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Growth Management ADHD Stimulants — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryGrowth Management ADHD StimulantsMRCPsych Paper B

A 12-year-old boy has taken modified-release methylphenidate for 9 months, with marked improvement in ADHD symptoms. His appetite is poor during the day, his weight has crossed down two centile lines, and his height trajectory is now below that expected for his age. Assessment identifies no alternative medical cause. His family would prefer to continue effective medication if possible. Which is the most appropriate management plan?

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Correct answer: B — Give medication with or after breakfast, increase nutritious intake when its effects have worn off, obtain dietary advice, and consider a planned school-holiday break

Option B is correct. NICE recommends administering ADHD medication with or after food, adding meals or snacks early in the morning or late in the evening when stimulant effects have worn off, obtaining dietary advice, and using nutritious high-calorie foods when weight loss is concerning. If height is significantly affected, a planned treatment break over school holidays should be considered to allow catch-up growth. Permanent discontinuation is not automatically necessary when treatment remains beneficial, although medication may later need changing if these measures fail. Increasing the dose may worsen appetite suppression. Continuing unchanged for another year would inadequately address an established adverse effect. Appetite-stimulating medicines are not recommended as routine management of stimulant-related growth problems.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations 1.8.5–1.8.7, 2018; page updated May 2025. https://www.nice.org.uk/guidance/ng87/chapter/recommendations