Abstract
Background: This study aimed to assess the efficacy of acupuncture for treating attention deficit hyperactivity disorder (ADHD) in children and adolescents. Patients and Methods: Systematic review and meta-analysis including randomized controlled trials that compared the effects of acupuncture treatment (AT) with pharmacotherapy (methylphenidate hydrochloride, MPH) among patients with ADHD. A total of 12 electronic databases were searched from inception until February 3, 2020. The main outcomes were the effective rate and post-treatment hyperactivity scores. We also assessed the incidence of adverse events and follow-up course. Results: A total of 10 studies involving 876 patients were included in this study. The meta-analysis revealed that AT yielded a significantly higher effective rate than MPH (odds ratio 2.239, 95% CI 1.438–3.487, p < 0.001, 8 studies), and that AT can reduce the hyperactivity scores to a lesser degree than MPH (standardized mean difference = –0.882, 95% CI –1.295 to –0.469, p < 0.001, 3 studies). Two studies reported no adverse events in the AT group, while one study suggested that AT can reduce adverse drug reactions. Furthermore, 3 studies concluded that the effects of AT were maintained, even after completion of treatment. Conclusion: This study suggests that AT may be more beneficial than MPH therapy for ADHD patients. However, the evidence may be highly limited, especially considering the outcome of hyperactivity scores with the high risk of bias, very low GRADE, and small number of studies. Thus, further studies of rigorous design and high quality are needed to confirm and strengthen the results, especially in the Western part of the world. Additionally, well-designed randomized controlled trials that evaluate adverse events and include a long-term follow-up should be conducted to determine the efficacy, safety, and side effects of AT for ADHD in children and adolescents.
References
1.
Reale
L
, Bartoli
B
, Cartabia
M
, Zanetti
M
, Costantino
MA
, Canevini
MP
, et al.; Lombardy ADHD Group
. Comorbidity prevalence and treatment outcome in children and adolescents with ADHD
. Eur Child Adolesc Psychiatry
. 2017
Dec
;26
(12
):1443
–57
.
[PubMed]
1018-88272.
Thomas
R
, Sanders
S
, Doust
J
, Beller
E
, Glasziou
P
. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis
. Pediatrics
. 2015
Apr
;135
(4
):e994
–1001
.
[PubMed]
0031-40053.
Xu
G
, Strathearn
L
, Liu
B
, Yang
B
, Bao
W
. Twenty-year trends in diagnosed attention-deficit/hyperactivity disorder among US children and adolescents, 1997-2016
. JAMA Netw Open
. 2018
Aug
;1
(4
):e181471
–71
.
[PubMed]
2574-38054.
Liu
A
, Xu
Y
, Yan
Q
, Tong
L
. The prevalence of attention deficit/hyperactivity disorder among Chinese children and adolescents
. Sci Rep
. 2018
Aug
;8
(1
):11169
.
[PubMed]
2045-23225.
Ferguson
JH
. National Institutes of Health Consensus Development Conference Statement: diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD)
. J Am Acad Child Adolesc Psychiatry
. 2000
Feb
;39
(2
):182
–93
.
[PubMed]
0890-85676.
Wolraich
ML
, Hagan
JF
Jr, Allan
C
, Chan
E
, Davison
D
, Earls
M
, et al.; SUBCOMMITTEE ON CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT/HYPERACTIVE DISORDER
. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents
. Pediatrics
. 2019
Oct
;144
(4
):e20192528
.
[PubMed]
0031-40057.
Brown
RT
, Borden
KA
, Wynne
ME
, Schleser
R
, Clingerman
SR
. Methylphenidate and cognitive therapy with ADD children: a methodological reconsideration
. J Abnorm Child Psychol
. 1986
Dec
;14
(4
):481
–97
.
[PubMed]
0091-06278.
Rajeh
A
, Amanullah
S
, Shivakumar
K
, Cole
J
. Interventions in ADHD: A comparative review of stimulant medications and behavioral therapies
. Asian J Psychiatr
. 2017
Feb
;25
:131
–5
.
[PubMed]
1876-20189.
Cortese
S
, Adamo
N
, Del Giovane
C
, Mohr-Jensen
C
, Hayes
AJ
, Carucci
S
, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis
. Lancet Psychiatry
. 2018
Sep
;5
(9
):727
–38
.
[PubMed]
2215-036610.
Charach
A
, Ickowicz
A
, Schachar
R
. Stimulant treatment over five years: adherence, effectiveness, and adverse effects
. J Am Acad Child Adolesc Psychiatry
. 2004
May
;43
(5
):559
–67
.
[PubMed]
0890-856711.
Brown
RT
, Borden
KA
, Wynne
ME
, Spunt
AL
, Clingerman
SR
. Compliance with pharmacological and cognitive treatments for attention deficit disorder
. J Am Acad Child Adolesc Psychiatry
. 1987
Jul
;26
(4
):521
–6
.
[PubMed]
0890-856712.
Thiruchelvam
D
, Charach
A
, Schachar
RJ
. Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD
. J Am Acad Child Adolesc Psychiatry
. 2001
Aug
;40
(8
):922
–8
.
[PubMed]
0890-856713.
Brinkman
WB
, Sucharew
H
, Majcher
JH
, Epstein
JN
. Predictors of medication continuity in children with ADHD
. Pediatrics
. 2018
Jun
;141
(6
):e20172580
.
[PubMed]
0031-400514.
Storebø
OJ
, Ramstad
E
, Krogh
HB
, Nilausen
TD
, Skoog
M
, Holmskov
M
, et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)
. Cochrane Database Syst Rev
. 2015
Nov
;(11
):CD009885
.
[PubMed]
1469-493X15.
Chan
E
, Rappaport
LA
, Kemper
KJ
. Complementary and alternative therapies in childhood attention and hyperactivity problems
. J Dev Behav Pediatr
. 2003
Feb
;24
(1
):4
–8
.
[PubMed]
0196-206X16.
Sinha
D
, Efron
D
. Complementary and alternative medicine use in children with attention deficit hyperactivity disorder
. J Paediatr Child Health
. 2005
Jan-Feb
;41
(1-2
):23
–6
.
[PubMed]
1034-481017.
Bader
A
, Adesman
A
. Complementary and alternative therapies for children and adolescents with ADHD
. Curr Opin Pediatr
. 2012
Dec
;24
(6
):760
–9
.
[PubMed]
1040-870318.
Yang
C
, Hao
Z
, Zhang
LL
, Guo
Q
. Efficacy and safety of acupuncture in children: an overview of systematic reviews
. Pediatr Res
. 2015
Aug
;78
(2
):112
–9
.
[PubMed]
0031-399819.
MacPherson
H
, Vertosick
EA
, Foster
NE
, Lewith
G
, Linde
K
, Sherman
KJ
, et al. The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain
. Pain
. 2017
May
;158
(5
):784
–93
.
[PubMed]
0304-395920.
Lam
CN
, Murnane
D
, Ruth
C
, Kim
Y
, Chou
CP
, Black
DS
. Demographic and clinical factors associated with patient adherence to acupuncture treatment
. J Altern Complement Med
. 2019
May
;25
(5
):522
–5
.
[PubMed]
1075-553521.
Cao
HJ
, Li
X
, Li
XL
, Ward
L
, Xie
ZG
, Hu
H
, et al. Factors influencing participant compliance in acupuncture trials: an in-depth interview study
. PLoS One
. 2020
Apr
;15
(4
):e0231780
.
[PubMed]
1932-620322.
Vickers
AJ
, Rees
RW
, Zollman
CE
, McCarney
R
, Smith
CM
, Ellis
N
, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial
. BMJ
. 2004
Mar
;328
(7442
):744
.
[PubMed]
0959-813823.
MacPherson
H
, Tilbrook
H
, Richmond
S
, Woodman
J
, Ballard
K
, Atkin
K
, et al. Alexander technique lessons or acupuncture sessions for persons with chronic neck pain: a randomized trial
. Ann Intern Med
. 2015
Nov
;163
(9
):653
–62
.
[PubMed]
0003-481924.
Vickers
AJ
, Vertosick
EA
, Lewith
G
, MacPherson
H
, Foster
NE
, Sherman
KJ
, et al.; Acupuncture Trialists’ Collaboration
. Acupuncture for chronic pain: update of an individual patient data meta-analysis
. J Pain
. 2018
May
;19
(5
):455
–74
.
[PubMed]
1526-590025.
Li
S
, Yu
B
, Zhou
D
, He
C
, Kang
L
, Wang
X
, et al. Acupuncture for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2011
(4).26.
Lee
MS
, Choi
TY
, Kim
JI
, Kim
L
, Ernst
E
. Acupuncture for treating attention deficit hyperactivity disorder: a systematic review and meta-analysis
. Chin J Integr Med
. 2011
Apr
;17
(4
):257
–60
.
[PubMed]
1672-041527.
Ni
XQ
, Zhang
JY
, Han
XM
, Yin
DQ
. A Meta-analysis on acupuncture treatment of attention deficit/hyperactivity disorder
. Zhen Ci Yan Jiu
. 2015
Aug
;40
(4
):319
–25
.
[PubMed]
1000-060728.
Higgins
JP
, Thomas
J
, Chandler
J
, Cumpston
M
, Li
T
, Page
MJ
, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane; 2019
. Available from: www.training.cochrane.org/handbook29.
McGuinness
L
, Higgins
J
. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments
. Res Syn Meth
; 2020
. pp. 1
–7
.30.
Zhang
L
, Chen
BG
. Acupuncture needle and auricular application in treating paediatric hyperactivity 60 cases.
Health must-read Magazine. 2010
;11:123.31.
Wei
HT
. A clinical treatment of ADHD in children and adolescents
. China Medicine and Pharmacy.
2011
;1
(20
):157
.32.
Chen
Y
, Zhu
DX
, Yang
L
. Observation of validity and safety of behavior therapy, acupuncture therapy combined with methylphenidate in treatment of attention deficit hyperactivity
. [Nat Sci Ed]
. J Jianghan Univ
. 2012
;40
(3
):94
–6
.33.
Meng
XH
, Zhang
QH
. Therapeutic observation on combining acupuncture with Western medication for attention deficit hyperactivity disorder of childhood
. Shanghai J Acupunct Moxibustion
. 2012
;31
(10
):732
–3
.1005-095734.
Zhou
X
. Observation of clinical effect of body acupuncture in children of attention deficit hyperactivity disorder
. Chinese and Foreign Medical Research
. 2013
;11
(25
):33
–4
.35.
Ji
XD
, He
JY
, Zhao
WS
, Kou
ZJ
, Zhou
X
. Acupuncture in treating 30 case of children ADHD
. Clinical Journal of Chinese Medicine.
2018
;10
(27
):125
–6
.36.
Cheng
Y
, Cui
J
, Cao
Y
. Acupuncture needle and auricular application in treating paediatric hyperactivity 32 cases
. Medical Information Medicine and Surgery.
2009
;22
(10
):909
–10
.37.
Hong
SS
, Cho
SH
. Treating attention deficit hyperactivity disorder with acupuncture: A randomized controlled trial
. Eur J Integr Med
. 2016
;8
(3
):150
–7
. 1876-382038.
Liu
J
. Observation of clinical curative effect of Xingnao Kaiqiao acupuncture in attention deficit hyperactivity disorder
. Tianjin Journal of Traditional Chinese Medicine.
2013
;30
(1
):54
–6
.39.
Moharreri
F
, Vakilzadeh
AK
, Soltanifar
A
, Abdollahian
E
, Eslami
S
, Nahidi
M
. Efficacy of adding acupuncture to Methylphenidate in children and adolescents with attention deficit hyperactivity disorder: A randomized clinical trial
. Eur J Integr Med
. 2018
;22
:62
–8
. 1876-382040.
Schachar
RJ
, Tannock
R
, Cunningham
C
, Corkum
PV
. Behavioral, situational, and temporal effects of treatment of ADHD with methylphenidate
. J Am Acad Child Adolesc Psychiatry
. 1997
Jun
;36
(6
):754
–63
.
[PubMed]
0890-856741.
Chen
SC
, Yu
BY
, Suen
LK
, Yu
J
, Ho
FY
, Yang
JJ
, et al. Massage therapy for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents: A systematic review and meta-analysis
. Complement Ther Med
. 2019
Feb
;42
:389
–99
.
[PubMed]
0965-229942.
Lystad
GO
, Johannessen
B
. Acupuncture and methylphenidate drugs in adults with attention deficit hyperactivity disorder: A pilot study of self-reported symptoms
. Complement Med Res
. 2018
;25
(3
):198
–200
.
[PubMed]
2504-209243.
Li
S
, Yu
B
, Lin
Z
, Jiang
S
, He
J
, Kang
L
, et al. Randomized-controlled study of treating attention deficit hyperactivity disorder of preschool children with combined electro-acupuncture and behavior therapy
. Complement Ther Med
. 2010
Oct
;18
(5
):175
–83
.
[PubMed]
0965-229944.
He
CD
, Lang
BX
, Jin
LQ
, Li
B
. [Attention deficit hyperactivity disorder treated with scalp acupuncture and EEG biofeedback therapy in children: a randomized controlled trial]
. Zhongguo Zhen Jiu
. 2014
Dec
;34
(12
):1179
–83
.
[PubMed]
0255-293045.
Wen
DY
, Zeng
M
. Therapeutric effect of acupuncute combined with sensory integration training on ADHD
. J Pract Trandit ChinMed.
2018
;34
(11
):85
.46.
Catalá-López
F
, Hutton
B
, Núñez-Beltrán
A
, Page
MJ
, Ridao
M
, Macías Saint-Gerons
D
, et al. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials
. PLoS One
. 2017
Jul
;12
(7
):e0180355
.
[PubMed]
1932-620347.
Razoki
B
. Neurofeedback versus psychostimulants in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a systematic review
. Neuropsychiatr Dis Treat
. 2018
Oct
;14
:2905
–13
.
[PubMed]
1176-632848.
Veloso
A
, Vicente
SG
, Filipe
MG
. Effectiveness of cognitive training for school-aged children and adolescents with attention deficit/hyperactivity disorder: A Systematic Review
. Front Psychol
. 2020
Jan
;10
:2983
.
[PubMed]
1664-1078© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
