skip to main content

Drug Holidays ADHD — MRCPsych Paper B MCQ

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

ModerateChild & Adolescent PsychiatryDrug Holidays ADHDMRCPsych Paper B

A 9-year-old boy with ADHD has taken methylphenidate for 3 years. At his annual review, his height and weight remain on their expected trajectories, he has no troublesome adverse effects, and missed doses are associated with clear deterioration in functioning at both school and home. His parents ask whether he should now have routine medication-free periods because he has received treatment for several years. According to NICE NG87, what is the most appropriate advice?

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

Reveal the answer and explanation

Correct answer: B — Continue treatment with at least annual review, considering a trial reduction or stop only if the balance of benefits and harms supports it

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

B is correct. NICE does not recommend routine drug holidays based solely on treatment duration. ADHD medication should be reviewed at least annually, including benefits, adverse effects, functional impact and the effects of missed doses or periods without treatment. A trial of dose reduction or stopping may be considered when the individual balance of benefits and harms makes this appropriate. Here, growth is normal, adverse effects are not troublesome and missed doses cause deterioration, favouring continuation. Routine weekend or annual breaks are therefore unsupported. School-holiday breaks are specifically considered when medication has significantly affected height, to permit catch-up growth; a planned break may also be one strategy for clinically concerning weight loss. Treatment should not, however, continue automatically until age 18 without regular review.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations 1.8.6, 1.8.7, 1.10.1 and 1.10.3. 2018, updated 2019. https://www.nice.org.uk/guidance/ng87/chapter/recommendations