ADHD Second-Line — MRCPsych Paper B MCQ

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

ModerateChild & Adolescent PsychiatryADHD Second-LineMRCPsych Paper B

A 9-year-old boy with ADHD has completed a 6-week trial of methylphenidate at an adequate, optimised dose. He has tolerated it, but there has been insufficient improvement in his ADHD symptoms and associated functional impairment. According to NICE NG87, which medication should be considered next?

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

Reveal the answer and explanation

Correct answer: A — Lisdexamfetamine

The correct answer is A, lisdexamfetamine. NICE recommends considering a switch to lisdexamfetamine for a child aged 5 years or over who has received methylphenidate at an adequate dose for 6 weeks without sufficient improvement in ADHD symptoms and associated impairment. Atomoxetine or guanfacine is offered when methylphenidate and lisdexamfetamine are not tolerated or when separate adequate 6-week trials of both stimulants have failed. Dexamfetamine is considered when lisdexamfetamine is effective but its longer duration of action is not tolerated—not simply when lisdexamfetamine is ineffective. Clonidine is not part of the routine medication sequence and should not be offered without advice from a tertiary ADHD service; NICE identifies possible specialist use in children with sleep disturbance, rages or tics.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations 1.7.8–1.7.10. 2018. https://www.nice.org.uk/guidance/ng87/chapter/recommendations