Use of Bach flower remedies in children and adolescents with attention deficit hyperactivity disorder: Systematic review and meta-analysis

Abstract

Objective

To systematically review the available evidence of the effect of Bach flower remedies (BFR) on the improvement of symptoms and behavior in children and adolescents with attention deficit hyperactivity disorder (ADHD).

Methods

This systematic review with meta-analysis was developed following PRISMA recommendations and the protocol was registered in PROSPERO. The search for controlled trials was performed in Cochrane Central Register of Controlled Trials, Embase, PubMed and LILACS and in grey literature from their inceptions until March, 2023. The population was children and adolescents diagnosed with ADHD. The intervention included the use BFR and the control included placebo or conventional therapies group. The outcome included improvement of symptoms and behavior. RoB 2.0 was used to assess the risk of bias, while GRADE was used to assess the quality of evidence. Stata version 16.0 was used to perform the meta-analysis.

Results

Of the 457 studies identified, only 4 studies that met the inclusion criteria remained and were included in the data analysis. The agreement between the reviewers for risk of bias assessment, based on the kappa statistic, was 0.91. Three studies reported improvement in ADHD symptoms with BFR. The studies presented some concerns regarding the risk of bias and the quality of evidence was “low”. The meta-analysis showed a positive effect favoring BFR (z = 2.57, p = 0.01) versus control with an effect size of 0.80 (0.19–1.42:95 %CI). I² test value was 35.96 %, indicating moderate heterogeneity among the studies.

Conclusions

BFR can have some effect on ADHD. However, further studies with higher methodological quality and long-term follow-up period are needed to reinforce these findings.