Presentation (CTI)

OBJECTIVES: To compare the efficacy and safety of East Asian traditional medicine (EATM) with medication in children with attention-deficit/hyperactivity disorder (ADHD).
METHODS: A comprehensive database search was conducted on February 28, 2025, to identify randomized controlled trials that investigated EATM interventions in children with ADHD. The primary outcome was the Conners’ Parent Rating Scale-Hyperactivity Index (CPRS-HI) score. Secondary outcomes included the CPRS-48 total score, Swanson, Nolan, and Pelham Rating Scale version IV score, total effective rate (at least a 30% improvement from baseline scores of validated ADHD rating scales), Conners’ Abbreviated Symptom Questionnaire score, and incidence of adverse events (AEs). A Bayesian network meta-analysis was performed using the R software. The risk of bias was evaluated using the Cochrane tool (RoB 2), and the certainty of evidence was evaluated using the Confidence in Network Meta-analysis tool.
RESULTS: Seventy-three studies involving 6,829 children were included. Sensitivity analysis indicated that herbal medicine (HM) combined with medication achieved the highest effect ranking for CPRS-HI scores (surface under the cumulative ranking curve [SUCRA] = 0.96) and TER (SUCRA = 0.73), suggesting a potent alternative intervention. Pairwise meta-analysis demonstrated that HM combined with medication was more effective than medication alone across all outcomes. Safety analysis revealed that acupuncture monotherapy was associated with the lowest incidence of AEs (SUCRA = 0.95) among all treatments, including EATM therapies and medication.
CONCLUSIONS: HM combined with medication was the most beneficial intervention for children with ADHD. Despite a moderate safety profile, this combination demonstrated greater safety than medication alone. Meanwhile, acupuncture monotherapy was found to have the fewest AEs of all interventions, which may provide clinical benefits to children at risk of adverse effects.