June 5, 2025

Meta-analysis Finds Little Evidence of Efficacy for Animal-Assisted Interventions for Treating Childhood ADHD

Study Background:

Animal-assisted interventions (AAIs) involve structured interactions with animals, designed and carried out by mental health teams assisted by trained human–animal professionals, to achieve specific therapeutic or educational goals. While a wide variety of animals may be used, horses and dogs tend to predominate. These interventions often involve physical contact, imitation, and play aimed at reducing stress and generating affection. Previous research has suggested that AAI to those with a range of developmental and mental health conditions.

Just how effective are they for treating ADHD in children and adolescents? Recent years have seen an increase in studies into AAIs for children with ADHD, but previous systematic reviews have not included quantitative meta-analysis to evaluate efficacy.

The Study:

A Chinese study team based in Nanjing set out to remedy that with a systematic search of the peer-reviewed published medical literature aimed at performing meta-analyses of efficacy.

The team limited its search to randomized controlled trials (RCTs) and pre–post single-group studies involving children and adolescents diagnosed with ADHD.

Meta-analysis of five studies with a combined total of 95 participants reported no significant effect of AAIs on ADHD symptom severity. There was negligible variation (heterogeneity) in outcomes among the studies.

Similarly, meta-analysis of the six studies encompassing 323 individuals found no significant improvements in social behavior. There was no heterogeneity and no sign of publication bias. Breaking that down into subcategories of social interaction (4 studies, 190 persons), social skill (3 studies, 53 persons), and problem behavior (4 studies, 80 participants) made no difference.

Likewise, meta-analysis of the three studies encompassing 61 individuals found no significant improvements in emotional control. Again, there was no heterogeneity and no sign of publication bias.

Three studies combining 56 participants reported no significant reductions in anxiety and depression, again with no heterogeneity and no sign of publication bias.

However, meta-analyses of five studies encompassing 194 individuals found a medium effect size association between AAIs and declines in attention problems, and a medium-to-large effect size improvement in learning and cognition. Heterogeneity was negligible to low.

Finally, meta-analysis of three studies combining 95 participants reported a large effect size improvement in motor proficiency, with moderate heterogeneity.

The Conclusion:

The team concluded, “As an ADHD management strategy complementary to gold-standard approaches, such as medication or multimodal interventions, AAIs did not appear to be more effective in improving the majority of core ADHD outcomes in children. Future studies should incorporate rigorous study designs with large sample sizes and a standard protocol to achieve more valid and reliable conclusions.”

Shuxin Yu, Hui Xue, Yuqing Xie, Guanyue Shao, Yihui Hao, Lijun Fan, and Wei Du, “Review: Animal-assisted intervention for children with attention-deficit/hyperactivity disorder – a systematic review and meta-analysis,” Child and Adolescent Mental Health (2025), 30, No. 1, 34-52, https://doi.org/10.1111/camh.12744.

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Acupuncture for ADHD: A Promising Alternative or Placebo? A Look at Recent Research

Attention Deficit Hyperactivity Disorder (ADHD) is a common condition affecting children and adolescents worldwide, characterized by symptoms such as hyperactivity, impulsivity, and inattention. While traditional treatments like medication and behavioral therapy are often used, some individuals are turning to complementary and alternative therapies (CAM) for help. One such option gaining attention is acupuncture. But does it really work for ADHD?

A recent comprehensive study aimed to evaluate the effectiveness of acupuncture in treating ADHD symptoms. Here’s a breakdown of the findings, with a focus on the age groups included in the research and what these findings could mean for ADHD treatment options.

What the Study Explored

The study in question conducted a systematic review and meta-analysis (SR/MA) of acupuncture trials for ADHD, comparing its effects to traditional treatments such as pharmacotherapy and behavioral therapy. The researchers focused on acupuncture’s impact on core ADHD symptoms like hyperactivity, impulsivity, inattention, and conduct problems, while also exploring how acupuncture might help with other issues, such as learning difficulties and psychosomatic symptoms.

One key feature of this study was the inclusion of a broad age range of participants, specifically children and adolescents. These two groups are the most commonly diagnosed with ADHD, and their responses to treatments can vary significantly. Understanding how acupuncture works for these age groups is critical for evaluating its effectiveness as an ADHD treatment.

Here’s what the study found across the different age groups:

  • Children: Acupuncture appeared to be particularly effective in reducing hyperactivity and impulsivity in younger children with ADHD. These symptoms, often more prominent in younger populations, responded well to acupuncture when used alongside other treatments like medication.

  • Adolescents: For adolescents, acupuncture seemed to improve both hyperactivity and inattention, two symptoms that can often become more challenging as children grow older. This age group also benefited from acupuncture’s ability to reduce side effects from ADHD medications, such as irritability or sleep disturbances.

  • Combined Effects for Both Groups: When acupuncture was used in combination with pharmacotherapy, it also helped reduce side effects such as sleep problems and appetite loss in both children and adolescents. This could make it an attractive adjunctive treatment for those already on medication but experiencing undesirable effects.

  • Inattention and Conduct Problems: For both children and adolescents, acupuncture used in conjunction with either medication or behavioral therapy showed notable improvements in inattention and conduct problems—two of the most difficult symptoms of ADHD to manage.

  • Learning Difficulties and Psychosomatic Symptoms: Interestingly, the combination of acupuncture and medication provided significant improvements in learning difficulties, which are particularly relevant for children with ADHD. Meanwhile, acupuncture paired with behavioral therapy had a positive impact on psychosomatic symptoms, such as anxiety or stress, that often co-occur with ADHD.

Despite these promising results, the study also highlighted several limitations:

  • Study Quality Issues: The quality of the studies reviewed was often low, with many trials lacking the rigorous controls needed for high confidence in their results. For example, only a small number of trials used objective ADHD diagnostic tools, which could lead to biases in assessing acupuncture’s effectiveness.

  • Need for More Research: There is a lack of large-scale, high-quality randomized controlled trials (RCTs) comparing acupuncture with placebo treatments, which makes it hard to determine whether acupuncture’s effects are truly therapeutic or simply a placebo.

Conclusion: Is Acupuncture a Good Option for ADHD?

In short, and as is so often the way of evidence-based medicine, we still can’t say with absolute certainty one way or the other. These studies may show promise in improving hyperactivity, impulsivity, inattention, and conduct problems– in both children and adolescents. However, the evidence is not yet strong enough to recommend it as a primary treatment. While it may serve as a helpful complement to standard therapies, especially for those struggling with medication side effects or access to behavioral therapy, more research is needed to establish its effectiveness.

April 21, 2025

Are Shared Care Models Effective in Treating Childhood ADHD?

Are Shared Care Models Effective in Treating Childhood ADHD?

A systematic review found five studies that evaluated shared care models involving children and adolescents, in which primary care providers(PCPs) collaborated with mental health care providers in treating ADHD. The 655 participants ranged in age from 5 to 17. Two of the studies were randomized.

In one, the largest, with 321 participants, care managers acted as liaisons between PCPs and psychiatrists and provided psychoeducation and skills training for families. Effect sizes on the Vanderbilt ADHD Diagnostic Teacher Rating Scale were very small, ranging from a standardized mean difference (SMDs) of 0.07 to 0.12. Improvement on the Clinical Global Impression scale was also small (SMD = 0.3)and was not significant (p = 0.4).

In the other randomized study, with 63 participants, care managers also acted as liaisons between PCPs and a psychiatric decision support panel to provide Positive Parenting Training. The SNAP-IV hyperactivity/impulsivity score showed a medium effect size (SMD = 0.7), with a medium-to-large effect size (0.7) for improvement in social skills. The score difference for SNAP-IV inattention was not statistically significant. The other three studies followed groups of individuals over time.

In one cohort with 129 participants, PSPs consulted with psychiatrists by telephone; an evaluation, where necessary, was performed within 4 weeks. As assessed by the Clinical Global Impression-Severity scale, symptoms declined from moderately severe to mild or borderline. On the Children's Global Assessment Scale, there was an improvement from problems in more than one area of functioning to just one area.

In another cohort with 116 participants, care managers acted as liaisons between pediatricians and a psychiatrist and provided education to parents. Just over a quarter of participants showed improvement of greater than one standard deviation on the Vanderbilt ADHD Diagnostic Parent Rating Scale, and just under one in seven on the Vanderbilt ADHD Diagnostic Teacher Rating Scale.

The remaining cohort had only 26 participants. It offered PCPs access to outpatient psychiatric consultations within three weeks. PCPs reported a high level of satisfaction with their improved skills in mental health care. There was no evaluation of the effect on symptoms.

With varied study designs, methodologies, and outcomes, the authors of the review could only conclude "that PCP collaboration with psychiatrists may be associated with the increased comfort level. However, the association with symptom outcome and increased capacity was variable." Given that randomized studies report only small effects, these shared care models cannot be routinely recommended.

July 22, 2021

Meta-Analysis: Physical Activity for Children and Adolescents with ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that significantly impacts children’s academic performance, social interactions, and overall quality of life (QoL). While medication is the standard treatment, it often comes with side effects and may not always provide sufficient benefits. A new systematic review and meta-analysis aims to investigate whether physical activity can offer a viable and effective alternative or complement to medication.

About the Study
This protocol, developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines, focuses on randomized clinical trials involving children and adolescents (ages 3–18) diagnosed with ADHD or hyperkinetic disorder. The study's goal is to evaluate the effects of physical activity on:

  • Quality of life (QoL)
  • Executive functions
  • ADHD symptoms
  • Functional impairments

Unlike earlier reviews, which often included non-randomized trials or imposed limits on activity types, this analysis takes a more robust and inclusive approach. It is the first of its kind to examine QoL as an outcome while also incorporating trial sequential analysis—a method to assess evidence strength over time.

Why Physical Activity?
Physical activity is believed to impact the same brain systems targeted by ADHD medications, particularly the catecholaminergic system. This overlap suggests that exercise could play a key role in managing symptoms, potentially reducing reliance on medication or enhancing its effects.

Methodology Highlights

  • The review will adhere to principles outlined in the Cochrane Handbook for Systematic Reviews of Interventions.
  • It incorporates the latest research and focuses on randomized trials to ensure high-quality evidence.
  • No restrictions are placed on the frequency or intensity of physical activity interventions, making the findings broadly applicable.

Significance and Dissemination
The results of this systematic review will provide critical insights into how physical activity could improve outcomes for children and adolescents with ADHD. It is also notable as the first review in this field to prioritize quality of life—a crucial, often-overlooked measure of treatment success.

The findings will be published in peer-reviewed journals and presented at relevant conferences to inform clinicians, educators, and families.

Conclusion
As concerns about the limitations of ADHD medication grow, exploring alternatives like physical activity becomes increasingly important. This systematic review has the potential to shape future treatment strategies, offering children with ADHD a chance for better symptom management and a higher quality of life.

January 21, 2025

What Metabolites Tell Us About ADHD — And What This Means for Diet and Treatment

New research has uncovered important links between certain blood metabolites and ADHD by using a genetic method called Mendelian randomization. This approach leverages natural genetic differences to help identify which metabolites might actually cause changes in ADHD risk, offering stronger clues than traditional observational studies.

Key Metabolic Pathways Involved:

The study found 42 plasma metabolites with a causal relationship to ADHD. Most fall into two major groups:

  • Amino acid metabolites from protein metabolism, including those related to tyrosine, methionine, cysteine, and taurine.

  • Fatty acids, especially long-chain polyunsaturated fatty acids (PUFAs) like DHA and EPA, important for brain function.

What Does This Mean for Diet and ADHD?

Since many metabolites come from dietary sources like proteins and fats this supports the idea that diet could influence metabolic pathways involved in ADHD. However, because the study focused on genetic influences on metabolite levels, it doesn’t directly prove that dietary changes will have the same effects.

Notable Metabolites:

  • 3-Methoxytyramine sulfate (MTS): linked to dopamine metabolism, higher genetic levels of MTS were associated with a lower risk of ADHD. Dopamine plays a crucial role in attention and behavior.

  • DHA and EPA: Omega-3 fatty acids abundant in the brain; higher levels were linked to reduced ADHD risk, supporting existing research on omega-3 supplements.

  • N-acetylneuraminate: Involved in brain development and immune function, with higher levels linked to increased ADHD risk, though more research is needed to understand this.

Five metabolites showed bidirectional links with ADHD, meaning genetic risk for ADHD also affects their levels which suggests a complex interaction between brain function and metabolism.

Twelve ADHD-related metabolites are targets of existing drugs or supplements, including:

  • Acetylcysteine: an antioxidant used in various treatments.

  • DHA supplements: widely used to support brain and heart health.

What This Study Doesn’t Show

While these findings highlight biological pathways, they don’t prove that changing diet will directly alter ADHD symptoms. Metabolite levels are shaped by genetics plus environment, lifestyle, and health factors, which require further study.

Conclusion: 

This research provides stronger evidence of metabolic pathways involved in ADHD and points to new possibilities for diagnosis and treatment. Future work could explore how diet or drugs might safely adjust these metabolites to help manage ADHD.

While this study strengthens the link between amino acid and fatty acid metabolism and ADHD risk, suggesting that diet could play a role, ultimately more research is still needed before experts could use this research to give specific nutritional advice.

July 21, 2025

Network Meta-analysis Explores Long-term Efficacy of Nonpharmacological Treatments for Improving Inhibitory Control in Children and Adolescents with ADHD

Background Info:

Executive functions include inhibitory control, working memory, and cognitive flexibility. Inhibitory control is the ability to suppress distractions and focus on goals, which is the main deficit in ADHD. 

Children and adolescents with ADHD often have off-task, unrelated thoughts and are easily distracted, limiting their sustained attention. This makes it difficult for them to focus on tasks and leads to impulsive behaviors that affect their daily life, academics, and social interactions. Improving inhibitory control in ADHD children and adolescents is essential. 

Stimulant medications are commonly used to treat ADHD. However, side effects like insomnia, loss of appetite, and headaches may make parents hesitant to use these medications for their children. 

Non-pharmacological treatments like cognitive training, behavior therapy, and physical exercise have gained attention for their lack of side effects. Research shows that some non-pharmacological methods can improve cognitive outcomes significantly, underscoring their potential in treating ADHD. 

Study:

A Chinese research team identified four key gaps in current research on non-pharmacological treatments for inhibitory control in children with ADHD: 

  • Existing meta-analyses seldom differentiate between short-term and long-term interventions.  
  • Most studies focus primarily on short-term effects and neglect evaluation of maintenance effects through follow-up assessments.  
  • New treatment methods, such as meditation and board games, have not been systematically assessed in meta-analyses for their impact on inhibitory control in children and adolescents with ADHD, leaving their effectiveness uncertain.  
  • Traditional meta-analysis does not tell us which intervention is most effective. Without this comparative analysis, it is difficult to rank efficacy. 

The team therefore performed a network meta-analysis of long-term randomized controlled trials (RCTs) to assess and rank the effectiveness of various non-pharmacological treatments on inhibitory control in children and adolescents with ADHD. 

The team included only RCTs relying on professional diagnoses of ADHD, excluding those based only on parent and teacher rating scales.  

The included studies measured inhibitory control using objective neurocognitive tasks, such as the Stroop test and the Go/No-Go test, to reduce potential subjective bias. Studies relying on parent- or teacher-reported questionnaires were excluded. 

Controls either received no intervention or placebo, such as watching running videos and attending history classes. 

Meta-analysis of 16 studies combining 546 participants found large short-term effect size improvements in inhibitory control from physical exercise. But the two studies with a total of 110 participants that performed a follow-up test reported only a small-to-medium effect size improvement. 

For cognitive training, a meta-analysis of fifteen studies totaling 674 participants reported a medium effect size of short-term improvement in inhibitory control. The ten studies with 563 participants that performed a follow-up test found only a small effect size improvement since treatment initiation. 

For behavioral therapy, meta-analysis of six studies encompassing 244 individuals likewise found a medium effect size short-term improvement in inhibitory control. In this case, however two studies combining 91 participants that performed a follow-up test reported that the medium effect size improvement was maintained. 

For neurofeedback, meta-analysis of seven studies encompassing 186 individuals found a small-to-medium effect size short-term improvement in inhibitory control. The only study that performed a follow-up test reported a small effect size improvement since treatment initiation. 

The two studies with a combined 44 individuals exploring board games found no significant improvement in inhibitory control. Likewise, the two studies combining 32 participants that explored meditation found no significant improvement in inhibitory control. 

There was no indication of publication bias. 

Conclusion:

The team concluded, “Existing evidence shows that physical exercise, behavior therapy, cognitive training, and neurofeedback can effectively improve the inhibitory control of children and adolescents with ADHD. However, meditation, EMG feedback, and board games did not significantly affect inhibitory control. Physical exercise has the best effect among all non-pharmacological treatments, but its impact will be weakened after intervention. Behavior therapy and cognitive training had a slightly lower effect, but they have a better maintenance effect.” 

Ultimately, the study results suggest that non-drug treatments can help children and teens with ADHD improve their ability to control their actions and stay focused. Some methods, like physical exercise, work well at first but may fade once the activity stops. Other methods, like behavioral therapy and cognitive training, may take a little longer to show results but can last longer and make a bigger difference over time. Ultimately, and most importantly, because this work did not study the symptoms of ADHD or its real-world impairments, it provides no reason to change current treatment practices for ADHD.

July 16, 2025

The Role of Serotonin in ADHD and Its Many Comorbidities

Serotonin is a key chemical in the body that helps regulate mood, behavior, and also many physical functions such as sleep and digestion. It has also been linked to how ADHD (attention-deficit/hyperactivity disorder) develops in the brain. This study looks at how serotonin may be involved in both the mental health and physical health conditions that often occur alongside ADHD.

It is well-established that ADHD is more than just trouble focusing or staying still. For many, it brings along a host of other physical and mental health challenges. It is very common for those with ADHD to also have other diagnosed disorders. For example, those with ADHD are often also diagnosed with depression, anxiety, or sleep disorders. When these issues overlap, they are called comorbidities. 

A new comprehensive review, led by Dr. Stephen V. Faraone and colleagues, delves into how serotonin (5-HT), a major brain chemical, may be at the heart of many of these common comorbidities.

Wait! I thought ADHD had to do with Dopamine–Why are we looking at Serotonin?

Serotonin is a neurotransmitter most often linked to mood, but its role in regulating the body has much broader implications. It regulates sleep, digestion, metabolism, hormonal balance, and even immune responses. Although ADHD has long been associated with dopamine and norepinephrine dysregulation, this review suggests that serotonin also plays a central role, especially when it comes to comorbid conditions.

The Study:

  • Objective: To systematically review which conditions commonly co-occur with ADHD and determine whether serotonin dysfunction might be a common thread linking them.

  • Method: The authors combed through existing literature up to March 2024, analyzing evidence for serotonin involvement in each comorbidity associated with ADHD.

  • Scope: 182 psychiatric and somatic conditions were found to frequently occur in people with ADHD.

Key Findings

  • 74% of Comorbidities Linked to Serotonin: Of the 182 comorbidities identified, 135 showed evidence of serotonergic involvement—91 psychiatric and 44 somatic (physical) conditions.

  • Psychiatric Comorbidities: These include anxiety disorders, depression, bipolar disorder, and obsessive-compulsive disorder—all of which have long-standing associations with serotoninergic dysfunction.

  • Somatic Comorbidities: Conditions like irritable bowel syndrome (IBS), migraines, and certain sleep disorders also showed a significant serotonergic link.

This research suggests that serotonin dysregulation could explain the diverse and sometimes puzzling range of symptoms seen in ADHD patients. It supports a more integrative model of ADHD—one that goes beyond the brain’s attention, reward and executive control circuits and considers broader physiological and psychological health.

future research into the role of serotonin could help develop more tailored interventions, especially for patients who don't respond well to stimulant medications. Future studies may focus on serotonin’s role in early ADHD development and how it interacts with environmental and genetic factors.

The Take-Away: 

This study is a strong reminder that ADHD is a complex, multifaceted condition. Differential diagnosis is crucial to properly diagnosing and treating ADHD. Clinicians' understanding of the underlying link between ADHD and its common comorbidities may help future ADHD patients receive the individualized care they need. By shedding light on serotonin’s wide-reaching influence, this study may provide a valuable roadmap for improving how we diagnose and treat those with complex comorbidities in the future. 

July 14, 2025