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ADHD — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryADHDMRCPsych Paper B

A 10-year-old boy has a confirmed diagnosis of ADHD, with symptoms across home and school. ADHD-focused information and support have been provided, and appropriate environmental modifications at home and school have been implemented and reviewed. Despite these measures, he continues to have persistent significant impairment in academic functioning. A baseline assessment identifies no contraindication to medication, and he has not previously received pharmacological treatment for ADHD. According to NICE NG87, which medication should be offered as first-line pharmacological treatment?

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Correct answer: C — Methylphenidate

Methylphenidate is the correct answer. NICE recommends medication for children aged 5 years and over when ADHD symptoms continue to cause persistent significant impairment after environmental modifications have been implemented and reviewed. Methylphenidate is the first-line pharmacological treatment in this age group. Lisdexamfetamine is considered after an adequate 6-week methylphenidate trial produces insufficient benefit. Dexamfetamine is reserved for patients who respond to lisdexamfetamine but cannot tolerate its longer duration of action. Atomoxetine or guanfacine is offered when methylphenidate and lisdexamfetamine are not tolerated or have both proved ineffective. The original keyed parent intervention was incorrect: parent training is first-line for children under 5 and is specifically indicated in older children with coexisting oppositional defiant or conduct symptoms.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations 1.5.13 and 1.7.7–1.7.10. 2018. https://www.nice.org.uk/guidance/ng87/chapter/recommendations