Acupuncture for Treating Attention Deficit Hyperactivity Disorder in Children: A Systematic Review and Meta-Analysis

Attention Deficit Hyperactivity Disorder (ADHD) represents one of the most frequent neurological problems in childhood, characterized by persistent patterns of inattention, hyperactivity, and impulsivity that can significantly interfere with children's development and functioning. Although there is no single known cause or definitive cure for ADHD, several treatments have proven effective at reducing symptoms and improving patients' quality of life. Among the therapeutic options, the combination of medication with behavioral therapy has demonstrated the best results. In this context, acupuncture has emerged as a promising complementary alternative, considered relatively safe, accessible, and easy to apply compared with other conventional procedures.

This systematic review aimed primarily to evaluate the efficacy of acupuncture in the treatment of children with ADHD, providing updated evidence on its benefits. The investigators conducted a comprehensive search of nine scientific databases, from inception through July 2022, including both international and Asian databases. Only randomized controlled clinical trials comparing acupuncture with conventional medications, sham acupuncture, or waitlist were selected. Inclusion criteria covered children younger than 18 years diagnosed with ADHD, regardless of sex or nationality.

Study quality was rigorously evaluated using standardized tools, and results were analyzed statistically through meta-analysis when appropriate.

The results of this investigation were based on fourteen studies involving 1,185 children with ADHD, primarily conducted in China, Korea, and Iran. The analysis revealed encouraging findings regarding the effects of acupuncture. When used as an adjunct to conventional drug treatment, acupuncture demonstrated significant positive effects in reducing conduct problems, learning difficulties, hyperactivity, and impulsivity compared with medication alone. Similarly, acupuncture applied as monotherapy also proved superior to conventional medications on several measures, including improvement in learning problems, reduction in hyperactivity and impulsivity, and greater overall treatment efficacy.

Notably, the studies reported no serious adverse events related to the procedure, suggesting a favorable safety profile.

The clinical implications of these findings are potentially important for both healthcare professionals and patients and families. Acupuncture may represent a valuable therapeutic option, especially when integrated with conventional treatment, offering additional benefits in improving ADHD symptoms. For clinicians, these results suggest that acupuncture could be considered as part of an integrated therapeutic approach, particularly for families seeking alternatives or complements to traditional pharmacologic treatments. For patients and their families, acupuncture offers a relatively safe option that may aid in symptom control, especially those related to behavior and learning.

However, it is essential to recognize the significant limitations of this study. The methodologic quality of the included trials was considered concerning, with important deficiencies in randomization, blinding, and follow-up of participants. Many studies did not provide adequate information on how participants were allocated to groups or how allocation concealment was maintained. In addition, most studies did not adequately assess adverse effects of treatment, and there was inconsistency in the scales used to measure ADHD symptoms, limiting comparison across studies.

The investigators emphasize that, despite the promising results, current evidence remains insufficient to recommend routine use of acupuncture in the treatment of ADHD. Future investigations with more rigorous methodology, larger samples, better control of variables, and long-term follow-up are needed to definitively validate the efficacy and safety of this intervention in children with ADHD.