Facts read from pncb.org and 1 more · last checked Nov 7, 2026
PNCB ranks this category first of 21 by the number of items it gets, across all four areas. In primary care it means three jobs: spotting a delay, sorting behavior from disorder, and starting first-line treatment before or alongside referral.
Practice questions
60 questions written to the CPNP-PC outline; each choice is explained once you pick.
Tap an option: why each one is right or wrong appears under it.
Developmental, Behavioral and Mental Health
A 3-year-old has been repeating whole words and phrases ("I want, I want juice", "can I, can I go") for 2 months. The child shows no tension, facial grimacing, or frustration when speaking, and there is no family history of stuttering. Which is the MOST appropriate management?
Relaxed repetition of whole words and phrases for a few months in a 3-year-old, with no tension, struggle, or family history, is typical developmental dysfluency; parents listen patiently and let the child finish.
Hearing testing is the step for delayed or unclear speech; fluent but repetitive speech in a child who is otherwise developing language does not point to hearing loss.
Referral is for sound or syllable repetitions, prolongations or blocks, visible tension or avoidance, more than about 6 months of dysfluency, or a family history of stuttering, none of which is present.
Telling a child to slow down or start over draws attention to the dysfluency and can turn normal repetitions into anxious stuttering.
At a 9-month visit, the ASQ-3 gross motor score is below the cutoff; the infant cannot sit without support. Which is the MOST appropriate next step?
Normal variation is wide, but sitting without support is expected by 9 months; reassurance after a failed screen is the classic delay.
A failed ASQ-3 gross motor domain confirmed by an infant who cannot sit alone at 9 months is a positive screen; referral to early intervention, with medical evaluation of the cause, starts now.
Imaging may be part of the workup for a cause, but early intervention does not require a diagnosis and should not wait for it.
Rescreening a positive result later loses months of therapy during the period when it helps most.
A 9-year-old has had eye blinking, shoulder shrugging, and repeated throat clearing that wax and wane for 14 months. The movements are briefly suppressible and are preceded by an urge. The MOST LIKELY diagnosis is:
Compulsions are purposeful acts done to relieve an obsession; a premonitory urge before a tic is a different experience, though OCD often coexists with tics.
Persistent motor tic disorder means only motor or only vocal tics; throat clearing counts as a vocal tic, so both types are present.
Provisional tic disorder covers tics of less than 1 year; at 14 months this child has passed that window.
Several motor tics plus at least one vocal tic (throat clearing) present for more than a year, waxing and waning, suppressible, and preceded by an urge, meet criteria for Tourette syndrome.
A 14-year-old reports worry and trouble falling asleep before exams for the past month. GAD-7 score is 7, PHQ-A score is 4 with no suicidal ideation, and grades and friendships are intact. Which plan is MOST appropriate?
An SSRI is for moderate to severe anxiety with impairment or when therapy has not helped; starting one for mild exam worry overtreats.
A GAD-7 of 7 is in the mild range, and with school and friendships intact the first step is coping strategies (relaxation, sleep routine, study planning) with a scheduled recheck.
Urgent psychiatric referral is for risk or severe impairment; mild symptoms in a functioning teen are managed in primary care.
Mild symptoms still need follow-up to see whether they settle or progress; dismissing a positive screen leaves no safety net.
A 7-year-old's teacher suspects ADHD because the child 'zones out' many times a day. Each episode lasts 5 to 10 seconds with eyelid fluttering, and the child does not recall it. Hyperventilation in the office triggers an episode. Which test should be obtained to establish the diagnosis?
MRI is usually normal in absence epilepsy and does not make the diagnosis.
Many daily staring spells of 5 to 10 seconds with eyelid flutter, no memory, and provocation by hyperventilation are childhood absence epilepsy; an EEG showing 3-Hz spike-and-wave discharges confirms it.
Rating scales measure ADHD symptoms, but ADHD inattention is not brief and amnestic, and it is not triggered by hyperventilation; scoring them here misdiagnoses a seizure disorder.
A sleep study looks for sleep-disordered breathing as a cause of daytime inattention, not for seizures provoked in the office.
A 6-year-old placed in foster care 2 months ago because of neglect and witnessed violence has nightmares, is easily startled, avoids the old neighborhood, and repeatedly acts out fighting during play. The child seeks comfort from the foster parent when upset. The MOST LIKELY diagnosis is:
Nightmares, reenacting the violence in play, avoidance of reminders, and an exaggerated startle lasting more than a month after trauma meet criteria for PTSD.
Reactive attachment disorder describes a child who rarely seeks or accepts comfort after neglect; this child turns to the foster parent when upset.
Separation anxiety centers on fear of being apart from attachment figures, not on nightmares and play about the violence that was witnessed.
Hyperarousal can look like hyperactivity, but ADHD does not include reexperiencing or avoidance, and its symptoms start before and apart from a trauma.
Parents of a 6-month-old report that the infant is very hard to soothe and has irregular sleep and feeding. Motor and language milestones are on track. Which screening tool BEST addresses this concern?
The M-CHAT-R/F is an autism screen validated for 16 to 30 months, so it does not fit a 6-month-old or this concern.
The ASQ:SE-2 screens social-emotional development, including self-regulation, crying, sleep, and feeding, from 1 month to 6 years, which matches a concern about soothability.
The ASQ-3 screens communication, motor, problem-solving, and personal-social skills, and these milestones are already on track.
The PSC-17 screens emotional and behavioral problems in school-age children, not regulation problems in an infant.
Parents of a 9-year-old ask how much daily recreational screen time is appropriate. Which response BEST reflects current AAP guidance?
Avoiding screens except video chat is the guidance for children under about 18 to 24 months.
The 1-hour limit of high-quality programming is the AAP advice for ages 2 to 5; applying it to a 9-year-old uses the wrong age band.
Educational content still displaces sleep and activity, so it is counted within the family's limits.
For children 6 and older the AAP advises consistent, individualized limits set in a family media plan that protects sleep, activity, and family time, rather than a fixed number of hours.
A 15-month-old cries hard when a toy is taken away, then stops breathing, turns blue, goes limp for a few seconds, and recovers fully within a minute. This has happened 4 times, always after crying. Growth and the examination are normal. Which is the MOST appropriate next step?
Spells that always follow crying, with cyanosis, brief limpness, and full recovery in a toddler with a normal exam, are cyanotic breath-holding spells; they are benign, and iron deficiency is checked because treating it reduces how often they happen.
An EEG is for events without a crying trigger or with prolonged postictal confusion; a provoked, stereotyped spell with quick recovery is not epilepsy.
Giving in to prevent crying teaches the toddler that spells get results; parents keep usual limits and stay calm during an episode.
Antiseizure medication has no role in breath-holding spells, which are reflexive and not epileptic.
A 16-year-old with type 1 diabetes has missed insulin doses and HbA1c has risen from 7.5% to 10.2%. PHQ-A score is 17 with no suicidal ideation. Which is the MOST appropriate next step?
Knowledge is rarely what is missing when an experienced teen stops dosing; education alone does not treat depression.
More insulin does not help a teen who is skipping doses; adjusting the regimen treats the number and misses the cause.
A PHQ-A of 17 is moderately severe depression, a common cause of missed insulin and rising HbA1c in teens with diabetes; treating it now with psychotherapy, an SSRI, or both addresses the reason self-care slipped.
Rescreening in 3 months leaves a positive, moderately severe screen untreated while glycemic control keeps worsening.
A 7-year-old with fluent speech talks at length about train schedules, does not notice when listeners are bored, has no close friends, and becomes very upset when routines change. The MOST LIKELY diagnosis is:
Social-communication deficits together with an intense narrow interest and distress at changes in routine meet DSM-5-TR criteria for autism spectrum disorder, even with fluent speech.
ADHD can strain friendships through impulsivity, but it does not explain a narrow special interest or insistence on sameness.
Social anxiety involves fear of being judged and avoidance of social situations, not obliviousness to listeners' cues.
Social communication disorder is diagnosed only when restricted, repetitive behavior is absent; the train fixation and rigidity rule it out.
For 8 months, a 9-year-old has argued with adults, refused requests, deliberately annoyed siblings, and been easily angered. There is no aggression toward people or animals, property destruction, or stealing. The MOST LIKELY diagnosis is:
Conduct disorder requires aggression to people or animals, destruction, deceit or theft, or serious rule violations, all of which are absent here.
DMDD needs severe temper outbursts about 3 or more times a week on top of persistent irritability for a year; being easily angered and argumentative is the ODD pattern.
Intermittent explosive disorder describes recurrent impulsive aggressive outbursts out of proportion to the trigger, not ongoing defiance.
At least 6 months of angry or irritable mood with arguing, defiance, and deliberately annoying others, without violating others' basic rights, is oppositional defiant disorder.
During a sick visit, a 13-year-old completes the Ask Suicide-Screening Questions (ASQ) and answers yes to 'Are you having thoughts of killing yourself right now?' Which is the MOST appropriate next step?
Rescreening later treats an acute positive as if it were uncertain and leaves imminent risk unaddressed.
Outpatient referral fits ongoing low-risk symptoms; it leaves an adolescent with active suicidal thoughts without immediate protection.
A yes to the ASQ acuity question about thoughts of suicide right now is an acute positive screen: the teen stays under observation and gets an emergency mental health evaluation.
A brief suicide safety assessment in the office is the step for a non-acute positive screen, when the teen answers no to current thoughts.
A 3-year-old functions at about the 20-month level in gross motor, fine motor, and language skills, with a normal neurologic exam. The MOST appropriate working diagnosis is:
Cerebral palsy requires abnormal tone, posture, or movement on exam; a normal neurologic exam argues against it.
A language disorder affects language alone; here motor skills are behind as well, so the broader label applies.
Intellectual disability is not reliably diagnosed until standardized IQ testing is valid, usually after age 5, so a 3-year-old receives the delay label instead.
Significant delay in two or more domains in a child under 5 is termed global developmental delay; it prompts a search for a cause (genetic testing, hearing, vision) and early intervention.
A running total sits here; it fills in after your last pick.
3
Age decides the first step
ADHD at 4 or 5. The AAP 2019 guideline puts parent training in behavior management first for preschoolers, and adds methylphenidate only if behavior therapy does not help enough. From age 6, FDA-approved medication is recommended, preferably together with behavioral treatment.
A diagnosis from one setting. ADHD symptoms need to be present in at least two settings, which is why Vanderbilt forms go to both parents and teachers.
Ignoring mood symptoms before 12. Bright Futures sets yearly depression screening from age 12; symptoms before then are assessed when they appear.
Bedwetting treated too early. Enuresis is not treated before age 5. The alarm is the first-line option with the most durable effect, and desmopressin suits short-term needs like camp.
Starting an SSRI without a follow-up plan. Antidepressants carry an FDA boxed warning on suicidal thinking in young people, so the plan includes early, scheduled contact.
4
Where pediatric mental health stops
Screening, first-line treatment and referral are pediatric primary care, and they are covered here. Psychiatric-level prescribing (antipsychotics, mood stabilizers, augmentation and switching) is psychiatric NP material, on PMHNP-BC diagnosis and treatment. Postpartum depression screening at infant visits uses the Edinburgh scale and is part of health maintenance.
Why is this category so large on the pediatric NP exam?
Ranked by item count, this category tops the outline's list, ahead of dermatology. Its questions turn up in all four content areas, from well-child guidance to management.
Is there a separate PNCB credential for pediatric mental health?
Yes, the PMHS, a specialty credential for pediatric primary care providers. It is not an NP board and has no pages on this site.