Quiz: Psychosocial & Behavioral Interventions

Owen, Age 5

Owen is a 5-year-old boy referred by his preschool after repeated incidents of hitting classmates and running from the classroom. His mother describes mornings as a "war zone": Owen refuses to get dressed, throws toys when redirected, and has prolonged tantrums. He was diagnosed with ADHD-Combined Presentation after a comprehensive evaluation. His pediatrician asks whether medication should be started.

Q1. Owen's pediatrician asks whether medication should be started. Which of the following represents the recommended first-line treatment for a 5-year-old with ADHD?

Q2. Owen's mother completes 14 sessions of Parent-Child Interaction Therapy. His disruptive behaviors at home have decreased markedly, but his preschool teacher reports minimal classroom change. Which concept best explains this discrepancy?

Q3. After one month on the Daily Behavior Report Card (DBRC), Owen's preschool teacher reports that "it isn't really making a difference." However, the behavioral consultant who conducted a structured classroom observation during the same period documented clear improvement in on-task behavior and reduced disruptions. Which of the following best explains the discrepancy and guides the clinician's next step?

Q4. After combined home and school behavioral intervention, Owen shows meaningful improvement but his mother asks whether the behavioral-first approach will disadvantage him compared to starting medication right away. Based on the sequencing evidence, which of the following is most accurate?

Grace, Age 10

Grace is a 10-year-old girl on stable methylphenidate ER (36 mg) for two years. Her attention in class is good, and her parents report that medication has made a clear difference. However, she is failing to turn in assignments despite completing them, her backpack is chaotic, she misjudges how long projects will take, and she consistently loses materials between school and home. Her teacher says: "She pays attention fine now, but she can't keep track of anything."

Q5. Grace's teacher observes that attention has improved but organizational skills remain impaired. Based on the performance-deficit framework, which of the following best explains this dissociation?

Q6. The clinician recommends organizational skills training (OST) for Grace. Her parents ask whether teachers will actually notice a difference or whether gains will only show up at home. Which response is best supported by the evidence?

Q7. Grace's parents ask why she needs both medication and behavioral intervention when the medication is "already working." Which of the following best supports adding behavioral intervention to her optimized medication?

Javi, Age 15

Javi is a 15-year-old boy on stable lisdexamfetamine (50 mg) who was diagnosed with ADHD-Combined Presentation at age 8. His grades have dropped from B's to D's since starting high school. He has stopped using his planner, refuses to discuss homework with his parents, and says "the medication doesn't help with the stuff I actually need help with." His parents report he is ambivalent about treatment and has started skipping doses.

Q8. Despite stable medication with good in-class attention, Javi's grades continue to drop. Which intervention is most appropriate?

Q9. Javi also carries a diagnosis of generalized anxiety disorder. His clinician is weighing whether his comorbid anxiety makes him a stronger or weaker candidate for adolescent cognitive behavioral therapy (CBT) adapted for ADHD. Based on the evidence, which of the following is most accurate?

Q10. Javi's treatment ambivalence and dose-skipping threaten engagement. Which evidence-based approach is most appropriate?

Q11. Javi's parents ask whether he will need medication "forever." His clinician explains that 16-year MTA follow-up data showed the majority of participants oscillated between recurrence and remission rather than following a stable course. Given this trajectory pattern, which treatment model is most appropriate for Javi's long-term care?

Lin's Question

Lin, the mother of a 9-year-old boy with ADHD on methylphenidate ER, tells you she has been researching neurofeedback online. A local clinic offers a 40-session program for $6,000 and claims it can "retrain the ADHD brain without drugs." She asks whether it is worth trying before her son starts middle school.

Q12. Lin's neurofeedback clinic cites parent testimonials showing symptom improvement after 40 sessions. You review the 2025 JAMA Psychiatry meta-analysis of 38 RCTs (n=2,472), which found an effect size of SMD 0.04 (95% CI -0.10 to 0.18) on total ADHD symptoms when measured by blinded raters, despite positive unblinded parent reports. Lin asks how parents could report improvement if the treatment does not work. Which explanation is most accurate?

Q13. Lin also asks about CogMed working memory training advertised at her son's school. You explain that meta-analyses show CogMed improves practiced working memory tasks (SMD 0.38-0.49) but that blinded ratings of ADHD symptoms show SMD 0.12 (not significant). Lin points out that improved working memory sounds promising and asks whether the training is still worth pursuing. Which response is most appropriate?

Q14. You recommend regular physical exercise as a complementary intervention. Lin asks what specific ADHD benefits exercise offers beyond general fitness. Which response is best supported by the evidence?

Rhea, Age 34

Rhea is a 34-year-old software engineer diagnosed with ADHD at age 28. She has been on mixed amphetamine salts XR (25 mg) for four years with good symptom control during work hours. She reports that "the medication keeps me employed, but my life is still falling apart." She misses personal deadlines, her apartment is chronically disorganized, her partner is frustrated by her inability to follow through on household commitments, and she has tried multiple productivity apps, abandoning each within weeks. She also reports 45-minute sleep onset delays and averaging 5.5 hours of sleep per night.

Q15. Rhea's residual impairment despite stable medication most directly indicates the need for which intervention?

Q16. Rhea's 5.5-hour sleep average is worsening her daytime functioning. Based on the evidence on sleep interventions in ADHD, which of the following is the most appropriate first step?

Q17. Rhea's partner asks to attend couples therapy specifically focused on ADHD. Given the current evidence, which of the following is the most appropriate clinician response?

Q18. Rhea asks whether mindfulness meditation could help her ADHD in addition to her CBT and medication. She also asks whether she should try it with her 8-year-old nephew who has ADHD. Which of the following is the most appropriate response?

Q19. Rhea asks whether she could switch her CBT sessions to videoconference format to reduce commute time. Based on the emerging telehealth evidence for ADHD interventions, which response is most appropriate?

Juanita, Age 8

Juanita is an 8-year-old girl with ADHD-Combined Presentation on methylphenidate ER 27 mg. Her parents describe partial response: improved classroom focus but persistent impulsivity and social difficulties at recess. She also has chronic headaches and intermittent abdominal pain that her pediatrician has not been able to explain. Her mother arrives with a list of questions about complementary approaches she has been researching online.

Q20. Juanita's mother has read that eliminating sugar from her daughter's diet could reduce ADHD symptoms. She asks whether a sugar-free diet is worth pursuing. Which response is best supported by the evidence?

Q21. Juanita's mother asks about the Few-Foods Diet she read about online. Given the current evidence, which description is most accurate?

Q22. Juanita's mother also asks about omega-3 supplements, which she has seen advertised at the pharmacy. Which characteristic of the omega-3 evidence is most important for setting realistic expectations?

Q23. Juanita's mother asks about a clinic-based social skills training group advertised at the school. Given the current evidence on SST for children with ADHD, which limitation is most important to communicate before referral?