ASD — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateChild & Adolescent PsychiatryASDMRCPsych Paper B

An 8-year-old boy with autism spectrum disorder has persistent severe aggression at school that poses a risk of harm to others. A multidisciplinary assessment has found no untreated physical disorder, coexisting mental health or behavioural disorder, or environmental trigger. A functional assessment-informed psychosocial intervention has been implemented consistently but has not produced sufficient improvement. Which medication is most appropriate to consider for this behaviour?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Risperidone

Risperidone is the best answer. NICE CG170 advises considering an antipsychotic for severe behaviour that challenges in an autistic child when potential physical, psychiatric and environmental causes have been addressed and an appropriate psychosocial intervention has been insufficient. Risperidone has direct trial evidence for reducing irritability and aggression in autistic children, although prescribing for ASD-related aggression is generally off-label in the UK. It should be initiated and monitored by a paediatrician or psychiatrist, with predefined target behaviours, review after 3–4 weeks and discontinuation if there is no clinically important response by 6 weeks. Fluoxetine treats conditions such as depression or anxiety, methylphenidate targets coexisting ADHD, melatonin treats sleep disturbance, and sodium valproate is not routinely recommended for ASD-related aggression.

Reference: NICE. Autism spectrum disorder in under 19s: support and management (CG170), recommendations 1.4.10–1.4.12. Published 2013; last updated 2021; reviewed 2025. https://www.nice.org.uk/guidance/cg170/chapter/recommendations