Under-5 ADHD First-Line — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatryUnder-5 ADHD First-LineMRCPsych Paper B

A 4-year-old child has received a specialist diagnosis of attention deficit hyperactivity disorder. According to current NICE guidance, which intervention should be offered as first-line treatment?

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Correct answer: A — An ADHD-focused group parent-training programme

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

B is correct. NICE NG87 recommends offering an ADHD-focused group parent-training programme to the parents or carers of a child under 5 years with ADHD as first-line treatment. This age is the decisive feature. Methylphenidate and atomoxetine are therefore not first-line options; if significant impairment persists after parent training and reviewed environmental modifications, advice should be obtained from a specialist ADHD service experienced in managing young children. Medication must not be offered to a child under 5 without a second specialist opinion. Individual CBT for the child is not the recommended preschool first-line intervention. An elimination diet should not be used as the sole treatment for ADHD.

Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. NICE guideline NG87, recommendations 1.5.7–1.5.9. 2018; last updated 13 September 2019 and reviewed 7 May 2025. https://www.nice.org.uk/guidance/ng87/chapter/recommendations