Neurodevelopment Disorders Flashcards
Which of the following is not required for a DSM-5 diagnosis of intellectual disability (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
Correct Answer: 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 development, 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 requires ongoing assistance with basic skills (dressing, feeding, and bathing himself; 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.
Correct Answer: 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 development, 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 requires ongoing assistance with basic skills (dressing, feeding, and bathing himself; 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.
Correct Answer: B. Moderate.
Which of the following statements about intellectual disability (intellectual developmental disorder) is false?
A. Individuals with intellectual disability have deficits in general mental abilities 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 subtest scores are highly discrepant.
C. Individuals with intellectual disability may have difficulty in managing their behaviour, 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 socio-cultural background, native language, associated communication/language disorder, and motor or sensory handicap.
Correct Answer: B. For individuals with intellectual disability, the full-scale IQ score is a valid assessment of overall mental abilities and adaptive functioning, even if subtest 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.
Correct Answer: 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 naiveté 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.
Correct Answer: 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 typically continue to meet criteria in adulthood even if their adaptive functioning improves.
Correct Answer: D. Adaptive functioning 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 prenatal 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.
Correct Answer: 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.
Explanation: The presence of a known genetic syndrome is not exclusionary if the criteria for intellectual developmental disorder are met. Prenatal, perinatal, and postnatal etiologies are demonstrable in approximately 70% of cases. If the diagnosis results from TBI, both diagnoses are given.
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 after 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.
Correct Answer: D. Major neurocognitive disorder may co-occur with intellectual developmental disorder.
Explanation: Intellectual disability is categorized as a neurodevelopmental disorder and is distinct from the neurocognitive disorders, which are characterized by a loss of cognitive functioning. Major neurocognitive disorder may co-occur with intellectual disability (e.g., an individual with Down syndrome who develops Alzheimer’s disease, or an individual with intellectual disability who loses further cognitive capacity following a head injury). In such cases, the diagnoses of intellectual disability and neurocognitive disorder may both be given. Delayed motor, language, and social milestones may be identifiable within the first 2 years of life among those with more severe intellectual disability. Head trauma with subsequent cognitive deficits would represent an acquired form of intellectual developmental disorders. Although intellectual disability is generally nonprogressive, in certain genetic disorders (e.g., Rett syndrome) there are periods of worsening, followed by stabilization, and in others (e.g., San Phillippo syndrome) progressive worsening of intellectual function. After early childhood, the disorder is generally lifelong, although severity levels may change over time. If early and ongoing interventions improve adaptive functioning and significant improvement of intellectual functioning occurs, the diagnosis of intellectual disability may no longer be appropriate.
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.
Correct Answer: D. In adulthood, the individual may be able to sustain competitive employment in a job that does not emphasize conceptual skills.
Explanation: Competitive employment may be attainable by individuals with a “Mild” level of impairment but would not be characteristic of those with a “Severe” level of impairment. Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains (DSM-5 Table 1, pp. 34– 36). The conceptual (academic) domain involves competence in memory, language, reading, writing, math reasoning, acquisition of practical knowledge, problem solving, and judgment in novel situations, among others. The social domain involves awareness of others’ thoughts, feelings, and experiences; empathy; interpersonal communication skills; friendship abilities; and social judgment, among others. The practical domain involves learning and self-management across life settings, including personal care, job responsibilities, money management, recreation, self-management of behavior, and school and work task organization, among others.
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.
Correct Answer: D. Major neurocognitive disorder due to traumatic brain injury.
Explanation: There are no exclusion criteria for a diagnosis of intellectual developmental disorder in DSM-5, which notes that both specific learning disorder and communication disorders can co-occur if the criteria are met. Although his full-scale IQ is 75, the statistical model associated with his intellect would allow for his actual IQ to be r 5 points. His adaptive functioning would be the key factor in his receiving the diagnosis of intellectual developmental disorder, with a mild level of severity due to needing to receive only some support in most of his areas of functioning. With his reading skills remaining disproportionately impaired in comparison with the rest of his cognitive profile, and because onset of these impairments was during the developmental period, he would continue to receive a diagnosis of specific learning disorder (dyslexia). His emotional symptoms in response to the accident would yield a potential diagnosis of an adjustment disorder. The boy’s deficits are not severe enough to qualify for a diagnosis of major neurocognitive disorder.
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 developmental disorder, but there is insufficient information about the level of cognitive impairment measured by standardized instruments.
E. The patient’s cognitive and adaptive impairments suggest intellectual developmental disorder, but there is insufficient information about age at onset of the condition.
Correct Answer: 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 disorders.
Correct Answer: A. The diagnosis is typically made in children younger than 5 years of age.
Explanation: The diagnosis of global developmental delay is reserved for individuals under the age of 5 years who fail to meet expected developmental milestones in several areas of intellectual functioning, when the clinical severity level cannot be reliably assessed during early childhood. The diagnosis is used for individuals who are unable to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardized testing.
A 3½-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.
Correct Answer: D. Global developmental delay.
Explanation: Although this girl’s deficits may be suggestive of intellectual disability (intellectual developmental disorder), that diagnosis cannot be made in this case because information is lacking (e.g., about age at onset of her symptoms), and she is too young to participate in standardized testing. At this point, there is no information to suggest that this child has dementia (major neurocognitive disorder), an autism spectrum disorder (no evidence of symptoms in the core autism spectrum disorder categories), a specific disorder relating to coordination, or a specific area of learning weakness (which generally would not be able to be diagnosed until the elementary years).
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 intonation, 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.
Correct Answer: B. Deficits in nonverbal communicative behaviors used for social interaction.
Which of the following statements about the development and course of autism 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.
Correct Answer: B. Symptoms are not typically noticeable until 5– 6 years of age or later.
Which of the following was a criterion symptom for autistic disorder in DSMIV that was eliminated from the diagnostic criteria for autism spectrum disorder 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.
Correct Answer: 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.
Correct Answer: B. Autism spectrum disorder.
Explanation: This child might have met criteria for Asperger’s disorder or pervasive developmental disorder NOS in DSM-IV. Autism spectrum disorder in DSM-5 subsumed Asperger’s disorder and pervasive developmental disorder NOS. Although the girl has intact formal language skills, it is the use of language for social communication that is particularly affected in autism spectrum disorder. A specific language delay is not required. She meets all three components of Criterion A (deficits in social-emotional reciprocity, deficits in nonverbal communicative behaviors used for social interaction, and deficits in developing, maintaining, and understanding relationships) and two components of Criterion B (highly restricted, fixated interests that are abnormal in intensity or focus; and hyperor hyporeactivity to sensory input or unusual interest in sensory aspects of the environment).
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.
Correct Answer: E. Deficits in nonverbal communicative behaviors.
A 10-year-old boy demonstrates hand-flapping and finger flicking, and he repetitively 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 (refers 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.
Correct Answer: 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.
Correct Answer: 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 tactile 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.
Correct Answer: E. Nonverbal communicative deficits.
Explanation: Criterion A of autism spectrum disorder lists nonverbal communicative deficits as one of the symptoms. The rest of the options represent associated features supporting diagnosis, which according to the DSM-5 text notes that “the gap between intellectual and adaptive functional skills is often large.”
An 11-year-old girl with autism spectrum disorder displays no spoken language and is minimally responsive to overtures from others. She can be somewhat 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.
Correct Answer: A. Level 3 (requiring very substantial support) for social communication, and level 1 (requiring support) for restricted, repetitive behaviors.
Explanation: In DSM-5, severity is noted separately for social communication impairments and for the restricted, repetitive patterns of behavior. In this case, the social communication deficits are quite severe, warranting a classification of level 3, but the restricted, repetitive behaviors are milder, reflecting the lowest classification of level 1. Level 2 is an intermediate category reflecting the need for “substantial support.”
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 disorder.
Correct Answer: 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.
Correct Answer: D. Regression across multiple domains occurs after age 2– 3 years.
Explanation: Regression across multiple domains after age 2– 3 years may occur, but it is not typical of the developmental course in autism spectrum disorder. As noted in DSM-5, some children with autism spectrum disorder experience developmental plateaus or regression, with a gradual or relatively rapid deterioration in social behaviors or use of language, often during the first 2 years of life. Such losses are rare in other disorders and may be a useful “red flag” for autism spectrum disorder. Much more unusual and warranting more extensive medical investigation are losses of skills beyond social communication (e.g., loss of self-care, toileting, motor skills) or those occurring after the second birthday.
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.
Correct Answer: 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 interaction.
E. Good psychosocial functioning in adulthood, as indexed by independent living and gainful employment.
Correct Answer: 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 reasons. 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 childhood, 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).
Correct Answer: 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.
Correct Answer: 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.
Correct Answer: 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).
Correct Answer: C. Persistence of symptoms for at least 12 months.
Explanation: The essential feature of ADHD is a pervasive pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, with persistence of symptoms for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. ADHD begins in childhood. The requirement that several symptoms be present before age 12 years conveys the importance of a substantial clinical presentation during childhood. Manifestations of the disorder must be present in more than one setting (e.g., home and school, work). Confirmation of substantial symptoms across settings typically cannot be done accurately without consulting informants who have seen the individual in those settings.
The parents of a 15-year-old female tenth grader believe that she should be doing better in high school, given how bright she seems and the fact that she received 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 WAISIV results are as follows: Verbal IQ, 125; Perceptual Reasoning Index, 122; FullScale IQ, 123; Working Memory Index, 55th percentile; Processing Speed Index, 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.
Correct Answer: C. Attention-deficit/hyperactivity disorder, predominantly inattentive
A 7-year-old boy is having behavioral and social difficulties in his secondgrade 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 difficulty 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.
Correct Answer: 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 diagnosed with attention-deficit/hyperactivity disorder (ADHD), combined inattentive 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. Nevertheless, he tends to perform fairly well and is quite successful, although he can occasionally feel overwhelmed and demoralised. 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. demoralized.
Correct Answer: D. ADHD, in partial remission.
