Child and Adolescent PRITE 2019-2022

The parents of a five-year-old with autism spectrum disorder mention to the child's psychiatrist that they are pregnant. They ask what the chances are that their next child will have autism. Which of the following is the best estimate of this risk?

* 2 to 10% 20 to 40% 50 to 70% 80 to 90% 2021 Child: 188

Which of the following are patients with complex partial seizures most likely to experience during the aura preceding a seizure?

* Anxiety Coproialia Obsessions Depression Hypersexuality 2022 Child: 7

A 13-year-old patient with autism and developmental delays is admitted to the medical hospital with a diagnosis of catatonia. After one week of high-dose benzodiazepine therapy there is minimal improvement. Which of the following is the best treatment option to utilize next?

* Electroconvulsive therapy Repetitive transcranial magnetic stimulation Addition of a neuroleptic such as olanzapine Continuation of benzodiazepine monotherapy Addition of an antiepileptic such as valproic acid 2021 Child: 124

The goal of "meaningful use," as instituted by the Centers for Medicare and Medicaid Services, is to ultimately improve clinical and population health outcomes using which of the following means?

* Electronic health records Medication prescribing guidelines Disease incidence and prevalence data Enforcement of mental health parity rules Research by the National Institute of Health 2019 Child: 174

Parents who are due to adopt an infant in several weeks ask for advice about when to discuss the fact of adoption with the child. How should the psychiatrist best respond?

* "Begin as young as toddlerhood, and revisit the topic over time." "Six or seven years, so that the child has processed the loss with a therapist." "Ten years, so that the child has the cognitive ability to understand parentage." "Adolescence, when the child is able to seek out the biological parents." "Wait until the child initiates a discussion about the topic." 2021 Child: 154

A school-age child is referred for evaluation due to new and significant temper tantrums on school-day mornings and refusal to attend school. The psychiatrist asks, "Why do you not want to go to school?" Which of the following child responses would best fit a separation anxiety disorder diagnosis?

* "School is so big, I will get lost." "The other kids are picking on me at school." "I don't like to talk to the teacher and other kids." "I just want to stay at home and play video games." "I don't understand what they are trying to teach me." 2021 Child: 6

In Margaret Mahler's description of the process of separation and individuation, the stage in which infants first begin to differentiate from their mothers after symbiosis is referred to as:

* hatching. practicing. consolidation. rapprochement. object constancy. 2020 Child: 126 ● Hatching refers to the phase when a child begins to separate from their mother, a crucial stage in individual development. ● Practicing involves a child exploring the environment, testing their autonomy while still maintaining a sense of security from the parental figure. ● Consolidation is the process where the child integrates their independent identity with their relationships, often seen in the 'rapprochement' phase. ● Rapprochement reflects the child's need for their caregiver, even while exploring independence. ● Object constancy is the understanding that, despite changes in perception, people and objects remain the same.

A very energetic and physically advanced five-year-old boy begins to have trouble in school due to his interactions with peers during recess. He is enrolled by his mother in a club soccer league and, at home, uses physical games to build his understanding of rules and limits. This mother is responding to which of the temperamental characteristics identified by Thomas and Chess?

*Activity Intensity Rhythmicity Adaptability Distractibility 2020 Child: 74

A five-year-old girl is excited to participate in a surprise birthday party for her uncle. She does not want for her uncle to see her, so she hides underneath a table in clear view of the door. The child's actions illustrate which of the following cognitive concepts?

*Egocentrism Conservation Accommodation Object permanence Deductive reasoning 2020 Child: 80

An adolescent is referred for substance use treatment after being found unresponsive in the bathroom by a younger sibling at home. The adolescent relapsed and used substances two days prior to the visit with the psychiatrist. At the visit, the adolescent states, "| feel like such a failure". Using a motivational interviewing approach, which of the following statements would be the next best response by the psychiatrist?

A. "lI wonder if your choice to use substances again may represent self-sabotage." B. "You do not fully understand the negative consequences of your substance use." C. "This recent relapse is making you upset because you were trying so hard to stay sober." D. "This choice was more about peer pressure and you need to find a new group of friends." E. "Let us try to view your recent relapse as a one-time occurrence and move forward together." 2022 Child: 158

An outpatient clinic uses a newly developed screening tool to assess 100 children for autism. The tool correctly identifies 15 children with autism. However, five children with autism were missed, and three children were identified as having autism when they do not actually have it. What is the sensitivity of this newly developed tool?

A. 5% B. 15% C. 20% D. 67% E. 75% 2022 Child: 182

A screening instrument for depression has a sensitivity of 95% and a specificity of 68%. The population prevalence for depression in adolescent malesis 4%. A 2x2 table is constructed for the instrument as follows: .......................Depression + Depression - Total Screen +............. 38 ......................307 ...........345 Screen -............... 2....................... 653 ...........655 Total .....................40...................... 960.......... 1000 What is the Positive Predictive Value of the screening instrument in adolescent males?

A. 6% B. 11% C. 12% D. 35% E. 47%

An adolescent presents with worsening academic performance, inattention, restless sleep, and daytime fatigue. Caregivers report that the adolescent snores loudly. Which of the following is the best diagnostic study to determine the underlying diagnosis?

A. Actigraphy Polysomnography Electroencephalogram Multiple Sleep Latency Test Maintenance of Wakefulness Test 2022 Child: 154

Which of the following headache types would most likely warrant an imaging study?

A. Headache with an aura Stress-induced headache Headache with photophobia Headache that disrupts sleep Headache with sinus tenderness 2022 Child: 147

How might a typically developing eight-month-old child be expected to play with a comb?

A. Hidesit B. Brush their hair with it C. Explore it with their mouth D. Pretend to brush a doll's hair E. Use itto create a gate for toy cars 2022 Child: 160

An adolescent patient in a psychiatric hospital is punching the wall and threatening to hurt other patients. Verbal de-escalation has not been effective and the patient is refusing oral medication. Due to safety concerns, the patient is placed in physical restraints. After a few minutes the patient is calm. After removing the physical restraints, the most appropriate next step would be which of the following?

A. Ignore the attention-seeking behavior B. Administer a psychotropic medication by mouth C. Conduct a debrief about the event with the patient D. Place the patientin a seclusion room for a short time E. Gather all patients for a group discussion about unit rules 2022 Child: 119

Social comparison first becomes an important aspect of self-esteem during which of the following stages of childhood?

A. Infancy B. Toddlerhood C. Preschool D. School-age E. Adolescence 2022 Child: 138

When do typically developing children first become able to devise strategies to remember?

A. Infancy B. Toddlerhood C. Preschool-age D. School-age E. Adolescence 2022 Child: 128

According to the 2019 AACAP consensus clinical pathway, which of the following is a key aspect of providing mental health consultation for a pediatric patient with Somatic Symptom and Related Disorder?

A. Initiate a selective serotonin reuptake inhibitor B. Conduct a multidisciplinary, diagnostic family meeting C. Identify a traumatic event causing the child's presentation D. Shift management from primary care to psychological services E. Ensure medical workup is complete before initiating consultation 2022 Child: 140

You are interviewing a five-year-old child who presents with aggressive behavior. At the start of the interview, the child turns their back to you and does not respond to your questions except for occasional growling. What is the next best step?

A. Initiate play with toys and invite the child to join in. B. Send the child to the waiting room and interview the child's parent. C. Userole reversal and ask the child how they would help if the examiner were the patient. D. Set a visual timer and inform the child they will receive a reward if they talk in five minutes. E. Inform the parent the appointment needs to be rescheduled for a time when the child can cooperate. 2022 Child: 185

Rising from the floor, a three-year-old boy braces his hands against the ground and then walks his hands up his legs, thereby pushing himself to a standing position. The child's gait Is waddling. Leg and arm strength are weak on exam even though muscle bulk appears good. The child's uncle suffered from a similar problem. Which of the following diagnostic tests would most likely show abnormal findings?

A. Karyotyping Tensilon test Nerve conduction study Electromyography Electroencephalography 2022 Child: 139

A study examining the effects of a cognitive behavioral therapy (CBT) group intervention for major depressive disorder (MDD) in adolescents inthe juvenile justice system randomized 45 to the active group and 48 to a life skills alternative group. MDD recovery rates were significantly greater inthe CBT group than in the life skills condition (17 of 44, 39% vs 90f47,19%; odds ratio= 2.66, 95% confidence interval, 1.03-6.85). Outcome measures showing significance included the Beck Depression Inventory Il, the Hamilton Depression Rating Scale, and the Social Adjustment Scale-Self Report for Youth. Overall Strength of Evidence for the study was rated as insufficient due to imprecision and unknown consistency. Which of the following is most likely to have contributed to imprecision inthe study?

A. Lack of blinding Small sample size Lack of a control group Use of adolescent self-report measures Predominance of a co-morbid diagnosis of conduct disorder in subjects 2022 Child: 136

Studies that look at changes with age in normal electroencephalography patterns show that sleep spindles appear at two months of age, and typically become synchronous in most children by approximately what age?

A. One year B. Two years C. Three years D. Five years E. Sevenyears 2022 Child: 143 Sleep spindles (also known as sigma bands or sigma waves) are short bursts of oscillatory activity detected on EEGs during NREM sleep stage 2. They appear as 11-16 Hz waves with a 0.5-1.5 second duration. In psychiatry, understanding sleep spindle development and synchrony is important as they are linked to memory consolidation, intelligence, brain development, and synaptic plasticity. Their appearance at two months marks the beginning of thalamocortical maturation, an essential part of the brain involved in processing sensory information and controlling consciousness, sleep, and alertness. At two years, synchrony of sleep spindles indicates successful brain development. Abnormal sleep spindles are linked to various neurodevelopmental and psychiatric disorders, such as autism and schizophrenia. Understanding sleep spindles aids in early detection and intervention of these disorders.

According to Erikson, what is the most significant emotional issue in the life of school-aged children?

A. Personal worth Identify formation Individual autonomy Ability to self-soothe Establishing trusting relationships 2022 Child: 173

An adolescent presents with symptoms of skin excoriation symptoms secondary to formication. Which of the following disorders is most likely?

A. Psychosis B. Tourette syndrome C. Depressive disorder D. Body dysmorphic disorder E. Obsessive-compulsive disorder 2022 Child: 126 Formication refers to the false sensation of insects crawling on or under skin. It is a type of tactile hallucination typically related to drug misuse or withdrawals, for example alcohol or sedative-hypnotic withdrawal. Formication can also appear with certain psychiatric or medical conditions. In child psychiatry, it is important to recognize formication as a symptom of psychosis, anxiety, delusional parasitosis, a medication side effect, or substance misuse.

A young child is engaged in cognitive-behavioral therapy for anxiety. The therapist introduces a "Worry Monster" that represents the child's symptoms. Which of the following would be the best explanation of the purpose of this characterization?

A. Reducing stigma associated with anxiety B. Simplifying abstract therapeutic concepts C. Bringing greater awareness to unconscious fears D. Pairing the conditioned response with a new stimulus E. Showing that the concerns are outside of the child's control 2022 Child: 181

A psychiatrist is treating an adolescent who committed a crime during a psychotic episode. The patient is now stabilized, but the diagnosis of mental illness is being used as an element of the defense. The patient's parents sign a release to allow the psychiatristot testify, but the patient adamantly refuses, saying "Il told them not to say itwas because | was crazy, | knew what | was doing." The psychiatrist receives a subpoena to appear. What is the most appropriate action for the psychiatrist to take?

A. Refuse to appear onthe grounds that a separate forensic evaluation was not done. B. Appear, but categorically refuse to answer questions about the patient or the treatment C. Refuse to appear onthe grounds thatthe patient has refused the release of information. D. Appear, but only answer questions about the patient and the treatment if instructed to do so bythe judge. E. Appear and answer all questions onthe grounds that the parents have consented to the release of information. 2022 Child: 120

In an attempt to establish an accurate time frame for events or symptoms from school-age children, which of the following approaches is likely to be helpful?

A. Show them a calendar and ask them to tell you when the events occurred Avoid asking about dates as the emotional narrative is more important Be efficient and ask these questions only of the caretakers Anchor the chronology in relation to major life events Directly ask them the days and dates 2022 Child: 162

According to the a 2019 AACARP clinical consensus pathway on the evaluation and management of pediatric delirium, in which of the foilowing steps in care is it most important to consult a child and adolescent psychiatrist?

A. Starting preventative measures to mitigate risk B. Providing assistance in the diagnostic assessment C. Providing psychoeducation to patients and families D. Conducting screening assessment of at-risk patients E. Establishing follow up mental health services following recovery 2022 Child: 164

Which of the following psychotherapy modalities focuses primarily on repairing or increasing ego strength?

A. Supportive B. Interpersonal C. Psychodynamic D. Cognitive behavioral E. Dialectical behavioral 2022 Child: 163

An adolescent with bipolar disorder is stable on lithium carbonate. High-dose ibuprofen is prescribed for persistent migraines. Which of the following potential medication interaction effects is most important to consider?

Acne exacerbation * Nausea and vomiting Increased weight gain risk Decreased therapeutic efficacy of the lithium Thyroid-stimulating hormone suppression 2022 Child: 78 SE of toxic serum lithium levels: EKG: - ST DEPRESSION, QTC PROLONGATION NEURO: - (TADS) TREMOR, ATAXIA, DYSARTHRIA, STATUS EPILEPTICUS KIDNEYS: - NEPHROTOXIC SX

The determination of a child's ability to make end-of-life decisions should be based on which legal, ethical, or clinical principal?

Age of consent Individual right for autonomy Religious wish of the parents * Developmental understanding Cultural history of child and parents 2021 Child: 19

A child and adolescent psychiatrist speaks before a state House of Representatives about the need to improve access to mental health care for youth. Which of the following best describes the psychiatrist's role in this situation?

Analyst Lobbyist * Advocate Consultant Expert witness 2022 Child: 33

Which of the following cognitive factors is most preserved in youth with child-onset schizophrenia?

Attention Working memory Short term memory * Rote language skills Fine motor coordination 2021 Child: 118

Deficits in which of the following early neurocognitive factors appears to be most associated with the development of aggression in youth?

Attention * Verbal Language Processing Speed Short Term Memory Visual-Spatial Perception 2021 Child: 148

A child with well-controlled eosinophilic esophagitis has been restricting dietary intake, resulting in a 20-pound weight loss in two months, unexplained by the esophagitis. The child is bradycardic, which is explained by recent nutritional deficiencies. The child denies any body image concerns and reports not wanting to eat blaming the texture of foad. Which of the following eating disorders is most likely to be the diagnosis?

Bulimia nervosa Atypical anorexia nervosa Unspecified feeding or eating disorder * Avoidant/restrictive food intake disorder Other specified feeding or eating disorder 2022 Child: 28

On physical examination, a child has difficulty getting up from a prone position without pushing up with the hands. Parents report that the child has become progressively weaker. A brain magnetic resonance imaging scan shows symmetric basal ganglia lesions. Which of the following is the most likely diagnosis given these findings?

Cerebral palsy Seizure disorder Tourette syndrome Fragile X syndrome * Mitochondrial disorder 2019 Child: 134 The described symptoms and imaging findings suggest a diagnosis of Leigh Syndrome, a severe neurological disorder that typically arises in the first year of life. This condition is characterized by progressive loss of mental and movement abilities (psychomotor regression) and typically results in death within a few years, usually due to respiratory failure. A subgroup of patients shows symptoms only at an older age, and these symptoms may include difficulties with movement that can progress to weakness and wasting of muscles. The characteristic lesions in the basal ganglia are a key diagnostic feature.

A child presents with progressive weakness, hypotonia, and an abnormal gait with considerable difficulty standing from a sitting position. Which of the following best explains these clinical findings?

Cerebral palsy Muscular dystrophy Posterior fossa tumor Traumatic brain injury Childhood Parkinson's 2022 Child: 114

On physical examination, a child has difficulty getting up from a prone position without pushing up with the hands. Parents report that the child has become progressively weaker. A brain magnetic resonance imaging scan shows symmetric basal ganglia lesions. Which of the following is the most likely diagnosis given these findings?

Cerebral palsy Seizure disorder Tourette syndrome Fragile X syndrome Mitochondrial disorder 2022 Child: 165

Which of the following neuroimaging findings is most frequently seen in non-accidental head injury?

Contusion Skull fracture Epidural hematoma Diffuse axonal injury * Subdural hematoma 2019 Child: 126

A child with a normal neurological examination is seen for several episodes of dizziness, vertigo, occipital headache, and hemiparesis, all of which resolve within 24 hours. Which of the following disorders could best explain the symptoms?

Conversion disorder * Basilar artery migraine Tension type headache Cyclical vomiting syndrome Confusional migraine disorder 2020 Child: 34

A school recently identified a cohort of students who were at-risk for trauma after being exposed to a surge of community violence. Following a multitiered system of supports approach, which evidence-based intervention would be appropriate for this group?

Coping Cat Psychological First Aid Strengthening Families Program Trauma-Focused Cognitive Behavioral Therapy * Cognitive-Based Intervention for Trauma in Schools 2022 Child: 63

Which of the following substances is positively associated with pleasure during sexual activity and is elevated in males and females after orgasm?

Cortisol Prolactin * Oxytocin Serotonin Progesterone 2021 Child: 24

A 15-year-old starts cognitive behavior therapy for the treatment of a fear of needles. Which of the following components of the therapy is most central for treating this patient?

* Graduated exposure to needles Processing of the emotion of fear of needles Maintenance of dysfunctional thought records Recognition of the irrational nature of the fear Examination of cognitive distortions about needles 2020 Child: 178

An adolescent is prescribed clozapine for refractory schizophrenia. The youth has been symptomatically stable on the drug for over a year. However, most recent bloodwork reveals neutrophil count (ANC) has fallen to 800/mm3. What is the most appropriate course of action for the treating psychiatrist?

Discontinue clozapine and do not rechallenge Continue clozapine and monitor ANC daily until ANC normalizes * Discontinue clozapine and rechallenge when ANC is >1000/mm3 Discontinue and rechallenge when ANC is > 2000/mm3vb Continue clozapine and monitor ANC every two weeks 2022 Child: 69

A preschool-age child's long-term babysitter moves away to a new city and the child is very upset. Which of the following would be the most beneficial strategy for the parent to use to help the child cope with the loss?

* Help the child to call the babysitter Take the child to grief counseling Arrange for a new babysitter as soon as possible Not mention the baby-sitter, in order to make a "clean break" Stay at home until the child stops mentioning the baby-sitter 2019 Child: 75

Mutations in which of the following genes have most consistently been linked to impulsive violent behavior?

* Monoamine oxidase A Monoamine oxidase B Acetylcholinesterase Glutamic acid decarboxylase cAMP response element binding protein 2019 Child: 89 Monoamine oxidase A (MAOA) is an enzyme that breaks down neurotransmitters, such as serotonin, dopamine, and norepinephrine. Mutations in the MAOA gene can cause decreased enzyme activity, leading to an imbalance of neurochemicals in the brain which can result in impulsivity, aggression, and violent behavior. These genetic mutations can be caused by SNPs or CNVs. Clinically, those with this mutation may exhibit impulsive aggression, mood swings, criminal activities, hyperactivity, and difficulty regulating emotions. It's important to note that not everyone with the mutation experiences these symptoms or acts aggressively; environmental influences, upbringing, and comorbid psychiatric conditions are all significant factors.

Significantly increased risk for impulsive violent behavior has been demonstrated through gene-environment interactions of trauma and low activity of which of the following enzymes?

* Monoamine oxidase A Tryptophan-5-hydroxylase Dopamine beta-hydroxylase Catechol O-methyltransferase Methylenetetrahydrofolate reductase 2019 Child: 121

Multifamily psychoeducational psychotherapy was initially developed as an adjunctive intervention for families of youth and proven to have the largest treatment effect for the most severely ill children with which of the following psychiatric disorders?

* Mood Eating Anxiety Psychotic Substance use 2020 Child: 165

When considering light therapy for treating delayed sleep-phase syndrome in an adolescent, the teen should be exposed to the light at which of the following times?

* Morning Midday Evening Both morning and evening Three times a day at meal times 2019 Child: 57 The primary treatment for delayed sleep phase syndrome is chronotherapy, or gradually delaying sleep time. This helps the body to gradually adjust to the desired sleep schedule. Light therapy, melatonin, and lifestyle changes, such as avoiding caffeine and nicotine, can also be helpful. Additionally, cognitive behavioral therapy (CBT) may be used to identify and modify behavior patterns that impact sleep.

When considering light therapy for treating delayed sleep-phase syndrome in an adolescent, the teen should be exposed to the light at which of the following times?

* Morning Midday Evening Both morning and evening Three times a day at meal times 2022 Child: 49

As part of counseling parents of children with autism spectrum disorder (ASD), a physician discloses there is a lack of objective evidence to support the effectiveness of a gluten free/casein free diet in treating children and adolescents with ASD. The physician should also counsel parents to ensure their child has an adequate level of which of the following nutrients?

* Niacin * Vitamin C * Vitamin D * Carbohydrates * Omega 3 fatty acids 2022 Child: 66

A 16-month-old child has recently started walking further and further away from the parents to explore and play. According to Margaret Mahler, this behavior is most likely indicative of the child being in what stage of development?

* Practicing Symbiosis Differentiation Normal autism Rapprochement 2021 Child: 47 Practicing : This stage involves the child practicing new abilities and emerging independence. It's a significant period for developing motor skills and cognitive abilities. Symbiosis: In child psychology, symbiosis refers to an early developmental stage where the infant perceives a unity with the mother. This stage is crucial for the formation of attachment and emotional development. Differentiation: This is a developmental process where the child starts to separate themselves from their primary caregivers. It's essential for the development of self-identity and autonomy. Normal autism: This term refers to a phase in the infant's life where they are self-absorbed and unaware of the external world. It's a natural part of early development and not indicative of Autism Spectrum Disorder. It's key to understanding the child's sensory perception and self-awareness growth. Rapprochement: This is a phase in a child's development where they alternately seek independence and closeness to their caregivers. It's a critical stage for the development of self-regulation and interpersonal skills. Understanding this stage can help in identifying any attachment or separation anxiety issues. Practicing : This stage typically occurs from 9 to 15 months. During this time, the child starts to explore their environment more actively and practices their newfound motor skills. Symbiosis: This stage takes place from birth to about 2 months. It's a time when the baby and mother are closely bonded, and the baby sees no separation between themselves and their primary caregiver. Differentiation: This stage usually begins around 2 to 7 months. It's when the child starts to realize they are a separate entity from their caregivers. Normal autism: This phase occurs from birth to about 1 month. It's a period when the infant is mostly self-absorbed and unaware of their surroundings. Rapprochement : This stage typically happens between 15 to 24 months. It's a time when the child alternates between seeking independence and wanting closeness with their caregivers. This stage is crucial for developing self-regulation and interpersonal skills.

In the treatment of depressed adolescents using cognitive behavior therapy, which of the following is an example of "behavioral activation"?

* Process of scheduling pleasurable activities to build motivation Mindfulness practice to improve academic and cognitive functioning Breathing technique using short, emphatic inhalation and exhalation Type of self-talk youth can mobilize to take on anxiety-producing tasks Coaching strategy parents can use with youth to minimize daytime somnolence 2020 Child: 144

Referencing a popular children's movie and asking a child, "Which character in the movie are you most like?" is an example of which of the following interview techniques?

* Projective Engagement Interactive Direct questioning 2021 Child: 182

For children who have experienced early adversity but are adopted at a young age, during which of the following developmental periods are abnormal neuroendocrine findings tikely to be reversed with a high-resource nurturing environment?

* Puberty onset Early adulthood Middle adulthood Late adolescence Early elementary school 2022 Child: 95

A psychiatrist is providing therapy to a child whose parents are undergoing divorce. The therapist emphasizes expression of feelings and helps the child to understand the change in his family and offers advice. This scenario best describes which of the following types of psychotherapy?

* Supportive Psychodynamic Dialectical behavior Cognitive behavioral Parent-child interaction 2020 Child: 168

An adopted three-year-old child with epilepsy is seen for evaluation of intellectual disability. On observation, the child has microcephaly, fair skin, blonde hair and blue eyes. The child never had routine newborn screening. This child most likely has what inborn error of metabolism?

* Phenylketonuria Gilbert's disease Tay-Sachs disease Niemann-Pick disease Maple syrup urine disease 2020 Child: 102 ● Phenylketonuria: An inherited disorder which causes intellectual disability by hindering the body's ability to break down phenylalanine. Diagnosed via newborn screening. ● Gilbert's Disease: A harmless condition which causes jaundice due to bilirubin buildup. ● Tay-Sachs Disease: A fatal disorder that destroys nerve cells in the brain and spinal cord, primarily affecting infants. ● Niemann-Pick Disease: A group of inherited metabolic disorders characterized by lipid accumulation in the spleen, liver, lungs, bone marrow, and brain. ● Maple Syrup Urine Disease: An inherited metabolic disorder which can cause neurological damage and sweet-smelling urine if not treated promptly. Diagnosed by newborn screening.

A six-year-old is admitted to the intensive care unit with pneumonia. On day three of the stay, the patient exhibits an acute change in mental status associated with inattention, agitation, poor awareness of surroundings, and difficulties sleeping. Brain MRI is normal and neurologic exam is otherwise non-focal. Which of the following pathophysiologic processes is implicated in the development of the child's change in mental status?

Discrete anoxic injury to the brain parenchyma Decreased cerebral cellular oxidative metabolism Decreased permeability at the blood-brain barrier Auto-antibody development to the NMDA receptor * Secretion of pro-inflammatory cytokines by macrophages 2021 Child: 98

Social aggression in primates and children has been correlated with low central transmission of which of the following neurotransmitters?

Dopamine GABA Norepinephrine Glutamate * Serotonin 2020 Child: 122

A school-age child views televised scenes of looting and violence after a major natural disaster. The parents notice the child becoming more fearful and clingy. What advice should the child psychiatrist give the parents about exposing the child to additional media coverage?

Encourage the child to talk even if the child does not wish to. * Permit limited viewing of the event only when the parents are present. Allow reading about, but not watching, the event. Keep the child home from school. Forbid all television viewing. 2020 Child: 138

Which of the following paraphilic disorders is most likely to be observed in females?

Fetishistic Voyeuristic Frotteuristic * Masochistic Exhibitionistic 2022 Child: 26

Over the past six months, an adolescent has made several unsolicited text messages to adults, trying to engage them in obscene conversations. The adolescent reports recurrent and intense sexual arousal from these texts, will often masturbate after the texts, and spends considerable amounts of time in this activity. Which of the following diagnoses best characterizes this presentation?

Fetishistic disorder Pedophilic disorder Frotteuristic disorder Sexual sadism disorder * Other specified paraphilic disorder 2020 Child: 159

A 19-year-old high-school senior is brought for evaluation after he was discovered having placed a camera in the female locker room, and was watching female peers disrobe from his computer. Teachers say the adolescent is a quiet student, has never been a behavior problem and gets B's and C's in most classes. The parents are mortified by their child's behavior, and have grounded him for three months. When interviewed alone, the adolescent reports becoming sexually aroused and repeatedly masturbating while watching or just thinking about the video. He has missed social events with friends because he would rather stay home and watch the videos he has recorded. He does not have any other mood or anxiety symptoms. Which of the following is the most likely diagnosis?

Fetishistic disorder Pedophilic disorder * Voyeuristic disorder Frotteuristic disorder Exhibitionistic disorder 2019 Child: 173

A 14-year-old obese patient has been started on a second-generation antipsychotic to treat acute mania in bipolar disorder. The patient has gained 17 lbs over two months since starting the medication despite maximizing nutritional and exercise interventions. What medication has the best available evidence to promote weight loss and prevent further weight gain?

Lithium Lactulose * Metformin Methylphenidate Omega 3 fatty acids 2021 Child: 99

An adolescent effectively treated for bipolar disorder with risperidone reports galactorrhea. Which of the following medications has evidence as a treatment for antipsychotic induced hyperprolactinemia?

Lithium Oxytocin * Aripiprazole Benztropine Diphenhydramine 2022 Child: 25

A young child presents with symptoms similarto Prader-Willi but the chromosome analysis is without abnormalities. This is best defined as which of the following?

Locus heterogeneity Allelic heterogeneity Polygenic inheritance Incomplete penetrance Phenocopy occurrence 2022 Child: 166 Phenocopy refers to a situation where environmental factors lead to symptoms that mimic a genetic disease. In the context of child psychiatry, this can be particularly relevant. For example, a child exposed to severe trauma may display behaviors similar to those seen in a genetically inherited mental disorder.

The pediatrician requests a psychiatric consultation for a possible case of caregiver- fabricated illness in a child. In order to warrant further investigation by the state child protective services, physicians are expected to identify which of the following in the caregiver?

Overanxious parenting Attention-seeking behavior Possible secondary motivation * Suspicion of child maltreatment Absence of psychotic processes 2022 Child: 1

Which of the following international entities has been most active in determining principles for the development of mental health programs?

Oxfam Doctors Without Borders * World Health Organization United Nations Children's Fund International Mental Health Research Organization 2019 Child: 141

A three-year-old child is referred to the psychiatrist by the preschool, where the child was noted to be hesitant and fearful of participating in physical activities with other children. In conducting an initial screening to rule out a neurologic contribution to this presentation, which of the following is the best way for the psychiatrist to assess the child's muscle strength?

Perform a finger-to-nose test Refer the child for electromyography testing * Ask the child to get up from the floor and climb into a chair Inquire about the child's subjective sense of own strength Have the family complete checklists regarding the child's abilities and functioning 2021 Child: 4

An eight-year-old patient with a history of intellectual disability and autism spectrum disorder presents to clinic with parents for worsening behavioral agitation over the past few weeks. The patient has been ignoring directions, making high-pitched vocalizations, and engaging in new head-banging behavior. What would be the most appropriate next step for the psychiatrist to take?

Prescribe clonidine Check serum lead levels Prescribe oral aripiprazole Refer to pediatric genetics * Inquire regarding dental history 2021 Child: 38

In which of the following situations is it most appropriate to evaluate a child with autism spectrum disorder with an electroencephalogram?

Presence of repetitive behaviors Part of routine initial assessment New onset of depressive symptoms Persistence of aggressive behaviors * New onset of developmental regression 2019 Child: 106

Which of the following characteristics is most consistent with Tanner Stage 2 development in girls?

Raised areola Elevated papilla Onset of menarche Thickening of pubic hair * Development of breast bud 2022 Child: 44 The Tanner Stages, also known as the Tanner Scale or Sexual Maturity Rating (SMR), is a system that describes the sequence of physical changes in children during puberty. Developed by Dr. James Tanner, the scale ranges from stage 1 to 5. ● Stage 1: This is the prepubertal stage with no sexual development. ● Stage 2: Initial signs of puberty appear, with breast buds in girls and testicular enlargement in boys. ● Stage 3: Further development, including growth of pubic hair and changes in voice pitch in boys. ● Stage 4: Continued physical development, including increased body hair and deepening of voice in boys. In girls, the onset of menstruation usually occurs. ● Stage 5: This is the final stage of puberty, where individuals reach reproductive maturity. Boys have fully developed genitalia and girls have regular menstrual cycles. Growth in height slows down and eventually stops in this stage.

Velocardiofacial syndrome, which has been repeatedly implicated in early-onset psychosis, is most often the result of what kind of genetic abnormality?

Methylation * Gene deletion Polymorphisms Trinucleotide expansion Chromosomal translocation 2020 Child: 54

A 16-year-old girl has recently immigrated to the United States. She presents to a community mental health clinic for evaluation accompanied by her mother who speaks very little English. A language interpreter is used. The mother expresses concern about her daughter's behavior characterized by talking back, keeping secrets by speaking in English, and running off with friends rather than being home where she is needed. The daughter reports frustration, as she prefers being with friends to helping at home. With the exception of this frustration with her mother, she denies all other symptoms. Which of the following would be the most appropriate first action for the psychiatrist to take?

Refer the child for psychotherapy Discuss the acculturation process with the mother Explain normal adolescent development to the mother Ask the daughter if she is engaging in any risky behaviors * Ask the mother how she explains the daughter's behaviors 2020 Child: 167

A parent observes a child giving hugs to a stuffed bear and remarks, "I like the gentle touches you are giving Mr. Bear. He must be happy to get a hug." According to social learning theory, which of the following most likely describes the child's response to the parent's comments?

Hitting the bear * Increasing nurturing behaviors Giving the bear to caregiver Grabbing a toy from a younger sibling Picking up another toy and ignoring the bear 2021 Child: 82 Social learning paradigms suggest that individuals take cues from influential figures (e.g., parents, peers) when it comes to adopting behaviors—both positive and negative, like substance use and abuse. Prevention strategies often work to promote positive behaviors by targeting these people, as well as encouraging open dialogue and setting clear expectations. When studying for the child psychiatry board exam, it's vital to understand social learning in the context of substance abuse prevention: mechanisms of observational learning, influential figures, and different prevention strategies. Know how to apply these concepts in clinical practice, like communicating with children and families about substance use, and recognize risk factors that raise one's vulnerability to substance abuse (e.g., environmental, genetic, psychological).

Parents bring their six-year-old natal boy for evaluation. They report that the child has repeatedly identified as a girl since early childhood, with consistent expression of strong preferences for feminine clothes and activities. The parents are concerned but have tried to be accepting and have permitted the patient to dress and play as a girl. The patient just started a new school which has different uniforms based on gender. The child has refused to wear the boys' uniform. For several weeks, the child has been refusing to attend school, complaining of frequent stomachaches, having difficulty sleeping and is often moody and irritable. Which of the following would be the best treatment approach?

Home-school the patient until he is less symptomatic Implement a behavioral plan to change patient's attitude Provide psychoeducation on importance of fitting in at school * Advocate for child to wear uniform that is consistent with gender identity Prescribe an antidepressant to address the patient's symptoms of anxiety 2022 Child: 59

A ten-year-old child has been participating in therapy for six months following the parents' divorce. The child's mother appears more supportive of the treatment than the father. The psychiatrist has good rapport with the child's mother, speaking regularly, in contrast to the father whom the psychiatrist has only spoken to once. The psychiatrist had felt the therapeutic relationship with the patient was good. However, the father left a voice message indicating that the child wished to discontinue therapy. Which of the following is the best course of action for the psychiatrist to take next?

Immediately discontinue therapy with the child Meet with the child to conduct a termination session Call the child to inquire as to why he or she no longer wants to continue therapy Call the child's mother to.express concern that the child's father is contributing to the child's therapeutic resistance * Call the child's father to learn more about the father's relationship with the child and to explore the child's desire to end therapy 2022 Child: 21

An abused child runs to hide in the bedroom closet at the sound of the garage door opening, even though the abusive parent no longer lives in the home, and even though hiding never prevented the abuse when that parent was present. This fear response can best be explained with which of the following learning models?

Incentive learning Operant conditioning Learned helplessness * Classical conditioning Contingency management 2020 Child: 1

In order to know which psychiatric conditions are uncommon, a resident should establish the percentage of individuals affected by different psychiatric disorders during a specified time period. Which of the following constructs will be most helpful to the resident in this scenario?

Incidence Specificity Sensitivity * Prevalence Number needed to treat 2021 Child: 17

An eight-year-old child with autism· spectrum disorder and attention-deficit/hyperactivity disorder presents with worsening aggression. The child has wraparound services with behavioral and therapeutic interventions. The child also sees a psychiatrist monthly for treatment with clonidine and a stimulant. Which of the following is the best initial approach to address the worsening aggression in this patient?

Increase therapy time with the patient * Perform a functional behavioral analysis Increase the dose of the stimulant medication Provide family therapy prioritizing system dynamics Add an atypical antipsychotic to the child's medication regimen 2021 Child: 106

The following two (2) questions pertain to this vignette: An adolescent with no prior medical or psychiatric disorders, with a typically normal circadian rhythm, was brought for an evaluation after noted irritability, poor school grades, and constant fatigue. On history, the only pertinent positive is the earlier school start time for this year, which has been a difficult adjustment. A deficiency in which of the following is most likely associated with the identified disorder?

Iron Folate * Melatonin Hypocretin-1 Anti-diuretic hormone 2020 Child: 135

Which of the following symptoms is most likely to distinguish children with early onset schizophrenia from those with non-psychotic behavioral or emotional disorders?

Irritability Hallucinations Language delays Social withdrawal * Loose associations 2021 Child: 168

Which of the following factors best distinguishes bipolar disorder from attention deficit hyperactivity disorder in youth?

Irritability lmpulsivity * Grandiosity Distractibility Restlessness 2020 Child: 103

Which of the following factors has been most closely associated with lasting psychological sequelae in young children with traumatic head injuries?

Irritability and agitation soon after the trauma * Anterograde amnesia lasting longer than seven days Brief loss of consciousness at the time of the occurrence Retrograde amnesia regarding the details of the accident 2021 Child: 180

Which of the following symptoms are more commonly seen in adolescents with major depressive disorder (MDD) than in children with MDD?

Irritable mood Hallucinations Somatic complaints * Melancholic symptoms 2021 Child: 189

Among individuals experiencing an initial bipolar prodrome, which of the following symptoms have the highest prevalence rate?

Irritable mood and fatigue Self-harm and mood !ability Sleep disturbance and disinhibition * Increased energy and talkativeness Auditory hallucinations and hypersexuality 2021 Child: 121

Which of the following are the most common outcomes of divorce mediation when compared to litigation? (Select three)

It leads to more joint custody agreements. It assists with access to therapy for the child. It is often more efficient and more cost effective. It commits the couple to settling outside of court. It eliminates the need for the child to be involved. It may increase parental cooperation about children. It prevents judges from making uninformed decisions. It includes multiple attorneys for a balance of opinions. 2022 Child: 197 CCC

A child is playing at the park and is stung by a bee. In the months following being stung, the child cries when asked to go to a park, and eventually refuses to partake in any activities that occur at a park. Which of the following represents the conditioned stimulus?

The bee * The park Child crying Child's parents Child's refusal to go to a park 2019 Child: 152

Which of the following best describes current reimbursement practices for telemedicine services?

Requires prior-authorization * Covered by Medicaid in all states Only covered through medical-home models Covered by all private payers at a reduced rate Determined by the technological specifications of the system used 2019 Child: 133 Medicare is a federal health insurance program that provides health coverage for those over the age of 65, people with certain disabilities, and people with end-stage renal disease. Medicaid is a state-run health insurance program funded by both the federal and state governments that provides health coverage for people with low incomes, depending on their financial and household situation.

A 16-year-old presents to a psychiatrist with concerning episodes of feeling detached from their body. During these times, the adolescent feels unreal, emotionally numb, and reports watching their body from outside in a dream-like state. There is no loss of consciousness with these episodes. The adolescent has no medical or psychiatric complaints and denies substance use. What is the most likely diagnosis?

Seizure disorder Dissociative identity disorder Post-traumatic stress disorder Borderline personality disorder * Depersonalization/derealization disorder 2020 Child: 41

Concomitant use of which medication is likely to increase risperidone levels due to inhibition of CYP2D6?

Sertraline * Fluoxetine Alprazolam Atomoxetine Lisdexamfetamine 2020 Child: 86

By what age can typically developing children first draw figures that are recognizable as human?

Two years Three years * Four years Five years Six years 2019 Child: 184 • Two years • At two years old, children typically begin to make straight lines and circle-like shapes. They may not be perfect, but this is the start of their drawing journey. • Three years • By three years, children's drawings start to become more complex. They can draw a basic human figure with 2 to 4 body parts. • Four years • At four years old, children can draw a more detailed person with at least 6 body parts. They can also start to draw basic shapes like squares and rectangles. • Five years • Five-year-olds can draw a person with at least 8 body parts and clothes. They can draw more complex shapes like triangles and can start to copy some capital letters. • Six years • At six years old, children can draw a detailed person with more than 8 body parts, including facial features, and clothes with details. They can draw complex shapes like hexagons and octagons, and can copy most letters and numbers. They may also start to draw three-dimensional objects.

A six-year-old child who is hospitalized with asthma for the third time in six months is more likely than an adolescent with the same history to experience:

distress due to loss of privacy. * thoughts about being punished. autonomy struggles with parents. concerns over changes in appearance. distress over inability to continue favorite activities. 2020 Child: 188

The father of a five-year-old child dies in a car accident. Before leaving home, the father had expressed being upset with the child for not listening to him. The child feels responsible and guilty for the accident. This is an example of:

causality. depression. arbitrary inference. all or nothing thinking. * age-appropriate response. 2019 Child: 142

The medical director of an outpatient clinic for youth with disruptive behavior disorders was concerned that patients treated with antipsychotic medications were developing metabolic syndrome. The clinic implemented a system in the electronic medical record in which charts were flagged for providers and the clinic manager if the patient's body mass index had increased by more than 2 points since baseline. This system is an example of:

root cause analysis. * continuous quality improvement. consumer satisfaction monitoring. health-plan sponsored practice protocol. disease-specific outcome measurement. 2020 Child: 4 • Root cause analysis is a problem-solving method used to identify the underlying reasons for specific issues. For instance, it could be applied in healthcare to understand why a certain medical error occurred to prevent it from happening in the future. • Continuous quality improvement, on the other hand, is an ongoing effort to increase the effectiveness of processes, services, or products. In a hospital setting, this may involve regularly reviewing and improving patient care procedures. • Consumer satisfaction monitoring involves tracking and analyzing customer feedback to assess the quality of service or product. In a healthcare context, this could mean evaluating patient feedback about their care experience. • Health-plan sponsored practice protocol refers to standard procedures put forth by health insurance providers that medical practitioners are expected to follow. These protocols are often based on evidence -backed research and aim to ensure consistent, high-quality care. For instance, a health insurance company might have a specific protocol for treating patients with chronic conditions like diabetes. • Disease-specific outcome measurement is a method of assessing the effectiveness of a treatment or intervention for a specific disease. This involves measuring certain outcomes, such as symptom reduction or improved quality of life, related to the disease in question. For example, the success of a cancer treatment could be measured by the patient's survival rate or the decrease in tumor size. • These terms are all related to healthcare quality, but they approach it from different angles. Root cause analysis focuses on problem-solving, continuous quality improvement is about ongoing process refinement, consumer satisfaction monitoring assesses service quality from the patient's perspective , health-plan sponsored practice protocol sets standards for care based on research, and disease-specific outcome measurement evaluates the effectiveness of specific treatments. Each term represents a unique strategy in the pursuit o

The earliest paraphilia to develop, frequently before the age of 15 years, is:

sadism. * voyeurism. frotteurism. exhibitionism. transvestic fetishism. 2021 Child: 145

sexual minority youth may have additional struggles with respect to stigmatization when dealing with cultural, ethnic, or religious factors. These factors may result in delays in the development of sexual:

behavior. orientation. milestones. *identity integration. group identification. 2020 Child: 42 Sexual identity integration refers to the process of understanding, accepting, and incorporating one's sexual identity into their overall identity. This process can be complex and multifaceted, involving various stages including exploration, confusion, acceptance, and finally integration. It's a journey that's unique to each individual, shaped by their personal experiences, societal influences, and cultural contexts. This concept is often studied in the field of psychology, particularly in relation to LGBTQ+ individuals, as they may face additional challenges in integrating their sexual identity due to societal stigma and discrimination. The study of sexual identity integration can provide valuable insights into mental health, self-esteem, and overall well-being.

Which of the following neurotransmitter systems develops first in children?

GABAergic Cholinergic Dopaminergic * Noradrenergic Serotoninergic 2021 Child: 103

A second language can best be learned if taught during which of the following developmental periods?

Infancy Toddlerhood * Preschool-age Latency Adolescence 2020 Child: 160

The capacity for shame typically develops by what age?

Six months One year * Three years Five years Seven years 2020 Child: 96

In considering an adolescent patient for admission to a residential treatment center, which of the following clinical characteristics would be the best indication for admission?

Worsening suicidal ideation with a plan for suicide Unclear diagnosis in a patient with multiple recent hospitalizations * Disruptive behavior with severely damaged parent-child relationship Physical aggression that is worsening despite recent psychiatric hospitalization Extensive medication changes that are difficult to implement in an outpatient setting 2022 Child: 67

A three-year-old child who uses ten to twenty words to communicate is being evaluated. The most appropriate assessment instrument to evaluate the child's intellectual ability is a(n):

achievement test. neuropsychological test. general intelligence test. * nonverbal intelligence test. abbreviated intelligence test. 2021 Child: 92

According to DSM, the diagnosis of premenstrual dysphoric disorder should be confirmed by:

the Daily Record of Severity of Problems. * a prospective symptom rating log over two months. the Premenstrual Tension Syndrome Rating Scale. the Visual Analogue Scales for Premenstrual Mood Symptoms. a validated depression rating scale during the week prior to menses. 2022 Child: 83

An adolescent is referred for substance use treatment after being found unresponsive in the bathroom by a younger sibling at home. The adolescent relapsed and used substances two days prior to the visit with the psychiatrist. At the visit, the adolescent states, "I feel like such a failure". Using a motivational interviewing approach, which of the following statements would be the next best response by the psychiatrist?

"I wonder if your choice to use substances again may represent self-sabotage." "You do not fully understand the negative consequences of your substance use." * "This recent relapse is making you upset because you were trying so hard to stay sober." "This choice was more about peer pressure and you need to find a new group of friends." "Let us try to view your recent relapse as a one-time occurrence and move forward together." 2019 Child: 13 The main principles of motivational interviewing are: 1. Express empathy: Show understanding and respect for the person's perspective and feelings. 2. Develop discrepancy: Help the person see the gap between their current behavior and their goals or values. 3. Roll with resistance: Avoid arguing or confrontations, instead, explore the person's reasons for not changing. 4. Support self-efficacy: Encourage the person to believe that they can change and have the ability to do so. 5. Encourage action and planning: Help the person to take steps towards change, and to make a plan for achieving their goals. Environmental Updating: Help the person to understand the impact that their environment, family and friends have on their decisions and behaviors.

Which of the following best characterizes the nature of social relationships during adolescence?

* A majority of friendships last less than a year A majority of friendships occur across gender Group identity is fluid and frequently changing A majority of teens show increased resilience to rejection A majority of romantic relationships show limited intimacy 2019 Child: 95

Sexual awareness and attraction in early adolescence is linked to which of the following biological factors?

* Adrenal androgens Gonadal development Pheromone emissions Epigenetic gene activation Cerebral cortical maturation 2019 Child: 59 Adrenal androgens can affect sexual awareness and attraction in early adolescence by influencing a variety of physiological and psychological processes. Adrenal androgens are hormones, like testosterone, that are produced by the adrenal glands and are involved in puberty and the development of secondary sex characteristics. Adrenal androgens can affect a person's sex drive and libido, as well as their physical appearance. They can also influence the development of realistic body image, the formation of gender identity and sex-role preferences, and can affect a person' s motivation and behavior related to sexual activity. Additionally, increased levels of androgens can increase feelings of attractiveness and the desire to be seen as attractive in the eyes of others, and can lead to higher levels of sexual awareness and engagement.

In youth with substance use disorders, evidence suggests the chance for recovery in a peer support group is best optimized if the patient is peer-matched along which parameter?

* Age Gender Ethnicity Substance of choice Socioeconomic status 2019 Child: 22 This is because research has shown that young people are most likely to benefit from peer support if they are matched with peers of similar age, as this helps build trust and encourages meaningful dialogue. Furthermore, it increases the likelihood of sharing experiences and strategies that are relevant and meaningful to the group.

Spinal muscular atrophy is a chronic neurological disorder in children that primarily involves which of the following areas?

* Anterior horn cells Cranial nerve nuclei Neuromuscular junctions Efferent peripheral nerves Afferent peripheral nerves 2019 Child: 31 The chronic neurological disorder in children that affects anterior horn cells is known as Spinal Muscular Atrophy (SMA) The chronic neurological disorder affecting Cranial nerve nuclei in children is Cerebral Palsy Myasthenia gravis affects neuromuscular Junctions Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disorder characterized by progressive nerve damage, resulting in numbness, tingling, and muscular weakness. CIDP affects afferent peripheral nerves. It is seen mostly in children and is characterized by progressive weakness and impaired sensation in the arms or legs. CIDP can also affect efferent peripheral nerves, leading to reduced or absent deep tendon reflexes, muscle atrophy, and impaired nerve conduction.

Which of the following psychiatric symptoms is most common in pediatric patients who have survived a brain tumor?

* Anxiety Psychosis lmpulsivity Aggression Self-injurious behavior 2019 Child: 17 The most common psychiatric symptom in pediatric patients who have survived a brain tumor is anxiety. Other common symptoms include depression, sleep disturbances, irritability, aggression, and learning problems. Brain tumors can cause a range of physical and psychological effects. Anxiety is one of the most common psychiatric symptoms experienced by pediatric patients who have survived a brain tumor, as the physical and psychological effects of the tumor can lead to insecurity, worry and fear. Other symptoms such as depression, sleep disturbances, irritability, and aggression can also arise as the child adapts to and comes to terms with the effects of their brain tumor. Additionally, cognitive and learning problems can arise due to the physical damage caused by the tumor or the effects of the treatments

A common trigger for the aggressive outbursts of a child is identified as unexpected disruptions in the patient's routine. The patient's parent and therapist develop a written schedule for each day. They teach the patient a calming breathing exercise to use when disruptions are anticipated or occur. Additionally, the parent is taught not to give candy in response to the outbursts. These interventions are most consistent with which of the following treatment strategies?

* Behavior analysis Habit reversal training Positive parenting program Parent management training Parent-child interaction therapy 2019 Child: 65 Behavior Analysis: Behavior analysis is a systematic approach to understanding and changing the behavior of individuals. It is based on the principle that all behavior is learned and that behavior can be changed through the use of reinforcement and other techniques Habit Reversal Training: Habit Reversal Training (HRT) is a behavior therapy approach designed to help individuals recognize and change problematic behaviors such as tics, impulsivity, aggression, and rumination. In this approach, the client learns to identify the prec ursors to the problem behavior, and then replace it with an alternative, more socially acceptable behavior Positive Parenting Program: The Positive Parenting Program (Triple P) is designed to support parents in developing the skills and confidence needed to manage their children's difficult behaviors. Triple P focuses on building strong parent-child relationships and providing parents with problem-solving strategies to manage their children's disruptive behaviors Parent Management Training: Parent Management Training (PMT) is an evidence-based treatment program designed to help parents learn effective strategies for managing their children's challenging behaviors. The program focuses on teaching parents to be proactive, consistent, and firm in their response to their child's behavior Parent-Child Interaction Therapy: Parent-Child Interaction Therapy (PCIT) is a type of family and child therapy that focuses on strengthening the parent-child relationship and teaching parents to become better problem-solvers. The goal of PCIT is to help parents learn to respond more appropriately to their children's behaviors, and to be more supportive and loving in their interactions with their child.

Depression occurring in the prepubertal period most typically shares risk factors and course similar to what other childhood disorder?

* Conduct disorder Tourette syndrome Autism spectrum disorder Separation anxiety disorder Attention-deficit/hyperactivity disorder 2019 Child: 72 There are several reasons behind this similarity between prepubertal depression and conduct disorder. Some of the key factors include: Genetic predisposition : Both conditions may have a genetic component, making individuals more susceptible to developing these disorders if they have a family history of mental health issues. Neurobiological factors: Research has shown that there may be similarities in the neurobiological processes underlying both prepubertal depression and conduct disorder. This includes alterations in neurotransmitter systems, such as serotonin and dopamine, which play a crucial role in mood regulation and impulse control. **Environmental influences **: Exposure to adverse environmental factors, such as trauma, abuse, or neglect, can increase the risk of developing both prepubertal depression and conduct disorder. These experiences can have a significant impact on a child's emotional and behavioral development. Psychosocial factors : Children who experience difficulties in social interactions or have poor attachment with their caregivers may be more prone to developing both depression and conduct disorder. A lack of support or understanding from family, peers, and teachers can contribute to the development of these disorders. Comorbidity: Prepubertal depression and conduct disorder often co-occur, meaning that a child may experience both disorders simultaneously. This comorbidity can make it difficult to differentiate between the two conditions and determine the most appropriate treatment plan.

Which of the following compensatory biochemical changes that occur during dieting explains the plateau in weight loss?

* Decreased leptin release Decreased ghrelin release Decreased neuropeptide Y release Increased pro-opiomelanocortin release Increased alpha-melanocyte stimulating hormone release 2019 Child: 29 Decreased leptin release can explain the plateau in weight loss because leptin is a hormone that communicates with the brain to indicate satiation or the feeling of being full. When the levels of leptin in the bloodstream decrease due to weight loss or a limited-calorie diet, the brain doesn't receive this signal to stop eating. This can cause people to eat more than they need and prevent them from further weight loss Ghrelin is known as the "hunger hormone". It is released by cells in the stomach and is responsible for stimulating appetite, increasing food intake and promoting fat storage. Ghrelin levels tend to rise before meals and fall after meals. Higher ghrelin levels are associated with increased hunger and cravings for high-calorie foods, making it more difficult to maintain a healthy diet and weight. Pro-opiomelanocortin (POMC) is a prohormone found in the hypothalamus of the brain. It is responsible for releasing beta-endorphin, a natural opioid peptide, and for producing melanocyte-stimulating hormone (MSH). The release of beta-endorphin has an effect on many areas of the body and can lead to a feeling of well-being and happiness, while MSH helps to regulate skin color and energy balance. POMC is also involved in regulating appetite, body weight, and other hormones related to metabolism. How does it affect appetite? POMC and its derivatives, such as beta-endorphin and MSH, can play a role in regulating appetite. Beta-endorphin stimulates hunger and can make food more desirable and desirable. MSH, on the other hand, is believed to suppress hunger. Furthermore, POMC neurons play an important role in the regulation of energy homeostasis, which can help maintain a balanced appetite. Alpha-melanocyte stimulating hormone (α-MSH), is a hormone that is secreted by the pituitary gland in response to changes in blood sugar levels. It plays a role in regulating hunger and appetite, by increasing the sense of fullness after meals and decreasing the sensations of hunger. Additionally, α-MSH is also thought to have an effect on metabolism and body fat levels.

Which of the following treatment options should be considered for severe Tourette's disorder that continues into adulthood, is debilitating, and is unresponsive to medication management and habit reversal therapy?

* Deep brain stimulation Vagus nerve stimulation Translabyrinthine craniotomy Transcranial magnetic stimulation Magnetic resonance imaging-guided laser ablation 2019 Child: 87 Deep Brain Stimulation (DBS) can be a viable treatment option for severe Tourette's disorder in adults when other therapies have failed. DBS involves implanting a stimulator device, which sends electrical impulses to specific areas of the brain. The stimulator is typically placed in one of the following brain regions: Thalamus: This area is involved in controlling movement and regulating emotions. Stimulating the thalamus can help reduce motor and vocal tics. Globus pallidus internus (GPi): This region is connected to the thalamus and is part of the basal ganglia, a group of structures responsible for movement regulation. Targeting the GPi can also help alleviate motor and vocal tics. Anterior limb of the internal capsule (ALIC): This is a white matter pathway connecting the frontal and subcortical brain areas. Stimulation of the ALIC has been shown to improve both tics and some psychiatric symptoms associated with Tourette's disorder. Nucleus accumbens: This area is involved in the brain's reward system and has been linked to impulse control. Stimulating the nucleus accumbens may help reduce impulsive behaviors and improve overall quality of life for those with severe Tourette's disorder. The exact location of the stimulator is determined based on the individual patient's symptoms and the specific brain region that is most likely to provide the greatest benefit. The decision is made through collaboration between the patient, their neurologist, and the neurosurgeon performing the procedure. DBS has been shown to significantly reduce the frequency and severity of tics in many patients with severe Tourette's disorder. Additionally, it may also help improve associated psychiatric symptoms, such as anxiety, depression, and obsessive-compulsive behaviors. However, it is important to note that DBS is not a cure for Tourette's disorder, and its effectiveness may vary from person to person.

Which of the following scenarios may be considered a relative contraindication to a child being evaluated via telepsychiatry?

* Depressed and suicidal child in their home Hyperactive and oppositional child at their school Anxious and somatic child at their primary care office Acutely psychotic adolescent in an emergency department Assaultive and aggressive adolescent in a detention facility 2019 Child: 62

Which of the following acutely inhibits the release of glucocorticoids in the adrenal glands?

* GABA Cortisol Estrogen Serotonin Acetylcholine 2019 Child: 1 GABA (gamma-aminobutyric acid) is an inhibitory neurotransmitter that acts on specific receptors in the body, including those in the adrenal glands. When GABA binds to its receptors in the adrenal glands, it can inhibit the release of the hormone glucocorticoids, such as cortisol, by reducing the activity of the enzymes and pathways involved in their synthesis and release.

Elevated release of Neuropeptide Y in response to stress results in decreased psychological distress by modulating the release of which of the following?

* GABA Serotonin Dopamine Glutamate Norepinephrine 2019 Child: 23 Neuropeptide Y (NPY) is a peptide hormone that plays a role in regulating various physical and psychological responses to stress. By modulating the release of GABA (Gamma-Amino-Butyric Acid) - a neurotransmitter that helps control movement, emotion, and stress - NPY is able to reduce psychological distress. GABA helps to create a calming and relaxing effect by inhibiting neuron activity in the brain, which can help to reduce anxiety and decrease stress hormones. NPY can thus help to calm the mind and reduce the feeling of being overwhelmed by stress. Neuropeptide Y is regulated by a variety of factors, including hormones, neurotransmitters, and nutrient levels. In addition, physical or emotional stress can cause an increase in neuropeptide Y levels. Neuropeptide Y is released from neurons in the central nervous system, as well as from certain cells in the peripheral nervous system. It binds to receptors on cells in the hypothalamus, autonomic nervous system, cardiovascular system, gastrointestinal tract, and adrenal glands, and acts to modulate these systems.

A ten-year-old boy has been preoccupied that he will develop leukemia since watching his younger brother succumb to the disease a year ago. The child is worried that he has all of the same symptoms, despite evidence to the contrary and reassurance from his parents and pediatrician. The child's friends have stopped associating with him because he only talks about how he will die soon, and his parents are frustrated with his repeated requests for blood tests. Which of the following is the most likely diagnosis?

* Illness anxiety disorder Body dysmorphic disorder Somatic symptom disorder Obsessive-compulsive disorder Adjustment disorder with anxiety 2019 Child: 26 Illness Anxiety Disorder (IAD) is a type of anxiety disorder characterized by extreme fear and anxiety about one's health. This fear is disproportionate to the actual risk of getting sick and is not relieved by medical reassurance. It is also known as hypochondria or health-related anxiety disorder Somatic Symptom Disorder (SSD) is a mental disorder characterized by physical symptoms that are not explained by a physical illness or injury. People with SSD tend to be preoccupied with their physical symptoms, and they experience significant distress and/or impairment in their daily functioning due to the physical symptoms. Unlike IAD, SSD is associated with actual physical symptoms that are present, and the symptoms may be more severe and persistent than those associated with IAD. Unlike IAD, the physical symptoms of SSD are the source of distress, rather than the fear of having a physical illness.

Which of the following goals is the primary focus of community systems-of-care programs?

* Limiting out-of-home placements for treatment Establishing a medical home for the patient and family Including the school system in the patient's treatment team Providing training for parents of children with mental health needs Providing mentors for youth at risk for juvenile justice involvement 2019 Child: 63 The primary focus of community systems-of-care programs is to provide comprehensive and coordinated services, supports and interventions to help children, youth and their families who have complex physical, mental, behavioral and/or substance abuse needs. These programs are designed to reduce the need for more restrictive levels of care, improve outcomes and foster successful transitions to adulthood.

In the application of dialectical behavior therapy for adolescents, which of the following skills should be taught first?

* Mindfulness Self-management Distress tolerance Emotion regulation Interpersonal effectiveness 2019 Child: 34 What are the primary principles of dialectical behavioral therapy for adolescents? Mindfulness: Understand and observe one's thoughts and feelings in the present moment without judgment. Distress tolerance: Learn to accept difficult thoughts, feelings, and situations rather than trying to escape or avoid them. Emotion regulation: Recognize and manage intense emotions by identifying and changing unhealthy thoughts, behaviors, and core beliefs. Interpersonal effectiveness: Communicate effectively, set boundaries, and maintain self-respect in social situations. Walking the Middle Path: Utilize strategies to resist urges, solve problems, and promote healthy behavior and decision-making.

A nine-year-old child with a history of attention-deficit/hyperactivity disorder that is well controlled with a long-acting stimulant is recently observed by teachers staring out the window and seems to be "in another world" for minutes at a time. The psychiatrist refers the child for an electroencephalogram that shows diffuse alpha rhythm during hyperventilation. Which of the following is the best diagnosis?

* Normal behavior Absence seizures Non-epileptic seizure Benign rolandic epilepsy Benign paroxysmal upgaze of childhood 2019 Child: 80 A diffuse alpha rhythm refers to a pattern of regular and smooth brain waves that are present throughout various regions of the brain. This rhythm is typically observed when a person is relaxed and awake, but not actively engaged in a task. There are several possible explanations for a diffuse alpha rhythm: • Normal resting state: The most common reason for a diffuse alpha rhythm is that the person is simply in a relaxed, resting state with their eyes closed. This is considered a normal finding on an EEG. • Drowsiness or sleep: A diffuse alpha rhythm can also be seen when a person is drowsy or transitioning into light sleep . This is because the brain's activity slows down as it prepares for sleep, and alpha waves often dominate during this stage. • Meditation or deep relaxation: Some individuals may exhibit a diffuse alpha rhythm during meditation or other forms of deep relaxation techniques. This is due to the calming effect these practices have on the brain, promoting a state of mental and physical rest. • Neurological disorders: In some cases, a diffuse alpha rhythm may be indicative of certain neurological disorders, such as encephalopathy or dementia. These conditions can cause disruptions in normal brain activity, leading to the presence of diffuse alpha waves. • Medications or substances: Certain medications, drugs, or substances can also influence brain wave patterns and lead to a diffuse alpha rhythm . Examples include sedatives, anti-anxiety medications, and alcohol. These substances can alter the brain's electrical activity, resulting in the observed rhythm. • Idiopathic: In some instances, a diffuse alpha rhythm may be present without any clear cause. This is referred to as idiopathic, meaning the reason for the rhythm cannot be determined. It is important for healthcare professionals to consider the patient's medical history and other factors when interpreting an EEG with a diffuse alpha rhythm.

Which of the following recommendations was made based on the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA) at the six- to eight-year follow up regarding the treatment of attention-deficit/hyperactivity disorder (ADHD) from childhood to adolescence?

* Periodic drug holidays should be given to assess continued need and benefit. The ADHD adolescents in treatment will normalize academically to the non-ADHD adolescents. Maintain intensive medication management treatment through adolescence for continued benefit. Initial benefits of combined treatment of intensive therapy and medication management are maintained through adolescence. Adolescents have better adherence to medication management, thus other interventions for ADHD symptoms are not as necessary. 2019 Child: 24 Conclusions from the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA): - An intensive, multimodal approach to the treatment of Attention Deficit Hyperactivity Disorder (ADHD) is the most effective solution available and leads to the best outcomes. - Combining medication and behavioral treatment can lead to significant improvements in social, academic, and psychological functioning for children with ADHD, and these improvements persist. - ADHD medications (stimulants) are safe and effective and can significantly improve symptoms. - A combination of medication and psychosocial interventions is the most effective way to manage long-term use of stimulant medications; this approach lowers the risk of relapse and helps children maintain their attained therapeutic gains. Dosage, adherence, side effects, and clinical monitoring of medication treatment should be taken into consideration to ensure the best outcomes. The MTA study showed that the benefits of medication and psychosocial interventions for treating ADHD continued up to three years after the initial treatment was completed. The improvements in academic, social, and psychological functioning persisted in the teenage years. The study also found that those who failed to complete the full treatment course showed a decline in functioning, suggesting that complete adherence to treatment is important for long-term benefits. The MTA study found that periodic drug holidays can be beneficial as the child transitions into adolescence. Drug holidays can be used to evaluate whether the medication is still necessary and effective, and whether modifications may be necessary as the child's needs evolve. The study found that such drug holidays do not pose a risk of relapse, and may actually help the child maintain their attained therapeutic gains.

A youth who has been on long-term risperidone treatment develops tardive dyskinesia which continues despite initially reducing the dose, and then sequential optimal trials of aripiprazole, olanzapine and quetiapine, each for sufficient duration and dose. The most appropriate next step is to start which of the following treatments?

* Switch neuroleptic to clozapine Add Vitamin E to neuroleptic use Switch neuroleptic to fluphenazine Add benztropine to neuroleptic use Add botulinum toxin injections to neuroleptic use 2019 Child: 8 Clozapine is less likely to cause extrapyramidal symptoms (EPS) than other atypical antipsychotics because it has a lower binding affinity for dopamine receptors in the brain. EPS are side effects of antipsychotic medications that can include movement disorders such as tremors, stiffness, and difficulty with coordination. These symptoms are caused by the blockade of dopamine receptors in the brain, which can occur with medications that bind strongly to these receptors. Clozapine has a lower binding affinity for dopamine receptors than other antipsychotics, which means that it is less likely to cause EPS. Additionally, Clozapine has a unique property of binding to multiple receptors in the brain, which may reduce its EPS-inducing properties. Extrapyramidal symptoms (EPS) are primarily associated with the blockade of dopamine receptors in the basal ganglia, which is a specific pathway in the brain that plays a key role in motor control and coordination. The basal ganglia is composed of several structures, including the striatum, globus pallidus, and substantia nigra. The striatum is the primary input nucleus of the basal ganglia and receives dopaminergic input from the substantia nigra. The globus pallidus and substantia nigra are the main output nuclei of the basal ganglia and are involved in the regulation of muscle tone and movement. When dopamine receptors in the basal ganglia are blocked, it can disrupt the normal functioning of this pathway and lead to EPS such as akathisia, parkinsonism, and dystonia.

Which of the following must be present for an adolescent to be diagnosed with borderline personality disorder?

* Symptoms that are present for at least one year A history of suicidal ideation with or without intent to die Lacking significant, ongoing interpersonal intimate relationships Having a significant family history of mood and personality disorders Experiencing early, significant interpersonal violence, harm or abuse 2019 Child: 71 While both adolescents and adults with BPD may exhibit similar symptoms, the presentation and severity of these symptoms can differ due to developmental factors. Adolescents may experience more identity disturbances as they navigate the challenges of adolescence, whereas adults may have a more stable sense of identity but still struggle with self-image. Additionally, the intensity and frequency of symptoms may vary between the two age groups, with adolescents potentially experiencing more severe mood swings and impulsivity. It is crucial for mental health professionals to consider these differences when diagnosing and treating BPD in adolescents and adults.

The psychiatrist serving as an expert witness testifies in court that the adolescent defendant was psychotic at the time of the alleged crime. As evidence of this, the psychiatric cites multiple witnesses who reported that the defendant ran out of his antipsychotic medication and began complaining about hearing voices in the days before the crime. The prosecutor objects that the psychiatrist's testimony is predicated on hearsay evidence, but the judge rules that the objection is invalid for which of the following reasons?

* The psychiatrist cited the witness accounts to justify an expert opinion The jury will decide if the psychiatrist's argument is valid and persuasive The prosecutor is attempting to discredit the psychiatrist prior to cross examination The judge considers the witness accounts cited by the psychiatrist to be highly credible The psychiatrist cited the witness accounts to establish the fact of the patient's symptoms 2019 Child: 37 Hearsay evidence is any statement made by a witness that is not based on the personal knowledge of the witness, but rather on something he or she heard from another person. Hearsay evidence is generally not considered to be reliable and, in most cases, is not allowed to be used as evidence in a court of law.

The psychiatrist evaluates a 17-year-old patient who reports sometimes feeling detached from himself and his surroundings. The patient also reports episodes during which he seems to "lose track of time." Friends have told the patient that he has behaved in ways that he does not remember. The patient denies hallucinations. There is no apparent delusional thinking. Reality testing and orientation are intact. The patient's diagnosis is most likely associated with which of the following?

* Trauma Intellectual disability Alcohol and drug use Medical comorbidity and etiology Prodrome to a primary psychotic disorder 2019 Child: 61 Trauma is often the precipitating event for dissociative disorders. Exposure to a traumatic event can cause the individual to dissociate in order to protect themselves from the emotional pain and fear associated with the event. Dissociative symptoms can be a way of coping with or managing the overwhelming emotions that can accompany a traumatic event, or can be a way of avoiding memories or reminders of the event.

When an eight-year-old XY male states that he is a boy, this meets the definition of:

* cisgender. alt-gender. third-gender. transgender. non-conforming gender. 2019 Child: 36

Maternal distress during pregnancy has been demonstrated to lead to heightened psychiatric risk in offspring. Multiple studies have suggested that this risk may be mediated via DNA methylation of glucocorticoid genes in the:

* placenta. fetal neural plate. fetal mitochondria. maternal HPA axis. maternal mitochondria. 2019 Child: 51 Maternal distress during pregnancy has been demonstrated to lead to heightened psychiatric risk in offspring. Multiple studies have suggested that this risk may be mediated via DNA methylation of glucocorticoid genes in the placental tissue of the offspring. Specifically, placental methylation of NR3C1 and NR3C2 genes have been linked to higher risk of psychiatric disorder in the offspring. Animal models have also been used to measure this effect, demonstrating epigenetic programming of offspring behavior in response to maternal stress experienced during pregnancy. Additionally, research suggests that maternal distress during pregnancy is associated with altered methylation of BDNF and Nr3c1 in the hippocampus of the offspring. In humans, maternal distress during pregnancy has been linked to increased rates of anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) in the child. Recent studies suggest that this effect may be chromatin-based, with an epigenetic component to the etiology of these disorders. These findings suggest that maternal distress can alter placental and neuronal epigenetic programming, potentially contributing to the development of psychiatric disorders in subsequent generations.

Parents bring their eight-year-old for psychiatric evaluation due to their child having episodes of screaming loudly almost every night about an hour after falling asleep. When they go to check on the child, they find the child sitting up in bed, staring blankly, and breathing quickly. During these episodes, the child does not seem to see or hear the parents and has no recollection of the episodes when asked about them the next morning. The psychiatrist should tell the family that this condition most likely will:

* remit around puberty. improve during adulthood. remit in the next one to two years. wax and wane throughout adolescence. become more intense during adulthood. 2019 Child: 66 Sleep terrors, also known as night terrors, are a parasomnia disorder that typically affects children between the ages of 4 and 12. However, they can also occur in adults. Sleep terrors usually remit as the child grows older and their sleep patterns mature. In most cases, sleep terrors gradually decrease in frequency and eventually disappear during adolescence. There are several factors that can contribute to the remission of sleep terrors: Improved sleep hygiene: Establishing a consistent bedtime routine, creating a comfortable sleep environment, and avoiding stimulating activities before bedtime can help reduce the occurrence of sleep terrors. Addressing stress and anxiety: Children who experience high levels of stressor anxiety may be more prone to sleep terrors. Providing emotional support, teaching coping strategies, and seeking professional help if necessary can assist in reducing sleep terrors. Developmental milestones: As children grow and reach various developmental milestones, their sleep patterns and brain function evolve, which can lead to a decrease in sleep terrors. Medical intervention: In some cases, sleep terrors may be associated with an underlying medical condition or sleep disorder. Identifying and treating these issues can help alleviate sleep terrors. Medication: While not typically recommended as a first-line treatment, certain medications may be prescribed to help manage severe or persistent sleep terrors. Cognitive-behavioral therapy (CBT): For some individuals,CBT may be an effective approach in addressing the underlying causes of sleep terrors and teaching coping mechanisms to reduce their occurrence.

In a hypothetical study, 60% of adolescents with depression treated with a selective serotonin reuptake inhibitor met the response rate criteria, while those who received a placebo had a response rate of 35%. What is the number needed to treat for this study?

1 * 4 10 40 400 2019 Child: 28 The number needed to treat (NNT) is an estimate of the number of people who need to receive a treatment in order to generate one additional positive outcome. It can be calculated by dividing 1 by the absolute risk reduction (ARR). So, if a treatment resulted in an ARR of 0.2, then the NNT would be 1 divided by 0.2, which equals 5. The absolute risk reduction (ARR) is the difference between the risk of a particular outcome in the control group and the treatment group of an experiment. It is expressed as a percentage or a fraction. For example, if the risk of an outcome in the control group is 20% and the risk of the same outcome in the treatment group is 15%, then the ARR would be 20% - 15% = 5%.

An outpatient clinic uses a newly developed screening tool to assess 100 children for autism. The tool correctly identifies 15 children with autism. However, five children with autism were missed, and three children were identified as having autism when they do not actually have it. What is the sensitivity of this newly developed tool?

5% 15% 20% 67% * 75% 2019 Child: 20

In a common psychological assessment, the subject is tasked to sort cards based on feedback from the tester. When the tester surreptitiously changes the rules for correct card assortment, the subject must notice the change in feedback, infer the new rule, and adopt a new sorting strategy. This psychological assessment best measures which of the following cognitive domains?

Attentional capacity Constructional abilities * Executive functioning Short-term memory Visual perception 2019 Child: 49 The Wisconsin Card Sorting Test (WCST) is a cognitive assessment measure used to assess executive functioning in a person's brain. It is measuring a person's ability to identify and adapt to new situational contexts. The test requires the participant to sort cards according to various stimuli and evaluate whether they have sorted them correctly while being unaware of the correct answer. Some tests commonly used to assess attentional capacity are the Stroop Test, the Digit Span Test, and the Continuous Performance Test (CPT). the Constructional Abilities Test, which is used to evaluate an individual's ability to construct visual figures with blocks of various sizes and shapes. This test is used to assess the perceptual and motor abilities of an individual, as well as his or her problem-solving skills. It is commonly used to identify areas of strength and weakness in children and adults. Common psychological assessment tests used to assess short-term memory include: the Rey Auditory Verbal Learning Test (RAVLT), the Rey-Osterrieth Complex Figure Test (ROCF), the Wechsler Memory Scale (WMS) and the California Verbal Learning Test (CVLT). One common psychological assessment test of visual perception is the Visual Perception Test (VPT). This test is used to assess visual perceptual skills, including form discrimination, visual memory, spatial relationships, visual attention, and visual closure.

An eight-year-old with severe anxiety has benefited from weekly in-person psychotherapy to date, but the long distance between the patient's home and the clinic precludes continuing this treatment. Based on the available evidence, web-based therapy for this child would most likely have the most beneficial effect if which of the following occurs?

Augmentation with pharmacotherapy Minimization of pictures and game play to avoid distraction Multiple sessions are digitally recorded for viewing at home * Implementation with the support of a parent, caregiver, or teacher Utilization of text-based input by the child to log events and feelings 2019 Child: 14 Web-based therapy for children can be beneficial, but it is likely to have its most effective benefits when combined with implementation and support by a parent, caregiver, or teacher. This is because parents, caregivers, and teachers will be able to provide direct support to the child during the therapy, helping to facilitate discussion and ensure that the child is getting the most out of the therapy. They will also be able to provide guidance and support in the application of newly-learned skills in the real world. In addition, having an adult partner in the therapy can provide a greater level of accountability with regards to the child's progress. Finally, they can provide additional insights into the child's behavior that may not be readily visible to the therapist.

Which of the following processes is mostly likely to facilitate a family's adaptation to the death of a child?

Avoiding overt displays of parental grief Encouraging the surviving children to assume roles previously filled by the deceased Limiting surviving siblings' exposure to daily life stressors for at least six months * Maintaining a legacy through memories and physical reminders of the deceased Finding substitute caretakers for the surviving children to allow parents to focus on their relationship 2019 Child: 83 GRIEF COUNSELING PROCESS: Acknowledging the loss: Accepting the reality of the child's death and allowing oneself to experience the pain of grief. Seeking support: Connecting with others who have experienced a similar loss, such as support groups, therapists, or spiritual leaders. Expressing emotions: Encouraging family members to express their feelings about the loss, whether through talking, writing, or creative outlets. Preserving memories: Honoring the child's memory by creating keepsakes, sharing stories, or engaging in activities that the child enjoyed. Adjusting to the new reality: Learning to adapt to life without the child, including changes in family roles and routines. Developing coping skills: Identifying healthy ways to manage emotions and stress, such as exercise, meditation, or spending time in nature. Reinvesting in life: Gradually re-engaging with activities and interests, and finding new sources of meaning and purpose. Creating a new family narrative: Integrating the loss into the family's ongoing story, and developing a sense of resilience and growth.

An adolescent boy was engaged in therapy lasting ten weeks. During this therapy the boy was able to relate his test-taking anxiety, chronic feeling of interpersonal inadequacy, and inaccurate sense of physical unattractiveness to an earlier relationship with his father who was often critical and harsh, and unpredictably embarrassed the boy in social settings. Which of the following therapies was most likely utilized?

Behavioral Cognitive behavioral Dialectical behavioral Motivational interviewing * Short-term psychodynamic 2019 Child: 4 Traditional psychodynamic therapy is a longer-term treatment that usually involves weekly sessions over a period of several months or even years. The focus of traditional psychodynamic therapy is on exploring the patient's unconscious thoughts, feelings, and behaviors that may be contributing to their current problems. This therapy aims to help the patient gain insight and understanding into their problems and how they developed, and how to change their maladaptive ways of thinking, feeling and behaving. Short-term psychodynamic therapy, on the other hand, is usually a more focused and time-limited treatment that may last for several weeks or months. The focus of short-term psychodynamic therapy is on addressing specific, well-defined problems or symptoms that the patient is experiencing. This therapy aims to help the patient identify and understand the underlying causes of their problems, but also providing them with specific techniques or strategies to cope with them in the short term. In summary, traditional psychodynamic therapy is a longer-term treatment that focuses on exploring the patient's unconscious thoughts, feelings, and behaviors, while short-term psychodynamic therapy is a more focused and time-limited treatment that addresses specific problems or symptoms.

Which of the following psychiatric disorders is most likely comorbid in an adolescent with diabetes?

Bipolar disorder Conduct disorder * Major depressive disorder Oppositional defiant disorder Attention-deficit/hyperactivity disorder 2019 Child: 16 Common psychiatric disorders that are comorbid with diabetes in adolescents include depression, anxiety, attention deficit hyperactivity disorder (ADHD), and eating disorders. The most likely psychiatric disorder to be comorbid in an adolescent with diabetes is depression, as it is the most prevalent of all the disorders. The most prevalent psychiatric disorder in adolescence is depression. According to the World Health Organization, depression is the most common mental health disorder among adolescents, affecting up to 20% of them worldwide.

An 11-year-old patient is referred for evaluation of a six-month history of weight loss. The child is significantly underweight by all standard measures for age and gender, and general medical workups have been negative. On interview, the child denies intentional weight loss and says, "I'm just a picky eater" and "trying to be healthy." When the doctor mentions the child is underweight, the child acknowledges this and reports currently trying to gain weight. When a plan for increasing caloric intake is discussed, the patient refuses most of the potential options saying either they do not like the food or they would not eat the food. When the health consequences of being underweight are brought up, the child says, "eating that food isn't healthy either." Which of the following is the most likely diagnosis?

Bulimia nervosa * Anorexia nervosa Binge-eating disorder Avoidant/restrictive food intake disorder Other specified feeding or eating disorder 2019 Child: 81

A 15-year old has a history of absence seizures, and has recently developed myoclonic jerks. The myoclonic jerks are reported to be more intense and frequent the mornings after the adolescent stays up late to complete homework assignments. Which of the following electroencephalogram (EEG) patterns is most likely to be observed in the adolescent?

Centrotemporal spikes Diffuse slow spike-and-wave pattern Symmetrical 3-Hz spike-and-wave activity Occipital spikes attenuated by eye opening * Brief bursts of generalized 3.5 to 4.0-Hz spike-and-waves 2019 Child: 42 What kind of childhood and Adolescent seizures result in EEG patterns characterized by Brief bursts of generalized 3.5 to 4.0-Hz spike-and-waves? This type of EEG pattern is known as epileptic spike-wave discharge (ESWD). It is seen in children and adolescents with absence (petit mal) seizures. What kind of childhood and Adolescent seizures result in EEG patterns characterized by Centrotemporal spikes? Centrotemporal spikes (also known as Rolandic spikes) are EEG patterns typically seen in children with benign Rolandic epilepsy, which is the most common type of childhood seizure disorder. It is characterized by confusion, facial twitching, and tongue movement. These seizures tend to occur during sleep and typically resolve by adolescence. The diffuse slow spike-and-wave pattern is associated with childhood absence epilepsy. What kind of childhood and Adolescent seizures result in EEG patterns characterized by Occipital spikes attenuated by eye opening? This pattern is most commonly seen in benign occipital epilepsy of childhood (BOEC). BOEC is a benign self-limiting seizure disorder in children and adolescents characterized by epileptic episodes with EEG patterns characterized by occipital spikes that are attenuated or abolished by eye opening. Symptoms typically include repeated episodes of staring, visual illusions or hallucinations, and eye deviation often occurring during drowsiness or sleep. what is the difference between Symmetrical 3-Hz spike-and-wave activity and Brief bursts of generalized 3.5 to 4.0-Hz spike-and-waves? Symmetrical 3-Hz spike-and-wave activity is a continuous pattern that consists of two or three bursts of spikes or sharp waves that occur at a frequency of three times per second. Brief bursts of generalized 3.5 to 4.0-Hz spike-and-waves consist of a series of fast bursts of spikes or sharp waves that occur at a frequency of three and a half to four times per second. In symmetrical 3-Hz spike-and-wave activity, the seizures tend to last longer, occur on both sides of the brain simultaneously, and involve more of the brain than in brief bursts of generalized 3.5 to 4.0-Hz spike-and-waves. The seizures associated with the brief bursts of generalized 3.5 to 4.0-Hz spike-and-waves tend to be shorter and more localized, and are often associated with myoclonic jerks.

A 13-year-old is brought for an initial assessment. The patient has an extensive psychiatric history with multiple diagnoses. The psychiatrist chooses to combine the unstructured interview with a more structured technique using a respondent-based interview. Which of the following would be most representative of a structured assessment using this technique?

Child Assessment Schedule * Diagnostic Interview Schedule for Children Child and Adolescent Psychiatric Assessment Interview Schedule for Children and Adolescents Kiddie Schedule for Affective Disorders and Schizophrenia 2019 Child: 97 **Child Assessment Schedule (CAS):** Semi-structured, ages 4-16, emotional and behavioral problems, clinical and research purposes. **Diagnostic Interview Schedule for Children (DISC):** Structured, ages 6-17, psychiatric disorders based on DSM criteria, research, clinical practice, and epidemiological studies. **Child and Adolescent Psychiatric Assessment (CAPA):** Semi-structured, ages 9-17, psychiatric symptoms, functioning, and impairment, clinical and research settings. **Interview Schedule for Children and Adolescents (ISCA):** Semi-structured, ages 6-18, psychopathology assessment, clinical assessment, treatment planning, and research purposes. **Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS):** Semi-structured, ages 6-18, current and past episodes of psychopathology based on DSM criteria, evaluation of mood disorders, anxiety disorders, and psychotic disorders, clinical and research settings. A structured interview is an interview in which the questions are predetermined and asked in a specific order, ensuring that each participant receives the exact same questions. This type of interview is highly standardized and leaves little room for variation or follow-up questions. Structured interviews are often used to gather quantitative data and allow for easier comparison across participants. A semi-structured interview, on the other hand, includes a set of predetermined questions but also allows the interviewer to ask additional follow-up questions or explore topics in more depth as they arise during the conversation. This type of interview provides more flexibility and allows for a deeper understanding of the participant's experiences and perspectives. Semi-structured interviews are often used in qualitative research to gather rich, detailed information about a specific topic.

Which of the following dyadic therapy approaches has the strongest evidence for reducing physically abusive parenting behaviors?

Child-parent psychotherapy Infant-parent psychotherapy Reflective parenting programs * Parent-child interaction therapy Dyadic developmental psychotherapy 2019 Child: 54 Child-parent psychotherapy seeks to reinforce the bond between a parent and their child through increased communication and improved problem-solving skills. Infant-parent psychotherapy focuses on the relationship between parent and infant and how this interaction affects emotional and cognitive development. Reflective parenting programs help parents gain insight into their parenting style and how it affects their child's behaviour. Parent-child interaction therapy focuses on improving the quality of interaction between parent and child by teaching communication and problem-solving skills. Finally, dyadic developmental psychotherapy is a technique designed to create a sensitive, secure attachment between parent and child, using the latest research on child development and the role of parents in their child's development. The Parent-Child Interaction Therapy (PCIT) has the strongest evidence for decreasing physical abusive parenting behaviors. It is an empirically supported treatment originally developed as a behavioral approach for working with young children with severe externalizing problems, but has been found to be effective with a wide range of parents and children age 2-7. PCIT is designed to improve the quality of the parent-child relationship and change parent-child interaction patterns.

Which of the following neurotransmitter systems is most prevalent and widely distributed in the human brain?

Cholinergic Dopaminergic * Glutamatergic Serotonergic Noradrenergic 2019 Child: 47 The most prevalent and widely distributed neurotransmitter system in the human brain is the glutamate system. It is involved in memory, learning, emotion, motivation, and more. Glutamate is the most common excitatory neurotransmitter in the brain.

Parents request that the psychiatrist treat their child with complementary and alternative medicine (CAM) modalities. Which of the following is most likely to be accurate regarding the psychiatrist's medicolegal dilemma in this situation?

Congress ruled that malpractice insurers must cover the use of CAM modalities. * Recommending a CAM modality and obtaining informed consent makes the provider responsible for this treatment. Referring the patient to a CAM specialist will shield the psychiatrist from medical liability related to use of a CAM modality. Laws regulating use of CAM modalities are likely to be consistent between the different state jurisdictions where the psychiatrist trained and practices. Possibility is nil of being charged with fraud for submitting a claim for reimbursement for a CAM intervention not generally recognized as medically necessary. 2019 Child: 79

During a psychiatric evaluation, which of the following methods would best help develop the therapeutic alliance between a psychiatrist and a new immigrant patient and family?

Consulting with the immigrant family's traditional healers Conducting the initial appointment with the identified patient only Relying on previous clinical experiences with this immigrant population * Using a qualified interpreter who has proficiency in the family's language of origin Maintaining consistent individualistic boundary practices across the spectrum of cultures 2019 Child: 5

Physical sexual arousal and climax are organized at which of the following levels of the central nervous system?

Cortex Brain stem * Spinal cord Limbic system Adrenal glands 2019 Child: 92 The spinal cord is pivotal for the regulation of sexual arousal and climax as it receives, processes, and transmits sensory input from erogenous zones, controls the autonomic nervous system's response, releases neurotransmitters, activates motor neurons for reflexes related to climax, and connects with higher brain centers to modulate behaviors, hormones, and learning/memory associations. It also participates in the development of sexual preferences and orientation, as well as management of inhibition and resilience.

An adolescent child of immigrant parents presents with symptoms of depression. The adolescent attributes this to frequent comments made by the parents that the child is obese. The parents confirm they make such comments. The parents say that in their native country, "you're expected to look a certain way'' and "all the other parents in our country do it this way." Which of the following is the most specific term for justifying problematic behavior in this manner?

Cultural bias * Cultural mask Category fallacy Cultural relativism Acculturative family distancing 2019 Child: 53 Cultural relativism is the concept that behaviors or beliefs should be evaluated in the context of the culture from which they come, rather than in comparison to another culture's societal norms. Cultural masking is the process of hiding or disguising certain aspects of one's culture in order to assimilate into another culture.

Which of the following symptoms of oppositional defiant disorder help to distinguish it from conduct disorder?

Deceitfulness Physical aggression Destruction of property * Emotional dysregulation Conflicts with authority figures 2019 Child: 39 What is the best way to differentiate the symptoms of Oppositional Defiant Disorder from conduct disorder? The best way to differentiate the symptoms of Oppositional Defiant Disorder (ODD) from conduct disorder is to assess the severity and frequency of the disruptive behaviors. ODD is characterized by defiant and hostile behaviors that are not seen with conduct disorder. Symptoms of ODD include frequent temper tantrums, argumentativeness, defiance of authority figures, and an unwillingness to comply with rules. In contrast, conduct disorder is more aggressive, with the presence of physical aggression, vandalism, truancy, and deceitfulness. emotional dysregulation is a core symptom of oppositional defiant disorder. Other symptoms may include difficulty with impulse control, frequent temper outbursts, and argumentative or defiant behavior.

One parent of a child patient requests that the child's treating psychiatrist write a letter of support for that parent's fitness as a parent to be used in an upcoming custody dispute during a tumultuous divorce. Which of the following is the best course of action for the child's psychiatrist to take?

Discontinue treatment of the child to avoid double agentry * Recommend that the parent make their request to a non-treating psychiatrist Provide a supportive letter if the parent's parenting is adequate and the patient assents Evaluate the parent and then write a letter if the parent waives the right to read it before it is sent to the judge Ask the parents to agree to appoint the child's psychiatrist as an independent witness to offer expert opinions to the judge on the fitness of each to parent 2019 Child: 41 What is double agentry in forensic psychiatry? Double agency in forensic psychiatry is when a psychiatrist is asked to provide a professional opinion in legal proceedings, such as a court hearing or inquisition. The psychiatrist is either asked to represent one side, or may be asked to remain impartial and provide an independent assessment. This can be a difficult and complex situation for a psychiatrist, as they may have to provide assessments that are at odds with their own ethical and professional codes, or risk breaching confidentiality.

During long term therapy, the therapist notices that, when talking about continuing to use substances, the patient anticipates a response of rejection and criticism from the therapist, like the patient's parents. This dynamic is best understood by which of the following psychoanalytic theories?

Ego ideal Libidinal drives * Object relations Mirroring transference Transmuting internalization 2019 Child: 78 Object relations theory is a psychoanalytic approach to understanding human behavior, relationships, and development. The basic tenants of this theory include: Internalized objects : Individuals create mental representations of significant others, known as internalized objects, which influence their thoughts, feelings, and behaviors. Object relations: These internalized objects form the basis of an individual's relationships with others, as well as their self-concept. Developmental stages: Object relations theory posits that individuals progress through a series of developmental stages, during which their internalized objects and relationships evolve. Separation-individuation: A key aspect of development is the process of separation-induation, during which individuals differentiate themselves from their primary caregivers and establish their own identity. Transference : In therapeutic settings, individuals may unconsciously transfer their feelings and expectations from past relationships onto the therapist, which can provide valuable insight into their internalized objects and relational patterns. Defense mechanisms: Individuals often employ various defense mechanisms to protect themselves from anxiety and emotional pain related to their internalized objects and relationships. Attachment: Secure attachment to caregivers during early development is crucial for healthy object relations and emotional well-being. Psychopathology: Difficulties in object relations can contribute to the development of mental health issues and maladaptive patterns of behavior.

Which of the following best describes a mechanism by which treatment goals are achieved in child-parent psychodynamic therapy?

Enhancement of parental organizational skills and time management Enhancement of parental quality of life by reducing parents' dysregulated emotions Increase in child's self-esteem through employment of free association techniques * Development of parental insight into use of the child as a negative transference object Development of child's awareness of how the parent's past experiences impact the relationship 2019 Child: 40 What best describes a mechanism by which treatment goals are achieved in child-parent psychodynamic therapy? Child-parent psychodynamic therapy emphasizes creating a collaborative relationship between the therapist and the family in order to promote understanding of the family system and identify potential issues that may lead to improvement in the relationship and in the individual. The underlying mechanism is the joint exploration and discussion of the past, the present, and the potential, in order to create a meaningful and positive interaction amongst the family members. This process helps to promote insight, compassion, and perspective, ultimately leading to the achievement of treatment goals. How does it lead to the Development of parental insight into use of the child as a negative transference object? Child-parent psychodynamic therapy encourages parents to explore their own emotional reactions to their child, by reflecting on their own history and the family dynamic. In doing so, parents can address their own unresolved issues that may be contributing to their negative behaviour toward the child. This process gives parents insight into their own use of the child as a negative transference object by allowing them to become aware of their own feelings and reactions towards the child and learn to respond more positively. what is a negative transference object? A negative transference object is a person or situation that a person unconsciously transfers the unwanted emotions, memories and desires onto. This can lead to inappropriate responses, such as using the person or situation as a scapegoat for negative feelings, avoiding or denying the person or situation, or trying to control them. Examples of negative transference objects include a child, an estranged family member, or an ex-lover.

Which of the following represents a primary parameter used in the scoring of sleep states?

Heart rate * Muscle tone Oxygenation Breathing rate Core body temperature 2019 Child: 56 parameters used in the scoring of sleep states: Electroencephalogram (EEG) Electrooculogram (EOG) Electromyogram (EMG) Respiratory effort Heart rate Body position

Parents bring their six-year-old natal boy for evaluation. They report that the child has repeatedly identified as a girl since early childhood, with consistent expression of strong preferences for feminine clothes and activities. The parents are concerned but have tried to be accepting and have permitted the patient to dress and play as a girl. The patient just started a new school which has different uniforms based on gender. The child has refused to ... wear the boys' uniform. For several weeks, the child has been refusing to attend school, complaining of frequent stomachaches, having difficulty sleeping and is often moody and irritable. Which of the following would be the best treatment approach?

Home-school the patient until he is less symptomatic Implement a behavioral plan to change patient's attitude Provide psychoeducation on importance of fitting in at school * Advocate for child to wear uniform that is consistent with gender identity Prescribe an antidepressant to address the patient's symptoms of anxiety 2019 Child: 93

Children typically demonstrate the most overt sexual interest and behavior during which of the following developmental stages?

Infancy Toddlerhood * Preschool Early school-age Late school-age 2019 Child: 6

A previously healthy child with a history of attention-deficit/hyperactivity disorder (ADHD) and depression is medically admitted for vomiting, headache, increased intracranial pressure, hepatosplenomegaly, skin desquamation, and musculoskeletal/abdominal pain. Caregivers report use of cod liver oil for the child's depression and ADHD over the last few years with steady increases in dosing due to lack of perceived effectiveness. The child has an otherwise normal diet and also is prescribed melatonin, and clonidine. Toxicity due to which of the following is the most likely etiology of the patient's symptoms?

Lead Clonidine * Vitamin A Melatonin Omega-3 fatty acids 2019 Child: 35 What are the symptoms of vitamin A toxicity? Symptoms of vitamin A toxicity include nausea, headache, dizziness, fatigure, dry skin, joint pain, irritability, blurred vision, and anorexia. Other more serious symptoms include conjunctivitis, hair loss, and liver damage. In extreme cases, coma and death may occur. What is the evidence for omega3 fatty acids in the treatment of ADHD? Studies have shown that omega 3 fatty acids can improve the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in both children and adults with the condition. In studies, omega 3 fatty acids have been found to improve symptoms such as hyperactivity, impulsivity, and inattention. The most common source of omega 3 fatty acids is fish oil supplementation. How effective is it? The results of studies into the effectiveness of omega 3 fatty acid supplements in the treatment of ADHD are mixed. Some studies have found that supplementation with omega 3 fatty acids can improve symptoms like impulsivity, attention, and hyperactivity in children and adults with ADHD, while others have found no benefit. Overall, the evidence suggests that omega 3 supplements may be of some benefit for some people with ADHD, but further research is needed to confirm this.

Which of the following medications has been shown to reduce weight gain associated with antipsychotic medication use?

Lithium Clonidine * Metformin Bupropion Lamotrigine 2019 Child: 27 There are several medications which can be used to reduce weight gain associated with antipsychotic medication use, including Metformin, Orlistat, Topiramate, Sibutramine, Naltrexone-Bupropion and Saxenda. Studies have suggested that Metformin can be effective at reducing weight gain associated with antipsychotic medication use. A study from 2006 found that Metformin was associated with a decrease in weight gain associated with the use of atypical antipsychotics, with a mean reduction of 5.3% over a 3-month period. Metformin use in children and adolescents can be associated with specific risks, such as lactic acidosis and hypoglycemia, especially in those with liver or kidney problems. Additionally, there have been reports of metabolic acidosis, increased intravascular volume and hypoxic states having been associated with Metformin therapy, although this is rare. Psychiatrists should consider the potential risks versus benefits of prescribing Metformin before giving it to a child or adolescent for antipsychotic induced weight gain. They should also ensure that the patient's liver and kidney function are monitored closely, as this can help to reduce the risk of adverse effects. Additionally, they should advise patients to increase their physical activity and follow a healthy diet, as this can help to optimize the effects of Metformin.

If an adolescent on an atypical antipsychotic medication presents with akathisia but without dystonia, which of the following medications would be most appropriate?

Lithium * Propranolol Benztropine Trihexyphenidyl Diphenhydramine 2019 Child: 52

An unmedicated 17-year-old patient presents with complaints of an uncomfortable and irresistible urge to move the legs, which usually occurs when laying down at bedtime, and is immediately relieved following movement, stretching, or walking around. Which of the following is the most appropriate first step intervention?

Low-dose clonidine Low-dose propranolol Low-dose diphenhydramine High-dose omega-3-fatty acids * Iron supplementation if deficient 2019 Child: 55

The majority of graduate medical education funding is derived from what source?

Medicaid * Medicare Private funds State budgets Hospital/institutional budgets 2019 Child: 45 Medicare is a federal health insurance program that provides health coverage for those over the age of 65, people with certain disabilities, and people with end-stage renal disease. Medicaid is a state-run health insurance program funded by both the federal and state governments that provides health coverage for people with low incomes, depending on their financial and household situation.

A student has been referred for a school-initiated psychiatric consultation. The parents refused consent. What is the most appropriate next step for the psychiatrist to take?

Meet with the student at least once to assess for risk of harm to self or others Recommend that the school obtain a court order for the evaluation to proceed * Observe the child in school unobtrusively and make recommendations to teachers Refer the student and parents for an assessment in the psychiatrist's private practice Advise the school to initiate a special education evaluation despite parental objections 2019 Child: 58

A 16-year-old is receiving cognitive behavioral therapy for depression. As part of the treatment, the adolescent is maintaining a thought record to identify automatic thoughts. He records, "I got my report card and found out I got an F in math this semester. I'm such a loser." The adolescent fails to write about the A's he received in his other subjects. The adolescent's thought record best exemplifies which of the following cognitive errors?

Minimizing Fortune telling Personalization Catastrophizing * Disqualifying the positive 2019 Child: 74

When e-mailing or providing mental health information on electronic platforms, the most important reason for providing a disclaimer that the information does not constitute professional advice is to make which of the following professional issues clear?

More involved care will require payment The limits of the physician's competence * That there is no doctor-patient relationship Transfer of responsibility for care to another provider The psychiatrist is providing only personal knowledge 2019 Child: 30 What are the legal components of a doctor patient relationship Compliant duty: This is when a doctor has a duty to provide proper medical care for their patient. Fiduciary duty: This is when a doctor must have a patient's best interest in mind and act accordingly. Duty of confidentiality: This is when a doctor must keep all medical information private, even if the patient requests it be discussed with a third party. Informed consent: This is when a doctor must provide full disclosure to the patient of the risks, benefits, and alternatives of any proposed treatment. Duty to refer: This is when a doctor must refer patients to specialists if their condition warrants it Negligence: This is when a doctor fails to provide a standard of care that a reasonably prudent doctor would provide in the same situation.

The blood concentration of lithium should be obtained at which of the following times?

Morning, within an hour after the last dose * Morning, twelve hours after the last dose Afternoon, five hours prior to the next dose Afternoon, five hours after the last dose Late afternoon, as close as possible to the next dose 2019 Child: 70 Timing: Ideally, lithium levels should be checked 12 hours after the last dose. This allows for a more accurate representation of the steady-state concentration in the bloodstream. Frequency: Monitoring frequency may vary depending on individual needs and physician recommendations. In general, lithium levels should be checked within the first week of starting treatment, then every 2-4 weeks until a stable level is reached. Once stable, levels can be checked every 3-6 months.

A sleep study of an eight-year-old shows multiple brief arousals at the transition points between REM and non-REM sleep. Which of the following best explains these arousals?

NREM parasomnia * Normative movement Sleep-related hypoventilation Circadian rhythm sleep disorder Periodic limb movement disorder 2019 Child: 73

Which of the following non-pharmacological interventions for attention-deficit/hyperactivity disorder has been most consistently validated in treatment trials?

Neurofeedback Social skills training * Behavioral parent training Cognitive behavioral therapy Removal of sugar and food additives from the diet 2019 Child: 15 Behavioral parent training (BPT) is a type of therapy that teaches parents specific strategies and techniques for managing their child's behavior. BPT helps parents learn how to develop and maintain a healthy family dynamic, create effective discipline practices, and provide support for their child's development. BPT has been found to be effective at reducing symptoms of ADHD in children by teaching parents how to handle difficult behavior, increase positive reinforcement, identify triggers that lead to problem behavior, and provide structure and routine. BPT also helps parents create an environment in which positive behavior is encouraged and nurtured. The goal of BPT is to reduce ADHD symptoms and teach better ways for families to handle conflicts and support the child's development.

Which of the following neurotransmitters is hypothesized to act by retrograde transport involving diffusion from a postsynaptic neuron to a presynaptic one?

Nitric oxide Eicosanoids Neurosteroids * Endocannabinoids Hydrogen sulphide 2019 Child: 68 The significance of endocannabinoids neurotransmitters acting by retrograde transport involving diffusion from a postsynaptic neuron to a presynaptic one is that it plays a crucial role in the regulation of synaptic transmission and plasticity. This unique mode of communication allows for the fine-tuning of neuronal activity and contributes to various physiological processes, such as: Modulation of neurotransmitter release: Endocannabinoids can inhibit the release of certain neurotransmitters, thereby controlling the intensity and duration of synaptic signaling. Regulation of synaptic plasticity: By modulating the release of neurotransmitters, endocannabinoids can influence the strength of synaptic connections, which is essential for learning and memory formation. Neuroprotection: Endocannabinoids canprovide protection to neurons from damage or degeneration, particularly in response to injury or neurodegenerative diseases. Stress response and anxiety regulation: Endocannabinoids play a role in the body's response to stress, helping to regulate anxiety and maintain emotional balance. Pain modulation: They are involved in the modulation of pain signals, contributing to the analgesic effects of certain compounds, such as cannabinoids found in cannabis. Appetite and energy balance: Endocannabinoids are involved in the regulation of appetite and energy homeostasis, influencing feeding behavior and metabolism. Immune system modulation: They can also influence immune system function, playing a role in the regulation of inflammation and immune cell activity.

Which of the following most directly influences neuronal survival, migration, process outgrowth, and the plasticity underlying learning and memory?

Oxytocin Nitric oxide lnterleukin-2 Endocannabinoids * Brain-derived neurotrophic factor 2019 Child: 90 BDNF, or Brain-Derived Neurotrophic Factor, is a crucial protein that supports the growth, maintenance, and survival of neurons. It plays a significant role in various aspects of brain function, including: Neuronal survival : BDNF promotes the survival of existing neurons by binding to its high-affinity receptor, TrkB. This interaction activates intracellular signaling pathways, such as PI3K/Akt and MAPK/ERK, which ultimately prevent apoptosis and promote cell survival. Migration: BDNF influences the migration of neurons during early brain development. It stimulates the movement of neurons towards their appropriate positions in the brain by activating various signaling pathways, including the PI3K/Akt and MAPK/ERK pathways. This ensures proper connectivity and functionality of the neural network. Process outgrowth : BDNF is essential for the growth and differentiation of neuronal processes, such as dendrites and axons. It promotes process outgrowth by interacting with TrkB receptors and activating downstream signaling cascades, like the Rho-GTPase and Cdc42 pathways, which regulate cytoskeletal dynamics and promote neurite extension. Plasticity underlying learning and memory: BDNF plays a key role in synaptic plasticity, the ability of synapses to strengthen or weaken over time. It supports the formation and stabilization of new synapses, as well as the modification of existing ones, through processes like long-term potentiation (LTP) and long-term depression (LTD). BDNF facilitates these changes by modulating the expression of synaptic proteins, regulating the trafficking and function of neurotransmitter receptors, and influencing the activation of intracellular signaling pathways, such as the CaMKII, PKA, and PKC pathways. These processes ultimately contribute to the consolidation and retrieval of memories, as well as the adaptation of neural circuits in response to learning experiences.

Research on typical development has focused on the acquisition of language as a foundation for cognitive and other areas of development. Which of the following has been demonstrated to be most significantly related to language proficiency in preschoolers in the United States?

Parental age Geographical location * Socioeconomic status Parental native language Contact with other children 2019 Child: 7 Socioeconomic status (SES) is closely related to language proficiency in preschoolers in the United States. Research has shown that children from low-SES backgrounds are more likely to have lower levels of language proficiency than children from higher-SES backgrounds. This can be due to a number of factors, including differences in access to quality early childhood education, exposure to language and literacy at home, and parenting practices that support language development. Children from low-SES backgrounds are more likely to attend preschools that have fewer resources and less qualified teachers, and they may not have the same opportunities to learn and practice language as children from higher-SES backgrounds. Additionally, children from low-SES backgrounds are more likely to be exposed to fewer books, educational toys, and other materials that promote language development. They also may not have the same opportunities to interact with adults and older children who can help them learn new words and concepts. Furthermore, parents from low-SES backgrounds may have less education and be less likely to engage in activities that promote language development such as reading to their children, telling them stories, or engaging them in conversation. It is important to note that this does not mean that all children from low-SES backgrounds will have lower language proficiency, but rather that children from low-SES backgrounds are more likely to have lower language proficiency than children from high-SES backgrounds. Also, early intervention programs and policies that aim to provide children from low-SES backgrounds with more opportunities to learn and practice language can help to close this gap.

A seven-year-old is being evaluated by a psychiatrist for inattention. The child's teacher expressed concern to the parents that the child seems to stare off for 8-10 seconds several times daily when in class. This behavior has also coincided with a decline in the child's grades. While staring off, the child is observed to engage in eye blinking. After obtaining more collateral information from the child's parents and teacher, which of the following is the best next step in the treatment of this child?

Prescribe an alpha-2 agonist Prescribe a stimulant medication Obtain a computed tomography scan * Obtain electroencephalography monitoring Obtain a magnetic resonance imaging scan 2019 Child: 85

Which of the following models of psychotherapy involves writing out a narrative of a negative experience as a part of treatment?

Rational-emotive therapy Mentalization-based therapy Interpersonal psychotherapy Mindfulness-based stress reduction * Trauma-focused cognitive behavioral therapy 2019 Child: 69 Trauma-focused Cognitive Behavioral Therapy (TF-CBT) is a specific type of psychotherapy designed to help children and adolescents overcome the negative effects of traumatic experiences. Some unique features of TF-CBT include: Integration of Cognitive and Behavioral Techniques: TF-CBT combines cognitive and behavioral interventions to address the thoughts, feelings, and behaviors related to the traumatic event. Trauma Narrative: TF-CBT encourages the development of a trauma narrative, which is a detailed account of the traumatic experience. This helps the individual process and make sense of the event. Parent/Caregiver Involvement: In TF-CBT, parents or caregivers are actively involved in the therapy process, providing support and learning new skills to help their child heal from the trauma. Gradual Exposure: TF-CBT uses a gradual exposure approach, allowing the individual to confront and process their traumatic memories in a safe and controlled manner.

A divorced mother brings her 14-year-old child for an initial appointment with the psychiatrist for an evaluation of depression. After interviewing the mother and then separately the child, the psychiatrist confirms the child's diagnosis of depression and finds no evidence of suicidality, self-injurious behaviors, or concerns for safety. The child is amenable to treatment with an antidepressant. The mother reports a shared custody arrangement with the child's father, but that the father "doesn't like medications." Which of the following is the psychiatrist's best course of action?

Recommend family therapy to resolve the inter-parental dispute Hospitalize the child and start an antidepressant as emergency treatment Start an antidepressant with the mother's consent, as it is in the child's best interest * Speak with the father and attempt to obtain his consent for starting the child on an antidepressant Give a prescription for an antidepressant, but tell the mother to discuss with the father whether or not to start the medication 2019 Child: 32

Which of the following is the most important guide when arranging the infrastructure necessary to provide telepsychiatric consultation to a school?

Rehabilitation Act * Family Educational Rights and Privacy Act (FERPA) Patient Protection and Affordable Care Act Health Information Portability and Accountability Act Individuals with Disabilities Education Improvement Act 2019 Child: 12 The Family Educational Rights and Privacy Act (FERPA), the Patient Protection and Affordable Care Act (ACA), the Health Information Portability and Accountability Act (HIPAA), and the Individuals with Disabilities Education Improvement Act (IDEIA) are all federal laws that address different aspects of education and healthcare in the United States. The Family Educational Rights and Privacy Act (FERPA) is a federal law that applies to educational institutions that receive federal funding. It gives parents certain rights with respect to their children's education records, such as the right to inspect and review the records, and the right to seek to have the records amended. It also requires educational institutions to protect the privacy of student education records and limits the sharing of student education records without parental consent. The Patient Protection and Affordable Care Act (ACA) is a federal law that was enacted to increase the availability and affordability of health insurance, and to reduce the number of uninsured Americans. It includes provisions such as the individual mandate which requires most Americans to have health insurance, the expansion of Medicaid, and the creation of health insurance marketplaces. The Health Information Portability and Accountability Act (HIPAA) is a federal law that sets national standards to protect individuals' personal medical and health information. It requires that healthcare providers and insurance companies protect the privacy and security of protected health information (PHI), and it gives individuals certain rights with respect to their PHI, such as the right to access and receive copies of their PHI. The Individuals with Disabilities Education Improvement Act (IDEA) is a federal law that provides federal special education funding to states, and sets standards for ensuring that children with disabilities receive a free, appropriate public education that meets their individual needs. It also provides students with disabilities the right to a "least restrictive environment" and requires that schools provide individualized educational plans for each student.

Under experimental conditions, an animal that has been given a benzodiazepine successfully responds to a fear extinction procedure. When the medication is discontinued, however, the initial fear response recurs upon exposure to the original fear-inducing stimulus. This type of learning is best described as which of the following?

Reinstatement Renewal effect * State-dependent Rapid reacquisition Counter-conditioning 2019 Child: 86 Reinstatement Reinstatement is a phenomenon where a previously extinguished behavior or response reappears due to the re-exposure to the same reinforcement or reward. Renewal effect The renewal effect refers to the recovery of a learned response when the context changes back to the original context where the learning occurred. State-dependent State-dependent learning is a type of learning where information is more easily retrieved when the individual is in the same mental state as during the initial learning. Rapid reacquisition Rapid reacquisition refers to the quick re-learning of a previously learned behavior or response after a period of extinction or non-reinforcement. Counter-conditioning Counter-conditioning is a process in which a previously learned response is replaced or weakened by associating it with a new, opposite response, often used in therapeutic settings to change maladaptive behaviors.

Projections from the retina to the hypothalamus may take up to four months after birth to make functional connections. This process explains which of the following developmental milestones?

Rolling over Self-soothing Social smiling * Sleeping at night Grasping an object 2019 Child: 94 The development of the retinal-hypothalamic pathway is essential for infants to establish their circadian rhythms. This connection can take up to four months to form, coinciding with the milestone of sleeping at night. Light from the retina is detected and signals are sent to the hypothalamus, which controls the sleep-wake cycle and regulates the body's internal clock. Because this pathway is not fully developed in the first few months of a baby's life, their sleep patterns will be irregular, with frequent nighttime wakings and inconsistent naps during the day. As the connection strengthens, the infant's circadian rhythm gradually becomes more regulated, resulting in longer periods of nighttime sleep and more predictable daytime naps. This transition benefits both the infant and parents, promoting better sleep quality and more structured daily routines Rolling over typically occurs around 4 to 6 months of age, as babies gain strength in their upper body. Self-soothing can begin as early as 3 months, but may not be fully developed until around 6 months. Social smiling usually starts between 6 to 8 weeks old, as babies become more aware of their surroundings and begin to engage with others. Sleeping through the night is a milestone that varies greatly among individual babies. Some may sleep for longer stretches as early as 6 weeks, while others may not consistently sleep through the night until they are closer to 1 year old or even later. It is important to remember that each baby is unique and will reach this milestone on their own timeline. Grasping an object is a skill that develops in stages. Early on, around 2 to 3 months, babies will start to reflexively grasp objects placed in their hand. By 4 to 6 months, they will begin to intentionally reach for and grasp objects with more control and coordination.

Which of the following traumatic events is most commonly experienced by children and adolescents in the United States?

Sexual abuse Physical abuse Natural disaster War-related trauma * Death of a loved one 2019 Child: 18 Death of a loved one is the most commonly experienced traumatic event by children and adolescents in the United States. According to a 2019 survey by the National Survey of Children's Health, a total of 12.9% of children between the ages of 6 to 17 had experienced the death of a parent or close family member in the past year.

According to the National Comorbidity Survey Replication Adolescent Supplement (NCS-A, 2004), which of the following anxiety disorders showed the highest rate of partial or full remission for the prior year?

Social phobia Panic disorder Specific phobia * Separation anxiety disorder Generalized anxiety disorder 2019 Child: 88 These are the typical developmental ages (onset and offset ages) for the following anxiety disorders: Social phobia Onset: 13-15 years Offset: varies, often persists into adulthood Panic disorder Onset: late adolescence or early adulthood (20-24 years) Offset: varies, may improve with treatment Specific phobia Onset: childhood (5-9 years) Offset: varies, may persist into adulthood Separation anxiety disorder Onset: early childhood (3-8 years) Offset: usually remits by late adolescence Generalized anxiety disorder Onset: late adolescence or early adulthood (19-21 years) Offset : varies, may persist or improve with treatment

Which of the following is most helpful in working up the diagnosis of nonepileptic seizures in children?

Structural magnetic resonance imaging scan Routine electroencephalograph (EEG) Serum creatine kinase levels Serum prolactin levels * Prolonged video EEG 2019 Child: 100

A seven-year-old presents with speech difficulties. On examination, examples of the child's speech include pronouncing "dat" for cat, and "pay" for play. The parents report that this problem bothers their child and also results in the child being bullied at school. The child has no hearing difficulties, and otherwise excels in academics. Which of the following is the most likely diagnosis?

Stuttering Normal development * Speech sound disorder Childhood apraxia of speech Social (pragmatic) communication disorder 2019 Child: 9 A speech sound disorder (SSD) is a condition in which a person has difficulty producing speech sounds correctly or consistently. This can include difficulty with articulation, phonology, or voice. Articulation refers to the physical production of speech sounds, such as difficulty with the formation of certain consonant sounds or the ability to coordinate the movement of the lips, tongue, and jaw. Phonology refers to the sound patterns of a language, such as difficulty with the use of specific sound combinations or sound sequences. Voice refers to the use of the vocal cords to produce speech sounds, such as difficulty with pitch, volume, or quality of the voice. An expressive language disorder (ELD) is a condition in which a person has difficulty with the use of language for communication. This can include difficulty with vocabulary, grammar, or the ability to put words together in a meaningful way. ELD can also include difficulty with the use of language for social interactions such as following conversation, making small talk, or understanding idioms. In summary, SSD is a disorder of speech production, which affects the physical production of speech sounds, and ELD is a disorder of language, which affects the use of language for communication and understanding of it. Both can co-occur in a person, but they are different disorders.

Substance-induced neurocognitive disorder due to inhalant abuse should be considered in a patient with which of the following computed tomography scan findings?

Subarachnoid hemorrhage Hydrocephalus and brain atrophy * Global cerebral and cerebellar atrophy Areas of hypoattenuation in the left occipital and parietal lobe * Loss of brain mass in the thalamus, basal ganglia, pons, and cerebellum 2019 Child: 44 Inhalant abuse can result in changes to the brain due to the chemicals in the inhalants being absorbed into the bloodstream. These chemicals can cause damage to the neurons in the brain, resulting in the various changes seen on computed tomography scans, such as ventricular enlargement, cerebral atrophy, white matter changes, and microbleeds in the basal ganglia area.

Children presenting with failure of upward gaze, lid retraction, convergence nystagmus, and pupils that react better to accommodation than direct light are most likely to have tumors in what brain region?

Thalamus * Pineal gland Optic pathway Hypothalamus Posterior fossa 2019 Child: 43 What cranial nerves are located around the pineal gland? The pineal gland is located near the posterior end of the third ventricle, and is surrounded by the thalamus, the quadrigeminal cistern, the mesencephalic aqueduct, and the temporal and occipital lobes. The nerves that can be found around the pineal gland include the oculomotor nerve (CN III), the trochlear nerve (CN IV), the trigeminal nerve (CN V), the abducent nerve (CN VI), the facial nerve (CN VII ), the vestibulocochlear nerve (CN VIII), the glossopharyngeal nerve (CN IX), the vagus nerve (CN X), and the accessory nerve (CN XI). How does a tumor affect failure of upward gaze, lid retraction, convergence nystagmus, and pupils that react better to accommodation than direct light? A tumor located near the cranial nerves that control eye movements can cause failure of upward gaze, lid retraction, convergence nystagmus, and pupils that react better to accommodation than direct light. This is due to the tumor placing pressure on the cranial nerves, which in turn causes a disruption in their ability to control eye movements and impacts pupillary reactions. In some cases, the tumor may also affect the optic nerve and cause decreased or absent vision.

The psychiatrist is considering using texting to communicate with several adolescent patients who prefer that method of communication. Which of the following represents an important professional standard regarding the use of texting with patients?

The American Academy of Child and Adolescent Psychiatry has firmly opposed the use of text messaging with patients. Adolescents who are employed, and pay for their own phone plan can provide the necessary consent to allow physicians to text message them. Text messaging for scheduling purposes only is not considered clinical communication and therefore does not fall under the purview of the Health Insurance Portability and Accountability Act (HIPAA.) * Physicians who choose to text message patients should find a way to document and store records of the exchanges as part of the patient's medical record. Text messages are naturally encrypted, and are considered secure electronic communication, as outlined by HIPM. 2019 Child: 21

When compared to an older child, adolescent, or adult, which of the following findings on mental status examination in a school-age child is most likely related to potential delays in cognitive development?

Thought blocking during interview Command hallucinations to harm peers Insistence that others are trying to hurt him * Difficulty differentiating fantasy from reality Disorientation to self, day, place and situation 2019 Child: 48 The Orientation and Thought Content section of the mental status exam reveals difficulty differentiating fantasy from reality. In this section, the mental health clinician may ask questions about the individual's ability to distinguish between fact and fantasy. Thought blocking is often revealed during the Mental Status Exam's assessment of the person's speech. This assessment is based on observations such as the rate, volume, rhythm and clarity of the person's speaking, as well as their ability to stay on topic and maintain connected thought. A school-age child displaying poor problem solving skills, diminished memory recall, and difficulty understanding and following multi-step directions is most likely exhibiting delays in cognitive development.

By age three years, toddlers can typically perform which of the following tasks?

Tie shoelaces Fasten buttons Close a zipper * Manipulate scissors Draw a person with realistic proportions 2019 Child: 3 By age three years, toddlers typically have developed the fine motor skills necessary to perform a variety of tasks such as: · Manipulating scissors: They can hold and open and close scissors with one hand and make basic cutting motions. · Drawing and coloring: They can hold a crayon, marker or pencil with a mature grip and make marks on paper. · Building with blocks: They can stack blocks, build towers and make simple structures. · Stringing beads: They can thread large beads on a string or lace. · Turning pages in a book: They can turn pages one at a time with thumb and index finger. · Dressing themselves: They can dress and undress themselves with some assistance. · Brushing their teeth: They can brush their teeth with some assistance. · Using utensils: They can use a fork and spoon with some assistance and may start using a knife to cut soft foods. It's important to note that children develop at different rates, so some children may be able to perform these tasks earlier or later than others. By age three years, toddlers typically cannot perform certain fine motor tasks that require more advanced dexterity, coordination, and control. Some examples of fine motor tasks that toddlers may not be able to perform at this age include: · Writing: They may not be able to form letters or numbers with a pencil or crayon. · Zipping and buttoning: They may not be able to fasten zippers or buttons on their own. · Cutting with scissors: They may not be able to cut along a straight line or make precise cuts. · Threading small beads or needles: They may not have the dexterity to thread small beads or needles. · Using small tools: They may not be able to use small tools such as tweezers or tongs. · Holding small objects: They may not be able to pick up small objects such as beads or coins with their fingers. · Tying shoelaces: They may not have the fine motor skills to tie shoelaces. It's important to note that children develop at different rates, so some children may be able to perform some of these tasks earlier or later than others. Typically, children around the age of 5 or 6 may start to draw people with more recognizable shapes, but it may take until around age 7 or 8 for them to begin to understand and use proportions correctly.

In systematic reviews and meta-analyses, funnel plots are used to assess which of the following types of bias?

Time lag Database Language * Publication Outcome reporting 2019 Child: 67 A funnel plot is a visual tool used in meta-analyses to detect publication bias. Publication bias occurs when studies with statistically significant results are more likely to be published than those with non-significant results. This can lead to an overestimation of the true effect size in a meta-analysis. Funnel plots can help address this issue by displaying the relationship between the effect size and the precision of individual studies. To create a funnel plot, the effect size (e.g., standardized mean difference, odds ratio, or risk ratio) is plotted on the x-axis, and a measure of precision (usually the inverse of the standard error) is plotted on the y-axis. In the absence of publication bias, the plot should resemble an inverted funnel, with studies of higher precision (lower standard error) appearing at the top and more concentrated around the true effect size, while studies with lower precision (higher standard error) appear at the bottom and are more widely dispersed. This pattern reflects the fact that smaller studies are generally less precise and therefore have a wider range of possible effect sizes, whereas larger studies tend to be more precise and have a narrower range of effect sizes. However, when publication bias is present, the funnel plot may appear asymmetric, with a gap in the lower part of the plot, indicating that smaller studies with non-significant results are underrepresented. This asymmetry can be visually inspected or assessed using statistical tests, such as Egger's test or the trim-and-fill method. If evidence of publication bias is found, researchers can take steps to address the issue, such as conducting a more comprehensive literature search, including unpublished studies, or using statistical techniques like the trim-and-fill method or the selection model to adjust the meta-analysis results.

A child has a history of angry outbursts. The child and parents develop a plan for grocery shopping that, if the child asks for candy at the checkout stand, has a meltdown and is unable to stay calm, the child will lose video game play time for the day. Which of the following terms best describes this strategy?

Time out Token economy Attending and ignoring Praise and positive reinforcement * Antecedent-behavior-consequence 2019 Child: 33 The Antecedent-Behavior-Consequence strategy is a type of behavior modification technique that aims to modify a person's behavior by focusing on the response to a given situation or circumstance. It involves identifying triggers for the target behavior, observing and recording the behavior, and providing a consequence or reward for the behavior. The idea behind this approach is to teach individuals to recognize and respond to certain situations, with the goal of making positive and desirable behavioral changes. The Antecedent-Behavior-Consequence strategy is a type of reinforcement. By reinforcing the desired behavior with either a positive or negative consequence, the individual can learn to repeat this behavior when presented with the same situation in the future.

A four-year-old child is brought by parents for psychiatric evaluation of the child's self-injurious behaviors. Parents report that the child started to have a rhythmic movement of the hands when the child was two years old. The child started hand-biting at preschool this past year. The biting episodes last a few seconds to a few minutes. The child can be distracted from hand-biting. Which of the following is the most appropriate diagnosis for this child?

Tourette syndrome Provisional tic disorder * Stereotypic movement disorder Developmental coordination disorder Persistent (chronic) motor or vocal tic disorder 2019 Child: 96 Stereotypic Movement Disorder Criteria Stereotypic movement disorder is a type of motor disorder characterized by repetitive, non-functional movements. To diagnose this disorder, medical professionals usually look for the following criteria: • Repetitive, seemingly driven, and non-functional motor behavior (e.g., hand flapping, body rocking, head banging, or self-biting). • The behavior interferes with social, academic, or other important areas of functioning. • The behavior is not attributable to the physiological effects of a substance or another medical condition. • The behavior is not better explained by another neurodevelopmental, mental, or medical disorder (such as autism spectrum disorder, intellectual disability, or seizure disorder). • The behavior persists for at least four weeks or is significantly impairing to the individual.

A teacher assigns the children in the class to solve as many math problems as they can on their own in a 20-minute period. The teacher makes a note of each student's progress, divides the class into groups to further work on the problems together, and provides help to each group when members are stuck. This strategy most directly makes use of which of the following educational concepts?

Transfer of learning Collective socialization Attunement to learning styles Transformative learning theory * Zone of proximal development 2019 Child: 2 The Zone of Proximal Development (ZPD) is a concept developed by Soviet psychologist Lev Vygotsky. It refers to the difference between what a child can do independently and what they can do with the help of a more skilled partner or teacher. The ZPD is the area where the most sensitive instruction or guidance should occur, as it represents the level at which a child is most ready to learn and make the most progress. The ZPD can be thought of as a range of tasks or activities that are just beyond a child's current level of ability, but with guidance and support, they can accomplish. It is the area where a child's potential for learning and development is the highest. Vygotsky believed that the ZPD is critical in the development of cognitive and social skills and that it can be used as a guide for instructional planning

An adolescent on an oral contraceptive presents with an unexpected pregnancy after starting a new medication. Which of the following was the most likely new medication?

Valproate Fluoxetine * Topiramate Risperidone Fluvoxamine 2019 Child: 82 An unexpected pregnancy while on oral contraceptives may be caused by certain medications, including Rifampin (antibiotic), Carbamazepine, Phenytoin, or Oxcarbazepine (anticonvulsants), Griseofulvin (antifungal), Ritonavir (antiretroviral), herbal supplement St. John's Wort, Omeprazole or Lansoprazole (PPIs), Lithium (mood stabilizer), Phenobarbital (barbiturate), Prednisone (corticosteroid, in high doses), Levothyroxine (thyroid medication), Fluoxetine or Sertraline (antidepressants), Olanzapine or Quetiapine (antipsychotics), or Propranolol or Metoprolol (beta-blockers).

A ten-year-old child's report card consists of all A's except for a C in math, the subject in which he has always had considerable difficulty. Which of the following assessment instruments would be most appropriate to help assess the child's academic deficit?

Wide Range Intelligence Test Stanford-Binet Intelligence Scales Leiter International Performance Scale Wechsler Intelligence Scare for Children * Woodcock-Johnson Tests of Achievement 2019 Child: 19 * Wide Range Intelligence Test (WRIT) - assesses a wide range of cognitive abilities, including verbal comprehension, perceptual reasoning, working memory, and processing speed * Stanford-Binet Intelligence Scales - measures cognitive abilities like problem-solving, memory, attention, and abstract reasoning in both verbal and non-verbal formats * Leiter International Performance Scale - evaluates a child' s intellectual functioning based on a series of tasks related to visual perception, problem-solving, and memory * Wechsler Intelligence Scale for Children (WISC) - evaluates a child's cognitive abilities in areas like verbal comprehension, perceptual reasoning, working memory, and processing speed * Woodcock-Johnson Tests of Achievement - evaluates a student's academic performance in a variety of areas, including reading, mathematics, written language, and oral language

A five-year-old child is observed to serve toy food onto the parent's miniature plastic plate, then hands the serving dish to the parent and says, "Now you feed me!" This is an example of:

animism. egocentrism. parallel play. * cooperative play. dual representation. 2019 Child: 91 Cooperative play is a shared activity where children and their parents work together, exchanging ideas, tasks, and responsibilities. For instance, the child is the server while the parent serves the child the pretend meal. Key aspects of cooperative play include: interaction with others, shared objectives, specified roles and responsibilities, communication and collaboration, and adaptability and flexibility. In this case, both the child and parent are actively playing their part, communicating and adapting to achieve a shared goal. This type of play helps a child develop socially and emotionally, improving their teamwork and communication skills. Animism: Animism is the belief that objects, places, and creatures possess a distinct spiritual essence. In the context of child development, animism refers to a stage where children attribute life-like qualities to inanimate objects, such as believing that a toy has feelings or thoughts. Egocentrism: Egocentrism is the inability to differentiate between one's own perspective and that of others. In child development, it is a stage where children believe that everyone sees, thinks, and feels the same way as they do. This stage is commonly observed in preschool-aged children. Parallel Play: Parallel play is a type of play observed in young children, where they play alongside each other but do not interact or engage with one another. Children participating in parallel play may be doing the same activity or using the same toys, but they do not share, communicate, or cooperate with each other in the process. Dual-representation: Dual-representation refers to a child's ability to understand that an object can represent something else, while still maintaining its original identity. For example, a child using a toy car to represent a real car in a pretend play scenario. This cognitive skill develops as children grow and is essential for understanding symbols, maps, and abstract concepts.

A longitudinal, prospective study of a large group of healthy infants of mothers with postpartum depression finds that 3% of the study population meet criteria for a mood disorder by age six years, a proportion that increases to 6% by age 12. This measure of mood disorder occurrence among the children is best described as the:

base rate. odds ratio. prevalence. * cumulative incidence. positive predictive value. 2019 Child: 11 Cumulative incidence, incidence, and prevalence are all measures used to describe the occurrence of a particular condition or disease in a population. They are similar in some ways but have important differences: 1. Incidence refers to the number of new cases of a disease that occur in a population over a specific period of time. It is typically measured as the number of new cases per unit of time (e.g. per year) and is often used to estimate the risk of developing a particular condition. 2. Prevalence refers to the total number of cases of a disease that are present in a population at a specific point in time. It includes both new and existing cases of a disease. Prevalence is typically measured as a proportion or percentage of the population that has the condition. 3. Cumulative incidence refers to the total number of new cases of a disease that occur in a population over a specific period of time, regardless of whether the individuals have ever had the disease before. It is typically measured as the proportion of a population that develops the disease during a certain period of time and is often used to estimate the risk of developing a particular condition. In summary, incidence and cumulative incidence are similar in that they both measure the number of new cases of a disease that occur in a population over a specific period of time, but cumulative incidence includes all new cases regardless of whether the individuals have ever had the disease before. Prevalence, on the other hand, is the proportion of the population that has the disease at a specific point in time.

The psychiatrist treating the ten-year-old child of divorcing parents receives a subpoena from the attorney for one of the parents requiring the psychiatrist to appear in court and provide a copy of the child's psychiatric medical record. The parents are in conflict about the child's custody. The psychiatrist thinks that a court appearance would jeopardize the treatment alliance. After obtaining legal advice, the psychiatrist's response upon receiving such a subpoena should be to:

decline request to appear in court. send copies of the medical record to the attorney who issues the subpoena. * seek informed consent from each parent to share information with the court. contact the judge directly and offer to provide information in a private meeting. recommend the appointment of a guardian ad litem to ascertain the child's wishes about custody. 2019 Child: 46

A six-year-old first-grader writes some letters backwards, and puts the letters in their own name in the wrong sequence, although the letters chosen are correct. This phenomenon is most likely explained by:

dyslexia. intellectual disability. * normal difficulties for age. specific learning disorder (reading). specific learning disorder (written expression). 2019 Child: 84 Dyslexia may be diagnosed at any age, but early intervention is key for successful outcomes. Here are some signs to look for when assessing age groups: Preschool (3-5): difficulty learning new words, difficulty recognizing letters and their sounds, difficulty with rhyming and word games. Elementary school (5-10): slow reading progress, difficulty with spelling and writing, struggles understanding and following directions. Middle school (10-14): continued reading, spelling, and writing difficulties, issues with organization and time management, struggles understanding complex texts and instructions. High school (14-18): persistent reading comprehension and written expression issues, problems with advanced vocabulary and grammar, difficulty completing assignments and managing workload. Adulthood (18 +): reading and writing difficulties in the workplace/higher ed, time management and organizational troubles, challenges in learning new skills and adapting to tasks. Accurate diagnosis requires a professional evaluation as signs and symptoms vary from person to person.

Universal prevention programs targeting mental health promotion related to decreasing risky behavior and improving function that have strong evidence of effectiveness include:

focus on parents and family rather than individual youth. * skill development in self-management and problem solving. comprehensive overview of consequences of risky behavior. tangible rewards for participation such as financial compensation. thorough mental health assessment with appropriate interventions. 2019 Child: 38 What are Universal prevention programs targeting mental health promotion related to decreasing risky behavior and improving function that have strong evidence of effectiveness? Positive Parenting Programs Strengthening Families Program Life Skills Training Triple P Positive Parenting Program Mindfulness-Based Stress Reduction Social and Emotional Learning (SEL) Screening, Brief Intervention and Referral to Treatment (SBIRT) Cognitive Behavioral Therapy (CBT) Interpersonal Therapy (IPT) Solution-Focused Brief Therapy (SFBT)

A three-year-old in preschool is most likely to identify a classmate as a "friend" based upon the other child's:

gender. ethnicity. physical appearance. * similarity of play interests. status within the larger peer group. 2019 Child: 50

A researcher creates a study in which each participant receives both placebo and active medication during the trial. This design is best known as:

mixed. factorial. * within subjects. between groups. quasi-experimental. 2019 Child: 99 Mixed design: This type of design combines both between-group and within-subject factors. It is useful when researchers want to examine the effects of multiple independent variables on a dependent variable, as well as interactions between these variables. Factorial design: In this design, multiple independent variables are manipulated simultaneously to determine their individual and combined effects on a dependent variable. The main advantage of factorial designs is that they allow researchers to examine interactions between factors. Within subjects design: Also known as a repeated measures design, this method involves testing the same participants multiple times under different conditions. This design is advantageous in reducing the influence of individual differences, as each participant serves as their own control. Between groups design: In this design, participants are divided into separate groups, with each group experiencing different conditions. This design is useful when comparing the effects of different treatments or interventions on a dependent variable. Quasi-experimental design: Unlike true experimental designs, quasi-experimental designs lack random assignment of participants to conditions. This design is often used when random assignment is not feasible or ethical. However, it may increase the risk of confounding variables influencing the results.

The classic triad of HIV-related encephalopathy in children is characterized by pyramidal tract motor deficits, acquired microcephaly and:

seizures. blindness. neoplasms. * developmental delays. attention-deficit hyperactivity disorder. 2019 Child: 25 HIV is believed to cause encephalopathy in children by directly infecting the brain, particularly the white matter of the brain, and causing direct damage to these tissue structures. This damage can lead to decreased brain growth, known as microcephaly, as well as disruptions in normal neuronal development, which can lead to the motor deficits and developmental delays commonly seen in HIV-related encephalopathy. HIV also can lead to increased inflammation and immune activation, which can contribute to further damage to the brain.

According to DSM, the diagnosis of premenstrual dysphoric disorder should be confirmed by:

the Daily Rating of Severity of Problems. * a prospective symptom rating log over two months. the Premenstrual Tension Syndrome Rating Scale. the Visual Analogue Scales for Premenstrual Mood Symptoms. a validated depression rating scale during the week prior to menses. 2019 Child: 10 The DSM-5 criteria for Premenstrual Dysphoric Disorder (PMDD) are as follows: 1. The presence of five (or more) of the following symptoms, which must occur during the week prior to menstruation and improve within a few days following onset of menses: • Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts • Markedly anxious mood or marked feelings of tension or reactivity • Persistent and marked anger or irritability or increased interpersonal conflicts • Decreased interest in usual activities (e.g. work, school, friends, hobbies) • Subjective difficulty in concentration • Lethargy, easy fatigability, or marked lack of energy • Markedly increased appetite or specific food cravings • Hypersomnia or insomnia • A sense of being overwhelmed or out of control • Physical symptoms such as breast tenderness or swelling, headache, joint or muscle pain, a sensation of bloating or weight gain 2. The symptoms are severe enough to interfere with work, school, usual social activities, or relationships with others 3. The symptoms are not due to a substance or a general medical condition 4. The symptoms are not better accounted for by Schizophrenia, Schizoaffective Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified 5. The symptoms are not accounted for by Schizophrenia, Schizoaffective Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. It is worth noting that the criteria for PMDD are similar to those for Major Depressive Disorder with an additional requirement that the symptoms must be linked to the menstrual cycle and the intensity of the symptoms. PMDD should be diagnosed only if the symptoms are severe enough to significantly interfere with daily activities and relationships, and are not due to another mental disorder or medical condition. The time criteria for diagnosing Premenstrual Dysphoric Disorder (PMDD) according to the Diagn and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) are as follows: • The symptoms occur consistently during the luteal phase of the menstrual cycle, which is typically the time between ovulation and the onset of menstruation. • The symptoms must start in the week prior to menses and end within a few days after the onset of menses. • The symptoms must be present for most menstrual cycles during the past year. • The symptoms should be severe enough to interfere with work, school, usual social activities, or relationships with others. It is important to note that the diagnosis of PMDD should be based on prospective daily ratings of symptoms over at least two menstrual cycles.

When a six-year-old child has a temper tantrum, the parents silently turn away and avoid eye contact or communication with the child until the behavior subsides. This parenting technique is known as:

time out. token economy. * planned ignoring. behavioral contingency. positive social attention. 2019 Child: 60 Time Out: Time out is a technique used to interrupt and redirect a child's behavior in order to decrease the occurrence of the targeted behavior. This approach works by removing the child from the reinforcing situation and environment, providing an opportunity to pause and collect themselves Token Economy: Token economies are designed to increase desirable behaviors and decrease undesirable behaviors. Often times, these economies are used in a classroom setting to increase positive behaviors such as completing work, following directions, etc. Tokens may be awarded to reinforce the desired behaviors, while removing tokens is used to reduce behaviors that are not desired Planned Ignoring: Planned ignoring is a technique used to reduce undesired behaviors by removing social interaction and attention for the undesired behavior. As a consequence of the lack of attention, the behavior is often extinguished as the consequence of the behavior (positive social attention) is removed Behavioral Contingency: Behavioral contingency refers to the idea that certain behaviors will have certain consequences, or outcomes, associated with them. Consequences may be either positive or negative depending on the desired behavior. For example, if a child completes their homework on time, they may get a reward (positive consequence). If the child does not complete their homework on time, they may lose technology privileges (negative consequence) Positive Social Attention: Positive social attention is a technique used to increase desirable behaviors by providing praise, recognition, and positive feedback when the desired behavior is exhibited. Positive social attention is used to reinforce desirable behaviors, which increases the likelihood that the behavior will be repeated in the future.

According to Kohlberg's theory, a boy who regularly exhibits conventional, Stage 3 moral judgment would determine morality based on which of the following principles of thinking?

"I should follow the rules to avoid punishment." "I should follow the rules but there may be exceptions." "I should follow the rules because a peaceful society requires it." *"I should follow the rules because it is fair and the other boys did." *"I should follow the rules because that's what good boys do in my family." 2020 Child: 68 (Punishment -> reward )-> (pleasing others -> duty to society) -> (personal values (justice) -> moral principles) Preconventional, Conventional, Postconventional

An adolescent with depression presents to clinic and has been nonadherent. During the course of the interview, the adolescent states 'Tm not sure what the reason is for me to take the fluoxetine, I feel great just smoking weed." Using a motivational interviewing approach, what would be the best next phrase to elicit further engagement from the patient?

"Smoking weed can make your depression worse." "Your depression is really impacting your judgment." "Are you having any side effects with using your fluoxetine?" * "You cannot imagine feeling good without smoking weed." "Can I share with you some of the hazards of smoking weed?" 2021 Child: 120

According to the principles of Parent-Child Interaction Therapy, which of the following instructions is most likely to elicit compliance in young children with oppositional behavior?

"Stop running around." "Don't throw those blocks." "How about cleaning up now?" "Let's put on your jacket, okay?" * "Put your stuffed animals on the bed." 2022 Child: 52

A 12-year-old newly diagnosed with attention-deficit/hyperactivity disorder is being evaluated for stimulant medication. The parents express concerns that this medication will stunt the child's ultimate height. Which of the following is the best physician response to address the parents' concerns?

"The impact of stimulants on height is greatest in older adolescents." "Methylphenidate products impact height more than amphetamine products." * "Stimulants may slow height velocity, but adult height may be minimally affected." "The impact of stimulants on height is minimized when the child is overweight or obese." "Stimulants impact height but this impact is often delayed with the smallest change occurring in the first year of use." 2021 Child: 151

An adolescent who has been recently diagnosed with non-epileptic seizures has been sent from school to the emergency department on multiple occasions due to having episodes during class. The adolescent and parents state that they do not want the school to be informed of the patient's diagnosis. If the physician wanted to advocate that the diagnosis should be shared with the school, which of the following statements made by the physician would be best?

"There are several potential legal ramifications of not informing the school." * "There is real potential risk of inappropriate and invasive medical treatment." "If the school is not informed, the hospital will no longer be able to admit your child." "We will have to make a report to child protective services if you do not disclose the diagnosis." "Due to the potential dangerousness of not informing the school, we are obligated to share the diagnosis with the school administrators." 2020 Child: 11

During a routine visit to the pediatrician, the mother of a 24-month-old girl states that she has witnessed her daughter touching her vulva during baths. The mother asks if this behavior is cause for concern. How should the pediatrician respond?

"This behavior is only atypical if done in a public setting." "Genital self-stimulation should raise concern for sexual abuse." "This behavior is only atypical if she displayed interests in other people's genitalia." * "Exploration of the body is a typical behavior at this age and there is no reason to be concerned." "Typically developing children do not begin to engage in genital self-stimulation until they are older." 2020 Child: 15

An 11-year-old's parent consults with a child psychiatrist after walking in on the child masturbating in the bathroom. The parent expresses concern. Which of the following is the psychiatrist's best response?

"This could be a sign of sexual abuse." * "This is most likely normal development." "This is a temporary phase and will decrease." "This likely represents signs of sexual dysfunction." "This may be an indicator for treatment of sex addiction." 2022 Child: 89

A 13-year-old patient is evaluated for escalating oppositional behaviors, including school truancy, running away from home and substance use. The patient is given a provisional diagnosis of conduct disorder. The patient's parents ask if their child is likely to become a "lifetime criminal." Which of the following would be the most appropriate response regarding the course of conduct disorder?

"We do not currently have enough data to say." "Most children are likely to become incarcerated as adults." * "Most children end up improving significantly by young adulthood." "Most children become symptom-free with medication management." "Most children progressively decline in functioning before they get better." 2020 Child: 115

Which of the following questions is the best example of a projective interviewing technique for a psychiatrist to use when evaluating a seven-year-old child?

"What pets do you have at home?" "What do you do after school?" "Do you have a best friend?" * "Who is your favorite super-hero?" "Do you ever have headaches or stomach aches?" 2020 Child: 157

The caregivers of a 17-year-old hospice patient report increased withdrawal and anger in their child and ask the doctor for advice. What would be the best treatment recommendation?

"You should continue with watchful waiting." "Consider starting your child on an antidepressant." "Provide your child with novel experiences and distractions." * "Include your child in the decision-making process regarding their death." "Continue to support your child and do not acknowledge their pending death." 2021 Child: 55

A psychiatrist evaluates a recently adopted three-and-a-half-year-old child who displays flat affect. The child does not initiate interaction with the parent nor show interest when spoken to. Which of the following questions to the parent is most relevant to support a diagnosis of reactive attachment disorder in the child?

* "Does your child turn to you for comfort or protection?" "Has your child ever been aggressive with other children?" "Does your child participate in pretend play with other children?" "Does your child experience unexplained episodes of irritability?" "Is your child preoccupied with specific toys to the exclusion of other types of play?" 2020 Child: 149

The mother of an adolescent with severe generalized anxiety disorder asks the psychiatrist if it would it be a good idea for the adolescent to be started on benzodiazepines for anxiety since they had been very helpful to treat her own anxiety. She asks the psychiatrist for the current scientific opinion on the use of benzodiazepines in childhood anxiety. Which of the following would be appropriate responses? (Select three). anxiety." anxiety in adults and adolescents."

* "There is risk of dependency in teenagers treated with benzodiazepines." "The most common adverse effect in adolescents is paradoxical hyperactivity." * "Benzodiazepines are sometimes used in youth to acutely reduce severe anxiety." "benzodiazepines are FDA-approved for the treatment of childhood sleep disorders." * "There is a relative paucity of studies examining the use of benzodiazepines in youth." "benzodiazepines have been approved by the FDA for treatment of childhood anxiety." "Randomized controlled trials indicate efficacy of benzodiazepines for childhood "Benzodiazepines are well-tolerated and are recommended for the treatment of chronic 2020 Child: 198 (PDA) Paucity...Dependence...Acute use

A clinician is performing an initial psychiatric evaluation on a 1 4-year-old adolescent. The adolescent's parents are immigrants from another country. The clinician makes a diagnosis of depression. In interacting with this family, which of the following statements would be most consistent with the Explanatory Models Approach of culturally-informed care?

* "What do you believe is the cause of this problem?" "You don't need to be afraid of this problem, it is treatable." "What do other people from your country believe is the cause of depression?" "What do other people from your country believe causes this sort of problem?" "| know there are differences in how people from your country perceive mental iliness compared people born in this country." 2022 Child: 88

An adolescent presents to the emergency room following a motor vehicle collision. On initial evaluation, the adolescent is found to have an elevated ethanol level in the serum. Which of the following assessment tools is most reliable in assessing this adolescent for a substance use disorder?

* Clinical history CRAFT screen Urine drug screen Adolescent Alcohol and Drug Involvement Scale Global Appraisal of Individual Needs-Short Screener 2020 Child: 92

The Child PTSD Symptom Scale has a cut-off point of 31, which is 93% sensitive for a probable posttraumatic stress disorder (PTSD) diagnosis. A psychiatrist administers this scale to an adolescent with a clinical diagnosis of PTSD who scores 29. How should the psychiatrist best explain this score to the adolescent?

* 7% of adolescents who have PTSD will score less than 31 points on the scale 29% of adolescents who have PTSD will score less than 31 points on the scale 71% of adolescents who have PTSD will score less than 31 points on the scale 93% of adolescents will score less than 31 points on the scale 2021 Child: 185

An adolescent with a past psychiatric history of major depressive disorder presents to an emergency department after ingesting eight 200 mg tablets of ibuprofen and is now medically cleared. The patient reports feeling increasingly irritable since recently learning charges against their alleged rapist were dismissed, and planned the ingestion. The patient is remorseful and promises never to do it again. What is the best initial disposition plan for this patient?

* Admit to an inpatient psychiatric unit Discharge home with in-home therapy Transfer to a long-term treatment facility Discharge home with outpatient follow-up Discharge home with a referral to a partial hospitalization program 2019 Child: 161

Which of the following has been observed regarding white matter tract and network development during the first two years of life?

* Almost all are present at birth and are already organized into adult-like networks. Almost all are present at birth, and networks organize gradually over the first two years of life. About half are present at birth, the rest develop rapidly in infancy, and are fully organized by age two About half are present at birth, and the rest both develop and organize rapidly during early infancy Only a limited number are present at birth and most network development occurs later during childhood 2020 Child: 49

What defense mechanism also describes a sociobiological behavior aimed at proliferation of a species at the expense of an individual organism within that species?

* Altruism Introjection Idealization Identification Reaction Formation 2020 Child: 64

A psychiatrist is conducting an evaluation of a youth who may be transferred from juvenile court to adult court, due to a serious and violent offense. Such an evaluation should focus on the youth's developmental maturity and what other factor?

* Amenability to intervention Level of emotional intelligence Likelihood of repeating incident Presence of a personality disorder Understanding of the criminal charges 2022 Child: 110

A 13-year-old is being evaluated for severe weight loss. The patient has a pattern of restrictive eating and, when forced to eat a meal, usually leaves the table quickly after finishing and spends long periods of time in the bathroom. The patient denies any problematic eating behaviors. Testing which of the following would be most helpful in determining if the patient is accurately reporting about eating behaviors?

* Amylase Calcium Phosphate Lipid profile Aspartate aminotransferase 2020 Child: 120

A 17-year-old has been unsuccessful in multiple attempts to quit using drugs and alcohol. Which of the following factors contributing to this individual's continued substance use is the best example of negative reinforcement?

* Drinking and using drugs to relieve emotional distress Craving a drink after driving by a popular neighborhood bar Anticipating the calming feeling that will occur when drinking or taking pills Attending social events where there is an abundance of alcohol and drugs Needing higher amounts of alcohol and drugs to get the same degree of pleasure as previously obtained with lower amounts 2021 Child: 56 Negative reinforcement RAvS me up (removes aversive stimuli)

When does a typically developing human brain first demonstrate the peak number of neurons?

* During gestation Infancy Toddlerhood Puberty Late Adolescence 2022 Child: 65

Which of the following are patients with complex partial seizures most likely to experience during the aura preceding a seizure?

* Anxiety Coprolalia Obsessions Depression Hypersexuality 2019 Child: 130 Patients with complex partial seizures are most likely to experience a variety of symptoms during the aura, which precedes the seizure. These can include: • A sudden sense of fear or anxiety • A feeling of déjà vu or jamais vu • Nausea or a rising sensation in the stomach • Distorted sounds, smells, tastes, or visual perceptions • A sense of spatial or temporal distortion • Strange or uncontrollable thoughts • Physical symptoms such as dizziness, lightheadedness, or tingling sensations These symptoms can vary greatly from person to person, and not everyone will experience all of them. It's also worth noting that the presence of an aura can sometimes provide a warning sign that a seizure is imminent, allowing the individual to take necessary precautions. This might involve moving to a safe location, alerting someone nearby, or adopting a comfortable position to reduce the risk of injury if a fall occurs during the seizure. In some cases, these auras can be so subtle that they are not recognized until after the seizure has occurred. This can make it difficult to predict when a seizure will occur, and can contribute to the overall unpredictability of complex partial seizures. Despite this, understanding and recognizing these aura symptoms can play a crucial role in managing and mitigating the impacts of this condition.

A child failed the second grade two years in a row despite intensive tutoring, and now no longer tries to pass. The child is then placed in a resource class that moves at a pace easily commensurate with the child's abilities. According to the learned helplessness model, which of the following best summarizes the child's reaction to this change?

* Apathetic towards the new class Angry over failures in the old class Optimistic about being able to be successful Enthusiastic about leaving the previous class Disappointed over being placed in a "slow" class 2019 Child: 149

A psychiatrist has been treating an adolescent for social anxiety for two years. A staff member from the practice, who knows the patient and family through visits at the psychiatrist's office, is invited to the school play by the patient and the family. After attending the school play, the staff member posts a picture with the patient on social media and comments, "Totally awed by your improvement. Congratulations on your hard work!" What is the best next step for the psychiatrist to address the situation?

* Ask the staff member to remove the post Inform the patient's family of the social media posting Report the staff member to their professional organization Prohibit the staff member from working with the patient further No action required as this is within the realm of acceptable interaction with patients via social media 2020 Child: 181

The strange situation protocol developed by Mary Ainsworth was designed to study which of the following concepts?

* Attachment Temperament Caregiver anxiety Caregiver self-esteem Cognitive development 2021 Child: 76

The psychiatrist receives a subpoena related to the treatment of an adolescent patient. There is no patient waiver of information or court order. The psychiatrist has contacted the issuing attorney and reported that the patient and family refuse release of information. What is the likely advice the psychiatrist's legal team would provide?

* Attend the court proceeding and only answer questions if directed by the judge Provide medical records rather than testimony to preserve the therapeutic alliance Attend the court proceeding and share the information requested by the subpoena Refuse to comply with the subpoena because of the protected nature of the information Ask that the court proceedings be delayed until the patient and family agree to disclose the requested information 2021 Child: 152

Which of the following is typical of the language development of six-month-old infants?

* Babbling with consonant and vowel sounds Production of grunting, crying, and gurgling noises Inconsistent and unclear use of the first few words Starting to string words together in a very basic way Using first words with reliable consistency and purpose 2020 Child: 8 The timeline for language development in children varies, but typically: • Babbling with consonant and vowel sounds begins anywhere from 6 to 9 months. • Production of grunting, crying, and gurgling noises usually starts as early as birth to 3 months. • Inconsistent and unclear use of the first few words often occurs from 12 to 15 months. • Starting to string words together in a very basic way is common from 18 to 24 months. • Using first words with reliable consistency and purpose generally happens around 24 to 36 months. At six months, infants begin to babble and make sounds that imitate the tones and rhythms of adult talk. They also start to recognize and respond to their own name. Their vocalizations become more varied, incorporating sounds such as "da", "ba", "ga", and other consonant-vowel combinations. Infants at this age also begin to understand simple words such as "no" and "bye-bye", and they start to use their voice to express joy and displeasure. They may also show recognition of commonly used words and can respond to changes in tone of voice.

In the 1970s, Stella Chess and Alexander Thomas studied temperament and psychological functioning in infancy through adolescence. They categorized subjects' temperaments into three distinct clusters. Which of the following are the temperament styles that they defined? (Select three)

* Easy Stable Neutral * Difficult Reactive Avoidant Hyperactive * Slow to warm up 2021 Child: 194

An adolescent is being treated with atomoxetine for attention-deficit/hyperactivity disorder. The patient develops symptoms of depression and is prescribed a medication to target low mood. Several weeks later the patient's parents bring their child to the emergency department for evaluation of intense irritability, agitation, and suicidal ideation. The patient describes feeling nauseated and is found to have elevated blood pressure. Which of the following medications was the adolescent most likely prescribed to target low mood?

* Bupropion * Fluoxetine Citalopram Venlafaxine Fluvoxamine 2022 Child: 34 Atomoxetine is primarily metabolized by the CYP2D6 enzyme in the liver. Bupropion is a moderate CYP2D6 inhibitor, which means it can reduce the metabolism of atomoxetine, potentially increasing its concentration in the body. On the other hand, Fluoxetine is a potent CYP2D6 inhibitor, which can significantly decrease the metabolism of atomoxetine, leading to an even higher concentration. This interaction may increase the risk of side effects from atomoxetine, which include nausea, dry mouth, decreased appetite, and increased blood pressure. Therefore, close monitoring and dosage adjustments may be necessary when atomoxetine is used with these medications. Citalopram is primarily metabolized by the enzymes CYP2C19, CYP2D6, and CYP3A4 in the liver. Venlafaxine is primarily metabolized by CYP2D6, and its active metabolite, O-desmethylvenlafaxine, is metabolized by CYP2D6 and CYP3A4. Fluvoxamine is primarily metabolized by CYP1A2 and CYP2D6, and it is a potent inhibitor of CYP1A2 and CYP2C19, which can lead to significant drug-drug interactions.

An adolescent presents with muscie rigidity and maintenance of odd postures following a heavy cannabis binge. Cannabis impact in which of the following brain regions is associated with this presentation?

* Cerebellum Hippocampus Frontal cortex Hypothalamus Anterior cingulate cortex 2022 Child: 85 ● Cerebellum ● The cerebellum plays a crucial role in motor control and coordination. It's also involved in cognitive functions like attention and language. In child psychiatry, abnormalities in cerebellar development have been linked to autism spectrum disorders and ADHD. ● Hippocampus ● The hippocampus is key to memory formation and spatial navigation. In child psychiatry, stress and trauma can result in hippocampal shrinkage, contributing to conditions like PTSD and depression. ● Frontal cortex ● The frontal cortex is responsible for higher cognitive functions, such as decision making, problem-solving, and social behavior. Abnormal activity in this region has been associated with ADHD, autism, and other neurodevelopmental disorders. ● Hypothalamus ● The hypothalamus is responsible for maintaining the body's internal balance, or homeostasis. It regulates functions like temperature, hunger, and sleep. In child psychiatry, disruptions in hypothalamic function have been linked to eating disorders, sleep disorders, and mood disorders. ● Anterior cingulate cortex ● The anterior cingulate cortex is involved in emotion regulation, decision making, and empathy. Abnormalities in this region have been associated with anxiety disorders, depression, and autism. In child psychiatry, early intervention strategies targeting this area could potentially improve outcomes for these conditions.

A four-year-old is observed walking with a broad-based gait lurching from side to side. Which area of the brain is likely affected?

* Cerebellum Motor cortex Hippocampus Basal ganglia Corpus callosum 2019 Child: 131 • • Ataxias associated with these different brain regions include: • • Cerebellum: Spinocerebellar ataxia, Friedreich's ataxia, and Ataxia-telangiectasia. • • Motor cortex: Cortical basal degenerative syndrome, also known as corticobasal syndrome. • • Hippocampus: Temporal lobe epilepsy can cause ataxia due to hippocampal sclerosis. • • Basal Ganglia: Wilson's disease and Huntington's disease can cause ataxia due to damage in the basal ganglia. • • Corpus callosum: Agenesis of the corpus callosum can cause ataxia. • • Brainstem: Multiple system atrophy and Progressive Supranuclear Palsy can cause ataxia due to damage in the brainstem.

Methylphenidate tends to be eliminated from children's bodies more quickly than from adults'. Which of the following best accounts for this finding?

* Children have greater hepatic capacity than adults The amount of fatty tissue in children is greater than in adults Children have lower glomerular filtration rates compared with adults Adults are more likely to be adherent with medications than children 2021 Child: 192

The pediatrics service consults child psychiatry for treatment non-adherence in a child with type I diabetes mellitus admitted for diabetic ketoacidosis. The patient is to be discharged later that day and is not suicidal. The patient's guardian is upset that child psychiatry has been consulted and is declining the consultation. Which of the following is the next best step for the child psychiatrist to take regarding the consultation request?

* Clarify the consultation question with the primary team Decline consultation as the patient is not acutely suicidal Ask that medical social work be consulted to assess the patient Meet the caregiver to address concerns about psychiatric consultation Inform the caregiver the patient needs to be seen today prior to discharge 2021 Child: 70

In addition to object conservation, the ability to demonstrate which of the following skills is a hallmark of typical cognitive development in a school-age child?

* Classifying and grouping objects and concepts Using general principles to determine particular outcomes Thinking about multiple solutions and outcomes to a problem Making a word or object stand for something other than itself Seeing the physical world from the viewpoint of another person 2019 Child: 177

A four-year-old child survives an automobile accident that kills the child's mother. One year later, the father brings the child to a therapist to evaluate the child for posttraumatic stress disorder (PTSD). According to the alternative PTSD criteria in preschool children, which of the following symptoms is consistent with PTSD?

* Constriction of play Excessive sleep Head banging Pseudomaturity 2019 Child: 196 The DSM 5 differentiates the diagnostic criteria for PTSD in children younger than 6 and those older than 6. For children younger than 6, it requires at least one symptom from each of the following categories: Intrusion Symptoms : recurrent memories, dreams, or play reenacting the traumatic event. Avoidance: of reminders of the traumatic event. Negative Alterations in Cognitions and Mood: substantially increased negative emotions, decreased interest in significant activities, or feelings of detachment. Alterations in Arousal and Reactivity: irritable behavior, hypervigilance, or exaggerated startle response. For those older than 6, the DSM 5 requires at least one symptom from the Intrusion Symptoms category, and at least one from the Avoidance category. In the Negative Alterations in Cognitions and Mood category, two symptoms are required. Lastly, for the Alterations in Aroual and Reactivity category, two symptoms are needed. These may include intrusive thoughts, avoidance of trauma-related stimuli, negative changes in mood or cognition, and alterations in arousal and reactivity. The symptoms should be present for more than a month and cause significant distress or impairment in the child's life. are there any differences in diagnostic symptoms in each population? Yes, there are differences in diagnostic symptoms between the two age groups. In children younger than 6, the symptoms are often less explicit and may be expressed through play and behavior rather than verbal communication. Their avoidance symptoms may not be as clear-cut, and may manifest as a general avoidance of situations rather than specific reminders of the trauma. On the other hand, children older than 6 can more clearly articulate their experiences and symptoms. They might express explicit memories or nightmares of the traumatic event. Their avoidance symptoms are often more specific and can be linked directly to the traumatic event. Furthermore, the requirement for the number of symptoms in the Negative Alterations in Cognitions and Mood and Alterations in Arousal and Reactivity categories is higher in children older than 6 compared to those youn

A child psychiatrist working for a hospital receives a subpoena regarding the divorce of parents of an adolescent in treatment, in which child protective services is involved. Which of the following immediate actions should the psychiatrist take?

* Contact risk management Consult with a private attorney Notify the patient and both parents Discuss with the child protective services supervisor Abstain from responding if there is no consent to release information 2020 Child: 163

A researcher wants to study the effects of several treatments for a disorder but has a limited number of subjects. What study design best achieves the researcher's goals?

* Crossover Naturalistic Double-blind Longitudinal Retrospective 2022 Child: 41

A 14-year-old physically aggressive, developmentally disabled male is given an intramuscular injection to calm his aggression. Within 30 minutes, his neck has twisted 30 degrees causing him pain. The blockage of what neurotransmitter receptor is the cause?

* D2 D3 D4 H1 H2 2019 Child: 148

A 17-year-old with treatment refractory obsessive-compulsive disorder is seeking consultation. Which of the following adult-approved neuromodulation treatment approaches may be indicated?

* Deep brain stimulation Vagal nerve stimulation Electroconvulsive therapy Transcranial magnetic stimulation / Transcranial direct current stimulation 2022 Child: 17

Which of the following principles regarding media coverage of adolescent deaths by suicide is widely recommended, including by the World Health Organization and the Centers for Disease Control?

* Engage in a nuanced discussion about the multifactorial nature of suicide. Highlight the word "suicide" in headiines to prepare viewers for the content. Illustrate reports of suicide attempts or completions with photos and videos. Destigmatize suicide as a means by which ill patients relieve their suffering. Focus on positive quotes and attributes regarding the deceased adolescent. 2022 Child: 79

An adolescent recalls smelling whiskey during an episode of sexual abuse as a child. Ever since, the teen sweats and shakes when around whiskey. According to classical conditioning theory, which of the following is the best term for the whiskey?

A. Conditioned stimulus Conditioned response Unconditioned stimulus Unconditioned response Conditioned suppression 2022 Child: 177

A previously healthy adolescent is admitted to the intensive care unit for meningococcal meningitis and is currently receiving antibiotic treatment. On the third day of hospitalization, the adolescent develops behavioral changes manifested in irritability, frequent crying, disrupted sleep, and poor eye contact with parents. The symptoms come and go throughout the day. The neurologic exam is otherwise unchanged. Which of the following is the most likely diagnosis?

* Delirium Adjustment disorder Acute stress disorder Transient ischemic event Autoimmune encephalitis 2021 Child: 149

Several members of a multigenerational household are diagnosed with a psychiatric disorder. Which of the following is an advantage of pedigree analysis in understanding the genetics of their condition?

* Detects rare variants of large effect Costs less than other genetic studies Allows incorporation of environmental data Increases ease of collecting clinical samples Identifies specific chromosomes shared by family members with the disorder 2022 Child: 73

To improve the competence and willingness of providers in implementing evidence-based practices in a child and adolescent psychiatry clinic, the medical director reviews the recent medical literature for information on the most effective approaches. Which of the following strategies has the best evidence for effectiveness?

* Develop a pay-for-performance incentive pian for clinic providers Train providers to understand and monitor relevant metabolic markers Provide computer decision support through the electronic medical record Offer diagnosis and treatment guidelines within the electronic medical record Create an internet portal for practitioner access to relevant practice guidelines 2022 Child: 9

Which of the following is the term Margaret Mahler assigned to the phase of development in which a child begins to understanding that the mother is an individual with a unique identity?

* Differentiation Autistic phase Rapprochement Symbiotic phase Object permanence 2019 Child: 114 Autistic phase (0-1 month): In this early stage, the infant is primarily focused on their own basic needs and is not yet aware of the existence of others. They are self-absorbed and have limited interaction with their environment. Symbiotic phase (1-5 months): During this stage, the infant forms a close emotional bond with their primary caregiver, usually the mother. They rely heavily on this caregiver to meet their needs and provide a sense of security. The infant and caregiver are seen as a single unit, with the infant unable to differentiate between their own needs and those of the caregiver. Differentiation (5-10 months): During this stage, the infant starts to develop a sense of self and begins to differentiate between self and others. They become more aware of their surroundings and start to explore their environment. Object permanence (8-12 months): This is the stage when the child starts to understand that objects and people continue to exist even when they are out of sight. This cognitive development allows the child to form mental representations of objects and people, which helps in building memory and understanding the concept of cause and effect. It also lays the foundation for the development of problem-solving skills and the ability to predict the consequences of actions. Rapprochement (15-24 months): As the child grows, they become more independent and start to explore the world around them. However, they still need the security of their primary caregiver and may show signs of separation anxiety. This stage is characterized by a back-and-forth movement between seeking independence and returning to the caregiver for reassurance and support.

A 16-year-old is seen in an outpatient psychiatric clinic for ongoing care after a recent discharge from a psychiatric hospitalization for self-injurious behavior. The patient discloses that they smoke marijuana to "help calm down." The patent later asks, "Are you going to tell my parents?" The psychiatrist responds, "not necessarily, let's talk about your safety and how to involve your family." Which of the following core principles is best illustrated in the psychiatrist's response?

* Discussing the limits of confidentiality Avoiding actions that might be harmful Promoting optimal well-being and functioning Taking a developmental perspective when providing clinical care Recognizing youth be involved in making their own informed decisions 2021 Child: 57

In contrast to for-profit hospitals, non-profit hospitals do not engage in which of the following?

* Distributing surplus revenue to hospital shareholders Participating in research trials directly involving patients Generating more revenue than needed to pay expenses Accepting payment from patients with commercial insurance Generating revenue from medical residents and fellow trainees 2019 Child: 181

In contrast to for-profit hospitals, non-profit hospitals do not engage in which of the following?

* Distributing surplus revenue to hospital shareholders Participating in research trials directly involving patients Generating more revenue than needed to pay expenses Accepting payment from patients with commercial insurance Generating revenue from medical residents and fellow trainees 2022 Child: 100

A 16-year-old patient with bipolar disorder is hospitalized for sudden onset of odd behavior: repetitive, purposeless gestures; near-constant movement; and no speaking, eating, or drinking for the past two days. The patient's movements prevent the measurement of vital signs. There is minimal response to lorazepam after a total of 10 mg administered over three hours. What is the next step in management?

A. Brainimaging Urine toxicology Switch to diazepam Intravenous haloperidol Electroconvulsive therapy 2022 Child: 127

Interpersonal psychotherapy is an effective, evidence-based treatment for depression in adolescents that focuses primarily on which of the following therapeutic activities? (Select three)

* Enhancing use of social supports * Improving communication with others Developing positive self-talk strategies Challenging automatic negative thoughts * Conceptualizing distress through relationships Enhancing the patient's motivations for change Addressing transference and countertransference Reviewing psychological traumas through narrative 2019 Child: 191 Interpersonal psychotherapy is an effective, evidence-based treatment for depression in adolescents that focuses primarily on which therapeutic activities? Identifying Emotionally Charged Life Events: Adolescents are guided to recognize and understand the significant life events that may contribute to their depression. Exploring Emotional Responses: Therapists help adolescents express and manage their emotional responses to these events. Improving Communication Skills: The therapy includes activities that enhance the adolescent's ability to communicate their feelings and needs effectively. Building Social Skills: Adolescents are taught to build and maintain healthy relationships, which can have a positive impact on their mood and self-esteem. Coping Mechanisms: The therapy aims to equip adolescents with coping strategies to manage their depressive symptoms. Problem-solving Techniques: Adolescents are encouraged to develop problem-solving skills to address issues that may trigger depressive symptoms. This includes learning to identify problems, generate solutions, evaluate the effectiveness of these solutions, and make necessary adjustments. Stress Management: The therapy also focuses on stress management techniques, which can help adolescents to reduce and manage their levels of stress, thus mitigating the potential impact on their depressive symptoms. Building Resilience: Therapists work with adolescents to build resilience, helping them to bounce back from difficult situations and maintain their mental health. Establishing Healthy Lifestyle Habits: Adolescents are guided to establish and maintain healthy lifestyle habits, such as regular physical activity, balanced nutrition, and sufficient sleep, which can contribute to their overall well-being and help to alleviate depressive symptoms. Enhancing Self-esteem: Through various therapeu

Which of the following diagnostic studies is helpful in predicting outcomes in patients who have experienced traumatic brain injury?

* Evoked potentials Polysomnography Electromyography Computed Tomography Electroencephalography 2021 Child: 54 Evoked potentials (EPs) are valuable diagnostic tools that measure the electrical activity of the brain in response to stimulation of specific sensory pathways. They can provide crucial insights into the functioning of the sensory pathways, even in unconscious patients. EPs are particularly useful in predicting outcomes in traumatic brain injury (TBI) patients as they can indicate the extent of the damage caused by the injury. For instance, somatosensory evoked potentials (SSEPs) can help in assessing the integrity of the sensory pathways in the spinal cord and brain. Abnormalities in SSEPs can indicate severe brain damage and correlate with poorer outcomes. Similarly, visual evoked potentials (VEPs) can indicate damage to the optic nerves and pathways, and brainstem auditory evoked potentials (BAEPs) can reveal damage in the auditory pathways. These different types of EPs can give a comprehensive view of the patient's neurological status, providing valuable prognostic information. For instance, a poor response in EPs can suggest a more severe injury and a potentially poorer prognosis. On the other hand, normal or near-normal EPs can indicate a better prognosis. Moreover, the use of EPs can also guide the course of treatment. For example, if the EPs indicate severe damage to the optic nerves, the treatment plan may include interventions aimed at preserving vision.

Public policy has increasingly focused on which of the following issues regarding child and adolescent mental health research?

* Facilitating inclusion of previously excluded research groups, such as minors adolescent research Expanding the right-to-try law to include experimental mental health medications Allowing children in foster care to give their own consent for research participation Requiring that an individual not involved in the research obtain consent and assent Removing the requirement for Institutional Board Review involvement for child and 2022 Child: 86

Which of the following is an example of a delayed developmental milestone?

* First rolling over at age 10 months. First walking at age 14 months. First running at age 24 months. First daytime continence at age 38 months. First tricycle riding at age 40 months. 2022 Child: 72

An adolescent presents to an ambulatory clinic with new onset of abrupt vocalizations and bilateral complex movements, occurring several times a week, often during sleep, lasting 30- 60 seconds. The patient, who is otherwise healthy, reports highly aggressive and impulsive behaviors during these events, but is asymptomatic between events. Previous head computed tomography electroencephalography show no evidence of pathology. Which area of the brain is most likely impacted?

* Frontal Lobe Parietal Lobe Occipital Lobe Temporal Lobe Generalized Brain Process 2020 Child: 44 • Frontal lobe epilepsy is a neurological disorder that originates in the frontal lobes of the brain. It is the second most common type of epilepsy after temporal lobe epilepsy. The frontal lobes are involved in a multitude of functions, including motor skills, higher level cognition, and expressive language. • Seizures originating from the frontal lobe can often be mistaken for psychiatric or sleep disorders due to their unusual manifestations, such as abrupt vocalizations and complex movements. These seizures can occur at any time, even during sleep, and are usually brief, lasting from a few seconds to a couple of minutes. • The patient's highly aggressive and impulsive behaviors during these events could be a result of the seizure activity in the frontal lobe. However, between seizure episodes, the individual might appear completely normal, with no overt symptoms. This is because the abnormal electrical activity that causes seizures is intermittent and does not continuously affect the brain's functioning. • While standard imaging tests like head CT scans or electroencephalography might not always show evidence of pathology, they are useful in ruling out other causes. The diagnosis is primarily clinical, based on the symptoms, and can be confirmed with video-EEG monitoring that captures the onset and spread of a seizure.

A physically healthy preschool child presents for evaluation of irritability and temper tantrums only around bedtime. For most nights over the past year, the child sat in bed tossing and turning at bedtime and repeatedly left the bedroom. Despite now sleeping with parents, the child continues to have frequent awakenings, along with delays in getting to sleep and early morning awakenings. The child has no other psychiatric or medical symptoms and no major environmental changes have occurred. What is the most likely diagnosis?

* Insomnia disorder Oppositional defiant disorder Breathing-related sleep disorder Periodic limb movement disorder Attention-deficit/hyperactivity disorder 2021 Child: 117

In anticipation of an impending transition to young adulthood, the parents of a soon-to-be 18-year-old with autism and intellectual disability of moderate severity are seeking direction for decision making in adults who lack capacity. Which of the following legal mechanisms wouid be most appropriate for the parents to pursue in this situation?

* Guardianship Conservatorship Power of attorney Representative payee Supported decision making 2022 Child: 23 ● Guardianship ● Guardianship in child psychiatry refers to a legal process where an adult is given the authority by a court to make decisions for a child who is unable to do so. This typically involves decisions related to education, health, and welfare. Key terms include 'best interest of the child', 'minor', and 'legal authority'. ● Conservatorship ● Conservatorship, on the other hand, is a legal concept where a person (conservator) is appointed by a court to manage the financial affairs and/or daily life of another due to physical or mental limitations or old age. In child psychiatry, this is often used when a child has significant mental health issues that impact their ability to function independently. Notable terms are 'conservatee', 'incompetence', and 'fiduciary responsibility'.

A preschcol-age child's long-term babysitter moves away to a new city and the child is very upset. Which of the following would be the most beneficial strategy for the parent to use to help the child cope with the loss?

* Help the child to call the babysitter Take the child to grief counseling Arrange for a new babysitter as soon as possible Not mention the baby-sitter, in order to make a "clean break" Stay at home until the child stops mentioning the baby-sitter 2022 Child: 31

In conducting social skills groups for adolescents with autism spectrum disorder, which of the following is important for therapeutic efficacy?

* Include neuro-typical participants Include participants from a wide range of ages Create separate groups for participants of each gender Provide feedback in an indirect, non-confrontational manner Provide feedback with the use of figurative, non-literal language 2022 Child: 30

A child has grunting and motor tics that involve the limbs and head and cause severe pain. This results in the patient's frequent school refusal. Which of the following is the best choice for initial treatment?

* Initiation of a neuroleptic Initiation of a monitoring period Initiation of botulinum toxin injection Initiation of a high dose of an alpha agonist Initiation of a selective serotonin reuptake inhibitor 2022 Child: 50

A school-aged natal male states, "The doctors made a mistake, I am a girl." This comment is an example of which of the following attributes, important in the differentiation of gender dysphoria and gender non-conforming youth?

* Insistence Persistence Consistence Gender variance Affective assertion 2021 Child: 9 Insistence: This refers to the strong assertion by a child about their gender identity, often different from their assigned sex at birth. It's a key indicator in understanding a child's gender dysphoria or nonconformity. Persistence: This term implies the continual assertion of gender identity over time. Persistent gender nonconformity or dysphoria, despite societal pressures, can indicate a stable gender identity different from the assigned sex. Consistence: This is the degree to which a child's gender identity remains the same across different situations and over time. Consistent gender nonconformity or dysphoria is a strong indicator of trans or non-binary identities. Gender variance: This refers to expressions of gender that significantly deviate from societal norms associated with the individual's assigned sex. Gender variance can be seen in behaviors, interests, and self-concept, and is not necessarily indicative of gender dysphoria, but can be a characteristic of gender non-conforming youth. Affective assertion: This term refers to the emotional expression tied to a child's assertion of their gender identity. The intensity and consistency of affective assertion can provide insight into the child's internal experience of gender, and may help to distinguish between gender dysphoria and non-conformity.

Which of the following is the largest individual risk factor for development of schizophrenia?

A. CNV deletion at 1921.1 B. CNV deletion at 22911.21 C. Parent with schizophrenia D. Older sibling with schizophrenia E. Identical twin with schizophrenia 2022 Child: 175

During psychodynamic psychotherapy with an adolescent patient, the therapist mentions, "You are very capable but seem to sabotage your success. Perhaps you fear that your mother will be envious of you." Which of the following techniques of psychodynamic psychotherapy is being used?

* Interpretation Observation Confrontation Clarification Encouragement to elaborate 2021 Child: 46 ● In psychodynamic psychotherapy, interpretation refers to the therapist's task of deciphering the underlying meanings behind a client's thoughts, feelings, and behaviors. This often involves analyzing past experiences, unconscious processes, and defense mechanisms. ● On the other hand, confrontation involves the therapist challenging the client's perceptions or behaviors that may be detrimental or counterproductive to their healing. This can be a matter of pointing out inconsistencies in the client's narrative or addressing harmful patterns of behavior.

In biosocial theory, borderline personality disorder criterion behaviors are understood as resulting from constitutional vulnerability and environmental factors. The key environmental factor is hypothesized to be which of the following?

* Invalidation Sexual abuse Lack of transitional objects Low socioeconomic status High expressed emotion in the home 2021 Child: 90 Invalidation, in the context of biosocial theory, is the chronic dismissal or undermining of children's emotional experiences, often by their caregivers. This invalidation ranges from ignoring feelings to completely disregarding reality, resulting in the child's difficulty in understanding and regulating their emotions - a key feature of borderline personality disorder. On the other hand, constitutional vulnerability is an individual's innate temperament or biological predisposition. Those with heightened emotional sensitivity are more vulnerable to invalidation, creating a transactional cycle in which the environment's response elicits further emotional dysregulation, furthering the BPD criteria of emotional instability, impulsivity, and relationship issues.

In which of the following ways will an eight-year-old child most likely conceptualize death?

* It is a punishment for their bad behavior It is an irreversible state that cannot be changed It is an inevitable part of life that will not happen to them It is a state of existence that holds little to no meaning for them It is a long journey from which the deceased will eventually return 2020 Child: 152 ● According to Jean Piaget's theory of cognitive development, children's understanding of death evolves as they mature. ● Preschool (2-4 years) ● Children at this age often perceive death as reversible and temporary. They may believe that the deceased person is simply sleeping or gone on a trip. ● Early Childhood (5-7 years) ● At this stage, children start to understand the permanence of death but may still believe it can be avoided or cheated. Magical thinking is common, with children often believing they have the power to cause or prevent death. ● Middle Childhood (8-11 years) ● Children at this age begin to understand death as a universal, irreversible, and inevitable part of life. They may start asking more detailed questions about death and its implications, showing a deeper understanding and curiosity. ● Adolescence (12-18 years) ● During adolescence, individuals fully comprehend the permanence and inevitability of death. They often grapple with existential questions and may experience a heightened fear of death. They may also start to understand the emotional and practical implications of death. ● Early Adulthood (19-29 years) ● In early adulthood, individuals typically understand death as a natural part of life. They may start to think about their own mortality and the legacy they want to leave behind. ● Middle Adulthood (30-49 years) ● Middle-aged adults often have a more complex understanding of death, acknowledging its inevitability while also contemplating its impact on their loved ones. ● Late Adulthood (50 years and above) ● At this stage, individuals often reflect more deeply on their own mortality. They might grapple with the reality of death more frequently, especially as they begin to lose peers and loved ones. They may also express a desire to discuss their end-of-life wishes and legacy. Despite the inherent discomfort, this can lead to a greater appreciation of life and the time th

Which of the following is the most accurate statement regarding the diagnosis of male hypoactive sexual desire disorder?

* It often manifests during puberty Symptoms can be caused by distress in a relationship Symptoms must occur with the onset of sexual activity The diagnosis is most prevalent between the ages of 26 and 44 Symptoms must be present for at least 12 months to make the diagnosis 2020 Child: 56

A family therapist begins a session with a discussion of neutral topics. The therapist refrains from addressing serious issues until each family member has engaged in conversation. What is this technique called?

* Joining Flooding Ignoring Attending Reframing 2022 Child: 54 ● Joining ● refers to the therapeutic technique of building a rapport and alliance with the child, essentially "joining" their world. Key buzzwords include empathy, rapport, and alliance. ● Flooding is a form of exposure therapy where the child is exposed to an anxiety-provoking stimulus until the anxiety subsides. Key terms include exposure, desensitization, and extinction. ● Ignoring in the context of child psychiatry, often refers to a behavioral management technique where certain behaviors are ignored to decrease their frequency. Key buzzwords include extinction, non-reinforcement, and selective attention. ● Attending is the act of being present and attentive during therapy sessions, demonstrating understanding and interest. Key terms include active listening, empathy, and engagement. ● Reframing ● is a cognitive-behavioral technique where negative or distorted thoughts are challenged and replaced with more positive or accurate thoughts. Key terms include cognitive restructuring, perspective taking, and cognitive shift.

Which of the following factors is more associated with pediatric obsessive-compulsive disorder when compared to adults?

* Less insight Less heritability Worse prognosis More common in females Presence of precipitating trauma 2021 Child: 61

Which of the following mood stabilizers is FDA-approved for acute mania and maintenance of bipolar disorder in youth greater than 12 years of age?

* Lithium Divalproex Lamotrigine Oxcarbazepine Carbamazepine 2021 Child: 13

A caretaker repeatedly engages in a prolonged argument with a toddler about picking up toys. The caretaker reports how tired they are of this problem. According to behavioral Psychology, which of the following is perpetuating this interactional pattern?

* The toddler learning ways to get attention Immaturity associated with the toddler's young age The toddler's need to demonstrate a need for independence Toddler's repeated efforts to work through an Oedipal complex Unconscious resentment the toddler has towards the caretaker 2022 Child: 107

Which of the following medications is more likely to increase agitation in a child with a developmental disability?

* Lorazepam Haloperidol Benztropine Chlorpromazine 2019 Child: 199 Benzodiazepines, despite being commonly used for their calming effects, can paradoxically increase agitation in children with developmental disabilities. This is due to a phenomenon called 'paradoxical disinhibition', where the intended sedative effect is replaced with an excitatory response. This can manifest as increased agitation, restlessness, and even aggression. Factors such as the child's unique neurochemistry, dosage, and the specific type of benzodiazepine can influence this unexpected reaction. It's always important to closely monitor any changes in behavior when introducing these medications.

Meta-analyses of genome wide association studies examining antipsychotic-induced weight gain in youth have identified a risk allele near which of the following genes?

* MC4R DRD4 DAT-1 DISP-1 SNAP-25 2022 Child: 76 MC4R This gene is involved in appetite regulation and energy homeostasis. Mutations can lead to obesity and insulin resistance, potentially contributing to the development of mood disorders and ADHD in children. DRD4 DRD4 is a dopamine receptor gene. Variations are associated with novelty seeking behaviors and ADHD. It's often a focus in the study of pharmacogenomics in psychiatry. DAT-1 This gene codes for the dopamine transporter. Associated with ADHD, it's important in dopamine reuptake in synaptic clefts. Altered function can influence mood and attention. DISP-1 Involved in the Sonic Hedgehog signaling pathway, mutations in DISP-1 can lead to holoprosencephaly, a severe brain malformation. This gene's role in brain development underscores its significance in understanding various psychiatric conditions in children. SNAP-25 SNAP-25 is a protein integral to synaptic vesicle fusion. Mutations can result in impaired neurotransmitter release, potentially leading to conditions like ADHD and learning disabilities. It is a target for various psychotropic drugs.

A 14-year-old patient being treated with fluoxetine becomes confused and is tremulous with fever, sweating, and myoclonus after using drugs. Which of the following drugs did the patient most likely use?

* MDMA Marijuana Alprazolam Heroin Codeine 2021 Child: 123

Which of the following is the most commonly identified challenge when implementing a patient portal in a child and adolescent psychiatric practice?

* Maintenance of patient confidentiality Unwillingness of providers to participate Lack of adolescent interest in online resources Refusal by parents to allow adolescents access Implementation difficulties within the electronic medical record 2020 Child: 55

What is the most frequent co-morbid disorder with childhood-onset schizophrenia?

* Major depressive disorder Generalized anxiety disorder Post-traumatic stress disorder ! Obsessive-compulsive disorder Attention-deficit/hyperactivity disorder i 2022 Child: 90

Which of the following forms of financing has had the most significant impact on the structure and organization of mental health services for individuals with severe mental illness in the United States?

* Medicaid Medicare Preferred Provider Organizations Fee for Service Private Insurance Heaith Maintenance Organizations 2022 Child: 45

Which of the following forms of financing has had the most significant impact on the structure and organization of mental health services for individuals with severe mental illness in the United States?

* Medicaid Medicare Preferred Provider Organizations Fee for Service Private Insurance Health Maintenance Organizations 2019 Child: 125 Eligibility Medicare is a federal program that provides health coverage for individuals aged 65 and older or with certain disabilities. On the other hand, Medicaid is a state and federal program that provides health coverage for low-income individuals and families, regardless of age. Coverage Medicare coverage is primarily divided into Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage). Medicaid coverage varies by state but generally covers a wide range of health services, including some not typically covered by Medicare, like nursing home care and personal care services.

Which of the following approaches to conducting a court-ordered child custody evaluation is generally considered to be optimal?

* Meeting with both parents and observing the child interacting with each parent when appropriate Observing and talking with the child only so that neither parent can assert that recommendations are biased Interviewing first the most dysregulated parent so that potentially questionable assertions can be checked against a better source Talking first with the parent who seems better able to put the child's needs above his or her own, and then determining whether to meet with the other parent Performing an evaluation with the more cooperative parent only, and clearly documenting that potential reporting biases were considered prior to making recommendations 2019 Child: 138

Which of the following is an example of an epigenetic regulation mechanism?

* Methylation of histone molecule Addition of poly(A) tail to mRNA Phosphorylation of target protein Cleavage of precursor protein at a specific site Transcription factor binding to promoter region of a gene 2022 Child: 38

Which of the following cells are primarily involved in scavenging debris upon cell death?

* Microglia Astrocytes Interneurons Schwann cells Oligodendrocytes 2022 Child: 82

A child is attending the funeral of a recently deceased family member. The child asks to save some food for the family member, saying they "must be hungry in Heaven." Which of following components of the concept of death is most relevant to the child's question?

A. Causality B. Universality C. Irreversibility D. Nonfunctionality E. Noncorporeal continuation 2022 Child: 133

In equivocal sleep studies, CSF orexin levels of less than 110 pg/ml is most suggestive of which of the following sleep disorders?

* Narcolepsy Restless legs syndrome REM sleep behavior disorder Delayed sleep phase disorder Advanced sleep phase disorder 2020 Child: 51 • Cerebrospinal fluid (CSF) orexin levels refer to the concentration of a neuropeptide known as orexin in the fluid that surrounds the brain and spinal cord. Orexin, also known as hypocretin, plays a crucial role in maintaining wakefulness and preventing non-REM sleep and REM sleep from occurring at inappropriate times. • In narcolepsy, a neurological disorder characterized by excessive daytime sleepiness, cataplexy, and abnormal REM sleep, there is typically a deficiency of orexin. This is because the neurons that produce orexin in the hypothalamus region of the brain are destroyed or damaged. • A CSF orexin level of less than 110 pg/ml in equivocal sleep studies is most suggestive of narcolepsy because it indicates a lower than normal concentration of this wakefulness-promoting neuropeptide. This deficiency can lead to the characteristic symptoms of narcolepsy, such as sudden bouts of sleep, disturbed nocturnal sleep, and cataplexy, which is a sudden loss of muscle tone triggered by strong emotions. • The measurement of CSF orexin levels is therefore a valuable tool in diagnosing narcolepsy, particularly in cases where symptoms are ambiguous or other diagnostic tests, such as polysomnography or the multiple sleep latency test, provide inconclusive results. • It's important to note, however, that while a low CSF orexin level is strongly suggestive of narcolepsy, it's not definitive proof of the condition. Other factors such as patient history, symptom presentation, and additional diagnostic tests must also be taken into account. Furthermore, other sleep disorders, such as idiopathic hypersomnia or sleep apnea, may also be associated with lower than normal CSF orexin levels.

Which of the following is a priority of community-based systems of mental health care?

* Participation of families in treatment planning Escalation to higher levels of care if nonadherence arises Restriction of services to those in need of psychopharmacology Reach of a greater number of individuals by imposing visit limits for existing clients Promotion of autonomy by requiring transitional age youth to independently arrange continued treatment 2021 Child: 141

Which of the following is included in the "meaningful use" requirement as it applies to the electronic health record (EHR)?

* Patients are provided with timely electronic access to their health information. Mental health providers must include psychotherapy process notes in the EHR. Clinicians maintain case registries of patients based upon DSM-5 diagnostic categories. All information about patient encounters is entered in the EHR while the patient is physically present. Hospitals use aggregate EHR data to more effectively market healthcare services to consumers. 2021 Child: 32 The "meaningful use" requirement, as it applies to the EHR system, is a set of standards defined by the Centers for Medicare & Medicaid Services (CMS). The goal is to encourage healthcare providers to show "meaningful use" of a certified EHR system. The requirements include: ● Using certified EHR technology in a meaningful manner, such as e-prescribing. ● Using certified EHR technology for electronic exchange of health information to improve quality of healthcare. ● Using certified EHR technology to submit clinical quality and other measures. Each of these requirements is intended to improve healthcare delivery and outcomes. The "meaningful use" requirement for electronic health records (EHR) includes giving patients access to their health information, including psychotherapy notes, maintaining patient registries, entering all encounter information in the EHR, and using aggregate data for marketing purposes.

Which of the following rating scales provides a general screening of behavioral health symptoms that identifies risk for childhood psychiatric disorders in a primary care setting?

* Pediatric Symptom Checklist Patient Health Questionnaire-9 Mood and Feelings Questionnaire McMaster Family Assessment Device Screen for Child Anxiety Related Disorders 2020 Child: 16 Pediatric Symptom Checklist Strengths: This checklist provides a broad screening of emotional and behavioral problems. It's simple and easy for parents to understand and complete. Weaknesses: It may not be specific enough to diagnose certain psychiatric disorders and doesn't provide information about the severity of symptoms. Patient Health Questionnaire-9 Strengths: This questionnaire is useful in identifying symptoms of depression, making it essential in any behavioral health screening. Weaknesses: It only focuses on depression and does not screen for other psychiatric disorders. Mood and Feelings Questionnaire Strengths: It's a comprehensive tool for evaluating mood disorders in children and adolescents, providing insight into both depressive and manic symptoms. Weaknesses: It may not be as effective in detecting other types of psychiatric disorders, and its length may be a deterrent for some respondents. McMaster Family Assessment Device Strengths: This device is unique in its focus on family dynamics, which can play a crucial role in a child's mental health. Weaknesses: It may overlook individual symptoms and conditions that aren't directly related to family interactions. Screen for Child Anxiety Related Disorders Strengths: It's a specialized tool for identifying symptoms of anxiety disorders in children. Weaknesses: It may not be as comprehensive in screening for other psychiatric disorders and conditions.

An adolescent presents due to anxiety about physical illness, despite negative medical workup. Which of the following characteristics would suggest a diagnosis of somatic symptom disorder rather than illness anxiety disorder?

* Persistent abdominal pain Frequent utilization of medical care Symptom duration greater than six months High levels of anxiety regarding physical health Repeatedly checking the body for signs of illness 2021 Child: 34

An 18-year-old is referred for neuropsychological testing. Which of the following domains would assess this student's executive functioning? (Select three)

* Planning Dexterity Spelling ability * Self-monitoring * Working memory Academic achievement Reading comprehension Personality characteristics 2021 Child: 200 an executive in the SWiM Pool Domains: ● Time Management and Attention ● This refers to a child's ability to estimate how much time a task will take, to pay attention, and to stay focused on a task. ● Task Initiation and Planning ● This involves the ability to begin a task without procrastination and to create an effective strategy for task completion. ● Working Memory and Detail Recall ● Working memory plays a key role in a child's ability to retain and recall information. It involves actively holding information in the mind and manipulating it to complete complex tasks. ● Inhibition and Self-regulation ● This domain covers a child's ability to control impulses, resist distractions, and to act in a socially appropriate way. It also includes emotional self-regulation, which is the ability to manage and respond to an emotional experience in a socially acceptable manner. ● Cognitive Flexibility ● Cognitive flexibility is the ability to switch mental gears, to think about multiple concepts simultaneously, and to adapt to new situations or changes in routine. This is crucial in a child 's ability to problem-solve and adapt to new environments. ● Goal-Directed Persistence ● This refers to a child's capacity to follow through on a task until completion. It involves the ability to maintain focus and motivation, even in the face of obstacles or difficulties. ● Metacognition ● Metacognition involves a child's ability to self-reflect and evaluate their own performance and strategies. It is the understanding of one's own thought processes, which is key for self-improvement and learning.

A ten-year-old child with a history of attention-deficit/hyperactivity disorder, not currently on any medication, presents to the office with parents who are concerned after receiving a report from the school that the child has been falling asleep during class. Parents report that the child goes to bed at a regular time each evening, and sleeps eight to ten hours each night. They are confident that the child sleeps through the night, because they can hear snoring all night long. Exam reveals a slightly overweight child, but is otherwise normal. Which of the following is the appropriate next step for the physician to take?

* Refer the child for polysomnography Start treatment with a low-dose stimulant Recommend a longer sleep period each night Recommend diet and exercise for weight control Refer the child for evaluation for adenotonsillectomy 2019 Child: 122

What is the primary reason given by teenage girls who have never had intercourse for abstaining from sex?

* Religious values Availability of birth control Desire to avoid pregnancy Not having met appropriate partner Fear of sexually transmitted diseases 2021 Child: 119

Despite a treating psychiatrist's recommendation, an insurance company denies payment of inpatient psychiatric treatment for a patient with a diagnosis of anorexia nervosa due to "lack of medical necessity." Which of the following duties does the psychiatrist have to the patient?

* Request an appeal of the insurance company's decision Refer the patient to another psychiatrist for a different treatment plan Inform the patient you will no longer be able to treat them adequately Increase the frequency of appointments with the patient for close monitoring Defer discussion of the insurance company's decision until another treatment plan is made 2022 Child: 108

Which of the following clinical features are consistent with benign Rolandic epilepsy? (Select three)

* Resolve by puberty * Usually occur at night Occur in the hippocampus Presents before age three Require treatment with medication * May cause lasting cognitive problems Often cause permanent behavioral problems Often accompanied by loss of consciousness 2021 Child: 195 ● It is the most common form of childhood epilepsy. ● It typically presents between the ages of 3 and 13 years and resolves by adolescence. ● Nocturnal seizures involving facial twitching, drooling, and speech arrest are common symptoms. ● Diagnosis is based on clinical presentation and characteristic EEG findings showing high-voltage centrotemporal spikes. ● The condition is self-limiting and often requires no treatment, but antiepileptic drugs may be used if seizures are frequent or distressing. ● The prognosis is generally good, with most children outgrowing the condition without long-term neurological or cognitive effects. ● However, some children may exhibit learning difficulties or behavioral problems which may need additional support in an educational or therapeutic setting.

A 16-year-old patient has been nonadherent to SSRI treatment for anxiety. When asked why, the patient looks uncomfortable and says, "I just don't like the feeling." Asking about which of the following social factors would be most helpful in identifying side effects related to medication non-adherence?

* Sexual activity Substance use Nutritional history Sports participation Academic performance 2021 Child: 80

From a systems of care perspective, which of the following components are integral to developing an empirically based "wraparound" process for individuals with serious emotional disturbances? (Select three)

* Skill mentorships Process driven care * Community-based care Problem-focused solutions Generalized service delivery * Strength-focused opportunities Categorical mental health funding Provision of care based on established conditions 2020 Child: 196 Community-based Skills Ment... for Strength

A psychiatrist is investigating the effectiveness of transcranial magnetic stimulation (TMS) for adolescent depression. A study is performed that compares two groups of adolescents on improvement in mean Hamilton Depression (HAM-D) Rating Scale scores at two weeks post-treatment, one of the groups receives TMS and the other group receives sham TMS. Which of the following statistical tests is most appropriate for detecting group differences?

* T-test Chi-square Logistic regression Correlation coefficient Mixed factorials ANOV A 2020 Child: 116 Each of these statistical methods and concepts are vital tools in child psychiatry research. They allow researchers to discern patterns, make predictions, and draw meaningful conclusions about the mental health of children. Understanding these key terms and their applications can greatly enhance one's ability to interpret and evaluate research findings in the field of child psychiatry. Significant buzzwords/pertinent conclusions associated with (each of) the above research study(ies) on child psychiatry boards: ● T-test: Often used to compare mean differences between two groups, such as treatment vs. control in child psychiatry research. ● Chi-square: Frequently applied in child psychiatry studies to measure the association between categorical variables, like presence or absence of a psychiatric disorder and demographic factors. ● Logistic regression: Essential in predicting binary outcomes in child psychiatry, such as the likelihood of a child developing a mental health disorder based on specific risk factors. ● Correlation coefficient: A common measure to determine the relationship strength between two continuous variables in child psychiatry, for example, the correlation between age and symptom severity in children with ADHD. ● Mixed factorials ANOVA: Used in child psychiatry studies to analyze the effects of two or more independent variables on a dependent variable, typically in experimental designs. For instance, it might be used to examine the influence of therapy type and medication dosage on the behavior of children with autism.

Which of the following structures is considered to be the gateway to cortical processing of incoming sensory information?

* Thalamus Amygdala Hippocampus Basal ganglia Nucleus accumbens 2021 Child: 31

Testimony about which research findings contributed directly to the legal desegregation of schools in Brown vs The Board of Education?

* The Doll Tests The Tuskegee Study The Strange Situation The Six Cultures Study The New York Longitudinal Study 2022 Child: 94 The Doll Tests: Conducted by psychologists Kenneth and Mamie Clark, these tests highlighted the internalized racism and self-hate in African American children. Significant buzzwords include racial bias, self-perception, and desegregation. The Tuskegee Study: A notorious medical experiment conducted by the U.S. Public Health Service, studying untreated syphilis in African American men. Buzzwords include medical ethics, informed consent, and racial discrimination. The Strange Situation: Developed by psychologist Mary Ainsworth, this study examined child-parent attachment styles. Key terms include secure attachment, insecure attachment, separation anxiety, and exploration behavior. The Six Cultures Study: This comprehensive study led by anthropologists Beatrice and John Whiting explored child-rearing practices across different cultures. Buzzwords include cultural relativity, socialization practices, and comparative anthropology. The New York Longitudinal Study : A groundbreaking study by psychiatrists Alexander Thomas and Stella Chess that investigated temperament in children and its impact on their development. Key terms include temperament, goodness-of-fit, and developmental psychology.

A three-year-old child is told the following scenario: "A child plays with a doll and places it on the bed before leaving the room. The child's sibling, who was not in the room before, comes in and moves the doll to the shelf. Where would the child look for the doll upon returning to the room?" The three-year-old indicates that the child will look on the shelf. This is because most three-year-olds have not acquired which cognitive process?

* Theory of mind Social referencing Object permanence Object conservation Transitional phenomena 2020 Child: 36 • Theory of Mind refers to the ability to attribute mental states, such as beliefs, desires, intentions, and emotions, to oneself and to others. This cognitive skill is crucial for understanding and predicting others' behaviors. It's believed to develop during early childhood, and is considered a key element of social cognition. • The concept has been widely studied in fields such as developmental psychology, cognitive science, and neuroscience. Various experiments, such as false-belief tasks, have been used to examine theory of mind in children and non-human animals. • Theory of mind is also crucial in understanding and diagnosing certain psychological disorders such as autism, where there's often a significant impairment in this area. Understanding theory of mind can also help in the development of interventions and therapies for these disorders. For example, social skills training and cognitive behavioral therapy often incorporate elements of theory of mind understanding.

The parent of a four-year-old expresses concern over the child's behavior. Some days the child will seem fine when dropped off at school, but at other times will be anxious and tearful. The child became attached to one of the teachers at school, and cried when that teacher left on maternity leave. The parent also notes that the child will often ask the same questions repeatedly about when the parent will pick them up from school, and the child prefers to bring a stuffed animal when leaving the house. Which of the following is most appropriate for the psychiatrist to tell the parent?

* This is developmentally appropriate behavior. This degree of attachment to a teacher is concerning. This child is showing early evidence of separation anxiety disorder. The repetition of the same questions is concerning for a learning disorder. The use of the stuffed animal is concerning because it prevents the development of other coping skills. 2019 Child: 175

Which of the following strategies has been most effective in overcoming barriers to delivering evidence-based psychotherapies to individuals in lower- and middle-income countries?

* Training and supervising lay counselors to deliver the intervention in a culturally sensitive manner Recruitment of patient family members to serve as interpreters between the patient and provider Introducing new explanatory models of illness and evidence support for psychotherapy to the community Use of specific clinical terminology to minimize confusion and to provide consistency in treatment delivery Maintaining strict adherence to the evidence-based treatment manual to produce outcomes similar to those in the United States 2021 Child: 63

A 13-year-old with a history of intellectual disability and infantile seizures is evaluated for a new skin finding on the lower back. On exam, there is a raised, thickened rough patch of skin approximately 5-cm in length. This cutaneous finding is most commonly associated with:

* Tuberous sclerosis. Sturge-Weber syndrome. Neurofibromatosis type 1. Neurofibromatosis type 2. Von Hippel-Lindau Syndrome. 2021 Child: 81 ● Tuberous sclerosis: A genetic disorder characterized by the growth of numerous benign tumors in many parts of the body. Significant buzzwords include angiofibromas, cortical tubers, and seizures. ● Sturge-Weber syndrome: A neurological disorder marked by a distinctive port-wine stain on the forehead, scalp, or around the eye. Clinical pearls include glaucoma, seizures, and intellectual disability. ● Neurofibromatosis type 1: A condition characterized by changes in skin coloring and the growth of tumors along nerves in the skin, brain, and other parts of the body. Pertinent conclusions include learning disabilities, scoliosis, and optic glioma. ● Neurofibromatosis type 2: A genetic disorder characterized by the growth of noncancerous tumors in the nervous system. The most common tumors associated with this condition are vestibular schwannomas, which grow along the nerves responsible for balance and hearing in the inner ear. Clinical pearls include hearing loss, tinnitus, and balance issues. ● Von Hippel-Lindau Syndrome: A rare genetic disorder characterized by the growth of tumors and cysts in many parts of the body. Significant buzzwords include hemangioblastomas (blood vessel tumors), renal cell carcinoma, and pheochromocytomas (tumors of the adrenal gland).

Which of the following environmental factors are associated with increased risk of developing schizophrenia? (Select three)

* Urban living Air pollution * Older father Nicotine use Summer birth * Cannabis use Sleep deprivation Radiation exposure 2021 Child: 196

Which of the following factors most likely account for the higher rate of completed suicides among adolescent males compared to females? (Select three)

* Use of more lethal means Higher suicide attempt rates Higher rate of suicidal ideation * Higher rates of substance abuse * Higher rates of antisocial behavior Greater exposure to social aggression Higher prevalence of major depression Greater susceptibility to "contagion effect" following a peer suicide 2019 Child: 190 Several factors could potentially explain this disparity. Gender Socialization: Society often pressures males to suppress their emotions, which could lead to internalized stress and a higher likelihood of suicide. Method Selection: Males tend to choose more lethal methods for suicide, such as firearms, compared to females who might opt for methods like poisoning. Access to Support: Males, especially in their adolescence, might be less likely to seek help due to societal stigma around mental health. Substance Abuse: Higher rates of substance abuse among adolescent males could also contribute to the higher suicide rates. Risk-Taking Behavior: Adolescent males are generally more prone to risk-taking behavior, which may extend to self-harmful actions including suicide. Mental Health Disorders: Studies have shown that mental health disorders are often underdiagnosed in males, leading to a lack of necessary treatment and support. Aggression and Impulsivity: Males, particularly during adolescence, are more likely to exhibit aggressive and impulsive behavior, which may contribute to a higher rate of suicide. Societal Expectations: The pressure to conform to societal expectations of masculinity could lead to increased stress and feelings of isolation. Cultural Factors: Certain cultural norms and beliefs may also play a role in the higher suicide rates among adolescent males. Lack of Awareness: There might be a lack of awareness about the severity of male suicide, leading to a gap in targeted prevention efforts. Economic Stress: Adolescent males may face unique economic stresses, such as the expectation to provide for a family in the future, which could contribute to feelings of hopelessness and increase the risk of suicide. Biological Factors: Some research suggests that biological differences between males and females, such as hormonal changes during adolescence, could influence the risk of

Systemic treatment with a derivative of which of the following vitamins has been associated with medication-induced depression in adolescents?

* Vitamin A Vitamin B12 Vitamin C Vitamin D Vitamin K 2020 Child: 148

Ina hypothetical study, 60% of adolescents with depression treated with a selective serotonin reuptake inhibitor met the response rate criteria, while those who received a placebo had a response rate of 35%. What is the number needed to treat for this study?

1 * 4 10 40 400 2022 Child: 5

An adolescent with symptoms of psychosis, self-injurious behavior and choreiform movements is found to have elevated liver transaminases. What genetically inherited disease is the most likely diagnosis?

* Wilson disease Tuberous sclerosis Huntington disease Sturge-Weber syndrome Neurofibromatosis type 1 2020 Child: 70 significant buzzwords/clinical pearls associated with each of the above disorders on child psychiatry boards: Wilson disease This is a rare autosomal recessive inherited disorder of copper metabolism. Key clinical pearls include the presence of Kayser-Fleischer rings in the eyes, liver disease, and neurological symptoms such as tremors and dysarthria. Tuberous sclerosis Known as a neurocutaneous disorder characterized by the development of multiple benign tumors of the skin and central nervous system. Look for signs such as ash-leaf spots, facial angiofibromas, and seizures. Huntington disease This is an autosomal dominant disorder characterized by progressive brain disorder that causes uncontrolled movements, emotional problems, and loss of cognitive ability. Key clinical pearls include chorea, psychiatric disturbances, and a family history of the disease. Sturge-Weber syndrome This is a neurological disorder marked by a distinctive port-wine stain on the forehead, scalp, or around the eye. This condition is often associated with seizures, developmental delay, and glaucoma. Neurofibromatosis type 1 This is a genetic disorder characterized by the growth of numerous noncancerous (benign) tumors in nerves throughout the body. Key features to look for include café-au-lait spots, freckling in the armpit or groin area, and Lisch nodules in the eyes.

Which of the following epigenetic processes is implicated in the phenotypic expression of Rett syndrome?

* X inactivation Dedifferentiation IGF 2 methylation Genomic imprinting Genomic polymorphism 2021 Child: 69 X inactivation, an epigenetic process, silences one of the two X chromosomes in female cells to compensate for the dosage difference of X-linked genes between males and females. In Rett syndrome, this random X inactivation can lead to mosaicism, where some cells express the healthy MECP2 gene and others express the mutated one. The severity and phenotype of Rett syndrome varies significantly due to this mosaicism, making it essential to comprehend for child psychiatry board exams. Furthermore, this knowledge can help the development of potential treatments such as reactivating the silenced X chromosome. Additionally, understanding X inactivation can explain why Rett Syndrome primarily affects females and the broad variation in symptoms. This deep understanding of X inactivation and its role in Rett Syndrome is essential for the medical and scientific community, as well as the child psychiatry board examination.

With regard to participation in research, the assent of a minor under the age of 18 years is:

* always needed and binding. disregarded if the guardian consents. okay to change by providing incentives. ignored if they lack understanding of procedures. unnecessary if their anonymity is always protected. 2019 Child: 158

According to cognitive psychology, negative emotional reactions to events that occur in individuals with depression are most likely caused by:

* automatic perceptions. level of cognitive ability. adverse childhood events. reinforced behavioral patterns. genetic determinants of illness. 2020 Child: 45

The primary mechanism by which very young children learn therapeutic concepts through cognitive-behavioral play therapy is:

* modeling. avoidance. safety-seeking. positive reward. negative reinforcement. 2020 Child: 29 • Modeling, in the context of cognitive-behavioral play therapy, refers to the process where a therapist demonstrates a particular behavior, thought process, or skill with the aim of teaching the child to emulate it. This method is based on the assumption that children learn by imitating adult behaviors. • In play therapy, the therapist may use toys or games to model coping strategies, problem-solving skills, or social interactions. For example, if a child struggles with anger management, the therapist might use a doll to demonstrate calming techniques. The child can then practice these techniques during the play therapy session and eventually, incorporate them into their real-life situations. • This approach is particularly effective because it allows children to learn in a safe, controlled environment before applying new skills and behaviors in their daily lives. It also provides an opportunity for the therapist to observe and provide immediate feedback, further facilitating the child's learning process. • Modeling is not only beneficial for teaching new behaviors, but it also helps to correct maladaptive behaviors. By witnessing the consequences of different actions through play, children gain a better understanding of the effects of their behaviors. This can lead to a change in their thought patterns and ultimately, a change in behavior.

A genetic abnormality resulting from the occurrence of two separate cell types in the same individual is known as:

* mosaicism. anticipation. premutation. polymorphism. copy number variation. 2021 Child: 86 Mosaicism: A condition where an individual has two or more genetically different sets of cells in his/her body. Clinical pearls include somatic mosaicism and germline mosaicism. These concepts are significant in child psychiatry as it can lead to genetic disorders like autism. Anticipation: The phenomenon where the symptoms of a genetic disorder become apparent at an earlier age with each generation. Clinical pearls include genetic anticipation and trinucleotide repeat expansion. This is pertinent in child psychiatry as it can influence the early onset of psychiatric disorders. Premutation: A mutation that precedes the full mutation. Clinical pearls include Fragile X syndrome. This is significant in child psychiatry as it can result in mental impairments. Polymorphism: A genetic variation that leads to different phenotypes or observable traits. Key terms include Single Nucleotide Polymorphism (SNP) and Variable Number Tandem Repeats (VNTR). This concept is relevant in child psychiatry as it can contribute to the genetic basis of psychiatric disorders. Copy Number Variation: A phenomenon where sections of the genome are repeated and the number of repeats varies among individuals. Clinical pearls include microdeletions and microduplications. This is pertinent in child psychiatry since it can lead to neurodevelopmental disorders such as schizophrenia and autism.

Evidence-based medicine suggests that randomized trials are considered the top of the hierarchy of evidence. This hierarchy is primarily based on study characteristics related to:

* risk of bias. type of funding. study question. study populations. investigator qualifications. 2019 Child: 140

The Supreme Court case Roper v Simmons (2005) ruled that juveniles cannot be:

* sentenced to capital punishment. tried as an adult for first degree murder. declared incompetent secondary to insanity. given life sentences without possibility of parole. 2019 Child: 198 Can't give kids the Rope!

Proceedings in juvenile court differ from those of adult court with respect to the right of the defendant to:

* trial by jury. due process. representation by counsel. protection from self-incrimination. "beyond a reasonable doubt" standard of proof. 2021 Child: 163

Inthe final session of a weekly course of psychotherapy, the therapist says, "Maintaining behavioral changes can be difficult. Remind yourself that slipping up and trying again is a normal part of the recovery process." This intervention is best described as:

* validation. * psychoeducation. * relapse prevention. * behavioral activation. * cognitive restructuring. 2022 Child: 70

A patient successfully finishes a course of brief psychodynamic psychotherapy focused on helping transition to middle school, but longer-term psychotherapy is recommended. The reason for continuing therapy that is most consistent with psychodynamic psychotherapy theory is that the patient:

* would benefit from being more self-aware. needs additional psychoeducation on role reversal. needs more practice managing cognitive distortions. should master mindfulness and staying in the present. should become more skilled in identifying external cues. 2021 Child: 100

A 16-year-old individual fell from a two-story building. The adolescent briefly lost consciousness after the fall and was initially confused, but recovered and did not seek medical attention. Three hours later, the adolescent became unconscious and was taken to the emergency room for evaluation. On physical examination, his right pupil was dilated. What is the most likely finding on a non-contrast head computed tomography scan?

*Epidural hematoma Subdural hematoma Diffuse axonal injury lntraventricular hemorrhage Generalized cerebral edema 2020 Child: 73 significant buzzwords/clinical pearls associated with each of the above terms/concepts on child psychiatry boards: Epidural hematoma Epidural hematomas are often associated with a "lucid interval" where the patient may regain consciousness before deteriorating again. It's typically caused by rupture of the middle meningeal artery. Subdural hematoma Subdural hematomas are commonly linked to bridging vein rupture, often in the elderly or in cases of child abuse. Symptoms may present gradually. Diffuse axonal injury Diffuse axonal injury is characterized by widespread damage to the brain's white matter. It's often associated with traumatic brain injuries and can lead to long-term coma or persistent vegetative state. Intraventricular hemorrhage Intraventricular hemorrhage, most common in premature infants, is bleeding into the brain's ventricular system. It may lead to hydrocephalus or developmental delays. Generalized cerebral edema Generalized cerebral edema refers to swelling of the entire brain, often due to traumatic brain injury, infection, or lack of oxygen. This condition can result in increased intracranial pressure, potentially leading to brain herniation if left untreated.

During what age range do most children first understand the concept of the finality of death?

1 to 4 years * 5 to 7 years 8 to 11 years 12 to 15 years 2019 Child: 193

Which of the following clinical features of sleep disorders are most consistent with night terrors? (Select three)

A. Childis easily reassured Behaviors are sudden and brief Behaviors are highly stereotyped Behaviors occur during REM sleep Behaviors tend to cluster in late nighttime Child has poor memory of nocturnal behavior Behavior is associated with autonomic activation Child is alert and oriented during nocturnal behavior 2022 Child: 189

An FDA meta-analysis of antidepressant studies in children found suicide-related adverse events in 4% of those given medication, compared to 2% of those given placebo. The number-needed to harm by administering antidepressants found by this study is:

2 4 20 25 * 50 2020 Child: 43

In a study of children at high risk for depression, subjects were randomly assigned to either observation or drug treatment over 1O weeks. In the observation group, 50% of the children developed depression. In the treatment group, only 25% of the children developed depression. How many children need to be treated with this new drug to prevent one case of depression?

1 2 * 4 5 10 2021 Child: 143

The Babinski sign is considered abnormal beyond what age?

4 months 6 months 12 months 18 months * 24 months 2021 Child: 14

During development, at which of the following ages is a girl's height most likely to be greater than a boy's height?

4 years 8 years 11 years 15 years 18 years 2022 Child: 111

The therapeutic effects of second-generation antipsychotic medications are partly mediated through action on which of the following receptor sites?

5-HT 1A 5-HT 18/D 5-HT 2A 5-HT 2C 5-HT 3 2020 Child: 17 • 5-HT 1A receptors are primarily involved in regulating mood, anxiety, and sleep. Activation of these receptors can lead to a reduction in anxiety and depressive symptoms. • 5-HT 1B/D receptors play a crucial role in the regulation of aggression and impulsivity. Their activation can potentially reduce aggressive behaviors and impulsivity. • 5-HT 2A receptors are major players in the regulation of mood and cognition. Their activation can result in mood elevation and cognitive enhancement. • 5-HT 2C receptors are involved in regulating appetite, mood, and anxiety. Overactivity at these receptors can lead to symptoms of anxiety, depression, and eating disorders. • 5-HT 3 receptors are mainly involved in emesis (vomiting). Their activation can cause nausea and vomiting, which can indirectly affect a patient's mood and behavior. Additionally, they play a role in the modulation of pain perception, which can influence cognitive processes.

An eight-year-old patient experiences episodic dystonia of the neck and ataxia precipitated by prolonged exercise or being startled. There is no loss of consciousness during these episodes. What isthe most likely diagnosis?

A. Complex partial seizures B. Lennox-Gastautsyndrome C. Juvenile myoclonic epilepsy D. Paroxysmal movement disorder E. Psychogenic movement disorder 2022 Child: 146 Paroxysmal movement disorders are a group of involuntary, episodic movement disorders, such as twitching, jerking, or shaking, most commonly occurring in childhood. They are divided into three types: paroxysmal kinesigenic dyskinesia (PKD), paroxysmal nonkinesigenic dyskinesia (PNKD), and paroxysmal exercise-induced dyskinesia (PED). PKD is the most common and occurs with sudden motion; PNKD has longer episodes, not triggered by movement; and PED is triggered by exercise or exertion. Each type has its own unique symptoms, triggers, and treatments. For PKD, anticonvulsants may be effective; PNKD may require alternative treatments; while rest after exercise often works for PED, medication may also help.

A psychiatrist is seeing an adolescent for weekly cognitive-behavioral therapy. The psychiatrist receives a social media friend request from the child. Which of the following would be the most appropriate statement to make during therapy?

A. "You found me on social media? Sorry, | hadn't seen that. | never check it." B. "l accepted your friend request. | want you to know it was not as a friend, but as your therapist." C. "I'm sorry, but | had to decline your friend request to maintain professional boundaries between us." D. "I saw you reached out on social media. We should talk about social media's possible impact on your mental health." E. "lI hope you experience our relationship as positive. Let's talk about the best way to communicate outside of our sessions." 2022 Child: 117

An adolescent is admitted to an inpatient psychiatric hospital for suicidal ideation and on hospital day two complains of poor sleep, headaches, and abdominal pain. Staff describe the child as more irritable with decreased appetite. Vital signs are within normal limits and physical examination is unremarkable. These symptoms are most suggestive of withdrawal from which of the following substances?

A. Alcohol B. Cocaine C. Caffeine D. Cannabis E. Oxycodone 2022 Child: 113 F. Alcohol: Alcohol withdrawal in children can lead to delirium tremens, seizures, and even death. Key buzzwords include "delirium tremens", "seizures", and "life-threatening". G. Cocaine: Cocaine withdrawal might present with symptoms such as depression, anxiety, and intense cravings. Significant terms include "mood disorders" and "cravings". H. Caffeine: Caffeine withdrawal can cause headache, fatigue, low energy, and difficulty concentrating. Buzzwords include "headache", "fatigue", and "concentration issues". I. Cannabis: Cannabis withdrawal may cause mood swings, irritability, sleep disturbances and decreased appetite. Key terms include "mood swings", "irritability", "sleep disturbances", and "decreased appetite". J. Oxycodone: Oxycodone withdrawal can lead to symptoms such as restlessness, muscle and bone pain, insomnia, and diarrhea. Significant buzzwords include "restlessness", "pain", "insomnia", and "diarrhea".

A child is being evaluated by a child psychiatrist for inattention, low mood, and frequent outbursts. As part of the examination, the psychiatrist asks the child to name three wishes. Which of the following elements of the mental status examination is best evaluated by this request?

A. Alertness B. Orientation C. Hallucinations D. Thought process E. Projective elicitation 2022 Child: 149

A nine-year-old recently removed from a profoundly neglectful home presents with the child's foster parents for a psychiatric evaluation. The foster parents report that since moving in with them, the child repeatedly wanders away without care, approaches and speaks to strange adults, and has occasionally tried to sit in the lap of individuals they just met. Which of the following diagnoses might best explain this child's behavior?

A. Autism spectrum disorder Reactive attachment disorder Disinhibited social engagement disorder Social (pragmatic) communication disorder Adjustment disorder with disturbance of conduct 2022 Child: 179

Which of the following processes is mostly likelyto facilitate a family's adaptation to the death of a child?

A. Avoiding overt displays of parental grief Encouraging the surviving children to assume roles previously filled by the deceased Limiting surviving siblings' exposure to daily life stressors for at least six months Maintaining a legacy through memories and physical reminders of the deceased Finding substitute caretakers for the surviving children to allow parents to focus on their relationship 2022 Child: 172

When evaluating for borderline personality disorder (BPD) in youth, which of the following is most accurate regarding the age of diagnosis?

A. BPD diagnosis should be deferred until the patient reaches age 18 B. BPD diagnosis has similar reliability in mid-adolescence as in adults C. BPD symptoms are core features of normal adolescent development D BPD can be diagnosed in youth once personality traits have been present for six months E. Theres less evidence to support BPD diagnosis in youth compared to other personality disorders 2022 Child: 161

A 14-year-old adolescent is referred for aggression. The parents state that over the past few years their child has increasingly been involved in fights at school with classmates. Two months ago, the patient was caught cornering a peer and demanding money. This type of aggression is most typical of which of the following diagnoses?

A. Bipolar disorder Conduct disorder Oppositional defiant disorder Intermittent explosive disorder Disruptive mood dysregulation disorder 2022 Child: 145

A four-year-old child survives an automobile accident that kills the child's mother. One year later, the father brings the child to a therapist to evaluate the child for posttraumatic stress disorder (PTSD). According to the alternative PTSD criteria in preschool children, which of the following symptoms is consistent with PTSD?

A. Constriction of play B. Excessive sleep C. Head banging D Pseudomaturity 2022 Child: 187 In regard to Post-Traumatic Stress Disorder (PTSD): the patient (age 6 years and younger) demonstrates symptoms (lasting for more than 1 month and which cause clinically significant distress or psychosocial impairment) concerning for post-traumatic stress disorder. EXPOSURE: The patient has history of exposure to traumatic events either through • directly experiencing the event(s), • witnessing, in person, the event(s) as it occurred to others, especially primary caregivers • learning but the traumatic event(s) occurred to a parador caregiving figure. INTRUSION SYMPTOMS: The patient has experienced the presence of at least one intrusion symptom associated with the traumatic event including: • recurrent, involuntary and intrusive memories of the traumatic event(s) (not necessarily appearing distressing and may be expressed as play reenactment) • recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic events, or which may be frightening dreams without recognizable content (in children) • dissociative reactions/flashbacks in which the child feels or acts as if the traumatic event(s) were recurring, or in which trauma specific reenactment may occur in play (in children) • Intense or prolonged psychological distress exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s) • marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). AVOIDANCE/COGNITIONS AND MOOD: the patient demonstrates at least one of the following symptoms representing other persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations in cognitions and mood associated with the traumatic event(s), including: • avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollection of the traumatic event(s), • avoidance of or efforts to avoid people, conversation, or interpersonal situations that arouse recollection of the traumatic event(s), • substantially increased frequencies of negative emotional states such as fear, g

A 16-year-old with a history of bipolar disorder is arrested after setting fire to a building during a manic episode. He tells his treating psychiatristthat he did it because he knew that the building was the headquarters for the secret society that is pursuing him. However, he has adamantly refused to speak to the forensic psychiatrist assigned to evaluate him for the court, saying "I don't need to talk to him. | already have you." What should the treating psychiatrist do?

A. Contact the court, offer to take over the role of the forensic evaluator. B. Contactthe court and offer to testify regarding the patient's mental state. C. Inform the courtthatthe patient's mentalillness played a role in his actions. D Ask the patient and his parents for permission to speak to the forensic evaluator. E. Contactthe forensic evaluator in order to provide his treatment notes as supporting evidence. 2022 Child: 178

What is the most common method used in completed suicides of adolescents in the U.S. ages 14 and over?

A. Cutting B. Firearm C. Overdose D. Suffocation E. Jumping from height 2022 Child: 153

A 14-year-old physically aggressive, developmentally disabled male is given an intramuscular injection to calm his aggression. Within 30 minutes, his neck has twisted 30 degrees causing him pain. The blockage of what neurotransmitter receptor is the cause?

A. D2 B. D3 C. D4 D. H1 E. H2 2022 Child: 167 ● Activation of D2 receptors can lead to improved cognition and motor control, while blockade may result in side effects such as parkinsonism and tardive dyskinesia. ● D3 receptor activation is associated with increased reward sensitivity, potentially contributing to addiction. Blockade of these receptors may be beneficial in treating conditions like schizophrenia and Parkinson's disease. ● D4 receptors play a role in novelty seeking and impulsivity. Activation can lead to increased exploratory behavior, while blockade may help reduce hyperactivity and impulsive behaviors. ● H1 receptor activation is primarily associated with allergic reactions and inflammation, but in the context of psychiatry, it is related to sedation and weight gain. Blockade may reduce these side effects, potentially making antipsychotic medication more tolerable for some patients. ● H2 receptors are primarily found in the stomach lining and are responsible for stimulating gastric acid secretion. However, in the context of psychiatry, activation of H2 receptors could potentially contribute to anxiety and agitation. Blockade of these receptors might help to reduce anxiety symptoms and could also be beneficial in the treatment of gastroesophageal reflux disease (GERD) often associated with the use of certain psychiatric medications.

Which of the following biological factors has most clearly been shown to be a characteristic response of resilient individuals to a stressor?

A. Decreased heart-rate variability B. Greater recruitment of subcortical regions C. Greater capacity to upregulate serotonin synthesis D Rapid return to baseline levels of neuroendocrine functioning A higher proportion of beta waves on electroencephalogram 2022 Child: 123

Which of the following compensatory biochemical changes that occur during dieting explains the plateau in weight loss?

A. Decreased leptin release B. Decreased ghrelin release C. Decreased neuropeptide Y release D. Increased pro-opiomelanocortin release E. Increased alpha-melanocyte stimulating hormone release 2022 Child: 152 A. Decreased leptin release: Leptin, a hormone produced by fat cells, plays a key role in regulating energy intake and expenditure. Decreased leptin levels can lead to increased hunger and decreased energy expenditure, potentially contributing to obesity. B. Decreased ghrelin release: Ghrelin, often called the 'hunger hormone', stimulates appetite and increases food intake. Decreased ghrelin release can lead to reduced hunger sensations, potentially contributing to weight loss or underweight conditions. C. Decreased neuropeptide Y release: Neuropeptide Y is a powerful appetite stimulant. Its decreased release can result in reduced food intake and potentially contribute to anorexia or other eating disorders. D. Increased pro-opiomelanocortin release : Pro-opiomelanocortin (POMC) is a precursor molecule that can be cleaved into several hormones, including melanocyte-stimulating hormone (MSH) which suppresses appetite. Increased POMC release can therefore lead to decreased food intake and potential weight loss. E. Increased alpha-melanocyte stimulating hormone release: Alpha-melanocyte stimulating hormone (α-MSH) is a derivative of POMC and acts as an appetite suppressant. Its increased release can suppress hunger and contribute to weight loss or maintenance of a healthy weight. Its role is also significant in conditions like anorexia nervosa and other eating disorders.

A psychiatrist uses play to explore anxiety-provoking topics with a preschool-aged child, rather than using direct questioning. Which defense mechanism, common in this age group, is circumvented with this strategy?

A. Denial B. Projection C. Regression D. Sublimation E. Displacement 2022 Child: 137

Which of the following imaging procedures is the best choice in an adolescent with persistent headaches six weeks after a sports-related concussion?

A. Diffusiontensorimagin(gDTI) B Magnetic resonance imaging (MRI) C. Computed tomography (CT) with contrast D. Computedtomography (CT) without contrast E Functional magnetic resonance imaging (fMRI) 2022 Child: 170

An adolescent is seeking treatment of a tic consisting of an arm fling and learns to press their elbow into their side whenever sensing the premonitory urge. This is an example of which of the following treatment methods?

A. Extinction B. Habit reversaltraining C. Applied behavior analysis D. Systematic desensitization E. Exposure andresponse prevention 2022 Child: 183

A child has experienced weight loss while being treated effectively for attention- deficit/hyperactivity disorder with dexmethylphenidate. Once environmental interventions have been optimized, which of the following medications is the best choice to augment the child's medication, allowing for a lower dose of the stimulant medication?

A. Fluoxetine Bupropion Guanfacine Aripiprazole Atomoxetine 2022 Child: 124

Further investigation might be needed if a three-month-old cannot perform which of the following developmental milestones?

A. Grasp at objects B. Sitwithout support C. Babble with strangers D. Coo when face-to-face E. Control head and neck 2022 Child: 121

A 15-year-old with a long history of mood disturbance in the context of childhood trauma presents to the emergency departmentwith suicidal ideations and a plan to overdose on acetaminophen. The patient is hospitalized for stabilization of symptoms. Prior to discharge, which of the following would be considered best practice for the prevention of suicide in this individual?

A. Having the patient sign a no-harm contract B. Step-downto an intensive outpatient program C. Referral for home-bound education to optimize supervision D. Pharmacotherapy directed at the patient's depressive symptoms E. Formulating a safety plan with strategies to use if suicidal ideations recur 2022 Child: 125

If an adolescent on an atypical antipsychotic medication presents with akathisia but without dystonia, which of the following medications would be most appropriate?

A. Lithium B. Propranolol C. Benztropine D. Trihexyphenidyl E. Diphenhydramine 2022 Child: 148

With which of the following interventions is electromyography (EMG) biofeedback most commonly utilized?

A. Meditation B. Mindfulness C. Relaxation Training D. Vagal Nerve Stimulation E. Eye Movement Desensitization and Reprocessing 2022 Child: 176

At preschool, a four-year-old child approaches a peer who is playing with toy cars. This child says, "I like cars, too. Do you want to play cars with me?" The way in which the four- year-old child approached the peer to play with the cars best demonstrates which of the following abilities?

A. Metacognition B. Theory of mind C. Object constancy D. Symbolic function E. Transductive reasoning 2022 Child: 129 "I like cars, too. Do you want to play cars with me?"

A 16-year-old is receiving cognitive behavioral therapy for depression. As part of the treatment, the adolescent is maintaining a thought record to identify automatic thoughts. He records, "Il got my report card and found outl got an F in math this semester. I'm such a loser." The adolescent fails to write about the A's he received in his other subjects. The adolescent's thought record best exemplifies which of the following cognitive errors?

A. Minimizing B. Fortune telling C. Personalization D. Catastrophizing E. Disqualifying the positive 2022 Child: 169

Several times a week, a 16-year-old is unable to focus, feels as if the surroundings are a dream, and says that peoples' voices sound distant. The concentration between the episodes is normal. Neurological workup was unremarkable. Onset of these episodes was three months ago, precipitated by knowledge of parental discord and their impending divorce. Which of the following disorders best describes this patient's symptoms?

A. Panic disorder Posttraumatic stress disorder Borderline personality disorder Attention-deficit/hyperactivity disorder Depersonalization/derealization disorder 2022 Child: 180

A 16-year-old reports a drop in grades due to an inability to earn participation points in classes. The patientis not able to ask or answer questions in class, and notes heart palpitations and sweating at the thought of speaking in front of peers. The patient admits to skipping classes to avoid being called on by teachers. Which of the following is the diagnosis that best fits this patient's presentation?

A. Panicdisorder B. Social anxiety disorder C. Separation anxiety disorder D. Generalized anxiety disorder E. Obsessive-compulsive disorder 2022 Child: 122

An adolescent has a long face with a prominent upper jaw, an underdeveloped lower jaw, and low-set ears presents with psychosis. What method can identify the suspected underlying genetic abnormality?

A. Pedigree analysis B. Pharmacogenomic testing C. Fluorescent in situ hybridization D. Transmission disequilibrium test E. Genome wide association studies 2022 Child: 112

A five-year-old child presents with episodic lapses of consciousness for around ten seconds. The child drops objects during these episodes. Which of the foliowing EEG patterns on hyperventilation is consistent with this presentation?

A. Polyspike-wave discharges B. Lateralized periodic discharges C. Periodic sharp wave complexes D. Spike and slow wave complexes E. 3-Hz spike and wave discharges 2022 Child: 134

Which of the following is the most frequent criticism of a meta-analysis?

A. Poor external validity of findings Takes into account unpublished studies Analyzes studies that are descriptive in nature Encompasses studies that lack statistical significance Inclusion of studies with different independent and dependent variables 2022 Child: 174

Which of the following measures for attention-deficit/hyperactivity disorder (ADHD) includes a child self-report?

ADHD Rating Scale Vanderbilt ADHD Rating Scale * Conners 3rd Edition Rating Scales Swanson, Nolan, and Pelham Questionnaire Strengths and Weaknesses of ADHD symptoms and Normal behavior 2019 Child: 162 • ADHD Rating Scale • This scale is a symptom checklist based on DSM-IV criteria for ADHD. It involves 18 items, and both parents and teachers can complete it. It helps in identifying the frequency of symptoms and their severity. • Vanderbilt ADHD Rating Scale • This tool is widely used in pediatric settings. It includes symptom assessment, comorbidity screening, and impairment assessment. It's completed by parents and teachers, providing a comprehensive view of the child's behavior across multiple settings. • Conners 3rd Edition Rating Scales • This revised edition provides a more thorough assessment of ADHD. It includes multiple versions to be filled out by parents, teachers, and self-reports for adolescents. It assesses a wide range of behaviors including inattention, hyperactivity, learning problems, executive functioning, aggression, and peer relations. • Swanson, Nolan, and Pelham Questionnaire • This is a comprehensive tool that measures ADHD symptoms and treatment response. It is completed by parents and teachers. It includes a set of questions that are based on the DSM-IV criteria for ADHD and provides a detailed analysis of the child's behavior. • Strengths and Weaknesses of ADHD symptoms and Normal behavior (SWAN) Scale • The SWAN scale is a rating tool that goes beyond identifying symptoms, it also identifies the strengths of a child. It is completed by parents and teachers, and it provides a balanced view of a child's behavior by focusing not only on weaknesses but also on their strengths. This tool is unique as it measures both ends of the behavior spectrum, enabling a more holistic understanding of the child's behavior. It is particularly useful in identifying both the positive and negative aspects of ADHD symptoms, which can be crucial in designing effective intervention strategies.

What parenting style has been shown to reduce externalizing behaviors in older adolescents?

A. Uninvolved B. Permissive C. Ambivalent D Authoritative 2022 Child: 186 ● Uninvolved ● This parenting style is characterized by neglectful or dismissive behavior. Key buzzwords are detachment, indifference, and emotional unavailability. Studies suggest that children with uninvolved parents often struggle with self-esteem and emotional regulation. ● Permissive ● Permissive parents are indulgent and lenient, often avoiding confrontation. Key terms include low demands, high responsiveness, and non-directive. Children with permissive parents may struggle with self-regulation and may display more behavioral problems. ● Ambivalent ● Ambivalent parenting is inconsistent and unpredictable. Key buzzwords include inconsistency, unpredictability, and emotional volatility. Children of ambivalent parents may experience anxiety and insecurity. ● Authoritative ● Authoritative parents are both responsive and demanding. Key terms include democratic, balanced, and nurturing. These parents set clear expectations, but also provide support and feedback. Children raised by authoritative parents tend to be more confident, competent, and have better emotional and social skills. ● Authoritarian ● Authoritarian parents are highly controlling and demand obedience. Key terms include strict, high expectations, and punitive. Children of authoritarian parents may have lower self-esteem, struggle with social skills, and show higher levels of anxiety.

An electroencephalogram (EEG) is most helpful in diagnosing which of the following?

A. Vasovagal syncope B. Migraine headaches C. Pseudotumor cerebri D Traumatic brain injury Benign paroxysmal vertigo 2022 Child: 155 An EEG measures the electrical activity in the brain. In the context of Traumatic Brain Injury (TBI), it can reveal abnormal brain wave patterns or electrical activity that may indicate a problem. It can help determine the severity of the injury and guide treatment strategies. For the child psychiatry board examination, understanding the use of EEG in diagnosing TBI is crucial. It's also important to know how to interpret the results, and understand its limitations. For instance, an EEG cannot measure brain function, it can only show the electrical activity. Therefore, a normal EEG does not necessarily mean that brain function is normal. Additionally, one should be aware of the potential impact of TBI on a child's mental health, as it can lead to conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD).

A brain-imaging research project is being proposed that will recruit children with childhood- onset obsessive-compulsive disorder (OCD.) Individual participants are not expected to benefit from the study. Which of the following will be a critical ethical consideration by the Institutional Review Board?

A. Whether the study also includes children without OCD for comparison B. The degree of functional impairment experienced by each participant C. Whether the study involves only a minor increase over minimal risk D. The availability of community-based treatment resources for follow-up care E. The amount of compensation being offered to families for their participation 2022 Child: 132

A ten-year-old child's report card consists of all A's except fora C in math, the subjectin which he has always had considerable difficulty. Which of the following assessment instruments would be most appropriate to help assess the child's academic deficit?

A. Wide Range Intelligence Test B. Stanford-Binet Intelligence Scales C. Leiter International Performance Scale D. Wechsler Intelligence Scale for Children E. Woodcock-Johnson Tests of Achievement 2022 Child: 116 A. **Wide Range Intelligence Test (WRIT)** This test assesses both verbal and non-verbal intelligence. It's ideal for a broad age range, from young children to adults. Key terms include 'Verbal IQ', 'Visual IQ', and 'General IQ'. B. Stanford-Binet Intelligence Scales These scales are designed to measure five factors of cognitive ability: Knowledge, Quantitative Reasoning, Visual-Spatial Processing, Working Memory, and Fluid Reasoning. Significant buzzwords include 'fluid reasoning', 'quantitative reasoning' and 'visual-spatial processing'. C. Leiter International Performance Scale This non-verbal assessment is useful for individuals who have speech, language, or hearing impairments. The test measures intelligence and cognitive abilities without relying on language skills. Key terms include 'non-verbal IQ', 'visual reasoning', and 'spatial perception'. D. Wechsler Intelligence Scale for Children This is a comprehensive test that assesses different aspects of intelligence and cognitive abilities in children. It includes subtests for verbal comprehension, perceptual reasoning, working memory, and processing speed. Key terms include 'verbal comprehension', 'processing speed' and 'perceptual reasoning'. E. Woodcock-Johnson Tests of Achievement This test measures academic achievement and cognitive abilities. It includes subtests for reading, writing, and mathematics. Key terms include 'academic achievement', 'reading comprehension', and 'mathematical reasoning'.

A ten-year-old who was sexually assaulted experiences new-onset auditory hallucinations of the perpetrator's voice. This symptom is most likely associated with:

A. catatonia. dissociation. blunted affect. manic episode. formal thought disorder. 2022 Child: 156

A ten-year-old boy has been preoccupied that he will develop leukemia since watching his younger brother succumb to the disease a year ago. The child is worried that he has all of the same symptoms, despite evidence to the contrary and reassurance from his parents and pediatrician. The child's friends have stopped associating with him because he only talks about how he will die soon, and his parents are frustrated with his repeated requests for blood tests. Which of the following is the most likely diagnosis?

A. lliness anxiety disorder B. Body dysmorphic disorder C. Somatic symptom disorder D. Obsessive-compulsive disorder E. Adjustmentdisorder with anxiety 2022 Child: 118

Attachment theory differs from traditional psychoanalytic theories of development in its emphasis on:

A. objectrelations. B. instinctual hunger. C. parental separation. D. biology and genetics. E. libido and aggression. 2022 Child: 115

The American Psychiatric Association Foundation offers a program called "Typical or Troubled" to educate teachers and others in the school system how to identify children and adolescents who might be exhibiting symptoms of mental illness. This is an example of:

A. primordial prevention. B. primary prevention. C. secondary prevention. D. tertiary prevention. E. quaternary prevention. 2022 Child: 144 (1 prevent, 2 detect, 3 halt)

A behavioral therapist is treating a child with a specific phobia of dogs. The therapist plays soothing music and leads the child in a progressive relaxation exercise while introducing images of dogs. This technique is an example of:

A. resurgence. renewal effect. counterconditioning. partial reinforcement. spontaneous recovery. 2022 Child: 157

The classic triad of HIV-related encephalopathy in children is characterized by pyramidal tract motor deficits, acquired microcephaly and:

A. seizures. B. blindness. C. neoplasms. D. developmental delays. E. attention-deficit/hyperactivity disorder. 2022 Child: 135 HIV is believed to cause encephalopathy in children by directly infecting the brain, particularly the white matter of the brain, and causing direct damage to these tissue structures. This damage can lead to decreased brain growth, known as microcephaly, as well as disruptions in normal neuronal development, which can lead to the motor deficits and developmental delays commonly seen in HIV-related encephalopathy. HIV also can lead to increased inflammation and immune activation, which can contribute to further damage to the brain.

Which scale for attention-deficit/hyperactivity disorder (ADHD) in children has a validated version for the child to complete?

ADHD Rating Scale-5 * Conners 3 rd Edition Rating Scale Vineland Adaptive Behavior Scales Swanson, Nolan, and Pelham-IV Rating Scale Strengths and Weaknesses of ADHD Symptoms and Normal Behavior 2020 Child: 10 • ADHD Rating Scale • This scale is a symptom checklist based on DSM-IV criteria for ADHD. It involves 18 items, and both parents and teachers can complete it. It helps in identifying the frequency of symptoms and their severity. • Vanderbilt ADHD Rating Scale • This tool is widely used in pediatric settings. It includes symptom assessment, comorbidity screening, and impairment assessment. It's completed by parents and teachers, providing a comprehensive view of the child's behavior across multiple settings. • Conners 3rd Edition Rating Scales • This revised edition provides a more thorough assessment of ADHD. It includes multiple versions to be filled out by parents, teachers, and self-reports for adolescents. It assesses a wide range of behaviors including inattention, hyperactivity, learning problems, executive functioning, aggression, and peer relations. • Swanson, Nolan, and Pelham Questionnaire • This is a comprehensive tool that measures ADHD symptoms and treatment response. It is completed by parents and teachers. It includes a set of questions that are based on the DSM-IV criteria for ADHD and provides a detailed analysis of the child's behavior. • Strengths and Weaknesses of ADHD symptoms and Normal behavior (SWAN) Scale • The SWAN scale is a rating tool that goes beyond identifying symptoms, it also identifies the strengths of a child. It is completed by parents and teachers, and it provides a balanced view of a child's behavior by focusing not only on weaknesses but also on their strengths. This tool is unique as it measures both ends of the behavior spectrum, enabling a more holistic understanding of the child's behavior. It is particularly useful in identifying both the positive and negative aspects of ADHD symptoms, which can be crucial in designing effective intervention strategies.

Which of the following motoric milestones must an infant accomplish in order to sleep safely in the prone position?

Ability to crawl Improved head control Development of a startle reflex Maturation of lung development * Rolling over from stomach to back 2022 Child: 42

Which of the following factors is the strongest predictor of suicidal behavior in a teenager?

Access to a firearm Intimate partner violence History of a mood disorder History of substance abuse * Previous intentional ingestion 2020 Child: 105

An adolescent with bipolar disorder is stable on lithium carbonate. High-dose ibuprofen is prescribed for persistent migraines. Which of the following potential medication interaction effects is most important to consider?

Acne exacerbation * Nausea and vomiting Increased weight gain risk Decreased therapeutic efficacy of the lithium Thyroid-stimulating hormone suppression 2019 Child: 117 Common side effects of lithium are nausea, vomiting, diarrhea, tremors, fatigue, increased thirst and urination, weight gain, and cognitive impairment. To reduce these effects, monitor lithium levels regularly, stay hydrated and eat a balanced diet, inform your healthcare provider of any side effects, follow the prescribed dosage, and be aware of drug interactions with lithium (such as NSAIDs and diuretics).

An adolescent has been written up several times at school for napping in class. The adolescent reports they cannot help it despite going to bed early. Which of the following studies is most indicated?

Actigraphy Electromyogram Holter monitoring * Multiple sieep latency test Quantitative electroencephalogram 2022 Child: 24

A 12th-grader is diagnosed with a brain tumor. The adolescent undergoes radiation and receives several months of chemotherapy. However, the adolescent's doctors inform the patient and family that the prognosis appears terminal, and the adolescent is likely to live only a few more months. After being given this information, the adolescent does not appear upset, and asks the parents to take a family trip to Europe to celebrate high school graduation. What is the most likely explanation for the adolescent's request?

Adjustment disorder * Normal adolescent thinking Delirium resulting from chemotherapy Memory impairment caused by brain tumor Lack of understanding of core concepts of death 2021 Child: 52

A 16-year-old is hospitalized after a serious suicide attempt and is noted to have severe major depressive symptoms. Parents consent for treatment with a selective serotonin reuptake inhibitor, however, the patient refuses to take the medication. Which course of action would be most consistent with the ethical principle of autonomy?

Administer the medication by concealing it in food Ask the parents to come in to administer the medication Pursue immediate court-ordered administration of medication Make unit privileges contingent on the patient taking the medication * Allow the patient to refuse the medication while providing psychoeducation about the medication 2022 Child: 3

A psychiatric consultant to a pediatric liver transplant team is asked to assist in setting expectations about drug and alcohol use among prospective transplant recipients. Which of the following would be the most appropriate recommendation for the psychiatrist to give to the team?

Adolescents facing transplantation rarely use drugs or alcohol Teens who use drugs or alcohol experimentally are poor candidates for transplants Random drug screens prior to transplant are strongly recommended for all adolescents * Infrequent experimental use of alcohol is not an absolute contraindication for liver transplant A presentation or lecture about the dangers of drugs and alcohol for these youth is adequate to prevent use 2021 Child: 35

What is the most common final outcome for children removed from their homes by Child Protective Services?

Adoption Guardianship Emancipation Placement with relatives * Reunification with parents 2021 Child: 41

During the evaluation of an eight-year-old child with school problems, the psychiatrist discovers that the family has been using corporal punishment as a disciplinary approach with the child. The child is punished one to two times weekly and often has welts afterwards on the back and buttocks. The family immigrated to the US approximately two years ago for economic reasons. Family members state that maintaining their cultural practices and values is very important. Corporal punishment is an accepted and approved method of managing children in their culture. Which of the following would be the best approach by the psychiatrist?

Affirm the importance for this family to honor its culture * Remain empathic yet firm while discussing US societal and legal norms Maintain a value-neutral approach, modeling openness to diverse practices Discuss parenting methods, allowing the parents to choose what is acceptable Continue to support family practices that are congruent with its cultural values 2019 Child: 107

Which of the following pieces of legislation addresses differential management and reimbursement of mental illness by insurance companies?

Affordable Care Act of 2010 Children's Health Act of 2000 Americans with Disabilities Act Garrett Lee Smith Memorial Act * Mental Health Parity and Addiction Equity Act 2020 Child: 84 significant buzzwords/clinical pearls associated with (each of) the above term(s)/concept(s) on child psychiatry boards: ● Affordable Care Act of 2010: Expanded health insurance coverage, preventative services coverage, and mental health and substance use disorder services. ● Children's Health Act of 2000: Focused on reducing health risks and improving health outcomes for children, including those with special health needs. ● Americans with Disabilities Act: Ensures equal opportunity for persons with disabilities in public accommodations, employment, transportation, state and local government services, and telecommunications. ● Garrett Lee Smith Memorial Act: Provides funding for suicide prevention programs and early intervention mental health services for youth. ● \* Mental Health Parity and Addiction Equity Act: Requires insurers to cover mental health and substance use disorder care to the same extent as physical health care.

Longitudinal data from the Course and Outcomes of Bipolar Youth (COBY) study revealed that patients who took lithium compared with other mood stabilizers experienced decreases in which of the following outcomes over a ten-year mean follow-up period? (Select three)

Aggression Functioning Substance use Hospitalizations Suicide attempts Manic symptoms Hypomanic symptoms Depressive symptoms 2022 Child: 196 decreased SADness COBY study monitored effects of lithium and other mood stabilizers on young bipolar patients over 10-year period. Results showed lithium was successful in decreasing aggression and suicide attempts, and lessening depressive symptoms. These findings suggest lithium could be meaningful in managing aggression, suicide risk, and depression in bipolar youth, ultimately improving their quality of life.

For the last six months, a seven-year-old child has shown marked fear whenever prompted to enter the elevator in the family's apartment building, instead insisting that he and his parents use the stairwell. The child uses elevators in other buildings, but only after much prompting. Which of the following is the most likely DSM diagnosis for this child?

Agoraphobia Panic disorder Social anxiety disorder * Specific phobia, situational Reactive attachment disorder 2021 Child: 36

The psychiatrist is asked by the parents of a 15-year-old psychotherapy patient to testify in court as an expert witness on the patient's behalf after the patient was charged with felony assault. The parents contend that the patient was provoked by bullying and the psychiatrist is widely considered an expert on the topic. The patient has refused to meet with the psychiatrist since the charge was filed. Which of the following is most likely the most appropriate course of action for the psychiatrist to take?

Agree to testify if the parents waive confidentiality Refuse the request because it would violate confidentiality * Decline the request because it would constitute double agentry Decline to testify because it would violate the patient's autonomy Agree to testify if the patient can meet and discuss the testimony beforehand 2019 Child: 151 Double agentry in the medical judicial context refers to a situation where a medical professional has dual roles that may conflict with each other. For example, a psychiatrist may be treating a patient but also be requested to provide a forensic evaluation for a court case. This could potentially create a conflict of interest because the goals of therapy and forensic assessment are fundamentally different. The therapist-patient relationship is based on trust and confidentiality, while a forensic evaluation requires objectivity and may involve sharing the patient's information with others. Hence, medical professionals are advised to avoid such double agentry situations whenever possible to maintain ethical standards.

A 17-year-old patient presents to the emergency department with symptoms of dehydration, hyperthermia, tachycardia, and rhabdomyolysis. The patient has recently begun treatment for schizophrenia and has a history of substance abuse. In addition to neuroleptic malignant syndrome, drug intoxication is part of the differential diagnosis. Which of the following drugs of abuse is most likely involved?

Alcohol Cannabis Heroin Gamma hydroxybutyrate * MDMA 2020 Child: 184

A diagnosis of substance-induced psychosis has been most strongly associated with later diagnosis of schizophrenia for which of the following substances?

Alcohol Cocaine * Cannabis Hallucinogens Amphetamines 2020 Child: 90

Use of what substance is the most common cause of referral to substance use treatment programs for individuals age 12 to 17 years?

Alcohol Opioids Inhalants * Marijuana Stimulants 2019 Child: 159

When comparing boys and girls with aggression, violent girls are more likely to have been diagnosed with which of the following disorders?

Alcohol use Schizophrenia Oppositional defiant * Posttraumatic stress Attention-deficit/hyperactivity 2022 Child: 68

Which of the following describes the role of a lobbyist?

An organization who is endowed or funded to work on specific issues * A person who works for an organization for pay or pro bono to influence legislation directly An individual who supports or promotes dissemination of information on a particular topic or issue An individual employed to review extant research and complete studies with the aim of scientifically informing policy A person hired by an organization to gather information about relevant policy and research its impact on the community 2021 Child: 140

A person with pedophilic disorder is most likely to act on his urges if he is also diagnosed with which of the following disorders?

Alcohol use disorder Posttraumatic stress disorder * Antisocial personality disorder Obsessive-compulsive disorder Narcissistic personality disorder 2019 Child: 155 The DSM-5 features of Antisocial Personality Disorder (ASPD) include a pervasive pattern of disregard for, and violation of, the rights of others. This is typically seen through seven key characteristics: • Failure to conform to social norms with respect to lawful behaviors. • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. • Impulsivity or failure to plan ahead. • Irritability and aggressiveness, as indicated by repeated physical fights or assaults. • Reckless disregard for safety of self or others. • Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. • Lack of remorse, as shown by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. These features need to be consistent and enduring across a range of personal and social situations, and cannot be better explained by another mental disorder, substance use, or a medical condition. It's important to note that a diagnosis of ASPD can only be made if the individual is at least 18 years old and has a history of conduct disorder before the age of 15.

What is the primary goal of family therapy for oppositional defiant disorder?

Allowing the therapist to set limits with the child Monitoring for signs of abuse to ensure child safety * Establishing a warm and mutually respectful relationship between parents and child Providing psychoeducation to the parents about features of oppositional defiant disorder Determining whether the family system has diffused or rigid boundaries with external systems 2020 Child: 9

An increased activity in which of the following electroencephalogram (EEG) waves has been one of the most prevalent quantitative electroencephalogram (qEEG) findings in individuals with attention-deficit/hyperactivity disorder?

Alpha Beta Delta * Theta 2019 Child: 197 This hyperactivity is often linked to the theta and beta wave frequencies. Theta waves are typically associated with drowsiness or the transition between awake and asleep states, while beta waves are related to alert, focused mental activity. In those with ADHD, a higher theta/beta ratio is often observed, indicating a potential imbalance in brain activity that could contribute to the symptoms of the disorder. Further studies are needed to fully understand the complexity of these EEG patterns and their implications for ADHD treatment and management.

Depersonalization experiences have been associated with which of the following neuroanatomic areas?

Amygdala * Parietal lobe * Occipital lobe Prefrontal cortex Corpus callosum 2019 Child: 110 The role of the parietal lobe in depersonalization The parietal lobe is responsible for processing sensory information from various parts of the body, as well as spatial awareness and coordination. In depersonalization experiences, individuals may report feeling detached from their body or surroundings, which could be attributed to altered activity in the parietal lobe. The occipital lobe's contribution to depersonalization experiences The occipital lobe is primarily responsible for processing visual information. Research suggests that disruptions in the occipital lobe may contribute to the visual disturbances and perceptual changes often reported during depersonalization episodes. The parietal and occipital lobes are interconnected, which allows for the integration of visual and sensory information needed for perception. Disruptions in these pathways may be responsible for the dissociative experiences of depersonalization. Theories of its causes include imbalances in excitatory and inhibitory neurotransmitters, altered connectivity between the parietal and occipital lobes and the prefrontal cortex and limbic system, and a dysfunctional stress response leading to a hyperactivation of the brain's default mode network. Despite our incomplete understanding, it is clear that the parietal and occipital lobes play an essential role in depersonalization. Further research is needed to develop more effective treatments.

In which of the following situations is drug testing of the patient most appropriate?

An adolescent admits to and describes in detail marijuana use * A teen presents to the emergency room with altered mental status Parents demand drug testing early in a teen's psychiatric evaluation An adolescent is being screened for participation in high school sports A youth with a recent head injury presents with confusion and drowsiness 2020 Child: 171

Several times in the space of a month, a seven-year-old child references a nanny that she last saw at the age of three. With respect to the child's emotional development, this is most consistent with which of the following?

Anxious temperament in the child Pathological grieving over loss of the nanny Attachment difficulties with primary caregivers * Attempt to rework the separation from the nanny Reactivation of a prior loss after a more recent loss 2020 Child: 53

Which of the following neurodevelopmental processes is most important as brain reorganization occurs during adolescence?

Arborization Neurogenesis * Synaptic pruning Neuronal migration Neuronal differentiation 2021 Child: 161

A seven-year-old child is evaluated for worsening vision of the left eye, severe headaches, and skin changes on the body. The child's father has similar skin findings. On physical examination, the child has decreased visual acuity of the left eye and fundoscopic examination demonstrates edema of the optic disc. The right eye findings are normal. Which cutaneous finding is commonly associated with this disorder?

Ash Leaf spots Port Wine Stain Shagreen Patch * Cafe Au Lait spots Axial Telangiectasias 2020 Child: 87 significant buzzwords on child psychiatry boards: ● Ash Leaf spots are often associated with Tuberous Sclerosis, a genetic condition causing non-cancerous tumors to grow in organs. ● Port Wine Stain is a birthmark that is often associated with Sturge-Weber Syndrome, which can cause neurological issues such as seizures and developmental delays. ● Shagreen Patches are another clinical sign of Tuberous Sclerosis. ● Cafe Au Lait spots are often associated with Neurofibromatosis Type 1, a condition that causes tumors to form on nerve tissue. ● Axial Telangiectasias are associated with Ataxia Telangiectasia, a rare genetic disorder that affects the nervous system, immune system, and other body systems.

In behavioral parent training, which of the following responses should a parent have when spending special time with their child?

Ask frequent questions * Ignore mildly negative behaviors Be directive to show engagement Provide frequent material rewards Practice non-specific praise frequently 2021 Child: 79

Which of the following is most likely to be a relative contraindication to ECT treatment for an adolescent?

Asthma Pregnancy Mitral valve prolapse * Active pulmonary infection History of complex partial seizures 2019 Child: 64 The medical condition most likely to be a relative contraindication to ECT treatment for an adolescent may be coronary artery disease, severe hypotension, severe respiratory disorders, kidney failure, or any other condition which affects the cardiovascular system. These conditions may complicate the administration of ECT, increase the risk of cardiac or respiratory complications, or interfere with the anesthetic agents necessary for the procedure. While active pulmonary infection is a contraindication to ECT treatment for any age, mitral valve prolapse is generally a relative contraindication for adolescents, meaning it may still be used with caution and extra monitoring.

An eight-year-old with severe anxiety has benefited from weekly in-person psychotherapy to date, but the long distance between the patient's home and the clinic precludes continuing this treatment. Based on the available evidence, web-based therapy for this child would most likely have the most beneficial effect if which of the following occurs?

Augmentation with pharmacotherapy Minimization of pictures and game play to avoid distraction Multiple sessions are digitally recorded for viewing at home * Implementation with the support of a parent, caregiver, or teacher Utilization of text-based input by the child to log events and feelings 2022 Child: 75

Therapy that restricts participants to single-sex, as opposed to mixed-sex groups, is recommended when focusing on which of the following?

Autism * Aggression Depression Social anxiety Substance use 2021 Child: 111

When a 30-month-old child presents to the primary care provider with significant speech delay and restrictive play, which of the following is the most appropriate screening instrument to use?

Autism Diagnostic Interview - Revised Leiter International Performance Scale * Modified Checklist for Autism in Toddlers Autism Diagnostic Observations Schedule Child and Adolescent Psychiatric Assessment 2021 Child: 72 ● **Autism Diagnostic Interview - Revised (ADI-R)**: A comprehensive interview that assesses individuals suspected of having autism or other pervasive developmental disorders. Buzzwords include "Structured Interview", "Diagnostic Tool", and "Autism Spectrum Disorders". ● **Leiter International Performance Scale (LIPS)**: A nonverbal assessment tool designed to measure cognitive functions in individuals aged 2 to 21 years. Significant terms include "Nonverbal", "Cognitive Assessment", and "Visual Perception". ● **Modified Checklist for Autism in Toddlers (M-CHAT)**: A screening tool used to identify children aged 16 to 30 months who should receive a more detailed assessment for potential autism. Key terms include "Early Detection", "Screening Tool", and "Potential Autism". ● **Autism Diagnostic Observations Schedule (ADOS)**: A semi-structured assessment of communication, social interaction, and play for individuals suspected of having autism. Pertinent terms include "Observational Assessment", "Social Interaction", and "Communication Skills". ● **Child and Adolescent Psychiatric Assessment (CAPA)**: A detailed interview providing a thorough assessment of psychiatric disorders in children and adolescents. Buzzwords include "Comprehensive Assessment", "Child Psychiatry", and "Adolescent Psychiatry".

An eight-year-old is brought to the emergency department by his legal guardian after yelling during an argument, "Nobody loves me, so I'm just going to walk across the street and get hit by a car." The child was removed from his parents' care six months ago due to physical abuse and neglect. The child is passing all his subjects at school and is popular with peers. The child reports feeling sad and has auditory hallucinations telling him he is "no good." Which of the following is high on the differential diagnosis for this patient?

Autism spectrum disorder Separation anxiety disorder Oppositional defiant disorder * Post-traumatic stress disorder Obsessive compulsive disorder 2020 Child: 46 In this case, the eight-year-old child has been exposed to both physical abuse and neglect, which are traumatic experiences that could potentially lead to the development of PTSD. His auditory hallucinations and expressed feelings of sadness are indicative of the emotional distress and negative self-perceptions often associated with this disorder. The child's auditory hallucinations of being "no good" can be a direct result of the negative self-image that PTSD can foster. It's important to note that such hallucinations are not a typical symptom of PTSD and may suggest the presence of another mental health condition.

Which of the following personality disorders is most frequently comorbid in patients with bulimia nervosa?

Avoidant Histrionic Borderline Narcissistic Obsessive-compulsive 2020 Child: 6 According to various studies, the personality disorders most frequently comorbid in patients with bulimia nervosa, listed by percentage, are: • Borderline Personality Disorder (BPD): Studies show that approximately 20-25% of patients with bulimia nervosa also have BPD. • Avoidant Personality Disorder (APD): This is seen in about 15-20% of bulimia nervosa patients. • Obsessive-Compulsive Personality Disorder (OCPD): Around 10-15% of bulimia nervosa patients are also diagnosed with OCPD. • Narcissistic Personality Disorder (NPD): This disorder is found in approximately 5-10% of patients with bulimia nervosa. • Antisocial Personality Disorder (ASPD): Around 5% of bulimia nervosa patients also suffer from ASPD. • Dependent Personality Disorder (DPD): This comorbidity is seen in about 3-5% of bulimia nervosa patients. • Histrionic Personality Disorder (HPD): HPD is diagnosed in approximately 2-3% of patients with bulimia nervosa. • Schizoid Personality Disorder (SPD): SPD is found in about 1-2% of bulimia nervosa patients. These percentages may vary depending on the study, and it's important to note that many patients may have more than one comorbid personality disorder. Also, the presence of these disorders can significantly impact the course, treatment, and prognosis of bulimia nervosa. It is therefore crucial that comprehensive assessment and treatment plans are developed to address not only the eating disorder but also any coexisting personality disorders. Finally, it's worth noting that the percentages listed above should be considered estimates, as actual rates can vary widely depending on factors such as study methodology and population sampled. It's also possible that some patients with bulimia nervosa have undiagnosed personality disorders, which could affect the reported comorbidity rates.

Which of the following best defines the role of a guardian ad litem?

Caretaker appointed by the court to care for a child in the child's home Parent or legal guardian that is responsible for caring for a minor child * Advocate appointed by the court to appear in court on behalf of a minor child Foster parent that cares for a minor child, but the state remains the legal guardian Lawyer or other court-appointed specialist whose job is to oversee a contentious custody dispute 2022 Child: 4

A psychiatrist reviews existing research on the prevalence of a specific side effect that occurs within a class of medications. Which of the following types of research articles will be most useful to the psychiatrist?

Case series * Meta-analysis Open label study Case control study Randomized controlled study 2020 Child: 57

Which of the following is necessary to determine capacity for a child to act as a witness in court proceedings?

Be at least five years old Understand court proceedings Have the ability to speak English Have an adult verify their testimony * Be able to distinguish truth from falsehood 2020 Child: 180

The parents of a 13-year-old boy who just came out to his parents as gay present to the psychiatrist to ask for a recommendation regarding the effectiveness of therapy to make their child straight. Which of the following would be most accurate to tell the parents?

Because the child is relatively young, reparative therapy has a moderate chance of success The child should wait until he is older to make the decision himself to change his orientation * Therapy to alter sexual orientation has not been found to be helpful and may be harmful Long-term psychodynamic therapy has shown mixed results in changing sexual orientation The child's orientation can be changed but only if the entire family participates in the therapeutic process 2021 Child: 144

Anine-year-old child has been newly diagnosed with atiention-deficit/hyperactivity disorder (ADHD) and anxiety. The child has been struggling academically. The child's caregivers are concerned about the child's academic performance. They also wish to minimize the dose of any recommended medications. The child resides in a lower socioeconomic environment. Based on results from the Multimodal Treatment of ADHD (MTA) Study, which of the following is the best treatment option?

Bupropion and parent training Atomoxetine and supportive therapy Clonidine and parent individuai therapy * Methylphenidate and behavioral therapy Guanfacine and parent psychoeducation 2022 Child: 22 The MTA Study is a large, long-term study investigating the effectiveness of four treatment approaches for ADHD: medication management, behavioral treatment, a combination of both, and routine community care. It is essential for child psychiatry board exam preparation, as understanding the study provides critical knowledge about ADHD management. Results suggest a combination of medication and behavioral treatment is the most effective in managing symptoms, influencing the standard of care in child psychiatry. In addition, factors such as comorbid anxiety/conduct disorder and individualized treatment plans were linked to improved ADHD management. Finally, a 14-year follow-up study found medication management alone was associated with slight increases in symptom severity, underlining the importance of behavior intervention.

Which of the following family therapy models has been associated with reduced rates of criminal offenses and out-of-home placements, reduction in days of psychiatric hospitalization, and reduction in other mental health problems when dealing with families of individuals with conduct disorder?

Behavioral * Multisystemic Psychodynamic Solutions-focused Psychoeducational 2021 Child: 170

A therapist's approach is described as, "I try to help my patients understand that behavior is an expression of an internal state. My goal is to encourage curiosity about their own internal experience, how it influences what they do, and generate curiosity about what might be driving the behavior of others." This therapist's work is most likely based on what theoretical approach?

Behaviorism * Mentalization Self-psychology Attachment theory Object relations theory 2019 Child: 164 Behaviorism focuses on the study of observable behaviours. It aims to change maladaptive behaviours through conditioning and reinforcement. Mentalization is the ability to understand the mental state, of oneself or others, that underlies overt behavior. It helps individuals understand what others might be thinking or feeling. Self-psychology emphasizes the development of the self through relationships with others. It focuses on understanding an individual's personal experiences and how they form their sense of self. Attachment theory postulates that the ability to form emotional and physical attachment to another person gives a sense of stability and security necessary to take risks, grow and develop, and solve problems. Object relations theory emphasizes the importance of internalized relationships with others. It suggests that our experiences with others, particularly in early childhood, shape how we relate to people in our adult lives. This theory aids therapists in understanding patterns of interaction and exploring ways to foster healthier relationships.

A therapist's approach is described as, "t try to help my patients understand that behavior is an expression of an internal state. My goal is to encourage curiosity about their own internal experience, how it influences what they do, and generate curiosity about what might be driving the behavior of others." This therapist's work is most likely based on what theoretical approach?

Behaviorism * Mentalization Self-psychology Attachment theory Object relations theory 2022 Child: 87

Which of the following types of medications is less effective in children than adults due to relative immaturity of noradrenergic pathways in the brain?

Benzodiazepines Atypical antipsychotics * Tricyclic antidepressants Selective serotonin reuptake inhibitors 2019 Child: 194 several studies suggest that the efficacy of tricyclic antidepressants in children may indeed be influenced by the development stage of their noradrenergic pathways. It is known that these pathways continue to mature throughout adolescence, which could potentially affect the drug's effectiveness.

A psychiatrist is being sued for malpractice, and the case has proceeded to civil court. By what standard of proof will the jury most likely be required to decide the outcome?

Beyond a reasonable doubt Clear and convincing evidence Reasonable degree of certainty * A preponderance of the evidence 2020 Child: 192

Which of the following treatments, when combined with cognitive behavioral therapy, has shown efficacy in adolescents with delayed sleep phase disorder?

Biofeedback Diphenhydramine * Morning bright light therapy Night-time background white noise Early afternoon bright light therapy 2020 Child: 127

Enuresis is most commonly associated with which of the following psychiatric disorders?

Bipolar Social phobia Major depressive Separation anxiety * Attention-deficit/hyperactivity 2022 Child: 14

What FDA-approved treatment for attention-deficit/hyperactivity disorder includes a black box warning about suicidality?

Buproprion Guanfacine * Atomoxetine Methylphenidate Lisdexamfetamine 2021 Child: 43

An adolescent presents to the psychiatrist as a follow-up after starting an antipsychotic mediation. During the evaluation the adolescent is noted to have difficulty staying seated and endorses a new onset sense of restlessness. Which of the following is a first-line treatment of these symptoms?

Buspirone * Propranolol Benztropine Carbamazepine Methylphenidate 2020 Child: 100

A typically developing adolescent presents with impulsive, angry outbursts that occur two or more times per week for the past six months. These outbursts are out of proportion to any provocation or stressor. The adolescent reports having no control over the outbursts and is distressed by them. Which of the following is the most likely diagnosis?

Bipolar disorder Conduct disorder Oppositional defiant disorder *Intermittent explosive disorder Disruptive mood dysregulation disorder 2020 Child: 79 unique distinguishing features of each of the above conditions that would be pertinent in a child psychiatry board exam: Bipolar Disorder in children often presents as a combination of mania (high energy, hyperactivity, racing thoughts) and depression (low mood, loss of interest, feeling worthless). It may also include periods of normal mood. Conduct Disorder is characterized by a pattern of violating the basic rights of others and societal norms. Children with this disorder may be aggressive, destruct property, lie or steal. Oppositional Defiant Disorder is marked by a pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness. This behavior is usually directed towards authority figures. Intermittent Explosive Disorder involves repeated, sudden episodes of impulsive, aggressive, violent behavior or angry verbal outburbursts in which they react grossly out of proportion to the situation. Damage or destruction of property, physical assaults, and frequent temper tantrums are common. Disruptive Mood Dysregulation Disorder is characterized by severe and frequent temper tantrums that interfere with the child's ability to function at home, in school, or with their peers. These outbursts are inconsistent with the child's developmental level.

The psychiatrist observes a 17-year-old patient to have pink papules present on his cheeks and nasolabial folds in a malar distribution. Further examination reveals five hypomelanotic macules on the arms and a raised area of roughened skin, resembling the texture of an orange peel, on the left leg. Patient's medical records contain results of a magnetic resonance imaging scan that describes numerous bright lesions in the cortex that are consistent with tubers. Which of the following psychiatric disorders is mostly likely to be present in this patient?

Bipolar disorder Hoarding disorder Tourette syndrome * Autism spectrum disorder Body dysmorphic disorder 2021 Child: 137

Which of the following disorders was encapsulated under the term "childhood psychosis" prior to the 1960s?

Bipolar disorder * Autism spectrum disorder Major depressive disorder Separation anxiety disorder Obsessive-compulsive disorder 2020 Child: 140

What stage of infancy is most associated with cooing, imitating, and other efforts to facilitate reciprocal social interactions?

Birth to 3 weeks 1 to 2 months * 3 to 7 months 8 to 18 months 19 to 36 months 2019 Child: 102 Neonatal period (Birth to 3 weeks): rapid growth and development; reflexive behaviors and limited voluntary movements; developing basic senses (hearing, vision, touch, taste, and smell); learning to recognize caregivers; sleep and feeding patterns emerge. Transitional period (1 to 2 months): improved motor skills and coordination; increased alertness and awareness of surroundings; social smiles and responding to caregivers; developing self-soothing techniques; sleep and feeding patterns become regular. Early infancy (3 to 7 months): increased physical strength and mobility (rolling, sitting, crawling); developing communication skills (cooing, babbling, gestures); object permanence forming; recognition of familiar faces/objects; interest in exploring environment; may show separation anxiety. Mid-infancy (8 to 18 months): improved fine motor skills (grasping, holding, manipulating objects); beginning language development (first words, simple sentences); developing problem-solving skills; imitating adult behaviors/actions; increased independence; curiosity/exploration; sense of self and personal identity forming. Late infancy (19 to 36 months): advanced language development (complex sentences, expanding vocabulary); improved cognitive skills (memory, attention, reasoning); developing social skills (sharing, taking turns); understanding emotions and empathy; self-control and coping mechanisms forming; beginning to form friendships, engaging in cooperative play; increasingly imaginative play and storytelling.

If a five-year-old child is obese, which of the following factors is the strongest predictor of obesity into adulthood?

Birth weight Level of parental education Family socioeconomic status * Degree of parental obesity Number of siblings living at home 2020 Child: 154

Which of the following signs, when present in young people with psychosis, is most Specific to early-onset schizophrenia?

Bizarre behavior Ideas of reference * Negative symptoms Auditory hallucinations Thought disorganization 2022 Child: 51

Which of the following is the most commonly recognized criterion for psychiatrists serving as expert witnesses in court?

Board certification in Forensic Psychiatry Established therapeutic relationship with either the plaintiff or defendant Board certification in the area about which the expert witness is asked to testify Published research in the area about which the expert witness is asked to testify * Ability to offer important information about a subject based on training and education 2021 Child: 1

The goal of stimulus control in the psychosocial treatment of adolescents with substance abuse refers to which of the following?

Building positive reinforcers for abstinence Withholding reinforcers when drug use occurs Assisting the teen to manage urges to use drugs Assisting the teen to avoid environmental stress * Assisting the teen in avoiding situations associated with drug use 2020 Child: 30 Stimulus control in the context of treating adolescents with substance abuse involves the process of identifying and modifying or avoiding the environmental cues or triggers that might lead to drug use. These triggers could be certain people, places, emotions, or events. By understanding and managing these stimuli, the individual can gain better control over their behavior and responses. This approach is often used in conjunction with other treatment methods such as cognitive-behavioral therapy, motivational interviewing, and family-based interventions. The ultimate aim is to empower the adolescent to make healthier choices and resist the urge to use substances.

A 16-year-old with severe depression has experienced profound improvement with treatment with a selective serotonin reuptake inhibitor (SSRI). Sometime after the medication was started, the adolescent's family reported hearing "gnashing" sounds when the teen is asleep, and a recent dental evaluation confirmed evidence of significant teeth-grinding. Attempts at lowering the dose of the SSRI have resulted in concerning relapses of depressive symptoms, and the teen would like to stay on the medication if possible. Which of the following would be the best option for the psychiatrist to propose to address this likely adverse medication effect?

Bupropion Clonazepam Hydroxyzine * Acrylic dental guard Botulinum toxin injections 2019 Child: 128

Which of the following best defines the role of a guardian ad Iitem?

Caretaker appointed by the court to care for a child in the child's home Parent or legal guardian that is responsible for caring for a minor child * Advocate appointed by the court to appear in court on behalf of a minor child Foster parent that cares for a minor child, but the state remains the legal guardian Lawyer or other court-appointed specialist whose job is to oversee a contentious custody dispute 2019 Child: 178

Which of the following is the largest individual risk factor for development of schizophrenia?

CNV deletion at 1q21 .1 CNV deletion at 22q11.21 Parent with schizophrenia Older sibling with schizophrenia * Identical twin with schizophrenia 2019 Child: 165 • Identical twin with schizophrenia has the highest risk factor contribution, with a 40-50% increased likelihood. This is due to the sharing of 100% of genes, including potential risk genes for schizophrenia. • CNV deletion at 1q21.1 contributes to about 25% increased likelihood. This deletion is associated with various neuropsychiatric disorders, including schizophrenia. • CNV deletion at 22q11.21 contributes to about 20% increased likelihood. The 22q11.21 deletion syndrome is a known risk factor for schizophrenia and other mental disorders. • Having a parent with schizophrenia contributes to about 10% increased likelihood. This is due to the hereditary nature of the condition. • An older sibling with schizophrenia contributes to about 9 % increased likelihood. This is likely due to both genetic and environmental factors shared in the family.

Which of the following neuroimaging findings has the greatest associated risk for subsequent neurological complications in a child?

Capillary telangiectasias Cavernous malformations Unidentified bright objects * Arteriovenous malformations Developmental venous anomalies 2021 Child: 83 Capillary telangiectasias: These are small, dilated blood vessels near the surface of the skin or mucous membranes. They are a common manifestation of certain neurological disorders in children, such as Sturge-Weber syndrome and Klippel-Trenaunay syndrome. Key terms include: vascular malformation, port-wine stain, seizures, glaucoma. Cavernous malformations: These are clusters of abnormal, dilated vessels that can occur in the brain and spinal cord, potentially leading to seizures, hemorrhages, or neurological deficits. Buzzwords include: angioma, familial cavernous malformation, hemosiderin deposits, epilepsy. 2. Unidentified bright objects: These are hyperintense lesions seen on T2-weighted MRI scans, often associated with neurofibromatosis type 1 in children. They are typically found in the brain's white matter and do not cause symptoms. Key terms include: UBOs, neurofibromatosis, optic pathway glioma, cafe-au-lait spots. Arteriovenous malformations: These are defects in the vascular system, primarily involving the connections between arteries and veins. They can cause serious health problems such as hemorrhagic stroke. Important terms include: AVM, intracranial hemorrhage, embolization, seizures. Developmental venous anomalies: These are the most common vascular malformations in the brain, often incidentally found during imaging. They are typically asymptomatic and have a low risk of bleeding. Pertinent terms include: DVA, venous angioma, thrombosis, brain imaging.

An eight-year-old girl is seen for the primary complaint of learning problems. On examination, she is cooperative and pleasant. On physical exam, her height is in the 10th percentile. Her spine has mild to moderate curvature consistent with scoliosis. She has multiple small light brown spots on her skin. Parents report the child has had increasing visual complaints and that she has an upcoming appointment with an ophthalmologist. Which of the following would be consistent with the most likely diagnosis?

Cataracts Facial paralysis * Axillary freckling Impaired balance Decreased hearing acuity 2019 Child: 147 FALCON B

Problems with selective attention are linked to inefficient information processing in which of the following circuits?

Cerebellar cortex Orbitofrontal cortex Prefrontal motor cortex Dorsolateral prefrontal cortex * Dorsal anterior cingulate cortex 2021 Child: 22 Cerebellar cortex: The cerebellar cortex is responsible for fine motor control, balance, and coordination. Clinical pearls may include ataxia and dysmetria, common symptoms in cerebellar disorders. In child psychiatry, cerebellar dysfunction may contribute to developmental disorders like Autism Spectrum Disorder. Orbitofrontal cortex: This region is involved in decision making and emotional processing. Deficits in this area could lead to impulsivity, poor judgement, and emotional dysregulation, often seen in conditions like ADHD and conduct disorder. Prefrontal motor cortex: It controls voluntary movements and motor planning. Disorders in this area can manifest as motor tics or uncontrolled movements, often associated with conditions like Tourette's syndrome and other motor disorders. Dorsolateral prefrontal cortex: This region is crucial for executive functions such as working memory, cognitive flexibility, planning, inhibition, and abstract reasoning. Impairments here could be associated with ADHD, Autism, and learning disorders. Dorsal anterior cingulate cortex: Involved in emotional regulation, decision making, and reward anticipation. Abnormalities in this area may be linked to mood disorders like depression and anxiety, as well as OCD and schizophrenia. The Dorsal Anterior Cingulate Cortex (DACC) sends signals to the Prefrontal Cortex (PFC) and Parietal Cortex (PC) - which respectively control cognitive control and sensory processing - during selective attention. Inefficient communication in this circuit, due to conditions like ADHD, can lead to difficulty focusing, ignoring irrelevant information, and multitasking. Interventions such as cognitive training and medication are used to improve selective attention. However, it is important to consider other factors such as stress, fatigue, and environmental distractions, as well as individual differences like personality and cognitive abilities, when looking at attention-related difficulties. Further research is vital to understand these complexities and develop effective interventions.

Compared to electroencephalograph recordings obtained by scalp electrodes, nasopharyngeal electrodes are inserted into the nostrils to achieve closer proximity to which brain area?

Cerebellar vermis Anterior cingulate Medulla oblongata Orbitofrontal cortex * Basal temporal lobe 2019 Child: 157 electroencephalograph recordings obtained by nasopharyngeal electrodes are inserted into the nostrils achieve closer proximity to the Basal temporal lobe. why? Because the basal temporal lobe is a critical region for various brain functions, such as memory and speech processing. Nasopharyngeal electrodes provide a more direct and accurate recording of electrical activity in this region. This can lead to more precise diagnoses and treatment plans for conditions like epilepsy, sleep disorders, and neurodegenerative diseases. Furthermore, this method can help in the detection of abnormalities that could be missed by standard surface electrodes, enhancing the overall efficacy of the electroencephalograph.

A school-aged child, recently diagnosed with acute disseminating encephalomyelitis, presents with inappropriate bursts of laughter followed by tearfulness, and inability to speak. Which of the following brain structures is most likely involved in the child's recent presentation?

Cerebellum * Frontal lobe Ocular nerves Ill, IV, VI Bulbar nerves IX, X, XII Cerebelopontine nerves V, VII, VIII 2021 Child: 156

A six-year-old child is brought for initial assessment of ongoing 'clumsiness.' The parents report that the child repeatedly bumps into the furniture and, compared to older siblings, has had some delays in achieving motor milestones for crawling and walking. They describe the child as 'awkward' while playing ball or doing puzzles. Teachers have reported that the child does not demonstrate any behavioral problems, socializes easily, makes good grades, and readily focuses on tasks, but struggles with using scissors. Gross neurological examination, vision and physical examination do not reveal any significant abnormalities. Which of the following is the most likely diagnosis?

Cerebral palsy Autism spectrum disorder Joint hypermobility syndrome * Developmental coordination disorder Attention-deficit/hyperactivity disorder 2019 Child: 156 features of the clinical presentation and course of Developmental coordination disorder (DCD): DCD is characterized by a delay in the development of motor skills or difficulty in coordinating movements that results in performance below that expected for the individual's age and intelligence. Some common features include: • Struggles with tasks that require balance, such as riding a bike or climbing stairs • Difficulty with fine motor tasks, such as writing or buttoning a shirt • Issues with spatial awareness, often resulting in clumsiness or frequent accidents • Problems with time management and organization, often seen in schoolwork • Difficulty with learning new tasks, requiring more practice than their peers The course of DCD varies among individuals but generally persists into adulthood. While some skills may improve over time, others may continue to present challenges. Early intervention and therapy can help to manage symptoms and improve functional abilities. The severity of DCD symptoms can range from mild to severe, and can fluctuate over time. Some individuals may show improvement in their motor skills as they grow older, while others may continue to struggle. • Limited progress despite ample opportunity for skill practice and learning • Continued struggle with tasks that peers of the same age can easily perform • Persistent difficulties in daily activities, such as getting dressed, using utensils, or participating in physical activities • Ongoing need for additional support in school or work settings • Increased risk of social and emotional difficulties due to struggles with motor tasks

Asix-year-old child is brought for initial assessment of ongoing 'clumsiness.' The parents i report that the child repeatedly bumps into the furniture and, compared to older siblings, has had some delays in achieving motor milestones for crawling and walking. They describe the child as 'awkward! while playing ball or doing puzzles. Teachers have reported that the child does not demonstrate any behavioral problems, socializes easily, makes good grades, and readily focuses on tasks, but struggles with using scissors. Gross , neurological examination, vision and physical examination do not reveal any significant : abnormalities. Which of the following is the most likely diagnosis?

Cerebral palsy Autism spectrum disorder Joint hypermobility syndrome * Developmental coordination disorder Attention-deficit/hyperactivity disorder 2022 Child: 92

Observing which of the following in a young toddler would be most helpful in assessing gross motor ability?

Chewing or swallowing Sitting on caretaker's lap Maintaining upward eye gaze * Getting up from the prone position Reaching across midline to grab a toy 2020 Child: 69

Which of the following assessments is considered the gold standard in evaluating cognitive and language skills in a child younger than 42 months?

Child Development Inventory * Bayley Scales of Infant Development Denver Developmental Screening Test Battelle Developmental Inventory Screening Test Developmental Indicators for the Assessment of Learning 2021 Child: 165 ● Child Development Inventory ● This is a parent-report measure that helps assess the developmental status of children aged 15 months to 6 years. Key terms associated with this include social interaction, self-help skills, and gross motor skills. ● Bayley Scales of Infant Development ● This is a standardized assessment tool used to measure the mental and motor development, and behavior of infants and toddlers. Associated buzzwords include cognitive, language, and motor development. ● Denver Developmental Screening Test ● This test is used to identify children who may have developmental problems. It covers four functions: gross motor, language, fine motor-adaptive, and personal-social skills. ● Battelle Developmental Inventory Screening Test ● This comprehensive test assesses a child's developmental skills and helps identify potential delays or problems. It covers five areas: adaptive, personal-social, communication, motor, and cognitive abilities. ● Developmental Indicators for the Assessment of Learning ● This tool is primarily used to assess the development of children in kindergarten. It focuses on key areas like language arts, math, and social-emotional development. Key terms associated with this tool include early literacy, numeracy skills, and social competence.

Which of the following is the prevailing legal doctrine used in the United States to make decisions about child custody in parental divorce proceedings?

Child preferences are most important. Fathers are considered the most fit parent. Mothers are considered the most fit parent. * The best interests of the child are paramount. 2019 Child: 195

A child with enuresis undergoes training with a bell and pad alarm that wakes the child when the child urinates in bed. Through this process, the child learns to sense when they have a full bladder and awakens in response. Which of the following is best conceptualized as the conditioned stimulus during this treatment?

Child's urination The soiled linens Ringing of the alarm * Child sensing a full bladder Child's awakening to the alarm 2021 Child: 91

Which of the following has some evidence of efficacy for bright light therapy in the treatment of adolescents?

Cyclothymic disorder Major depressive disorder * Seasonal affective disorder Adjustment disorder with depressed mood Bipolar disorder type II depressed episode 2021 Child: 158

Variations in which of the following genes is associated with clozapine-induced agranulocytosis and neutropenia in individuals with Japanese ancestry?

HLA-C ACKR1 * HLA-B59 HLA-DQB1 SLCO1 B3/7 2021 Child: 171 HLA Bronco LooP dying of neutropenia

A 17-year-old patient is brought to the emergency department with new-onset psychosis. Parents describe the patient as having a flu-like illness followed by paranoia, disorganized thought, and catatonia. Physical examination is notable for a left lower quadrant abdominal mass. Which of the following tests is most likely to confirm the diagnosis?

HSV serology CSF 14-3-3 protein * Anti-NMDA receptor antibodies 24-hour electroencephalogram Magnetic resonance imaging scan of brain 2020 Child: 162

A five-year old is attending play therapy. The child attempts to put a shoe on a doll and the shoe does not easily fit. The child puts the doll down. The therapist says, "You chose not to put that shoe on. It was too difficult." The therapist's statement is an example of which of the following psychodynamic therapeutic techniques?

Clarification Observation * Interpretation Empathic validation Encouragement to elaborate 2021 Child: 75

Which of the following medications may worsen juvenile myoclonic epilepsy? END OF CHILD PSYCHIATRY RESIDENT IN-TRAINING EXAMINATION.

Clonazepam Valproic acid Levetiracetam * Oxcarbazepine 2019 Child: 200 Oxcarbazepine may potentially worsen juvenile myoclonic epilepsy due to its mechanism of action. It primarily works by blocking voltage-sensitive sodium channels, which can help control certain types of seizures. However, in the case of juvenile myoclonic epilepsy, this mechanism may paradoxically increase the frequency of myoclonic seizures. This could be due to the unique neurophysiology of juvenile myoclonic epilepsy, where the balance of inhibitory and excitatory neurotransmission is different from other types of epilepsy. Therefore, using oxcarbazepine may inadvertently disrupt this balance, leading to more frequent or severe seizures. The unique neurophysiology of juvenile myoclonic epilepsy is characterized by a hypersensitivity of the brain's motor cortex to stimuli, particularly upon waking. There's a higher prevalence of rapid firing neurons, leading to an imbalance between excitatory and inhibitory neurotransmission. The exact cause of this hypersensitivity is still under investigation, but it's thought to involve genetic factors that affect the development and function of ion channels in the brain. Additionally, the thalamocortical network, responsible for the generation of rhythmic electrical activity in the brain, is believed to play a significant role. In this context, oxcarbazepine's effect on sodium channels might exacerbate this hypersensitivity, thereby worsening the condition.

A school-age child with autism spectrum disorder, mild intellectual disability and attention- deficit/hyperactivity disorder is being assessed in the emergency room for otitis media. The patient is currently on risperidone and long-acting methylphenidate, both with reported benefit, and is otherwise medically stable. During the examination, the patient becomes agitated. Non-pharmacologic strategies have been unsuccessful in de-escalating the child. Which of the following is the next best pharmacologic strategy to address the patient's acute behavioral escalation?

Clonidine Lorazepam Olanzapine * Risperidone Diphenhydramine 2020 Child: 35

A clinician is evaluating a child who speaks to peers without issue, but does not respond when spoken to by teachers, nodding instead or whispering to a friend who will speak on the child's behalf. The child is described as shy and withdrawn, but appears to play well with same age peers. The child is meeting developmental milestones, is physically healthy, and academically bright. Hearing evaluation is normal. There are no sensory aversions and no evident restricted interests. The use of which of the following medications may improve symptoms of this psychiatric condition when paired with behavioral therapy?

Clonidine * Fluoxetine Aripiprazole Risperidone Clomipramine 2020 Child: 93 ● Children with Selective Mutism (SM) excel in familiar settings but remain silent in social situations, like at school, when around adults. Characteristic of SM is speaking to peers but not to teachers. Nonverbal communication, such as nodding or whispering to a friend, is often used. The child's shyness and withdrawnness do not prevent them from interacting normally with peers, signifying no global social interaction difficulties. SM is independent of developmental deficits, as shown by the child's meeting of developmental milestones, physical health, and brightness. It should not be mistaken for shyness or introversion as, unlike shyness, SM causes significant impairment in daily functioning and social interaction. Early identification and intervention, involving the child, parents, teachers, and peers, is key to management of SM. Cognitive-behavioral therapy (CBT) is the most commonly used approach, helping the child to overcome their fear of speaking. ● Fluoxetine, an SSRI, has been found effective in treating anxiety-based psychiatric conditions in children. In this case, the child's selective mutism - an inability to talk in certain social contexts - may be a sign of a hidden anxiety disorder. Combining fluoxetine with behavioral therapy could reduce anxiety symptoms, enabling the child to communicate better with teachers and authority figures. Behavioral therapy provides the child coping skills for managing anxiety, while fluoxetine works to balance neurotransmitters in the brain, reducing overall anxiety.

A 15-year-old has a family history of mood disorder and is struggling to develop a positive sense of self in the context of conflict with parents and academic difficulties. After a blow-up with parents, the teenager is referred for psychotherapy. The therapist focuses on resolving difficulties with the parents and extending the patient's social support network. Which of the following psychotherapeutic models is the therapist most likely using?

Cognitive Behavioral Supportive * Interpersonal Psychoanalytic 2020 Child: 47 Interpersonal psychotherapy - ARC (Adjustment, Roles, Connections)

An adolescent presents with a chief complaint of an inability to move the arms, thus preventing the patient from performing any activities of daily living. On examination, the deep tendon reflexes are intact, and the patient is unable to hold a pen. When the physician raises the patient's arms overhead and releases them, the arms fall randomly but never hit the patient's face. Which of the following is the most likely diagnosis?

Factitious disorder Illness anxiety disorder Somatic symptom disorder * Functional neurological symptom disorder Psychological factors affecting other medical conditions 2022 Child: 103

For teachers struggling to manage a child with attention-deficit/hyperactivity disorder in the classroom, which of the following interventions was found to be the most effective based on a large meta-analysis?

Cognitive therapy Social skills groups Behavioral therapy Mindfulness training * Contingency management 2020 Child: 76 significant buzzwords/pertinent conclusions associated with (each of) the above research study(ies) on child psychiatry boards? Contingency management in child psychiatry often involves the use of positive reinforcement or rewards to encourage desired behaviors. Key concepts often associated with this approach include: Behavior Modification: This is the process of changing behavior through the use of rewards or punishments. Operant Conditioning: A learning process where behavior is controlled by consequences. Key concepts are reinforcement, punishment, and extinction. Token Economy: A system of contingency management based on the systematic reinforcement of target behavior. The reinforcers are symbols or "tokens" that can be exchanged for other reinforcers. Motivational Incentives: These are used to encourage the child to change or maintain positive behavior. Delay of Gratification: This is a concept where the child is asked to resist an immediate reward and wait for a later reward. It is related to impulse control and long-term goal setting. Shaping: This involves reinforcing progress towards a certain behavior. It can be used to teach new behaviors by breaking them down into manageable steps. Differential Reinforcement: This technique involves reinforcing only the specific behavior you want to increase and ignoring all others. Positive and Negative Reinforcement: Positive reinforcement involves the addition of a rewarding stimulus following a behavior, making the behavior more likely to occur in the future. Negative reinforcement involves the removal of an unpleasant stimulus following a behavior, also making the behavior more likely to occur. Generalization and Discrimination: These concepts are related to how the child applies learned behaviors to different but related situations (generalization) or learns to respond differently to varied but similar situations (discrimination). Extinction: This involves the discontinuation of a reinforcement, leading to the decrease or elimination of the behavior it followed. Punishment: This is the application of an adverse stimulus or

Which of the following is the best research study design to understand causal association of rare disorders?

Cohort Case series Case reports * Case-control Ecological studies 2021 Child: 112

An adolescent receiving interpersonal psychotherapy for depression is in the initial phase of treatment. Which of the following tasks is the adolescent most likely participating in during these early sessions?

Completing a communication analysis * Creating an inventory of their relationships Exploring ways to increase problem-solving Assisting with activity on the mood thermometer Engaging in role plays to enhance perspective-taking 2020 Child: 85

A researcher wants to measure the amygdalar activity in patients with conduct disorder. Which of the following imaging studies would be best to use?

Computed tomography Diffusion tensor imaging Positron emission tomography * Functional magnetic resonance imaging Single-photon emission computed tomography 2021 Child: 10 ● • Computed Tomography (CT) - This imaging technique uses X-rays and computers to create detailed images of the body. In child psychiatry, it can help identify structural abnormalities in the brain that might be associated with certain disorders. Key buzzwords include contrast, axial images, and Hounsfield units. ● • Diffusion Tensor Imaging (DTI) - DTI is a type of MRI that measures the movement of water molecules in the brain. It's used to study white matter tracts, which are crucial for understanding many psychiatric disorders. Key terms include fractional anisotropy and tractography. ● • Positron Emission Tomography (PET) - PET scans use a radioactive substance to visualize functional processes in the brain. This can be particularly useful in child psychiatry for investigating metabolic changes and neurotransmitter activity associated with various disorders. Key terms include radiotracer, glucose metabolism, and neuroreceptor mapping. ● • Functional Magnetic Resonance Imaging (fMRI) - fMRI scans measure brain activity by detecting changes in blood flow. This technique is used to study the brain's functional organization and how it changes in response to various psychiatric conditions. Key terms include blood-oxygen-level dependent (BOLD) signal, task-based fMRI, and resting-state fMRI. ● • Single-Photon Emission Computed Tomography (SPECT)- SPECT is a nuclear medicine technique that provides 3D images of the brain. This imaging modality is used to visualize brain function by measuring the distribution of a radiotracer in the brain. This can be helpful in identifying areas of the brain that are overly active or underactive in children with psychiatric conditions. Key terms include perfusion, gamma camera, and radiopharmaceuticals.

Which of the following imaging modalities is best suited to rule out a pituitary tumor in a patient with anorexia nervosa?

Computed tomography * Magnetic resonance imaging Positron emission tomography Magnetic resonance spectroscopy Single-photon emission computed tomography 2020 Child: 131

A 15-year-old patient in psychotherapy begins to express resentment of weekly sessions and no longer wishes to attend treatment. The patient's parents fear that, if treatment is stopped, the patient's prior high-risk behaviors will resume. The psychiatrist is asked whether or not treatment should continue. Which of the following is the most relevant core principle of the AACAP code of ethics?

Confidentiality Advocacy and equity * Assent and consent Third-party influence Legal considerations 2021 Child: 96

Which of the following receptors is hypothesized to mediate the impact of environmental influences on brain development?

Glutamate Dopamine * Glucocorticoid Thyroid hormone Orexin/Hypocretin 2022 Child: 15

Increased white matter maturation in the frontostriatal and frontotemporal cortex is most closely associated with which of the following changes over the course of development?

Greater coordination of gait and balance systems Sharper visual discrimination and pattern detection Increased autonomic nervous system responsiveness * Improved language and executive function performance Clearer sensory perception and cross-modality integration 2020 Child: 88

A 14-year-old with a history of sexual abuse and depression is brought to the emergency department with passive suicidal ideations. During the interview, the patient shares that she superficially cuts her wrist and consumes alcohol with friends "to ease the pain" of her low mood. She has begun seeing a psychiatrist, however, has not been prescribed medication. She denies having, or ever having had, suicidal intent or plan. The psychiatrist elicits reasons for living from her and they create a safety plan. The psychiatrist also counsels the caregiver to restrict access to dangerous self-harm methods. Which of the following best describes an action that should be included as part of the therapeutic assessment and intervention in the emergency department?

Create a "no suicide contract" with the patient Recommend that the patient obtain a new psychiatrist Initiate lithium to address symptoms of depression and suicidality * Counsel the patient and caregiver about substance use related disinhibition Explore the relationship between the patient's childhood trauma and self-harm behaviors 2020 Child: 24

A 15-year-old previously healthy female presents with altered mental status and severe agitation. She slowly developed progressive confusion and memory deficits three weeks ago, with no clear trigger. Over the past two weeks, she has experienced hallucinations, poor sleep and inattention. Prior to the visit she had a witnessed brief seizure episode. On assessment, she exhibits significant tachycardia and hypertension with an otherwise normal physical exam. Her preliminary ultrasound shows an ovarian lesion. Which of the following diagnoses is most likely consistent with this presentation?

Creutzfeldt-Jakob disease Herpes simplex virus encephalitis Lambert-Eaton myasthenia syndrome * Anti-N-methyl-d-aspartate receptor encephalitis Voltage-gated potassium channel antibody encephalitis 2020 Child: 48 • Creutzfeldt-Jakob disease (CJD) is a rare, degenerative, invariably fatal brain disorder. It affects about one in every one million people per year worldwide. Psychiatric manifestations may include rapidly progressive dementia, personality changes, hallucinations, and psychosis. • Herpes simplex virus encephalitis is a type of infectious encephalitis which happens when herpes simplex virus (HSV) infects the brain. It can result in significant neurological damage and death. Psychiatric symptoms can include irritability, restlessness, and even psychosis in severe cases. • Lambert-Eaton myasthenic syndrome Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder that affects the neuromuscular junction. It's characterized by muscle weakness, fatigue, and autonomic dysfunction. Psychiatric manifestations are not common but patients may experience depression and anxiety due to the chronic nature of the disease. • Anti-N-methyl-d-aspartate receptor encephalitis is a type of inflammation of the brain that is caused by the body's own immune system attacking NMDA receptors. This can lead to a variety of psychiatric symptoms such as hallucinations, paranoia, and manic or psychotic episodes, often preceded by flu-like symptoms. • Voltage-gated potassium channel antibody encephalitis is an autoimmune neurological condition where the body's immune system mistakenly attacks the potassium channels in the brain. This can result in a variety of symptoms including memory problems, seizures, and sleep disorders. Psychiatric manifestations may include depression, anxiety, and in some cases, psychosis.

For children with suspected autism or intellectual disability, clinical guidelines recommend that genotyping for which of the following genes should be included to establish a molecular diagnosis?

DAT1 DRD4 MC4R * MECP2 SNAP-25 2022 Child: 102 MECP2, also known as Methyl CpG binding protein 2, is a gene associated with Rett Syndrome—a rare genetic disorder that causes cognitive and physical impairments in girls. To prepare for the child psychiatry board examination, it is essential to understand how MECP2 affects brain development and function. Mutations in the gene can lead to abnormal brain development, including loss of hand skills, slowed growth and movement difficulties, along with cognitive impairment and behavioral issues. Clinical presentation of Rett Syndrome is typified by normal development followed by a dramatic regression in abilities, including speech, motor skills, and functional hand use, as well as repetitive hand movements. MECP2 mutations can also cause other neuropsychiatric disorders, such as autism, schizophrenia, and bipolar disorder. Therefore, knowledge of the gene and its effects is essential for diagnosis and management of these conditions. Early detection and intervention can significantly improve quality of life for those with Rett Syndrome and other MECP2-related disorders.

Which of the following factors are most important in developing a strong therapeutic alliance for a telepsychiatry visit? (Select three)

Dark room * Hand signals * Erect posture Large gestures Monotone voice * Nodding frequently Using the phrase "tell me more" Visually interesting background 2020 Child: 197 (HEN) Hand Erect Nodding

Severe childhood abuse may most notably interfere with typical neurodevelopment in which of the following ways?

Decreased cortisol leading to enlarged lateral ventricles Increased norepinephrine and subsequent frontal lobe atrophy * Increased adrenocorticotropic hormone causing hippocampal atrophy Decreased serotonin with chronic deactivation of hypothalamic pituitary axis 2021 Child: 181

Which of the following biological factors has most clearly been shown to be a characteristic response of resilient individuals to a stressor?

Decreased heart-rate variability Greater recruitment of subcortical regions Greater capacity to upregulate serotonin synthesis * Rapid return to baseline levels of neuroendocrine functioning A higher proportion of beta waves on electroencephalogram 2019 Child: 120 Research suggests that those who exhibit resilience often return to normal neuroendocrine functioning quickly after experiencing stress due to various factors. These include efficient stress response systems, strong social support networks, effective coping strategies, positive outlook and optimism, high self-efficacy, emotional regulation skills, and physical fitness and self-care. Efficient stress response systems allow individuals to react to stressors appropriately and recover quickly. Having a strong network of friends, family, and colleagues buffers the negative effects of stress and promotes faster recovery. Adaptive coping strategies, such as problem-solving, seeking social support, and engaging in self-care activities, help mitigate the impacts of stress. A positive mindset and the ability to maintain hope in difficult situations promotes a quicker return to baseline neuroendocrine functioning. Self-efficacy promotes confidence in handling stressors and overcoming challenges, thus mitigating the negative effects of stress. Effective emotional regulation prevents prolonged stress responses and fosters resilience. Additionally, regular exercise, proper nutrition, and adequate sleep are essential components of overall health and wellbeing, and can help improve an individual's ability to withstand stress and recover more quickly.

The psychiatrist is consulted to evaluate a child who survived a house fire and has been in the ICU for two weeks to treat inhalation injuries. The child exhibits irritability, repeatedly screams "get me out", is restless overnight, and thrashes upon awakening from sleep. On mental status exam, the patient is consistently alert and attentive, but does not remember the events leading to the hospitalization. Which of the following disorders likely best explains the child's current presentation?

Delirium Mood disorder Specific phobia * Acute stress disorder Posttraumatic stress disorder 2021 Child: 60

Children with somatic symptom disorder have an increased risk of developing which of the following disorders in adulthood?

Delusional disorder Alcohol use disorder Body dysmorphic disorder * Generalized anxiety disorder Borderline personality disorder 2022 Child: 109

In research using the Adult Attachment Interview, parents who have secure relationships with their children are most likely to be able to describe their own childhood experiences and relationships in which of the following ways?

Demonstrating strong affect * Presenting in a coherent narrative Avoiding the negative experiences Focusing primarily on attachment issues Describing content with incongruent affect 2020 Child: 32 This study is rooted in attachment theory, which proposes that the emotional bond formed between a child and their primary caregiver greatly influences their psychological development and interpersonal relationships in adulthood. Parents who can articulate their own childhood experiences in a coherent narrative are likely to have processed their past effectively, fostering a secure attachment style. This self-awareness and emotional maturity enable them to form secure relationships with their own children, providing a consistent, responsive, and nurturing environment. The Adult Attachment Interview is a tool used to assess this, asking adults to reflect on their childhood experiences and their relationships with their parents or caregivers. The responses are analyzed for the coherence of the narrative, which is indicative of the individual's attachment style. Securely attached individuals are able to discuss their experiences, both positive and negative, with clarity and understanding, suggesting a balanced perspective and emotional resilience. Conversely, those with insecure attachment styles may struggle to articulate their experiences or may display inconsistencies in their narratives, reflecting unresolved issues or emotional instability. The implications of this study are significant. It suggests that secure attachment in childhood is not only beneficial for the child's development but also has a lasting impact on their ability to form secure relationships in adulthood. Furthermore, it underscores the importance of self-awareness and emotional processing in fostering secure attachments. This understanding can guide interventions aimed at promoting secure attachments and improving parent-child relationships.

An administrator has been tasked with developing policies and procedures related to implementing and maintaining a patient portal for the child and adolescent psychiatry service within a large healthcare system with a shared electronic medical record. After reviewing the relevant Health Insurance Portability and Accountability Act regulations, which of the following is the next best step for the administrator?

Determine the relevant national best policies and practices Poll parents and guardians about their preferences regarding access Ask system providers for their opinions about who should have access * Review state laws regarding consent by minors for specific type of care Consult with system attorneys to determine strategies to minimize liability 2022 Child: 27

An eight-year-old awakens several times a month complaining of severe bilateral pain to the lower extremities that lasts 10-30 minutes. The episodes occur more frequently on days of intense activity or when the child is particularly irritable. Physical examination is normal. Which of the following is the best next step?

Develop a behavioral plan Refer for a neurological workup * Provide reassurance and watchful waiting Order laboratory testing for metabolic causes Begin psychotherapy for a depressive disorder 2021 Child: 132 Growing pains, a common condition in children, are characterized by muscle aches and pains, mostly in the legs, particularly at night. The cause is unknown, but linked to a period of rapid growth or increased physical activity. For the child psychiatry board exam, it's vital to differentiate it from medical conditions or psychiatric disorders. While the physical exam is usually normal, it's important to rule out juvenile idiopathic arthritis, restless leg syndrome, and even somatic symptom disorder.

A four-year-old child, whose parents recently divorced and have joint legal and physical custody, has started becoming aggressive each time he is picked up from one parent's house. Verbal altercations ensue as soon as the parents see each other, after which they start yelling at the child for misbehaving. At the urging of the divorce mediator, the parents reluctantly agree to parent guidance meetings. Which of the following should be the first step in the treatment process?

Devising acceptable forms of discipline for the child * Identifying the parents' shared concerns about the child Educating the parents about normal preschool-age behavior following divorce Pointing out that the parents' animosity is having a deleterious effect on the child Strategizing ways the parents can minimize contact with each other during visitation 2020 Child: 109

Which of the following elements of a patient's case should only be provided by a psychiatrist testifying specifically as an expert witness?

Diagnosis * Prognosis Treatment plan Clinical formulation Comorbid medical illnesses 2021 Child: 102

Which of the following features would preclude a clinician from making a diagnosis of selective mutism?

Diagnosis of social phobia Symptoms occur in only one setting Symptoms have only occurred for six weeks Patient maintains non-verbal communication * Symptoms occur during the first month of school 2020 Child: 52

Which of the following factors most likely influences the ability of an adolescent to learn the grammar of a secondary language?

Differences in reasoning ability Neuronal death and synaptic pruning Hormonal changes associated with puberty Developmental changes in working memory * Epiphenomena of social and cultural changes 2021 Child: 42

Which of the following neuroimaging techniques measures the blood oxygen level- dependent signal to represent utilization of energy by the brain during a cognitive, sensory, or a motor task?

Diffusion tensor Imaging Positron emission tomography Magnetic resonance spectroscopy * Functional magnetic resonance imaging Single-photon emission computed tomography 2021 Child: 179

A nine-year-old child and their family that frequently arrive late to clinic are transferred from a graduating fellow to a new fellow. At their first appointment with the new fellow, the family are late again and are eating food in the waiting room. The fellow is annoyed by this behavior. What action should the fellow take?

Disregard the annoyance as the family probably couldn't help it. Disregard the annoyance as this is the first meeting with the family. Reveal the annoyance to the family and implore them not to be late again. * Notice the annoyance and plan to address the lateness with the family after establishing rapport. Notice the annoyance and recognize that the family does not respect the importance of the fellow's time. 2020 Child: 110

A 16-year-old adolescent recently diagnosed with schizophrenia has a history of language delay requiring speech therapy. The psychiatrist observes the adolescent has a long, narrow face with small mouth and hypernasal speech. Discussion with the adolescent's parent reveals the patient had repair of a cleft palate and ventricular septal defect when younger. The adolescent should be further evaluated for which of the following syndromes?

Down Angelman Fragile X * DiGeorge Prader-Willi 2021 Child: 142

A high school athlete fears being removed from the team by the coaches, despite adequate performance. Which of the following theories views the patient's current problem as a repetition of earlier interactions?

Drive theory * Object relations Self-psychology Defense analysis Identity formation 2021 Child: 45 Drive Theory: This is a Freudian concept that suggests behavior is driven by two primary instincts: Eros (the life instinct, which includes sexual drives) and Thanatos (the death instinct). Key terms include 'libido', 'aggression' and 'unconscious motivation'. Object Relations: This theory focuses on interpersonal relations, suggesting that the way people relate to others is shaped by early childhood experiences. Key concepts include 'internal objects', 'attachment', and 'separation-individuation'. Self-Psychology: Developed by Heinz Kohut, it emphasizes the importance of self-object experiences in shaping personality. It introduces the concepts of 'mirroring', 'idealizing', and 'twinship'. Defense Analysis: This approach looks at the various psychological defenses that individuals use to cope with anxiety and maintain self-esteem. Key terms include 'repression', 'denial', 'projection', and 'sublimation'. Identity Formation: This concept, often associated with Erik Erikson's stages of psychosocial development, refers to the process of developing a distinct personality or self-concept. Key terms include 'identity crisis', 'role confusion', and 'ego identity'.

A clinician responds to a subpoena and appears in court. This act, however, does not waive which of the following without express consent?

Duty Fidelity * Privilege Beneficence Confidentiality 2021 Child: 109

A psychiatrist speaks to the parent of a child who is severely emaciated due to anorexia nervosa. The parent persists that the child should be started on a psychiatric medication for depression. The psychiatrist explains that, given current medical concerns and literature supporting the ineffectiveness of antidepressants in the acute, malnourished phase of the disorder, such treatment is not currently indicated, but that food is the "best medication," and an urgent medical evaluation is needed. Which of the following ethical principles is the psychiatrist honoring by refusing to prescribe the medication?

Duty Justice Privilege Autonomy * Beneficence 2021 Child: 12

A college student presents to clinic with relationship difficulties. She describes having a supportive partner, but not wanting sex as much as her partner. Rarely drinking previously, she now consumes a shot of vodka to facilitate sexual interest before sex with her partner. The patient denies sexual fantasies and physical arousal during coitus. She has had similar experiences with previous partners. The remainder of her history is unremarkable. What is the most likely diagnosis?

Dyspareunia Alcohol use disorder Normal female sexuality Female orgasmic disorder * Female sexual interest/arousal disorder 2021 Child: 133

A five-year-old child engages in doctor-nurse games with opposite sex children. What is the most likely explanation for this child's behavior?

Early career aspirations Precocious development Early childhood sexual abuse * Age-appropriate sexual exploration Exposure to adult sexual activity 2020 Child: 172

According to self-psychology, which of the following is considered typical in children?

Ego Avoidance * Narcissism Mentalization Object constancy 2020 Child: 156

Which of the following affective symptoms in young children is most suggestive of grief related to the death of a family member rather than major depressive disorder or posttraumatic stress disorder?

Guilt Anxiety * Longing Anhedonia Depressed mood 2022 Child: 20

"Juuling" has become a popular method of using nicotine in youth, and uses which of the following forms of delivery?

Gum Cigar Patch * E-cigarette Chewing tobacco 2020 Child: 61

Which of the following physiologic factors is associated with persistent aggression?

Elevated heart rate * Reduced serum cortisol Elevated skin conductance Increased serum 5HT function Increased cerebrospinal fluid 5HIAA 2020 Child: 20 • Elevated heart rate is often associated with heightened emotional states, including aggression. • Reduced serum cortisol can impair the body's stress response, potentially leading to aggressive behavior. • Elevated skin conductance is a sign of increased emotional arousal, which can be linked to aggression. • The relationship between serotonin and aggression is complex and not fully understood. Some studies suggest that increased serotonin activity can lead to reduced aggression, while others suggest the opposite. It seems that the effect of serotonin on aggression may depend on various factors, such as the specific serotonin receptors involved and individual differences in brain chemistry. Therefore, it's not accurate to state categorically that increased serotonin function causes or improves aggression. More research is needed to fully understand this relationship.

Which of the following are most commonly seen as a comorbidity with obsessive-compulsive disorder in children?

Encopresis Autism spectrum disorder Schizophrenia * Mood disorder Sleep disorder * Other anxiety disorder * Disruptive behavior disorder Intellectual disability 2019 Child: 192 Which disorders/conditions are most commonly seen as a comorbidity with obsessive-compulsive disorder in children? Rank them by how commonly associated they are. 1. Anxiety Disorders: This includes conditions like generalized anxiety disorder, panic disorder, and social anxiety disorder. These are the most common co-occurring conditions with OCD in children. Depressive Disorders: Major depressive disorder and other depressive disorders often co-occur with OCD in children. **Attention Deficit Hyperactivity Disorder (ADHD):** Many children with OCD also have symptoms of ADHD. Tourette's Syndrome: This neuropsychiatric disorder characterized by tics is often associated with OCD in children. Autism Spectrum Disorders: Some studies have shown a higher prevalence of OCD in children with autism spectrum disorders. Eating Disorders: While less common, eating disorders can also co-occur with OCD in children. Children with OCD may develop specific rituals related to food and eating, leading to conditions like anorexia nervosa or bulimia nervosa. 2\. Learning Disorders: Children with OCD may struggle with learning disorders, as their symptoms can interfere with their ability to focus and retain information in a conventional learning environment. 3\. **Oppositional Defiant Disorder (ODD):** While not as common, some children with OCD may exhibit symptoms of ODD, a behavior disorder characterized by defiant, disobedient, and hostile behavior toward authority figures. 4\. **Post-Traumatic Stress Disorder (PTSD):** Children with OCD may have experienced a traumatic event that triggers their obsessive-compulsive symptoms. This can lead to a dual diagnosis of OCD and PTSD. 5\. Bipolar Disorder: Though less common, some children with OCD may also have bipolar disorder. This is a mood disorder that involves periods of severe mood swings that include manic (high mood) and depressive (low mood) episodes. 6\. Conduct Disorder: Some children with OCD may exhibit symptoms of conduct disorder, a serious behavioral and emotional disorder that can involv

Which of the following best describes a typical practice by the therapist in supportive psychotherapy?

Encouraging free associations * Suspending therapeutic neutrality Exploring and analyzing fantasies Supporting transference regression Avoiding interpretations of present events 2019 Child: 160 Supportive psychotherapy differs from psychoanalytic therapy in several ways: it is focused on short-term goals, deals with current issues, emphasizes empathy and reassurance, has an active therapist role, is effective in crisis intervention, focuses on present reality, and is less intensive and time-consuming. Unlike psychoanalytic therapy, it is pragmatic, provides advice, builds on existing strengths, and does not delve into unconscious processes or past experiences.

Which of the following statements is most accurate regarding the decision to involve terminally ill adolescents in end of life decisions?

End of life issues affecting adolescents can only be discussed with parents present. Ambivalence about end of life issues indicates lack of readiness for open discussion. Adolescents should be asked their opinion regarding open discussions about end of life issues. Adolescents lack the cognitive development to understand and participate in endof life decisions. Because it causes excessive anxiety, the majority of adolescents prefer not to discuss end of life issues. 2022 Child: 184

An adolescent with moderate intellectual disability is being treated for an adjustment disorder with anxiety. Which of the following psychotherapies is most likely to be the best initial choice for the treatment of this patient?

Habit reversal training * Supportive psychotherapy Cognitive behavioral therapy Interpersonal psychotherapy Expressive psychodynamic psychotherapy 2021 Child: 7

Interpersonal psychotherapy is an effective, evidence-based treatment for depression in adolescents that focuses primarily on which of the following therapeutic activities? (Select three)

Enhancing use of social supports Improving communication with others Developing positive self-talk strategies Challenging automatic negative thoughts Conceptualizing distress through relationships Enhancing the patient's motivations for change Addressing transference and countertransference Reviewing psychological traumas through narrative 2022 Child: 190

A clinician is conversing with an adolescent who reports several reasons for using cannabis, without any perceived negatives. The clinician responds, "You can't imagine what your life might be like without using weed." Which likely motivational interviewing process are the clinician and adolescent involved in during this interaction?

Evoking Planning Focusing * Engaging Sustaining 2020 Child: 143 • Evoking • Evoking refers to the process of drawing out the individual's own motivations for change. Key buzzwords include eliciting, exploring, and understanding. The concept is backed by research demonstrating the effectiveness of patient-centered approaches in motivating change in child psychiatry. • Planning • Planning involves setting achievable goals and developing a strategy for change. Buzzwords include goal-setting, strategizing, and implementation. Clinically, planning has been shown to enhance treatment adherence and outcomes in child psychiatry. • Focusing • Focusing is about directing the conversation towards specific areas of change. Pertinent terms include direction, clarity, and concentration. Research highlights the importance of focus in effectively addressing psychiatric issues in children. • Engaging • Engaging is about building a therapeutic alliance with the child, fostering trust and openness. Key terms associated with this include rapport, connection, and cooperation. Studies emphasize the role of a strong therapeutic alliance in improving treatment outcomes in child psychiatry. • Sustaining • Sustaining refers to the maintenance of change and the prevention of relapse. Significant buzzwords include continuity, perseverance, and resilience. This concept is supported by research showing the importance of sustained efforts and resilience in long-term recovery in child psychiatry.

According to ego psychology, which of the following is the most common psychodynamic explanation for when young children blame others when they get in trouble?

Excessive libidinal drive Conflicting drive derivatives Lack of fully formed superego Attempt to fulfill the ego-ideal * Defense against painful affects 2020 Child: 133 EGO PSYCHOLOGY BUZZ WORDS Reality Testing: This is the ability to differentiate between the internal world, fantasies and the external, real world. Defense Mechanisms: These are unconscious strategies the ego uses to manage anxiety and protect the individual from psychological harm. Ego Strength: This refers to an individual's capacity to maintain their identity and manage stressors. Ego Ideal and Superego: These are two components of the ego that represent internalized societal standards and parental expectations, respectively. Adaptive Capacity:This involves the ability of the ego to adapt to changes and stressors in the environment. Ego Mastery: This is the individual's ability to control impulses and behaviors in order to meet the demands of reality. Object Relations: This is the study of how mental representations of self and others formed in early childhood affect interpersonal relationships. Ego Autonomy: This is the degree to which the ego operates independently of the id and superego, demonstrating a mature and balanced personality. Synthetic Function: This refers to the ego's role in integrating and making sense of diverse thoughts, feelings, and experiences.

Which of the following is an evidence-based outpatient treatment for an adolescent with non- suicidal self-harm?

Exposure therapy Multisystemic therapy * Mentalization-based therapy Insight-oriented psychotherapy Attachment-based family therapy 2020 Child: 98

Family Focused Treatment for Adolescents with Bipolar Disorder focuses primarily on which of the following aspects of care? (Select three)

Externalizing the illness Improving sleep hygiene * Providing psychoeducation * Improving communication skills Reducing risk for substance use * Reducing conflict in relationships Developing a daily schedule of activities Analyzing unhealthy defense mechanisms 2021 Child: 193

A child with anorexia nervosa has tantrums at mealtimes. The parent responds by removing the food from the table, and the child immediately calms down. This is an example of which of the following types of behavioral conditioning?

Extinction Positive punishment Negative punishment Positive reinforcement * Negative reinforcement 2020 Child: 146

An adolescent is seeking treatment of a tic consisting of an arm fling and learns to press their elbow into their side whenever sensing the premonitory urge. This is an example of which of the following treatment methods?

Extinction * Habit reversal training Applied behavior analysis Systematic desensitization Exposure and response prevention 2019 Child: 129 Habit Reversal Training (HRT) for disorders such as tics and Trichotillomania involves four main principles: awareness training, development of a competing response, building motivation, and generalization of skills. On the other hand, Exposure and Response Prevention (ERP) techniques, often used in Obsessive-Compulsive Disorder (OCD), involve the patient being systematically exposed to feared stimuli while preventing the associated compulsive behavior. The major difference between HRT and ERP lies in their approach. While HRT focuses on replacing the unwanted behavior with a competing response, ERP emphasizes on resisting the urge to perform the compulsive behavior in the presence of anxiety-inducing stimuli. Thus, HRT is more about substitution, whereas ERP is about resisting and tolerating distress. Additionally, HRT requires the individual to be actively aware of their habits and triggers, while ERP often requires a gradual exposure to the feared stimuli, starting from the least distressing. Another key distinction is that ERP is primarily used for anxiety disorders, while HRT is primarily used for habit disorders. In terms of effectiveness, both techniques have proven to be highly effective when correctly implemented and adhered to. However, the choice between HRT and ERP largely depends on the specific disorder, the individual's personal characteristics, and their willingness to engage in the process.

Which of the following is a widely used broad-based measure of behavioral problems with subscales for internalizing and externalizing symptoms and adaptive skills?

Eyberg Child Behavior Inventory Social Communication Questionnaire Vineland Adaptive Behavior Scales Children's Global Assessment Scale * Behavior Assessment System for Children 2021 Child: 27 (*Bask INside and OUTside the guidance office -- you can't fake it*)

What validity subtype refers to the ability of a test to measure the concept that it is intended to measure?

Face Content Criterion lnterrater * Construct 2021 Child: 51 Face Validity refers to the degree to which a test appears to measure what it's supposed to measure. In child psychiatry, it relates to the clarity and relevance of the questions in assessing a child's mental health. Content Validity involves the extent to which a measure represents all facets of a given construct. In child psychiatry, it's crucial in ensuring that all aspects of a child's mental health are covered. Criterion Validity refers to a type of validity that is established by comparing the test scores to some other measure of the same construct that has been previously validated. This is critical in child psychiatry to ensure that the assessments are accurately measuring the intended constructs. Interrater Reliability is the level of agreement among different raters or evaluators assessing the same thing. In child psychiatry, it's important to have high interrater reliability to ensure consistent diagnoses across different practitioners. Construct Validity refers to the degree to which a test measures the construct it claims to measure. In child psychiatry, it's important to ensure that the assessments accurately capture the complexity of a child's mental health status.

A landmark study of young adults homozygous for the short allele of the serotonin transporter gene found that they were at much increased risk of depression in which of the following circumstances?

Lack of available treatment Presence of comorbid anxiety Parental history of depression * Presence of negative life events Prepubertal onset of depression 2021 Child: 129

A child researcher is studying the impact of employing a social and emotional skills-building intervention in public schools. The researcher assigns five schools to receive the intervention and five other schools to be the control by lottery. Which of the following designs is the research team employing in this study?

Factorial Crossover Time series * Cluster randomization Comparative effectiveness 2020 Child: 95 significant buzzwords/pertinent conclusions associated with (each of) the above research study(ies) on child psychiatry boards: Factorial often relates to complex study designs where multiple interventions are evaluated simultaneously. Buzzwords include 'interaction effect', 'multi-arm trial', and 'efficacy evaluation'. Crossover is a type of research design where participants receive multiple treatments in a random order. Buzzwords include 'washout period', 'carryover effect', and 'within-subject design'. Time series refers to a sequence of numerical data points in successive order. In child psychiatry, it may be used to track symptom progression over time. Buzzwords include 'trend analysis', 'seasonality', and 'autocorrelation'. Cluster randomization involves randomizing groups of participants, rather than individuals. Buzzwords include 'group-level intervention', 'inter-cluster variation', and 'intra-cluster correlation'. Comparative effectiveness research aims to determine the relative effectiveness of different treatments. Key terms include 'head-to-head comparison', 'real-world effectiveness', and 'patient-centered outcomes'.

For transitional age youth, which of the following resilience factors are considered the most significant in determining adult competence? (Select three)

Family affluence * Intellectual ability * Effective caretakers Early physical maturation High expressed emotions Attendance at a private school * Close relationships with others Involvement in multiple extracurricular activities 2019 Child: 189 There are several resilience factors that play a crucial role. Firstly, Positive Peer Relationships are vital as they provide support, validation, and life skills. Secondly, Mental Health is a significant factor, as coping mechanisms can assist in handling stress and adversity. Thirdly, Education and Employment opportunities can provide stability and a sense of purpose. Fourthly, Family Support can offer emotional backing and guidance. Lastly, Coping Skills and Problem-Solving Abilities are critical resilience factors as they enable youth to navigate through life's challenges effectively.

For transitional age youth, which of the following resilience factors are considered the most significant in determining adult competence? (Select three)

Family affluence Intellectual ability Effective caretakers Early physical maturation High expressed emotions Attendance at a private school Close relationships with others Involvement in multiple extracurricular activities 2022 Child: 199 CRIECy - the resilient kids have good friends, parents and smarts

The Child Guidance Clinic movement initially began to address which of the following problems?

Family poverty * Juvenile delinquency Child abuse and neglect Education of children with disability Deinstitutionalization of the mentally ill 2020 Child: 81

During a routine check-up, the parents of a seven-year-old girl express concern that their daughter continues to wet the bed at least once a week. The father states, "I wet the bed until I was ten, and it kept me from going to camp, so I want to figure this out." The child reports having no control over the episodes, and wishes they would stop. History reveals that the family followed a strict toilet training regimen that allowed the girl to achieve day1ime urinary continence early, and that she has a history of separation anxiety. Which of the following represents this patient's most significant risk factor for enuresis?

Female sex Early toilet training Strict toilet training * Paternal history of enuresis History of separation anxiety 2021 Child: 150

The National Institute of Mental Health Recovery After an Initial Schizophrenia Episode (RAISE) Initiative demonstrated which of the following outcomes in individuals with a shorter duration of untreated psychosis?

Fewer hospitalizations * Greater improvement in quality of life Less improvement in symptoms of anxiety Same improvement in psychotic symptoms Greater improvement in symptoms of depression 2020 Child: 113 The RAISE initiative is a large-scale research project funded by the National Institute of Mental Health (NIMH) aimed at exploring different aspects of schizophrenia. It primarily focuses on the early stages of the disorder, specifically after an individual's initial episode. The main goal is to prevent the progression of the disease and improve the quality of life for those affected. The study employs a comprehensive approach by integrating medication, psychosocial therapies, case management, family involvement, and supported education and employment services. The initiative believes in early intervention, which can potentially alter the course of schizophrenia and reduce its long-term impacts. significant buzzwords/pertinent conclusions associated with (each of) the above research study(ies) on child psychiatry boards: ● Early intervention Comprehensive approach ● Family involvement ● Supported education and employment services ● Case management ● Psychosocial therapies ● Prevention of disease progression ● Improvement of quality of life Pertinent conclusions from the RAISE initiative include: ● Early and comprehensive intervention can potentially alter the course of schizophrenia. ● Integrating medication, psychosocial therapies, case management, and family involvement can help manage schizophrenia more effectively. ● Supported education and employment services are crucial in improving the quality of life for individuals with schizophrenia. ● The initiative has highlighted the importance of focusing on the early stages of the disorder to prevent its progression.

A child and adolescent psychiatrist is treating a 15-year-old with depression and anxiety with medication management and psychotherapy. The adolescent reveals in therapy that she has been skipping school with her friends and "vaping." She does not want her parents to know about these new behaviors. Which ethical principle would most apply when the psychiatrist is deciding what to do next?

Fidelity Beneficence * Confidentiality Assent/consent Non-maleficence 2020 Child: 89 Fidelity: This concept refers to the trustworthiness and reliability of a professional towards their clients/patients. In child psychiatry, it often involves maintaining the therapeutic relationship and providing consistent care. Beneficence: It's about promoting the well-being and ensuring the best interests of the child. Psychiatrists must consider the potential benefits and harms of their interventions. Confidentiality: It's crucial in building trust. However, this principle can be complex in child psychiatry as the information shared by the child might need to be disclosed to parents or other professionals for the child's welfare. Assent/Consent: In child psychiatry, obtaining informed consent can be challenging due to the child's cognitive development. Assent, the agreement of someone not able to give legal consent, becomes significant. It's about respecting the child's autonomy and ensuring they are a part of the decision-making process. Non-maleficence: This principle involves not causing harm to the child. In child psychiatry, it's about ensuring that the benefits of any intervention outweigh the potential risks or harms. It also includes avoiding any unnecessary distress or discomfort for the child.

Which of the following ethical principles refers to the importance of providing patients with truthful information about their medical conditions to allow them to make a truly informed decision about accepting or rejecting recommended medical interventions?

Fidelity Justice * Veracity Beneficence Non maleficence 2019 Child: 101 Ethical Principles: Fidelity and Veracity Fidelity Fidelity refers to the ethical principle of being loyal, faithful, and keeping promises or commitments made to others. In professional settings, this means maintaining trust and confidentiality with clients, colleagues, and stakeholders. Key Aspects of Fidelity Keeping promises and commitments Maintaining trust and confidentiality Upholding professional standards and guidelines Demonstrating loyalty to clients and colleagues Veracity Veracity, on the other hand, is the ethical principle of being truthful and honest in all communication and interactions. This includes being transparent about intentions, knowledge, and expertise. Key Aspects of Veracity Providing accurate and honest information Being transparent about intentions and motives Acknowledging limitations in knowledge or expertise Avoiding deception or manipulation in communication Differences Between Fidelity and Veracity While both fidelity and veracity are essential ethical principles, they focus on different aspects of professional conduct. Fidelity emphasizes loyalty, trustworthiness, and the fulfillment of commitments, whereas veracity emphasizes honesty, transparency, and accuracy in communication. Examples of Fidelity and Veracity in Practice • A therapist maintains fidelity by keeping their client's information confidential and upholding the boundaries of the therapeutic relationship. They demonstrate veracity by honestly discussing their client's progress and providing accurate information about their treatment options. • A researcher exhibits fidelity by adhering to the guidelines of their institution and protecting the privacy of their research subjects. They demonstrate veracity by accurately reporting their findings, acknowledging any limitations in their study, and avoiding any manipulation or fabrication of data. • A manager shows fidelity by supporting their team members and maintaining their trust, as well as honoring any agreements made with employees. They exhibit veracity by providing honest feedback, being transparent about company policies, and making decisions based on accurate information.

According to the AACAP code of ethics, before prescribing medications to a child, the psychiatrist should obtain assent from the child using developmentally appropriate language. Which of the following ethical principles is described?

Fidelity * Autonomy Beneficence Confidentiality Non maleficence 2021 Child: 146

A researcher wants to search for genetic variants that might contribute to early-onset psychosis, and collaborates with other researchers to collect DNA samples from a large group of children. Genotypes are determined on thousands of single nucleotide polymorphisms for each sample, and data are analyzed to find loci that are affected at a significant frequency in affected children compared to children without psychosis. This approach is best described as which of the following techniques?

Fine mapping Linkage analysis Whole-exome sequencing Fluorescent in situ hybridization * Genome-wide association study 2021 Child: 157

A young child becomes fearful and avoidant every time an animal is present. According to social learning theory, which of the following would be a therapeutic strategy to assist this child overcome this anxiety?

Flooding * Modeling Play therapy Token economy Cognitive restructuring 2022 Child: 60

Which of the following scales provide developmentally appropriate questions for assessing the presence and severity of obsessive-compulsive disorder in youth?

Florida Obsessive-Compulsive Inventory Obsessive-Compulsive Inventory-Revised Family Accommodation Scale-Patient Version * Children's Yale-Brown Obsessive-Compulsive Scale National Institute of Mental Health-Global Obsessive-Compulsive Scale 2021 Child: 114

Preliminary evidence shows high dose treatment with which of the following supplements may help in preventing the progression to schizophrenia in youth at high risk for psychosis?

Folate Thiamine Vitamin D Vitamin 812 * Omega-3 Fatty Acids 2020 Child: 175

In order to maintain an ABPN certification, child psychiatrists must complete or have which of the following? (Select three)

Follow practice guidelines * Unrestricted license to practice * Complete self-assessment modules Provide outcome data on select patients * Complete performance in practice modules Obtain Drug Enforcement Administration license Maintain membership in American Medical Association Attend American Academy of Child and Adolescent Psychiatry annual meeting 2020 Child: 200 Lp-Sam-Pipm

A clinician notes on exam that a child with attention-deficit/hyperactivity disorder exhibits increasing difficulty getting up from the floor to a chair in the past six months. Which of the following is a possible cause?

Freidreich's Ataxia Neurofibromatosis Tuberous Sclerosis Fragile X syndrome * Duchenne's Dystrophy 2020 Child: 71 Research suggests that there may be a correlation between muscular dystrophy and ADHD, as both conditions involve anomalies in the brain's neural networks. ADHD, or Attention Deficit Hyperactivity Disorder, is characterized by inattention, hyperactivity, and impulsivity. On the other hand, muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscle mass. The common factor between these two conditions could be the brain's neuroplasticity, which is affected in both cases. However, more research is needed to establish a definitive link and understand the underlying mechanisms.

Which of the following brain regions is most likely to show interictal asymmetric spike and wave discharges in adolescents with partial complex seizures?

Frontal Parietal Occipital * Temporal Hippocampus 2022 Child: 64

The central executive network involved in attention, working memory, and decision making involves connections mainly between the dorsolateral prefrontal cortex and what other region of the brain?

Frontoinsular cortex Anterior cingulate cortex Posterior cingulate cortex Ventromedial prefrontal cortex * Lateral posterior parietal cortex 2022 Child: 6 Frontoinsular cortex: This area of the brain is associated with empathy, self-awareness, and cognitive control. Clinical pearls include its role in conditions like autism and attention deficit hyperactivity disorder (ADHD), where these functions can be impaired. Anterior cingulate cortex: Important for emotional regulation and processing pain. Significant in studies of depression and anxiety in children, where it's often found to be hyperactive. ("Feelings" processing) Posterior cingulate cortex: Involved in memory and visual processing. Pertinent conclusions include its importance in conditions like dyslexia and ADHD. Ventromedial prefrontal cortex: Plays a role in decision-making and emotional responses. Clinically, it's linked to mood disorders and anxiety in children. Lateral posterior parietal cortex: This region is associated with spatial attention and perception. It's significant in studies of developmental disorders such as dyspraxia. Dorsolateral prefrontal cortex: Crucial for working memory and executive function. It's often implicated in conditions like ADHD and schizophrenia.

A 12-year-old girl admitted with features of paranoia, hallucinations, and mood !ability is found to be resistant to antipsychotic management. She subsequently develops facial tics, autonomic instability and obtundation. Work-up reveals an adnexal mass. Removal of the mass is most likely to help normalize the activity of a receptor for which of the following neurotransmitters?

GABA Serotonin Dopamine * Glutamate Acetylcholine 2019 Child: 104 This syndrome is likely Anti-NMDA Receptor Encephalitis, which is a rare autoimmune disorder characterized by the production of antibodies against NMDA receptors. It is often associated with ovarian teratomas in females. The symptoms can include: Cognitive and psychiatric disturbances Seizures Movement disorders Autonomic instability Language dysfunction Treatment typically involves immunotherapy and removal of the associated tumor if present. Early recognition and intervention are crucial for improving the prognosis of this condition. In some cases, patients may require intensive care management, including mechanical ventilation, to manage severe symptoms. Here is a brief overview of the disorder: Anti-NMDA Receptor Encephalitis Symptoms - Cognitive and psychiatric disturbances - Seizures - Movement disorders - Autonomic instability - Language dysfunction Treatment - Immunotherapy Tumor removal (if associated with an ovarian teratoma) - Supportive care and management of severe symptoms, including mechanical ventilation if necessary Early diagnosis and treatment are essential for a better outcome in patients with this rare but potentially severe condition.

Increased activation of which of the following receptors is thought to be a common pathway through which inflammation causes depressive-like behavior?

GABA Serotonin Dopamine * Glutamate Acetylcholine 2019 Child: 116 One possibility is that increased activation of glutamate receptors leads to an imbalance in the excitatory and inhibitory neurotransmitters in the brain. This imbalance can result in neurotoxicity and increased oxidative stress, which are known to contribute to depressive-like behavior. Additionally, increased glutamate receptor activation can trigger the release of pro-inflammatory cytokines, further exacerbating the inflammatory response and potentially leading to a vicious cycle of inflammation and depression. Furthermore, alterations in glutamate receptor function can disrupt the normal functioning of neural circuits involved in mood regulation, such as the prefrontal cortex and hippocampus, ultimately contributing to the development of depressive symptoms. Some studies have also suggested that increased activation of glutamate receptors may cause a reduction in brain-derived neurotrophic factor (BDNF), a protein that plays a crucial role in neuronal survival, growth, and synaptic plasticity. Lower levels of BDNF have been associated with depression and impaired cognitive function. Moreover, excessive glutamate receptor activation may lead to the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, a key stress response system in the body, which has been implicated in the pathophysiology of depression. Additionally, increased activation of glutamate receptors could contribute to alterations in the serotonergic system, which is critically involved in the regulation of mood and emotional behavior. Excessive glutamate receptor activation may disrupt serotonin release and reuptake, leading to an imbalance in serotonin levels that is often observed in individuals with depression. Furthermore, glutamate receptor overactivation may influence the functionality of other neurotransmitter systems, such as the dopaminergic and noradrenergic systems, which are also implicated in the pathophysiology of depression. Dysregulation of these neurotransmitter systems may result in altered reward processing, motivation, and cognitive function, all of which can contribute to the development of depressive symptoms.

Cholecystokinin, a peptide neurotransmitter, is thought to have impact on psychiatric syndromes through modulation of which of the following neurotransmitters?

GABA Serotonin * Dopamine Glutamate Acetylcholine 2021 Child: 85 CCK, a complex peptide neurotransmitter, modulates dopamine, a neurotransmitter linked to pleasure and reward. Dopamine is central to brain activities like mood, motivation, attention, and learning; an imbalance of dopamine can cause mental health issues like depression, schizophrenia, and ADHD. CCK curbs dopamine release, which can lead to psychiatric disorders dependant on the extent of dopamine inhibition and other factors. Studies demonstrate CCK's effects on dopamine-related behaviors: higher CCK levels are connected to a decrease in reward-seeking behavior, potentially indicating links to conditions such as depression and addiction. Variants of the CCK gene have been linked to an increased risk of psychiatric diseases, implying a genetic component.

In dialectical behavior therapy for adolescents, self-injurious behaviors are principally conceptualized as being learned methods of doing which of the following?

Gaining attention Manipulating others Obtaining masochistic pleasure * Decreasing negative emotional states Gradually getting over the fear of suicide 2021 Child: 104

A seven-year-old boy repeatedly says, "I'm a girl," but continues to wear boy clothing. The child is functioning well at home and at school. Which of the following concepts does this best exemplify?

Gender role * Gender identity Gender variance Gender dysphoria Gender expression 2022 Child: 53

Gene imprinting refers to a process when which of the following occurs?

Genes are repressed after a period of activity. Intrans are selectively spliced into the genome. * Genes of either paternal or maternal origin are silenced. Adenine nucleotides are added to mRNA prior to its translation into DNA. There is an increase in expression of a gene over several family generations. 2020 Child: 91

A 15-year-old presents with left eye pain and intermittent decreased vision, as well as occasional headaches. The patient also reports some weakness of the right leg that interferes with playing soccer. For the last month, the patient has not been able to attend school due to these symptoms, and now expresses feeling sad and hopeless. Which of the following disorders would be highest on the differential diagnoses list?

Glioblastoma Optic neuroma * Multiple sclerosis Factitious disorder Conversion disorder 2019 Child: 150 Internuclear ophthalmoplegia (INO) associated with multiple sclerosis (MS) primarily manifests as impaired eye movements. Patients often experience difficulty in moving their eyes horizontally, which is termed as horizontal gaze palsy. This occurs due to damage in the medial longitudinal fasciculus (MLF), a pathway in the brainstem that coordinates eye movements. In terms of pathophysiology, MS causes an immune-mediated inflammatory process that results in the destruction of myelin, the protective covering of nerve fibers. When this happens in the MLF, it leads to INO. The primary symptoms include: • Diplopia or double vision, which is typically worse when the patient looks to the side • Oscillopsia, or the sensation of the world shaking or moving, often described as a bouncing or jumping vision • Nystagmus, or involuntary eye movements, which is often observed in the unaffected eye • Abnormal head thrusts, as patients may turn their head to compensate for the inability to move their eyes horizontally These symptoms can significantly affect a person's quality of life, making it difficult to perform daily tasks such as reading or driving. In severe cases, it may even lead to mobility problems and falls. It's important to note that the severity and progression of INO can vary greatly among patients, depending on the extent of the damage in the MLF and the overall progression of MS.

A 15-year-old with a long history of mood disturbance in the context of childhood trauma presents to the emergency department with suicidal ideations and a plan to overdose on acetaminophen. The patient is hospitalized for stabilization of symptoms. Prior to discharge, which of the following would be considered best practice for the prevention of suicide in this individual?

Having the patient sign a no-harm contract Step-down to an intensive outpatient program Referral for home-bound education to optimize supervision Pharmacotherapy directed at the patient's depressive symptoms * Formulating a safety plan with strategies to use if suicidal ideations recur 2019 Child: 185

A child recently diagnosed with parenchymal neurocysticercosis with multiple disseminated lesions develops waxing and waning attentional deficits, confusion, disorientation, and agitation a day after starting treatment. These new symptoms are most likely related to which of the following processes?

Hepatotoxicity Nephrotoxicity Medication allergy * Neuroinflammation Drug-drug interaction 2021 Child: 138 FYI - Neurocysticercosis, a parasitic infection of the central nervous system, commonly causes seizures globally. It is caused by ingestion of eggs from the Taenia solium tapeworm. Parenchymal neurocysticercosis is marked by cysts in brain tissue. Multiple, disseminated lesions spread infection throughout the brain, leading to attention deficits, confusion, disorientation, and agitation. Treatment may worsen symptoms, as a reaction to medication or dying parasites.

In the Pediatric Obsessive Compulsive Disorder Treatment Study for Young Children (POTS), which of the following treatments was found to be most efficacious in children ages five-to-eight years old?

High dose N-acetyl cysteine Family-based relaxation training Selective serotonin reuptake inhibitors * Family-based exposure and response prevention Selective serotonin reuptake inhibitors plus atypical antipsychotics 2019 Child: 103 The POTS Study for young children aged 5-8 looked at the effectiveness of Cognitive Behavioral Therapy (CBT), medication (Sertraline), and their combination, versus placebo, as treatments for Pediatric Obsessive Compulsive Disorder (OCD). Results indicated that 72% of children responded positively to CBT, 61% to the combination, and 50% to Sertraline - all more than the 39% in the placebo group. The study also showed the importance of early intervention for the disorder, as well as the need for tailored treatments based on the individual. There were no major side effects, but further research into the long-term effects of these treatments, as well as prevention strategies, is necessary. POTS has helped inform healthcare providers and families of the best strategies for managing OCD in young children, and stressed the importance of the involvement of parents/caregivers in the treatment process.

In the Harvard Study of Adult Development (Grant Study), which of the following aspects of childhood experience was most closely associated with professional and financial success and optimal adaptation later in life?

High intelligence * Warm relationships Extroverted personality Elite socioeconomic status Athleticism and attractiveness 2021 Child: 73 The Grant Study, a landmark in human development research, provides key insights for child psychiatry. It suggests that a child's relationships in early life influence their future professional and financial success, as well as their overall wellbeing. This reinforces the importance of a nurturing environment for a child's future. Child psychiatrists must recognize not only familial relationships, but also those with peers, teachers, and other significant figures. Furthermore, the study illustrates long-term consequences of childhood experiences, indicating the value of interventions and preventive measures in childhood for adult mental health. This knowledge can inform child psychiatrists' approach to treatment, emphasizing both immediate and future concerns.

Which of the following is an important theoretical advantage to foster care through kinship placement?

Higher socioeconomic status * Greater stability of placement More supervision by child welfare workers Improved adherence to parental visitation schedules Greater likelihood of placement in a two-parent household 2021 Child: 155

Compared to typically developing youth, which of the following early neuroanatomical findings is the most widely replicated in children with autism spectrum disorder?

Hippocampal neuronal atrophy Possessing a larger brain volume at birth * Accelerated increase in brain volume by the end of the first year Decreased density of small neurons in interconnecting limbic nuclei Diffuse connection problems between the septum and mammillary bodies 2021 Child: 177

Which of the following clinical factors best distinguishes autism spectrum disorder from social (pragmatic) communication disorder?

History of social anxiety Age of onset of symptoms History of restricted behaviors Degree of intellectual impairment Family history of autism spectrum disorder 2022 Child: 141

An elementary-school child has behavioral difficulties in school that include hiding under desks, running out of the classroom, and becoming verbally agitated when teachers impose limits. The guidance counselor recommends psychiatric consultation offered through the school, but the parents decline. The psychiatrist can take which of the following actions without parental consent, in accordance with legal and ethical guidelines? (Select three)

Interview the child * Observe the student in a classroom setting Prescribe medication to be used on an as-needed basis * Address a teacher's questions without meeting the child Observe the parent-child dyad in an unobtrusive manner Develop and implement an individualized education program * Assist school staff in coordinating emergency treatment if necessary Report the parents to Child Protective Services as a mandated reporter after they refuse psychiatric consultation 2021 Child: 197

A 12-year-old girl with a history of abuse in the home and currently in psychotherapy for depression and low self-esteem is suspended from school after getting into a fight with an older girl who had been teasing her for several weeks. The school is concerned by the fact that the girl struck the other student in the face, and required teachers to disengage her. Which of the following best characterizes the aggression displayed in this incident?

Hostile * Affective Predatory Proactive Instrumental 2019 Child: 136 • Hostile aggression is driven by anger and its main aim is to cause harm to others. This type of aggression is often impulsive, unplanned, and happens in the heat of the moment. • Affective aggression, also known as emotional aggression, is characterized by strong emotions, particularly anger. It is usually a response to perceived threats or provocations, and is not premeditated. • Predatory aggression is calculated, planned, and goal-oriented. It is devoid of emotion and is used as a means to achieve a certain end, often related to survival or dominance. • Proactive aggression, similar to predatory aggression, is deliberate and purposeful. It is used to achieve a specific goal and is not associated with strong emotions or arousal. • Instrumental aggression is used to achieve a specific goal, but unlike Proactive and Predatory aggression, it involves some level of emotional arousal. This type of aggression is often seen as a means to an end, where the aggressor uses aggression to achieve a certain outcome, such as gaining control or dominance.

A school-age child is seen for worsening chronic encopresis that is minimally responsive to laxative use. Following initial psychoeducation with the patient and family, which of the following has the most evidence as additional treatment for this patient?

Hypnosis Biofeedback Gluten free diet Dialectical behavior therapy * Parent management training 2021 Child: 33

Which of the following neurological signs is suggestive of upper motor neuron dysfunction?

Hypotonia * Spasticity Muscle fasciculations Bilateral burning foot pain Absent deep tendon reflexes 2021 Child: 18

In delirium, which of the following etiologies are more common in children compared to adults? (Select three)

Hypoxia Head trauma Hyponatremia Seizure disorder Drug intoxication Medulloblastoma Hepatic encephalopathy Central nervous system infection 2022 Child: 198 HIT

Mental health professionals should be aware that reluctance in making the diagnosis of borderline personality disorder in youth is most likely based on which of the following?

Lack of evidence-based treatments Lack of diagnostic reliability over time Symptoms explained by another diagnosis * Stigma in mental health professionals Diagnostic criteria of at least 18 years of age 2021 Child: 128

A 15-year-old individual raised by parents who are both physicians states from an early age his intention to attend medical school. Which identity status is this individual most likely demonstrating?

Identity diffusion * Identity foreclosure Identity moratorium Identity achievement Identity determination 2020 Child: 25 • Identity status refers to the degree to which an individual has explored and committed to a certain identity. It is a key concept in the study of adolescence and emerging adulthood. • Identity crisis, on the other hand, is a period of uncertainty and confusion in which a person's sense of identity becomes insecure, typically due to a change in their expected aims or role in society. Identity Diffusion: This term refers to a state where an individual has not yet experienced a crisis or made any commitments. They are undecided about occupational and ideological choices and are likely to feel out of place. Identity Foreclosure: This occurs when individuals commit to an identity without exploring other options. They simply accept the values and expectations of others, particularly parents, without question. Identity Moratorium: This is a status of individuals who are in the midst of a crisis but whose commitments are either absent or only vaguely defined. They are actively exploring and questioning their identities, but haven't yet committed to any specific values or roles. Identity Achievement: This is the status of individuals who have undergone an identity crisis and emerged with a stronger sense of self. They have explored various identities and made a commitment to one. Identity Determination: This is a term used to describe individuals who have not only achieved their identity but are also determined to maintain and develop it. They have a clear understanding of their values, beliefs, and aspirations and are committed to them.

During the moments after a car accident, an adolescent describes feeling calm, losing sense of time, and floating above the car watching the events occur. Which of the following terms best describes this symptom?

Illusion Hallucination Derealization * Depersonalization Dissociative fugue 2021 Child: 169 ● Depersonalization is characterized by a feeling of being detached or disconnected from oneself, observing one's actions, thoughts, and feelings from an outside perspective. It's a sense of being an outside observer of one's own self. ● On the other hand, derealization is a feeling of being detached or disconnected from the world around you. People experiencing this may feel as if they are living in a dream or a movie, with the world seeming unreal or distorted.

When describing her fondness for a particular activity, a seven-year-old child reports, "Sometimes I really like it, but not all the time, because sometimes it's not fun for me." This is an example of the child's use of which of the following processes?

Imagination * Metacognition Implicit memory Learned behavior Social reciprocity 2021 Child: 74

A ten-year-old child has been participating in therapy for six months following the parents' divorce. The child's mother appears more supportive of the treatment than the father. The psychiatrist has good rapport with the child's mother, speaking regularly, in contrast to the father whom the psychiatrist has only spoken to once. The psychiatrist had felt the therapeutic relationship with the patient was good. However, the father left a voice message indicating that the child wished to discontinue therapy. Which of the following is the best course of action for the psychiatrist to take next?

Immediately discontinue therapy with the child Meet with the child to conduct a termination session Call the child to inquire as to why he or she no longer wants to continue therapy Call the child's mother to express concern that the child's father is contributing to the child's therapeutic resistance * Call the child's father to learn more about the father's relationship with the child and to explore the child's desire to end therapy 2019 Child: 179

Which of the following changes in sleep architecture occurs as a result of sleep deprivation?

Increased sleep latency Decreased sleep efficiency Increased sleep fragmentation Decreased NREM sleep duration * Increased REM sleep duration 2019 Child: 112 Effects of Sleep Deprivation on Sleep Architecture Increased REM Sleep Latency: Sleep deprivation often leads to a delay in the onset of REM sleep, causing a longer period of time spent in non-REM sleep before entering the REM phase. Reduced REM Sleep Duration: The overall duration of REM sleep may be shortened due to sleep deprivation, resulting in less time spent in this restorative sleep stage. Fragmented Non-REM Sleep: Sleep deprivation can cause non-REM sleep to become more fragmented, with more frequent awakenings and interruptions throughout the night. Increased Sleep Pressure: As sleep deprivation continues, the pressure to fall into deep sleep (stages 3 and 4 of non-REM sleep) increases, potentially leading to longer periods spent in these restorative stages when sleep finally occurs. Altered Sleep Cycle Progression: Sleep deprivation can disrupt the normal progression of sleep cycles, causing rapid shifts between REM and non-REM sleep stages or a reduced number of complete cycles. Impaired Memory Consolidation: Since REM and deep non-REM sleep are crucial for memory consolidation, sleep deprivation can negatively impact this process, leading to difficulties in learning and retaining new information. Increased Risk of Sleep Disorders: Chronic sleep deprivation can increase the risk of developing sleep disorders, such as insomnia and sleep apnea, which can further disrupt sleep architecture. Decreased Sleep Efficiency: Due to the disruptions in sleep stages and increased awakenings, sleep efficiency is often reduced in those experiencing sleep deprivation, leading to a lower percentage of time spent asleep compared to the total time spent in bed. Mood Disturbances: Sleep deprivation can have a significant impact on mood, with individuals experiencing increased irritability, anxiety, and depression, which can further interfere with sleep quality and architecture. Reduced Daytime Functioning: The changes in sleep architecture caused by sleep deprivation can result in decreased daytime functioning, including poor concentration, reduced productivity, and increased susceptibility to accidents and errors.

Accumulating evidence indicates that which of the following public health interventions related to infection is most likely to decrease the onset of psychiatric disorders in youth?

Increasing the rate of influenza vaccinations during pregnancy Decreasing the types and number of vaccines during childhood Adding the shingles vaccine to the regime of vaccinations given to children Delaying the administration of the human papillomavirus vaccine until adulthood Giving the meningococcal B vaccine only to medically fragile children and adolescents 2022 Child: 150

Which of the following behaviors in a child is most consistent with a high novelty seeking personality trait?

Indifferently watching the door Being friendly towards all classmates * Making a game out of random items Packing their backpack the evening before school Continually working on their performance in sports 2021 Child: 3 Openness: This trait involves characteristics such as imagination and insight. A person with high levels of openness enjoys trying new things and appreciates various forms of artistic expression. Conscientiousness: People high in conscientiousness are organized, reliable, and prompt. They're aware of their actions and the consequences that can follow. Extraversion: This trait is characterized by excitability, sociability, and emotional expressiveness. Extraverts are outgoing and thrive in social situations. Agreeableness: This trait involves attributes such as trust, altruism, kindness, and affection. Highly agreeable individuals are cooperative and considerate. Neuroticism: Individuals with high neuroticism tend to be emotionally unstable, often experiencing anxiety, moodiness, irritability, and sadness. They may have a higher tendency to perceive ordinary situations as threatening, and minor frustrations as hopelessly difficult.

When assessing therapeutic benefit fro~ a clinical interv~ntion, results from whic: of the following types of evidence should be given the most weight compared to others.

Individual randomized clinical trials (RCTs) with narrow confidence interval Systematic review of cohort studies * Systematic review of RCTs Individual cohort study Case series 2019 Child: 163

The tasks of classification and conservation are typically mastered during which developmental period?

Infancy Toddlerhood Preschool * SchoolAge Adolescence 2020 Child: 101 (ODLA - object constancy, decentration, logic (age 7), abstraction)

By which of the following ages do most youth start developing a "theory of mind"?

Infancy * Preschool Latency Pre-adolescence Adolescence 2021 Child: 84 Typically developing children acquire an understanding of the difference between inner life and outer reality (theory of mind) by age 4 yo

A child watches a TV report on the impact of a hurricane. The child cries and does not want to go outside, thinking the hurricane is happening in the local neighborhood. This child is most likely in what age group?

Infants * Preschool-age School-age Early adolescence Late adolescence 2021 Child: 134

An adolescent with obsessive-compulsive disorder who has responded well to fluvoxamine 200 mg daily suddenly has a relapse of symptoms. Which of the following is the most likely factor behind the relapse?

Initiation of a paleo diet * Initiation of nicotine use Initiation of an oral contraceptive Developmental increase in metabolism Development of tolerance to the fluvoxamine 2020 Child: 176 Fluvoxamine, an SSRI, is used to treat psychiatric disorders. Nicotine, an ingredient of tobacco, induces the CYP1A2 enzyme which metabolizes fluvoxamine, resulting in decreased levels of the drug in the body. This interaction could necessitate dosage adjustments, reduce drug efficacy, and increase the risk of adverse drug reactions if nicotine use is suddenly stopped.

Which of the following symptoms is more common in adolescents with depression compared to younger children with the disorder?

Irritability * Melancholia Hallucinations Temper outbursts Somatic complaints 2020 Child: 12 Atypical is reActive melANcholic has ANhedonia

Which of the following is the primary role of orexin signaling in the regulation of sleep-wake cycles?

Initiation of sleep Generation of a wakeful state Maintenance of a wakeful state Maintenance of a sleeping state * Coordination of sleep-wake states 2020 Child: 27 The primary role of orexin signaling in the regulation of sleep-wake cycles is to maintain wakefulness and prevent transition into sleep states. Orexins, also known as hypocretins, are neurotransmitters produced in the hypothalamus. They function to stabilize sleep-wake patterns by promoting arousal, wakefulness, and vigilance. Additionally, orexin signaling plays a critical role in the regulation of REM sleep and is implicated in sleep disorders such as narcolepsy. Orexin signaling plays a vital role in the Coordination of sleep-wake states by acting as a bridge between various brain regions involved in sleep and wake regulation. It synchronizes the activities of these regions, ensuring a smooth transition between sleep and wake states. During wakefulness, orexins stimulate arousal-promoting areas in the brain, maintaining alertness. During sleep, orexin activity is suppressed, allowing sleep-promoting areas to take over. Disruptions in this coordination due to impaired orexin signaling can lead to sleep disorders such as insomnia and narcolepsy.

A young child playing soccer tells the coach, after missing a goal as the game ended, "I don't want to play anymore 'cause I'm not good like the other kids!" Which aspect of psycho-social development does this statement illustrate?

Initiative vs. guilt Trust vs. mistrust Autonomy vs. shame * Industry vs. inferiority Identity vs. role confusion 2020 Child: 123

Which of the following modalities has been demonstrated to be the most cost effective for young people with mental illness?

Inpatient hospitalization * Early intervention programs Residential treatment centers Intensive outpatient programs Assertive community treatment teams 2022 Child: 48

During an interview with a 16-year-old individual, the psychiatrist asks, "At these parties where you and your friends have been drinking, how do you get home?" Which of the following aspects of the Mental Status Examination is being most directly assessed?

Insight * Judgment Thought Content Thought Process Fund of Knowledge 2022 Child: 10

Executive functioning is composed of which of the following abilities? (Select three)

Insight Inhibition Language Set shifting Working memory Semantic memory Auditory perception Visual motor integration 2022 Child: 192

The deletion of paternal 15q11-15q13 chromosome results in a syndrome characterized by hypotonia, obesity, small hands, short stature and micro-orchidism. Which of the following psychiatric symptoms is most commonly comorbid in patients with this syndrome?

Insomnia Delusions Anhedonia * Compulsions Hallucinations 2019 Child: 176 It's Prader-Willi syndrome. Patients with this syndrome often have comorbid psychiatric symptoms, including obsessive-compulsive disorder, autism spectrum disorder, and mood disorders such as depression and bipolar disorder. In addition, these individuals can also exhibit challenging behaviors like temper tantrums and stubbornness.

The deletion of paternal 15q11-15q13 chromosome results in a syndrome characterized by hypotonia, obesity, small hands, short stature and micro-orchidism. Which of the following psychiatric symptoms is most commonly comorbid in patients with this syndrome?

Insomnia Delusions Anhedonia * Compulsions Hallucinations 2022 Child: 71

Which of the following domains, not generally evaluated through routine psychological testing, would be assessed by a neuropsychological evaluation?

Intellect Personality * Sensory perception Emotional functioning Academic achievement 2020 Child: 28

Parents and their three-year-old child were in a serious motor vehicle accident. The parents ask if the child will remember the event when older. The child's declarative memory of this incident is probably most dependent on which of the following factors?

Intelligence level Physical stamina Affective stability * Language ability Self-regulation capability 2021 Child: 11

An adolescent patient, working on challenges that she has with her mother, reveals during a therapy session that she forgot to invite her mother to watch her compete in an important sporting event occurring the following day. The patient is anxious about the performance. During therapy, the psychiatrist allows the patient to talk about the upcoming event, rather than the issue relating to the invitation. Which of the following best describes this psychotherapeutic intervention?

Interpersonal therapy * Supportive psychotherapy Dialectical behavior therapy Cognitive behavioral therapy Psychodynamic psychotherapy 2021 Child: 59

An adolescent with polysubstance use for the last six months has agreed to treatment after an incident with law enforcement where the adolescent appeared irrational and belligerent. The first urine drug screen at 14 days of known abstinence comes back positive. Which of the following substances is likely to be found in the adolescent's urine?

LSD * PCP MDMA Opioids Amphetamine 2021 Child: 147 BUZZWORDS - trx with HALDOL, BENZODIAZEPINES, CLOSE SUPERVISION AND RELATIVELY DARK, QUIET SURROUNDINGS. - & Ammonium Chloride (acidify urine to increase clearance)

Secondary enuresis differs from primary enuresis in which of the following ways?

Is equally likely to occur in both genders Has a better response to psychopharmacology Has a worse response to behavioral interventions * Is more highly associated with comorbid psychiatric disorders Has a higher probability of a structural abnormality as the etiology 2019 Child: 182 • Primary enuresis refers to a condition where a child has never been consistently dry at night. It is often associated with a family history of the condition and is more common in boys than girls. • Secondary enuresis, on the other hand, refers to a situation where a child or adult starts wetting the bed after having been dry for a significant period of time. This type of enuresis is usually triggered by a specific event or condition such as a urinary tract infection, stress, or a significant change in life circumstances.

Which of the following distinguishes the AACAP Code of Ethics from other physician organizational codes of ethics?

It prioritizes patient autonomy as the main principle. It offers information on how to avoid boundary problems. * It includes developmental considerations as a key principle. It provides clear instruction on how to be an effective advocate. It describes the specific situations that cause conflict of interest. 2022 Child: 43

Which of the following theorists developed the concept of a transitional object, such as a blanket, that serves as a substitute for a caregiver during the process of separation and individuation?

Jean Piaget John Bowlby Lev Vygotsky * Donald Winnicott Harry Stack Sullivan 2019 Child: 118 Jean Piaget focused on cognitive development and believed that children progress through four stages of development: sensorimotor, preoperational, concrete operational, and formal operational. He emphasized the importance of play and social interactions in cognitive development. John Bowlby was a pioneer in attachment theory, which emphasizes the importance of a secure emotional bond between a child and their primary caregiver. His research showed that children who experience secure attachment are more likely to develop healthy relationships and emotional regulation skills later in life. Lev Vygotsky's sociocultural theory posits that children's cognitive development is heavily influenced by their social and cultural environment. He believed that children learn through social interactions and that language plays a crucial role in cognitive development. Donald Winnicott was a British psychoanalyst who focused on the importance of the mother-infant relationship and the concept of the "good enough" mother. He believed that a nurturing and supportive environment was essential for a child's emotional and psychological well-being. Winnicott introduced the idea of transitional objects, such as a favorite toy or blanket, which provide comfort and security during times of stress or separation from caregivers. Harry Stack Sullivan, an American psychiatrist, developed the interpersonal theory of psychiatry, which emphasizes the importance of social relationships in mental health. Sullivan believed that children's emotional and behavioral problems stem from difficulties in forming and maintaining healthy relationships with others. He argued for the significance of peer relationships, particularly during adolescence, in shaping a child's sense of self and emotional well -being.

A 14-month-old child is playing with a caregiver and older sibling. The sibling excitedly shows the child their new pet kitten. The child appears apprehensive and immediately looks to the caregiver, who calmly says "you can touch the kitten". The child then smiles and gently pets the kitten with the caregiver's assistance. This scenario best describes which of the following developmental concepts?

Joint attention * Social referencing Selective attention Dual representation Object permanence 2021 Child: 164

Rising from the floor, a three-year-old boy braces his hands against the ground and then walks his hands up his legs, thereby pushing himself to a standing position. The child's gait is waddling. Leg and arm strength are weak on exam even though muscle bulk appears good. The child's uncle suffered from a similar problem. Which of the following diagnostic tests would most likely show abnormal findings?

Karyotyping Tensilon test Nerve conduction study * Electromyography Electroencephalography 2019 Child: 168 what is the disorder? The disorder the child seems to be exhibiting symptoms of is Duchenne Muscular Dystrophy (DMD). This genetic disorder is characterized by progressive muscle degeneration and weakness. The condition is primarily observed in males and often emerges in early childhood. DMD is caused by an absence of dystrophin, a protein that helps keep muscle cells intact. The symptom of using hands to stand up is known as Gower's sign, which is a classic characteristic of this disorder. how is it diagnosed? Duchenne Muscular Dystrophy (DMD) is usually diagnosed through a series of tests. Initially, a physical exam and review of medical history might reveal symptoms suggestive of DMD. The definitive diagnosis is often made through a blood test that measures levels of creatine kinase, an enzyme that leaks into the blood when muscle fibers are damaged. Genetic testing can also be done to identify the specific mutation in the dystrophin gene. In some cases, a muscle biopsy may be required to confirm the diagnosis, where a small sample of muscle tissue is taken for microscopic examination. • Karyotyping is a laboratory procedure that helps to visualize a person's set of chromosomes. It can identify genetic disorders and may also be used to determine a person's sex. • The Tensilon test is used to diagnose myasthenia gravis, a neuromuscular disorder. It involves the administration of a drug called Tensilon, which causes temporary improvement in muscle strength. • A nerve conduction study measures how quickly electrical signals move through a nerve. This test is commonly used to diagnose conditions such as carpal tunnel syndrome and peripheral neuropathy. • Electromyography (EMG) measures the electrical activity of muscles at rest and during contraction. It can help diagnose muscle disorders, nerve disorders, and disorders affecting the connection between nerves and muscles. • Electroencephalography (EEG) records the electrical activity of the brain. It's primarily used to diagnose epilepsy, but it can also help detect other brain disorders. EEG is often used in conjunction with other neurological t

Which of the following neuropsychological testing results are most dependent on school curriculum and home environment?

Kaufman Assessment Battery Raven's Progressive Matrices * Wide Range Achievement Test Leiter International Performance Scale Wechsler Intelligence Scale for Children 2021 Child: 173 BUZZWORDS - assess a pt's premorbid intellectual functioning (can the rat read?) - useful screening test to evaluate an 8 y/o child's academic performance Kaufman Assessment Battery The Kaufman Assessment Battery for Children (KABC) is a cognitive assessment tool that measures intelligence and achievement in children aged 2.5 to 12 years. Key buzzwords include sequential processing, simultaneous processing, and learning ability. Raven's Progressive Matrices Raven's Progressive Matrices (RPM) is a nonverbal test used to measure abstract reasoning and regarded as a non-verbal estimate of fluid intelligence. Buzzwords include non-verbal, abstract reasoning, and fluid intelligence. Wide Range Achievement Test The Wide Range Achievement Test (WRAT) is a test of reading recognition, spelling, and arithmetic. It's often used as a basic measure of academic achievement. Buzzwords include reading recognition, spelling, and arithmetic. Leiter International Performance Scale The Leiter International Performance Scale (LIPS) is a nonverbal intelligence test designed to assess children and adults with speech, language, or hearing impairments. Key terms include nonverbal, visual reasoning, and attention span. Wechsler Intelligence Scale for Children The Wechsler Intelligence Scale for Children (WISC) is an individually administered intelligence test for children between the ages of 6 and 16. Buzzwords include verbal comprehension, perceptual reasoning, working memory, and processing speed.

Stimulant medication for attention-deficit/hyperactivity disorder is mostly likely to be associated with which of the following cardiac effects?

Large risk of severe tachycardia Increased long-term risk of hypertension * Mild increases in pulse and blood pressure Higher risk of serious cardiovascular disease Persistent long-term adrenergic effect on the heart 2022 Child: 80

Which of the following hormones is derived from the serotonin molecule?

Leptin Cortisol Prolactin * Melatonin Growth hormone 2020 Child: 33

Which of the following neuropeptides promotes synaptogenesis and reduces apoptosis during toddlerhood?

Leptin Hypocretin Anandamide Agouti-related peptide * Brain-derived neurotrophic factor 2020 Child: 119 significant buzzwords/pertinent conclusions associated with (each of) the above research study(ies) on child psychiatry boards: ● Leptin: Associated with regulating energy balance by inhibiting hunger. Leptin deficiency is linked to obesity and can lead to mood disorders in children. ● Hypocretin: Also known as orexin, it plays a major role in sleep regulation. Hypocretin deficiency is linked to narcolepsy, a condition that can impact a child's daily functioning and overall mental health. ● Anandamide: An endocannabinoid that affects mood, memory, and pain perception. Disruptions in anandamide signaling can contribute to a range of psychiatric conditions in children, including anxiety and depression. ● Agouti-related peptide: Involved in the regulation of feeding behavior and energy homeostasis. Increased levels of this peptide have been associated with overeating and obesity in children, which can indirectly affect their mental well-being. ● Brain-derived neurotrophic factor: This protein is crucial for the growth, maturation, and survival of neurons. It's closely associated with cognitive development and various psychiatric disorders in children. Low levels of this factor can lead to conditions such as ADHD, autism, and depression.

The Treatment of Severe Childhood Aggression (TOSCA) study enrolled children ages 6-12 with both diagnosed attention-deficiUhyperactivity disorder and disruptive behavior with significant aggression. Participants whose symptoms did not resolve in the first stage of the study received augmented treatment which of the following?

Lithium Fluoxetine * Risperidone Parent training Methylphenidate 2019 Child: 108 The Treatment of Severe Child Aggression (TOSCA) study abstract aimed to explore the added benefit of a second drug (risperidone) to the effect of the first (stimulant) in treating severe child aggression. The study sample included children (ages 6-12) with both diagnosed ADHD and disruptive behavior disorder, accompanied by severe physical aggression. Stimulant medication was openly titrated to optimal effect in 3 weeks. Those whose symptoms were not normalized were randomly assigned to receive risperidone or placebo, while those whose symptoms were normalized continued with stimulant only. Families participated in a parent training program throughout the study as part of the comparison of stimulant+parent training versus stimulant+antipsychotic+parent training.

When held to the standard of typical inclusion and exclusion criteria for clinical trials for adolescents with major depressive disorder, more than 60% of depressed adolescents who participated in the National Comorbidity Survey: Adolescent Supplement would have been excluded from at least one study. Which study criterion would have led to the largest number of exclusions?

Lifetime bipolar disorder * Significant risk of suicide Lifetime psychotic features Past year alcohol/drug use Past year use of psychotropic medication 2020 Child: 23 The National Comorbidity Survey: Adolescent Supplement (NCS-A) studied 10,123 U.S. adolescents aged 13-18, and found that 1 in every 4-5 youths has had a lifetime mental disorder with severe impairment. Eating and impulse-control disorders peaked in childhood, while substance use and depression peaked in adolescence. The study also found high comorbidity of disorders, suggesting common underlying factors. It highlighted the need for early detection and intervention, as well as improved access to mental health services and less stigma towards mental health conditions. The study did not explicitly exclude adolescents who are suicidal. In fact, it aimed to capture a comprehensive picture of mental health disorders among young people, which would likely include individuals with suicidal tendencies. This characteristic is significant and unique because it provides a holistic understanding of adolescent mental health, including severe and often overlooked conditions such as suicidality. This characteristic was unique and important because it allowed the study to provide a more accurate and thorough understanding of the state of adolescent mental health. By including adolescents with suicidal tendencies, the study was able to delve into the severity and diversity of mental health issues faced by this age group. This inclusive approach ultimately contributes to the development of more effective prevention strategies, early detection methods, and treatment plans, hence playing a critical role in enhancing mental health support for adolescents.

A child hospitalized for abdominal pain has an extensive medical workup that is normal. The mother insists that her child is sick and that further medical interventions be pursued. When consulted, the mother refuses to allow the child psychiatrist to interview her child alone. Which of the following is the best next course of action?

Limit communication with the family to the father only Mandate that the child and mother begin family therapy Call child protective services to place the child with a foster family * Obtain records from the child's past and present medical providers Refer the child to a gastrointestinal specialist for further medical workup 2020 Child: 130

A 16-year-old diagnosed with bipolar I disorder, most recent episode manic, has been hospitalized for one month. The patient has beliefs of being the next messiah and has stopped eating and drinking, thinking that only their death will bring peace to the world. The patient's heart rate is dipping intermittently below 50. Trials of valproic acid with different antipsychotic medications have resulted in severe dystonic reactions. Which of the following would be the best treatment option at this time?

Lithium Biofeedback Ketamine infusion * Electroconvulsive therapy Transcranial magnetic stimulation 2020 Child: 155

A 12-year-old child with a recent diagnosis of attention-deficit/hyperactivity disorder is referred for treatment. The child's parents describe frequent outbursts of aggression at school and at home, resulting in significant disruption. in addition to these episodes, the child is moody and has daily, almost constant irritability. The child's parents state that they feel like they are "walking on eggshells" in their own home. In addition to starting psychotherapy, which of the following medications is most appropriate to start to address the child's behavior?

Lithium Bupropion Guanfacine Oxcarbazepine * Methylphenidate 2022 Child: 19

An adolescent female is experiencing severe obsessions and compulsions. Despite having partial improvement on an adequate dose of sertraline for twelve weeks, the symptoms remain debilitating. After weighing the risks and benefits of combined pharmacotherapy, the psychiatrist recommends augmenting the sertraline. Of the following [medications], which has been shown to be most effective, in conjunction with SSRls, as augmentation in refractory obsessive- compulsive disorder?

Lithium Bupropion Lorazepam *Risperidone Clomipramine 2020 Child: 60

In addition to clomipramine and benzodiazepines, which of the following may be beneficial as an augmentation strategy for obsessive-compulsive disorder symptoms?

Lithium Buspirone * Aripiprazole Atomoxetine Valproic acid 2022 Child: 91

A 10-year-old is seen emergently after attempting to jump out of a third story window. Family reports that the child has not slept for almost five days and insists that he has a job to do that no one else can assist with. On interview, he reports the belief that he is a superhero. There is a strong family history of bipolar disorder. Which of the following medications has the best evidence to support its use in the treatment of these acute symptoms in a pediatric patient?

Lithium Lamotrigine * Risperidone Valproic Acid Oxcarbazepine 2020 Child: 164

The Treatment of Early-Age Mania study evaluated response to manic symptoms in 279 youth, ages 6-15 years, and found that most responded to which of the following pharmacological agents?

Lithium Valproate Lamotrigine Risperidone Oxcarbazepine 2019 Child: 127 Diagnosing early-age mania is difficult due to its similarity to other childhood conditions. It was noted that the presentation of mania in children may differ from adults. Thus, distinct diagnostic criteria is needed. Treatments for early-age mania, such as mood stabilizers and psychotherapy, can be beneficial. However, much about early-age mania is unknown, necessitating further research. The study mentioned that Risperidone, an atypical antipsychotic, has been found to be potentially effective in treating early-age mania, but should be closely monitored due to the risk of side effects.

Which of the following polysomnogram findings is consistent with narcolepsy?

Long n2 phase * Sleep onset REM Low total sleep time Increased sleep efficiency Increased slow wave sleep 2020 Child: 58

Sleep cycles in infants, as compared to those in adults, are characterized by which of the following?

Longer cycle length Longer ultradian cycle Diurnal circadian cycle * More time in REM sleep Later onset of REM sleep 2022 Child: 58

When terminally ill, which of the following is the main expressed [fear] by preschool-age children?

Losing emotional control Being different from peers Becoming a burden on others * Being separated from the primary caretaker 2021 Child: 191

Which of the following patient characteristics best fits with criteria for psychoanalytic treatment?

Low frustration tolerance Need for immediate symptom relief Disorganized behavior and thoughts * Ability to form and maintain relationships Recent diagnosis of a severe medical illness 2020 Child: 106

Which of the following genetic factors was first identified as possibly protective in children who have experienced early maltreatment?

Low numbers of D2 receptors * High levels of the monoamine oxidase A enzyme A genotype with a duplication of the MECP2 gene Deficiency in the aldehyde dehydrogenase enzyme 2020 Child: 195

Lithium has a lower plasma concentration in the pediatric population compared to adults because of which of the following?

Lower bioavailability Lower body fat stores Lower protein binding Higher clearance rate * Higher volume of distribution 2020 Child: 22 When drug has a higher volume of distribution in a pediatric population than an adult one, it means that the drug spreads more extensively within the body of a child compared to an adult. The volume of distribution is a theoretical value that represents the extent of a drug's distribution in the body relative to the total amount of the drug in the body. If a drug has a higher volume of distribution in a pediatric population, it suggests that the drug is more widely distributed in the tissues of children, possibly due to differences in body composition, metabolism, or other physiological factors. This could potentially impact the drug's efficacy and side effects, necessitating careful dosage adjustments and monitoring in pediatric patients. Lithium's higher volume of distribution in pediatric patients can be attributed to several factors. Firstly, children generally have a higher percentage of body water compared to adults, which allows for greater dilution and distribution of lithium, a water-soluble drug. Secondly, children's kidneys are more efficient at excreting substances, which can lead to a higher volume of distribution as the drug is rapidly cleared from the bloodstream and into tissues. Lastly, differences in children's metabolic rates and organ function could also contribute to lithium's increased distribution. However, the exact mechanisms behind this phenomenon are still being researched and understood. It's crucial to consider these factors when prescribing and dosing lithium for pediatric patients to ensure therapeutic effectiveness and minimize potential side effects.

An adolescent presents to clinic with new-onset depressed mood. Before developing depressive symptoms, the adolescent reports three discrete episodes of tremulousness, mild ataxia and an irregular cadence of speech, each involving complete recovery to baseline. Which of the following diagnostic studies is needed to make the diagnosis for the patient's underlying condition?

Lumbar puncture (LP) Electroencephalogram (EEG) Computed Tomography (CT) * Magnetic resonance imaging (MRI) Positron Emission Tomography (PET) 2021 Child: 30

Young males with limited prosocial emotional expression appear to have relative basal deficit in which of the following hormones?

Lutin * Cortisol Estrogen Prolactin Growth Hormone 2020 Child: 183 Young males with limited prosocial emotional expression have relatively lower cortisol levels--a hormone linked to stress responses. This trait, termed 'prosocial emotional expression,' may lead to social and mental health issues. A 'basal deficit' in cortisol refers to a reduced level of the hormone, which can impair the body's response to stress and affect health. The study suggests that reduced cortisol levels may be a biological marker of this trait, potentially indicating the degree to which an individual expresses prosocial emotions.

An infant presents to the ER with new onset hypotonia, constipation, poor feeding and pupil dilatation, after being introduced to a new food. Which of the following tests might assist in establishing the correct diagnosis?

MRI EEG * EMG PETscan Cranial Ultrasound 2021 Child: 23

A child tries playing baseball but immediately wants to quit, stating, "I didn't get a hit and I never will!" What cognitive distortion does this reaction exemplify?

Magnifying * Absolutism Mind-reading Personalization * Catastrophizing 2021 Child: 105

A child presents with frequent involuntary leg movements at night and daytime somnolence. Which of the following psychiatric disorders is most strongly associated with this disorder?

Major depressive Generalized anxiety Oppositional defiant Posttraumatic stress * Attention-deficit/hyperactivity 2022 Child: 36

Functional abdominal pain in childhood is most closely associated with which of the following?

Male gender Parental neglect * Maternal anxiety and depression Attention-deficit/hyperactivity disorder Absence of other indications of anxiety in the child 2020 Child: 169

The strongest evidence for the utility of psychodynamic approaches in children and adolescents exists for which of the following symptom domains? (Select three)

Mania Autism Anxiety Trauma Psychosis Depression Learning disability Language disorder 2022 Child: 200

What is the most preventable cause of brain damage worldwide?

Marasmus Phenylketonuria Down syndrome * Iodine deficiency Fragile X syndrome 2021 Child: 107 FYI - Marasmus is a type of severe malnutrition seen in children, resulting in weight loss or the inability to gain weight, and an emaciated appearance. Its causes include inadequate caloric intake, an unbalanced diet, and frequent infections or diseases. Understanding this condition is essential for child psychiatry board exams. Additionally, marasmus can affect a child's mental health, causing developmental delays and mental disorders such as depression and anxiety.

An adolescent is referred by the pediatrician to the emergency department with a history of restrictive eating over the past six months. The patient has lost 20 pounds but is still at greater than 80% of ideal body weight with normal vitals, examination and laboratory assessment. Which of the following settings is most appropriate to care for the patient?

Medical admission * Partial hospitalization Psychiatric admission Outpatient primary care Long-term residential care 2021 Child: 88

A child gets 90% on a test. However, the child feels like a total failure for not getting a perfect score. According to cognitive psychology, this conceptualization represents which of the following types of cognitive distortion?

Mental filter Catastrophizing Over-generalization * Absolutistic thinking Jumping to conclusions 2020 Child: 151

Which of the following opportunities was first offered to children as their rights expanded in the 17th century?

Mental health care Physical health care * Educational activities Protection from abuse Juvenile specific legal rights 2021 Child: 167

An adolescent female calls your office complaining of milky discharge from her breast after initiation of risperidone two weeks ago. Which of the following neuronal tracts is most likely implicated in the development of this side effect?

Mesolimbic Nigrostriatal Mesocortical *Tubero-infundibular Retinohypothalamic 2020 Child: 66 Excess or deficient amounts of dopamine in the: • Mesolimbic pathway can lead to conditions such as schizophrenia, addiction, and mood disorders. • In the Nigrostriatal pathway, dopamine deficiency is primarily associated with Parkinson's disease, while an excess can lead to movement disorders such as Huntington's disease. • The Mesocortical pathway, when faced with dopamine imbalances, can result in cognitive and emotional issues, including the development of schizophrenia and attention deficit hyperactivity disorder (ADHD). • Lastly, in the Tubero-infundibular pathway, a deficiency in dopamine can lead to hyperprolactinemia, causing irregular menstrual cycles in women and decreased libido in men, while an excess can lead to a decrease in prolactin levels, potentially causing issues with lactation in women and decreased sperm production in men. Maintaining a balanced dopamine level in this pathway is crucial for normal reproductive function and sexual health.

At around three to four weeks of human gestation, failure of which of the following neurodevelopmental processes results in spina bifida?

Migration * Neurulation Gastrulation Notochord formation Neural tube induction 2022 Child: 16 Migration: This process involves the movement of cells from their birthplace to their final location in the brain. Key terms include radial and tangential migration, cortical layers, and Reelin protein. A notable clinical pearl is that abnormal neuronal migration can lead to neurodevelopmental disorders such as lissencephaly. Neurulation: This is the formation of the neural tube, which will eventually form the brain and spinal cord. Buzzwords include neural plate, neural groove, neural folds, and neural crest cells. An associated clinical pearl is that defects in neurulation can lead to neural tube defects like spina bifida and anencephaly. Gastrulation: This is the process by which the single-layered blast ula is reorganized into a trilaminar (three-layered) structure known as the gastrula. Key terms include ectoderm, mesoderm, and endoderm. A pertinent conclusion is that errors during gastrulation can result in abnormalities such as congenital malformations. Notochord formation : The notochord is a rod-like structure that forms the primitive axial skeleton in embryos. Important terms include notochordal process and notochordal plate. The notochord plays a critical role in inducing the formation of the neural plate. Abnormalities in notochord formation can lead to skeletal malformations. Neural tube induction: This process involves the transformation of the neural plate into the neural tube. Key terms include neural fold fusion and neural crest migration. Neural tube induction is crucial for the development of the central nervous system. A significant clinical pearl is that disruptions in this process can lead to serious conditions such as anencephaly and spina bifida.

Which of the following cognitive behavioral therapy techniques is used specifically to manage the physiological symptoms of panic attacks?

Mindfulness Activity scheduling Socratic questioning * Interoceptive exposure Self-monitoring and management 2019 Child: 145

An adolescent's mood shifts many times a day with minor provocation. The patient describes feelings of emptiness, multiple suicide attempts, superficial cutting, and volatile relationships. Which of the following would be core components of the recommended psychotherapeutic treatment? (Select three)

Mindfulness Core beliefs Distress tolerance Automatic thoughts Conditional assumptions Contingency management Interpersonal role disputes Interpersonal effectiveness 2022 Child: 194 per DIEM

A fourth grade child is killed in a car accident. Which of the following describes the most likely response of the deceased child's friends and classmates?

Minimal curiosity or interest about the event Concerns about the meaning and finality of death * Fears about the safety of themselves and their family Refusal to engage in a class discussion of the event Feelings of guilt and responsibility for not preventing the accident 2019 Child: 105 Infants and Toddlers (0-2 years) At this stage, children have little to no understanding of death. They may notice the absence of a loved one, but they do not comprehend the permanence of death. Preschoolers (3-5 years) During the preschool years, children begin to grasp the concept of death but often view it as reversible or temporary. They may believe that deceased individuals can come back to life or that they are simply sleeping. School-age Children (6-12 years) As children enter school, their understanding of death becomes more concrete. They start to realize that death is a permanent and irreversible event. However, they may still have misconceptions about the specific causes and processes involved in death. Adolescents (13-18 years) In adolescence, young people develop a more mature understanding of death. They are more likely to grasp the abstract concepts surrounding death, such as the emotional and spiritual aspects. They may also begin to contemplate their own mortality and explore philosophical questions related to life, death, and the afterlife.

A 15-year-old is brought to a child and adolescent psychiatrist for evaluation of low mood. When feeling "down", the patient eats 20-30 cookies at a time when not hungry, noting, "I just keep eating, and | can't stop." During these episodes, the patient eats until feeling "stuffed" and shares this has been happening multiple times weekly for the past three months. Which of the following additional symptoms, if present, would characterize this patient as experiencing binge eating disorder?

Misuse of laxatives Fear of gaining weight * Feeling guilty after eating BM! greater than or equal to 25 Self-worth based on body shape 2022 Child: 96

A clinician wants to study if certain medical conditions predict suicidal thoughts when adolescents are seen in an emergency room. Suicidal thoughts would be considered what type of variable?

Mixed * Dependent Extraneous Independent 2020 Child: 193

An adolescent complains of blurred vision in the late afternoon. Parents report that the teen's eyelids can also appear "low and droopy" at times. Testing with which of the following drugs will likely confirm the diagnosis?

Modafinil Prednisone Azathioprine * Edrophonium Pyridostigmine 2021 Child: 48

Which of the following statistical tools are also known as measures of central tendency? (Select three)

Mode Mean Median Variance Covariance Point estimator Standard deviation Correlation coefficient 2022 Child: 191

A 12-year-old has reported abdominal pain for a year. An extensive medical workup has been unrevealing, and there has been no weight loss. The child does well in school but has missed 30 days of school due to abdominal pain. The child reports being constantly worried about the abdominal pain and avoids restaurant outings or discussing food-related topics due to a fear of future abdominal pain. Which of the following is the most likely diagnosis?

Mood disorder Factitious disorder Illness anxiety disorder * Somatic symptom disorder Avoidant/restrictive food intake disorder 2020 Child: 190

In addition to a prior suicide attempt, which of the following factors confer the highest risk for a subsequent suicide attempt in patients aged 15-24? (Select three)

Mood disorder Previous arrest Recent break-up Access to firearm History of bullying Single-parent home Developmental delay Non-suicidal self-injury 2022 Child: 188 o MAN!

Polymorphisms in which of the following genes has been tested repeatedly as a predictor of response to psychostimulants in youth with attention-deficit/hyperactivity disorder?

NET1 *DAT1 ABCB1 SNAP-25 Latrophilin-3 2020 Child: 72 • The DAT1 gene, also known as the dopamine transporter gene, plays a crucial role in regulating dopamine, a neurotransmitter associated with attention and impulse control. Certain variations or polymorphisms of this gene can potentially influence how an individual might respond to psychostimulants, which are commonly used in the treatment of attention-deficit/hyperactivity disorder (ADHD). • In the context of ADHD, researchers often focus on a specific 10-repeat allele in the DAT1 gene. Some studies suggest that individuals with this allele may show a more favorable response to psychostimulants. However, the results have been mixed, with other studies indicating no significant association between this allele and treatment response. • Further complicating matters, the influence of the DAT1 gene on ADHD treatment response can also be affected by other factors, such as the presence of comorbid conditions, the specific type of psychostimulant used, and individual variations in drug metabolism. • In addition, there is also the possibility of gene-environment interactions. For instance, the impact of the DAT1 gene on treatment response may vary depending on environmental factors like stress levels or dietary habits. • Therefore, while the DAT1 gene may potentially influence response to psychostimulants in youth with ADHD, it is only one piece of a complex puzzle. More research is needed to fully understand how genetic and environmental factors interact to influence treatment outcomes for this disorder. • NET1, also known as norepinephrine transporter, plays a significant role in the regulation of norepinephrine levels in the synaptic cleft. Alterations in its function have been linked to various psychiatric disorders like depression and ADHD. • ABCB1, also known as MDR1, is a protein that pumps multiple drugs and toxins out of cells. Polymorphisms in this gene are linked to drug resistance in treatment of psychiatric disorders such as schizophrenia. • SNAP-25 is involved in the molecular regulation of neurotransmitter release. Mutations in this gene have been implicated in conditions like ADHD, schizophrenia, and bipolar disorder, as they may disrupt sy

Which receptor's expression has most conclusively been shown to be altered by epigenetic modification in a patient who experienced a history of sexual abuse as child?

NMDA receptor Serotonin receptor 1A D2 dopamine receptor * Glucocorticoid receptor Adrenocorticotropin receptor 2020 Child: 114

A 17-year-old patient presents with sleep deficiency that includes symptoms of excessive daytime sleepiness, especially in the morning hours, making it difficult to get up for school. Which of the following sleep disorders is most likely?

Narcolepsy Parasomnia Kleine-Levin syndrome Obstructive sleep apnea * Circadian rhythm sleep disorder 2019 Child: 143 DSM-V criteria for circadian rhythm sleep disorder: include a persistent or recurrent pattern of sleep disruption that is primarily due to alterations in the individual's circadian system or misalignment between the circadian rhythm and the sleep-wake schedule required by an individual's physical environment or social or professional schedule. This disruption leads to excessive sleepiness or insomnia, or both, and causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The disorder is not better explained by another sleep disorder, medical or neurological disorder, mental disorder, medication use, or substance use disorder.

A previously healthy adolescent has difficulty falling asleep, frequent nighttime awakenings, and difficulty returning to sleep. There is no history of snoring or difficulty breathing. The adolescent reports sleep improves on the weekend. The adolescent has had recent decline in school performance with these sleep difficulties. What is the most likely diagnosis for this adolescent?

Narcolepsy Restless legs syndrome Obstructive sleep apnea * Circadian rhy1hm sleep disorder Periodic limb movement disorder 2021 Child: 115

A child has been falling asleep during class. The child reports feeling a burning sensation in the lower extremities at night with urges to move the limbs. Diagnostic evaluation is only remarkable for a low serum ferritin level. What is the most likely diagnosis?

Narcolepsy Tic disorder Rolandic epilepsy * Restless legs syndrome Obstructive sleep apnea 2020 Child: 124

Which of the following traumatic events is associated with the greatest risk of subsequent development of posttraumatic stress disorder in children and adolescents?

Natural disaster Death of a loved one Motor vehicle accident News reports of terrorism * Physical abuse by caregiver 2021 Child: 66

A child with Down Syndrome presents with worsening irritability, impulsivity, inattention and sleep disturbance with persistent nocturnal enuresis. Which of the following diagnostic studies would be most helpful in the patient's initial assessment?

Neck ultrasound * Polysomnography Electroencephalography Pulmonary function testing Brain magnetic resonance imaging 2021 Child: 126

Plaques associated with multiple sclerosis are noted to have a loss of which of the following types of cells?

Neurons Microglia Astrocytes Leukocytes * Oligodendrocytes 2019 Child: 183 The plaques associated with multiple sclerosis are noted to have a significant loss of oligodendrocytes. These cells are crucial in the central nervous system as they produce the myelin sheath, a protective covering for nerve fibers. Without sufficient oligodendrocytes, the myelin sheath deteriorates, leading to the formation of scar tissue or plaques, characteristic of multiple sclerosis. This process, known as demyelination, is responsible for the variety of neurological symptoms observed in patients with multiple sclerosis.

A patient presents to clinic, accompanied by parents, with reports of recent personality changes, tremor, and aggression. The parents also report that a relative had a similar presentation that eventually led to a liver transplant. What disorder is the patient most likely suffering from?

Niemann-Pick * Wilson's disease Huntington disease Spinocerebellar ataxia Idiopathic childhood cirrhosis 2021 Child: 122 ● Niemann-Pick ● Niemann-Pick is a group of inherited metabolic disorders, wherein the body is unable to metabolize cholesterol and lipids properly. This leads to the accumulation of harmful amounts of lipids in various organs. Significant buzzwords include: sphingomyelinase, lipid storage, hepatosplenomegaly, and neurological decline. ● Wilson's disease ● Wilson's disease is a rare inherited disorder that causes excessive amounts of copper to accumulate in the liver, brain, and other vital organs. Clinical pearls include: Kayser-Fleischer rings, hepatic dysfunction, neurological symptoms, and copper chelation therapy. ● Huntington disease ● Huntington disease is a genetic disorder that causes the progressive breakdown of nerve cells in the brain. It has a broad impact on a person's functional abilities and usually results in movement, cognitive and psychiatric disorders. Key terms associated with this disease include: chorea, CAG repeat, neurodegeneration, and genetic testing. ● Spinocerebellar ataxia ● Spinocerebellar ataxia refers to a group of hereditary ataxias that are characterized by degenerative changes in the part of the brain related to the control of movement, and sometimes in the spinal cord. Relevant buzzwords include: ataxia, dysarthria, oculomotor disturbances, and genetic inheritance. ● Idiopathic childhood cirrhosis ● Idiopathic childhood cirrhosis is a rare condition in which there is progressive liver cirrhosis without a known cause. This can lead to liver failure and requires a liver transplant in severe cases. Pertinent terms include: jaundice, hepatomegaly, portal hypertension, and liver transplantation.

A child suddenly screams in the early part of the night with associated diaphoresis and tachypnea, lasting for 1-2 minutes. The child has no recall of the events the next day. These events are most associated with which of the following parasomnias?

Nightmares * Sleep terrors Sleep talking Confusional arousals REM sleep behavior disorder 2020 Child: 2 Sleep terrors, also known as night terrors, typically occur during the stages of non-REM sleep, more specifically during stage 3. This stage of sleep is also referred to as deep sleep or slow-wave sleep. It is during this time that the body undergoes most of its physical restoration and recovery. Sleep terrors are more common in children but can occur in adults as well, often as a result of stress, sleep deprivation, or certain medications.

Which of the following electroencephalogram (EEG) findings is most commonly seen in patients with toxin induced encephalopathy?

Normal pattern * Diffuse slowing Triphasic waves Epileptiform discharges Spike and wave pattern 2019 Child: 167

During the process of transmembrane signaling, which of the following receptor types is directly responsible for generating intracellular second messengers?

Nuclear receptors Ionotropic receptors Phosphatase receptors Tyrosine kinase receptors * G protein-coupled receptors 2022 Child: 101

During the process of transmembrane signaling, which of the following receptor types is directly responsible for generating intracellular second messengers?

Nuclear receptors lonotropic receptors Phosphatase receptors Tyrosine kinase receptors * G protein-coupled receptors 2019 Child: 180 • Nuclear Receptors • Nuclear receptors are intracellular proteins that are responsible for sensing steroid and thyroid hormones, and certain other molecules. They regulate the expression of specific genes, thus controlling development, homeostasis, and metabolism. • Ionotropic Receptors • Ionotropic receptors are a type of ligand-gated ion channels. They open or close in response to the binding of a neurotransmitter, allowing or preventing ionic flow across the cell membrane. This directly influences the membrane potential and cellular excitability. • Phosphatase Receptors • Phosphatase receptors are integral membrane proteins that remove phosphate groups from other molecules in a process called dephosphorylation. This can turn off signal transduction pathways, regulating a variety of cellular functions such as cell growth and division. • Tyrosine Kinase Receptors • Tyrosine kinase receptors are high-affinity cell surface receptors for many polypeptide growth factors, cytokines, and hormones. Upon ligand binding, they undergo autophosphorylation, activating various intracellular signaling pathways that control cell proliferation, differentiation, and metabolism. • G Protein-Coupled Receptors • G protein-coupled receptors (GPCRs) are a large family of cell surface receptors that respond to a variety of external signals. They activate intracellular second messengers via the activation of G proteins, leading to a cascade of cellular responses such as neurotransmission, immune response, and sensory perception.

A child is being evaluated for attention-deficit/hyperactivity disorder due to school failure. The child is often tired and irritable with no established bedtime routines and frequent naps. The patient typically snores while sleeping and is also mildly obese, eating with no set meal schedule. Which of the following is the best indication for obtaining polysomnography?

Obesity Fatigue * Snoring Irritability Inattention 2020 Child: 150

The following two (2) questions pertain to this vignette: An adolescent with no prior medical or psychiatric disorders, with a typically normal circadian rhythm, was brought for an evaluation after noted irritability, poor school grades, and constant fatigue. On history, the only pertinent positive is the earlier school start time for this year, which has been a difficult adjustment. What is the most likely etiology for the noted changes?

Obstructive sleep apnea Benign Rolandic epilepsy Limit setting sleep disorder * Delayed sleep phase syndrome Sleep-onset association disorder 2020 Child: 136

An emergency room physician evaluates a child with new-onset symptoms of obsessions and compulsions. The physician cannot determine a cause for the child's symptoms. Which of the following steps taken by the emergency room physician is considered lifelong learning?

Obtain a psychiatry consult Pursue further medical evaluation Refer the patient to an outpatient psychiatrist * Review evidence-based literature regarding the symptoms Develop a committee to create a standard evaluation for mental illness 2020 Child: 3

The psychiatrist is most likely considered to have established a doctor-patient relationship with the parent of a child patient after doing which of the following?

Obtaining consent for treatment of the child Conducting family therapy with the child as the identified patient Meeting privately with the parent to discuss the child's treatment * Giving the parent relationship advice in a separate parent session 2021 Child: 187

Which of the following statistical measures best allows for the synthesis of numerous studies in order to provide for an overall estimate of the strength of the relationship between an intervention and an outcome?

Odds ratio * Effect size Average t-score Cronbach's alpha Confidence interval 2022 Child: 74 Odds Ratio (OR) An odds ratio is a statistical term that measures the probability of an event occurring in one group to its probability in another group. In child psychiatry, it could be used to compare the likelihood of a certain behavior in children exposed to a particular factor versus those not exposed. Effect Size Effect size refers to the magnitude of a treatment effect. It's crucial in child psychiatry to determine the effectiveness of a treatment or intervention. A large effect size implies a significant change in behavior or symptoms. Average t-score In research, the average t-score is used to compare the means of two groups. In child psychiatry, it could be used to compare the mean scores of a psychiatric test between two groups of children, such as those with ADHD and those without. Cronbach's Alpha Cronbach's Alpha is a measure of internal consistency or reliability of a test or scale. In child psychiatry, it ensures that the tools used for diagnosis or assessment are reliable and consistent. Confidence Interval A confidence interval provides a range of values, derived from a statistical procedure, that is likely to contain the population parameter of interest. In child psychiatry, it could be used to estimate the prevalence of a certain disorder in the pediatric population.

Which of the following indexes is most clinically relevant due to its ability to demonstrate the strength of a relationship between two variables, especially in single studies?

Odds ratio * Effect size Confidence interval Relative risk reduction Number needed to harm 2021 Child: 162 ● Odds Ratio: A measure used in research studies to compare the odds of an event occurring in one group to the odds of it occurring in another group. Significant buzzwords include "odds", "comparison", and "probability". ● Effect Size: A quantitative measure of the magnitude of a phenomenon. Key terms include "magnitude", "impact", and "significance". ● Confidence Interval: An estimated range of values which is likely to include an unknown population parameter. Pertinent conclusions often revolve around the reliability and precision of these estimates. ● Relative Risk Reduction: A measure of the percentage reduction in risk of a specified outcome in the treatment group compared to a control group. Buzzwords are "risk", "reduction", and "control group". ● Number Needed to Harm: The number of patients that need to be exposed to a risk factor over a specific period to cause harm in one patient that would not have been harmed otherwise. This concept often involves terms like "risk factor", "exposure", and "potential harm".

Which of the following best summarizes the core aim of the Health Information Technology for Economic and Clinical Health Act of 2009?

Penalize systems of care for failing to adopt technologically based interventions for patients Increase privacy protections for the use of technology in health care by increasing penalties for breaches * Incentivize the adoption and meaningful use of health information technology, particularly electronic health records Improve diagnostic accuracy through big data synthesis of patient information and dissemination to practitioners 2020 Child: 194

Which of the following interventions with premature newborn infants has been shown to improve self-regulation and to increase the amount of calm sleep at ages three to six months?

Periodic gentile rocking of the incubator * Daily periods of maternal skin-to-skin contact Intermittent visual stimulation with human faces Sustained exposure to low-volume recordings of maternal heartbeat Regulation of ambient lighting to replicate normal diurnal patterns of day vs. night 2022 Child: 18

Which of the following is promoted as an alternative treatment for attention- deficit/hyperactivity disorder, but lacks evidence for efficacy and carries a risk of hypertension and cardiovascular problems?

Omega3 Caffeine Gingkobiloba St. John's-Wort * Dimethylamylamine 2021 Child: 176 Omega3 Omega3 fatty acids are essential nutrients often used in child psychiatry for their potential benefits on brain health. Buzzwords include neuroprotective, anti-inflammatory, and cognitive enhancement. Caffeine Caffeine is a stimulant that can impact children's nervous system, especially in high doses. Pertinent conclusions often include increased alertness but also potential for anxiety and sleep disturbances. Gingkobiloba Gingkobiloba is a natural supplement believed to improve cognitive function. Buzzwords often associated with Gingkobiloba include antioxidant, neuroprotective, and memory enhancement. St. John's-Wort St. John's-Wort is a herbal supplement often used to manage mood disorders in children. It's associated with terms such as serotonin reuptake inhibition, mood regulation, and potential photosensitivity. Dimethylamylamine Dimethylamylamine, also known as DMAA, is a stimulant often found in pre-workout supplements. Clinical pearls for this supplement include increased focus and energy, but also potential risks such as cardiovascular complications and neurological effects.

By what age does a child typically establish hand preference?

One year Three years * Five years Seven years Nine years 2021 Child: 65

A neurotypical child is asked to draw family members. The child draws a caregiver as a circle with four lines sticking out of the circle to represent arms and legs. The circle has two dots for eyes, but does not contain a nose, mouth, hair, fingers or toes. Which of the following best depicts the age of the child?

One year old * Three years old Five years old Seven years old 2021 Child: 190 Children's drawings can be used to assess their cognitive and physical development. At age 3, a child's drawings typically involve basic shapes, such as circles and lines, to represent people, a stage known as the "tadpole stage". This lack of detail in their drawings is not unusual and simply reflects the child's current stage of development. As the child matures, they will add more details, such as facial features, hair, fingers, and toes. This progression closely follows their cognitive development and indicates their increasing understanding of the human form. Assessing a child's drawings is an important tool for child psychiatrists studying for their board exam to identify any deviations from the norm. If a child significantly older than 3 is still in the "tadpole stage", it may suggest a delay in their development. It is essential for child psychiatrists to interpret these drawings to understand what they mean for a child's development.

Which of the following learning procedures inspired development of systematic desensitization?

Operant conditioning * Counter conditioning Classical conditioning Sensory preconditioning Second order conditioning 2021 Child: 178

A child is diagnosed in 2nd grade with a reading disability, and does well for the next few years with an individualized education program. After the first couple of months of 5th grade, the parents report that the child has declining self-esteem and a reluctance to do homework. A learning difficulty in which of the following areas is most likely to be a contributing factor to the child's new behaviors?

Oral expression Math calculations * Written expression Phonological awareness Listening comprehension 2021 Child: 175

The pediatrician requests a psychiatric consultation for a possible case of caregiver-fabricated illness in a child. In order to warrant further investigation by the state child protective services, physicians are expected to identify which of the following in the caregiver?

Overanxious parenting Attention-seeking behavior Possible secondary motivation * Suspicion of child maltreatment Absence of psychotic processes 2019 Child: 153 In order to warrant investigation by the state child protective services, physicians are expected to identify what in the caregiver? Signs of potential child abuse or neglect. This could include, but is not limited to: • Unexplained injuries on the child, such as bruises, burns, or fractures. • Behavioral changes in the child, such as fear, anxiety, depression, aggression, or withdrawal. • Neglectful behavior by the caregiver, such as failing to provide necessary food, clothing, medical care, or supervision. • Inappropriate or harmful caregiver-child interactions, such as belittling, blaming, rejecting, or ignoring the child. • Other concerning behavior, such as substance abuse or mental health issues that could negatively impact the child's wellbeing.

Which of the following most directly influences neuronal survival, migration, process outgrowth, and the plasticity underlying learning and memory?

Oxytocin Nitric oxide Interieukin-2 Endocannabinoids * Brain-derived neurotrophic factor 2022 Child: 77

Which of the following statistics is a descriptor of effect size in a randomized control trial?

P value Central tendency Standard deviation Confidence interval * Number needed to treat 2021 Child: 5 P value: A statistical term that helps determine if the hypothesis in a study is valid. A P value less than 0.05 is often considered statistically significant, indicating a less than 5% probability that the results occurred by chance. Central tendency: Refers to the measure that determines the center of a distribution. Mean, median, and mode are common measures. In child psychiatry, understanding central tendency can help identify typical behaviors or responses within a group. Standard deviation: A measure of the dispersion or variation in a set of values. A low standard deviation indicates that values tend to be close to the mean, while a high standard deviation suggests a greater variety in responses. In child psychiatry, it could help understand the range of behaviors or symptoms within a patient group. Confidence interval : This is a range of values, derived from a statistical method, that is likely to contain the true value of an unknown population parameter. In child psychiatry, it can provide an estimate of the uncertainty around a measurement or result. Number needed to treat: This is the average number of patients who need to be treated to prevent one additional bad outcome. It is a key concept in evidence-based medicine. In child psychiatry, it can help determine the effectiveness of a treatment strategy or intervention.

A female adolescent with epilepsy that is controlled with an antiepileptic medication is referred to a psychiatrist for evaluation of poor ability to concentrate and challenges with memory. The psychiatrist observes dark hair growth on the adolescent's chin, and hyperplasia of the gingiva. If HLA-8*1502 positive, the adolescent is at increased risk for which of the following side effects related to the antiepileptic medication?

Pancreatitis Nephrolithiasis Atrial fibrillation Rhabdomyolysis * Stevens-Johnson syndrome 2019 Child: 124 This medication is Phenytoin, commonly known as Dilantin. This drug is often used to control seizures. It is worth noting that these side effects are not common but can occur in some individuals. Further, the impact of these side effects can be reduced with good oral hygiene and regular dental check-ups. The human lymphocyte antigen HLA-B*1502 is associated with significantly increased risk of Stevens-Johnson syndrome (though typically with carbamazepine) the clinical pharmacogenetics implementation consortium (CPIC) guidelines states that people who are positive for HLA-B*1502 and any HLA-A*3101 genotype (or HLA-A*3101 genotype unknown) have a higher risk for developing carbamazepine-induced toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS). In identified patients who have not previously used carbamazepine, the use of the drug is discouraged.

Achild psychiatrist observes an eight-year-old child with intellectual disability to have a "scissoring gait" with adducted and straight legs. This finding is most likely related to which of the following?

Parkinsonism * Spastic paraparesis Dysdiadochokinesia Psychogenic disturbance Weak proximal hip muscles 2022 Child: 12

The psychiatrist evaluates an adolescent who presents with social anxiety. The patient's mood is euthymic and the only functional impairment is moderate avoidance of meeting new people and large social gatherings. A referral to which of the following would most likely be the best next step for this patient?

Partial hospitalization * Outpatient group therapy Peer mentorship program School guidance counselor Psychodynamic psychotherapy 2021 Child: 68

A therapist using psychodynamic psychotherapy to treat a child is more likely to make use of which of the following interventions compared to when treating an adult?

Passivity Neutrality * Education Clarification Interpretation 2020 Child: 63

A 17-year-old with significant benzodiazepine use is hospitalized for detoxification, prior to referral to a rehabilitation facility. The patient resides in foster care due to past abuse. Reportedly, the patient's mother recently died of a drug overdose. The patient has been hospitalized multiple times for self-injurious behavior and suicide attempts but has had poor response to treatment. On interview, sufficient criteria are endorsed for a diagnosis of major depressive episode and post-traumatic stress disorder. When compiling a diagnostic formulation of this case, which of the following would be considered a perpetuating factor?

Past history of abuse Recent death of mother * Poor response to treatment Benzodiazepine intoxication Family history of alcohol and substance use 2020 Child: 139 • Predisposing Factor • Predisposing factors are those elements that increase the likelihood of developing a certain disorder. In child psychiatry, these could be genetic predispositions, such as a family history of mental health disorders, or early life events, such as trauma or neglect. • Precipitating Factor • Precipitating factors are the triggers that initiate the onset of a psychiatric disorder. In children, these could include stressful life events, such as parental divorce, abuse, or the death of a loved one. • Perpetuating Factor • Perpetuating factors are those that maintain or worsen the psychiatric disorder once it has begun. In child psychiatry, these could be ongoing stressors, such as bullying, academic pressures, or chronic illness . • Protective Factor • Protective factors are those that reduce the likelihood of the onset or recurrence of a psychiatric disorder. In child psychiatry, these could include strong social support networks, positive school environments, and effective coping strategies. These factors can help children resist stressors and bounce back from adversity, promoting resilience and overall mental health.

Per the AACAP committee on telepsychiatry, which of the following should be most concerning regarding relative contraindications for telepsychiatry?

Patient age * Patient setting Patient diagnosis Participant number Medical comorbidities 2021 Child: 94

The Mental Health Parity and Addiction Equity Act requires insurance companies to do which of the following?

Pay for all levels of care, including residential tax Charge the same premiums for mental and medical benefits Charge the same deductibles for mental and medical benefits Reimburse at the same rates for mental and medical illnesses * Offer comparable limitations for medical and mental health benefits 2021 Child: 37

Which of the following interventions with premature newborn infants has been shown to improve self-regulation and to increase the amount of calm sleep at ages three to six months?

Periodic gentle rocking of the incubator * Daily periods of maternal skin-to-skin contact Intermittent visual stimulation with human faces Sustained exposure to low-volume recordings of maternal heartbeat Regulation of ambient lighting to replicate normal diurnal patterns of day vs. night 2019 Child: 115

A 17-year-old is receiving cognitive behavioral therapy for depression. The patient says, "My coach hates me," after not playing in the last game, although the teen had played the previous five games. This thought process best exemplifies which of the following cognitive errors?

Personalization Ignoring evidence l Arbitrary inference Overgeneralization * Selective abstraction 2020 Child: 59 • In Cognitive Behavioral Therapy (CBT), overgeneralization refers to the process of viewing a single negative event as a never-ending pattern of defeat. For example, if you fail at a particular task, you might think that you're always a failure. • On the other hand, selective abstraction (also known as 'mental filter') is when a person focuses solely on the negative aspects of a situation, ignoring any positive or neutral information. For instance, you might receive numerous compliments on a presentation, but obsess over one minor criticism. Both of these cognitive distortions can significantly skew a person's perception of reality and contribute to mental health issues such as anxiety and depression.

A seven-year-old child presents with a history of multiple staring spells. The child's electroencephalogram demonstrates a symmetrical 3-Hz spike and wave activity. Which of the following is the best initial choice for management of these seizures?

Phenytoin Diazepam * Ethosuximide Phenobarbital Carbamazepine 2020 Child: 125

A six-year-old-child presents to the outpatient clinic with a six-month history of frequent anger outbursts, argumentative behavior towards parents, pattern of blaming others for own misbehaviors and spiteful behaviors towards other children. Which of the following treatment strategies is most appropriate?

Play therapy Alpha agonist Strategic family therapy * Parent management training Selective serotonin reuptake inhibitor 2019 Child: 76

A psychiatrist uses the model of 'the four P's' (predisposing, precipitating, perpetuating, and protective factors) to develop a case formulation of an adolescent patient. The adolescent has significant symptoms of anxiety and depression, which worsened since starting high school several months ago. Additional relevant information includes: several family members with mood disorders, ongoing academic difficulties due to a chronic learning disorder, active participation in several varsity sports teams, and recent election to student council. Which of the following patient factors is best considered a perpetuating factor?

Playing sports Having ill relatives Starting high school Joining school council * Having learning issues 2019 Child: 186 A biopsychosocial formulation's components include: Predisposing Factors : These are the biological, psychological, and social factors that make an individual susceptible to developing a disorder. For example, genetic predisposition, early traumatic experiences, or socio-economic status. Perpetuating Factors: These are factors that maintain or exacerbate the disorder once it has developed. This could include ongoing stress, unhealthy lifestyle behaviors, or a lack of social support. Precipitating Factors: These are events or situations that trigger the onset of a disorder. They could be a major life event, such as the loss of a loved one, an accident, or any significant change in one's life. Protective Factors : These are the elements that enhance resilience and help to counteract the risk factors. It could be a strong social network, healthy coping mechanisms, or a supportive family environment. In a biopsychosocial formulation, it's crucial to identify and understand these components as they provide a holistic view of the individual's condition. This understanding can guide the development of a comprehensive and personalized treatment plan aimed at addressing the specific needs and challenges of the individual. It is also essential for predicting the course of the disorder and the individual's response to treatment. It's a dynamic process that requires ongoing assessment and adjustment as the individual's circumstances change.

A psychiatrist uses the model of 'the four P's' (predisposing, precipitating, perpetuating, and protective factors) to develop a case formulation of an adolescent patient. The adolescent has significant symptoms of anxiety and depression, which worsened since starting high school several months ago. Additional relevant information includes: several family members with mood disorders, ongoing academic difficulties due to a chronic learning disorder, active participation in several varsity sports teams, and recent election to student council. Which of the following patient factors is best considered a perpetuating factor?

Playing sports Having ill relatives Starting high school Joining school council Having learning issues 2022 Child: 168

Which of the following genetic mechanisms most likely represents the molecular basis of fragile X syndrome?

Point mutation Uniparental disomy Genomic imprinting * Triplet repeat expansion Contiguous gene deletion 2021 Child: 8

Several studies were eliminated from consideration in a meta-analysis because of the need to reduce heterogeneity of the studies. What kind of problem does this create in interpreting these results?

Possibility of a Type 1 error Treatment efficacy may be underestimated * External validity of the results may be limited Type II errors may still explain the positive finding * Negative trials may have been eliminated from the study 2020 Child: 121

During a Parent-Child Interaction Therapy (PCIT) session, a parent is coached to play "picnic" with their child. The child says, "Yum, ice cream!" and pretend to lick a plastic scoop of ice cream. In response, the parent says, "You think the ice cream is yummy." Which of the following PCIT child-directed interactions skills is the child's parent exhibiting?

Praise Imitation * Reflection Enjoyment Behavioral description 2021 Child: 153 PRIDE skills refer to Praise, Reflect, Imitate, Describe and Enthusiasm. These are core techniques used in Parent-Child Interaction Therapy (PCIT), a behavioral-based, family-oriented therapy designed to enhance the parent-child relationship. For the child psychiatry board examination, understanding PRIDE is crucial as it forms the foundation of PCIT. Praise refers to the positive reinforcement given to the child for their good behaviors. It encourages the child to repeat the same behavior. Reflect involves mirroring the child's speech. This shows that the parent is listening and values the child's communication. Imitate is when the parent copies the child's play. It shows the child that their actions are important and worth replicating. Describe involves the parent narrating the child's actions, which assists in language development and allows the child to understand their actions better. Lastly, Enthusiasm refers to the parent displaying genuine excitement and joy during interactions with the child. This helps build a positive emotional connection and encourages the child to engage more in the activity. Understanding and applying these PRIDE skills in PCIT can significantly improve the parent-child relationship, which is a key factor evaluated in the child psychiatry board examination. Hence, a thorough grasp of these concepts is beneficial for those preparing for the exam.

Which of the following environmental factors involving the primary caretaker are considered fundamental to the formation of a secure infant-parent attachment?

Precise feeding schedule * Frequent face-to-face interactions Avoidance of expressions of negative affect Proactive caretaking to prevent any episodes of infantile distress Availability of a soft toy for use as a comforting "transitional object" 2019 Child: 166 Research suggests that frequent face-to-face interactions by the primary caretaker can greatly influence the formation of a secure attachment in infants. Through these interactions, the infant learns to associate the caretaker with feelings of comfort, safety, and satisfaction. This is because they begin to understand that their needs will be met consistently. The caretaker's responses to the infant's cues also play a crucial role. If the caretaker is attentive and responsive, the infant is more likely to develop a secure attachment. Conversely, if the caretaker is neglectful or inconsistent, the infant may develop an insecure attachment. This highlights the importance of consistent, positive interactions in the early stages of an infant's life.

A school hires a psychiatrist to be a consultant following a student suicide. Which of the following responsibilities would most likely be handled by the psychiatrist as a consultant rather than as a psychiatrist working at the school clinically?

Prescribe medication as appropriate Direct group therapy among students Evaluate staff for grief and depression * Advise administrators on how to respond Evaluate students for grief and depression 2020 Child: 112

In which of the following situations is it most appropriate to evaluate a child with autism spectrum disorder with an electroencephalogram?

Presence of repetitive behaviors Part of routine initial assessment New onset of depressive symptoms Persistence of aggressive behaviors * New onset of developmental regression 2022 Child: 46

Which of the following is a common administrative barrier to receiving preventative mental health care?

Psychotherapy services are not reimbursed by insurance Psychiatric medication management is not considered to be medically necessary * Many insurance companies deem preventative services as not medically necessary Patients must be prescribed medication for insurance to reimburse for a medication management visit Insurance companies will not reimburse services provided by a physician if care can be provided by mid-level providers 2021 Child: 108

During a neurological exam, a patient is asked to focus on the neurologist's finger as it moves closer to the patient's eyes. What is the neurologist assessing with this exam?

Ptosis Nystagmus Lateral eye movement * Accommodation reflex Afferent pupillary defect 2021 Child: 15

Which of the following cortical regions is a core part of a cortico-striatal-thalamic loop circuit and involved in the process of assigning value to rewards?

Primary motor cortex Somatosensory cortex Posterior cingulate cortex * Medial orbitofrontal cortex Dorsomedial prefrontal cortex 2020 Child: 77 OCD has increased OCTopus activity in brain also cingulus Primary motor cortex This region is associated with the voluntary control of skeletal muscles. Key terms include motor homunculus, corticospinal tract, and motor neuron disease. Somatosensory cortex This area processes sensory input from the body. Buzzwords include sensory homunculus, thalamus, and phantom limb syndrome. Posterior cingulate cortex Involved in memory and emotional processing. Associated terms include Alzheimer's disease, episodic memory, and default mode network. **\* Medial orbitofrontal cortex** This region is associated with decision making and reward-based behavior. Key terms include addiction, impulse control disorders, and reward system. Dorsomedial prefrontal cortex Involved in high-level cognitive functions and social cognition. Associated terms include executive function, theory of mind, and schizophrenia.

The mother of a six-month old is referred to Child Protective Services (CPS) after testing positive for methamphetamine during pregnancy. She tested positive recently for the same drug, resulting in a court judgement requiring that the child be taken into CPS care due to neglect. Which of the following principles does this case best exemplify?

Privilege Police Power * Parens Patriae Dusky Formulation Fudiciary Responsibility 2021 Child: 50 Parens Patriae is Latin for "parent of the nation" and is employed by the state to protect those unable to protect themselves, such as children or disabled individuals. In the field of child psychiatry, this doctrine is of particular importance when intervention is necessary for the welfare of a child due to abuse, neglect, or a psychiatric condition. Terms related to Parens Patriae include state intervention, child protection, guardianship, and best interest of the child. These concepts emphasize the state's responsibility to safeguard those incapable of self-preservation, with child safety and wellbeing the top priority. In clinical setting, this doctrine may affect decisions regarding involuntary hospitalization or treatment, child custody disputes, and protective services involving a child. It also highlights the role of mental health professionals in reporting possible abuse or neglect and working with legal and social systems to protect the child.

According to the Consensus Guidelines developed by the American Diabetes Association and the American Psychiatric Association, which parameters should be checked at least annually in a child who is taking risperidone? (Select three)

Prolactin Amylase Liver enzymes Blood pressure Fasting lipid panel Fasting blood glucose White blood cell count Absolute neutrophil count 2022 Child: 193

What can a surviving parent do to help decrease a child's psychological risk following parental loss?

Promote physical activity * Support the mourning process Avoid talking about the deceased parent Promote cognitive understanding of death Limit child's exposure to daily life stressors 2020 Child: 191

Which of the following medications is known to worsen delirium in children?

Propofol Clonidine * Diazepam Melatonin Olanzapine 2020 Child: 38

A child with a history of sexual trauma and attention-deficit/hyperactivity disorder presents to the emergency room highly aggressive. The child is on methylphenidate. The child is ultimately placed in restraint and eventually de-escalates. Restraints are eventually removed. Which of the following is the next best step in the management of the child's care in the emergency department?

Provide trauma-informed psychotherapy Increase the child's dose of methylphenidate Add a neuroleptic to the child's medication regimen * Debrief the restraint use with the child and caregiver Place the child in seclusion briefly to allow for further de-escalation 2021 Child: 40

Which of the following is a core developmental concept proposed by Winnicott?

Psychoeducational role of the primary caregiver Family's influence in the socialization of the developing child Parent as a source of cultural assimilation in child development Primary caregiver as a regulator of expressed emotion in the family * Infant-caretaker dyad as an emotionally facilitating force in development 2020 Child: 147 ICD EFD

The grandparent of a five-year-old child complains that early morning sleep is disturbed by the child's loud play. Although the grandparent scolds the child, the behavior is getting worse. A psychiatrist advises the grandparent to praise the child frequently during quiet play, and to consistently ignore any loud play. The psychiatrist hypothesizes that the grandparent's scolding is serving which of the following functions for the child?

Punishment * Reinforcement Omission of reward Conditioned stimulus Unconditioned stimulus 2020 Child: 111

An adolescent with a history of intellectual delay and bipolar disorder presents to the emergency room after aggression with peers. While in the emergency room, the adolescent continues to be agitated, but is willing to take an oral medication to calm down. Which of the following antipsychotics is the treatment of choice for management of the patient's aggression?

Quetiapine Haloperido! Ziprasidone Aripiprazole * Risperidone 2022 Child: 11

An adolescent is referred for treatment of severe insomnia. Prior trials of multiple agents have been without benefit and the clinician is considering the use of clonazepam or zolpidem. In contrast to benzodiazepines, zolpidem minimally affects which of the following aspects of sleep architecture?

REM sleep Stage 1 sleep Stage 2 sleep * Stage 3 sleep Number of nocturnal arousals 2022 Child: 104 Alcohol USE causes: - DECREASED REM SLEEP - DECREASED SLEEP LATENCY - FRAGMENTATION OF STAGE 4 SLEEP

Asa diagnostic tool for sleep disorders, actigraphy can best discern which of the following parameters?

REM sleep Stage 4 sleep Apneic episodes * Night awakenings Gastroesophageal reflux 2022 Child: 57 Actigraphy Actigraphy is a non-invasive method of monitoring human rest/activity cycles. In child psychiatry, it's often used to track sleep patterns or to monitor the effectiveness of treatments for disorders such as ADHD. Key terms associated with actigraphy include 'circadian rhythm', 'sleep efficiency', and 'activity level'. Polysomnography Polysomnography is a comprehensive recording of the biophysiological changes that occur during sleep. It's utilized in diagnosing sleep disorders in children such as insomnia, sleep apnea, and narcolepsy. Buzzwords include 'REM sleep', 'sleep stages', and 'sleep architecture'. MSLT The Multiple Sleep Latency Test (MSLT) is a sleep disorder diagnostic tool that measures the speed at which a person falls asleep in a quiet environment during the day. It's often used in pediatric psychiatry to diagnose conditions like narcolepsy or hypersomnia. Pertinent terms associated with MSLT include 'sleep latency', 'sleep onset', and 'rapid eye movement (REM) sleep'.

Which of the following brain regions is the site of the primary circadian oscillator in humans?

Raphe nucleus Globus pallidus Dentate nucleus Inferior colliculus * Suprachiasmatic nucleus 2022 Child: 2

A divorced mother brings her 14-year-old child for an initial appointment with the psychiatrist for an evaluation of depression. After interviewing the mother and then separately the child, the psychiatrist confirms the child's diagnosis of depression and finds no evidence of suicidality, self-injurious behaviors, or concerns for safety. The child is amenable to treatment with an antidepressant. The mother reports a shared custody arrangement with the child's father, but that the father "doesn't like medications." Which of the following is the psychiatrist's best course of action?

Recommend family therapy to resolve the inter-parental dispute Hospitalize the child and start an antidepressant as emergency treatment Start an antidepressant with the mother's consent, as it is in the child's best interest * Speak with the father and attempt to obtain his consent for starting the child on an antidepressant Give a prescription for an antidepressant, but tell the mother to discuss with the father whether or not to start the medication 2022 Child: 56

An emergency room doctor consults psychiatry for an adolescent medically cleared after ingesting diphenhydramine for reportedly "wanting to go to sleep" following an argument with a friend. The patient endorses symptoms of worsening depression in the past two months along with new-onset self-injurious behavior. The patient has a history of several suicide attempts in the past six months. The parents express frustration at the adolescent for "being dramatic again" and request a discharge to follow up next week with the patient's established therapist. What is the best disposition for this patient?

Referral to family therapy Referral to an intensive outpatient program * Referral for an inpatient psychiatric admission Initiate an antidepressant and discharge to outpatient psychiatric care Attempt to move up the patient's next outpatient psychiatry appointment 2022 Child: 62

An eight-year-old boy presents with new-onset seizures associated with right-sided paresthesias, facial dyskinesias, and speech arrest. The seizures generalize during sleep. An electroencephalogram shows high-voltage spikes in the central temporal region predominantly during sleep. Which of the following is the best next step in the management of this patient?

Referral to speech therapy * Parent education and watchful waiting Rectal diazepam dosed prior to sleep onset Neuroimaging to rule out a structural abnormality Psychotherapy to address the child's somatic response to stress 2022 Child: 39

Under experimental conditions, an animal that has been given a benzodiazepine successfully responds to a fear extinction procedure. When the medication is discontinued, however, the initial fear response recurs upon exposure to the original fear-inducing stimulus. This type of learning is best described as which of the following?

Reinstatement Renewal effect State-dependent Rapid reacquisition Counter-conditioning 2022 Child: 171

Which of the following signs or symptoms discriminates a primary psychotic disorder from the psychotic-like phenomena experienced secondary to trauma?

Repetitive play Distorted beliefs Auditory hallucinations * Disorganized thought and behavior Exacerbations during times of stress 2020 Child: 108

A psychiatrist works for an institution that does not allow governmental lobbying. The psychiatrist is allowed to engage in advocacy on behalf of their profession. Which of the following would be an acceptable activity for the psychiatrist to perform in their official institutional role?

Requesting a lawmaker to support a specific bill related to mental health Staging a protest in front of lawmakers opposing a pro-mental health bill * Sharing professional knowledge in response to a question by a lawmaker Contacting colleagues to write their lawmakers to support specific legislation Requesting passage of a specific bill to fund a designated mental health program 2021 Child: 116

Which of the following is a major criticism in the development of Kohlberg's theory of stages of moral reasoning?

Research methodology relies on largely non-verbal abilities Excessive focus on the results of the decision-making process * Stages of moral reasoning may not consistently correlate with behavior Theory developed from research predominantly of female psychiatric patients Ability to move back and forth between stages differed from other development theories 2021 Child: 39

An eight-year-old child prepares a bowl of milk and cereal for breakfast and dresses. The parents praise the child for getting ready for school on-time. Which developmental construct, central to developing a sense of personal worth, is the child developing?

Resilience * Competence Conservation Socialization Mentalization 2021 Child: 95

A child with depression on venlafaxine is in remission for several years. The decision to discontinue using a slow taper results in jitteriness, sweating, diarrhea, and myalgias. What should the treating psychiatrist recommend?

Resume maintenance dose of venlafaxine Transition to venlafaxine extended release Start clonidine for discontinuation symptoms Start fluoxetine for discontinuation symptoms Start cyproheptadine for discontinuation symptoms 2022 Child: 130

Which of the following genetic syndromes is caused by a microdeletion? c.

Rett syndrome Down syndrome * Williams syndrome Huntington disease Fragile X syndrome 2019 Child: 144 • Williams syndrome is caused by the deletion of genetic material from a specific region of chromosome 7. The deleted region includes more than 25 genes, and researchers believe that a loss of several of these genes probably contributes to the characteristic features of this disorder. • Rett syndrome is caused by mutations in the MECP2 gene located on the X chromosome. This gene provides instructions for making a protein (MeCP2) that is critical for normal brain development. • Down syndrome is caused by an extra copy of chromosome 21. This additional genetic material alters the course of development and causes the characteristics associated with Down syndrome. • Huntington disease is caused by a mutation in the HTT gene. This gene provides instructions for making a protein called huntingtin. Although the function of this protein is not fully understood, it appears to play an important role in nerve cells (neurons) in the brain. • Fragile X syndrome is caused by a mutation in the FMR1 gene located on the X chromosome. This gene provides instructions for making a protein (FMRP) that plays a crucial role in nerve development. The mutation causes the gene to shut down, leading to various developmental problems.

An adolescent with insulin-dependent diabetes who is in treatment for medical non- adherence is pregnant. She wants to keep her pregnancy a secret and not inform her parents, citing the right to health care confidentiality. The physician feels obligated to inform the parents of the pregnancy. Which of the following concepts may justify the physician informing the parents of the pregnancy?

Rights of the fetus Family-centered care * Imminent danger to patient Parents must consent to care Inability to document patient is a mature minor 2020 Child: 13

A child is being treated for NMDA-receptor encephalitis. The patient is anxious and confused with waxy flexibility, minimal verbalization and staring episodes. In addition to continuing treatment of the encephalitis, which of the following medications should the psychiatrist initially recommend for this patient's motoric symptoms?

Risperidone Haloperidol * Lorazepam Clonidine Bromocriptine 2021 Child: 25s

A patient is brought to clinic for reported untriggered episodes of fear. During these occurrences, the patient complains of smelling an odor. The patient runs in a circle and becomes aggressive when confronted. This presentation is most consistent with which of the following seizure disorders?

Rolandic epilepsy * Complex partial epilepsy Lennox-Gastaut syndrome Juvenile myoclonic epilepsy Non-epileptiform paroxysmal 2021 Child: 2

Which of the following genetic tests is most useful to detect large deletions and duplications of genetic material?

Sanger sequencing Southern blot testing * Chromosomal microarray Polymerase chain reaction Next generation sequencing 2021 Child: 113

An older school-age child presents with excessive cleanliness and has been hand-washing and disinfecting furniture for hours each day. This is due to worries about getting cancer, and the child feels better after cleaning. Despite education on cancer, the child is able to comprehend the information but remains concerned that cancer could be caused by unclean objects. The remainder of the patient's physical and mental status exam is unremarkable. Which of the following is the most accurate diagnosis?

Schizophrenia Delusional disorder Illness anxiety disorder Somatic symptom disorder * Obsessive-compulsive disorder 2021 Child: 71

An eight-year-old male patient presents with seizures, intellectual disability and he was noted to have a port wine colored stained skin on one half of the face. What is the likely diagnosis?

Schwannomatosis Tuberous sclerosis Neurofibramatosis-1 Neurofibramatosis-2 * Sturge-weber syndrome 2020 Child: 129 ● Schwannomatosis: Characterized by multiple schwannomas without the presence of bilateral vestibular schwannomas. Clinical pearls include pain, neurological deficits, and possible association with meningiomas. ● Tuberous sclerosis: An autosomal dominant disorder characterized by the growth of numerous benign tumors. Clinical pearls include seizures, intellectual disability, skin abnormalities, and tubers in the brain. ● Neurofibramatosis-1: A condition marked by changes in skin coloring and the growth of tumors along nerves in the skin, brain, and other parts of the body. Clinical pearls include café-au-lait spots, freckling in the armpits or groin, and optic gliomas. ● Neurofibramatosis-2: A genetic disorder that causes noncancerous tumors to grow in the nervous system. Clinical pearls include hearing loss, balance problems, and vision complications due to schwannomas on the vestibular nerves. ● Sturge-weber syndrome: A neurological disorder indicated by a port-wine birthmark on the face, glaucoma, and neurological abnormalities. Clinical pearls include seizures, developmental delay, and weakness on one side of the body.

Which of the following is a key principle of the AACAP's Practice Parameters on gay, lesbian, bisexual orientation, gender nonconforming or gender discordant youth?

Screen all patients for sexually transmitted diseases Screen for substances of abuse prior to each clinic visit Refer patients to clinicians who are specialized in treating this population * Know the relevant community and professional resources for this population Encourage patients who are minors to refrain from disclosing their sexual orientation 2020 Child: 177

In the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study, molindone, a first-generation antipsychotic medication, conveyed a higher risk of what side effect as compared to the second-generation antipsychotic medications (olanzapine, risperidone)?

Sedation * Akathisia Arrythmia Weight gain Prolactinemia 2021 Child: 97

Gene environmental interaction increases the risk that an adolescent with AKT1 gene single nucleotide polymorphism who smokes cannabis will develop which of the following?

Seizures Addiction Psychosis Depression Hyperemesis 2022 Child: 131 Cannabis use in adolescents may increase the risk of psychosis, as it has been shown to increase dopamine release. This is concerning as dopamine signaling is a key pathway implicated in psychotic disorders, and AKT1 gene is involved in this pathway. Adolescents are particularly at risk as their brains are still developing.

The core dimensional impairments of borderline personality disorders for adolescents, as described by the Alternative DSM-5 Model for Personality Disorders, includes which of the following? (Select three)

Self-injury * Social dysfunction Excessive anxiety Cognitive inflexibility Psychotic processes Bodily preoccupations * Impairments in identity * Affective dysregulation 2021 Child: 199

A 17-year-old patient is accompanied by parents who report concern over the teen's increasing alcohol use. The striatum of this patient would most likely be responsible for which of the following elements of the adolescent's experience with alcohol?

Self-reflection on alcohol Emotionally cued reinforcement of alcohol Ataxia that develops with alcohol intoxication * Alcohol-seeking behavior and habit formation 2021 Child: 184 BUZZWORDS - Activation of neural circuits by drugs of abuse generates signals in the ventral tegmental area that lead to release of Dopamine into the NA - Functional magnetic resonance imaging studies have shown the highest level of response to anticipated rewards in the NA during ADOLESCENCE - MESOLIMBIC dopaminergic pathway includes the NA and mediates addiction and associated behaviors - is most consistently associated with the rewarding effects of drugs of abuse

A child observes as water is poured from one container into a second with a wider shape. The child states that "the second container contains more liquid because it is wider." According to Piaget, which of the following best describes the child's cognitive stage?

Sensorimotor * Preoperational Formal operational Concrete operational 2021 Child: 186 ODLA - object constancy, decentration, logic, abstraction

An immigrant youth who is rooted in their culture of origin and also has the knowledge and social skills to navigate the mainstream culture is best described as having developed which of the following?

Separation Assimilation Marginalization * Bicultural identity Negative identification 2021 Child: 139

Because of zero-order kinetics, which of the following medications at a clinically relevant dose may lead to toxicity in children?

Sertraline Bupropion * Paroxetine Duloxetine Citalopram 2019 Child: 123 Zero-order kinetics is a type of reaction rate which is independent of the concentration of the reactants. This means that the rate of reaction remains constant over time. This type of kinetics is often observed in chemical reactions where the rate-limiting step is a surface reaction, such as in catalytic reactions. It is also observed in certain biochemical reactions, particularly enzyme-catalyzed reactions when the enzyme is saturated with substrate.

Which of the following medications has the most evidence for efficacy for pediatric depression?

Sertraline * Fluoxetine Citalopram lmipramine Escitalopram 2021 Child: 166

A 15-year-old is diagnosed with severe major depression without psychotic features. Which of the following medications has the most evidence from randomized, placebo-controlled trials to support its use as a first line medication in this case?

Sertraline * Fluoxetine Venlafaxine Desipramine Escitalopram 2020 Child: 185

According to psychodynamic theory, which of the following is the main role of the therapist in play therapy?

Serve as a surrogate for the absent parent figure Enable the child to discuss feelings towards the aggressor Reduce violence by modelling appropriate gender roles and behavior * Provide a setting for the child to develop the capacity for self-observation Devise a strategy for the patient to ask for time-out when feeling frustrated 2020 Child: 7 The main role of the therapist in play therapy, as per psychodynamic theory, is to provide a safe and non-judgmental environment where children can express their thoughts and feelings through play. The therapist acts as an observer, interpreting the child's behavior and play symbols to understand their subconscious thoughts and conflicts. They then use this understanding to guide the child towards resolving these issues. It's crucial that the therapist maintains a neutral stance, allowing the child to project their feelings and experiences onto the play without interference. Providing a setting for the child to develop the capacity for self-observation is key in play therapy. This allows the child to gain insight into their own behaviors and emotions, fostering self-awareness and emotional intelligence. It encourages the child to reflect upon their actions and feelings, helping them understand why they react the way they do. Moreover, this self-observation can lead to self-regulation, enabling the child to manage their emotions and behaviors more effectively. This process can ultimately promote healthier coping mechanisms and improve their interpersonal relationships.

A child presenting with which of the following issues would be most likely to benefit from group therapy?

Severe family conflict Depression and anhedonia Impulsive and acting out behavior * Deficits in the ability to make and keep friends An abuse history that hsas not previously been disclosed 2021 Child: 20

A school age child is assessed for diurnal enuresis. One of the identified problems is the child is not taking enough breaks from playing video games to go to the bathroom. One of the psychiatrist's suggestions is that the parent have the child wash the soiled clothes following episodes of daytime enuresis. This is an example of which of the following shaping techniques?

Shaping Extinction * Overcorrection Response cost Token economy 2021 Child: 93 Shaping Shaping involves the reinforcement of successive approximations of a desired behavior. It's a key component of operant conditioning and is used to teach new behaviors by rewarding behaviors that are increasingly closer to the intended one. Key buzzwords include 'successive approximations', 'reinforcement', and 'desired behavior'. Extinction Extinction in behavioral psychology refers to the gradual weakening of a conditioned response that results in the behavior decreasing or disappearing. In child psychiatry, extinction is used as a method to decrease or eliminate unwanted behaviors. Buzzwords include 'conditioned response', 'weakening', and 'elimination of behavior'. Overcorrection Overcorrection is a behavioral principle used to reduce inappropriate behaviors. It involves having the individual correct the consequence of their inappropriate behavior and then engage in an exaggerated practice of the appropriate behavior. This is often used in child psychiatry to teach children the impact of their actions and promote positive behavioral change. Buzzwords include 'behavioral consequence', 'exaggerated practice', and 'positive behavioral change'. Response Cost Response cost is a form of negative punishment where a desired item or privilege is removed each time an undesired behavior is exhibited. This method is often used in child psychiatry as a way to decrease undesirable behaviors. Key terms associated with this concept include 'negative punishment', 'loss of privileges', and 'behavioral decrease'. Token Economy A token economy is a system of behavior modification based on the systematic reinforcement of target behavior. The reinforcers are symbols or "tokens" that can be exchanged for other reinforcers. In child psychiatry, this method is used to encourage positive behaviors and discourage negative ones. Buzzwords associated with this concept include 'systematic reinforcement', 'tokens', and 'behavior modification'.

A young woman presents to her doctor for pre-pregnancy counselling, reporting that her brother is severely affected by fragile X syndrome. She has had no problems, but worries about having a child with fragile X. Which of the following accurately describes her options for pre-pregnancy planning?

She is a carrier, and all her sons will be affected Her carrier status can be determined via karyotyping She cannot be a carrier, so she need not be concerned * Her carrier status can be determined using southern blotting Her carrier status can be determined using high-throughput sequencing 2020 Child: 99 ● Southern blotting is a molecular biology technique used to detect a specific DNA sequence in DNA samples. It involves transferring electrophoresis-separated DNA fragments to a filter membrane before detecting them with a DNA probe. This method can help to determine a woman's carrier status for the fragile X syndrome gene. If she is a carrier, this increases the likelihood of her child having the condition, although it does not guarantee it. ● Fragile X syndrome is a genetic disorder which is often inherited in an X-linked dominant pattern. This means that if a parent carries the mutation, each of their children has a 50% chance of inheriting it. The syndrome is caused by a mutation in the FMR1 gene on the X chromosome, leading to an overabundance of repeats of a particular genetic sequence. ● However, Fragile X inheritance can be complex due to 'premutation' carriers. These individuals have an increased number of repeats, but not enough to cause the syndrome. Yet, they are at risk of having children who develop the full mutation and the associated syndrome.

In _an attem~t to establish an accurate time frame for events or symptoms from school-age children, which of the following approaches is likely to be helpful?

Show them a calendar and ask them to tell you when the events occurred Avoid asking about dates as the emotional narrative is more important Be efficient and ask these questions only of the caretakers * Anchor the chronology in relation to major life events Directly ask them the days and dates 2019 Child: 77

In which of the following clinical situations would diagnostic neuroimaging be indicated?

Six-year-old reports hearing a deceased relative calling the child's name at night Seven-year-old with attention-deficit/hyperactivity disorder presents with new motor tics * Ten-year-old with autism stops performing previously acquired skills Twelve-year-old with anxiety reports intrusive sexual thoughts Sixteen-year-old hospitalized with depression describes a feeling of bodily decay 2021 Child: 160

Ina typically developing three-year-old child, which of the following skills is most likely to be observed?

Skip Hold pencil * Ride tricycle Tie shoelaces Perform somersault 2022 Child: 35

Which of the following psychiatric disorders is highly comorbid in children with Fragile X syndrome?

Social anxiety disorder Major depressive disorder Generalized anxiety disorder Avoidant personality disorder * Attention-deficit/hyperactivity disorder 2020 Child: 142

Which of the following is considered a cardinal clinical feature of fetal alcohol spectrum disorders?

Social impairment * Intellectual disability Obsessionality and rigidity Excessively friendly personality Abnormalities of the palate, heart and face 2019 Child: 169 FASDs are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. The cardinal clinical features include: Physical abnormalities : These may include distinctive facial features such as small eye openings, thin upper lip, and a smooth area between the nose and upper lip. Other physical abnormalities can include growth problems and defects in organs such as the heart or kidneys. Brain damage: This can result in issues with memory, attention, and problem-solving. It may also lead to behavioral problems, impulse control issues, and poor judgment. Cognitive impairments: Individuals with FASDs may struggle with learning, remembering, understanding, and applying information. Social and behavioral issues: These can include difficulty with social interaction, forming relationships, and understanding social cues. Behavioral problems can include impulsivity, stubbornness, and a tendency to get easily frustrated. Adaptive skill deficits : These involve difficulties with daily life skills, such as self-care, planning, and understanding time and money. Poor coordination and motor skills: This can manifest as clumsiness, difficulty with balance, and poor handwriting.

Multiple studies have found that babies reared in traditional African cultures achieve motor milestones prior to babies raised in industrialized Western cultures. Which of the following factors contributes to this phenomenon?

Social isolation * Deliberate teaching Nutritional variation Cognitive stimulation Temperamental differences 2021 Child: 64

A severely malnourished adolescent with anorexia nervosa is admitted to the hospital and started on a refeeding regimen. During the first weeks of refeeding it is essential to closely monitor which of the following levels to avoid lethal complications?

Sodium Calcium Chloride Creatinine * Phosphate 2021 Child: 136

Elevation of which of the following lab values may signal lithium toxicity? (Select three)

Sodium Calcium Potassium Creatinine Alanine Transaminase Creatinine Phosphokinase Aspartate Aminotransferase Thyroid stimulating hormone 2022 Child: 195

What type of gait abnormality might be observed in a child with muscular dystrophy?

Spastic Lurching * Waddling Scissoring Hemiplegic 2021 Child: 125 Spastic This term is associated with an abnormal increase in muscle stiffness and reflexes, typically seen in cerebral palsy. Significant buzzwords include hypertonia, clonus, and spastic paralysis. Lurching Lurching gait is often seen in individuals with neurological disorders. It is characterized by sudden, unsteady, and staggering movements. Buzzwords include ataxia, imbalance, and proprioception. Waddling Waddling gait is characterized by a side-to-side motion and is often associated with muscular dystrophy or hip dysplasia. Pertinent terms include gait instability, pelvic tilt, and Duchenne muscular dystrophy. Scissoring Scissoring is a type of gait associated with spastic cerebral palsy, characterized by legs crossing each other in a scissor-like movement. Key terms include spastic diplegia, hypertonia, and adductor spasm. Hemiplegic Hemiplegic gait is seen in individuals who have had a stroke or other brain injury affecting one side of the body. They may drag the affected foot or circle it outward and forward (circumduction). Key terms include hemiparesis, stroke, and foot drop.

A 16-year-old adolescent with anorexia nervosa is at 80% median body mass index with Stable vital signs and daily passive suicidal ideation for the past one month. The parents have been able to prevent any purging and enforce approximately 2000 kCal intake per day with strict rules that have resulted in frequent arguments. In the past week, the patient started throwing and hiding food items and has presented to the emergency room twice. The patient is afraid of gaining weight but has been complying with parental demands under threats such as denying phone use or school club participation. What level of care is appropriate for this youth and family?

Specialized outpatient Acute medical inpatient * Partial hospital program Acute psychiatric inpatient Residential treatment facility 2022 Child: 99

A school-age child with autism and attention-deficit/hyperactivity disorder is admitted to the medical floor for dehydration. For the past few weeks, the child has refused to eat except for oatmeal and macaroni and cheese. The child reports being worried about vomiting with other foods, as these foods "smell bad." The child denies body image disturbance or fear of gaining weight. Outpatient medications include guanfacine and methylphenidate. Which of the following is the most likely diagnosis?

Specific phobia Anorexia nervosa Obsessive-compulsive disorder Stimulant-induced eating disorder *Avoidant-restrictive food intake disorder 2020 Child: 67

An eight-year-old is referred to a child psychiatrist for germ phobia. The child does not like using the bathroom at school, though does so in public places with parents' encouragement. The child loves collecting action figures and lining them up, and likes to sleep with their favorite stuffed animal. Parents report that these routines take up approximately 20 minutes daily. The child is doing well academically and has friends in school and in the neighborhood. Which of the following is most likely?

Specific phobia Autism spectrum disorder Normal ritualistic behavior Generalized anxiety disorder Obsessive-compulsive disorder 2022 Child: 142

Which of the following aspects of a young child's mental status exam are most likely to reflect traits of the parent rather than the child?

Speech and language Judgment and insight * Grooming and hygiene Motor behavior and activity Attention and concentration 2020 Child: 94

A child is observed walking with small paces, a stooped posture, and reduced arm swing. When the examiner asks him to start and stop walking, the child appears to have difficulty with both actions. A lesion in which of the following brain regions is likely to contribute to this presentation?

Spinal cord * Basal ganglia Insular cortex Cerebral cortex Cerebellar cortex 2020 Child: 26 This presentation is indicative of Parkinsonian gait, commonly associated with damage to the basal ganglia, particularly the substantia nigra. This region of the brain plays a critical role in controlling voluntary movement, and its impairment can lead to the observed motor symptoms. The child's difficulty with initiating and stopping movement is a classic sign of bradykinesia, a key feature of Parkinsonism. Further neurologic examination and medical imaging may be necessary to confirm this diagnosis and rule out other possible causes. Spinal cord: Lesions in the spinal cord can result in spastic gait, characterized by a stiff, foot-dragging walk. Patients may also experience muscle weakness and difficulty with balance and coordination. Basal ganglia: Damage to this area often results in Parkinsonian gait, which is characterized by small, shuffling steps and a general lack of movement (bradykinesia). Insular cortex: While not typically associated with gait abnormalities, lesions in the insular cortex can lead to poor coordination and balance, potentially affecting gait indirectly. Cerebral cortex: Lesions in various areas of the cerebral cortex can lead to several gait abnormalities, including hemiplegic gait (one-sided paralysis), ataxic gait (uncoordinated movements), and spastic gait (stiff, foot-dragging walk). Cerebellar cortex: Damage to the cerebellar cortex can result in ataxic gait, characterized by uncoordinated, irregular movements, and difficulties with balance. Patients may also display a wide-based stance and staggering.

A child with intellectual disabilities presents to the psychiatrist's office. Which of the following neuropsychological tests should the psychiatrist recommend to best assess the child's independent living skills?

Stanford-Binet Test Differential Ability Scales Wide Range Achievement Test * Vineland Adaptive Behavior Scales Leiter International Performance Scale 2022 Child: 106

An eight-year-old presents for pharmacologic management of recently diagnosed attention- deficit/hyperactivity disorder with moderate impairment in functioning from symptoms. Family history is notable for unexplained syncope. Which of the following is the next appropriate step?

Start a stimulant medication Start a non-stimulant medication * Refer the patient to a cardiologist for electrocardiogram Obtain medical records of the patient's family members with syncope Monitor the patient in an inpatient psychiatric unit while initiating pharmacotherapy 2020 Child: 145

An adolescent complains of blurred vision in the late afternoon. Parents report that the teen's eyelids can also appear "low and droopy" at times. Abnormality in which of the following glands is commonly seen in patients with similar symptoms?

Thyroid * Thymus Pituitary Pancreas Adrenal gland 2021 Child: 49

Which of the following would be considered an essential tool for population-based disease management?

Stepped care Telemedicine * Patient registries Direct care handoffs Individual treatment plans 2020 Child: 65 Patient registries play a crucial role in population-based disease management by providing valuable data on disease prevalence, impact, and outcomes. They aid in identifying patterns and trends in disease progression, which can guide healthcare strategies and interventions. Additionally, these registries can facilitate clinical research and trials, leading to the development of new treatments and therapies. They also play a significant role in monitoring the effectiveness and safety of existing treatments, thereby contributing to improved patient care and health outcomes. Further, they assist in policy-making by providing evidence-based data.

Discussions about expressed emotion, dysfunctional communication, and problem-solving with the goals of reducing illness recurrence and rehospitalization are approaches most closely associated with which type of family therapy?

Strategic Structural Functional Behavioral * Psychoeducational 2019 Child: 113 -- Strategic Family Therapy Strategic family therapy focuses on problem-solving and communication within the family. Therapists help families develop new strategies for dealing with conflicts and improving relationships. Structural Family Therapy Structural family therapy examines the family's structure, including roles, boundaries, and patterns of interaction. The therapist works to strengthen the family system by reorganizing its structure and establishing clear boundaries. Functional Family Therapy Functional family therapy aims to identify and change dysfunctional patterns of behavior within the family. It emphasizes the importance of each family member's role in maintaining these patterns and works to establish healthier interactions among them. Behavioral Family Therapy Behavioral family therapy is based on the principles of behavior modification and seeks to change maladaptive behaviors within the family. It often involves setting specific goals and using techniques such as reinforcement, modeling, and communication skills training. Psychoeducational Family Therapy Psychoeducational family therapy focuses on providing education and information to families about mental health issues, coping strategies, and communication techniques. The goal is to increase understanding and improve the family's ability to support and manage mental health challenges. In summary, each type of family therapy has a unique focus and approach to addressing family issues: - Strategic: problem-solving and communication - Structural: family structure and boundaries - Functional: dysfunctional patterns of behavior - Behavioral: behavior modification and goal-setting - Psychoeducational: education and information on mental health and coping strategies

A facility is implementing an indicated prevention parenting program targeting families with children at risk of developing disruptive behavior. The use of which of the following has the strongest evidence of success in this type of program?

Strict discipline Psychoeducation Problem solving skills * Natural consequences Emotion regulation skills 2021 Child: 44 Natural consequences are the real-world outcomes of a child's behavior. They are an effective parenting strategy for teaching responsibility, decision-making, and problem-solving, especially for children at risk of developing disruptive behavior disorders. A longitudinal study by the American Academy of Child and Adolescent Psychiatry found that when natural consequences are used, children show a reduction in disruptive behaviors, improved problem-solving skills, and increased independence. This research emphasizes the importance of natural consequences and their potential to prevent disruptive behavior disorders.

Following an incidence of sexual trauma, an adolescent presents to the emergency room for evaluation. The adolescent performs well academically, is well-liked by peers, and has a large group of friends. The adolescent has no prior mental health or physical comorbidities, and belongs to an intact family with two supportive and responsive caregivers. Which of the following protective factors is the most robust predictor of resilient adaptation in this case?

Strong peer support * Strong parental support Strong academic performance Lack of prior mental health concerns Lack of prior physical health concerns 2021 Child: 174

A 15-month-old girl shows an increase in both curiosity about things her mother is paying attention to and reactivity to shifts in her mother's emotional tone. These behaviors are precursors of which of the following developmental outcomes?

Strong verbal skills * Capacity for empathy Inhibited temperamental style Higher-than-average intelligence Intense rivalry with mother during the Oedipal phase 2021 Child: 21

Among youth with widespread axonal injury from traumatic brain injury, which radiologic modality is emerging as the best predictor of clinical outcomes?

Transcranial Doppler (TOD) Diffusion Tensor Imaging (DTI) Magnetoencephalography (MEG) Positron Emission Tomography (PET) Single Photon Emission Computed Tomography (SPECT) 2022 Child: 151

Which of the following differentiates efficacy from effectiveness studies?

Subjects are randomized only in effectiveness studies. Only effectiveness studies are conducted with blinding. * Effectiveness studies are conducted under real world conditions. Only efficacy studies can demonstrate the efficacy of a medication. Results of efficacy studies are more generalizable than those of effectiveness studies. 2020 Child: 83

An adolescent with major depressive disorder continues to experience depressive symptoms, despite being treated with the highest recommended dose of a selective serotonin reuptake inhibitor for four weeks. Presence of which of the following supports pharmacological treatment augmentation rather than change of antidepressant?

Suicidal ideation Co-morbid somatization Mild to moderate depression * Partial response to treatment Family history of bipolar disorder 2021 Child: 29

A seven-year-old child presents to the psychiatrist for evaluation of oppositional and disruptive behaviors. Which of the following treatment interventions involves coaching by the psychiatrist through direct observation to teach the parent how to attend positively and consistently to the child as the first step to improving their relationship and the child's behavior?

Supportive psychotherapy Interpersonal psychotherapy Cognitive behavioral therapy Psychodynamic play therapy * Parent-child interaction therapy 2020 Child: 174

A study comparing two treatments for social anxiety disorder in children assigns the participants based on family preference. The lack of randomization increases the risk for which of the following biases?

Survival Selection Sampling Structural * Systematic 2022 Child: 55 Survival Bias Survival bias, also known as survivorship bias, refers to the logical error of concentrating on the people or things that made it past some selection process, while overlooking those that did not. In child psychiatry, this can lead to skewed results if studies only consider children who have survived certain conditions, ignoring those who did not. Selection Bias Selection bias in child psychiatry research can occur when the participants chosen for a study are not representative of the entire population. This can lead to inaccurate findings that do not reflect the true prevalence or impact of psychiatric conditions in children. Sampling Bias Sampling bias is a bias in which a sample is collected in such a way that some members of the intended population have a lower or higher sampling probability than others. This can occur in child psychiatry research when researchers inadvertently select a sample that is not representative of the population, such as only selecting children from certain socio-economic backgrounds or geographic locations. Structural Bias Structural bias in child psychiatry research refers to a systematic error in the research design or data collection process that favors certain results. This can manifest in various ways, including unequal access to resources, cultural bias in diagnostic criteria, or the underrepresentation of certain demographic groups in the sample. Systematic Bias Systematic bias, also known as non-random error, is a consistent, repeatable error associated with faulty measurement or flawed research design. In child psychiatry, this could be a bias in the diagnostic process, where certain symptoms are consistently over or under-diagnosed due to preconceived notions or biases. This can lead to skewed data and misrepresentation of the prevalence of certain psychiatric conditions in children. For example, if a study consistently downplays the severity of symptoms in boys compared to girls, it can lead to a systematic bias that underrepresents the prevalence of certain disorders in boys.

Which of the following is the most likely psychological explanation for school-age children's fantasies about superheroes and heroic acts?

Tactic to impress peers and become popular and a leader * Strategy to manage fears related to knowledge of world events Phenomenon due to a lack of understanding of the finality of death Attempt to deal with being unsuccessful and inadequate in real life Approach to understand how adults prioritize and understand problems 2019 Child: 111

Fora child diagnosed with somatic symptom disorder, how can the child's primary care provider most effectively contribute to the ongoing management?

Transfer care to a psychiatrist Continue io escalate further medical workup * Provide frequently scheduled follow-up visits Start the patient on an SSRI to improve physica! symptoms Complete a letter to support homebound schooling to facilitate recovery 2022 Child: 97

A six-year-old is enrolled in a clinical trial of a vitamin supplement as a possible intervention for attention-deficit/hyperactivity disorder symptoms. The parents provided informed consent at the time of enrollment, and the child assented to participation. At the mid-point study visit, the child's mother enthusiastically reports that symptoms seem to be improving. Later in the visit, the child becomes upset upon realizing that blood will have to be drawn, begins crying and says, "I want to go home." The mother replies, "You have to do this study if you want to play baseball this spring." What action should the researcher take?

Terminate the child's participation in the study Skip the blood draw, but allow the child to proceed in the study Draw the blood as scheduled, even if the child continues to protest * Explain that the child must voluntarily assent to continue in the study Draw the blood as scheduled only if the child calms down and assents 2020 Child: 182

The Positive Action Program is a school-based program that teaches self-management skills and strategies to increase the use of positive social behavior among all elementary and middle school students, without regard to specific risk factors. This program is an example of what type of preventive intervention?

Tertiary Selective Indicated * Universal Secondary 2021 Child: 159

A study is assessing whether a new medication is effective in decreasing aggression in adolescent males hospitalized in a residential facility. The sample consists of the patients in the facility who scored the highest on an aggression rating scale. This study is most likely to suffer from which of the following threats to validity?

Testing Attrition Maturation * Regression Instrumentation 2019 Child: 137 • Testing refers to the effects that the process of testing can have on participants' performance in a study. It includes factors like learning from a pre-test, which can influence post-test results. • Attrition, also known as dropout, refers to participants leaving a study before it's completed. This can skew results, as those who remain may not be representative of the initial sample. • Maturation refers to changes that occur naturally over time, irrespective of the intervention in a study. These can confound results if not properly controlled for. • Regression, or regression to the mean, is the statistical phenomenon where if a variable is extreme on its first measurement, it will tend to be closer to the average on its next measurement. This can affect the interpretation of results in a study, especially if the initial scores are extreme. • Instrumentation refers to changes in the measurement tools or procedures used in a study over time. This can introduce variability in the data and potentially lead to inaccurate conclusions. For instance, if the measurement tool becomes more accurate over the course of the study, it may appear as though there is a trend when, in fact, the perceived change is due to the improved accuracy of the tool.

Which of the following brain regions is implicated in selectively processing faces, and thought to be implicated in the neuropathology of autism spectrum disorder?

Thalamus Hippocampus Prefrontal cortex Corpus callosum * Lateral fusiform gyrus 2020 Child: 186 Thalamus: The thalamus is a large mass of gray matter located in the diencephalon of the brain. It acts as a relay station for sensory information, regulating sleep and alertness. Key terms associated with Thalamus include: relay station, consciousness, sleep, and sensory interpretation. Hippocampus: The hippocampus is a part of the limbic system and plays an essential role in the formation of new memories and spatial navigation. Clinical pearls: Memory formation, spatial recognition, and Alzheimer's disease. Prefrontal Cortex: The prefrontal cortex is part of the brain's frontal lobe and is involved in cognitive behavior, personality expression, decision making, and social behavior modulation. Pertinent terms: cognitive functions, personality, decision-making, social behavior. Corpus Callosum: The corpus callosum is the largest white matter structure in the brain. It facilitates communication between the left and right cerebral hemispheres. Significant buzzwords: interhemispheric communication, cognitive performance, split-brain. Lateral Fusiform Gyrus: The lateral fusiform gyrus, also known as the fusiform face area, is involved in facial recognition and processing. Clinical pearls: facial recognition, visual processing, prosopagnosia (face blindness).

The psychiatrist is considering using texting to communicate with several adolescent patients who prefer that method of communication. Which of the following represents an important professional standard regarding the use of texting with patients?

The American Academy of Child and Adolescent Psychiatry has firmly opposed the use of text messaging with patients. Adolescents who are employed, and pay for their own phone pian can provide the necessary consent to allow physicians to text message with them. Text messaging for scheduling purposes only is not considered clinical communication, and therefore does not fall under the purview of the Health Insurance Portability and Accountability Act (HIPAA.) * Physicians who choose to text message with patients should find a way to document and store records of the exchanges as part of the patient's medical record. Text messages are naturally encrypted, and are considered secure electronic communication, as outlined by HIPAA. 2022 Child: 93

A toddler's caregivers request a psychiatric evaluation after witnessing their child masturbate, as they believe the child is too young to engage in this behavior. Which of the following is consistent with masturbation at this stage?

Typical in females but not in males Associated with future psychopathology Requires an endocrinological evaluation * A component of normative development Requires an evaluation for sexual abuse 2021 Child: 53

Which of the following guarantees access to acute psychiatric care regardless of an individual's insurance status or ability to pay?

The Stark Law Healthcare Quality Improvement Act Children's Health Insurance Program Hospital Readmissions Reduction Program * Emergency Medical Treatment and Labor Act 2020 Child: 132 • The Stark Law, also known as the Physician Self-Referral Law, prohibits physicians from referring patients to receive certain healthcare services payable by Medicare or Medicaid from entities in which the physician or an immediate family member has a financial relationship. Buzzwords associated with this law include "self-referral", "financial relationship", and "Medicare/Medicaid services". • The Healthcare Quality Improvement Act was enacted with the goal of improving the quality of medical care nationwide. It encourages peer review of physicians and protects hospitals and their staff from legal action when they participate in peer review activities. Buzzwords include "peer review", "legal immunity", and "quality improvement". • Children's Health Insurance Program (CHIP) provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. CHIP is designed to cover uninsured children in families with incomes that are modest but too high for Medicaid eligibility. Buzzwords include "low-cost coverage", "uninsured children", and "income-based eligibility". • The Hospital Readmissions Reduction Program is a Medicare value-based purchasing program that reduces payments to hospitals with excess readmissions. The program is designed to incentivize hospitals to improve their care transition processes and reduce unnecessary readmissions. Buzzwords include "readmission reduction", "value-based purchasing", and "care transition". • The Emergency Medical Treatment and Labor Act (EMTALA) requires any emergency department to stabilize and treat anyone needing emergency healthcare treatment regardless of their insurance status or ability to pay. Buzzwords associated with EMTALA include "emergency care", "patient stabilization", and "non-discriminatory treatment".

A seven-year-old child with attention-deficit/hyperactivity disorder struggles to read and perform academically at grade level. The parents would like the child to have an Individual Education Plan (IEP) at school. The psychiatrist recommends that they write a letter requesting an IEP. Which of the following components are important to get the school to initiate an IEP evaluation for a learning disability? (Select three)

The child has impaired motor skills The child is culturally disadvantaged The child has below average intelligence The child is attending a disadvantaged school The child's primary language is other than English * Vision problems have been ruled out by a professional * The child has failed high quality interventions to learn to read * Emotional factors for inhibiting learning are ruled out by psychiatrist 2020 Child: 199 MEF - Medical/emotional conditions (which could explain problem) have been ruled out....there is functional impairment

A new study reports a five-fold increased risk of a rare side effect in a group of individuals exposed to a new medication during childhood compared to a group of individuals who were not exposed to the medication during the same period of time. What information would be most important for a psychiatrist to communicate when discussing the interpretation of this study?

The difference between sensitivity and specificity The difference between reproducibility and reliability * The difference between absolute risk and relative risk reduction The difference between a cohort study and a case control study The difference between modifiable and nonmodifiable risk factors 2020 Child: 153

The parents of an eight-year-old child decide to divorce, and the mother is awarded physical custody of the child. In addition to low parental conflict, which factor has been shown to be positively correlated to the well-being of the child post-divorce?

The financial security of the father The child's age at the time of the divorce Full custody being awarded to the mother * The post-divorce psychological adjustment of the mother Participation of the family in post-divorce education programs 2022 Child: 37

The parents of an adolescent with depression ask the psychiatrist about a recent clinical trial. The trial researchers found that a new antidepressant outperformed placebo with a p value of 0.05. How should the psychiatrist explain the meaning of the p value?

The number needed to treat for the antidepressant is 20. The magnitude of the antidepressant effect is clinically relevant. The sample size was too small to find a statistically significant difference. The researchers have 95% confidence that the antidepressant is effective. * These results would be only 5% likely if the antidepressant were not effective. 2019 Child: 139 The P value is a statistical measure that helps determine whether the results of an experiment are statistically significant. A smaller P value suggests that the results are not due to chance, thus enhancing the clinical significance of the study. The confidence interval provides a range within which the true value lies with a certain level of confidence. A narrow confidence interval indicates a higher level of precision and thus greater clinical significance. The sample size directly affects the statistical power of a study. Larger sample sizes can more accurately reflect the population, reducing the margin of error and increasing the clinical significance. The magnitude of the effect size is a measure of the strength or importance of a treatment effect. A larger magnitude of effect size indicates a more significant clinical impact . The **number needed to treat (NNT)** is a measure that indicates the number of patients that need to be treated in order to prevent one additional bad outcome. A lower NNT suggests a more effective treatment, thus increasing its clinical significance. Understanding these factors can help medical professionals make more informed decisions about the validity and relevance of a study's findings.

What criterion is most consistent with the Individual with Disabilities Educational Act in regards to public schools?

The prohibition of educational services is denied The child will receive services until 18 years of age * The school must provide a free, appropriate education in the least restrictive setting A school can place a disabled student in an alternative educational setting against parental consent 2021 Child: 183

The psychiatrist has been served with a subpoena related to a current child psychotherapy patient whose parents are divorcing and contesting custody. Which of the following is the most likely reason for the subpoena?

The psychiatrist has done something wrong related to the case. * The psychiatrist has information potentially relevant to the court case. The child has assented to the psychiatrist discussing session content. The parent with legal custody has consented to release of session content. The non-custodial parent has convinced the judge to release session information. 2019 Child: 98

Studies using functional magnetic resonance imaging (fMRI) scans have demonstrated that adults who learn another language develop a second language center in their brains. Children who learn two languages demonstrate which of the following on fMRI?

The same findings as in adults * A single language center No clear focal language center Three or more language centers Differences dependent on the languages 2019 Child: 154

Studies using functional magnetic resonance imaging (fMRI) scans have demonstrated that adults who learn another language develop a second language center in their brains. Children who learn two languages demonstrate which of the following on fMRI?

The same findings as in adults * A single language center No clear focal language center Three or more language centers Differences dependent on the languages 2022 Child: 32

Which of the following findings was observed in a 2015 meta-analysis of placebo-controlled trials examining the risk of tics associated with psychostimulant use?

The use of long acting methylphenidate was associated with an increase in tics. The use of short acting methylphenidate was associated with an increase in tics. * No association between new onset or worsening of tics and psychostimulant use. The use of long acting dextroamphetamine was associated with an increase in tics. The use of short acting dextroamphetamine was associated with an increase in tics. 2020 Child: 161

By what age can typically developing children first draw human figures that have realistic proportions?

Three years * Five years Seven years Nine years Eleven years 2020 Child: 104 At three years, children usually start to draw simple shapes and lines. They can create a basic human figure, but it's usually a "head-feet" figure, with the arms and legs attached directly to the head. At five years, children's drawings become more detailed and they start to use more colors. They can draw a basic human figure with more realistic proportions, including a body and limbs attached to it. At seven years, children's drawing skills improve further. They start to add more details to their drawings, such as clothing and facial features. They also begin to use shading and perspective. At nine years, children start to draw more complex scenes and their drawings become more realistic. They pay attention to details and their drawings often reflect their understanding of the world around them. They can portray depth and distance in their drawings, and their human figures start to interact with each other and the environment. At eleven years, children's drawings become even more sophisticated. They can draw from memory or imagination, and their drawings often tell a story. They are able to use a variety of techniques, such as cross-hatching for shading, and they have a good understanding of proportions and perspective.

An adolescent is noted to generally be pleasant and cooperative but has discrete periods of "losing all control" and becoming "really upset", irritable and highly aggressive. These episodes only last for a few minutes. The adolescent does well in school, has no other abnormal behaviors, and has had no difficulty with teachers at school. Parents are terrified by these episodes as they note the adolescent is generally "a good kid". Which of the following is the most likely diagnosis?

Tic Disorder Bipolar disorder Conduct disorder Oppositional defiant disorder * Intermittent explosive disorder 2021 Child: 130

What is the most commonly diagnosed psychiatric comorbidity in youth with epilepsy?

Tic disorder Bipolar disorder Major depressive disorder Generalized anxiety disorder * Attention-deficit/hyperactivity disorder 2022 Child: 98

During which developmental period do peer interactions first begin to take precedence over relationships within the family?

Toddlerhood Preschool period * School-age period Adolescence Early adulthood 2020 Child: 173

Children typically adopt gender-specific behavior and avoid opposite-gender behavior during which of the following developmental stages?

Toddlerhood Preschool-age * Early school-age Late school-age Adolescence 2019 Child: 132

The methyl-CpG-binding protein (Mecp2) is altered in both Rett and Fragile X syndromes. Its normal function is regulation of which of the following processes?

Translation * Transcription Histone methylation Post-translational processing Post-transcriptional regulation 2019 Child: 146 The methyl-CpG-binding protein (Mecp2) is altered in both Rett and Fragile X syndromes. Its normal function is regulation of: gene transcription through binding to methylated DNA and recruiting co-repressor proteins. Additionally, Mecp2 modulates synaptic plasticity and neuronal maturation, contributing to cognitive function. Mutations in the MECP2 gene result in abnormal brain development, leading to neurological symptoms observed in both Rett and Fragile X syndromes.

An adolescent presents to a dermatologist seeking treatment for acne, and reports wanting the most intensive treatment available. The adolescent reports feeling "deformed," and has avoided school and social outings due to this belief. The patient describes a three-hour skin care routine. On exam, the patient has two small papules with mild erythema from self- inflicted trauma. Which of the following is the most likely diagnosis given this presentation?

Trichotillomania Excoriation disorder Illness anxiety disorder * Body dysmorphic disorder Obsessive-compulsive disorder 2020 Child: 118

A 15-year-old patient is referred by a dermatologist for psychiatric evaluation due to sores on the patient's face that have been worsening since he was about 13 years old. The patient says that he picks his facial skin and tries to pluck out the facial hairs several times daily while looking in a mirror he carries with him, asserting that he will look "deformed" and "everyone will see how disgusting" his face is if he does not. Aside from the sores, the appearance of the patient's face is unremarkable. Which of the following is the most likely DSM diagnosis?

Trichotillomania Excoriation disorder * Body dysmorphic disorder Obsessive-compulsive disorder Delusional disorder, somatic type 2021 Child: 127

When a five-year child presents with behavioral problems at school, which of the following elements of the history and exam should prompt a physician to order an EEG as part of the assessment? (Select three)

Trouble focusing * Family history of seizures Difficulty with tandem walking * New onset daytime incontinence Difficulty with sustained hopping on one foot * Twitching movements of face while sleeping Difficulty with rapid alternating hand movements History of constipation and overflow incontinence 2021 Child: 198

A sixth-grader is being bullied at school for not being athletic. The child comes from a family where other siblings are known for being gifted athletically. The coach and the child's parents frequently remind the child of how his athletic abilities are not at par with peers and siblings. With which Ericksonian stage is this child likely struggling?

Trust vs. Mistrust Initiative vs. Guilt * Industry vs. Inferiority Identity vs. Role confusion Autonomy vs. Shame and doubt 2021 Child: 62

Most substance abuse prevention programs are based on data gleaned from which of the following?

Twin studies Genetic research Attachment theory Psychodynamic principles * Social learning paradigms 2021 Child: 78 Social learning paradigms suggest that individuals take cues from influential figures (e.g., parents, peers) when it comes to adopting behaviors—both positive and negative, like substance use and abuse. Prevention strategies often work to promote positive behaviors by targeting these people, as well as encouraging open dialogue and setting clear expectations. When studying for the child psychiatry board exam, it's vital to understand social learning in the context of substance abuse prevention: mechanisms of observational learning, influential figures, and different prevention strategies. Know how to apply these concepts in clinical practice, like communicating with children and families about substance use, and recognize risk factors that raise one's vulnerability to substance abuse (e.g., environmental, genetic, psychological).

At what age can a typically developing child first be expected to ride a tricycle?

Two years of age * Three years of age Four years of age Five years of age Six years of age 2020 Child: 31

Which of the following factors has been shown to directly predict both retention and outcome for patients in psychotherapy?

Use of a medication Therapeutic modality Experience of the clinician * Quality of therapeutic alliance Signed patient-physician contract 2021 Child: 135

A 16-year-old has a diagnosis of migraine headache and major depressive disorder. Which of the following medications for migraine prophylaxis can worsen depression and should be used with caution?

Valproate Verapamil Topiramate * Propranolol Amitriptyline 2020 Child: 128

A large prospective clinical study performed at the Danish National Tourette Center Clinic examining the course of Tourette Syndrome and comorbidities found that the severity of which of the following parameters worsened with age?

Vocal tics Motor tics Obsessions Hyperactivity * Sleep disturbance 2022 Child: 40

Which of the following represents the primary benefit in a clinical trial of a randomized controlled crossover design over a parallel design?

Wash-out periods are not required * Subjects serve as their own controls There is less likelihood of carry-over effects Asymmetrical transfer effects are minimized It requires larger subject numbers, which increases the power 2021 Child: 101

As part of the evaluation process in residency, which of the following would be considered an example of both formative and summative assessment?

Weekly supervision Mid-rotation feedback Annual clinical skills assessment * Clinical Skills Verification assessments Child Psychiatry Resident-In-Training Examination 2020 Child: 97 ● Formative and summative assessments are two key components of the evaluation process in a medical residency program. ● A formative assessment is an ongoing process that involves regular feedback and learning opportunities. It's designed to help residents identify their strengths and weaknesses, and to guide their learning throughout the residency. It often includes activities such as case presentations, direct observation, and feedback sessions. ● On the other hand, a summative assessment is a comprehensive evaluation conducted at the end of a learning period. It measures the resident's competency in various areas and determines whether they have met the program's learning objectives. This could involve written exams, oral assessments, or performance evaluations.

A previously healthy school-age child develops jerking movements of the arms and legs that often progress to whole body, rhythmic convulsions. The symptoms occur predominantly in the morning, and the child has an uncle who had similar symptoms in adolescence. Workup is unremarkable except for an EEG demonstrating polyspike discharges. Which of the following is the most likely diagnosis for this patient?

West Syndrome * Juvenile Myoclonic Epilepsy Childhood Absence Epilepsy Early Myoclonic Encephalopathy Benign Focal Epilepsy of Childhood 2022 Child: 13

A five-year-old entering first grade at a new school will most likely choose peers based on which of the following criteria, as compared to an older school-aged child?

Whether the peer is smart How nice the peer is to them The peer's physical appearance What kind of clothes the peer wears How good the peer is at playing games 2020 Child: 78

A brain-imaging research project is being proposed that will recruit children with childhood-onset obsessive-compulsive disorder (OCD.) Individual participants are not expected to benefit from the study. Which of the following will be a critical ethical consideration by the Institutional Review Board?

Whether the study also includes children without OCD for comparison The degree of functional impairment experienced by each participant * Whether the study involves only a minor increase over minimal risk The availability of community-based treatment resources for follow-up care The amount of compensation being offered to families for their participation 2019 Child: 171 what are critical ethical considerations made by the Institutional Review Board when evaluating research project proposals? The Institutional Review Board (IRB) primarily considers the potential risk to participants. They ensure that the benefits outweigh the risks, that the selection of participants is fair, and that informed consent is obtained. Additionally, they ensure privacy and confidentiality of participants is maintained. The IRB also ensures the research is conducted in an ethical manner and follows all applicable laws and regulations. how does the potential size of the benefit vs risk of the proposal influence their consideration? The potential size of the benefit versus the risk of the proposal significantly influences the IRB's consideration. If the potential benefits are substantial and the risks are minimal, the proposal is more likely to be approved. Conversely, if the risks are high and the benefits are low, the proposal may be rejected. The IRB carefully weighs these aspects to ensure that the research justifies any potential harm or discomfort to the participants. It is essential for the researchers to provide a detailed risk-benefit analysis, highlighting the potential gains for science, society, or the individual participants, against the possible harm or discomfort. This comprehensive evaluation helps the IRB make a fair and ethical decision.

Which of the following laboratory tests should be obtained in an adolescent who has been taking aripiprazole for three months and does not endorse having any side effects to the medication?

White blood cell count Early morning prolactin * Fasting total cholesterol Alanine aminotransferase Thyroid-stimulating hormone 2020 Child: 141

A child with attention-deficit/hyperactivity disorder presents with an optic glioma, axillary freckling, and cafe-au-lait macules. What is the most likely co-morbid diagnosis?

Williams syndrome Fragile X syndrome * Neurofibromatosis type 1 McCune-Albright syndrome Tuberous sclerosis complex 2021 Child: 58 * Williams Syndrome: Characterized by cardiovascular disease (specifically supravalvular aortic stenosis), developmental delays, and learning challenges. However, individuals are often highly social, friendly, and endearingly empathetic. Buzzwords include "elfin facies" and "cocktail party personality". * Fragile X Syndrome: The most common inherited cause of intellectual disability and autism. Symptoms often include learning disabilities, cognitive impairment, and particular physical characteristics such as long face, large ears, and macroorchidism. FMR1 gene mutation is a significant buzzword. * Neurofibromatosis Type 1: A genetic disorder causing skin abnormalities and nerve tumors (neurofibromas). Symptoms include café-au-lait spots, freckling in the armpit or groin, and Lisch nodules in the eye. The NF1 gene mutation is a key buzzword. FALCON B \* McCune-Albright Syndrome: A complex genetic disorder affecting the bones, skin, and endocrine tissues. It causes fibrous dysplasia, café-au-lait spots, and precocious puberty. GNAS gene mutation is a significant buzzword. \* Tuberous Sclerosis Complex: A genetic disease causing non-cancerous tumors to grow in the brain and other vital organs. Symptoms include seizures, developmental delay, and skin abnormalities. TSC1 and TSC2 gene mutations are pertinent buzzwords.

In Caspi's seminal study on genetic and environmental risk factors for depression, which of the following was the environmental risk factor required for a significantly increased risk of adult depression in an individual who had two copies of the short allele (s/s homozygotes) of the 5-HTT promoter polymorphism?

Winter birth date * Stressful childhood event Prenatal maternal infection Intrauterine illicit drug exposure Early exposure to polycarbonates 2019 Child: 119 Caspi et al. studied 847 people born in 1972-1973 in New Zealand. The study focused on their environmental exposure to stressors and 5-HTT promoter polymorphism, which is the difference between the short (s) and long (l) alleles. It found that those with s/s genotype who had experienced a childhood stressor were more likely to have depression in adulthood than those with s/l or l/l genotypes under the same stressors. This shows that susceptibility to depression is not just based on genetics, but also on environmental factors. Further, for those with the s/s genotype, multiple stressors in childhood increased the risk of depression. These results suggest that early intervention and support for children facing trauma, especially those with genetic predisposition, is important. Caspi's study showed the complicated interplay of genetics and environmental factors, and since then, studies have looked into other genetic factors and environmental stressors regarding mental health. This has implications for prevention and treatment, showing the need to consider both of these elements. Therefore, support should be aimed at individuals with genetic risk factors and at reducing environmental stressors. This comprehensive approach can help those at heightened risk for depression improve their mental health and well-being.

When a 15-year-old is asked about school during an interview, the patient says, "My friends keep me company by describing all the things I do when I'm in class. I really hope they serve pizza for lunch in the cafeteria today. I'm going to the movies with my family this weekend." Which of the following would best describe the patient's thought process?

Word salad Perseveration Circumstantiality * Loose associations Linear and goal-directed 2020 Child: 137 Word salad: This refers to a confused or unintelligible mixture of seemingly random words and phrases, often seen in severe cases of schizophrenia. Key buzzwords include "disorganized speech" and "incoherent". Perseveration: This is the repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus. It's usually a symptom of frontal lobe lesions or psychiatric disorders like autism. Clinical pearls include "repetitive behavior" and "obsessive tendencies". Circumstantiality: This is a communication disorder in which the focus of a conversation drifts, but often comes back to the point. It's common in conditions like schizophrenia and autism. Key buzzwords include "prolixity" and "tangential speech". Loose associations : This refers to a thought disorder characterized by shifts from one topic to another that are unrelated or only obliquely related, creating a lack of clear narrative or logical progression. It's often seen in schizophrenia. Pertinent conclusions include "disorganized thinking" and "illogical connections". Linear and goal-directed: This refers to a style of thinking and communication that is logical, orderly, and focused on achieving a specific outcome or goal. It's the opposite of disorders like word salad and loose associations. Significant buzzwords include "coherent" and "rational".

In the Treatment of Early Age Mania study, the effectiveness of risperidone in participants was influenced by comorbid attention-deficit/hyperactivity disorder (ADHD). In describing the statistical relationship of ADHD to effectiveness of risperidone, ADHD is:

a co-variate. * a moderator. a confounder. a dependent variable. an independent variable. 2021 Child: 131 A co-variate is a variable that influences both the dependent and independent variables, causing a spurious association. It's crucial in statistical modeling and analysis to adjust for co-variates and avoid biased results. Key terms include "control", "adjustment", and "statistical correction". A moderator is a variable that affects the strength or direction of the relationship between the dependent and independent variables. It answers the question "for whom" or "under what conditions" a certain effect occurs. Clinical pearls include "interaction effect", "conditional effect", and "subgroup analysis". A confounder is a variable that is correlated with both the dependent and independent variables and can lead to a false association if not properly controlled. It can distort the perceived relationship between the study variables if not addressed. Relevant buzzwords include "spurious correlation", "bias", and "stratification". A dependent variable is the outcome that researchers are interested in explaining or predicting. It's the variable that is influenced by the independent variable(s). Key terms include "outcome variable", "response variable", and "predicted variable". An independent variable is the variable that is presumed to influence or determine the dependent variable. It's the factor that the researchers manipulate to observe its effect on the dependent variable. Important terms associated with this concept are "predictor", "explanatory variable", and "manipulated variable".

In the Treatment of Early-Onset Schizophrenia Spectrum Study, in addition to lack of efficacy, the majority of the participants taking antipsychotic medications dropped out of the study due to:

akathisia. * weight gain. hyperprolactinemia. metabolic syndrome. extrapyramidal symptoms. 2020 Child: 75 The TEOSS study revealed risperidone and olanzapine were more effective than molindone in reducing symptoms of schizophrenia in children and adolescents. Molindone had fewer side effects, particularly in terms of weight gain and metabolic issues. It was found that the effectiveness was not dependent on the severity of symptoms and there was no significant difference in the effectiveness of the three drugs in treating negative symptoms. Long-term effects of these medications were also observed with a decrease in effectiveness over time. Additionally, notable side effects, such as weight gain and metabolic changes, were noted with risperidone and olanzapine, indicating the need for monitoring. This study underscores the need for comprehensive care for children and adolescents with early-onset schizophrenia, including medication, psychotherapeutic interventions, family support, and educational assistance.

An adolescent is found unconscious in the school bathroom. The student has a perioral rash and perinasal dermatitis. A plastic bag is found on the floor next to the adolescent's backpack. A search of the backpack is most likely to reveal:

alcohol. cannabis. cough syrup. an e-cigarette. * an aerosol can. 2020 Child: 5

Both a 504 plan and an individualized education program (IEP) can protect the rights of children with disabilities, but an important difference is that:

an IEP protects parental rights. only an IEP can address behavioral problems. * federal funds support the development of an IEP. the 504 plan is only a state-mandated intervention. a 504 plan requires children be placed in an inclusion classroom. 2021 Child: 89

A five-year-old child is observed to serve toy food onto the parent's miniature plastic plate, then hands the serving dish to the parent and says, "Now you feed me!" This is an example of:

animism. egocentrism. paraliel play. * cooperative play. dual representation. 2022 Child: 47

The neurodevelopmental process that involves strengthening of temporally correlated cortical connections as well as weakening of non-correlated cortical connections is best known as:

apoptosis. neurogenesis. cell proliferation. * synaptic plasticity. cell differentiation. 2021 Child: 172

Anticholinergic agents prescribed to prevent extrapyramidal side effects of antipsychotic medications should be gradually tapered after stabilization of the patient primarily in order to:

avoid chronic suppression of acetylcholine. avoid the risk for anticholinergic psychosis. reduce potentiation of long-term GI side effects. * decrease the cognitive burden from anticholinergics. lower the potential for increased weight gain in the long term. 2020 Child: 107

A clinician is consulted to see a school-age child for emotional outbursts. The child has a labile affect that is incongruent with speech content, and the clinician notes that the child's speech exhibits variable rhythm and intensity with periods of "explosive" speech. The child is otherwise attentive on interview. On neurologic assessment, the clinician notes that the child has a brisk gag reflex with subsequent intense crying and coughing. The child is also endorsing recent onset dysphagia although evaluation of the oropharynx is negative for pathology. Based on this assessment, the psychiatric symptoms are most likely related to:

bulbar palsy. multiple sclerosis. myasthenia gravis. * pseudobulbar palsy. conversion disorder. 2020 Child: 37 • Pseudobulbar palsy is a medical condition characterized by the inability to control the muscles involved in speech and swallowing. It's a form of paralysis that affects the areas of the brain responsible for these functions. The condition is typically caused by damage to the motor neurons in the brainstem. • In this case, the child's emotional outbursts, labile affect, and irregular speech rhythm and intensity, along with the "explosive" speech, are likely manifestations of pseudobulbar affect, a common symptom of pseudobulbar palsy. This symptom involves sudden, uncontrollable episodes of crying, laughing, or other emotional displays that are exaggerated or not connected to the individual's emotional state. • The child's brisk gag reflex with intense crying and coughing, as well as the recent onset of dysphagia (difficulty swallowing), further support this diagnosis. These symptoms reflect the impairment in controlling the muscles of the throat and mouth, which are essential for swallowing and speech. Despite an absence of pathology in the oropharynx, these symptoms suggest a neurological issue at the level of the brainstem, where the motor neurons controlling these functions are located. • Pseudobulbar palsy can occur due to various underlying conditions such as stroke, brain injury, or neurodegenerative diseases. The treatment primarily focuses on managing symptoms and improving the quality of life. Speech and swallowing therapy can help manage the communication and eating difficulties. Medications may also be used to control emotional outbursts and other behavioral symptoms. In severe cases, surgical interventions or the use of feeding tubes may be necessary to ensure proper nutrition and prevent choking or aspiration.

A child recently diagnosed with autism spectrum disorder is referred for chromosomal microarray analysis testing. This test assesses for:

changes in the number of chromosomes. changes in the structure of chromosomes. the presence or absence of specific genes. * deletions or duplications of sections of DNA. the presence and location of sections of mRNA. 2019 Child: 109 The core principle behind microarrays is hybridization between two DNA strands, the property of complementary nucleic acid sequences to specifically pair with each other by forming hydrogen bonds between complementary nucleotide base pairs. A high number of complementary base pairs in a nucleotide sequence means tighter non-covalent bonding between the two strands. After washing off non-specific bonding sequences, only strongly paired strands will remain hybridized. Fluorescently labeled target sequences that bind to a probe sequence generate a signal that depends on the hybridization conditions (such as temperature), and washing after hybridization. Total strength of the signal, from a spot (feature), depends upon the amount of target sample binding to the probes present on that spot. Microarrays use relative quantitation in which the intensity of a feature is compared to the intensity of the same feature under a different condition, and the identity of the feature is known by its position.

After a student from the local high school commits suicide, the school psychiatrist is asked to make recommendations for a program to prevent suicidality. This type of intervention is called:

crisis intervention. case management. * systems consultation. direct case consultation. indirect case consultation. 2020 Child: 179

The use of endophenotypes identified in familial aggregate studies of child onset schizophrenia is useful because it is a method capable of identifying:

de novo mutations. copy number variants. chromosomal translocations. single polynucleotide polymorphisms. * pathways resulting in illness from at-risk genes. 2021 Child: 67 PRIAR-G

The definition of child maltreatment used by a psychiatrist when reporting abuse must be:

defined in the AACAP practice parameter. * determined by the state where the child resides. based on the clinical judgment of the evaluating physician. specified under the Federal Child Abuse Prevention and Treatment Act. based on the policy written by the medical system which employs the physician. 2021 Child: 77

A 15-year-old biracial adolescent expresses feelings of alienation from peers and family members stating, "I don't fit in anywhere!" The therapist can best support healthy identity formation in this teen by:

encouraging the adolescent to adopt a multiethnic cultural identity. encouraging the adolescent to primarily identify with the culture of the same-sex parent. reflecting to the adolescent that these feelings are a natural part of development and will pass. requiring a family session so that the adolescent can receive guidance from both parents in a safe and therapeutic setting. * emphasizing that developing a cultural identity is a personal choice that can be made and remade over time. 2021 Child: 16

Acchild and adolescent psychiatrist is asked to evaluate a transgender teen for the adolescent's ability to provide informed consent for gender affirming interventions that have potentially irreversible consequences, such as infertility. The adolescent currently denies any concern about these long-term effects and is able to describe details about the treatment and why being in treatment is important. The parents are very concerned about the potential loss of the adolescent's ability to have biological children. The most important aspect of the informed consent process for the psychiatrist to assess is the adolescent's ability to:

express a choice and preference. articulate the parents' perspective. understand the presented information. * appreciate potential future ramifications. discuss the impact of treatment on others. 2022 Child: 81

A three-year-old in preschool is most likely to identify a classmate as a "friend" based upon the other child's:

gender. ethnicity. physical appearance. * similarity of play interests. status within the larger peer group. 2022 Child: 84

The mechanism of action of lamotrigine is best described as inhibition of:

glial calcium channel influx. glial steroidogenesis and alpha 2 receptors. * 5HT3 and release of aspartate and glutamate. catabolic enzymes of GABA and protein kinase C signaling. phosphatidylinositol and protein kinase C signaling pathways. 2019 Child: 135 • Lamotrigine primarily works by inhibiting voltage-sensitive sodium channels, which results in the stabilization of neuronal membranes. This inhibition prevents the release of excessive glutamate and aspartate, two neurotransmitters involved in the excitation of neurons. • In addition, lamotrigine also inhibits the 5HT3 (serotonin) receptors. Serotonin is generally involved in the regulation of mood, appetite, and sleep. By inhibiting the 5HT3 receptors, the drug can potentially influence these functions. • Overall, by mitigating the over-excitation of neurons and influencing neurotransmitter activity, lamotrigine helps to control and prevent seizures and mood episodes in various neurological and psychiatric disorders.

A psychiatrist evaluating a four-year-old pre-schooler asks the child about his skills and abilities. The child responds indiscriminately, positively rating himself as the "best" at everything. This response at his age is most consistent with:

grandiosity and mania * normative development guardedness towards interviewer pathologic deficit in mentalization compensated narcissistic vulnerability 2021 Child: 87

Research shows that the one commonality among mass school shooters is that offenders commonly:

had symptoms of conduct disorder. * told others of their plans but weren't taken seriously. displayed behaviors of self-injury before the incident. acted out violently towards peers prior to the incident. had a primary diagnosis of major depressive disorder. 2021 Child: 28

Construct validity is best defined as the degree to which a measure:

has a clinical impact. is influenced by other variables. * tests what it purports to measure. accurately predicts a future criterion. is comparable to a measure of a related criterion. 2020 Child: 82

According to the Education for All Handicapped Children Act (PL 94-142) and its successor acts (now called the Individuals with Disabilities Education Improvement Act), all children regardless of handicap must be provided with an education that:

is minimal in cost. maximizes the potential of each child. * occurs in a least restrictive context. provides appropriate services as available. is reviewed every two years. 2019 Child: 172 According to the Education for All Handicapped Children Act (PL 94-142) and its successor acts (now called the Individuals with Disabilities Education Improvement Act), all children regardless of handicap must be provided with an education that meets their unique needs and prepares them for further education, employment, and independent living. This is achieved by formulating an Individualized Education Program (IEP) for each child, which is designed with their specific requirements in mind. Special education services must be tailored to the child's individual needs rather than fitting the child into an existing program. Furthermore, these services should be delivered in the least restrictive environment possible, promoting inclusion and interaction with non-disabled peers.

Diffusion tensor imaging may be useful in studying neurodevelopmental disorders such as schizophrenia because it provides information about:

normal and abnormal cerebellar functioning. glucose metabolism in cortical structures. rates of apoptosis in the prefrontal cortex. * the orientation and integrity of white matter tracts. the cytoarchitecture of deep nuclei. 2020 Child: 158

A three-year-old child is looking at a book by himself. He insists that his mother can see the pictures despite the fact that the mother is in a different room. This is an example of:

object permanence. * egocentrism. circular reaction. centering. assumptive reality. 2019 Child: 170 • Object permanence refers to the understanding that objects continue to exist even when they cannot be seen, heard, or otherwise sensed. This is a fundamental concept in the field of cognitive development. • Egocentrism, in psychology, refers to the inability to differentiate between self and other. More specifically, it is the inability to accurately assume or understand any perspective other than one's own. • Circular reaction is a repetitive action that achieves a desired result. In human development, it's a behavior observed in infants as they start to learn and explore their environment. • Centering, in the context of cognitive development, refers to the tendency of children to focus on one aspect of a situation while ignoring others. This often leads to errors in logic and reasoning. • Assumptive reality refers to a person's acceptance of a certain reality based on their own assumptions or beliefs, regardless of whether these assumptions are valid. In terms of human development, it can play a significant role in a person's understanding and perception of the world around them.

A three-year-old child is looking at a book by himself. He insists that his mother can see the pictures despite the fact that the mother is in a different room. This is an example of:

object permanence. * egocentrism. circular reaction. centering. assumptive reality. 2022 Child: 8

An adolescent presents with increased episodes of mood !ability, dysregulated sleep, impulsivity and risk-taking behaviors. The patient, who is otherwise physically healthy, has a paternal uncle with Bipolar I disorder and several cousins with attention-deficit/hyperactivity disorder (ADHD). The patient was previously diagnosed with ADHD by their primary care provider. A diagnosis of bipolar disorder in this patient is most likely if the symptoms:

occur predominantly at home. worsen progressively over time. appear before eight years of age. * fluctuate with episodic mood changes. result consistently in periods of impulsive aggression. 2020 Child: 187

Time away from enjoyable activities or parental attention, also known as "time out," relies on removal of:

punishment. token economy. aversive stimulus. * positive reinforcement. negative reinforcement. 2022 Child: 105

According to the theories of Russian psychologist Lev Vygotsky, children learn best when:

reinforcers of attention and effort are potent. affective connections exist with their teacher. environments are simplified to limit distraction. * skills taught are just beyond their current level. caregivers are accessible and co-learners of the skills. 2019 Child: 187 Vygotsky proposed the sociocultural theory of cognitive development, emphasizing the role of culture and social interaction. He believed that children learn through guided interactions with adults and peers, a concept known as the Zone of Proximal Development (ZPD). This is the difference between what a child can achieve independently and what they can achieve with guidance. Furthermore, Vygotsky highlighted the importance of language in cognitive development, viewing it as a tool for thought and interaction. He also introduced the concept of internalization, where social activities evolve into internal cognitive processes.

A 15-year-old patient with major depressive disorder has recently attempted suicide. The psychiatrist has recommended psychotherapy and an antidepressant. Both the parents and the patient are ambivalent about the use of antidepressant medication. The psychiatrist's best approach would be to:

report the family to child protective services for medical neglect. call the patient's school and ask them to administer the medication in that setting. advise the parents that without treatment, their child is at high risk to commit suicide. * explore the beliefs that the patient and parents have about the recommended medication. refuse to see the patient unless the parents guarantee compliance with the treatment recommendations. 2020 Child: 189

An eight-year-old child is reportedly "spacey" and does not follow teachers' directions in the third-grade classroom. The child seems to respond to requests but not always in an appropriate manner. However, written homework is usually completed properly, and the child is not disorganized, forgetful, impulsive or hyperactive. Sensory evaluations are normal. The best diagnosis is:

selective mutism. * auditory processing disorder. phonological speech disorder. intellectual disability. attention-deficit/hyperactivity disorder. 2020 Child: 21 • Symptoms of Auditory Processing Disorder (APD) include having difficulty understanding speech in noisy environments, following spoken directions, distinguishing between similar sounds, learning songs or rhymes, remembering spoken information, paying attention for long periods, or having issues with reading and spelling. Additionally, they may have trouble with musical ability and appreciation, frequently requiring repetition or clarification, or difficulty understanding the concept of time. • Selective mutism is characterized by a consistent failure to speak in specific social situations where there is an expectation for speaking, despite speaking in other situations. Unlike APD, it is not associated with a difficulty in understanding speech in noisy environments or struggles with musical ability. • Phonological speech disorder involves difficulty in understanding and creating sounds appropriate for speech. The symptoms are more focused on producing speech sounds rather than understanding or interpreting them, which makes it different from APD. • Intellectual disability, formerly known as mental retardation, features below-average intelligence or mental ability and a lack of skills necessary for day-to-day living. The symptoms are broader and affect overall cognitive function, not just auditory processing. • Attention-deficit hyperactivity disorder (ADHD) is characterized by problems with paying attention, impulsive behavior, and excessive activity. While there might be some overlap with APD, especially in terms of attention difficulties, ADHD does not typically involve problems with understanding speech or differentiating similar sounds

An adolescent is having difficulty making friends, struggles with initiating conversations, exhibits poor eye contact, and has difficulty understanding social cues. The adolescent becomes easily upset with unexpected transitions and is very "rules focused." The patient prefers to be alone and spends considerable time reading about and discussing the solar system. The most likely diagnosis is:

social anxiety disorder. * autism spectrum disorder. obsessive-compulsive disorder. attention-deficit/hyperactivity disorder. social (pragmatic) communication disorder. 2020 Child: 117

In the mental status assessment, a unique component to evaluating infants may include observation for:

speech. hyperactivity. affect regulation. * feeding behaviors. dysmorphic features. 2020 Child: 14

A psychiatrist is conducting an initial interview for medication management with a 16-year-old patient and the patient's parent. The parent answers questions for the patient throughout most of the interview. Eventually, the patient stops answering questions and refuses to further participate in the interview. At this point the best course of action is for the psychiatrist to:

suggest the patient begin participating in the interview. ask the patient to leave the room, and continue interviewing the parent. * ask the parent to leave the room, and continue interviewing the patient. continue with the interview to further observe the dynamics between the patient and parent. ask if the patient would like the parent to leave the room for the remainder of the interview. 2020 Child: 170

Diagnosing seizures in individuals with intellectual disability can be more challenging than in typically developing children because youth with intellectual disability:

tend to develop seizure disorders later. are less likely to have seizure disorders. tend to have less severe types of seizures. have fewer environmental precipitating factors. * have more repetitive and stereotyped behaviors at baseline. 2021 Child: 110

Adolescents have more risk-taking behaviors, sensation seeking and increased emotional reactivity, because the last brain structure to develop is the:

thalamus. amygdala. cerebellum. hippocampus. * prefrontal cortex. 2020 Child: 50 • The thalamus starts to develop around week 6 of gestation and continues to mature until early childhood. • The amygdala, involved in emotional processing, begins to form prenatally around the 8th week of gestation, but continues to mature into adolescence. • The cerebellum starts its development in the first trimester but continues to grow and mature well into the first year of life. • The hippocampus, central to learning and memory, starts developing in the late gestational period, but its maturation extends into the early twenties. • The prefrontal cortex, responsible for complex cognitive behavior and decision making, starts to develop early but is one of the last areas of the brain to mature, usually in the mid to late twenties. This area of the brain is crucial for higher-order thinking, impulse control, and evaluating consequences of actions. Its prolonged development period underpins the significant cognitive and behavioral changes observed during adolescence and early adulthood.

A parent brings an adolescent to an initial evaluation with an outpatient psychiatrist. The parent tells the psychiatrist that the adolescent may have sexually abused another child, and "obviously needs help," and that an attorney has already been hired. In discussing confidentiality, the psychiatrist is most likely to have an obligation to report information obtained in the evaluation to:

the court/judge. * child protective services. the child victim and/or their family. the attorney hired on behalf of the adolescent. the attorney hired on behalf of the alleged child victim. 2020 Child: 166

In psychiatric billing, current procedural terminology codes refer to the:

time required to perform the service. insurance to be billed for the service. diagnosis for which services are being billed. specific service delivered in a treatment session. level of training of the clinician performing the service. 2020 Child: 18 CPT (Current Procedural Terminology) codes are used by medical professionals to categorize and bill for services provided. For psychiatric appointments, specific CPT codes are utilized to represent different types of mental health services. These can range from individual psychotherapy (90832, 90834, 90837), to psychiatric diagnostic evaluation (90791), to group psychotherapy (90853). Each code corresponds to a specific service, and the healthcare provider submits these codes to insurance companies for reimbursement. The use of accurate CPT codes is crucial for appropriate billing and compensation.

The significant increase in processing speed in children between 6-12 years of age is most likely correlated with developmental change in:

total brain volume. noradrenergic-dependent brain systems. * cortical synaptic pruning and myelination. morphologic modification of thalamic brain structures. functional efficiency of the hippocampus and amygdala. 2021 Child: 26

Secondary enuresis differs from primary enuresis in which of the following ways?

ts equally likely to occur in both genders Has a better response to psychopharmacology Has a worse response to behavioral interventions * Is more highly associated with comorbid psychiatric disorders Has a higher probability of a structural abnormality as the etiology 2022 Child: 29

When performing a pain assessment in a two-year-old who is terminally ill with cancer, the highest level of detail that is reasonable to expect the child to:

verbalize the intensity of pain. respond to a ten-point analog scale. describe the changes in pain severity. utilize a face-based pain severity scale. * identify the presence and location of pain. 2019 Child: 188

If a child is determined by the special education committee to need services and requires an individualized education plan, which of the following must be adhered to?

• * The plan has to be developed within 30 calendar days • An evaluation is required every five years to determine continued eligibility • A comprehensive review must be conducted and revised every two years • The child can be mandated to change settings against the parent's will • The most restrictive setting should be tried first in order to maximize success 2020 Child: 39

A 17-year-old patient with a diagnosis of bipolar disorder reports experiencing "fast" thoughts and high energy over the past week despite sleeping four hours nightly. The patient says her mood has been "really good" most of the time but admits to becoming irritable with her friends and boyfriend. She has been spending extra time on her schoolwork and is doing well academically. She was recently sent to the principal for being uncharacteristically rude towards her teacher. Parents note stability with lithium treatment, however, the patient has decided that her diagnosis is incorrect and that she doesn't need to take medications. Which of the following depicts the best first step in the management of this patient?

• Discontinue lithium and initiate an alternative mood stabilizer • Provide education on coping skills to use in stressful situations • Increase the current lithium dose to target breakthrough symptoms • Referral for inpatient admission for acute stabilization of safety risks • Educate about the negative impact of symptoms on her daily functioning 2020 Child: 19

An adolescent was admitted medically overnight for chronic abdominal pain that has persisted for nine months despite three previous hospitalizations. Physical examination, laboratory studies and imaging are all inconsistent with physical disease. The patient has stopped attending school for the past four months, and spends considerable time distressed about the seriousness of the pain and focusing on this impairment. What is the initial best step in supporting the care of this patient given the likely diagnosis?

• Explain that symptoms are due to anxiety and stress • Inform the patient that psychiatric hospitalization is indicated • Counsel patient on the need to return to school as soon as possible • * Convene a multidisciplinary informing meeting to review assessment and diagnosis • Provide reassurance that medical studies were normal and no further testing is needed 2020 Child: 62 • The DSM diagnosis likely points towards a condition known as Somatic Symptom Disorder. This disorder is characterized by an individual's intense focus on physical symptoms—such as chronic abdominal pain—that cause significant distress and impairment. Despite medical evaluations and tests, no physical cause can be identified for these symptoms. • The individual's continual preoccupation with the severity of their symptoms often results in high levels of anxiety and distress. This preoccupation can lead to excessive time and energy spent on these symptoms and health concerns, as seen in this adolescent who has stopped attending school. The duration of these symptoms, which have persisted for more than six months, also aligns with the DSM criteria for Somatic Symptom Disorder. • It's important to note that the diagnosis of this disorder isn't an indication that the patient's pain is 'imaginary' or 'made up'. Rather, the physical pain is very real to the individual and can be extremely debilitating. The disconnect arises from the absence of a medical explanation for the physical symptoms.

The care of a child with autism spectrum disorder and significant co-morbid anxiety, irritability and functional decline at school has been managed by an outpatient pediatrician due to a lack of access to mental health services locally. The child would benefit from additional expertise and services. Which of the following is an appropriate next step?

• Refer the child to a local emergency room for stabilization • * Enroll in a telepsychiatry program with a child psychiatrist • Work with the closest psychiatric hospital for admission and stabilization • Contact Child Protective Services to obtain improved community support • Transfer the child's care to a different primary care provider, closer to outpatient mental health • adolescent with no prior medical or psychiatric disorders, with a typically normal 2020 Child: 134

An 11-year-old child with a history of attention-deficit/hyperactivity disorder, parent-child relational problem and depressive symptoms has been seen by a child and adolescent psychiatrist for the past two years. The psychiatrist learns that the parents have decided to divorce after receiving a subpoena to appear in family court to provide testimony regarding custody of the child. The psychiatrist can provide testimony:

• only with a subpoena. • after performing a separate forensic evaluation. • * after ensuring parents were notified to provide consent. • in the form of a deposition in lieu of appearing in person. • as an expert and offer an opinion regarding custody of the child. 2020 Child: 40

The psychiatrist in a busy clinic is running late due to an emergency. After apologizing for the delay, the psychiatrist realizes that there is no time to perform the scheduled new patient evaluation. The child has a current diagnosis of attention-deficit/hyperactivity disorder and is running out of medication. Your next new patient appointment is in three months. Which of the following would be the psychiatrist's next best step?

● Have the patient follow up with their primary care physician ● Review your schedule to prioritize this patient's appointment ● Offer to refer the patient and family to another child psychiatrist ● Send the family to the scheduler for the first available appointment ● Provide a prescription for medications the child has previously taken 2022 Child: 159