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ABP Developmental-Behavioral Pediatrics study materials
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ABP Developmental-Behavioral Pediatrics practice questions

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Question 1Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

At what age do most typically developing infants sit independently without hand support for several minutes?

  1. 4 to 5 months
  2. 12 to 14 months
  3. 6 to 8 months Correct answer.
  4. 2 to 3 months

Explanation

Independent sitting is a gross motor milestone usually achieved between 6 and 8 months, once head and trunk control are mature. It typically precedes pulling to stand, cruising, and walking. Inability to sit without support by about 9 months is a red flag that warrants developmental assessment.

Question 2Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A responsive social smile toward a caregiver's face or voice normally first appears at which age?

  1. 8 to 9 months
  2. At birth
  3. 4 to 5 months
  4. 6 to 8 weeks Correct answer.

Explanation

The social smile emerges at about 6 to 8 weeks and marks the start of reciprocal social engagement. Smiles seen in the first weeks are usually related to sleep state or spontaneous facial movement rather than to social contact. Absence of a social smile by 3 months calls for developmental and visual assessment.

Question 3Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A neat pincer grasp, in which the thumb and index finger pick up a small pellet, typically develops at which age?

  1. 15 to 18 months
  2. 6 to 7 months
  3. 9 to 12 months Correct answer.
  4. 3 to 4 months

Explanation

Hand use progresses from a raking grasp at about 6 to 7 months to an inferior pincer and then a neat thumb-index pincer between roughly 9 and 12 months. This fine motor advance parallels the ability to feed oneself small items. Persistence of a raking or whole-hand grasp beyond 12 months suggests fine motor delay.

Question 4Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

Most children begin combining two words into short phrases such as "more milk" at approximately what age?

  1. 12 months
  2. 15 months
  3. 24 months Correct answer.
  4. 18 months

Explanation

Single words typically appear around 12 months, a vocabulary of roughly 50 words with fast mapping follows by 18 months, and two-word combinations emerge around 24 months. The appearance of word combinations marks a shift from single-word to combinatorial language. Absence of two-word phrases by 24 months is a language red flag.

Question 5Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

The Moro reflex is normally no longer elicitable after approximately which age?

  1. 9 to 12 months
  2. 3 to 4 months Correct answer.
  3. At birth
  4. 6 to 8 months

Explanation

The Moro reflex is present in the newborn period and normally fades by about 3 to 4 months as cortical control matures. Persistence beyond 4 to 6 months suggests neuromotor abnormality. Its absence in the newborn period can indicate depression of the central nervous system.

Question 6Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

Serial head circumference measurement is recommended at well-child visits at least until what age?

  1. 6 months
  2. 24 months Correct answer.
  3. 5 years
  4. 10 years

Explanation

Head circumference reflects brain growth and should be measured at every well-child visit through at least 24 months, with at least one measurement after age 2 years. Rapid growth, plateau, or a measurement crossing percentiles prompts evaluation. After infancy the measurement becomes less sensitive to brain growth because of skull thickening.

Question 7Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 30-month-old plays beside peers with similar toys but does not coordinate, share, or adopt roles with them. This pattern is best described as which type of play?

  1. Solitary play
  2. Parallel play Correct answer.
  3. Associative play
  4. Cooperative play

Explanation

Parallel play, in which toddlers play alongside one another with similar materials but without true interaction, is typical of children around 2 to 3 years. It usually gives way to associative and then cooperative play in the preschool years. Solitary play involves no awareness of peers at all.

Question 8Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 10-month-old lifts a cloth to retrieve a toy that was hidden while she watched. This behavior demonstrates the development of which concept?

  1. Conservation
  2. Object permanence Correct answer.
  3. Reversibility
  4. Deferred imitation

Explanation

Searching for an object that is no longer visible shows that the infant holds a mental representation of the object, which is object permanence. It emerges between roughly 8 and 12 months and is a hallmark of Piaget's sensorimotor stage. Before this, hidden objects are treated as though they no longer exist.

Question 9Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

An 18-month-old speaks no single words, although he responds to his name and follows simple directions. What is the most appropriate next step?

  1. Prescribe a trial of iron supplementation before referral
  2. Reassure the family that boys often talk late
  3. Refer for audiologic testing and developmental evaluation Correct answer.
  4. Advise the family to reduce screen time and recheck at 30 months

Explanation

No single words by 18 months is a language red flag that warrants audiologic testing and developmental evaluation rather than observation alone. Hearing loss, language disorder, and autism spectrum disorder are among the conditions to exclude. Early identification allows earlier intervention, which improves outcomes.

Question 10Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 20-month-old no longer uses the 15 words he had at 15 months and has stopped waving and making eye contact. This presentation most strongly suggests which of the following?

  1. High-frequency hearing loss
  2. Developmental regression requiring urgent evaluation Correct answer.
  3. An isolated expressive language delay
  4. A normal variation in language development

Explanation

Loss of previously acquired language and social skills is developmental regression and is not a normal variant. It warrants urgent comprehensive evaluation, including consideration of autism spectrum disorder and neurodegenerative or seizure-related conditions. Early referral for intervention should not wait for a confirmed diagnosis.

Question 11Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

The Modified Checklist for Autism in Toddlers, Revised is designed to be administered at which ages?

  1. 12 and 15 months
  2. 30 and 36 months
  3. 18 and 24 months Correct answer.
  4. 6 and 12 months

Explanation

The M-CHAT-R is validated for toddlers and is recommended at the 18-month and 24-month well-child visits. Repeat screening at 24 months captures children who regress or whose symptoms become clearer later. A positive screen requires prompt diagnostic evaluation, not repeat screening alone.

Question 12Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 12-month-old consistently reaches and feeds with only the left hand while the right hand stays fisted. What does this finding most warrant?

  1. Reassurance that left-handedness runs in families
  2. Evaluation for a peripheral nerve injury only
  3. No action, because handedness is established by 12 months
  4. Assessment for hemiparesis or cerebral palsy Correct answer.

Explanation

Consistent hand preference before about 18 to 24 months is abnormal because true handedness is not established that early. Combined with fisting of the other hand, it suggests asymmetric tone or weakness such as hemiparesis. A thorough neuromotor examination and developmental referral are indicated.

Question 13Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

The parent of a 3-year-old reports that unfamiliar adults understand about three quarters of the child's speech. How should this be interpreted?

  1. Indicative of a language disorder rather than a speech problem
  2. Below expectation; refer for speech evaluation
  3. Above expectation for age
  4. Within normal limits for age Correct answer.

Explanation

Intelligibility to unfamiliar listeners is roughly 50% at 2 years, 75% at 3 years, and nearly 100% by 4 years. Three quarters intelligible at age 3 therefore falls within expectations. Intelligibility is a measure of speech production, distinct from language comprehension and use.

Question 14Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A child watches a doll place candy in a cupboard and leave; the candy is then moved. The child correctly predicts that the doll will search the original cupboard. This understanding typically emerges at which age?

  1. 8 to 9 years
  2. 18 to 24 months
  3. 6 to 7 years
  4. 4 to 5 years Correct answer.

Explanation

Passing a false-belief task shows theory of mind, the ability to represent another person's incorrect belief. This capacity typically develops around 4 to 5 years. Younger children generally assume others know what they themselves know.

Question 15Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 4-year-old insists that a tall narrow glass contains more water than a short wide glass holding the same volume. According to Piaget, the child has not yet acquired which concept?

  1. Egocentric speech
  2. Conservation Correct answer.
  3. Object permanence
  4. Classification

Explanation

Conservation is the understanding that quantity stays the same despite changes in appearance, and it is generally lacking in the preoperational stage until about age 7. The child centers on the height dimension and ignores width. This is a normal preoperational pattern rather than a sign of delay.

Question 16Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 9-month-old born at the 50th percentile for weight has fallen to the 5th percentile over 4 months. What does this pattern most warrant?

  1. Evaluation for inadequate intake or organic disease Correct answer.
  2. A change to a higher-calorie formula only
  3. Repeat measurement in 6 months
  4. Reassurance, since weight percentile varies with feeding style

Explanation

Crossing two or more major weight percentiles downward describes growth faltering and requires a structured evaluation of intake, feeding interactions, and possible organic causes. Serial measurements and a dietary and medical history are essential. Isolated percentile position matters less than the trajectory over time.

Question 17Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

The American Academy of Pediatrics recommends standardized general developmental screening at which set of well-child visits?

  1. 12, 24, and 36 months
  2. Every visit from birth to 3 years
  3. 2, 4, and 6 months
  4. 9, 18, and 30 months Correct answer.

Explanation

General developmental screening is recommended at 9, 18, and 30 months, alongside autism-specific screening at 18 and 24 months. Developmental surveillance, by contrast, occurs at every well-child visit. Screening tools standardize detection of delays that surveillance alone may miss.

Question 18Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 3-year-old repeats whole words and phrases at the start of sentences, especially when excited, without tension or struggle. What is the most appropriate management?

  1. Starting fluency-shaping drills at home
  2. Referral for stuttering therapy
  3. Observation and reassurance with follow-up Correct answer.
  4. Advising parents to finish the child's sentences

Explanation

Whole-word and phrase repetitions without struggle, tension, or secondary behaviors are typical developmental dysfluency of early childhood. It usually resolves without treatment, so reassurance and monitoring are appropriate. Referral is indicated for part-word repetitions, prolongations, blocking, or associated tension and avoidance.

Question 19Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

For an infant who does not pass newborn hearing screening, diagnostic audiologic evaluation should be completed by what age?

  1. 3 months Correct answer.
  2. 12 months
  3. 6 months
  4. 1 month

Explanation

The early hearing detection and intervention benchmarks are screening by 1 month, diagnostic evaluation by 3 months, and enrollment in intervention by 6 months. Early confirmation allows hearing aids or other intervention during the critical period for language development. Delaying diagnosis past 3 months risks avoidable language delay.

Question 20Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

Which finding best indicates readiness to begin toilet training in a 26-month-old?

  1. Disliking a wet diaper
  2. Staying dry about 2 hours and showing interest Correct answer.
  3. Naming body parts correctly
  4. Reaching 24 months of age

Explanation

Readiness reflects physiologic and developmental signs: dryness for about 2 hours, awareness of the need to go, interest in the toilet, and the motor ability to pull pants down and sit. Chronologic age alone is not a reliable criterion. Pushing training before readiness prolongs the process and increases conflict.

Question 21Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 6-month-old's occipitofrontal circumference plots 2.5 standard deviations below the mean for age and sex. This measurement is classified as which of the following?

  1. Microcephaly Correct answer.
  2. Cranial molding
  3. Macrocephaly
  4. Normal variation

Explanation

Microcephaly is defined as an occipitofrontal circumference below 2 standard deviations from the mean, or below the 3rd percentile, for age and sex. It warrants evaluation for congenital infection, genetic syndromes, and brain malformation, and comparison with the child's length and weight. Serial measurements help distinguish congenital from acquired forms.

Question 22Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

An asymmetric tonic neck reflex is still easily elicited in a 9-month-old who does not sit or reach across midline. This finding is best described as which of the following?

  1. Positional plagiocephaly from supine sleeping
  2. An isolated delay in gross motor milestones
  3. A retained primitive reflex Correct answer.
  4. A normal variant that resolves by 12 months

Explanation

The asymmetric tonic neck reflex normally fades by about 6 months; persistence at 9 months is a retained primitive reflex that signals neuromotor abnormality. Persistent primitive reflexes, together with delayed sitting and midline reaching, warrant evaluation for cerebral palsy. Truncal tone and posture should also be assessed.

Question 23Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 24-month-old has 20 single words, does not point to share interest, and rarely responds to his name; M-CHAT-R screening is positive. What is the most appropriate next step?

  1. Refer promptly for diagnostic evaluation and early intervention Correct answer.
  2. Order an EEG before any referral
  3. Reassure the family and provide a language-rich environment
  4. Repeat the M-CHAT-R in 6 months

Explanation

A positive M-CHAT-R combined with limited words, absent pointing, and poor response to name warrants immediate referral for diagnostic evaluation and early intervention services. Eligibility for early intervention does not require a confirmed diagnosis. Repeat screening or reassurance delays access to services during a period of rapid brain development.

Question 24Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 7-year-old girl presents with breast development and a growth spurt. Which statement about this finding is correct?

  1. It warrants evaluation for precocious puberty Correct answer.
  2. It is normal because thelarche begins at age 6
  3. It is precocious only if menses have begun
  4. It requires no evaluation if height is normal

Explanation

In girls, breast development before age 8 defines precocious puberty and warrants evaluation for central or peripheral causes, including hypothalamic lesions and exogenous estrogen exposure. Height and growth velocity may be normal early, so they do not exclude the diagnosis. Bone age and gonadotropin testing help distinguish central from peripheral causes.

Question 25Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 2-year-old from a home where both Spanish and English are spoken uses 15 words total across both languages. How should the clinician interpret this?

  1. Vocabulary across both languages is low for age Correct answer.
  2. Bilingual children cannot be assessed for language delay
  3. The child should be raised in a single language
  4. The delay is expected and needs no further screening

Explanation

Vocabulary should be counted across all languages a child is learning; at 2 years, roughly 50 words and early word combinations are expected. A total of 15 words across both languages is low and warrants hearing assessment and developmental evaluation. Bilingualism does not cause language delay, and advising a family to drop a language is not supported.

Question 26Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

At what age do most children begin to walk independently without support?

  1. 24 to 30 months
  2. 12 to 15 months Correct answer.
  3. 18 to 21 months
  4. 6 to 9 months

Explanation

Independent walking is typically achieved between 12 and 15 months, and about 90% of children walk by 15 months. A child who is not walking independently by 18 months warrants developmental and neuromotor evaluation. Achievement before 12 months is uncommon but not by itself abnormal.

Question 27Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

An infant picks up a small raisin by opposing the tips of the thumb and index finger while the wrist is lifted off the table surface. At which age does this skill typically emerge?

  1. 3 to 4 months
  2. 15 to 18 months
  3. 9 to 12 months Correct answer.
  4. 20 to 24 months

Explanation

A neat pincer grasp using the fingertips of the thumb and index finger emerges between 9 and 12 months, replacing the raking grasp of the 7- to 8-month-old. It parallels the ability to pick up cereal pieces and small objects. Older infants refine this into a precise, well-controlled pinch.

Question 28Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A responsive smile to a human face or voice, distinct from reflexive neonatal smiling, typically appears at which age?

  1. 6 to 8 weeks Correct answer.
  2. At birth
  3. 2 to 4 weeks
  4. 4 to 6 months

Explanation

A true social smile emerges at about 6 to 8 weeks and is elicited by faces, voices, and eye contact. It marks the shift from reflexive to socially mediated smiling. Absence by 2 to 3 months warrants attention to vision, hearing, and social engagement.

Question 29Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A healthy term infant is expected to triple the birth weight by approximately what age?

  1. 12 months Correct answer.
  2. 9 months
  3. 6 months
  4. 3 months

Explanation

Term infants usually regain birth weight by 2 weeks, double it by 4 to 5 months, and triple it by about 12 months. In the same period length increases by roughly 50% and head circumference by about 12 cm. These benchmarks anchor growth surveillance in the first year.

Question 30Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 14-month-old cries and clings when left at child care, settles within a few minutes, plays well, and greets her mother happily at pickup. How should this be interpreted?

  1. A sign of insecure attachment requiring referral
  2. Age-appropriate separation anxiety Correct answer.
  3. A presentation consistent with autism spectrum disorder
  4. Evidence of a regulatory disorder of infancy

Explanation

Separation anxiety normally emerges around 7 to 9 months, peaks between 9 and 18 months, and gradually resolves. Rapid soothing after the caregiver leaves and intact functioning across the day distinguish it from a disorder. Reassurance and consistent, brief goodbyes are the appropriate management.

Question 31Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 12-month-old enters an unfamiliar room, sees a moving toy, looks back at her mother, sees a fearful expression, and then retreats from the toy. What does this behavior illustrate?

  1. Symbolic play
  2. Object permanence
  3. Deferred imitation
  4. Social referencing Correct answer.

Explanation

Between roughly 9 and 14 months infants begin to use a caregiver's emotional expression to appraise ambiguous situations, a phenomenon known as social referencing. A fearful adult expression typically suppresses approach to a novel object. This skill reflects emerging understanding that others' affect carries information about the environment.

Question 32Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

An 18-month-old watches his father grind coffee and pour it into a cup. The next morning he repeats the entire sequence with a toy cup and spoon. Which process does this demonstrate?

  1. Immediate imitation
  2. Deferred imitation Correct answer.
  3. Primary circular reaction
  4. Operant conditioning

Explanation

Deferred imitation is the reproduction of a modeled action after a delay, which emerges late in the second year as children retain mental representations of observed events. It differs from immediate imitation, which is present from early infancy. This capacity supports the growing complexity of pretend play.

Question 33Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 24-month-old holds a block to her ear and says "hello," then offers a spoon to her teddy bear. What does this behavior represent?

  1. Symbolic (pretend) play Correct answer.
  2. Ritualistic behavior
  3. Echolalia
  4. Joint attention

Explanation

Substituting one object for another and assigning roles in a playful frame is symbolic, or pretend, play, which typically emerges between 18 and 24 months. It builds on deferred imitation and later develops into multi-step, role-based scenarios. It is a positive marker of cognitive and social development.

Question 34Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 3-year-old recites numbers to 10, but when asked to count four blocks she points at them in random order and answers "five." What is the best interpretation?

  1. A visual-perceptual deficit needing further evaluation
  2. Expected; one-to-one correspondence emerges around age 4 to 5 Correct answer.
  3. An early sign of a mathematics learning disability
  4. Evidence of intellectual disability from inability to count

Explanation

Rote counting precedes the meaningful counting principles, and one-to-one correspondence (assigning one number word to each object) consolidates between about 4 and 5 years. Cardinality, knowing that the last number names the quantity, follows soon after. Preschoolers are not expected to count objects accurately at age 3.

Question 35Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

Global developmental delay is best defined as which of the following?

  1. Delay in a single domain, such as expressive language, in a child under age 5
  2. An IQ score below 70 on preschool testing
  3. Any loss of previously acquired skills before age 5
  4. Delay in two or more domains in a child younger than 5 years Correct answer.

Explanation

Global developmental delay describes significant delay in two or more developmental domains in a child under 5 years, an age at which standardized intelligence testing is unreliable. It is a descriptive, provisional designation that prompts etiologic evaluation and early intervention. Intellectual disability is defined later using both cognitive testing and adaptive functioning.

Question 36Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

Most children consolidate a dynamic tripod pencil grasp, holding the shaft between thumb, index, and middle fingers with a stabilized wrist, at what age?

  1. 2 to 3 years
  2. 4 to 6 years Correct answer.
  3. 3 to 4 years
  4. 7 to 9 years

Explanation

A dynamic tripod grasp typically consolidates between 4 and 6 years as fine motor control and hand arch strength mature. Younger preschoolers commonly use a static tripod or digital-pronate grasp, which is normal for their age. Persistence of primitive whole-hand grasps beyond about 6 years may warrant fine motor evaluation.

Question 37Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

An 18-month-old calls cows, horses, and sheep "doggie." His hearing is normal and he uses about 40 other words appropriately. What does this pattern represent?

  1. A receptive-expressive gap that warrants speech therapy referral
  2. A word-finding deficit consistent with a language disorder
  3. Echolalia suggesting an autism spectrum disorder
  4. Semantic overextension typical of early vocabulary Correct answer.

Explanation

Between roughly 12 and 24 months children commonly overextend labels, applying a word such as "doggie" to all four-legged animals. This reflects emerging category formation rather than a naming error and resolves as vocabulary and perceptual discrimination mature. It is expected in a child with an otherwise appropriate word inventory.

Question 38Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 4-year-old consistently says "wabbit" for rabbit and "wed" for red. His language is otherwise age-appropriate and intelligible. What is the most accurate statement?

  1. Possible hearing loss requiring immediate audiologic testing
  2. Within normal limits, since /r/ is often mastered after age 5 Correct answer.
  3. A delay that should have resolved by age 3 and needs referral
  4. A phonological disorder that warrants therapy now

Explanation

Most children master /r/ between about 5 and 7 years, so gliding to /w/ at age 4 is a common and usually transient pattern. Children with otherwise intelligible speech and typical language are typically monitored with reassessment around 5 to 6 years. Persistent errors past that point warrant speech evaluation.

Question 39Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 22-month-old with typical motor and cognitive skills repeatedly tries to sit on a dollhouse-sized chair and to squeeze into a toy car, persisting despite falling over. What does this behavior most likely represent?

  1. Perseverative behavior suggesting autism spectrum disorder
  2. Evidence of a visual-perceptual deficit requiring eye examination
  3. A normal scale error from immature size-action coupling Correct answer.
  4. Emerging pretend play that should be encouraged

Explanation

Scale errors peak between about 18 and 30 months, when toddlers fail to integrate the perceived size of an object with the size of their own body when planning an action. They occur in typically developing children and largely disappear by 3 years as action planning matures. The behavior is distinct from perseveration because it is not repeated in the absence of a meaningful goal.

Question 40Typical and Atypical Development (growth, motor, language, cognitive, social-emotional, regulatory)

A 20-month-old clings to her mother for the first 20 minutes in new settings and then plays happily. In a loud, crowded music class she cries throughout but enjoys small quiet play groups. What is the most appropriate guidance?

  1. Refer for evaluation of an anxiety disorder before age 3
  2. Temperament is fixed, so the family should avoid new settings
  3. Gradual, supported introduction to new settings fits her temperament Correct answer.
  4. Immediate, repeated exposure will extinguish the inhibited behavior

Explanation

Goodness of fit means adjusting environments and expectations to a child's temperament rather than trying to alter the trait itself. Slow-to-warm-up children do best with gradual transitions, a familiar caregiver present, and lower-stimulation settings. This approach supports participation without generating chronic distress.

Question 41Behavioral and Mental Health Conditions of Childhood

According to DSM-5, several symptoms of attention-deficit/hyperactivity disorder must be present before which age?

  1. 12 years Correct answer.
  2. 5 years
  3. 16 years
  4. 7 years

Explanation

DSM-5 requires several ADHD symptoms to be present before age 12, although the diagnosis may be made later if criteria are met. DSM-IV used an age-of-onset cutoff of 7 years, which is no longer current.

Question 42Behavioral and Mental Health Conditions of Childhood

Which medication class is first-line pharmacologic treatment for ADHD in school-age children?

  1. Atypical antipsychotics such as risperidone
  2. Stimulants such as methylphenidate Correct answer.
  3. Selective serotonin reuptake inhibitors
  4. Alpha-2 agonists such as clonidine

Explanation

Stimulants such as methylphenidate and amphetamines are first-line pharmacotherapy for ADHD in school-age children because of large effect sizes and extensive evidence. Nonstimulants are generally used when stimulants are ineffective, poorly tolerated, or contraindicated.

Question 43Behavioral and Mental Health Conditions of Childhood

Which pair best describes the core symptom domains of autism spectrum disorder?

  1. Social-communication deficits and repetitive behavior Correct answer.
  2. Language regression and seizures
  3. Hyperactivity and impulsivity
  4. Motor tics and vocal tics

Explanation

ASD is defined by persistent deficits in social communication and social interaction plus restricted, repetitive patterns of behavior, interests, or activities. Hyperactivity, tics, and seizures can co-occur but are not core diagnostic domains.

Question 44Behavioral and Mental Health Conditions of Childhood

At what age is the M-CHAT-R/F typically administered as a universal autism screening tool?

  1. 6 months
  2. 18 to 24 months Correct answer.
  3. 12 months
  4. 36 months

Explanation

The M-CHAT-R/F is a parent-completed screening tool for ASD, typically administered at the 18- and 24-month well-child visits. It is not designed for infants under 12 months or for preschool-only screening.

Question 45Behavioral and Mental Health Conditions of Childhood

A 7-year-old refuses school most mornings, clings to her mother, and repeatedly worries that her mother will be harmed or will not return. Which diagnosis is most likely?

  1. Generalized anxiety disorder
  2. Separation anxiety disorder Correct answer.
  3. Social anxiety disorder
  4. Oppositional defiant disorder

Explanation

Separation anxiety disorder involves developmentally inappropriate, excessive fear or anxiety about separation from attachment figures, often with school refusal and worries about harm befalling caregivers. The symptoms persist and cause impairment, distinguishing them from transient normative separation distress.

Question 46Behavioral and Mental Health Conditions of Childhood

A 6-year-old has nightly bedwetting with no daytime symptoms and no prior dry period. What is the most appropriate initial management?

  1. Desmopressin at bedtime
  2. Restricting fluids throughout the day
  3. Imipramine at bedtime
  4. Reassurance and behavioral measures Correct answer.

Explanation

Primary nocturnal enuresis in a child older than 5 years is common and benign; initial management is reassurance, education, and behavioral measures such as a bladder diary, timed fluids, and reward systems. Medications are reserved for persistent cases or specific situations.

Question 47Behavioral and Mental Health Conditions of Childhood

Pica is defined as persistent eating of nonnutritive substances for at least what duration in a child older than 2 years?

  1. 2 weeks
  2. 1 week
  3. 6 months
  4. 1 month Correct answer.

Explanation

Pica is persistent eating of nonnutritive, nonfood substances for at least 1 month, developmentally inappropriate, and not part of a culturally supported practice. It is associated with iron deficiency and must be distinguished from rumination disorder.

Question 48Behavioral and Mental Health Conditions of Childhood

Which feature is most typical of normal temper tantrums in a 2-year-old?

  1. Causing self-injury that requires medical care
  2. Occurring only when the child is alone
  3. Lasting more than 30 minutes on most days
  4. Brief frustration-triggered outbursts that resolve with comfort Correct answer.

Explanation

Normal temper tantrums in toddlers are brief, frustration-related outbursts that often resolve with comfort or distraction and decrease with age. Tantrums that are prolonged, frequent, self-injurious, or persistent beyond preschool age warrant further evaluation.

Question 49Behavioral and Mental Health Conditions of Childhood

A 9-year-old screens positive for ADHD on a parent rating form. What is the most appropriate next step?

  1. Diagnose ADHD from the parent form alone
  2. Order a brain MRI
  3. Obtain teacher ratings and assess cross-setting impairment Correct answer.
  4. Start a stimulant immediately

Explanation

ADHD diagnosis requires symptoms in two or more settings and clear impairment, so cross-setting information is essential. Parent ratings alone can over- or under-identify symptoms; teacher ratings and school functioning are part of the assessment.

Question 50Behavioral and Mental Health Conditions of Childhood

A child started methylphenidate and has decreased appetite and difficulty falling asleep. What is the best initial approach?

  1. Ignore the side effects
  2. Adjust timing/dose and monitor growth Correct answer.
  3. Add an atypical antipsychotic
  4. Discontinue the medication permanently

Explanation

Appetite suppression and insomnia are common stimulant side effects; adjusting timing and dose, giving medication after breakfast, and monitoring growth are appropriate initial steps. Persistent or severe effects may prompt a change in formulation or medication.