EPPP: Part 1, Knowledge Quiz: Developmental Disorders
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Developmental DisordersQuestion 1 of 20

A psychologist is evaluating a 4-year-old boy who exhibits significant delays across multiple developmental domains, including communication, motor skills, and social interaction. His parents report he is not yet speaking in sentences and has difficulty with simple puzzles. Due to his age and inability to cooperate fully with standardized testing procedures, the psychologist is unable to obtain a valid IQ score.

Which diagnosis is most appropriate for this child at this time?

Intellectual Disability, Severity Unspecified
Autism Spectrum Disorder, Level 3
Global Developmental Delay
Unspecified Neurodevelopmental Disorder
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EPPP: Part 1, Knowledge Quiz

EPPP: Part 1, Knowledge Quiz: Developmental Disorders

Practice Developmental Disorders in EPPP: Part 1, Knowledge with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Developmental Disorders, giving you a quick way to practice the rules, question types, and explanations that matter most for EPPP: Part 1, Knowledge.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

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Question 1

A psychologist is evaluating a 4-year-old boy who exhibits significant delays across multiple developmental domains, including communication, motor skills, and social interaction. His parents report he is not yet speaking in sentences and has difficulty with simple puzzles. Due to his age and inability to cooperate fully with standardized testing procedures, the psychologist is unable to obtain a valid IQ score.

Which diagnosis is most appropriate for this child at this time?

  1. Intellectual Disability, Severity Unspecified
  2. Autism Spectrum Disorder, Level 3
  3. Global Developmental Delay (correct answer)
  4. Unspecified Neurodevelopmental Disorder
Explanation: Global Developmental Delay (GDD) is the most appropriate diagnosis. It is reserved for individuals under the age of 5 when the clinical severity level cannot be reliably assessed during early childhood. This child shows delays in multiple domains, but his young age and inability to complete standardized testing make a formal diagnosis of Intellectual Disability (ID) premature. While his symptoms could be part of ASD, GDD specifically addresses the failure to meet expected developmental milestones in several areas of intellectual functioning without being able to formally assess it. ID requires standardized testing of both intellectual and adaptive functioning, which is not possible here. Unspecified Neurodevelopmental Disorder is used when a clinician chooses not to specify the reason that criteria are not met for a specific neurodevelopmental disorder.

Question 2

An 8-year-old boy presents with a history of both involuntary throat-clearing sounds and rapid eye blinking that began 14 months ago. These behaviors occur many times a day, nearly every day. While the eye blinking has been consistent, the throat-clearing has waxed and waned, sometimes being replaced by a sniffing sound for several weeks. The symptoms cause him some social distress at school.

What is the most likely diagnosis for this boy?

  1. Persistent (Chronic) Motor Tic Disorder
  2. Provisional Tic Disorder
  3. Tourette's Disorder (correct answer)
  4. Stereotypic Movement Disorder
Explanation: The most likely diagnosis is Tourette's Disorder. The key criteria are the presence of both multiple motor tics (eye blinking) and at least one vocal tic (throat-clearing, sniffing), which have persisted for more than one year since the first tic onset, and with onset before age 18. Persistent (Chronic) Motor Tic Disorder would be appropriate if only motor tics were present for over a year. Provisional Tic Disorder is diagnosed when tics have been present for less than one year. Stereotypic Movement Disorder involves repetitive, seemingly driven, and purposeless motor behavior (e.g., hand-waving, body rocking) which is phenomenologically different from tics.

Question 3

A 9-year-old boy is described by his parents as constantly irritable and angry. He has temper outbursts, involving screaming and throwing objects, approximately three to four times a week, both at home and at school. These reactions are grossly out of proportion to the situation. Between these outbursts, his mother states he is consistently 'touchy' and 'grumpy.' This pattern has been present for over a year and is causing significant impairment in family and school functioning.

This clinical presentation is most characteristic of:

  1. Oppositional Defiant Disorder
  2. Bipolar I Disorder
  3. Disruptive Mood Dysregulation Disorder (correct answer)
  4. Intermittent Explosive Disorder
Explanation: The correct diagnosis is Disruptive Mood Dysregulation Disorder (DMDD). The key diagnostic features are severe recurrent temper outbursts that are inconsistent with developmental level, occurring on average three or more times per week. Critically, the mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, which is a hallmark of DMDD and differentiates it from ODD and Intermittent Explosive Disorder. The symptoms are not episodic in the way required for a Bipolar Disorder diagnosis.

Question 4

An 11-year-old girl exhibits a distinct behavioral pattern. She is talkative and engages appropriately with her family at home. However, she consistently does not speak in school or in other social situations where there is an expectation for speaking, such as at a community event. This has persisted for the entire school year and is interfering with her academic and social progress. A hearing and language assessment revealed no abnormalities.

This child's symptoms are most consistent with:

  1. Social Anxiety Disorder (Social Phobia)
  2. Autism Spectrum Disorder
  3. Selective Mutism (correct answer)
  4. Oppositional Defiant Disorder
Explanation: The diagnosis that best fits this presentation is Selective Mutism. The core feature is a consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations (e.g., at home). This pattern interferes with educational or social functioning. While there is often comorbid social anxiety, the specific and consistent failure to speak is the defining characteristic of Selective Mutism. ASD would involve broader deficits in social communication and interaction, not just speaking. ODD would involve a pattern of negativistic and defiant behavior, not a specific failure to speak.

Question 5

A 15-year-old is evaluated for long-standing behavioral issues. He is described as hyperactive, impulsive, and having a short attention span. School records indicate these problems have been present since early elementary school. Additionally, his medical history is significant for prenatal alcohol exposure, and he exhibits subtle facial dysmorphisms including a smooth philtrum and thin upper lip. He has difficulty with abstract reasoning and adaptive functioning, with an IQ score of 68.

While the adolescent displays symptoms consistent with ADHD, the broader clinical picture and history is most indicative of:

  1. Attention-Deficit/Hyperactivity Disorder, Combined Presentation
  2. A neurocognitive disorder due to traumatic brain injury
  3. Fetal Alcohol Spectrum Disorder (correct answer)
  4. Unspecified Intellectual Disability
Explanation: The adolescent's presentation is most indicative of a Fetal Alcohol Spectrum Disorder (FASD). The combination of CNS dysfunction (hyperactivity, attention deficits, impaired abstract reasoning), specific facial features (smooth philtrum, thin upper lip), and confirmed prenatal alcohol exposure are the classic signs. While the symptoms overlap significantly with ADHD and he also meets criteria for a mild Intellectual Disability (IQ of 68), FASD is the underlying etiological condition that accounts for the entire constellation of physical, cognitive, and behavioral deficits. Diagnosing only ADHD or ID would be incomplete.

Question 6

A 13-year-old girl is referred for an evaluation due to academic problems specifically in math. She performs at an average or above-average level in reading and writing but has profound difficulty understanding number concepts, mastering math facts, and performing calculations. She reports intense anxiety when faced with math homework and tests, often leading to avoidance. Her parents wonder if she just has 'math anxiety.' Standardized testing confirms a significant discrepancy between her overall cognitive ability and her mathematical skills.

The most appropriate diagnosis to explain her core difficulty is:

  1. Generalized Anxiety Disorder
  2. Specific Learning Disorder with impairment in mathematics (correct answer)
  3. Math Anxiety as a V-code (Other Conditions That May Be a Focus of Clinical Attention)
  4. Nonverbal Learning Disability
Explanation: Specific Learning Disorder with impairment in mathematics (dyscalculia) is the most accurate diagnosis. This is indicated by the specific and significant difficulties with number sense, memorization of arithmetic facts, and accurate calculation that are not consistent with her overall intellectual ability. While she does experience math anxiety, this is likely secondary to her underlying learning disability. The anxiety is a reaction to her struggles, not the primary cause of them. Nonverbal Learning Disability is not a formal DSM-5 diagnosis, though it describes a profile that often includes math difficulties.

Question 7

A 4-year-old boy presents with notable speech difficulties. His mother reports he frequently repeats sounds and syllables (e.g., 'ca-ca-ca-can I have?') and sometimes seems to get 'stuck' on a word, unable to get it out. These disfluencies are causing him noticeable frustration. His vocabulary and sentence structure are otherwise considered age-appropriate.

This child's symptoms are most characteristic of which disorder?

  1. Language Disorder
  2. Speech Sound Disorder
  3. Childhood-Onset Fluency Disorder (Stuttering) (correct answer)
  4. Social (Pragmatic) Communication Disorder
Explanation: The pattern described is characteristic of Childhood-Onset Fluency Disorder, more commonly known as Stuttering. Its core features are disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual's age. These include sound and syllable repetitions, sound prolongations, and broken words. Language Disorder involves broader deficits in comprehension or use of vocabulary and grammar. Speech Sound Disorder relates to the production of phonemes. Social (Pragmatic) Communication Disorder involves deficits in the social use of language, not its fluency.

Question 8

A 16-year-old male is brought to therapy by his parents due to concerns about his mood and behavior. They report periods lasting 1-2 weeks where he is extremely irritable, sleeps very little, talks nonstop, and engages in risky behaviors like reckless driving. These periods are followed by weeks of depressed mood, social withdrawal, and hypersomnia. His teachers also note that he is generally impulsive and has difficulty maintaining focus in class, a pattern that has been present since he was younger.

What is the most critical diagnostic consideration to differentiate a Bipolar Disorder from ADHD in this adolescent?

  1. The presence of irritability, as this is unique to Bipolar Disorder.
  2. The episodic nature of the mood symptoms versus the chronic, pervasive nature of inattention. (correct answer)
  3. The presence of risky behaviors, which is a key criterion for Bipolar Disorder but not ADHD.
  4. The adolescent's family history of mood disorders, which confirms a Bipolar diagnosis.
Explanation: The most critical differentiating factor is the pattern of symptoms over time. Bipolar Disorder is characterized by distinct episodes of mania/hypomania and depression that are a change from the person's usual functioning. ADHD, in contrast, is a chronic, pervasive condition with symptoms of inattention and/or hyperactivity-impulsivity that are present across time and situations. While symptoms like irritability, talkativeness, and impulsivity can overlap, their episodic vs. pervasive nature is the key to differential diagnosis. Family history is a risk factor but not a diagnostic criterion. Risky behaviors can occur in both disorders.

Question 9

A psychologist is evaluating a 12-year-old boy who exhibits a repetitive, seemingly driven behavior of rocking his body back and forth for extended periods, especially when tired or bored. He also engages in complex hand-waving movements. These behaviors have been present since he was a toddler. They sometimes interfere with his ability to participate in classroom activities. The movements are distinct from the sudden, rapid, and nonrhythmic nature of tics.

Which diagnosis best accounts for these specific motor behaviors?

  1. Stereotypic Movement Disorder (correct answer)
  2. Persistent (Chronic) Motor Tic Disorder
  3. Tourette's Disorder
  4. Part of Attention-Deficit/Hyperactivity Disorder
Explanation: Stereotypic Movement Disorder is characterized by repetitive, seemingly driven, and purposeless motor behavior (e.g., hand shaking or waving, body rocking). The description of the movements as rhythmic and driven, and the specific examples of body rocking and hand-waving, fit this diagnosis well. The key distinction from tic disorders is the quality of the movements; stereotypies are typically more rhythmic and less 'jerky' or sudden than tics. While fidgeting is common in ADHD, these movements are described as more complex and driven, warranting a separate diagnosis.

Question 10

An 8-year-old girl is referred for soiling her underpants with feces. This occurs at least twice a week and has been happening for the past six months. She has a history of chronic constipation and often withholds her stool, leading to leakage of liquid stool around the retained mass. She is very embarrassed by the accidents, which often happen at school.

The most appropriate diagnosis is:

  1. Elimination Disorder Not Otherwise Specified
  2. A medical condition (e.g., Hirschsprung's disease)
  3. Encopresis, without constipation and overflow incontinence
  4. Encopresis, with constipation and overflow incontinence (correct answer)
Explanation: The diagnosis is Encopresis, which involves the repeated passage of feces into inappropriate places, whether involuntary or intentional. The specifier 'with constipation and overflow incontinence' is appropriate here because the soiling is a direct result of chronic constipation and stool withholding, which leads to leakage. The child's chronological age is over 4, meeting the age criterion. While a medical condition could cause constipation, the clinical picture described is the classic presentation of retentive encopresis, which is a DSM-5 diagnosis. The 'without constipation' specifier would be incorrect.

Question 11

A 10-year-old student is struggling significantly with writing assignments. His teacher reports that while his spoken ideas are creative and well-organized, his written work is marked by numerous grammatical and punctuation errors, poor paragraph organization, and a lack of clarity. His handwriting (penmanship) is slow but legible, and he does not seem to have issues with the physical act of forming letters.

This pattern of difficulty most strongly suggests:

  1. Developmental Coordination Disorder
  2. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation
  3. Language Disorder
  4. Specific Learning Disorder with impairment in written expression (correct answer)
Explanation: The correct diagnosis is Specific Learning Disorder with impairment in written expression. This diagnosis encompasses a range of difficulties, including problems with spelling accuracy, grammar and punctuation accuracy, and clarity or organization of written expression. The key here is the deficit in the cognitive aspects of writing (organization, grammar), not just the motor act. Since his handwriting is legible, Developmental Coordination Disorder is less likely. While Language Disorder can affect writing, the vignette specifies his spoken ideas are well-organized, pointing to a specific deficit in translating those ideas to written form. Inattention could contribute, but the specific, pronounced deficits in the mechanics and organization of writing are the hallmark of this SLD.

Question 12

A 9-year-old child presents with a combination of symptoms that cause significant impairment but do not neatly fit the criteria for any single neurodevelopmental disorder. The child has mild social communication deficits, some motor clumsiness, and borderline intellectual functioning. The clinician determines that the symptoms cause clinically significant distress but criteria are not fully met for ASD, DCD, or Intellectual Disability, and it would be inappropriate to use an 'other specified' diagnosis.

In this situation, where the symptom presentation does not meet the full criteria for any specific disorder in the neurodevelopmental class, the most appropriate diagnosis would be:

  1. Adjustment Disorder with mixed disturbance of emotions and conduct
  2. Global Developmental Delay
  3. Other Specified Neurodevelopmental Disorder
  4. Unspecified Neurodevelopmental Disorder (correct answer)
Explanation: Unspecified Neurodevelopmental Disorder is the appropriate diagnosis. This category is used in situations where the clinician chooses not to specify the reason that the criteria are not met for a specific neurodevelopmental disorder, including presentations where there is insufficient information to make a more specific diagnosis. 'Other Specified' is used when the clinician does specify the reason the presentation does not meet criteria for a specific disorder. GDD is only for children under 5. Adjustment Disorder is a response to a stressor and does not fit a long-standing developmental pattern.

Question 13

A 7-year-old child is referred for an evaluation due to delayed language skills. He has a limited vocabulary and uses simple grammatical structures compared to his peers. His parents mention that he had recurrent, severe ear infections during his first three years of life which resulted in fluctuating hearing loss, though his hearing is now in the normal range after medical intervention.

When considering a diagnosis of Language Disorder, the psychologist must first:

  1. consider the possibility that the language deficits are a result of his history of hearing impairment. (correct answer)
  2. evaluate for the presence of restricted and repetitive behaviors to rule out Autism Spectrum Disorder.
  3. administer a nonverbal intelligence test to rule out Intellectual Disability.
  4. determine if the child meets criteria for a Specific Learning Disorder.
Explanation: According to DSM-5, a diagnosis of Language Disorder requires that the difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition. Given the child's significant history of ear infections and hearing loss during a critical period for language acquisition, the psychologist must carefully consider whether the current language delays are a direct consequence of that sensory impairment rather than a primary neurodevelopmental disorder. While ruling out ID and ASD is part of a comprehensive evaluation, the history of hearing impairment is the most direct and crucial factor to consider first in this specific case.

Question 14

A 6-year-old child is referred for an evaluation due to clumsiness. The parents report that the child has always been behind peers in motor milestones, struggling with activities like running, hopping, and using utensils. At school, the child has significant difficulty with handwriting and participating in gym class. A medical workup has ruled out cerebral palsy, muscular dystrophy, and other neurological conditions. The child's cognitive abilities are in the average range.

Given that other medical and neurological conditions have been ruled out, what is the most likely diagnosis?

  1. Stereotypic Movement Disorder
  2. Developmental Coordination Disorder (correct answer)
  3. Specific Learning Disorder with impairment in written expression
  4. Other Specified Neurodevelopmental Disorder
Explanation: Developmental Coordination Disorder (DCD) is the most appropriate diagnosis. It is characterized by a marked impairment in the performance of motor coordination that significantly interferes with academic achievement or activities of daily living. The diagnosis is made only if the coordination difficulties are not better explained by a medical condition (e.g., cerebral palsy), Intellectual Disability, or visual impairment. The vignette specifies that these have been ruled out. While the child has poor handwriting, the deficits are broader (running, hopping), making DCD a better fit than a specific learning disorder focused only on writing. Stereotypic Movement Disorder involves repetitive, purposeless movements, which are not described here.

Question 15

A 10-year-old child is referred for academic difficulties. The child's teacher notes significant problems with reading comprehension and spelling despite average intelligence and adequate instruction. The child often struggles to sound out unfamiliar words and reads slowly and with great effort. During the evaluation, the psychologist notes that the child's ability to focus on tasks not involving reading is age-appropriate, and there are no significant behavioral concerns reported at home or school.

Which diagnosis best explains this child's difficulties?

  1. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation
  2. Specific Learning Disorder with impairment in reading (correct answer)
  3. Intellectual Disability, Mild
  4. Language Disorder
Explanation: Specific Learning Disorder with impairment in reading (often called dyslexia) is the most fitting diagnosis. It is characterized by difficulties with accurate or fluent word recognition, poor decoding, and poor spelling abilities. The vignette specifies that the child's intelligence is average and the difficulties are specific to reading, which rules out Intellectual Disability. While inattention can affect reading, the problem is described as being specific to reading tasks, with age-appropriate focus otherwise, making ADHD less likely as the primary cause. Language Disorder might affect reading comprehension, but the core issue described here is with decoding and word reading, which is the hallmark of this type of SLD.

Question 16

A 7-year-old child is referred for a psychological evaluation due to significant difficulties with peer interactions. The parents report the child struggles with conversational turn-taking, understanding non-literal language like sarcasm, and adjusting their communication style to match the context, such as speaking differently to a teacher versus a playground friend. The child has friends but often alienates them with socially inappropriate remarks. Standardized testing reveals average intellectual ability and strong language structure and grammar skills. No history of restricted interests or repetitive behaviors is reported.

Based on the information provided, which diagnosis best accounts for the child's pattern of difficulties?

  1. Autism Spectrum Disorder, Level 1
  2. Social (Pragmatic) Communication Disorder (correct answer)
  3. Language Disorder
  4. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive
Explanation: The correct answer is Social (Pragmatic) Communication Disorder (SCD). The child's difficulties are specifically in the social use of verbal and nonverbal communication (pragmatics), such as understanding context and non-literal language. The absence of restricted, repetitive patterns of behavior, interests, or activities (RRBs) is a key feature that differentiates SCD from Autism Spectrum Disorder. Language Disorder is less likely given the report of strong language structure and grammar. ADHD may involve social difficulties, but the primary deficit described is in social communication pragmatics, not inattention.

Question 17

A pediatrician refers a 13-year-old for evaluation. The teen experienced a significant decline in functioning over the past year, becoming socially withdrawn and developing bizarre beliefs, such as thinking that television commercials contain secret messages intended for them. They also report hearing voices when no one is around. Their academic performance has plummeted, and their speech has become disorganized and difficult to follow. Their presentation is distinct from their previously normal developmental trajectory.

This clinical picture is most suggestive of the onset of which disorder, which represents a severe deviation from the expected developmental course?

  1. Schizophrenia, childhood-onset (correct answer)
  2. Disruptive Mood Dysregulation Disorder
  3. Autism Spectrum Disorder, Level 3
  4. Obsessive-Compulsive Disorder with poor insight
Explanation: The correct answer is Schizophrenia. The presence of positive symptoms like delusions (ideas of reference), hallucinations (auditory), and disorganized speech, coupled with a marked deterioration in functioning, is characteristic of schizophrenia. Onset before age 13 is considered very early or childhood-onset. While severe ASD can involve social withdrawal, it does not typically include the formal thought disorder and frank psychotic symptoms described. OCD can involve bizarre thoughts, but the presence of hallucinations and disorganized speech makes schizophrenia a much better fit. DMDD is characterized by irritability and temper outbursts, not psychosis.

Question 18

A psychologist is asked to differentiate between two children with social difficulties. Child A has significant deficits in social-emotional reciprocity and nonverbal communication and displays a highly restricted, intense interest in train schedules. Child B shows similar deficits in social reciprocity and communication but has no history of restricted or repetitive behaviors. Both children's symptoms date back to early childhood.

The most appropriate diagnoses for Child A and Child B, respectively, are:

  1. Autism Spectrum Disorder; Social (Pragmatic) Communication Disorder (correct answer)
  2. Autism Spectrum Disorder; Autism Spectrum Disorder
  3. Social (Pragmatic) Communication Disorder; Avoidant Personality Disorder
  4. Reactive Attachment Disorder; Social (Pragmatic) Communication Disorder
Explanation: Child A displays both hallmark symptom clusters for Autism Spectrum Disorder (ASD): (1) persistent deficits in social communication and social interaction, and (2) restricted, repetitive patterns of behavior, interests, or activities (RRBs). Child B displays the first cluster (social communication deficits) but not the second (RRBs). This distinction is the key diagnostic differential between ASD and Social (Pragmatic) Communication Disorder (SCD). Therefore, Child A's diagnosis is ASD, and Child B's is SCD.

Question 19

A 5-year-old girl is brought for an evaluation due to concerns about her social interactions at preschool. She is described as being very withdrawn, rarely initiating social contact, and not seeking comfort from her teachers when distressed. A review of her history reveals she spent her first three years in an institutional setting with a high child-to-caregiver ratio and experienced severe social neglect before being adopted. She shows minimal social and emotional responsiveness to others but can be cuddly with her adoptive parents.

The child's presentation, particularly considering her history, is most consistent with a diagnosis of:

  1. Autism Spectrum Disorder
  2. Disinhibited Social Engagement Disorder
  3. Selective Mutism
  4. Reactive Attachment Disorder (correct answer)
Explanation: The correct diagnosis is Reactive Attachment Disorder (RAD). The core features of RAD are a pattern of inhibited, emotionally withdrawn behavior toward adult caregivers and a history of insufficient care (social neglect). The child's lack of comfort-seeking and minimal social/emotional responsiveness are hallmark symptoms. While some symptoms overlap with ASD, the clear history of severe neglect and the absence of restricted/repetitive behaviors point toward RAD. Disinhibited Social Engagement Disorder also stems from neglect but is characterized by overly familiar behavior with strangers, which is the opposite of this child's presentation. Selective Mutism involves a failure to speak in specific situations but not others, which is not the primary concern here.

Question 20

A 3-year-old child is brought to a clinic due to concerns about her eating habits. Her mother reports that for the past three months, the child has persistently eaten non-food substances, including paint chips and soil from houseplants. This behavior occurs despite adequate nutrition. The psychologist notes that the child's developmental level is appropriate for her age.

The child's behavior is most consistent with a diagnosis of:

  1. Avoidant/Restrictive Food Intake Disorder
  2. Pica (correct answer)
  3. Normal exploratory mouthing behavior
  4. Autism Spectrum Disorder
Explanation: The diagnosis is Pica, which involves the persistent eating of nonnutritive, nonfood substances over a period of at least one month. The behavior is inappropriate to the developmental level of the individual (a 3-year-old should not be persistently eating paint and soil) and is not part of a culturally supported or socially normative practice. While mouthing objects is normal for infants and young toddlers, the persistent eating of these specific substances at age 3 is clinically significant. ARFID involves a lack of interest in food or avoidance based on sensory characteristics, not eating nonfood items. While pica can be associated with ASD, it is not a core diagnostic feature.