A 7-year-old boy has been diagnosed with ADHD (combined presentation). His parents refuse stimulant medication. Which non-pharmacological intervention has the STRONGEST evidence base as monotherapy in this age group?

• A Play therapy
• B Behavioural parent training (parent-directed behaviour management therapy) ✓
• C Dietary elimination (removing artificial food colours and additives)
• D Social skills training groups alone

Explanation

Behavioural parent training (BPT) is the most evidence-based non-pharmacological intervention for ADHD, particularly in children under 12 years. The American Academy of Pediatrics (AAP) guidelines recommend behavioural therapy as first-line treatment in preschool-age children (4–5 years) and as an important component of multimodal treatment in school-age children. BPT teaches parents contingency management (reward systems, consistent limit-setting) which directly addresses ADHD behaviours in the home environment. Dietary interventions have very weak evidence; social skills training and play therapy lack sufficient RCT evidence as monotherapy for core ADHD symptoms.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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