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PE3.1-4,PE4.1-2 | Developmental Disorders — Practice Quiz
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A 2-year-old boy is brought by his mother because he does not respond to his name, avoids eye contact, and has no meaningful words. He was noted to have had normal development until 18 months, after which regression was observed. Which of the following is the MOST appropriate first-line screening tool for his likely diagnosis?
M-CHAT is the validated first-line screening tool for Autism Spectrum Disorder (ASD) in toddlers aged 16–30 months. It specifically screens for the social-communication deficits characteristic of ASD, such as lack of joint attention, pointing, and social reciprocity.
M-CHAT is the validated first-line autism screening tool for toddlers aged 16–30 months; a positive M-CHAT score requires follow-up and diagnostic workup by a developmental paediatrician.
DDST-II is a general developmental screening tool, not autism-specific. DASII assesses developmental quotients across domains but is not autism-specific. Vineland measures adaptive behaviour and may be used for severity assessment in confirmed ASD, not initial screening.
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A 3-year-old girl is brought for evaluation because she is not yet using 2-word phrases and cannot follow 2-step commands. She walks independently and feeds herself. There is no history of regression. On assessment, her developmental age is 18 months across all domains. Which term BEST describes her condition?
Global developmental delay (GDD) is defined as significant delay (≥2 SD below the mean) in two or more developmental domains (motor, language, cognition, social-adaptive, activities of daily living) in children under 5 years. Here, all domains are equally delayed.
Global developmental delay = ≥2 SD below mean in ≥2 developmental domains in children <5 years; full developmental assessment with DASII or equivalent is mandatory.
Regression implies loss of previously achieved milestones, which is not described here. Specific language impairment is isolated to language with preservation of other domains. ASD requires social-communication deficits and restricted/repetitive behaviours, not described here.
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A 7-year-old boy has academic difficulties, short attention span, acts impulsively, and is described by teachers as 'always on the go'. His parents report the same behaviour at home since age 4. Symptoms are present in school, home, and tuition settings. Which DSM-5 criterion is ESSENTIAL to establish the diagnosis of ADHD?
DSM-5 requires ADHD symptoms to be present in at least two settings (e.g., school AND home), cause functional impairment, and have onset before age 12 years. This cross-situational pervasiveness distinguishes ADHD from situational behaviour problems.
DSM-5 ADHD requires ≥6 inattentive or hyperactive-impulsive symptoms (≥5 in older adolescents/adults), present in ≥2 settings, onset before age 12, for ≥6 months with functional impairment.
A 2-week duration criterion is used for Major Depressive Disorder, not ADHD. ADHD by definition must appear in more than one setting — school-only symptoms suggest another cause (e.g., specific learning disorder or anxiety). Intellectual disability is an exclusion consideration, not a diagnostic criterion.
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A 4-year-old child with global developmental delay is evaluated. The mother reports her pregnancy was complicated by poor antenatal care and heavy alcohol consumption. Physical examination reveals microcephaly, short palpebral fissures, a smooth philtrum, and a thin upper lip. Which of the following is the MOST LIKELY cause of this child's developmental delay?
The triad of microcephaly, smooth philtrum, and thin upper lip together with a history of maternal alcohol use identifies Foetal Alcohol Syndrome (FAS), the most severe form of FASD. FAS is a preventable cause of intellectual disability due to prenatal alcohol exposure.
Foetal Alcohol Syndrome is characterised by the triad of growth restriction, CNS dysfunction (including intellectual disability), and characteristic facies (smooth philtrum, thin upper lip, short palpebral fissures) due to prenatal alcohol exposure — a fully preventable condition.
Down syndrome features include upslanting palpebral fissures, single palmar crease, and hypotonia — not a smooth philtrum. Congenital hypothyroidism causes coarse facies, macroglossia, and constipation. Fragile X syndrome presents with macro-orchidism, large ears, and long face in a male.
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The parents of a 5-year-old with newly diagnosed Autism Spectrum Disorder ask about the expected outcome and management plan. Which of the following is the MOST EVIDENCE-BASED first-line non-pharmacological intervention for ASD?
Applied Behaviour Analysis (ABA) is the most evidence-based behavioural intervention for ASD. It uses reinforcement strategies to improve communication, social skills, and adaptive behaviour. Early intensive ABA (25–40 hours/week) shows the best outcomes, especially when started before age 5.
ABA-based therapy is the gold-standard behavioural intervention for ASD; early, intensive, structured therapy (≥25 hours/week before age 5) yields the best long-term outcomes in language and adaptive skills.
Antipsychotics (risperidone, aripiprazole) are used only for specific ASD symptoms like irritability, aggression, or self-injurious behaviour — not as primary therapy. Gluten/casein-free diets have no robust evidence for core ASD symptoms. Social isolation is counterproductive; peer interaction is therapeutic.
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A developmental paediatrician is counselling the parents of a 3-year-old with a new diagnosis of ADHD. The father asks whether his son will 'grow out of it'. Which of the following BEST reflects the current understanding of ADHD prognosis?
ADHD persists into adolescence in approximately 50–70% of children diagnosed in childhood, and into adulthood in 30–50%. Hyperactivity symptoms often diminish with age but inattention and impulsivity frequently persist. Long-term management planning is therefore essential.
ADHD persists into adolescence in 50–70% and into adulthood in 30–50% of children; long-term follow-up and multi-modal management (behavioural therapy + pharmacotherapy when indicated + educational support) is essential.
ADHD does not always resolve. Longitudinal studies confirm significant rates of persistence into adulthood with ongoing impacts on academic performance, employment, and relationships. A 2-year ceiling is incorrect.
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A 6-year-old boy with known intellectual disability (ID) is referred. His intelligence quotient (IQ) is 42 on standardised testing. According to DSM-5 / ICD-11 classification, he is BEST categorised as having which severity of intellectual disability?
IQ 35–55 corresponds to moderate intellectual disability (ID). Children with moderate ID can acquire communication skills, benefit from vocational training, and function in supervised settings. They typically achieve academic skills equivalent to late primary-school level.
Intellectual disability is classified by IQ (mild 55–70, moderate 35–55, severe 20–35, profound <20) AND adaptive functioning across conceptual, social, and practical domains (DSM-5/ICD-11); IQ alone is insufficient for classification.
Mild ID: IQ 55–70 (most common, ~85% of ID). Severe ID: IQ 20–35 (requires ongoing supervision). Profound ID: IQ <20 (requires total care). DSM-5 also emphasises adaptive functioning across conceptual, social, and practical domains, not IQ alone.
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Parents of a 2-year-old ask about early signs ('red flags') that suggest developmental delay in language. Which of the following is the MOST SIGNIFICANT red flag for language delay at 18 months?
The developmental red flag for language at 18 months is the absence of at least single meaningful words. By 18 months, a child should have approximately 10–15 meaningful words. No words at 18 months is a clear red flag requiring urgent evaluation.
Language red flags: no babbling by 12 months, no single words by 18 months, no 2-word phrases by 24 months, any loss of language skills at any age — all warrant urgent developmental evaluation.
Inability to run smoothly is a motor milestone concern, not specific to language delay. Feeding with spillage and stair-climbing are fine-motor and gross-motor milestones respectively, not language markers.
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A paediatrician is counselling parents of a 4-year-old with moderate intellectual disability. The father expresses guilt and asks 'Did I cause this?'. Which communication approach is MOST appropriate?
Best-practice counselling for developmental disability begins with empathic acknowledgement of the parent's emotional state, honest and jargon-free explanation that many causes are multifactorial and unpreventable, followed by a constructive focus on the support plan. This integrates person-centred communication with accurate information.
Parental counselling for developmental delay requires empathic communication: acknowledge emotions first, explain multifactorial causation without blame, outline the interdisciplinary support plan including physiotherapy, speech therapy, special education, and community resources.
Blanket reassurance attributing a single cause (genetics alone) is inaccurate and patronising. Avoiding causation leaves the parent uninformed and anxious. Leading with genetic testing without emotional acknowledgement is not patient-centred and may reinforce guilt.
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A child with Autism Spectrum Disorder (ASD) is also noted to have repetitive hand-flapping, insistence on sameness in daily routines, and unusual attachment to a toy car. These features map to which DSM-5 core domain of ASD?
DSM-5 defines ASD by two core domains: (1) persistent deficits in social communication and social interaction, AND (2) restricted, repetitive patterns of behaviour, interests, or activities (RRBs). Hand-flapping, insistence on sameness, and restricted interests are all manifestations of RRBs.
DSM-5 ASD has TWO core domains: (A) social communication/interaction deficits, and (B) restricted, repetitive behaviours — both must be present. RRBs include stereotypies, insistence on sameness, restricted interests, and sensory sensitivities.
Social communication deficits are the first domain; the described features belong to the second. Language impairment is not a DSM-5 core criterion for ASD (language level varies widely). Sensory differences are a specifier within DSM-5 ASD, not a separate diagnosis.
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