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ASD and ADHD Comorbidity — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatryASD and ADHD ComorbidityMRCPsych Paper B

A 16-year-old with an established diagnosis of autism spectrum disorder is referred to a specialist because of persistent inattention and hyperactivity across home and school, causing significant impairment. Which statement best reflects NICE guidance on diagnosing comorbid ADHD?

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Reveal the answer and explanation

Correct answer: D — ADHD may be diagnosed if its diagnostic criteria are independently met

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

The correct answer is B. Autism spectrum disorder does not exclude a concurrent ADHD diagnosis. NICE recommends diagnosing ADHD when characteristic inattention and/or hyperactivity-impulsivity meet recognised diagnostic criteria, occur in at least two important settings and cause clinically significant impairment; exclusion solely because of a pervasive developmental disorder is not recommended. The symptoms must nevertheless be distinguished from manifestations of autism and other explanations. Options A, C and E incorrectly impose a diagnostic hierarchy between the two neurodevelopmental disorders. Option D is also incorrect: NICE recommends the same ADHD medication choices for autistic people as for other people with ADHD, although dose titration should be slower and monitoring more frequent when autism or another neurodevelopmental condition is present.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations 1.3.3, 1.7.18 and 1.7.28. 2018, amended 2023. https://www.nice.org.uk/guidance/ng87/chapter/recommendations