Summary:
This study is a systematic review of clinical trials examining the safety and effectiveness of acupuncture for children and adolescents with attention-deficit/hyperactivity disorder (ADHD). ADHD is a neurodevelopmental condition characterised by difficulties with attention, impulsivity, and hyperactivity. Although genetics play a major role in ADHD, environmental factors also influence symptom severity. Standard treatment commonly includes stimulant medications such as Methylphenidate and Amphetamines, alongside behavioural therapies and non-stimulant medications. While these treatments can improve symptoms, they may also cause side effects including insomnia, reduced appetite, headaches, abdominal pain, and fatigue. Consequently, many families seek complementary therapies such as acupuncture. This study included 25 studies involving 1,758 participants. Acupuncture was compared with standard care, medication, or behavioural therapy, either alone or in combination. Findings suggested that acupuncture produced similar outcomes to Methylphenidate for conduct and learning difficulties, while showing greater improvements in impulsive and hyperactive symptoms. Acupuncture combined with behavioural therapy was more effective than behavioural therapy alone for psychosomatic symptoms, and when added to conventional treatment, it also improved attention and cognitive task performance. In addition, acupuncture appeared to reduce medication-related side effects such as appetite loss, sleep disturbances, constipation, abdominal pain, and dry mouth. Despite these findings, the evidence quality was low due to methodological limitations including high risk of bias, small sample sizes, and limited long-term follow-up. This study concluded that acupuncture may be a safe and potentially beneficial adjunctive therapy for children and adolescents with ADHD, particularly for those who do not tolerate stimulant medications well. However, the evidence remains insufficient to support routine clinical recommendation, and further high-quality randomised controlled trials are required.
Abstract:
Background and aim: The use of acupuncture is becoming increasingly popular in the management of attention-deficit/hyperactivity disorder (ADHD). This systematic review consolidates evidence on acupuncture’s efficacy and safety for treating ADHD in children and adolescents. Methods: Controlled clinical trials assessing acupuncture against waitlist-control, placebo or active controls, or as an adjunct treatment were systematically searched across seven databases from inception to November 2024. Cochrane criteria were adhered to. Results: We reviewed 25 studies with 1758 participants. None compared acupuncture to placebo or behavioral therapy. Subdomain analysis of the Conners’ Parent Rating Scale indicated that acupuncture and Methylphenidate had comparable effects on Conduct Problems [SMD = 0.03, 95 %CI (-0.93, 0.99), p = 0.95] and Learning Problems [SMD = 0.29, 95 %CI (-0.38, 0.97), p = 0.39], but acupuncture was more effective in controlling Impulsive/Hyperactive symptoms [SMD = -1.71, 95 %CI (-2.08, −1.35), p < 0.01]. Insufficient sample size prevented confirmation of potential false positives. Acupuncture was safer and reduced Methylphenidate-related side-effects, including appetite loss, sleep disturbances, dry mouth, abdominal pain, and constipation. Acupuncture combined with behavioral therapy outperformed behavioral therapy alone in improving Psychosomatic symptoms [SMD = -0.88, 95 %CI (-1.54, −0.23), p < 0.01]. In the Integrated Visual and Auditory Continuous Performance Test, ADHD patients receiving acupuncture alongside conventional care performed better than those receiving conventional care alone. Nevertheless, the methodological quality of the included trials was very low to low, with significant bias risk, and 88 % lacked follow-up. Conclusions: Acupuncture may offer an alternative for children and adolescents with ADHD who are intolerant to medication (primarily Methylphenidate). When combined with medication or behavioral therapy, it appeared more effective in ameliorating hyperactivity/impulsivity, inattention and conduct problems than standard treatments alone. It is also safe and well-tolerated. However, the supporting evidence is of low quality, and well-designed randomized controlled trials are needed. Thus, it is premature to recommend acupuncture as an alternative or adjunctive therapy for ADHD management.
Article Publication Date: 19/03/2025
DOI: 10.1016/j.ctim.2025.103163
