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ADHD Presentation — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatryADHD PresentationMRCPsych Paper B

A 6-year-old boy undergoes a specialist assessment because of difficulties at home and school. For the past 18 months, he has shown at least six developmentally inappropriate symptoms of inattention and at least six symptoms of hyperactivity and impulsivity. These occur frequently in both settings and have caused significant deterioration in his learning and peer relationships. There is no persistent pattern of aggression, serious rule-breaking or social-communication impairment. What is the most likely diagnosis?

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Correct answer: A — Attention deficit hyperactivity disorder

The correct answer is A, attention deficit hyperactivity disorder. He has persistent, developmentally inappropriate symptoms in both core ADHD domains— inattention and hyperactivity/impulsivity—which occur frequently across home and school and cause significant educational and social impairment. This pattern meets the central NICE diagnostic requirements. Autism spectrum disorder requires persistent social-communication difficulties and restricted or repetitive behaviour, which are not described. Conduct disorder involves serious violation of others' rights or age-appropriate rules, while oppositional defiant disorder is characterised by persistent angry, argumentative or defiant behaviour; neither explains the prominent attentional and hyperactivity symptoms. Separation anxiety disorder would be centred on excessive distress about separation rather than pervasive symptoms across settings.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), section 1.3, Diagnosis. 2018, updated 2019; recommendation 1.3.1 updated 2024. https://www.nice.org.uk/guidance/ng87/chapter/recommendations