Non-Stimulant ADHD Treatment — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatryNon-Stimulant ADHD TreatmentMRCPsych Paper B

A 7-year-old girl with ADHD has had trials of methylphenidate and lisdexamfetamine, but both were stopped because of clinically significant adverse effects. According to the standard medication pathway in NICE NG87, which medication option should be offered next?

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Correct answer: E — A trial of atomoxetine or guanfacine

Explanation lettering: E = shown as B · B = shown as C · C = shown as E

C is correct. NICE NG87 recommends offering atomoxetine or guanfacine to children aged 5 years and over who cannot tolerate methylphenidate or lisdexamfetamine. Both standard stimulant options have been stopped here because of significant adverse effects. Dexamfetamine is reserved for patients who respond to lisdexamfetamine but cannot tolerate its longer duration of action, rather than for general stimulant intolerance. Risperidone is not routine ADHD monotherapy; antipsychotic augmentation for pervasive aggression, rages or irritability requires tertiary-service advice. Clonidine is also not a standard next-line option and should not be offered to a child without tertiary ADHD service advice. Atomoxetine and guanfacine are therefore the appropriate non-stimulant choices.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations 1.7.10 and 1.7.17. 2018, amended 2019. https://www.nice.org.uk/guidance/ng87/chapter/recommendations