LATEST CHILD & ADOLESCENT PSYCHIATRY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 9-year-old male has difficulty sustaining attention
in class, frequently loses his homework, fidgets
constantly, and interrupts others. Symptoms have
been present since age 6 and occur in both school
and home. Which is the first-line pharmacologic
treatment?
A) Clonidine
B) Methylphenidate
C) Fluoxetine
D) Risperidone
Correct answer: B
Rationale: Methylphenidate (stimulant) is first-line for
ADHD, with the strongest evidence for reducing core
symptoms of inattention, hyperactivity, and
impulsivity. Alpha-agonists are second-line.
2. A 14-year-old female has had a depressed mood,
anhedonia, insomnia, poor appetite, and difficulty
,concentrating for 8 weeks. She denies suicidal
ideation. Which antidepressant has FDA approval for
adolescent major depressive disorder?
A) Sertraline
B) Paroxetine
C) Venlafaxine
D) Escitalopram
Correct answer: D
Rationale: Escitalopram and fluoxetine are FDA-
approved for adolescent MDD. Sertraline is approved
for pediatric OCD but not MDD. Paroxetine is not
approved due to suicidality risk.
3. A 7-year-old male has a 6-month history of severe
temper outbursts, irritable mood between outbursts,
and hyperarousal (difficulty sleeping). Symptoms
occur at home and school. Which is the most likely
diagnosis?
A) Bipolar I disorder
B) Oppositional defiant disorder
C) Disruptive mood dysregulation disorder (DMDD)
D) Intermittent explosive disorder
Correct answer: C
,Rationale: DMDD is characterized by severe,
recurrent temper outbursts with irritable/angry mood
between outbursts, onset before age 10, and
duration >12 months. It was introduced to avoid
overdiagnosis of pediatric bipolar disorder.
4. A 15-year-old male reports recurrent, intrusive
thoughts of contamination followed by repetitive
hand washing lasting 2 hours daily. Symptoms cause
significant distress and academic impairment. Which
is the first-line pharmacotherapy?
A) Clomipramine
B) Fluoxetine
C) Clonazepam
D) Aripiprazole
Correct answer: B
Rationale: SSRIs (fluoxetine, sertraline, fluvoxamine)
are first-line for pediatric OCD. Clomipramine is
effective but has more side effects; it is second-line.
Aripiprazole is augmenting.
5. A 12-year-old female has had separation anxiety,
excessive worry about school performance, and
physical symptoms (headaches, stomachaches) for 4
, months. Which psychotherapy has the strongest
evidence?
A) Psychodynamic therapy
B) Cognitive-behavioral therapy (CBT)
C) Family therapy
D) Play therapy
Correct answer: B
Rationale: CBT is the most evidence-based
psychotherapy for pediatric anxiety disorders,
including separation anxiety, generalized anxiety,
and social anxiety, with large effect sizes.
6. An 8-year-old male has had repetitive motor tics
(eye blinking, head jerking) and vocal tics (throat
clearing, sniffing) for 18 months. Symptoms wax and
wane. Which is the first-line pharmacotherapy for
moderate to severe tics?
A) Haloperidol
B) Clonidine
C) Tetrabenazine
D) Botulinum toxin
Correct answer: B
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 9-year-old male has difficulty sustaining attention
in class, frequently loses his homework, fidgets
constantly, and interrupts others. Symptoms have
been present since age 6 and occur in both school
and home. Which is the first-line pharmacologic
treatment?
A) Clonidine
B) Methylphenidate
C) Fluoxetine
D) Risperidone
Correct answer: B
Rationale: Methylphenidate (stimulant) is first-line for
ADHD, with the strongest evidence for reducing core
symptoms of inattention, hyperactivity, and
impulsivity. Alpha-agonists are second-line.
2. A 14-year-old female has had a depressed mood,
anhedonia, insomnia, poor appetite, and difficulty
,concentrating for 8 weeks. She denies suicidal
ideation. Which antidepressant has FDA approval for
adolescent major depressive disorder?
A) Sertraline
B) Paroxetine
C) Venlafaxine
D) Escitalopram
Correct answer: D
Rationale: Escitalopram and fluoxetine are FDA-
approved for adolescent MDD. Sertraline is approved
for pediatric OCD but not MDD. Paroxetine is not
approved due to suicidality risk.
3. A 7-year-old male has a 6-month history of severe
temper outbursts, irritable mood between outbursts,
and hyperarousal (difficulty sleeping). Symptoms
occur at home and school. Which is the most likely
diagnosis?
A) Bipolar I disorder
B) Oppositional defiant disorder
C) Disruptive mood dysregulation disorder (DMDD)
D) Intermittent explosive disorder
Correct answer: C
,Rationale: DMDD is characterized by severe,
recurrent temper outbursts with irritable/angry mood
between outbursts, onset before age 10, and
duration >12 months. It was introduced to avoid
overdiagnosis of pediatric bipolar disorder.
4. A 15-year-old male reports recurrent, intrusive
thoughts of contamination followed by repetitive
hand washing lasting 2 hours daily. Symptoms cause
significant distress and academic impairment. Which
is the first-line pharmacotherapy?
A) Clomipramine
B) Fluoxetine
C) Clonazepam
D) Aripiprazole
Correct answer: B
Rationale: SSRIs (fluoxetine, sertraline, fluvoxamine)
are first-line for pediatric OCD. Clomipramine is
effective but has more side effects; it is second-line.
Aripiprazole is augmenting.
5. A 12-year-old female has had separation anxiety,
excessive worry about school performance, and
physical symptoms (headaches, stomachaches) for 4
, months. Which psychotherapy has the strongest
evidence?
A) Psychodynamic therapy
B) Cognitive-behavioral therapy (CBT)
C) Family therapy
D) Play therapy
Correct answer: B
Rationale: CBT is the most evidence-based
psychotherapy for pediatric anxiety disorders,
including separation anxiety, generalized anxiety,
and social anxiety, with large effect sizes.
6. An 8-year-old male has had repetitive motor tics
(eye blinking, head jerking) and vocal tics (throat
clearing, sniffing) for 18 months. Symptoms wax and
wane. Which is the first-line pharmacotherapy for
moderate to severe tics?
A) Haloperidol
B) Clonidine
C) Tetrabenazine
D) Botulinum toxin
Correct answer: B
