The use of acupuncture is becoming increasingly popular in the management of attention-deficit/hyperactivity disorder (ADHD). This systematic review summarizes the evidence on acupuncture’s efficacy and safety for treating ADHD in children and adolescents.
Controlled clinical trials assessing acupuncture against waitlist-control, placebo or active controls, or as an adjunct treatment were systematically searched across seven databases from inception to November 2024. Cochrane criteria were adhered to.
The researchers reviewed 25 studies with 1,758 participants. The results showed the following:
- None compared acupuncture to placebo or behavioral therapy.
- Subdomain analysis of the Conners’ Parent Rating Scale indicated that acupuncture and Methylphenidate had comparable effects on Conduct Problems and Learning Problems, but acupuncture was more effective in controlling Impulsive/Hyperactive symptoms. Insufficient sample size prevented confirmation of potential false positives.
- Acupuncture was safer and reduced Methylphenidate-related side-effects, including appetite loss, sleep disturbances, dry mouth, abdominal pain, and constipation.
- Acupuncture combined with behavioral therapy outperformed behavioral therapy alone in improving Psychosomatic symptoms. In the Integrated Visual and Auditory Continuous Performance Test, ADHD patients receiving acupuncture alongside conventional care performed better than those receiving conventional care alone.
- The methodological quality of the included trials was very low to low, with significant bias risk, and 88% lacked follow-up.
The authors concluded that acupuncture may offer an alternative for children and adolescents with ADHD who are intolerant to medication (primarily Methylphenidate). When combined with medication or behavioral therapy, it appeared more effective in ameliorating hyperactivity/impulsivity, inattention and conduct problems than standard treatments alone. It is also safe and well-tolerated. However, the supporting evidence is of low quality, and well-designed randomized controlled trials are needed. Thus, it is premature to recommend acupuncture as an alternative or adjunctive therapy for ADHD management.
I am more than a little skeptical that acupuncture may offer an alternative for children and adolescents with ADHD. There are several reasons for my skepticism, e.g.:
- Almost all of the RCTs originated from China, a country that has been shown many times to never reposrt negative findings from acupuncture studies.
- The quality of most RCTs was simal.
- Only 8 RCTs reported safety outcomes (the authors nonetheless conculded that it is also safe and well-tolerated)
I also have my doubts about the authors of this review. There are several reasons for my skepticism, e.g.:
- They failed to discuss the lack of plausibility of acupuncture as a treatment of ADHD.
- They failed to discuss the limitations of the primary trials fully.
- They conclude that acupuncture is safe without having the data to prove it.
- They failed to discuss the well-known bias of Chinese acupuncture researchers.
But the most important reason for my doubt is the authors’ conclusion. Bases on the evidence provied, the correct conclusion must be something along the following lines:
This review shows that there are plenty of positive RCTs of acupuncture for ADHD. However, based on their poor quality, its effectiveness remains unproven.
2 Responses to Acupuncture for the Management of Attention-Deficit/Hyperactivity Disorder
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It is surprising that, in patients who have been diagnosed with ADHD, the possibly confounding effect of the acupuncture clinical encounter does not appear to have been considered in this study. It seems plausible that these patients would have been more susceptible to the attention of caring practitioner.
one more reason why studies that do not have a sham control group are nest to worthless.