Developmental Review

ages & stages

100

A nine-year-old child is diagnosed with depression after a prolonged quarantine. After spending the previous school year in a virtual learning environment, the child returned to an in-person school setting one month ago. A disruption in which of the following developmental processes should be assessed as a possible contributing factor to the child's diagnosis?

A. Fidelity

B. Wisdom

C. Hope

D. Purpose

E. Competency

E. Competency

Erikson's Stages:

Hope - 0-1 yr, trust vs mistrust

Purpose - 3-6 yrs, initiative vs guilt

Competency - 7-11 yrs, industry vs inferiority

Fidelity - 12-18 years, identity vs confusion

Wisdom - 65 +, integrity vs depair

200

A 23-year-old patient began psychotherapy due to feelings of inadequacy and depression in the context of working in a coffee shop since graduating from college and deferring medical school acceptance. The patient has been having conflicts with parents over his ambivalence about becoming a physician. Which of the following is the most likely developmental task with which the patient is struggling?

A. Identity

B. Intimacy

C. Mastery

D. Productivity

E. Generativity

A. Identity

Explanation:

 At age 23, emerging adults often re-experience or extend adolescent identity crises regarding career choices, autonomy from parents, and self-definition.

300

According to Erikson, the predominant emotional issue in typically developing, school-age children is:

A. ordinal position

B. physical appearance

C. identity consolidation

D. parental attachment and love

E. personal worth and competence

E. personal worth and competence

Explanation: According to Erikson, school-age children (roughly ages 6 to 12) fall into the Industry vs. Inferiority stage. During this period, children primarily focus on mastering new skills, interacting with peers, and performing academic and social tasks.

A. ordinal position: This refers to birth order (e.g., first-born, middle child), which is a focus of Alfred Adler's individual psychology, not Erikson's theory.

B. physical appearance: Preoccupation with body image and appearance peaks during adolescence (Identity vs. Role Confusion) rather than standard school-age childhood. 

C. identity consolidation: Identity formation is the predominant conflict of adolescence (ages 12 to 18), which follows the school-age stage. 

D. parental attachment and love: Establishing attachment, trust, and basic security is the primary emotional milestone of infancy (Trust vs. Mistrust).

400

An 11-year-old child who has previously been reluctant to take part in team sports asks a parent about joining the cross-country team at school. The parent responds that participating in team sports is an important experience to consider and asks whether the child would enjoy being on the team. This interaction is most congruent with which parenting style?

A. Authoritarian

B. Authoritative

C. Demanding

D. Permissive

E. Uninvolved

B. Authoritative

Parenting styles:
Authoritarian - strict and cold

Authoritative - firm but loving

Permissive - warm with no rules

Uninvolved - detached and neglectful

500

Which of the following advancements in language development is typical in a preschool-age child?

A. Understanding the passive voice

B. Using morphemes to understand new words

C. Putting two words together to form a sentence

D. Incorporating question words such as "why" and "how"

E. Using single words in combination with gestures to communicate

D. Incorporating question words such as "why" and "how"

Other answers:

passive voice - 1st grade, 6yo +
morphemes (eg prefixes/suffixes) - kindergarten (5-6 yo)
two words for a sentence - 2 yo
single words with gestures to communicate - 1 yo

you're cute genes

100

Which of the following genetic disorders are X-linked ? (Select three.)

A. Lesch-Nyhan syndrome

B. Rett syndrome

C. Gaucher disease

D. Phenylketonuria

E. Fragile X syndrome

F. Ataxia telangiectasia

G. Angelman syndrome

H. Prader-Willi syndrome

A, B, and E

Lesch-Nyhan syndrome: X-linked recessive

Rett syndrome: X-linked dominant (mostly sporadic/de novo mutations)

Gaucher disease: Autosomal recessive

Phenylketonuria: Autosomal recessive

Fragile X syndrome: X-linked dominant with trinucleotide repeat expansion

Ataxia telangiectasia: Autosomal recessive

Angelman syndrome: Genomic imprinting / maternal chromosome 15 loss (deletion, uniparental disomy, or mutation)

Prader-Willi syndrome: Genomic imprinting / paternal chromosome 15 loss

200

A ten-year-old-girl is brought to a psychiatrist's office by her mother for evaluation of temper outbursts, mood lability, daytime somnolence, and a compulsive need to put her toys in a certain order. Her mother reports that she struggles in school and has been diagnosed with learning disabilities. Her BMI places her in the obese category, and her height is below the normal range for her age. During the interview, the psychiatrist notices some areas of raw skin on the child's arm, and her mother reports that she picks at bug bites when she is stressed.

Which of the following is the inheritance pattern yof the child's most likely genetic condition?

A. Autosomal dominant

B. Trinucleotide repeat expansion

C. X-linked recessive

D. Maternal disomy of chromosome 15

E. Deletion in chromosome 22

D. Maternal disomy of chromosome 15

Prader Willi - genetic disorder characterized by childhood obesity, short stature, learning disabilities, and compulsive skin picking

300

Which of the following investigational methods is most likely to demonstrate the relative contribution of genetic versus environmental factors in disease etiology?

A. Karyotyping

B. Twin studies

C. Linkage analysis

D. Candidate gene studies

E. Next generation sequencing

B. Twin studies

Explanation:

• Karyotyping: Visualizes macro-level chromosome structures to identify large aneuploidies like Down syndrome.
• Twin studies: Compares identical and fraternal twins to differentiate genetic versus environmental disease influences.
• Linkage analysis: Tracks co-inheritance of DNA markers in families to map causal disease genes.
• Candidate gene studies: Tests if a specific, pre-selected gene variant occurs more often in patients.
• Next generation sequencing: Parallel-sequences millions of DNA fragments to find unknown, genome-wide variants.

400

A genetic abnormality resulting from the occurrence of two separate cell types in the same individual is known as:

A. mosaicism.

B. anticipation.

C. premutation.

D. polymorphism.

E. copy number variation

A. mosaicism

Explanation:

• Mosaicism: The presence of distinct cell lines from one zygote, classically causing a milder phenotype of Down syndrome (Trisomy 21).
• Anticipation: Genetic symptoms worsen or appear earlier across generations, seen in trinucleotide repeat expansion disorders like Huntington disease.
• Premutation: An unstable, intermediate-stage genetic expansion that can transition to a full mutation, seen in Fragile X syndrome carriers.
• Polymorphism: A benign genetic variation that does not cause disease, but instead drives normal human variations like height, hair color, or determining ABO blood groups.
• Copy number variation: Structural DNA changes resulting from deleted or duplicated gene copies, causing conditions like DiGeorge syndrome (22q11.2 deletion).

500

Which of the following genetic tests is most useful to detect large deletions and duplications of genetic material?

A. Sanger sequencing

B. Southern blot testing

C. Chromosomal microarray

D. Polymerase chain reaction

E. Next generation sequencing

C. Chromosomal microarray

Genetic Tests:

• Sanger sequencing: Used to confirm single-gene mutations or small variants identified by other testing methods.
• Southern blot testing: Used to diagnose fragile X syndrome, Huntington's disease, and other large expansion or structural repeat disorders.
• Chromosomal microarray: Used as a first-tier test to investigate developmental delays, autism spectrum disorders, and multiple congenital anomalies.
• Polymerase chain reaction: Used for rapid viral or bacterial pathogen detection and genetic disease screening from small tissue samples.
• Next generation sequencing: Used for comprehensive multi-gene panel testing, whole-exome sequencing, and identifying complex mutations in tumor profiles.

conscious babies

100

An infant who engages in an interactive game of peek-a-boo most closely demonstrates the concept ofwhich of the following cognitive abilities?

A. Centering

B. Egocentrism

C. Conservation

D. Object permanence

E. Tertiary circular reaction

D. Object Permanence

Explanation:

Centering: A child focuses on only one feature of a situation, such as throwing a tantrum because their juice was poured into a wide bowl instead of a tall glass

Egocentrism: A toddler assumes everyone shares their exact perspective, like holding up a picture book facing themselves while asking a parent across the room to look at the drawing.

Conservation: A child understands that core properties stay the same despite changes in shape, knowing that smashing a clay ball into a flat pancake does not actually give them more clay.

Object Permanence: An infant realizes that things still exist even when hidden from view

Tertiary Circular Reaction: toddlers purposefully vary their behaviors to experiment and observe different outcomes. A toddler sitting in a high chair drops a cup, metal spoon, and then food. They are intentionally changing the object to see how the drop sound changes and how different items bounce or slide across the floor

200

A 22-month-old is observed to place a wooden block on a toy train track and say, "choo-choo!" whilemoving the block back and forth along the track. This behavior is most likely an example of which ofthe following types of play?

A. Fantasy

B. Parallel

C. Symbolic

D. Cooperative

E. Sensorimotor

C. Symbolic

Different types of play:

Fantasy Play: Children act out imaginary roles, scenarios, and stories, pretending to be characters like superheroes or animals.

Parallel Play: Children play side-by-side with similar toys in close proximity, but they do not actively try to influence or interact with each other's play. 

Symbolic Play: Children use one object to stand for or represent another object, such as using a block as a ringing telephone.

Cooperative Play: Children work together in an organized group or game, sharing ideas, following rules, and pursuing a common goal.

Constructive Play: Children manipulate materials like blocks, clay, or craft supplies to build, construct, or create a specific structure or item.

300

Parents and their three-year-old child were in a serious motor vehicle accident. The parents ask if the child will remember the event when older. The child's declarative memory of this incident is probably most dependent on which of the following factors?

A. Intelligence level

B. Physical stamina

C. Affective stability

D. Language ability

E. Self-regulation capability

D. Language ability

At 3 years old, children heavily rely on verbal encoding to solidify and retain long-term autobiographical memories; events not translated into language at this developmental stage are typically forgotten due to childhood amnesia

400

Which of the following is the best example of a second stage or "self-conscious" emotion, which is believed to develop around the end of the second year of life?

A. Envy

B. Fear

C. Anger

D. Altruism

E. Empathy

A. Envy

Explanation:
The definitive developmental theory mapping out primary emotions versus second-stage (self-conscious) emotions based on a child's emerging cognitive self-awareness was formulated by Dr. Michael Lewis.

• Stage 1 (Primary, 0–6 months): Infants experience innate, biologically programmed emotional reflexes like joy and anger before developing any cognitive sense of self.
• Stage 2 (Self-Conscious Exposure, 18–24 months): Emerging self-awareness and the mental representation of "me" directly trigger exposure emotions like envy, empathy, and embarrassment.
• Stage 3 (Self-Conscious Evaluative, 2.5–3 years): Children internalize societal rules and evaluate their own behavior against these standards, producing complex emotions like pride, shame, and guilt

500

A 15-month-old girl shows an increase in both curiosity about things her mother is paying attention to and reactivity to shifts in her mother's emotional tone. These behaviors are precursors of which of the following developmental outcomes?

A. Strong verbal skills

B. Capacity for empathy

C. Inhibited temperamental style

D. Higher-than-average intelligence

E. Intense rivalry with mother during the Oedipal phase

B. Capacity for empathy

on the spectrum

100

Which of the following is seen most frequently as a comorbid condition in children with autism spectrum disorder?

A. Selective mutism

B. Intellectual disability

C. Early-onset schizophrenia

D. Obsessive-compulsive disorder

E. Attention-deficit/hyperactivity disorder

Our answer E. ADHD

PRITE answer: B. Intellectual disability

Most clinical studies and reviews report that 50% to 70% of children diagnosed with autism spectrum disorder (ASD) also meet the full criteria for attention-deficit/hyperactivity disorder (ADHD)

Approximately 30% to 50% of children with autism spectrum disorder experience co-occurring intellectual impairment

200

Which genetic technique is a first-line assessment tool for autism spectrum disorders?

Chromosomal Microarray

Chromosomal microarray (CMA) is now recognized as the first-tier genetic test for detection of copy number variations (CNVs) in patients with autism spectrum disordor.

300

Autism spectrum disorders in children and adolescents are most highly comorbid with which of the following types of disorder?

A. Anxiety
B. Eating
C. Elimination
D. Personality
E. Psychotic

A. Anxiety

High prevalence rates for clinical anxiety range from 30% to over 80% in autistic youth.

Common presentations include specific phobias, obsessive-compulsive disorder (OCD), and social anxiety

400

Which of the following neurodevelopmental changes is most consistently found in patients with autism spectrum disorders?

A. Ventricular enlargement that increases in adulthood

B. Decreased hippocampal volume as symptoms worsen

C. Increased cerebellar Purkinje neuron count on autopsy

D. Decreased density of cortical interneurons at time of diagnosis 

E. Accelerated increase in total brain volume in the first four years of life

E. Accelerated increase in total brain volume in the first four years of life

While infants with ASD typically have a normal head circumference at birth, a substantial subset experiences a rapid acceleration in brain growth between 6 months and 4 years of age, which later levels off or decelerates toward normal volumes by adolescence and adulthood

• A is incorrect because progressive ventricular enlargement is a hallmark neuroimaging finding in schizophrenia
• C is incorrect because postmortem studies of patients with autism spectrum disorder consistently reveal a decreased number of cerebellar Purkinje cells rather than an increase.

500

Phelan-McDermid syndrome, which can be associated with autism spectrum disorder, is caused by the mutation of what gene?

A. DRD2

B. COMT

C. SHANK3

D. SLC6A4

E. 5HTT

C. SHANK3

Explanation

A. DRD2: Codes for the Dopamine Receptor D2

B. COMT: Codes for Catechol-O-methyltransferase. degrades catecholamines like dopamine and epinephrine, and is associated with executive function and pain tolerance.

D. SLC6A4: Codes for the Serotonin Transporter. 

E. 5HTT: Serotonin Transporter (encoded by SLC6A4)

screen time

100

An individual who is taking the Continuous Performance Test (CPT) is asked to press a key whenever any letter except "X" is displayed on the screen.  The letter "F" is displayed, and the patient fails to press a key.  This is most likely a problem with:

Attention

200

Intelligence quotient (IQ) scores are generally considered to bestable beginning at what age?

7 years old

300

An 8-year-old child recently had testing with the Wechler Intelligence Scale for Children (WISC-IV) and received a full scale IQ score of 60. Which of the following additional tests would determine if the child meets criteria for intellectual disability?

Vineland Adaptive Behavior Scales, 2nd ed. (VABS-II)

400

Which of the following is a broad-based rating scale for psychiatric symptoms in children?

A. Vineland Adaptive Behavior Scales (VABS-II)
B. Revised Conners' Parent Rating Scale (CPRS-R)
C. Denver Developmental Screening Test (DDST-II)
D. Revised Behavior Problem Checklist (RBPC)
E. Child Behavior Checklist (CBCL)

E. Child Behavior Checklist (CBCL)

500

A 3-year-old child and parents present for evaluation. The child is playing alone in the corner of the room, stacking and unstacking blocks. The child appears oblivious to the presence of the parents and physician. Parents report that the child has not yet begun to speak, and that an audiology evaluation was negative for hearing loss. What screening tool would be the most useful instrument for further assessment of this patient?

Autism Diagnostic Observation Schedule (ADOS)