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ADHD and Tics — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryADHD and TicsMRCPsych Paper B

A 14-year-old boy with ADHD is taking modified-release methylphenidate 54 mg daily with substantial improvement in his ADHD symptoms. He develops intermittent motor tics. According to NICE NG87, what is the most appropriate approach?

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Correct answer: C — Assess causality and impact, then reduce the dose or switch medication if the tics are stimulant-related

The correct answer is C. NICE advises first considering whether the tics are genuinely related to the stimulant, because tics naturally wax and wane, and whether tic-related impairment outweighs the benefits of ADHD treatment. If the tics are stimulant-related, management may include reducing the stimulant dose or changing to guanfacine, atomoxetine or, with appropriate specialist advice, clonidine; stopping medication is another option. Immediate discontinuation is therefore not routinely required. Continuing unchanged may sometimes follow an individual risk–benefit assessment, but it is not justified merely by assuming that all tics are self-limiting. Tics can occur or worsen during stimulant treatment, so option A is incorrect. Adding haloperidol without first assessing causality, severity and treatment benefit is not the NICE-recommended initial approach.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), sections 1.8.13–1.8.14, 2018 (reviewed 2025). https://www.nice.org.uk/guidance/ng87/chapter/recommendations