LATEST DEVELOPMENTAL-BEHAVIORAL
PEDIATRICS CERTIFICATION EXAM OFFERED
BY AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. An 18-month-old child is brought for evaluation
because he does not speak any words. He babbles
and points to desired objects but does not follow
simple commands. His social smile is present, and he
makes eye contact. Hearing screen is normal. What
is the most appropriate next step?
A) Reassure the parents that boys often speak later
B) Refer to audiology for formal hearing testing
C) Refer to early intervention (birth-to-three) for
developmental evaluation and speech therapy
D) Order lead level and CBC
Correct answer: C
Rationale: At 18 months, lack of any words is a red
flag for language delay. Early intervention (Part C)
should be initiated for evaluation and therapy.
Hearing has already been screened and is normal.
Lead testing (D) is routine at 12 and 24 months but
not the most immediate step.
,2. A 4-year-old child is noted to have difficulty with
buttons, zippers, and holding a crayon. He can walk
up stairs but needs assistance. He has a history of
mild delay in sitting (8 months) and walking (16
months). On examination, there is mild hypotonia and
hyperreflexia. What is the most likely diagnosis?
A) Developmental coordination disorder (DCD)
B) Autism spectrum disorder (ASD)
C) Intellectual disability (ID)
D) Muscular dystrophy (Duchenne)
Correct answer: A
Rationale: Developmental coordination disorder
(DCD) is characterized by motor coordination below
expected for age, interfering with activities of daily
living (buttons, zippers, drawing), not due to a
general medical condition (muscular dystrophy,
cerebral palsy). Hypotonia and hyperreflexia may be
associated.
3. A 7-year-old child is brought by his parents
because he refuses to attend school. He complains of
stomachaches and headaches on school mornings.
On weekends and summer vacation, he is
asymptomatic. He has no chronic medical conditions.
What is the most likely diagnosis?
,A) School refusal (anxiety-based, separation anxiety)
B) Malingering (factitious)
C) Chronic abdominal pain (functional)
D) Social anxiety disorder (generalized)
Correct answer: A
Rationale: School refusal (anxiety-based) presents
with somatic symptoms (headaches, stomachaches)
on school days that resolve on weekends/holidays. It
is often associated with separation anxiety or social
anxiety. Malingering (B) is rare in children.
4. A 2-year-old child has a vocabulary of 50 words
and uses two-word phrases ("more milk"). He follows
one-step commands. He is socially interactive. What
is the most appropriate interpretation?
A) Language delay (red flag)
B) Normal language development for age
C) Expressive language disorder
D) Autism spectrum disorder (ASD)
Correct answer: B
Rationale: By 24 months, typical expressive language
milestones: 50-100 words, two-word phrases (by 24
months), and following two-step commands. This
, child is on track. Red flags at 24 months: no two-word
phrases, loss of language, or no words by 18 months.
5. A 5-year-old child in kindergarten is noted to have
difficulty sitting still, interrupts the teacher, and
blurts out answers. He fidgets constantly. These
behaviors occur at home and at school. What is the
most appropriate next step?
A) Recommend behavioral therapy alone (parent
training)
B) Refer to child psychiatry for stimulant medication
(methylphenidate)
C) Obtain Vanderbilt rating scales from parents and
teachers to assess for ADHD
D) Diagnose ADHD based on history and start
treatment
Correct answer: C
Rationale: ADHD diagnosis requires symptoms in ≥2
settings (home, school) with onset before age 12,
lasting ≥6 months, and impairment. Vanderbilt (or
Connors) rating scales from parents and teachers
are essential for diagnosis. Behavioral therapy is
first-line for preschoolers; medication may be added
for school-age.
PEDIATRICS CERTIFICATION EXAM OFFERED
BY AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. An 18-month-old child is brought for evaluation
because he does not speak any words. He babbles
and points to desired objects but does not follow
simple commands. His social smile is present, and he
makes eye contact. Hearing screen is normal. What
is the most appropriate next step?
A) Reassure the parents that boys often speak later
B) Refer to audiology for formal hearing testing
C) Refer to early intervention (birth-to-three) for
developmental evaluation and speech therapy
D) Order lead level and CBC
Correct answer: C
Rationale: At 18 months, lack of any words is a red
flag for language delay. Early intervention (Part C)
should be initiated for evaluation and therapy.
Hearing has already been screened and is normal.
Lead testing (D) is routine at 12 and 24 months but
not the most immediate step.
,2. A 4-year-old child is noted to have difficulty with
buttons, zippers, and holding a crayon. He can walk
up stairs but needs assistance. He has a history of
mild delay in sitting (8 months) and walking (16
months). On examination, there is mild hypotonia and
hyperreflexia. What is the most likely diagnosis?
A) Developmental coordination disorder (DCD)
B) Autism spectrum disorder (ASD)
C) Intellectual disability (ID)
D) Muscular dystrophy (Duchenne)
Correct answer: A
Rationale: Developmental coordination disorder
(DCD) is characterized by motor coordination below
expected for age, interfering with activities of daily
living (buttons, zippers, drawing), not due to a
general medical condition (muscular dystrophy,
cerebral palsy). Hypotonia and hyperreflexia may be
associated.
3. A 7-year-old child is brought by his parents
because he refuses to attend school. He complains of
stomachaches and headaches on school mornings.
On weekends and summer vacation, he is
asymptomatic. He has no chronic medical conditions.
What is the most likely diagnosis?
,A) School refusal (anxiety-based, separation anxiety)
B) Malingering (factitious)
C) Chronic abdominal pain (functional)
D) Social anxiety disorder (generalized)
Correct answer: A
Rationale: School refusal (anxiety-based) presents
with somatic symptoms (headaches, stomachaches)
on school days that resolve on weekends/holidays. It
is often associated with separation anxiety or social
anxiety. Malingering (B) is rare in children.
4. A 2-year-old child has a vocabulary of 50 words
and uses two-word phrases ("more milk"). He follows
one-step commands. He is socially interactive. What
is the most appropriate interpretation?
A) Language delay (red flag)
B) Normal language development for age
C) Expressive language disorder
D) Autism spectrum disorder (ASD)
Correct answer: B
Rationale: By 24 months, typical expressive language
milestones: 50-100 words, two-word phrases (by 24
months), and following two-step commands. This
, child is on track. Red flags at 24 months: no two-word
phrases, loss of language, or no words by 18 months.
5. A 5-year-old child in kindergarten is noted to have
difficulty sitting still, interrupts the teacher, and
blurts out answers. He fidgets constantly. These
behaviors occur at home and at school. What is the
most appropriate next step?
A) Recommend behavioral therapy alone (parent
training)
B) Refer to child psychiatry for stimulant medication
(methylphenidate)
C) Obtain Vanderbilt rating scales from parents and
teachers to assess for ADHD
D) Diagnose ADHD based on history and start
treatment
Correct answer: C
Rationale: ADHD diagnosis requires symptoms in ≥2
settings (home, school) with onset before age 12,
lasting ≥6 months, and impairment. Vanderbilt (or
Connors) rating scales from parents and teachers
are essential for diagnosis. Behavioral therapy is
first-line for preschoolers; medication may be added
for school-age.
