Abstract

Background
Attention deficit hyperactivity disorder (ADHD) is one of the most common neurological and mental developmental disorders in children. Published systematic reviews (SRs) and meta-analyses (MAs) concerning the use of acupuncture for ADHD have compared the efficacy of acupuncture treatment to that of drug therapies. However, the quality of these articles has not been evaluated and the evidence varies widely.

Objective
To summarize and assess the efficacy of acupuncture for ADHD based on existing SRs and MAs.

Methods
A systematic search of the literature was conducted from inception until September 16 2021, using seven electronic databases. The AMSTAR-2 tool was used to evaluate the quality of SRs and MAs, and the GRADE system was used to assess the quality of evidence.

Results
There are a total of five SRs and MAs included in this overview. Using the AMSTAR-2, three articles were rated as having ‘Low’ quality, while two were rated as having of ‘Critically Low’ quality. The GRADE system was used to measure the quality of evidence for ten outcomes (five response rate outcomes, three Conners’ Index of Hyperactivity (CIH) score outcomes, one Conners’ rating scale score outcome, and one Chinese medicine syndrome outcome) across the five included MAs. Four of the ten outcomes demonstrated ‘moderate’ quality, four demonstrated ‘low’ quality, and two demonstrated ‘very low’ quality. The risk of bias and inconsistency accounted for most downgrading factors in the included reviews.

Conclusion
It is still debatable whether acupuncture is efficacious in improving the CIH score and the Response rate. Considering the heterogeneity of clinical trials and the fact that this study did not search and evaluate the relevant data of each randomized controlled trial, large-sample and high-quality randomized controlled trials are still needed to draw reliable conclusions regarding acupuncture’s role in treating ADHD. Due to the poor quality of existing available evidence, little inference can be drawn from the included studies.

Introduction

Attention deficit hyperactivity disorder (ADHD), characterized by abnormal inattention, hyperactive behavior, and impulsivity is one of the most common neurological and mental developmental disorders observed in children.1 According to recent studies,2., 3. the prevalence of ADHD in China is roughly 5.6 % and the estimated global prevalence in children is between 8 % and 12 %. The prevalence of ADHD is increasing alongside the development of society, and the disorder is potentially burdensome for the individuals suffering from it, as well as their families and communities.4 Strategies for treating ADHD should be individualized, integrated, and multimodal, incorporating both non-pharmacological therapies (e.g., cognitive training and evidence-based behavioral therapies) and pharmacological therapies (e.g., psychostimulants).5 In China, Chinese medicine (CM) offers complementary and alternative therapies for ADHD in addition to pharmaceutical therapies.6 Although stimulants are the most effective therapeutic medications for treating the symptoms of ADHD, non-stimulants are also useful management tools.5 Notably, drug treatments may entail adverse side effects such as insomnia, abdominal pain, headache, dry mouth, nausea, and others.7

Traditional therapies based on the theory of Chinese Medicine (CM) have been practiced and developed for centuries. Acupuncture is a wonderful mode of CM. Based on the theory of the differentiation of CM syndromes, acupuncture plays an important role in the correction of Qi (i.e., vital energy), blood imbalances, Yin-Yang imbalances, and so on.8 Acupuncture therapy includes manual acupuncture, electroacupuncture, auricular acupuncture, scalp acupuncture, etc. From the perspective of CM, ADHD is a disease related to pathological congenital insufficiency and a lack of postnatal nourishment.6 The CM theory of meridians and collaterals has guided the clinical practice of Chinese medicine for thousands of years and provides the theoretical basis for acupuncture. Acupuncture induces a unique feeling known as ‘needle sensation,’ which is a manifestation of its therapeutic effect. The stimulation of specific acupoints regulates the function of Qi, blood, and immunological function.6

Conclusion

According to the evidence of the five SRs/MAs involved in this overview, acupuncture as an alternative therapy for ADHD may be therapeutically effective and improve ADHD scale scores. However, because of methodological flaws in the included studies, conclusive evidence is still lacking. Large-sample and high-quality randomized controlled trials are still needed to draw reliable conclusions about the value of acupuncture in the treatment of ADHD.