skip to main content

ASD and Anxiety — MRCPsych Paper B MCQ

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

HardChild & Adolescent PsychiatryASD and AnxietyMRCPsych Paper B

A 10-year-old boy with autism spectrum disorder reports recurrent, intrusive contamination fears that he experiences as distressing and unwanted. He performs prolonged handwashing to neutralise the anxiety, causing moderate-to-severe functional impairment. He has had 12 weeks of developmentally adapted CBT including exposure and response prevention, involving his parents, without an adequate response. Following multidisciplinary review, CBT will continue. According to the NICE guidance applicable through CG170, which medication may now be considered as an adjunct?

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

Reveal the answer and explanation

Correct answer: B — Sertraline

The correct answer is B, sertraline. The distressing, unwanted contamination thoughts and neutralising handwashing indicate coexisting OCD rather than an autism-related restricted or repetitive behaviour. CG170 directs clinicians to use the relevant NICE guideline for coexisting disorders. Under CG31, after multidisciplinary review, an SSRI may be added to ongoing CBT with ERP for a child aged 8–11 years with moderate-to-severe impairment who has not responded adequately to CBT. Sertraline is licensed for paediatric OCD from age 6 and requires low-dose initiation and careful monitoring. Risperidone may be considered for severe behaviour that challenges, not routine OCD treatment. Methylphenidate treats ADHD. Clonidine and buspirone are not NICE-recommended pharmacological treatments for paediatric OCD.

Reference: NICE, Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31), recommendations 1.5.5.2 and 1.5.6.1–1.5.6.4, 2005, https://www.nice.org.uk/guidance/cg31/chapter/Recommendations