizophreniform symptoms.

E. Deficits in nonverbal communicative behaviors

E. Deficits in nonverbal communicative behaviors

A 10-year-old boy demonstrates hand-flapping and finger flicking, and he re petitively flips coins and lines up his trucks. He tends to “echo” the last several words of a question posed to him before answering, mixes up his pronouns (re fers to himself in the second person), tends to repeat phrases in a perseverative fashion, and is quite fixated on routines related to dress, eating, travel, and play. He spends hours in his garage playing with his father’s tools. What do these behaviors represent?

A. Restricted, repetitive patterns of behaviors, interests, or activities characteristic of autism spectrum disorder.

B. Symptoms of obsessive-compulsive disorder.

C. Prototypical manifestations of obsessive-compulsive personality.

D. Symptoms of pediatric acute-onset neuropsychiatric syndrome (PANS).

E. Complex tics.

A. Restricted, repetitive patterns of behaviors, interests, or activities characteristic of autism spectrum disorder.

A 25-year-old man presents with long-standing nonverbal communication deficits, inability to have a back-and-forth conversation or share interests in an appropriate fashion, and a complete lack of interest in having relationships with others. His speech reflects awkward phrasing and intonation and is mechanical in nature. He has a history of sequential fixations and obsessions with various games and objects throughout childhood; however, this is not currently a major issue for him. This patient meets criteria for autism spectrum disorder; true or false?

A. True.

B. False

A. True.

A 9-year-old girl presents with a history of intellectual impairment, a structural language impairment, nonverbal communication deficits, disinterest in peers, and inability to use language in a social manner. She has extreme food and tac tile sensitivities. She is obsessed with one particular computer game that she plays for hours each day, and she scripts and imitates the characters in this game. She is clumsy, has an odd gait, and walks on her tiptoes. In the past year she has developed a seizure disorder and has begun to bang her wrists against the wall repetitively, causing bruising. On the other hand, she plays several musical instruments in an extremely precocious manner. Which feature of this child’s clinical presentation fulfills a criterion symptom for DSM-5 autism spectrum disorder?

A. Motor abnormalities.

B. Seizures.

C. Structural language impairment.

D. Intellectual impairment.

E. Nonverbal communicative deficits

E. Nonverbal communicative deficits

An 11-year-old girl with autism spectrum disorder displays no spoken lan guage and is minimally responsive to overtures from others. She can be some what inflexible, which interferes with her ability to travel, do schoolwork, and be managed in the home; she has some difficulty transitioning; and she has trouble organizing and planning activities. These problems can usually be managed with incentives and reinforcers. What severity levels should be specified in the DSM-5 diagnosis?

A. Level 3 (requiring very substantial support) for social communication, and level 1 (requiring support) for restricted, repetitive behaviors.

B. Level 1 (requiring support) for social communication, and level 3 (requiring very substantial support) for restricted, repetitive behaviors.

C. Level 1 (requiring support) for social communication, and level 2 (requiring substantial support) for restricted, repetitive behaviors.

D. Level 3 (requiring very substantial support) for social communication, and level 1 (requiring support) for restricted, repetitive behaviors.

E. Level 2 (requiring substantial support) for social communication, and level 1 (requiring support) for restricted, repetitive behaviors.

A. Level 3 (requiring very substantial support) for social communication, and level 1 (requiring support) for restricted, repetitive behaviors.

Which of the following is not a specifier included in the diagnostic criteria for autism spectrum disorder?

A. With or without accompanying intellectual impairment.

B. With or without associated dementia.

C. With or without accompanying language impairment.

D. Associated with a known medical or genetic condition or environmental factor.

E. Associated with another neurodevelopmental, mental, or behavioral disor der

B. With or without associated dementia.

Which of the following is not characteristic of the developmental course of children diagnosed with autism spectrum disorder?

A. Behavioral features manifest before 3 years of age.

B. The full symptom pattern does not appear until age 2–3 years.

C. Developmental plateaus or regression in social-communicative behavior is frequently reported by parents.

D. Regression across multiple domains occurs after age 2–3 years.

E. First symptoms often include delayed language development, lack of social interest or unusual social behavior, odd play, and unusual communication patterns.

D. Regression across multiple domains occurs after age 2–3 years.

A 5-year-old girl has some mild food aversions. She enjoys having the same book read to her at night but does not become terribly upset if her mother asks her to choose a different book. She occasionally spins around excitedly when her favorite show is on. She generally likes her toys neatly arranged in bins but is only mildly upset when her sister leaves them on the floor. These behaviors should be considered suspicious for an autism spectrum disorder; true or false?

A. True.

B. False

B. False

Which of the following is not representative of the typical developmental course for autism spectrum disorder?

A. Lack of degenerative course.

B. Behavioral deterioration during adolescence.

C. Continued learning and compensation throughout life.

D. Marked presence of symptoms in early childhood and early school years, with developmental gains in later childhood in areas such as social interac tion.

E. Good psychosocial functioning in adulthood, as indexed by independent living and gainful employment.

B. Behavioral deterioration during adolescence.

A 21-year-old man, not previously diagnosed with a developmental disorder, presents for evaluation after taking a leave from college for psychological rea sons. He makes little eye contact, does not appear to pick up on social cues, has become disinterested in friends, spends hours each day on the computer surfing the Internet and playing games, and has become so sensitive to smells that he keeps multiple air fresheners in all locations of the home. He reports that he has had long-standing friendships dating from childhood and high school (corroborated by his parents). He reports making many friends in his fraternity at college. His parents report good social and communication skills in child hood, although he was quite shy and was somewhat inflexible and ritualistic at home. What is the least likely diagnosis?

A. Depression.

B. Schizophreniform disorder or schizophrenia.

C. Autism spectrum disorder.

D. Obsessive-compulsive disorder.

E. Social anxiety disorder (social phobia)

C. Autism spectrum disorder.

Which of the following characteristics is generally not associated with autism spectrum disorder?

A. Anxiety, depression, and isolation as an adult.

B. Catatonia.

C. Poor psychosocial functioning.

D. Insistence on routines and aversion to change.

E. Successful adaptation in regular school settings.

E. Successful adaptation in regular school settings.

Which of the following disorders is generally not comorbid with autism spectrum disorder (ASD)?

A. Attention-deficit/hyperactivity disorder (ADHD).

B. Rett syndrome.

C. Selective mutism.

D. Intellectual disability (intellectual developmental disorder).

E. Stereotypic movement disorder.

C. Selective mutism.

Which of the following is not a criterion for the DSM-5 diagnosis of attention deficit/hyperactivity disorder (ADHD)?

A. Onset of several inattentive or hyperactive-impulsive symptoms prior to age 12 years.

B. Manifestation of several inattentive or hyperactive-impulsive symptoms in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).

C. Persistence of symptoms for at least 12 months.

D. Clear evidence that symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

E. Inability to explain symptoms as a manifestation of another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal)

C. Persistence of symptoms for at least 12 months.

The parents of a 15-year-old female tenth grader believe that she should be do ing better in high school, given how bright she seems and the fact that she re ceived mostly A’s through eighth grade. Her papers are handed in late, and she makes careless mistakes on examinations. They have her tested, and the WAIS IV results are as follows: Verbal IQ, 125; Perceptual Reasoning Index, 122; Full Scale IQ, 123; Working Memory Index, 55th percentile; Processing Speed In dex, 50th percentile. Weaknesses in executive function are noted. During a psychiatric evaluation, she reports a long history of failing to give close attention to details, difficulty sustaining attention while in class or doing homework, failing to finish chores and tasks, and significant difficulties with time management, planning, and organization. She is forgetful, often loses things, and is easily distracted. She has no history of restlessness or impulsivity, and she is well liked by her peers. What is the most likely diagnosis?

A. Adjustment disorder with anxiety.

B. Specific learning disorder.

C. Attention-deficit/hyperactivity disorder, predominantly inattentive.

D. Developmental coordination disorder.

E. Major depressive disorder.

C. Attention-deficit/hyperactivity disorder, predominantly inattentive.

A 7-year-old boy is having behavioral and social difficulties in his second grade class. Although he seems to be able to attend and is doing “well” from an academic standpoint (though seemingly not what he is capable of), he is constantly interrupting, fidgeting, talking excessively, and getting out of his seat. He has friends, but he sometimes annoys his peers because of his diffi culty sharing and taking turns and the fact that he is constantly talking over them. Although he seeks out play dates, his friends tire of him because he wants to play sports nonstop. At home, he can barely stay in his seat for a meal and is unable to play quietly. Although he shows remorse when the consequences of his behavior are pointed out to him, he can become angry in response and seems nevertheless unable to inhibit himself. What is the most likely diagnosis?

A. Bipolar disorder.

B. Autism spectrum disorder.

C. Generalized anxiety disorder.

D. Attention-deficit/hyperactivity disorder, predominantly hyperactive/impulsive.

E. Specific learning disorder

D. Attention-deficit/hyperactivity disorder, predominantly hyperactive/impulsive.

A 37-year-old Wall Street trader schedules a visit after his 8-year-old son is di agnosed with attention-deficit/hyperactivity disorder (ADHD), combined in attentive and hyperactive. Although he does not currently note motor restlessness like his son, he recalls being that way when he was a boy, along with being quite inattentive, being impulsive, talking excessively, interrupting, and having problems waiting his turn. He was an underachiever in high school and college, when he inconsistently did his work and had difficulty following rules. Nevertheless, he never failed any classes, and he was never evaluated by a psychologist or psychiatrist. He works about 60–80 hours a week and often gets insufficient sleep. He tends to make impulsive business decisions, can be impatient and short-tempered, and notes that his mind tends to wander both in one-on-one interactions with associates and his wife and during business meetings, for which he is often late; he is forgetful and disorganized. Neverthe less, he tends to perform fairly well and is quite successful, although he can oc casionally feel overwhelmed and demoralized. What is the most likely diagnosis?

A. Major depressive disorder.

B. Generalized anxiety disorder.

C. Specific learning disorder.

D. ADHD, in partial remission.

E. Oppositional defiant disorder.

D. ADHD, in partial remission.

A 5-year-old hyperactive, impulsive, and inattentive boy presents with hypertelorism, highly arched palate, and low-set ears. He is uncoordinated and clumsy, he has no sense of time, and his toys and clothes are constantly strewn all over the house. He has recently developed what appears to be a motor tic involving blinking. He enjoys playing with peers, who tend to like him, al though he seems to willfully defy all requests from his parents and kindergarten teacher, which does not seem to be due simply to inattention. He is delayed in beginning to learn how to read. What is the least likely diagnosis?

A. Autism spectrum disorder.

B. Developmental coordination disorder.

C. Oppositional defiant disorder (ODD).

D. Specific learning disorder.

E. Attention-deficit/hyperactivity disorder (ADHD)

A. Autism spectrum disorder.

What is the prevalence of attention-deficit/hyperactivity disorder (ADHD) in children?

A. 8%.

B. 10%.

C. 2%.

D. 0.5%.

E. 5%.

E. 5%.

What is the prevalence of attention-deficit/hyperactivity disorder (ADHD) in adults?

A. 8%.

B. 10%.

C. 2.5%.

D. 0.5%.

E. 5%.

C. 2.5%.

What is the gender ratio of attention-deficit/hyperactivity disorder (ADHD) in children?

A. Male:female ratio of 2:1.

B. Male:female ratio of 1:1.

C. Male:female ratio of 3:2.

D. Male:female ratio of 5:1.

E. Male:female ratio of 1:2.

A. Male:female ratio of 2:1.

Which of the following is a biological finding in individuals with attention deficit/hyperactivity disorder (ADHD)?

A. Decreased slow-wave activity on electroencephalograms.

B. Reduced total brain volume on magnetic resonance imaging.

C. Early posterior to anterior cortical maturation.

D. Reduced thalamic volume.

E. Both B and C.

B. Reduced total brain volume on magnetic resonance imaging.

Which of the following is not associated with attention-deficit/hyperactivity disorder (ADHD)?

A. Reduced school performance.

B. Poorer occupational performance and attendance.

C. Higher probability of unemployment.

D. Elevated interpersonal conflict.

E. Reduced risk of substance use disorders

E. Reduced risk of substance use disorders

Which of the following is not associated with attention-deficit/hyperactivity disorder (ADHD)?

A. Social rejection.

B. Increased risk of developing conduct disorder in childhood and antisocial personality disorder in adulthood.

C. Increased risk of Alzheimer’s disease.

D. Increased frequency of traffic accidents and violations.

E. Increased risk of accidental injury

C. Increased risk of Alzheimer’s disease.

A 15-year-old boy has developed concentration problems in school that have been associated with a significant decline in grades. When interviewed, he explains that his mind is occupied with worrying about his mother, who has a serious autoimmune disease. As his grades falter, he becomes increasingly demoralized and sad, and he notices that his energy level drops, further com promising his ability to pay attention in school. At the same time, he complains of feeling restless and unable to sleep. What is the most likely diagnosis?

A. Bipolar disorder.

B. Specific learning disorder.

C. Attention-deficit/hyperactivity disorder (ADHD).

D. Adjustment disorder with mixed anxiety and depressed mood.

E. Separation anxiety disorder.

D. Adjustment disorder with mixed anxiety and depressed mood.

A 5-year-old boy is consistently moody, irritable, and intolerant of frustration. In addition, he is pervasively and chronically restless, impulsive, and inattentive. Which diagnosis best fits his clinical picture?

A. Attention-deficit/hyperactivity disorder (ADHD).

B. ADHD and disruptive mood dysregulation disorder (DMDD).

C. Bipolar disorder.

D. Oppositional defiant disorder (ODD).

E. Major depressive disorder (MDD).

B. ADHD and disruptive mood dysregulation disorder (DMDD).

Which of the following statements about comorbidity in attention-deficit/hyperactivity disorder (ADHD) is true?

A. Oppositional defiant disorder co-occurs with ADHD in about half of children with the combined presentation and about a quarter of those with the predominantly inattentive presentation.

B. Most children with disruptive mood dysregulation disorder do not also meet criteria for ADHD.

C. Fifteen percent of adults with ADHD have some type of anxiety disorder.

D. Intermittent explosive disorder occurs in about 5% of adults with ADHD.

E. Specific learning disorder very seldom co-occurs with ADHD.

A. Oppositional defiant disorder co-occurs with ADHD in about half of children with the combined presentation and about a quarter of those with the predominantly inattentive presentation.

Specific learning disorder is defined by persistent difficulties in learning academic skills, with onset during the developmental period. Which of the following statements about this disorder is true?

A. It is part of a more general learning impairment as manifested in intellectual disability (intellectual developmental disorder).

B. It can usually be attributed to a sensory, physical, or neurological disorder.

C. It involves pervasive and wide-ranging deficits across multiple domains of information processing.

D. It can be caused by external factors such as economic disadvantage or lack of education.

E. It replaces the DSM-IV diagnoses of reading disorder, mathematics disorder, disorder of written expression, and learning disorder not otherwise specified

E. It replaces the DSM-IV diagnoses of reading disorder, mathematics disorder, disorder of written expression, and learning disorder not otherwise specified

In distinction to DSM-IV, DSM-5 classifies all learning disorders under the diagnosis of specific learning disorder, along with the requirement to “specify all academic domains and subskills that are impaired” at the time of assessment. Which of the following statements about specific learning disorder is false?

A. There are persistent difficulties in the acquisition of reading, writing, arithmetic, or mathematical reasoning skills during the formal years of schooling.

B. Current skills in one or more of these academic areas are well below the average range for the individual’s age, gender, cultural group, and level of education.

C. There usually is a discrepancy of more than 2 standard deviations (SD) between achievement and IQ.

D. The learning difficulties significantly interfere with academic achievement, occupational performance, or activities of daily living that require these academic skills.

E. The learning difficulties cannot be acquired later in life.

C. There usually is a discrepancy of more than 2 standard deviations (SD) between achievement and IQ.

Which of the following statements about the diagnosis of specific learning dis order is false?

A. Specific learning disorder is distinct from learning problems associated with a neurodegenerative cognitive disorder.

B. If intellectual disability (intellectual developmental disorder) is present, the learning difficulties must be in excess of those expected.

C. An uneven profile of abilities is typical in specific learning disorder

D. Attentional difficulties and motor clumsiness that are subthreshold for attention-deficit/hyperactivity disorder or developmental coordination dis order are frequently associated with specific learning disorder.

E. There are four formal subtypes of specific learning disorder

E. There are four formal subtypes of specific learning disorder

Which of the following statements about prevalence rates for specific learning disorder is false?

A. Prevalence rates range from 5% to 15% among school-age children across languages and cultures.

B. Prevalence in adults is approximately 4%.

C. Specific learning disorder is equally common among males and females.

D. Prevalence rates vary according to the range of ages in the sample, selection criteria, severity of specific learning disorder, and academic domains investigated.

E. Gender ratios cannot be attributed to factors such as ascertainment bias, definitional or measurement variation, language, race, or socioeconomic status.

C. Specific learning disorder is equally common among males and females.

Which of the following statements about comorbidity in specific learning disorder is true?

A. Attention-deficit/hyperactivity disorder (ADHD) does not co-occur with specific learning disorder more frequently than would be expected by chance.

B. Speech sound disorder and specific language impairments are not commonly comorbid with specific learning disorder.

C. Identified clusters of co-occurrences include severe reading disorders; fine motor problems and handwriting problems; and problems with arithmetic, reading, and gross motor planning.

D. The co-occurrence of specific learning disorder and specific language impairments has been shown in up to 20% of children with language problems.

E. Co-occurring disorders generally do not influence the course or treatment of specific learning disorder.

C. Identified clusters of co-occurrences include severe reading disorders; fine motor problems and handwriting problems; and problems with arithmetic, reading, and gross motor planning.

Which of the following statements about developmental coordination disorder (DCD) is true?

A. Some children with DCD show additional (usually suppressed) motor activity, such as choreiform movements of unsupported limbs or mirror movements.

B. The prevalence of DCD in children ages 5–11 years is 1%–3%.

C. In early adulthood, there is improvement in learning new tasks involving complex/automatic motor skills, including driving and using tools.

D. DCD has no association with prenatal exposure to alcohol or with low birth weight or preterm birth.

E. Impairments in underlying neurodevelopmental processes have not been found to primarily affect visuomotor skills.

A. Some children with DCD show additional (usually suppressed) motor activity, such as choreiform movements of unsupported limbs or mirror movements.

Which of the following statements about developmental coordination disorder (DCD) is true?

A. The disorder is usually not diagnosed before the age of 7 years.

B. Symptoms have usually improved significantly at 1-year follow-up.

C. In most cases, symptoms are no longer evident by adolescence.

D. DCD has no clear relationship with prenatal alcohol exposure, preterm birth, or low birth weight.

E. Cerebellar dysfunction is hypothesized to play a role in DCD.

E. Cerebellar dysfunction is hypothesized to play a role in DCD.

Which of the following is not a criterion for the DSM-5 diagnosis of stereotypic movement disorder?

A. Motor behaviors are present that are repetitive, seemingly driven, and apparently purposeless.

B. Onset of the behaviors is in the early developmental period.

C. The behaviors result in self-inflicted bodily injury that requires medical treatment.

D. The behaviors are not attributable to the physiological effects of a substance or neurological condition or better explained by another neurodevelopmental or mental disorder.

E. The behaviors interfere with social, academic, or other activities.

C. The behaviors result in self-inflicted bodily injury that requires medical treatment.

Which of the following statements about the developmental course of stereo typic movement disorder is false?

A. The presence of stereotypic movements may indicate an undetected neuro developmental problem, especially in children ages 1–3 years.

B. Among typically developing children, the repetitive movements may be stopped when attention is directed to them or when the child is distracted from performing them.

C. In some children, the stereotypic movements would result in self-injury if protective measures were not used.

D. Whereas simple stereotypic movements (e.g., rocking) are common in young typically developing children, complex stereotypic movements are much less common (approximately 3%–4%).

E. Stereotypic movements typically begin within the first year of life

E. Stereotypic movements typically begin within the first year of life

Which of the following is a DSM-5 diagnostic criterion for Tourette’s disorder?

A. Tics occur throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.

B. Onset is before age 5 years.

C. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset.

D. Motor tics must precede vocal tics.

E. The tics may occur many times a day for at least 4 weeks, but no longer than 12 consecutive months.

C. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset.

At her child’s third office visit, the mother of an 8-year-old boy with a 6-month history of excessive eye blinking and intermittent chirping says that she has noticed the development of grunting sounds since he started school this term. What is the most likely diagnosis?

A. Tourette’s disorder.

B. Provisional tic disorder.

C. Temporary tic disorder.

D. Persistent (chronic) vocal tic disorder.

E. Transient tic disorder, recurrent.

B. Provisional tic disorder.

A 5-year-old girl is referred to your care with a DSM-IV diagnosis of chronic motor or vocal tic disorder. Under DSM-5, she would meet criteria for persistent (chronic) motor or vocal tic disorder. Which of the following statements about her new diagnosis under DSM-5 is false?

A. She may have single or multiple motor or vocal tics, but not both.

B. Her tics must persist for more than 1 year since first tic onset without a tic free period for 3 consecutive months to meet diagnostic criteria.

C. Her tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset.

D. She has never met criteria for Tourette’s disorder.

E. A specifier may be added to the diagnosis of persistent (chronic) motor or vocal tic disorder to indicate whether the girl has motor or vocal tics

B. Her tics must persist for more than 1 year since first tic onset without a tic free period for 3 consecutive months to meet diagnostic criteria.

A highly functional 20-year-old college student with a history of anxiety symptoms and attention-deficit/hyperactivity disorder, for which she is prescribed lisdexamfetamine (Vyvanse), tells her psychiatrist that she has been researching the side effects of her medication for one of her class projects. In addition, she says that for the past week she has been feeling stressed by her schoolwork, and her friends have been asking her why she intermittently bobs her head up and down multiple times a day. What is the most likely diagnosis?

A. Provisional tic disorder.

B. Unspecified tic disorder.

C. Unspecified anxiety disorder.

D. Obsessive-compulsive personality disorder.

E. Unspecified stimulant-induced disorder.

B. Unspecified tic disorder.

Which of the following is not a DSM-5 diagnostic criterion for language disorder?

A. Persistent difficulties in the acquisition and use of language across modalities due to deficits in comprehension or production.

B. Language abilities that are substantially and quantifiably below those expected for age.

C. Symptom onset in the early developmental period.

D. Inability to attribute difficulties to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition.

E. Failure to meet criteria for mixed receptive-expressive language disorder or a pervasive developmental disorder

E. Failure to meet criteria for mixed receptive-expressive language disorder or a pervasive developmental disorder

Which of the following statements about speech sound disorder is true?

A. Speech sound production must be present by age 2 years.

B. “Failure to use developmentally expected speech sounds” is assessed by comparison of a child with his or her peers of the same age and dialect.

C. The difficulties in speech sound production need not result in functional impairment to meet diagnostic criteria

D. Symptom onset is in the early developmental period.

E. Both A and C are true

D. Symptom onset is in the early developmental period.

A mother brings her 4-year-old son to you for an evaluation with concerns that her son has struggled with speech articulation since very young. He has not sustained any head injuries, is otherwise healthy, and has a normal IQ. His pre school teacher reports that she does not always understand what he is saying and that other children tease him by calling him a “baby” due to his difficulty with communication. He does not have trouble relating to other people or understanding nonverbal social cues. What is the most likely diagnosis?

A. Selective mutism.

B. Global developmental delay.

C. Speech sound disorder.

D. Avoidant personality disorder.

E. Unspecified anxiety disorder.

C. Speech sound disorder.

A 6-year-old boy is failing school and continues to struggle significantly with grammar, sentence construction, and vocabulary. When he speaks, he also interjects “and” in between all his words. His teacher reports that he requires more verbal redirection than other students in order to stay on task. He is generally quiet and does not cause trouble otherwise. Which of the following diagnoses would be on your differential?

A. Language disorder.

B. Expressive language disorder.

C. Childhood-onset fluency disorder.

D. Attention-deficient/hyperactivity disorder (ADHD).

E. A and D

E. A and D

Which of the following types of disturbance in normal speech fluency/time patterning included in the DSM-IV criteria for stuttering was omitted in the DSM-5 criteria for childhood-onset fluency disorder (stuttering)?

A. Sound prolongation.

B. Circumlocution.

C. Interjections.

D. Words produced with an excess of physical tension.

E. Sound and syllable repetitions

C. Interjections.

A 14-year-old boy in regular education tells you that he thinks a girl in class likes him. His mother is surprised to hear this, because she reports that, since a young age, he has often struggled with making inferences or understanding nuances from what other people say. The teacher has also noticed that he some times misses nonverbal cues. He tends to get along better with adults, perhaps because they are not as likely to be put off by his overly formal speech. When he makes jokes, his peers do not always find the humor appropriate. Although he enjoys spending time with his best friend, he can be talkative and struggles with taking turns in conversation. What is the most likely diagnosis?

A. Social (pragmatic) communication disorder.

B. Asperger’s disorder.

C. Autism spectrum disorder.

D. Social anxiety disorder.

E. Language disorder.

A. Social (pragmatic) communication disorder.

A 15-year-old boy with a prior diagnosis of Tourette’s disorder is referred to your care. His mother tells you that during middle school he was teased for having vocal and motor tics. Since starting ninth grade, his tics have become less frequent. Currently, only mild motor tics remain. What is the appropriate DSM-5 diagnosis?

A. Tourette’s disorder.

B. Persistent (chronic) motor tic disorder.

C. Provisional tic disorder.

D. Unspecified tic disorder.

E. Persistent (chronic) vocal tic disorder

A. Tourette’s disorder.

Tics typically present for the first time during which developmental stage?

A. Infancy.

B. Prepuberty.

C. Latency.

D. Adolescence.

E. Adulthood.

B. Prepuberty.

A 7-year-old boy who has speech delays presents with long-standing, repetitive hand waving, arm flapping, and finger wiggling. His mother reports that she first noticed these symptoms when he was a toddler and wonders whether they are tics. She says that he tends to flap more when he is engrossed in activities, such as while watching his favorite television program, but will stop when called or distracted. Based on the mother’s report, which of the following conditions would be highest on your list of possible diagnoses?

A. Provisional tic disorder.

B. Persistent (chronic) motor or vocal tic disorder.

C. Chorea.

D. Dystonia.

E. Motor stereotypies

E. Motor stereotypies

Assessment of co-occurring conditions is important for understanding the overall functional consequence of tics on an individual. Which of the following conditions has been associated with tic disorders?

A. Attention-deficit/hyperactivity disorder (ADHD).

B. Obsessive-compulsive and related disorders.

C. Other movement disorders.

D. Depressive disorders.

E. All of the above

E. All of the above

By what age should most children have acquired adequate speech and language ability to understand and follow social rules of verbal and nonverbal communication, follow rules for conversation and storytelling, and change language according to the needs of the listener or situation?

A. Ages 2–3 years.

B. Ages 3–4 years.

C. Ages 4–5 years.

D. Ages 5–6 years.

E. Ages 6–7 years.

C. Ages 4–5 years.

Having a family history of which of the following psychiatric disorders in creases an individual’s risk of social (pragmatic) communication disorder?

A. Social anxiety disorder (social phobia).

B. Autism spectrum disorder

C. Attention-deficit/hyperactivity disorder (ADHD).

D. Specific learning disorder.

E. Either B or D.

E. Either B or D.

A 6-year-old boy with a history of mild language delay is brought to your office by his mother, who is concerned that he is being teased in school because he misinterprets nonverbal cues and speaks in overly formal language with his peers. She tells you that her son was in an early intervention program, but his written and spoken language is now at grade level. The boy does not have a history of repetitive movements, sensory issues, or ritualized behaviors. Al though he prefers constancy, he adapts fairly well to new situations. Addition ally, he has a long-standing interest in trains and cars and is able to recite for you all the car models he memorized from a book on the history of transportation. Which of the following disorders would be a primary consideration in the differential diagnosis?

A. Social (pragmatic) communication disorder.

B. Autism spectrum disorder.

C. Global developmental delay.

D. Language disorder.

E. A and B.

A. Social (pragmatic) communication disorder.

Below what age is it difficult to distinguish a language disorder from normal developmental variations?

A. Age 2 years.

B. Age 3 years.

C. Age 4 years.

D. Age 5 years.

E. Age 6 years

C. Age 4 years.

Which of the following psychiatric diagnoses is strongly associated with language disorder?

A. Attention-deficit/hyperactivity disorder.

B. Developmental coordination disorder.

C. Autism spectrum disorder.

D. Social (pragmatic) communication disorder.

E. All of the above.

E. All of the above.

Which of the following statements about the development of speech as it ap plies to speech sound disorder is false?

A. Most children with speech sound disorder respond well to treatment.

B. Speech sound production should be mostly intelligible by age 3 years.

C. Most speech sounds should be pronounced clearly and accurately accord ing to age and community norms before age 10 years.

D. Lisping may or may not be associated with speech sound disorder.

E. It is abnormal for children to shorten words when they are learning to talk.

E. It is abnormal for children to shorten words when they are learning to talk.

Which of the following would likely not be an important condition to rule out in the differential diagnosis of speech sound disorder?

A. Normal variations in speech.

B. Hearing or other sensory impairment.

C. Dysarthria.

D. Depression.

E. Selective mutism.

D. Depression.

Which of the following statements about the development of childhood-onset fluency disorder (stuttering) is true?

A. Stuttering occurs by age 6 for 80%–90% of affected individuals.

B. Stuttering always begin abruptly and is noticeable to everyone.

C. Stress and anxiety do not exacerbate disfluency.

D. Motor movements are not associated with this disorder.

E. None of the above.

A. Stuttering occurs by age 6 for 80%–90% of affected individuals.