NRNP 6665 FINAL EXAM 3
LATEST VERSIONS A, B & C 2026/2027
Each Version Contains 100 Questions and Correct Detailed Answers
PMHNP Care Across the Lifespan I | Walden University
Aligned with DSM-5-TR, ANCC Certification, and 2026/2027 Curriculum Standards
300 Total Questions | Multiple Choice (A-D) | With Answer Key and Rationales
VERSION A
Section 1: Foundations of Psychiatric Assessment and Diagnosis (MSE, History Taking, & Screening Tools)
1. A PMHNP is conducting a mental status examination (MSE) on a new patient. The patient repeatedly checks the door locks
during the interview and expresses persistent worry about intruders. Which MSE component is most directly assessed by this
observation?
A. Thought content
B. Perceptual disturbances
C. Behavior and psychomotor activity [CORRECT]
D. Insight and judgment
Correct Answer: C
Rationale: The MSE component of behavior and psychomotor activity includes observable actions, mannerisms, and level of psychomotor agitation or retardation.
The patient's compulsive door-checking and anxious restlessness fall directly under this domain. Thought content examines beliefs and obsessions. Perception
assesses hallucinations. Insight and judgment evaluate awareness of illness and decision-making.
2. During a psychiatric interview, a patient states, 'I hear my deceased mother calling my name when I am alone at night.' The
PMHNP documents this finding under which MSE category?
A. Thought process
B. Perception [CORRECT]
C. Thought content
D. Cognition
Correct Answer: B
Rationale: Auditory hallucinations are documented under the perception component of the MSE. Perception assesses hallucinations (auditory, visual, tactile, olfactory,
gustatory) and illusions. Thought process refers to logical flow of ideas (tangentiality, loose associations). Thought content examines delusions, obsessions, and
overvalued ideas. Cognition assesses orientation, memory, and attention.
3. A PMHNP administers the PHQ-9 to a patient who reports feeling down, little interest in activities, trouble sleeping, fatigue,
poor appetite, and feeling like a failure. The patient scores 18. What does this score indicate?
A. Minimal depression (score 0-4)
B. Moderate depression (score 10-14)
C. Moderately severe depression (score 15-19) [CORRECT]
D. Severe depression (score 20-27)
Correct Answer: C
Rationale: The PHQ-9 score ranges from 0 to 27. Scores of 0-4 indicate minimal depression, 5-9 mild, 10-14 moderate, 15-19 moderately severe, and 20-27 severe. A
score of 18 falls within the moderately severe range, typically warranting active treatment with pharmacotherapy and/or psychotherapy. This screening tool is not
diagnostic but guides clinical decision-making about treatment intensity.
Page 1
,NRNP 6665 Final Exam - Walden PMHNP 2026/2027 Walden University PMHNP 2026/2027
4. Which screening tool is most appropriate for a PMHNP assessing a patient's risk of alcohol use disorder?
A. PHQ-9
B. GAD-7
C. AUDIT [CORRECT]
D. MoCA
Correct Answer: C
Rationale: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item WHO-validated screening tool specifically for hazardous and harmful alcohol
consumption, dependence symptoms, and alcohol-related problems. The PHQ-9 screens for depression. The GAD-7 screens for generalized anxiety. The Montreal
Cognitive Assessment (MoCA) screens for cognitive impairment. The AUDIT is the gold standard for alcohol screening in primary care and psychiatric settings.
5. During a psychiatric assessment, a patient demonstrates difficulty recalling three words after 5 minutes, cannot name the
current president, and is disoriented to time. Which cognitive domain is most impaired?
A. Attention
B. Memory and orientation [CORRECT]
C. Abstract thinking
D. Executive function
Correct Answer: B
Rationale: Inability to recall words after a delay indicates short-term memory impairment, and disorientation to time reflects impaired orientation. Both are
fundamental cognitive domains assessed during the MSE. Attention is assessed through serial 7s or digit span. Abstract thinking is evaluated through proverb
interpretation. Executive function involves planning, organizing, and task-switching abilities assessed through clock drawing or trail-making tasks.
6. A PMHNP is obtaining a psychiatric history from a patient with newly diagnosed major depressive disorder. Which element is
most critical for determining appropriate pharmacological treatment?
A. Family history of psychiatric disorders
B. Previous medication trials, responses, and adverse effects [CORRECT]
C. Childhood developmental milestones
D. Legal history and previous hospitalizations
Correct Answer: B
Rationale: Previous medication trials including which medications, doses, durations, therapeutic responses, and adverse effects is the most critical element for guiding
pharmacological treatment. This helps avoid repeating ineffective treatments, select medications with favorable side effect profiles, and consider augmentation or
combination strategies. Family history is important for genetic risk assessment but less directly actionable for immediate prescribing.
7. The C-SSRS (Columbia-Suicide Severity Rating Scale) is administered to a patient. The patient endorses passive suicidal
ideation without intent or plan. How should the PMHNP document this?
A. Wish to be dead, no active suicidal ideation [CORRECT]
B. Active suicidal ideation with method but without intent
C. Active suicidal ideation with intent and plan
D. Suicidal behavior with preparatory acts
Correct Answer: A
Rationale: The C-SSRS categorizes suicidal ideation severity into levels. 'Wish to be dead' represents the mildest form where the patient may wish they were dead but
has no active thoughts of killing themselves. Active ideation with method involves thinking about a specific method without intent. Active ideation with intent and
plan indicates higher acuity requiring immediate safety planning. Suicidal behavior refers to actual preparatory acts or self-harm.
8. A PMHNP is conducting a biopsychosocial assessment of a patient with anxiety. Which finding represents the biological
domain?
A. The patient reports marital conflict and job dissatisfaction
B. The patient has a first-degree relative with GAD and elevated cortisol levels [CORRECT]
C. The patient avoids social gatherings and has few friends
D. The patient believes that worry is a sign of weakness
Correct Answer: B
Rationale: The biological domain includes genetic predisposition (family history), neurochemical imbalances, and physiological markers such as elevated cortisol
levels. Marital conflict and job dissatisfaction are social domain factors. Social avoidance and limited friendships are psychosocial factors. Beliefs about worry
represent the psychological domain through cognitive patterns. A comprehensive biopsychosocial formulation integrates all three domains.
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,NRNP 6665 Final Exam - Walden PMHNP 2026/2027 Walden University PMHNP 2026/2027
9. A patient presents with a flat affect, monotone speech, and minimal spontaneous movement. The MSE documentation should
describe this as which of the following?
A. Psychomotor agitation
B. Euthymic mood with appropriate affect
C. Psychomotor retardation with blunted affect [CORRECT]
D. Catatonic behavior with waxy flexibility
Correct Answer: C
Rationale: Psychomotor retardation involves visible slowing of movements, speech, and thought processes, commonly seen in major depressive disorder and
schizophrenia (negative symptoms). Blunted affect refers to significant reduction in emotional expression intensity. Psychomotor agitation involves restlessness and
excess movement. Euthymic mood indicates normal mood. Catatonia with waxy flexibility is specific to schizophrenia spectrum disorders.
10. Which statement by a patient during an MSE most accurately reflects impaired insight?
A. I know I have depression but I think the medication will help me get better
B. I understand my anxiety is excessive but I cannot control it
C. There is nothing wrong with me; I do not need to be here; everyone else is the problem [CORRECT]
D. I sometimes hear things that are not there, which is part of my illness
Correct Answer: C
Rationale: Impaired insight is characterized by inability to recognize or acknowledge psychiatric illness, symptoms, or need for treatment. Option C demonstrates
complete lack of awareness, attributing problems entirely to external factors. The other options demonstrate varying degrees of intact insight where the patient
acknowledges their symptoms. Poor insight is common in schizophrenia, bipolar mania, and substance use disorders.
11. A PMHNP uses the GAD-7 screening tool. A patient scores 14. What is the recommended next step?
A. No treatment indicated; reassess at next visit
B. Watchful waiting; provide education only
C. Consider pharmacotherapy and/or psychotherapy; further assessment for GAD diagnosis [CORRECT]
D. Immediate hospitalization for severe anxiety
Correct Answer: C
Rationale: The GAD-7 ranges from 0-21. Scores 0-4 indicate minimal anxiety, 5-9 mild, 10-14 moderate, and 15-21 severe. A score of 14 falls in the moderate range,
warranting active treatment consideration including SSRIs, SNRIs, or CBT. The PMHNP should conduct further diagnostic assessment to confirm GAD and evaluate
for comorbid conditions before initiating treatment.
12. When conducting a psychiatric interview, the PMHNP observes rapid, loud speech difficult to interrupt, with topic jumps.
How should this be documented?
A. Poverty of speech with delayed latency
B. Pressured speech with flight of ideas [CORRECT]
C. Echolalia with verbigeration
D. Tangential speech with circumstantiality
Correct Answer: B
Rationale: Pressured speech is rapid, increased volume, and difficult to interrupt, commonly seen in mania. Flight of ideas describes rapid topic shifts with
understandable associations but no clear logical connection. Poverty of speech and delayed latency are seen in depression and schizophrenia negative symptoms.
Echolalia is repetition of another person's words. Tangentiality refers to responses drifting from the topic.
13. A PMHNP is assessing a patient using the MMSE. The patient scores 22 out of 30. How should this be interpreted?
A. Normal cognitive function (24-30)
B. Mild cognitive impairment (21-23) [CORRECT]
C. Moderate cognitive impairment (10-20)
D. Severe cognitive impairment (below 10)
Correct Answer: B
Rationale: The MMSE is a 30-point screening tool. Scores 24-30 are normal, 21-23 suggest mild cognitive impairment, 10-20 indicate moderate, and below 10
indicate severe. A score of 22 warrants further evaluation for possible neurocognitive disorders and underlying reversible causes such as medication side effects,
metabolic disturbances, depression (pseudodementia), or vitamin deficiencies.
Page 3
, NRNP 6665 Final Exam - Walden PMHNP 2026/2027 Walden University PMHNP 2026/2027
14. A patient reports a history of childhood physical abuse, parental substance use, and current homelessness. Which assessment
framework best captures these multi-layered factors?
A. DSM-5-TR multiaxial system
B. The biopsychosocial formulation model [CORRECT]
C. The SF-36
D. The GAF scale
Correct Answer: B
Rationale: The biopsychosocial model provides a comprehensive framework for understanding biological, psychological, and social factors. Childhood abuse
(psychological trauma), parental substance use (biological/psychosocial risk), and homelessness (social determinant) are all captured. The DSM-5-TR no longer uses
the multiaxial system. The SF-36 measures quality of life. The GAF was replaced by WHODAS 2.0.
15. A PMHNP evaluates a new patient who reports excessive worry about multiple life circumstances, muscle tension, irritability,
and sleep disturbance for 8 months. GAD-7 score is 16. Which initial diagnostic impression is most consistent?
A. Panic disorder
B. Generalized anxiety disorder [CORRECT]
C. Adjustment disorder with anxious mood
D. Social anxiety disorder
Correct Answer: B
Rationale: GAD requires excessive anxiety occurring more days than not for at least 6 months, difficulty controlling worry, and at least three additional symptoms
including restlessness, fatigue, concentration difficulty, irritability, muscle tension, or sleep disturbance. The 8-month duration, multiple worry domains, combined
symptoms, and GAD-7 of 16 strongly support GAD. Panic disorder involves discrete attacks.
Section 2: Neurodevelopmental and Childhood Disorders
16. A 7-year-old child has persistent difficulties with reading, slow reading speed, difficulty decoding unfamiliar words, and poor
comprehension despite average intelligence. Which disorder is most consistent?
A. Autism spectrum disorder
B. Specific learning disorder with impairment in reading [CORRECT]
C. ADHD, predominantly inattentive presentation
D. Intellectual disability
Correct Answer: B
Rationale: Specific learning disorder with reading impairment (dyslexia) involves persistent difficulties with word recognition, fluency, and comprehension
significantly below age expectations for at least 6 months despite intervention. These cannot be attributed to intellectual disability, sensory deficits, or inadequate
education. ASD involves social communication deficits. ADHD involves inattention/hyperactivity. Intellectual disability involves IQ below 70.
17. A 4-year-old child displays persistent deficits in social-emotional reciprocity, reduced shared enjoyment, absence of interest in
peers, repetitive hand-flapping, and insistence on sameness. Which diagnosis best fits?
A. Social communication disorder
B. Autism spectrum disorder [CORRECT]
C. Intellectual disability
D. Childhood-onset fluency disorder
Correct Answer: B
Rationale: ASD requires persistent deficits in social communication (reciprocity, nonverbal communication, relationships) plus restricted/repetitive behaviors
(stereotypies, insistence on sameness, restricted interests, sensory abnormalities). This child's social deficits plus hand-flapping and insistence on sameness meet
DSM-5-TR criteria. Social communication disorder lacks the repetitive behaviors.
Page 4
LATEST VERSIONS A, B & C 2026/2027
Each Version Contains 100 Questions and Correct Detailed Answers
PMHNP Care Across the Lifespan I | Walden University
Aligned with DSM-5-TR, ANCC Certification, and 2026/2027 Curriculum Standards
300 Total Questions | Multiple Choice (A-D) | With Answer Key and Rationales
VERSION A
Section 1: Foundations of Psychiatric Assessment and Diagnosis (MSE, History Taking, & Screening Tools)
1. A PMHNP is conducting a mental status examination (MSE) on a new patient. The patient repeatedly checks the door locks
during the interview and expresses persistent worry about intruders. Which MSE component is most directly assessed by this
observation?
A. Thought content
B. Perceptual disturbances
C. Behavior and psychomotor activity [CORRECT]
D. Insight and judgment
Correct Answer: C
Rationale: The MSE component of behavior and psychomotor activity includes observable actions, mannerisms, and level of psychomotor agitation or retardation.
The patient's compulsive door-checking and anxious restlessness fall directly under this domain. Thought content examines beliefs and obsessions. Perception
assesses hallucinations. Insight and judgment evaluate awareness of illness and decision-making.
2. During a psychiatric interview, a patient states, 'I hear my deceased mother calling my name when I am alone at night.' The
PMHNP documents this finding under which MSE category?
A. Thought process
B. Perception [CORRECT]
C. Thought content
D. Cognition
Correct Answer: B
Rationale: Auditory hallucinations are documented under the perception component of the MSE. Perception assesses hallucinations (auditory, visual, tactile, olfactory,
gustatory) and illusions. Thought process refers to logical flow of ideas (tangentiality, loose associations). Thought content examines delusions, obsessions, and
overvalued ideas. Cognition assesses orientation, memory, and attention.
3. A PMHNP administers the PHQ-9 to a patient who reports feeling down, little interest in activities, trouble sleeping, fatigue,
poor appetite, and feeling like a failure. The patient scores 18. What does this score indicate?
A. Minimal depression (score 0-4)
B. Moderate depression (score 10-14)
C. Moderately severe depression (score 15-19) [CORRECT]
D. Severe depression (score 20-27)
Correct Answer: C
Rationale: The PHQ-9 score ranges from 0 to 27. Scores of 0-4 indicate minimal depression, 5-9 mild, 10-14 moderate, 15-19 moderately severe, and 20-27 severe. A
score of 18 falls within the moderately severe range, typically warranting active treatment with pharmacotherapy and/or psychotherapy. This screening tool is not
diagnostic but guides clinical decision-making about treatment intensity.
Page 1
,NRNP 6665 Final Exam - Walden PMHNP 2026/2027 Walden University PMHNP 2026/2027
4. Which screening tool is most appropriate for a PMHNP assessing a patient's risk of alcohol use disorder?
A. PHQ-9
B. GAD-7
C. AUDIT [CORRECT]
D. MoCA
Correct Answer: C
Rationale: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item WHO-validated screening tool specifically for hazardous and harmful alcohol
consumption, dependence symptoms, and alcohol-related problems. The PHQ-9 screens for depression. The GAD-7 screens for generalized anxiety. The Montreal
Cognitive Assessment (MoCA) screens for cognitive impairment. The AUDIT is the gold standard for alcohol screening in primary care and psychiatric settings.
5. During a psychiatric assessment, a patient demonstrates difficulty recalling three words after 5 minutes, cannot name the
current president, and is disoriented to time. Which cognitive domain is most impaired?
A. Attention
B. Memory and orientation [CORRECT]
C. Abstract thinking
D. Executive function
Correct Answer: B
Rationale: Inability to recall words after a delay indicates short-term memory impairment, and disorientation to time reflects impaired orientation. Both are
fundamental cognitive domains assessed during the MSE. Attention is assessed through serial 7s or digit span. Abstract thinking is evaluated through proverb
interpretation. Executive function involves planning, organizing, and task-switching abilities assessed through clock drawing or trail-making tasks.
6. A PMHNP is obtaining a psychiatric history from a patient with newly diagnosed major depressive disorder. Which element is
most critical for determining appropriate pharmacological treatment?
A. Family history of psychiatric disorders
B. Previous medication trials, responses, and adverse effects [CORRECT]
C. Childhood developmental milestones
D. Legal history and previous hospitalizations
Correct Answer: B
Rationale: Previous medication trials including which medications, doses, durations, therapeutic responses, and adverse effects is the most critical element for guiding
pharmacological treatment. This helps avoid repeating ineffective treatments, select medications with favorable side effect profiles, and consider augmentation or
combination strategies. Family history is important for genetic risk assessment but less directly actionable for immediate prescribing.
7. The C-SSRS (Columbia-Suicide Severity Rating Scale) is administered to a patient. The patient endorses passive suicidal
ideation without intent or plan. How should the PMHNP document this?
A. Wish to be dead, no active suicidal ideation [CORRECT]
B. Active suicidal ideation with method but without intent
C. Active suicidal ideation with intent and plan
D. Suicidal behavior with preparatory acts
Correct Answer: A
Rationale: The C-SSRS categorizes suicidal ideation severity into levels. 'Wish to be dead' represents the mildest form where the patient may wish they were dead but
has no active thoughts of killing themselves. Active ideation with method involves thinking about a specific method without intent. Active ideation with intent and
plan indicates higher acuity requiring immediate safety planning. Suicidal behavior refers to actual preparatory acts or self-harm.
8. A PMHNP is conducting a biopsychosocial assessment of a patient with anxiety. Which finding represents the biological
domain?
A. The patient reports marital conflict and job dissatisfaction
B. The patient has a first-degree relative with GAD and elevated cortisol levels [CORRECT]
C. The patient avoids social gatherings and has few friends
D. The patient believes that worry is a sign of weakness
Correct Answer: B
Rationale: The biological domain includes genetic predisposition (family history), neurochemical imbalances, and physiological markers such as elevated cortisol
levels. Marital conflict and job dissatisfaction are social domain factors. Social avoidance and limited friendships are psychosocial factors. Beliefs about worry
represent the psychological domain through cognitive patterns. A comprehensive biopsychosocial formulation integrates all three domains.
Page 2
,NRNP 6665 Final Exam - Walden PMHNP 2026/2027 Walden University PMHNP 2026/2027
9. A patient presents with a flat affect, monotone speech, and minimal spontaneous movement. The MSE documentation should
describe this as which of the following?
A. Psychomotor agitation
B. Euthymic mood with appropriate affect
C. Psychomotor retardation with blunted affect [CORRECT]
D. Catatonic behavior with waxy flexibility
Correct Answer: C
Rationale: Psychomotor retardation involves visible slowing of movements, speech, and thought processes, commonly seen in major depressive disorder and
schizophrenia (negative symptoms). Blunted affect refers to significant reduction in emotional expression intensity. Psychomotor agitation involves restlessness and
excess movement. Euthymic mood indicates normal mood. Catatonia with waxy flexibility is specific to schizophrenia spectrum disorders.
10. Which statement by a patient during an MSE most accurately reflects impaired insight?
A. I know I have depression but I think the medication will help me get better
B. I understand my anxiety is excessive but I cannot control it
C. There is nothing wrong with me; I do not need to be here; everyone else is the problem [CORRECT]
D. I sometimes hear things that are not there, which is part of my illness
Correct Answer: C
Rationale: Impaired insight is characterized by inability to recognize or acknowledge psychiatric illness, symptoms, or need for treatment. Option C demonstrates
complete lack of awareness, attributing problems entirely to external factors. The other options demonstrate varying degrees of intact insight where the patient
acknowledges their symptoms. Poor insight is common in schizophrenia, bipolar mania, and substance use disorders.
11. A PMHNP uses the GAD-7 screening tool. A patient scores 14. What is the recommended next step?
A. No treatment indicated; reassess at next visit
B. Watchful waiting; provide education only
C. Consider pharmacotherapy and/or psychotherapy; further assessment for GAD diagnosis [CORRECT]
D. Immediate hospitalization for severe anxiety
Correct Answer: C
Rationale: The GAD-7 ranges from 0-21. Scores 0-4 indicate minimal anxiety, 5-9 mild, 10-14 moderate, and 15-21 severe. A score of 14 falls in the moderate range,
warranting active treatment consideration including SSRIs, SNRIs, or CBT. The PMHNP should conduct further diagnostic assessment to confirm GAD and evaluate
for comorbid conditions before initiating treatment.
12. When conducting a psychiatric interview, the PMHNP observes rapid, loud speech difficult to interrupt, with topic jumps.
How should this be documented?
A. Poverty of speech with delayed latency
B. Pressured speech with flight of ideas [CORRECT]
C. Echolalia with verbigeration
D. Tangential speech with circumstantiality
Correct Answer: B
Rationale: Pressured speech is rapid, increased volume, and difficult to interrupt, commonly seen in mania. Flight of ideas describes rapid topic shifts with
understandable associations but no clear logical connection. Poverty of speech and delayed latency are seen in depression and schizophrenia negative symptoms.
Echolalia is repetition of another person's words. Tangentiality refers to responses drifting from the topic.
13. A PMHNP is assessing a patient using the MMSE. The patient scores 22 out of 30. How should this be interpreted?
A. Normal cognitive function (24-30)
B. Mild cognitive impairment (21-23) [CORRECT]
C. Moderate cognitive impairment (10-20)
D. Severe cognitive impairment (below 10)
Correct Answer: B
Rationale: The MMSE is a 30-point screening tool. Scores 24-30 are normal, 21-23 suggest mild cognitive impairment, 10-20 indicate moderate, and below 10
indicate severe. A score of 22 warrants further evaluation for possible neurocognitive disorders and underlying reversible causes such as medication side effects,
metabolic disturbances, depression (pseudodementia), or vitamin deficiencies.
Page 3
, NRNP 6665 Final Exam - Walden PMHNP 2026/2027 Walden University PMHNP 2026/2027
14. A patient reports a history of childhood physical abuse, parental substance use, and current homelessness. Which assessment
framework best captures these multi-layered factors?
A. DSM-5-TR multiaxial system
B. The biopsychosocial formulation model [CORRECT]
C. The SF-36
D. The GAF scale
Correct Answer: B
Rationale: The biopsychosocial model provides a comprehensive framework for understanding biological, psychological, and social factors. Childhood abuse
(psychological trauma), parental substance use (biological/psychosocial risk), and homelessness (social determinant) are all captured. The DSM-5-TR no longer uses
the multiaxial system. The SF-36 measures quality of life. The GAF was replaced by WHODAS 2.0.
15. A PMHNP evaluates a new patient who reports excessive worry about multiple life circumstances, muscle tension, irritability,
and sleep disturbance for 8 months. GAD-7 score is 16. Which initial diagnostic impression is most consistent?
A. Panic disorder
B. Generalized anxiety disorder [CORRECT]
C. Adjustment disorder with anxious mood
D. Social anxiety disorder
Correct Answer: B
Rationale: GAD requires excessive anxiety occurring more days than not for at least 6 months, difficulty controlling worry, and at least three additional symptoms
including restlessness, fatigue, concentration difficulty, irritability, muscle tension, or sleep disturbance. The 8-month duration, multiple worry domains, combined
symptoms, and GAD-7 of 16 strongly support GAD. Panic disorder involves discrete attacks.
Section 2: Neurodevelopmental and Childhood Disorders
16. A 7-year-old child has persistent difficulties with reading, slow reading speed, difficulty decoding unfamiliar words, and poor
comprehension despite average intelligence. Which disorder is most consistent?
A. Autism spectrum disorder
B. Specific learning disorder with impairment in reading [CORRECT]
C. ADHD, predominantly inattentive presentation
D. Intellectual disability
Correct Answer: B
Rationale: Specific learning disorder with reading impairment (dyslexia) involves persistent difficulties with word recognition, fluency, and comprehension
significantly below age expectations for at least 6 months despite intervention. These cannot be attributed to intellectual disability, sensory deficits, or inadequate
education. ASD involves social communication deficits. ADHD involves inattention/hyperactivity. Intellectual disability involves IQ below 70.
17. A 4-year-old child displays persistent deficits in social-emotional reciprocity, reduced shared enjoyment, absence of interest in
peers, repetitive hand-flapping, and insistence on sameness. Which diagnosis best fits?
A. Social communication disorder
B. Autism spectrum disorder [CORRECT]
C. Intellectual disability
D. Childhood-onset fluency disorder
Correct Answer: B
Rationale: ASD requires persistent deficits in social communication (reciprocity, nonverbal communication, relationships) plus restricted/repetitive behaviors
(stereotypies, insistence on sameness, restricted interests, sensory abnormalities). This child's social deficits plus hand-flapping and insistence on sameness meet
DSM-5-TR criteria. Social communication disorder lacks the repetitive behaviors.
Page 4
