Barkley PMHNP CHaPter Quiz 8:
DisorDers of CHilDreN aND
aDolesCeNts CoMPreHeNsive 150-
QuestioN MultiPle-CHoiCe
exaMiNatioN a well DetaileD oNe
writteN aND graDeD a+
uPgraDeD
Instructions:
• Difficulty Level: Advanced / Hard
• Target Audience: PMHNP students and certification candidates
• Format: 150 multiple-choice questions with one correct answer each
• Content Coverage: Neurodevelopmental disorders, disruptive behavior disorders, mood
and anxiety disorders in children, ADHD, autism spectrum disorder, conduct disorder,
oppositional defiant disorder, tic disorders, elimination disorders, and
psychopharmacological management in pediatric populations
Section A: Neurodevelopmental Disorders (Questions 1–30)
1. A 4-year-old male presents with delayed speech development, limited eye contact,
repetitive hand-flapping motions, and an intense fixation on spinning objects. He becomes
,dysregulated when his daily routine is altered. Which of the following is the most appropriate
initial screening tool for this presentation?
A) M-CHAT (Modified Checklist for Autism in Toddlers)
B) CBCL (Child Behavior Checklist)
C) Vanderbilt ADHD Diagnostic Rating Scale
D) SCARED (Screen for Child Anxiety Related Disorders)
Correct Answer: A) M-CHAT
Rationale: The M-CHAT is the most widely used and validated screening tool for autism
spectrum disorder (ASD) in toddlers and young children. The child's presentation—delayed
speech, limited eye contact, repetitive behaviors, and rigidity regarding routines—is classic for
ASD. The CBCL is a broad behavioral screening tool, Vanderbilt is specific to ADHD, and SCARED
assesses anxiety disorders.
2. A 7-year-old female with a diagnosis of autism spectrum disorder (ASD) exhibits significant
language regression at age 3, currently has a vocabulary of approximately 20 words, and
requires substantial support for activities of daily living. According to DSM-5-TR criteria, which
severity specifier is most appropriate?
A) Level 1 – Requiring support
B) Level 2 – Requiring substantial support
C) Level 3 – Requiring very substantial support
D) Not enough information to determine
Correct Answer: C) Level 3 – Requiring very substantial support
Rationale: Level 3 ASD is characterized by "requiring very substantial support," with severe
deficits in verbal and nonverbal social communication skills, limited initiation of social
interaction, and minimal response to social overtures. The patient's significant language
regression, limited vocabulary (20 words), and substantial support needs for ADLs indicate Level
3 severity.
3. A 9-year-old male with ASD engages in self-injurious behavior including head-banging
during transitions. Which of the following is the FIRST-line behavioral intervention that should
be implemented?
A) Atypical antipsychotic medication
B) Functional behavior assessment (FBA) followed by positive behavior support
,C) Seclusion and restraint during episodes
D) Immediate referral for residential placement
Correct Answer: B) Functional behavior assessment (FBA) followed by positive behavior
support
Rationale: FBA is the standard first-line approach to understanding the function of self-injurious
behaviors in ASD. This assessment identifies antecedents and consequences maintaining the
behavior, allowing for development of positive behavior support plans. Pharmacological
interventions like atypical antipsychotics are considered after behavioral interventions have
been optimized or in acute crisis situations.
4. A 6-year-old male with ASD and intellectual disability has been prescribed risperidone for
severe irritability and aggression. Which of the following is the MOST important baseline and
ongoing monitoring parameter for this patient?
A) Serum glucose and hemoglobin A1c
B) Weight, BMI, and waist circumference
C) Complete blood count with differential
D) Serum creatinine and BUN
Correct Answer: B) Weight, BMI, and waist circumference
Rationale: Atypical antipsychotics including risperidone are associated with significant
metabolic side effects including weight gain, increased BMI, and central adiposity in pediatric
populations. Baseline and ongoing monitoring of weight, BMI, and waist circumference is
essential, along with fasting glucose, lipids, and blood pressure. CBC and renal function are not
the primary monitoring concerns.
5. A 3-year-old female is brought in by her parents because she has not developed any spoken
words and does not respond to her name. She does not point to objects of interest and
appears to be in her "own world." Which of the following represents the SINGLE BEST next
step in management?
A) Referral to audiology and early intervention services
B) Immediate initiation of speech therapy only
C) MRI of the brain to rule out structural abnormalities
D) Observation for 6 months to assess for spontaneous improvement
Correct Answer: A) Referral to audiology and early intervention services
Rationale: When a child presents with language delay and social communication deficits
, concerning for ASD, the immediate priority is to rule out hearing impairment through audiology
assessment and refer to early intervention services. Early intensive behavioral intervention has
been shown to improve outcomes. Observation without intervention is inappropriate, and MRI
is not the first-line investigation.
6. Which of the following genetic syndromes is MOST strongly associated with autism
spectrum disorder?
A) Down syndrome (Trisomy 21)
B) Fragile X syndrome
C) Klinefelter syndrome (XXY)
D) Turner syndrome (XO)
Correct Answer: B) Fragile X syndrome
Rationale: Fragile X syndrome is the most common inherited cause of intellectual disability and
the most common known single-gene cause of ASD, with approximately 30-50% of males with
Fragile X meeting criteria for ASD. While Down syndrome and other genetic conditions have
increased rates of ASD compared to the general population, Fragile X has the strongest
association.
7. A 5-year-old male with ASD is being evaluated for school placement. He has moderate
intellectual disability, limited functional communication, and requires assistance with
toileting and feeding. Which educational setting is MOST appropriate?
A) Full inclusion in a general education classroom with a paraprofessional
B) Self-contained special education classroom with a low student-to-teacher ratio
C) Residential treatment facility
D) Homeschooling with speech therapy twice weekly
Correct Answer: B) Self-contained special education classroom with a low student-to-teacher
ratio
Rationale: Children with ASD who have moderate intellectual disability and require substantial
support for daily living skills benefit from specialized educational settings with a low student-to-
teacher ratio and access to related services (speech, OT, behavioral support). Full inclusion may
not provide adequate support, and residential placement is premature without first attempting
community-based educational options.
DisorDers of CHilDreN aND
aDolesCeNts CoMPreHeNsive 150-
QuestioN MultiPle-CHoiCe
exaMiNatioN a well DetaileD oNe
writteN aND graDeD a+
uPgraDeD
Instructions:
• Difficulty Level: Advanced / Hard
• Target Audience: PMHNP students and certification candidates
• Format: 150 multiple-choice questions with one correct answer each
• Content Coverage: Neurodevelopmental disorders, disruptive behavior disorders, mood
and anxiety disorders in children, ADHD, autism spectrum disorder, conduct disorder,
oppositional defiant disorder, tic disorders, elimination disorders, and
psychopharmacological management in pediatric populations
Section A: Neurodevelopmental Disorders (Questions 1–30)
1. A 4-year-old male presents with delayed speech development, limited eye contact,
repetitive hand-flapping motions, and an intense fixation on spinning objects. He becomes
,dysregulated when his daily routine is altered. Which of the following is the most appropriate
initial screening tool for this presentation?
A) M-CHAT (Modified Checklist for Autism in Toddlers)
B) CBCL (Child Behavior Checklist)
C) Vanderbilt ADHD Diagnostic Rating Scale
D) SCARED (Screen for Child Anxiety Related Disorders)
Correct Answer: A) M-CHAT
Rationale: The M-CHAT is the most widely used and validated screening tool for autism
spectrum disorder (ASD) in toddlers and young children. The child's presentation—delayed
speech, limited eye contact, repetitive behaviors, and rigidity regarding routines—is classic for
ASD. The CBCL is a broad behavioral screening tool, Vanderbilt is specific to ADHD, and SCARED
assesses anxiety disorders.
2. A 7-year-old female with a diagnosis of autism spectrum disorder (ASD) exhibits significant
language regression at age 3, currently has a vocabulary of approximately 20 words, and
requires substantial support for activities of daily living. According to DSM-5-TR criteria, which
severity specifier is most appropriate?
A) Level 1 – Requiring support
B) Level 2 – Requiring substantial support
C) Level 3 – Requiring very substantial support
D) Not enough information to determine
Correct Answer: C) Level 3 – Requiring very substantial support
Rationale: Level 3 ASD is characterized by "requiring very substantial support," with severe
deficits in verbal and nonverbal social communication skills, limited initiation of social
interaction, and minimal response to social overtures. The patient's significant language
regression, limited vocabulary (20 words), and substantial support needs for ADLs indicate Level
3 severity.
3. A 9-year-old male with ASD engages in self-injurious behavior including head-banging
during transitions. Which of the following is the FIRST-line behavioral intervention that should
be implemented?
A) Atypical antipsychotic medication
B) Functional behavior assessment (FBA) followed by positive behavior support
,C) Seclusion and restraint during episodes
D) Immediate referral for residential placement
Correct Answer: B) Functional behavior assessment (FBA) followed by positive behavior
support
Rationale: FBA is the standard first-line approach to understanding the function of self-injurious
behaviors in ASD. This assessment identifies antecedents and consequences maintaining the
behavior, allowing for development of positive behavior support plans. Pharmacological
interventions like atypical antipsychotics are considered after behavioral interventions have
been optimized or in acute crisis situations.
4. A 6-year-old male with ASD and intellectual disability has been prescribed risperidone for
severe irritability and aggression. Which of the following is the MOST important baseline and
ongoing monitoring parameter for this patient?
A) Serum glucose and hemoglobin A1c
B) Weight, BMI, and waist circumference
C) Complete blood count with differential
D) Serum creatinine and BUN
Correct Answer: B) Weight, BMI, and waist circumference
Rationale: Atypical antipsychotics including risperidone are associated with significant
metabolic side effects including weight gain, increased BMI, and central adiposity in pediatric
populations. Baseline and ongoing monitoring of weight, BMI, and waist circumference is
essential, along with fasting glucose, lipids, and blood pressure. CBC and renal function are not
the primary monitoring concerns.
5. A 3-year-old female is brought in by her parents because she has not developed any spoken
words and does not respond to her name. She does not point to objects of interest and
appears to be in her "own world." Which of the following represents the SINGLE BEST next
step in management?
A) Referral to audiology and early intervention services
B) Immediate initiation of speech therapy only
C) MRI of the brain to rule out structural abnormalities
D) Observation for 6 months to assess for spontaneous improvement
Correct Answer: A) Referral to audiology and early intervention services
Rationale: When a child presents with language delay and social communication deficits
, concerning for ASD, the immediate priority is to rule out hearing impairment through audiology
assessment and refer to early intervention services. Early intensive behavioral intervention has
been shown to improve outcomes. Observation without intervention is inappropriate, and MRI
is not the first-line investigation.
6. Which of the following genetic syndromes is MOST strongly associated with autism
spectrum disorder?
A) Down syndrome (Trisomy 21)
B) Fragile X syndrome
C) Klinefelter syndrome (XXY)
D) Turner syndrome (XO)
Correct Answer: B) Fragile X syndrome
Rationale: Fragile X syndrome is the most common inherited cause of intellectual disability and
the most common known single-gene cause of ASD, with approximately 30-50% of males with
Fragile X meeting criteria for ASD. While Down syndrome and other genetic conditions have
increased rates of ASD compared to the general population, Fragile X has the strongest
association.
7. A 5-year-old male with ASD is being evaluated for school placement. He has moderate
intellectual disability, limited functional communication, and requires assistance with
toileting and feeding. Which educational setting is MOST appropriate?
A) Full inclusion in a general education classroom with a paraprofessional
B) Self-contained special education classroom with a low student-to-teacher ratio
C) Residential treatment facility
D) Homeschooling with speech therapy twice weekly
Correct Answer: B) Self-contained special education classroom with a low student-to-teacher
ratio
Rationale: Children with ASD who have moderate intellectual disability and require substantial
support for daily living skills benefit from specialized educational settings with a low student-to-
teacher ratio and access to related services (speech, OT, behavioral support). Full inclusion may
not provide adequate support, and residential placement is premature without first attempting
community-based educational options.
