1
NR547 DIFFERENTIAL DIAGNOSIS PMH MIDTERM
PRACTICUM EXAM 2026/2027 | Across the Lifespan |
Complete Review | Latest Update | Pass Guaranteed - A+
Graded
Section 1: Neurodevelopmental Disorders & Differential Diagnosis (Questions 1-
12)
Q1. A 4-year-old boy shows no eye contact, does not respond to his name, lines up
toys obsessively, and engages in repetitive hand flapping. He speaks in 2-word
phrases. His preschool teacher notes he plays alongside peers but never with them.
Developmental history reveals no regression. What is the most likely diagnosis?
A. Social (pragmatic) communication disorder
B. Autism spectrum disorder
C. Intellectual disability
D. Global developmental delay
B. Autism spectrum disorder [CORRECT]
Rationale: ASD requires persistent deficits in social communication and social
interaction across multiple contexts, plus restricted, repetitive patterns of behavior,
interests, or activities. Social (pragmatic) communication disorder lacks
restricted/repetitive behaviors. Intellectual disability requires IQ ≤70 plus adaptive
functioning deficits. Global developmental delay is reserved for children under age 5
when standardized testing is not feasible.
Correct Answer: B
,2
Q2. A 6-year-old girl speaks fluently at home with family but has not spoken at
school for 4 months. She participates nonverbally in classroom activities and does
not appear anxious about speaking. At home, she is outgoing and talkative. How is
this presentation most clearly distinguished from social anxiety disorder?
A. Autism spectrum disorder; distinguished by social communication deficits across
all settings
B. Selective mutism; distinguished by speaking in some settings but consistent failure
in specific social situations without fear of negative evaluation in non-speaking
contexts
C. Social anxiety disorder; distinguished by fear of humiliation in all social
performance situations
D. Specific phobia; distinguished by fear of a specific object or situation
B. Selective mutism; distinguished by speaking in some settings but consistent failure
in specific social situations without fear of negative evaluation in non-speaking
contexts [CORRECT]
Rationale: Selective mutism involves consistent failure to speak in specific social
situations where speech is expected, despite speaking in other situations, lasting ≥1
month. Social anxiety disorder involves marked fear of negative evaluation across a
range of social situations, not merely selective speech inhibition.
Correct Answer: B
Q3. Which of the following is REQUIRED for a diagnosis of specific learning disorder
with impairment in reading?
A. Intelligence quotient below 70
B. Reading achievement substantially below that expected for the individual's
chronological age and adequate instruction, not attributable to intellectual disability,
visual impairment, or inadequate educational opportunity
C. Comorbid attention-deficit/hyperactivity disorder
D. Presence of a communication disorder
,3
B. Reading achievement substantially below that expected for the individual's
chronological age and adequate instruction, not attributable to intellectual disability,
visual impairment, or inadequate educational opportunity [CORRECT]
Rationale: Specific learning disorder requires academic skills substantially and
quantifiably below expectations for chronological age, causing interference with
academic achievement or activities of daily living, not better explained by intellectual
disability, visual/auditory acuity deficits, neurological or motor disorders, or lack of
language proficiency.
Correct Answer: B
Q4. A 16-year-old with newly diagnosed ADHD, combined presentation, presents
with irritability, academic decline, and statements that "life isn't worth living." He
denies a specific suicide plan but has immediate access to firearms at home. His
parents are present and concerned. What is the priority action?
A. Start methylphenidate immediately and schedule follow-up in 3 months
B. Conduct a comprehensive suicide risk assessment, ensure firearm removal from
the home, and implement immediate safety planning with family involvement
C. Diagnose major depressive disorder and initiate an SSRI without further
assessment
D. Recommend outpatient family therapy with next available appointment
B. Conduct a comprehensive suicide risk assessment, ensure firearm removal from
the home, and implement immediate safety planning with family involvement
[CORRECT]
Rationale: Firearm access is one of the strongest acute risk factors for completed
suicide in adolescents. Even without a disclosed plan, a comprehensive risk
assessment, lethal means restriction, and safety planning are mandatory before any
treatment planning. Starting medication without addressing acute safety is
inappropriate.
Correct Answer: B
, 4
Q5. A 9-year-old girl has been failing mathematics for 2 years despite intensive
tutoring. Psychological testing reveals full-scale IQ 98 but mathematics achievement
at the 3rd percentile. She has no attention problems, hyperactivity, social deficits, or
emotional disturbances. What is the most appropriate diagnosis?
A. Attention-deficit/hyperactivity disorder, predominantly inattentive presentation
B. Specific learning disorder with impairment in mathematics
C. Intellectual disability
D. Autism spectrum disorder
B. Specific learning disorder with impairment in mathematics [CORRECT]
Rationale: Specific learning disorder requires academic achievement substantially
below age/grade level despite adequate instruction and normal intelligence. The
isolated mathematics deficit with normal IQ and no attention, social, or behavioral
symptoms supports this diagnosis over ADHD, intellectual disability, or ASD.
Correct Answer: B
Q6. A 5-year-old boy has delays in fine motor skills, expressive language, and social
reciprocity. He cannot dress himself, speaks in 1-word utterances, and does not
engage in pretend play. Standardized IQ testing is deferred due to age. How does
this presentation differ from intellectual disability?
A. Autism spectrum disorder; distinguished by the presence of restricted repetitive
behaviors
B. Global developmental delay; diagnosed when younger than 5 years with delays in
multiple developmental domains and IQ testing deferred
C. Specific learning disorder; distinguished by isolated academic underachievement
D. Communication disorder; distinguished by language impairment in the absence of
other delays
B. Global developmental delay; diagnosed when younger than 5 years with delays in
multiple developmental domains and IQ testing deferred [CORRECT]
Rationale: Global developmental delay is diagnosed in children under age 5 when
standardized testing is not feasible or reliable, but there are significant delays in ≥2
NR547 DIFFERENTIAL DIAGNOSIS PMH MIDTERM
PRACTICUM EXAM 2026/2027 | Across the Lifespan |
Complete Review | Latest Update | Pass Guaranteed - A+
Graded
Section 1: Neurodevelopmental Disorders & Differential Diagnosis (Questions 1-
12)
Q1. A 4-year-old boy shows no eye contact, does not respond to his name, lines up
toys obsessively, and engages in repetitive hand flapping. He speaks in 2-word
phrases. His preschool teacher notes he plays alongside peers but never with them.
Developmental history reveals no regression. What is the most likely diagnosis?
A. Social (pragmatic) communication disorder
B. Autism spectrum disorder
C. Intellectual disability
D. Global developmental delay
B. Autism spectrum disorder [CORRECT]
Rationale: ASD requires persistent deficits in social communication and social
interaction across multiple contexts, plus restricted, repetitive patterns of behavior,
interests, or activities. Social (pragmatic) communication disorder lacks
restricted/repetitive behaviors. Intellectual disability requires IQ ≤70 plus adaptive
functioning deficits. Global developmental delay is reserved for children under age 5
when standardized testing is not feasible.
Correct Answer: B
,2
Q2. A 6-year-old girl speaks fluently at home with family but has not spoken at
school for 4 months. She participates nonverbally in classroom activities and does
not appear anxious about speaking. At home, she is outgoing and talkative. How is
this presentation most clearly distinguished from social anxiety disorder?
A. Autism spectrum disorder; distinguished by social communication deficits across
all settings
B. Selective mutism; distinguished by speaking in some settings but consistent failure
in specific social situations without fear of negative evaluation in non-speaking
contexts
C. Social anxiety disorder; distinguished by fear of humiliation in all social
performance situations
D. Specific phobia; distinguished by fear of a specific object or situation
B. Selective mutism; distinguished by speaking in some settings but consistent failure
in specific social situations without fear of negative evaluation in non-speaking
contexts [CORRECT]
Rationale: Selective mutism involves consistent failure to speak in specific social
situations where speech is expected, despite speaking in other situations, lasting ≥1
month. Social anxiety disorder involves marked fear of negative evaluation across a
range of social situations, not merely selective speech inhibition.
Correct Answer: B
Q3. Which of the following is REQUIRED for a diagnosis of specific learning disorder
with impairment in reading?
A. Intelligence quotient below 70
B. Reading achievement substantially below that expected for the individual's
chronological age and adequate instruction, not attributable to intellectual disability,
visual impairment, or inadequate educational opportunity
C. Comorbid attention-deficit/hyperactivity disorder
D. Presence of a communication disorder
,3
B. Reading achievement substantially below that expected for the individual's
chronological age and adequate instruction, not attributable to intellectual disability,
visual impairment, or inadequate educational opportunity [CORRECT]
Rationale: Specific learning disorder requires academic skills substantially and
quantifiably below expectations for chronological age, causing interference with
academic achievement or activities of daily living, not better explained by intellectual
disability, visual/auditory acuity deficits, neurological or motor disorders, or lack of
language proficiency.
Correct Answer: B
Q4. A 16-year-old with newly diagnosed ADHD, combined presentation, presents
with irritability, academic decline, and statements that "life isn't worth living." He
denies a specific suicide plan but has immediate access to firearms at home. His
parents are present and concerned. What is the priority action?
A. Start methylphenidate immediately and schedule follow-up in 3 months
B. Conduct a comprehensive suicide risk assessment, ensure firearm removal from
the home, and implement immediate safety planning with family involvement
C. Diagnose major depressive disorder and initiate an SSRI without further
assessment
D. Recommend outpatient family therapy with next available appointment
B. Conduct a comprehensive suicide risk assessment, ensure firearm removal from
the home, and implement immediate safety planning with family involvement
[CORRECT]
Rationale: Firearm access is one of the strongest acute risk factors for completed
suicide in adolescents. Even without a disclosed plan, a comprehensive risk
assessment, lethal means restriction, and safety planning are mandatory before any
treatment planning. Starting medication without addressing acute safety is
inappropriate.
Correct Answer: B
, 4
Q5. A 9-year-old girl has been failing mathematics for 2 years despite intensive
tutoring. Psychological testing reveals full-scale IQ 98 but mathematics achievement
at the 3rd percentile. She has no attention problems, hyperactivity, social deficits, or
emotional disturbances. What is the most appropriate diagnosis?
A. Attention-deficit/hyperactivity disorder, predominantly inattentive presentation
B. Specific learning disorder with impairment in mathematics
C. Intellectual disability
D. Autism spectrum disorder
B. Specific learning disorder with impairment in mathematics [CORRECT]
Rationale: Specific learning disorder requires academic achievement substantially
below age/grade level despite adequate instruction and normal intelligence. The
isolated mathematics deficit with normal IQ and no attention, social, or behavioral
symptoms supports this diagnosis over ADHD, intellectual disability, or ASD.
Correct Answer: B
Q6. A 5-year-old boy has delays in fine motor skills, expressive language, and social
reciprocity. He cannot dress himself, speaks in 1-word utterances, and does not
engage in pretend play. Standardized IQ testing is deferred due to age. How does
this presentation differ from intellectual disability?
A. Autism spectrum disorder; distinguished by the presence of restricted repetitive
behaviors
B. Global developmental delay; diagnosed when younger than 5 years with delays in
multiple developmental domains and IQ testing deferred
C. Specific learning disorder; distinguished by isolated academic underachievement
D. Communication disorder; distinguished by language impairment in the absence of
other delays
B. Global developmental delay; diagnosed when younger than 5 years with delays in
multiple developmental domains and IQ testing deferred [CORRECT]
Rationale: Global developmental delay is diagnosed in children under age 5 when
standardized testing is not feasible or reliable, but there are significant delays in ≥2
