ADHD — MRCPsych Paper B MCQ
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Correct answer: A — Methylphenidate
The correct answer is A, methylphenidate. NICE NG87 recommends short- or long-acting methylphenidate as first-line pharmacological treatment for children aged 5 years and over and young people with ADHD. Lisdexamfetamine is considered after an adequate 6-week methylphenidate trial has produced insufficient benefit. Atomoxetine or guanfacine is offered when methylphenidate and lisdexamfetamine are not tolerated or when symptoms have not responded to separate adequate 6-week trials of both stimulants. Dexamfetamine is considered when lisdexamfetamine is effective but its longer duration of action is not tolerated. The original keyed answer was correct, but the stored explanation incorrectly implied that methylphenidate intolerance leads directly to lisdexamfetamine; NICE instead places atomoxetine or guanfacine on the intolerance pathway when methylphenidate or lisdexamfetamine cannot be tolerated.
Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), section 1.7, recommendations 1.7.7–1.7.10. 2018, amended 2019. https://www.nice.org.uk/guidance/ng87/chapter/recommendations