A recent systematic review and meta-analysis of 25 clinical trials involving 1,758 children and adolescents has concluded that acupuncture, when integrated with conventional care, significantly reduces key symptoms of attention-deficit/hyperactivity disorder (ADHD)—including impulsivity, hyperactivity, inattention, and conduct problems—while also lowering the incidence of adverse effects commonly associated with pharmacologic treatment [1].
The review, conducted by researchers at the University of Sydney, RMIT University in Australia, Shanghai University of Traditional Chinese Medicine, and The Hong Kong Polytechnic University, evaluated randomized and non-randomized trials. Trials included only children and adolescents with formally diagnosed ADHD, and focused exclusively on traditional needle acupuncture (TNA), including both manual and electroacupuncture, while excluding auricular or laser techniques [2].
In comparing acupuncture to the psychostimulant methylphenidate (e.g., Ritalin), five studies (n=347) showed significantly greater reductions in the Conners’ Hyperactivity Index (CHI) scores in the acupuncture group [mean difference = -4.98, 95% CI (-5.27, -4.70), p < 0.01], although trial sequential analysis suggested the sample size was insufficient to confirm these findings beyond reasonable doubt [3]. Notably, in the Conners’ Parent Rating Scale (CPRS), acupuncture alone was more effective than methylphenidate in reducing impulsive and hyperactive symptoms [SMD = -1.71, 95% CI (-2.08, -1.35), p < 0.01], but offered no significant difference in conduct or learning problems [4].
When used in combination with conventional care, including methylphenidate or behavioral therapy, acupuncture consistently outperformed standard treatments alone. Eleven studies (n=707) evaluating CHI scores found combination therapy superior [SMD = -1.21, 95% CI (-1.88, -0.54), p < 0.01], with sufficient sample size to validate the effect [5]. The same pattern held for CPRS global scores and subdomains, including impulsivity/hyperactivity [SMD = -1.39], conduct problems [SMD = -0.97], psychosomatic symptoms [SMD = -0.90], and learning difficulties [SMD = -1.11], all with p-values < 0.05 [6].
Only six studies incorporated objective neuropsychological testing using the Integrated Visual and Auditory Continuous Performance Test (IVA/CPT). These showed significant improvements in attention and response control when acupuncture was combined with medication, with gains in Full Scale Attention Quotient (FSAQ) [SMD = 0.83] and Full Scale Response Control Quotient (FSRCQ) [SMD = 0.82], both p < 0.01 [7].
In terms of safety, acupuncture was well-tolerated. Mild needling-site pain (10.3%) and transient headache (6.5%) were the most common adverse events. Importantly, when combined with methylphenidate, acupuncture reduced the incidence of several drug-related side effects. Loss of appetite dropped from 13.8% to 4.5%, sleep disturbances from 10.2% to 1.4%, and dry mouth and abdominal pain were eliminated entirely [8].
Most included trials used standardized acupuncture point prescriptions consistent with TCM syndrome differentiation. For hyperactivity and impulsivity, scalp acupuncture methods such as Baihui (GV20), Shenting (GV24), and Sishencong (EX-HN1) were frequently employed. These points were needled to a depth of 10–25 mm using 0.25 mm gauge filiform needles, retained for 30 minutes per session. Manual stimulation was typically applied every 10 minutes to reinforce the calming effects of the treatment [9].
Electroacupuncture was used in several studies, particularly when targeting hyperactivity. Electrodes were often connected between GV20 and Yintang (EX-HN3), or between bilateral LI4 (Hegu) and LV3 (Taichong), delivering continuous wave stimulation at 2–4 Hz [10]. Session frequency varied across trials, ranging from twice per week over six weeks to five sessions weekly for up to 24 weeks, with longer durations appearing more effective in reducing psychosomatic symptoms [11-12].
Mechanistically, the authors cite neuroimaging and animal data suggesting that acupuncture may regulate dopaminergic and noradrenergic activity in the prefrontal cortex—similar to the mechanisms of stimulant medications. One referenced animal study using spontaneously hypertensive rats, a common ADHD model, found that acupuncture increased norepinephrine and serotonin levels while improving attention and reducing impulsivity [13].
Notably, while acupuncture appeared effective across most ADHD symptom clusters, its additive benefits were context-dependent. For example, acupuncture enhanced learning outcomes only when paired with methylphenidate, while psychosomatic symptom improvements were seen only when combined with behavioral therapy. [14].
In conclusion, this meta-analysis provides preliminary but compelling evidence that acupuncture, particularly when combined with medication or behavioral therapy, improves core symptoms of ADHD and reduces adverse drug effects in pediatric populations. Future rigorously controlled trials with standardized protocols, objective outcome measures, and long-term follow-up are essential to confirm optimal standards for protocols of patient care.
Source:
1-14. Fei-Yi Zhao et al., 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, Complementary Therapies in Medicine 90 (2025): 103163.