2018 Child Psychiatry Resident In-Training Examination® PDF

## The American College of Psychiatrists ### 2018 Child Psychiatry Resident In-Training Examination® **December 2018** © 2018 by The American College of Psychiatrists. All rights reserved. ### Instructions Select the single best response for each of the questions on the page. ### Questions 1....

## The American College of Psychiatrists ### 2018 Child Psychiatry Resident In-Training Examination® **December 2018** © 2018 by The American College of Psychiatrists. All rights reserved. ### Instructions Select the single best response for each of the questions on the page. ### Questions 1. Diagnosing seizures in individuals with intellectual disability can be more challenging than in typically developing children because youth with intellectual disability: - tend to develop seizure disorders later. - are less likely to have seizure disorders. - tend to have less severe types of seizures. - have fewer environmental precipitating factors. - have more repetitive and stereotyped behaviors at baseline. 2. Health care for children in foster care is generally funded by: - Medicare - Medicaid - Social Security disability - Foster parents' insurance - Supplemental Security Income 3. In a study of children at high risk for depression, subjects were randomly assigned to either observation or drug treatment over 10 weeks. In the observation group, 50% of the children developed depression. In the treatment group, only 25% of the children developed depression. How many children need to be treated with this new drug to prevent one case of depression? - 1 - 2 - 4 - 5 - 10 4. 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? - Intelligence level - Physical stamina - Affective stability - Language ability - Self-regulation capability 5. A child with benign tumors of the brain, heart and kidney, seizures, and intellectual disability will most likely also present with symptoms of which of the following? - Autism - Schizophrenia - Bipolar mood disorder - Chronic motor or vocal tic disorder - Posttraumatic stress disorder 6. A psychiatrist is treating an adolescent with anxiety and cannabis use disorder. The adolescent reports being motivated to abstain from cannabis use, and has had negative urine toxicology screens during appointments. The adolescent's parents report they found evidence of use following the last appointment, and they performed an at-home cannabis urine toxicology screen that was positive. To maximize engagement with the adolescent, the psychiatrist should say which of the following to broach the topic of cannabis discontinuation? - "Let's make a plan to get you back on track." - "Has something changed about your motivation to stay clean?" - "What caused you to use after all that hard work to stay clean?" - "We don't have to talk about your cannabis use if you don't want." - "Can I remind you of all the reasons why cannabis is bad for your brain?" 7. According to the American Academy of Child and Adolescent Psychiatry Code of Ethics, sexual contact by the psychiatrist with family members or guardians of patients is discouraged for what period of time? - Indefinitely - Until the child turns 18 - Until the child is no longer seen by the psychiatrist - Until the child no longer lives with the parent or guardian - Five years after the termination of the patient-physician relationship <start_of_image> **** 8. In which of the following clinical situations would diagnostic neuroimaging be indicated? - Six-year-old reports hearing a deceased relative calling the child's name at night - Seven-year-old with attention-deficit/hyperactivity disorder presents with new motor tics - Ten-year-old with autism stops performing previously acquired skills - Twelve-year-old with anxiety reports intrusive sexual thoughts - Sixteen-year-old hospitalized with depression describes a feeling of bodily decay 9. The psychiatrist who previously treated the child of a divorcing couple is subpoenaed to testify in court during the divorce proceedings. The most appropriate testimony of this psychiatrist would be to report on which of the following? - The benefits of shared joint custody - The effect the divorce had on this child - The effect of divorce on children in general - Why the child was treated by the psychiatrist - Which parent should have sole legal custody 10. The school refers a 4th-grader for diagnostic assessment. Teachers and parents report that the child has been argumentative and unwilling to cooperate with rules both at school and at home since early childhood. For the past year, the child has had severe temper outbursts, including episodes of physical aggression towards parents and school personnel, on an almost daily basis, often triggered by minor frustration and disappointment. When not having an outburst, the child is described as consistently irritable and angry. However, when engaged in certain pleasurable activities, such as sports, classroom games and social events, the child can be silly, hyperactive and giddy lasting for a few hours. The child is struggling academically and facing placement in an alternative school setting because of the chronic behavioral problems. The child is in good physical health. Which of the following is the most appropriate diagnosis for this child? - Bipolar disorder - Conduct disorder - Oppositional defiant disorder - Intermittent explosive disorder - Disruptive mood dysregulation disorder 11. An eight-year-old child with autism spectrum disorder and attention-deficit/hyperactivity disorder presents with worsening aggression. The child has wraparound services with behavioral and therapeutic interventions. The child also sees a psychiatrist monthly for treatment with clonidine and a stimulant. Which of the following is the best initial approach to address the worsening aggression in this patient? - Increase therapy time with the patient - Perform a functional behavioral analysis - Increase the dose of the stimulant medication - Provide family therapy prioritizing system dynamics - Add an atypical antipsychotic to the child's medication regimen 12. One of the foundational premises of infant psychiatry, exemplified by the work of Fraiberg, is that the parents' view of the baby and parenting is based on: - the behavior and attitudes of their peers. - previous exposure to babies and other children. - the beliefs of and information from their parents. - information obtained from reading and physicians. - their memories of early life experiences with caregivers. 13. Vygotsky suggested that which of the following supports the social learning that occurs when children interact with peers, teachers and parents? - Cognitive schemata - The Strange Situation - Good enough mothering - The holding environment - Zone of proximal development 14. Which of the following types of threat to internal validity is of particular concern in longitudinal pediatric studies? - Maturation - Selection bias - Testing situations - Statistical regression - Experimental mortality 15. A researcher wants to study the distribution of D1 receptors in the brains of children with obsessive-compulsive disorder. Which of the following neuroimaging techniques would be best for the researcher to select in designing the study? - Computed tomography - Diffusion tensor imaging - Magnetoencephalography - Positron emission tomography - Functional magnetic resonance imaging 16. Which of the following factors has been found to be protective in the transition from preschool to school attendance, and is associated with positive attitudes toward school? - Ability to make friends - Parental education level - Having a same-sex schoolteacher - Living in close proximity to the school - Being in daycare prior to entering school 17. Which of the following mood stabilizers would be the best choice for an adolescent with hepatic insufficiency? - Lamotrigine - Topiramate - Valproic acid - Oxcarbazepine - Carbamazepine 18. A college student receives a poor grade on a pop quiz, and then fears this will lead to failing out of school and becoming homeless. This is likely what type of cognitive error? - Self-referencing - Catastrophizing - Overgeneralizing - All or none thinking - Selective abstraction 19. Which of the following is a widely used broad-based measure of behavioral problems with subscales for internalizing and externalizing symptoms and adaptive skills? - Eyberg Child Behavior Inventory - Social Communication Questionnaire - Vineland Adaptive Behavior Scales - Children's Global Assessment Scale - Behavior Assessment System for Children 20. In typically developing children, the 24-hour sleep-wake cycle is most commonly established by about what age? - Birth - 4 months - 8 months - 12 months - 18 months 21. Which of the following is a risk of repetitive transcranial stimulation? - Hormonal changes - Induction of seizure - Retrograde amnesia - Cardiac arrhythmia - Post-treatment confusion 22. Which of the following structures is considered to be the gateway to cortical processing of incoming sensory information? - Thalamus - Amygdala - Hippocampus - Basal ganglia - Nucleus accumbens 23. Medically unexplained recurrent abdominal pain in children is most commonly associated with which of the following conditions? - Bipolar disorder - Anxiety disorder - Autism spectrum disorder - Posttraumatic stress disorder - Attention-deficit/hyperactivity disorder 24. A hospitalized patient with a known history of non-epileptic seizures appears to have an organic seizure. Which of the following serum measurements, if performed promptly, may be able to help differentiate between the two? - Glucose - Sodium - Prolactin - Cortisol - 5-HIAA 25. In which of the following situations would individual psychodynamic psychotherapy be the treatment of choice? - A child becomes the symptom-bearer of systemic family issues. - Suicidal and parasuicidal behaviors need to be brought under control. - Maladaptive cognitions have led to feelings of inadequacy and shame. - Stress reactions begin to overwhelm a child with limited coping skills. - A stressor has resolved, but a child's defenses have become fixed and maladaptive. 26. A pediatrician refers a patient with academic delays for psychiatric evaluation. During the assessment, the psychiatrist realizes that the patient attends the school where the psychiatrist is a consultant. Which of the following is most important for the psychiatrist to consider when taking over as the child's psychiatrist while continuing as the school consultant? - Justice - Fidelity - Autonomy - Beneficence - Nonmaleficence 27. Which of the following techniques would be most appropriate for a researcher to use in order to identify rare or novel genetic mutations in a patient with an atypical presentation of autism spectrum disorder and no family history? - Karyotype - Linkage analysis - Microarray analysis - Whole-exome sequencing - Single gene-specific testing 28. A 14-year-old patient being treated with fluoxetine becomes confused and is tremulous with fever, sweating, and myoclonus after using drugs. Which of the following drugs did the patient most likely use? - MDMA - Marijuana - Alprazolam - Heroin - Codeine 29. Parents who are due to adopt an infant in several weeks ask for advice about when to discuss the fact of adoption with the child. How should the psychiatrist best respond? - "Begin as young as toddlerhood, and revisit the topic over time." - "Six or seven years, so that the child has processed the loss with a therapist." - "Ten years, so that the child has the cognitive ability to understand parentage." - "Adolescence, when the child is able to seek out the biological parents." - "Wait until the child initiates a discussion about the topic." 30. According to the Federation of State Medical Boards, what is the most severe disciplinary action a state board could impose if it finds evidence of unprofessional online behavior by a child psychiatrist? - Written sanction - Disciplinary hearing - Criminal prosecution - Revocation of the medical license - Required CMEs in professionalism 31. A five-year-old child on the way to the first day of school screams and cries about how she is scared to leave her parents and does not want to go. Upon arrival at the school, her parents take the child to her classroom and promptly leave. When they pick her up in the afternoon, she says what a great time she had, and that she is no longer afraid. The parents' technique was an example of what type of behavioral therapy? - Flooding - Assertiveness training - Systematic desensitization - Therapeutic-graded exposure - Exposure and response prevention 32. A child is diagnosed in 2nd grade with a reading disability, and does well for the next few years with an individualized education program. After the first couple of months of 5th grade, the parents report that the child has declining self-esteem and a reluctance to do homework. A learning difficulty in which of the following areas is most likely to be a contributing factor to the child's new behaviors? - Oral expression - Math calculations - Written expression - Phonological awareness - Listening comprehension 33. What information from this patient's history should compel the physician to order a polysomnography as part of this child's workup? - Age of the patient - Frequency of episodes - Self-injury during episodes - Excessive daytime sleepiness - Absence of periodic limb movements 34. A polysomnography reveals sleep-disordered breathing, and the child is diagnosed with obstructive sleep apnea. In addition to referral for sleep apnea treatment, what is the appropriate next step in the management of the sleep terrors? - Trial of pemoline - Trial of melatonin - Trial of clonazepam - Watchful monitoring - Cognitive behavior therapy 35. A child presenting with which of the following issues would be most likely to benefit from group therapy? - Severe family conflict - Depression and anhedonia - Impulsive and acting out behavior - Deficits in the ability to make and keep friends - An abuse history that has not previously been disclosed 36. For a child with attention-deficit/hyperactivity disorder and anxiety, which of the following would require an individualized education program (IEP) rather than a 504 plan? - Allowing the student extra time to take an examination - Providing the student with verbal and visual cues to stay on task - Seating the student in the front of the classroom to improve attention - Providing a staff escort to help the student avoid conflicts in the hallways - Holding the student to a different academic standard in challenging subjects 37. The physician evaluates a two-year-old child. The child pulls a man doll and a woman doll out of the toy chest, then has the man doll repeatedly hit the woman doll while yelling, "Shut up!" How should the physician respond? - Have the child put away the dolls and get other toys - Ask the child if this happens with his parents at home - Ask the child why the man doll is hitting the woman doll - Remain quiet and watch to see what the child does next - Give the child a little boy doll and see what the child does with it 38. A six-year-old child routinely throws temper tantrums at home until allowed by the parents to play video games. The psychiatrist educates the parents that their behavior is likely reinforcing the child's disruptive behavior. The parents subsequently stop allowing the child to play video games after temper tantrums. After this change, the child's temper tantrums escalate in frequency and intensity. Which of the following phenomena is most likely occurring in this scenario? - Flooding - Overcorrection - Extinction burst - Unconditioned response - Aversive counterconditioning 39. Bulimia nervosa is most commonly comorbid with which of the following personality traits? - Avoidant - Borderline - Histrionic - Schizoid - Obsessive-compulsive 40. Social aggression in primates and children has been correlated with low central transmission of which of the following neurotransmitters? - Dopamine - GABA - Norepinephrine - Glutamate - Serotonin 41. Gilligan's study of moral development led her to postulate that, compared to most boys, most girls' moral development is based upon: - a wish to please their father. - a strict adherence to rules. - an orientation to authority. - an emphasis on compliance. - the importance of social relationships. 42. A 17-year-old with early-onset schizophrenia has been effectively treated with olanzapine. However, metabolic concerns are mandating a change to a different therapeutic agent. Histamine rebound would be most likely to occur during a cross-taper of olanzapine with which of the following? - Clozapine - Quetiapine - Aripiprazole - Perphenazine - Chlorpromazine 43. During the initial assessment of a 12-year-old, the Aberrant Behavior Checklist is administered as part of the battery of tests. This instrument is most helpful when there is suspicion for which of the following differential diagnoses? - Enuresis - Conduct disorder - Intellectual disability - Substance use disorder - Attention-deficit/hyperactivity disorder 44. Which of the following findings on the multiple sleep latency test is considered to confirm the diagnosis of narcolepsy? - REM sleep on two or more naps - REM sleep on the majority of naps - Latency of REM to 20 minutes or less - Latency to sleep of 8 minutes or less - Preserved nighttime REM after multiple naps 45. According to Erik Erikson, which of the following is the primary psychosocial crisis that typically occurs during toilet training? - Initiative versus guilt - Trust versus mistrust - Industry versus inferiority - Identity versus role confusion - Autonomy versus shame and doubt 46. Which of the following family therapy models emphasizes individuals' differentiation from their family of origin and ability to be their true selves in the face of familial pressures? - Structural - Functional - Bowenian - Strategic - Multisystemic 47. Longitudinal studies have shown that, in the majority of cases, symptom development of borderline personality disorder becomes clinically apparent in: - childhood, then continues to increase. - childhood, peaks in adolescence, then decreases. - adolescence, then decreases. - adolescence, then continues to increase. - adolescence, peaks in young adulthood, then decreases. 48. A seven-year-old child presents with parents to the outpatient clinic. The parents describe the child's problems with attention, decreased appetite, hyperactivity, and falling asleep. After obtaining a comprehensive history, the physician gives the parents a self-report assessment instrument. According to evidence-based practice, the purpose of this initial self-report instrument should be to: - rule in or out a specific diagnosis. - establish a specific treatment target. - quantify the behaviors mentioned in the chief complaint. - obtain broad measures of the major problem dimensions. - focus on problems related specifically to the chief complaint. 49. Physical aggression in boys is most common during which of the following stages of development? - Preschool-age - Younger school-age - Older school-age - Early adolescence - Late adolescence 50. A psychiatrist is attempting to create an effective behavioral modification plan for a child with oppositional defiant disorder. The psychiatrist allows the child to engage freely in several different activities, and notes how long the child chooses to engage in each one. Based upon the results of this preference test, the psychiatrist will attempt to reinforce less preferred behaviors by increasing access to preferred behaviors. The psychiatrist is applying which of the following approaches to reinforcement? - Law of effect - Sign tracking - Token economy - Premack principle - Second-order conditioning 51. The parents of a 13-year-old boy who just came out to his parents as gay present to the psychiatrist to ask for a recommendation regarding the effectiveness of therapy to make their child straight. Which of the following would be most accurate to tell the parents? - Because the child is relatively young, reparative therapy has a moderate chance of success. - The child should wait until he is older to make the decision himself to change his orientation. - Therapy to alter sexual orientation has not been found to be helpful, and may be harmful. - Long-term psychodynamic therapy has shown mixed results in changing sexual orientation. - The child's orientation can be changed, but only if the entire family participates in the therapeutic process. 52. A large health organization is attempting to establish patient portal access for the patients in its adolescent medicine clinics. Which of the following is most likely to be a major barrier to implementation? - Inability of adolescents to access the internet - Difficulty in establishing confidentiality policies - Lack of patient or family interest in using portal - Unreliable encryption and password technology - Discouragement of portals in government recommendations 53. Which of the following brain regions is part of the neurocircuitry implicated in response inhibition? - Cerebellum - Dorsal striatum - Corpus callosum - Inferior frontal cortex - Anterior cingulate cortex 54. In psychodynamic psychotherapy with children, the process whereby the therapist helps the child overcome resistance to change through repetition and elaboration is referred to as which of the following? - Working through - Flight into health - Transference cure - Repetition compulsion - Regression in the service of the ego 55. Which of the following symptoms would prompt an evaluation for Landau-Kleffner syndrome? - Hearing loss - Failure to thrive - Muscle wasting - Acquired aphasia - Intermittent blindness 56. Using DSM criteria, how would a child with reactive attachment disorder likely react in Ainsworth's Strange Situation experiment once the caretaker returned while the stranger was still in the room? - Hug the caretaker - Cling to the stranger - Cry once the caretaker returned - Ignore both the caretaker and stranger - Engage both the caretaker and stranger 57. A 13-year-old with Crohn's disease is being treated by a psychiatrist for major depressive disorder. The patient entered psychiatric treatment one year ago after trying to end her life by taking "sleeping pills." The patient reports having feelings of hopelessness and worthlessness. The parents report that the patient is "sad" and has a tendency to lash out verbally at them when upset. Which of the following risk factors most strongly predicts a future suicide attempt? - Hopelessness - Impulsive aggression - Previous suicide attempt - Major depressive disorder - Chronic medical condition 58. Due to information from a study that was terminated for lack of efficacy in treating early-onset schizophrenia, AACAP practice parameters for the treatment of schizophrenia recommend that which of the following agents be avoided? - Quetiapine - Haloperidol - Paliperidone - Ziprasidone - Olanzapine 59. Neuroimaging studies have demonstrated structural differences in the grey and white matter development of patients with childhood onset schizophrenia and attention-deficit/hyperactivity disorder compared to healthy controls. Which of the following neuroimaging techniques was used to detect these differences? - Computed axial tomography - Magnetic resonance imaging - Positron-emission tomography - Magnetic resonance spectroscopy - Single-photon emission computed tomography 60. Which of the following is the major function of the group sessions in dialectical behavior therapy for adolescents? - Safely expressing feelings - Learning from group peers - Acquiring new coping skills - Obtaining support from peers - Processing emotions and issues 61. A six-year-old boy with severe intellectual disability has particularly large ears and a long face for his age, and looks quite a bit like his maternal grandfather who is also intellectually delayed, but is able to work and function independently. What genetic principle best explains the differences in the child's presentation compared to his grandfather? - Anticipation - Co-dominance - X-linked inheritance - Incomplete penetrance - Phenotypic heterogeneity 62. Poverty has been shown to be a risk factor for a broad range of negative outcomes for children. Animal stress-models and human studies have most consistently shown associated structural changes, along with recent findings of functional connectivity changes, in which of the following brain regions? - Thalamus - Cerebellum - Hippocampus - Prefrontal cortex - Corpus callosum 63. A psychiatric consultant to a pediatric liver transplant team is asked to assist in setting expectations about drug and alcohol use among prospective transplant recipients. Which of the following would be the most appropriate recommendation for the psychiatrist to give to the team? - Adolescents facing transplantation rarely use drugs or alcohol. - Teens who use drugs or alcohol experimentally are poor candidates for transplants. - Random drug screens prior to transplant are strongly recommended for all adolescents. - Infrequent experimental use of alcohol is not an absolute contraindication for liver transplant. - A presentation or lecture about the dangers of drugs and alcohol for these youth is adequate to prevent use. 64. According to evidence-based interventions for preventing substance abuse, which of the following statements by a psychiatrist to an adolescent patient would be the most effective in decreasing marijuana use? - "Your marijuana use is really making your parents upset." - "You should just say 'No' if you are asked to use marijuana." - "Your marijuana could be laced with something more dangerous." - "You can get addicted to smoking marijuana just as you can with other drugs." - "You seem to feel that using marijuana makes you more accepted by your friends." 65. By what age do most children begin to use symbolic thinking? - Infancy - Toddlerhood - Preschool-age - School-age - Adolescence 66. Retinoic acid, anticonvulsants, and folate deficiency are known to cause failure of what process? - Gastrulation - Blastulation - Neurulation - Tubulation - Cleavage 67. A 13-year-old patient with autism and developmental delays is admitted to the medical hospital with a diagnosis of catatonia. After one week of high-dose benzodiazepine therapy there is minimal improvement. Which of the following is the best treatment option to utilize next? - Electroconvulsive therapy - Repetitive transcranial magnetic stimulation - Addition of a neuroleptic such as olanzapine - Continuation of benzodiazepine monotherapy - Addition of an antiepileptic such as valproic acid 68. Proceedings in juvenile court differ from those of adult court with respect to the right of the defendant to: - trial by jury. - due process. - representation by counsel. - protection from self-incrimination. - "beyond a reasonable doubt" standard of proof. 69. A seven-year-old child presents with new-onset esotropia. Which of the following is the recommended first step in management? - Measure serum TSH/T4 - Refer for corrective surgery - Start alternate eye patching - Order magnetic resonance imaging of the brain - Hospitalize for continuous video electroencephalogram 70. A 15-year-old patient is referred by a dermatologist for psychiatric evaluation due to sores on the patient's face that have been worsening since he was about 13 years old. The patient says that he picks his facial skin and tries to pluck out the facial hairs several times daily while looking in a mirror he carries with him, asserting that he will look "deformed" and "everyone will see how disgusting" his face is if he does not. Aside from the sores, the appearance of the patient's face is unremarkable. Which of the following is the most likely DSM diagnosis? - Trichotillomania - Excoriation disorder - Body dysmorphic disorder - Obsessive-compulsive disorder - Delusional disorder, somatic type 71. Parent support groups are most likely to differ from traditional group therapy in which of the following ways? - Frequency of group sessions - Length of individual group sessions - Facilitation by professional therapists - Fluctuation of group members over time - Promotion of outside interaction between members 72. During a job interview at an inpatient mental health center, another physician at the health center asks the psychiatrist for recommendations on a patient's care. The psychiatrist would most likely be found liable regarding the treatment of this patient if the psychiatrist: - interviewed the patient. - was later offered the job. - reviewed the medical record. - failed to document recommendations. - gave recommendations to the physician. 73. Which of the following neurotransmitters is a precursor of the hormone responsible for influencing circadian rhythms? - GABA - Dopamine - Serotonin - Acetylcholine - Norepinephrine 74. The psychiatrist evaluates a 16-year-old for unresolved irritability, sadness, and impulsivity despite multiple medication trials and ongoing psychotherapy. On mental status exam, the patient has a tremor, drooling, speech problems, and a brownish tinge around the cornea. Which of the following would be the most useful screening test to rule in the suspected disorder? - Liver biopsy - Genetic testing - Blood ceruloplasmin - 24-hour urine copper test - Computed tomography scan of brain 75. A 12th-grader is diagnosed with a brain tumor. The adolescent undergoes radiation and receives several months of chemotherapy. However, the adolescent's doctors inform the patient and family that the prognosis appears terminal, and the adolescent is likely to live only a few more months. After being given this information, the adolescent does not appear upset, and asks the parents to take a family trip to Europe to celebrate high school graduation. What is the most likely explanation for the adolescent's request? - Adjustment disorder - Normal adolescent thinking - Delirium resulting from chemotherapy - Memory impairment caused by brain tumor - Lack of understanding of core concepts of death 76. A 16-year-old is brought to the psychiatrist for initial evaluation of severely depressed mood of four months duration. The teen also describes long-standing symptoms of "not being able to feel" and often feeling "numb." The teen reports often wondering, "whether I truly exist,” and says, "I know I wake up every day and go to school and stuff, but I feel more like a robot than a person." The teen tells the psychiatrist, "You must think I'm crazy." In addition to depression, the psychiatrist should consider what other most likely diagnosis? - Schizophrenia - Panic disorder - Illness anxiety disorder - Attention-deficit/hyperactivity disorder - Depersonalization/derealization disorder 77. According to the Treatment for Adolescents with Depression Study (TADS), which of the following was reported regarding efficacy of cognitive behavior therapy (CBT) for depression when compared to treatment with fluoxetine alone or in combination with fluoxetine after 36 weeks? - All treatment groups were equally efficacious. - CBT alone was ineffective without adjunctive fluoxetine. - CBT alone was more effective than all other treatment groups. - CBT and fluoxetine in combination was more effective than monotherapy. - None of the treatment groups were more efficacious compared to placebo. 78. Which of the following disorders is typically diagnosed without confirmation by polysomnography? - Insomnia - Narcolepsy - Obstructive sleep apnea - Periodic limb movement disorder - Sleep-related breathing disorder 79. In preclinical studies, the licking of rat pups by their mothers has been shown to have long-term effects on the regulation of the rat pups' stress response by epigenetic regulation of what type of hippocampal receptor? - Oxytocin - Serotonin - Glucocorticoid - Norepinephrine - Brain-derived neurotrophic factor 80. Which of the following was the first standardized scale for intelligence? - Binet-Simon test - Differential Ability Scales - Wechsler Intelligence Scale for Children - Kaufman Assessment Battery for Children - Woodcock-Johnson Tests of Cognitive Ability 81. In dialectical behavior therapy for adolescents, every chain analysis begins with which of the following? - Brainstorming alternative solutions - Identifying a specific environmental event - Identifying consequences weakening problematic response - Identifying consequences strengthening problematic response - Constructing and testing hypotheses about events generating problem behavior 82. A physician interviews a child with possible migraines. Which of the following information from the evaluation would compel the physician to order a computed tomography scan of the head? - Recurrent nausea - Lack of family history - Abnormal motor exam - Baseline photosensitivity - Absence of premonitory symptoms 83. The expectation that girls are less likely than boys to engage in rough-and-tumble play is an example of gender: - role. - identity. - dysphoria. - discordance. - nonconformity. 84. An eight-year-old child has 11 hyperpigmented, ovoid and smooth macules on the arms, chest and back. Additionally, the child has freckling on the axilla bilaterally. The child's mother shares that she also has hyperpigmented macules and freckling in her axilla, and she recently was diagnosed with a tumor of the optic pathway. Which of the following psychiatric disorders is mostly likely to be present in the child? - Tourette syndrome - Autism spectrum disorder - Oppositional defiant disorder - Attention-deficit/hyperactivity disorder - Disruptive mood dysregulation disorder 85. Which of the following represents the primary benefit in a clinical trial of a randomized controlled crossover design over a parallel design? - Wash-out periods are not required. - Subjects serve as their own controls. - There is less likelihood of carry-over effects. - Asymmetrical transfer effects are minimized. - It requires larger subject numbers, which increases the power. 86. The earliest paraphilia to develop, frequently before the age of 15 years, is: - sadism. - voyeurism. - frotteurism. - exhibitionism. - transvestic fetishism. 87. In the Pediatric Obsessive-Compulsive Treatment Study (POTS I) which of the following factors predicted lack of efficacy for youth engaged in cognitive behavior therapy alone? - Age - Gender - Comorbidity - Family history - Initial Children's Yale-Brown Obsessive-Compulsive scale score 88. A set of healthcare researchers are interested in advocating for public policy to improve the lives of children, adolescents and families. Which of the following processes is most likely to result in the researchers' input successfully leading to policy development? - Limiting disclosure of research results and implications to lawmakers - Balancing recommendations with the priorities and needs of lawmakers - Concentrating on the research and allowing others to negotiate policies - Advocating with the political party most sympathetic to the researcher's position - Mandating that policy provides for the recommendations that will include optimal health standards 89. Which of the following techniques would best facilitate engagement during the interview of a child or adolescent? - Passive listening - Praising adaptive skills - Commenting on nonverbal behaviors - Focusing primarily on questionnaires - Maintaining a neutral demeanor and tone 90. A 16-year-old adolescent recently diagnosed with schizophrenia has a history of language delay requiring speech therapy. The psychiatrist observes the adolescent has a long, narrow face with small mouth and hypernasal speech. Discussion with the adolescent's parent reveals the patient had repair of a cleft palate and ventricular septal defect when younger. The adolescent should be further evaluated for which of the following syndromes? - Down - Angelman - Fragile X - DiGeorge - Prader-Willi 91. A child is being treated for NMDA-receptor encephalitis. The patient is anxious and confused with waxy flexibility, minimal verbalization and staring episodes. In addition to continuing treatment of the encephalitis, which of the following medications should the psychiatrist initially recommend for this patient's motoric symptoms? - Risperidone - Haloperidol - Lorazepam - Clonidine - Bromocriptine 92. What part of the brain is most associated with working memory? - Caudate - Amygdala - Hippocampus - Prefrontal cortex - Anterior parietal lobe 93. Which of the following research terms refers to assigning the wrong diagnosis to a patient? - True positive - True negative - False negative - Omission error - Commission error 94. The outpatient treating