Behavioral and Mental Health
Core content
Behavioral and mental health questions test normal development against pathology, screening, and first-line management. Know the presentation and criteria for ADHD, autism spectrum disorder, anxiety, depression, disruptive behavior, eating disorders, elimination disorders, and sleep problems. Screening tools are part of the workup: M-CHAT-R for autism, Vanderbilt or Conners for ADHD, PHQ-A or similar for adolescent depression, and HEADSS for psychosocial history. Symptoms must be persistent, impairing, and present across settings.
Traps
Examiners exploit single-setting reports, normal developmental variation, and medication questions. For preschool ADHD, behavioral parent training is first-line before medication; for school-age ADHD, stimulants are first-line with behavioral support. For adolescent depression, fluoxetine plus cognitive behavioral therapy is a common first-line approach, and any suicidality requires immediate safety assessment. Do not attribute regression or social withdrawal to shyness without screening. Confidentiality is a trap: adolescents deserve private time, but safety concerns override confidentiality.
Worked example
A 7-year-old has inattention at school and home, fails to finish work, and is described as constantly moving. The Vanderbilt scales are positive in both settings, and symptoms began before age 12 with clear impairment. This supports ADHD; start behavioral parent training and school accommodations, and consider medication if impairment persists. Rule of thumb: ADHD requires symptoms in at least two settings, before age 12, with functional impairment.