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ADHD Monitoring — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryADHD MonitoringMRCPsych Paper B

A 9-year-old boy with ADHD takes modified-release methylphenidate 36 mg daily. Over 3 months, he has developed poor appetite, lost 3 kg and crossed from the 50th to the 25th height centile. According to NICE NG87, which minimum scheduled growth-monitoring regimen should be used while he is taking ADHD medication, in addition to any extra measurements required because concerns have arisen?

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

Reveal the answer and explanation

Correct answer: B — Measure height every 6 months and weight every 3 months, plotting both on a growth chart

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

NICE NG87 specifies age-dependent growth monitoring. In a child aged 10 years or under, weight should be measured every 3 months and height every 6 months; both should be plotted on a growth chart and reviewed by the responsible clinician. Measurements should be taken more often when concerns arise, as here. Option B misses the required 3-monthly weight checks, while C reverses the recommended frequencies. Options D and E provide inadequate routine monitoring. The weight loss warrants strategies such as administering medication with or after food, dietary measures, a planned treatment break or changing medication. If height is significantly affected, a planned break during school holidays may allow catch-up growth. Monitoring before and after dose changes applies specifically to heart rate and blood pressure, not the routine growth schedule.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations 1.8.5–1.8.7. 2018, updated 2019. https://www.nice.org.uk/guidance/ng87/chapter/recommendations