Is Integrating Acupuncture into the Management of Attention-Deficit/Hyperactivity Disorder Among Children and Adolescents Now Opportune and Evidence-Based? A Systematic Review with Meta-Analysis and Trial Sequential Analysis.
Fei-Yi Zhao, Yan Xu, Gerard A Kennedy, Russell Conduit, Wen-Jing Zhang, Ting Jiang, Peijie Xu, Yuen-Shan Ho, Qiang-Qiang Fu, Chin-Moi Chow
{"title":"Is Integrating Acupuncture into the Management of Attention-Deficit/Hyperactivity Disorder Among Children and Adolescents Now Opportune and Evidence-Based? A Systematic Review with Meta-Analysis and Trial Sequential Analysis.","authors":"Fei-Yi Zhao, Yan Xu, Gerard A Kennedy, Russell Conduit, Wen-Jing Zhang, Ting Jiang, Peijie Xu, Yuen-Shan Ho, Qiang-Qiang Fu, Chin-Moi Chow","doi":"10.1016/j.ctim.2025.103163","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>We reviewed 25 studies with 1,758 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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10545,"journal":{"name":"Complementary therapies in medicine","volume":" ","pages":"103163"},"PeriodicalIF":3.3000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Complementary therapies in medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ctim.2025.103163","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INTEGRATIVE & COMPLEMENTARY MEDICINE","Score":null,"Total":0}
引用次数: 0
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 1,758 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.
期刊介绍:
Complementary Therapies in Medicine is an international, peer-reviewed journal that has considerable appeal to anyone who seeks objective and critical information on complementary therapies or who wishes to deepen their understanding of these approaches. It will be of particular interest to healthcare practitioners including family practitioners, complementary therapists, nurses, and physiotherapists; to academics including social scientists and CAM researchers; to healthcare managers; and to patients. Complementary Therapies in Medicine aims to publish valid, relevant and rigorous research and serious discussion articles with the main purpose of improving healthcare.