The Child and Adolescent Psychiatry Board Exam generally has a fairly high pass rate compared with the general Psychiatry Boards, which tend to be more difficult. Quickly going through a question bank can help identify weak spots. Below are a couple of sample Child Psychiatry Board Review questions.
Sample Child Psychiatry Board Questions
Question 1. Assessment and Diagnostic QID 31290
A 14 year old female has extreme mood swings, is constantly arguing with friends and family, and complains of feeling chronically empty inside. She does not seem to meet the criteria for a mood or anxiety disorder. The psychiatrist would like to formally assess her complex psychological and personality traits. Which test would be most appropriate?
A. Minnesota Multiphasic Personality Inventory (MMPI-A)
B. Behavior Assessment System for Children, Second Edition (BASC-2)
C. Vineland Adaptive Behavior Scales, Second Edition (Vineland-II)
D. Leiter International Performance Scale-Revised (Leiter-R)
E. Wisconsin Card Sorting Test (WCST)
Answer: A. Minnesota Multiphasic Personality Inventory (MMPI-A).
Minnesota Multiphasic Personality Inventory (MMPI-A) is a test of personality and psychopathology in adolescents age 14 through 18, and is useful for assessing complex or deep characterological problems. It is derived from the very popular MMRPI-2, which is used in adults. So for personality test in adolescents, think MMPI-A.
Behavior Assessment System for Children, Second Edition (BASC-2) is an instrument to assess problem behaviors (like aggression, hyperactivity, and conduct disorder symptoms) and problematic emotions such as depression and anxiety. As such, it can be used to assist in the diagnoses of conduct disorder, ADHD, depression, and ODD. It is less useful in this question because the goal was to gain a deeper psychological profile on the patient, rather than screen for axis I disorders or record behavioral problems. BASC-2 is often used in school-based assessments since it is tailored to work with The Individuals with Disabilities Education Act. It asks for parent, teacher, and self-ratings, which may be a distinguishing feature on a test. Used for ages 2 through 21. If question is about a school based consultation to measure the emotional and behavioral disturbances in a child, think BASC-2.
Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) is an instrument that mainly helps diagnose developmental disorders such as Autism and other developmental delays. A key distinguishing feature for test purposes is that it is usually given to a caretaker to report about the child. The caretaker lists what the child does and can do, and this gives a sense of where the child is adaptively at from a developmental perspective. If a question asks about how who fills out the Vineland, it’s the caretaker. If a question asks about an instrument to assess for autism and functioning, consider the Vineland as a possible choice.
The Leiter International Performance Scale-Revised (Leiter-R) is somewhat unique in being able to evaluate memory, attention, and overall intelligence in children who have difficulty with verbal communication. This difficulty can come from the child having a speech problem, or perhaps having English as a second language, or having other neurological problems that prevent normal communication. This is the main high yield fact about this test to remember. So if a question asks about testing intelligence or attention/memory in a child who has trouble with verbal communication, be thinking Leiter. It also has a very wide age range, from 2-20 years, much wider than many other intelligence tests.
Wisconsin Card Sorting Test (WCST) tests the ability of someone to adapt to changing rules in a complex card matching game. This is a good test of executive functioning (e.g. the frontal lobe), and is often used to assess patients with brain injuries or severe mental illnesses such as schizophrenia, which can affect executive functioning. So if there is a question about executive functioning, frontal lobe, or brain damage, consider the WCST.
Reference: Click to see an MMPI: http://www.pearsonclinical.com/talent/products/100000465/minnesota-multiphasic-personality-inventory-adolescent-mmpi-a.html
Question 2. Neurodevelopmental Disorders QID 19000
A 4 year-old female is brought in by her parents for symptoms of impairment of non-verbal language, failure to meet expected social milestones, as well as profound psychomotor retardation. Her parents report that she developed normally for the first 5 months of life and this was followed by a deceleration of head growth. What is the genetic marker responsible for this condition?
A. Trisomy of chromosome 21
B. Parental deletion or maternal uniparental disomy of chromosome 15q11.13
C. A microdeletion on chromosome 7q11.23
Answer: D. MECP2.
Rett’s Disorder is caused by mutation in the X-linked MECP2 gene encoding methyl-CpG-binding protein 2. It is almost exclusively found in females and is the second most important cause of intellectual disability in females after Down syndrome. The typical physical development is normal head circumference for the first 5 months followed by a deceleration of head growth between 6 months and 4 years as well as a loss of motor, social and language skills. Typically females with Rett’s have profound language difficulty and psychomotor retardation.
Approximately 3-5% of persons with autism have Fragile X syndrome. Fragile X syndrome is a trinucleotide repeat disease caused by a mutation of the FMR1 gene at Xq27.3. Thus, all persons with autism are tested for Fragile X syndrome. Fragile X is the most common genetic cause of intellectual disability in boys. Physical traits include large ears, a long face, and macroorhidism, a high arched palate, double jointed fingers and hyper-flexible joints. Behavioral characteristics can include ADHD, social anxiety, hand-biting, hand flapping, poor eye contact, sensory disorders and aggression.
Williams syndrome is caused by a microdeletion on chromosome 7q11.23 and has a prevalence of 1/7,500. Williams syndrome is typical constellation of symptoms including excessive friendliness and anxiety, connective tissue abnormalities, heart disease, failure to thrive and growth deficiency. Patients with Williams syndrome typically have mild to moderate intellectual disability (ID) as well as a strong verbal short term memory, indiscriminate social initiation and a strong sense of empathy.
Prader-Willi Syndrome (PWS) is caused by a parental deletion or maternal uniparental disomy of chromosome 15q11.13, which is the same genetic marker that is affected in Angelman syndrome. PWS is relatively rare occurring in about 1/30,000 births. Individuals with PWS are born with hypotonia and failure to thrive with leads to hyperphagia and obesity. Other noted features of PWS include hypogonadism, short stature with small hands and feet, sleep apnea and behavioral problems. Patients with PWS have a higher risk of developing OCD as well as impulse-control disorders and affective disorders. Compulsive food-seeking and hoarding are typical and frequently lifelong.
Down Syndrome (DS) occurs in about 1/800 births and is the most common genetic cause of ID. The cause of DS is trisomy of chromosome 21. The most common features of Down Syndrome are cognitive impairment, hypotonia, heart disease, and facial dysmorphisims. Patients with DS have strong visual processing and impaired language functioning.
Fetal alcohol syndrome (FAS) is considered a spectrum and the broad phenotype is thought to occur at a rate of about 1% of live births and when defined narrowly about 0.5-2 per 1,000 births. The hallmark of FAS is intellectual disability as well as facial anomalies including a smooth philtrum, a vermilion border of the upper lip and short palpebral fissures. Patients with FAS may have multiple physical anomalies including renal, cardiac and orthopedic. Behavioral and cognitive associated with FAS include learning disorders, attention problems and difficulty with executive functioning.
Source: Dulcan, M. K. (2010). Dulcan’s textbook of child and adolescent psychiatry. Washington, DC: American Psychiatric Pub