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ADHD Transition to Adult Services — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatryADHD Transition to Adult ServicesMRCPsych Paper B

A 17-year-old with ADHD is preparing to transfer from CAMHS to adult services. His symptoms remain impairing when doses are missed, and methylphenidate continues to provide substantial benefit without significant adverse effects. According to NICE NG87, what should happen to his medication during transition?

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Correct answer: B — Review the need for it and continue it if clinically indicated

The correct answer is B. NICE recommends reassessing a young person with ADHD around school-leaving age to establish whether treatment is still needed in adulthood. Medication should also be reviewed at least annually, considering ongoing clinical need, effectiveness, adverse effects, functioning and the person's preferences. Here, symptoms remain impairing without treatment, while methylphenidate is effective and well tolerated, so continuation is appropriate. Medication is not automatically stopped at 18, and transition alone is not an indication to switch from a stimulant to atomoxetine or to reduce the dose. A trial dose reduction or treatment break may be considered when the individual balance of benefits and harms supports it, but no mandatory 6-month drug holiday is required.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations 1.1.4 and 1.10.1–1.10.3. 2018, updated 2019. https://www.nice.org.uk/guidance/ng87/chapter/recommendations