Acupuncture for Treating Attention Deficit Hyperactivity Disorder in Children: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Study Registration
2.2. Study Selection
2.2.1. Types of Studies
2.2.2. Types of Participants
2.2.3. Types of Interventions and Controls
2.2.4. Types of Outcome Measures
2.3. Data Sources and Searches
2.3.1. Databases and Other Searches
2.3.2. Search Strategy
2.4. Data Collection, Extraction, and Quality Assessment
2.4.1. Data Extraction
2.4.2. Quality Assessment
2.5. Data Analysis
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Risk-of-Bias Assessment
3.4. Effects of Interventions
3.4.1. Acupuncture vs. Conventional Medicine
Inattention
Hyperactivity–Impulsivity
Hyperactivity
Conduct Problems
Learning Problems
Total Treatment Efficacy
3.4.2. Acupuncture Plus Conventional Medicine vs. Conventional Medicine
Hyperactivity–Impulsivity
Hyperactivity
Anxiety
Conduct Problems
Psychosomatic
Learning Problems
Total Treatment Efficacy
3.4.3. Acupuncture Plus Conventional Medicine vs. Sham Acupuncture Plus Conventional Medicine
Inattention
Hyperactivity–Impulsivity
3.4.4. Adverse Events (AEs)
4. Discussion
4.1. Summary of Main Results
4.2. Overall Completeness and Applicability of Evidence
4.3. Agreements and Disagreements with Other Reviews
4.4. Limitations
4.5. Implications for Practice and Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study ID | Sample Size Gender (M/F) | Age Disease Course (I/C, yr.) | Intervention Group (Regimen, n) | Control Group (Regimen, n) | Acupuncture Points (Main Points) | Outcome Measures/ Rating Scale Used | Results (MD/RR [95%CI], p-Value) |
---|---|---|---|---|---|---|---|
Meng 2012 [14] | 68 52/16 | 9/9 5.2/5.3 | (A) AT (3 times per week for 12 weeks, n = 36), plus B | (B) CM (methylphenidate hydrochloride ER tablets, once a day, n = 32) | DU20, DU24, GB13(bil), EM1, PC6, HT7, SP6, KI3, LV3 | (1) PSQ score (2) Treatment efficacy | (1) Anxiety: MD −0.07 [−0.88, 0.74], NS; conduct problems: MD −1.16 [−2.13, −0.19], p = 0.02; hyperactivity: MD −1.75 [−2.69, −0.81], p = 0.0002; hyperactivity–impulsivity: MD −1.09 [−1.80, −0.38], p = 0.003; learning problems: MD −1.09 [−1.80, −0.38], p = 0.003; psychosomatic: MD −0.07 [−0.27, 0.13], NS (2) RR 1.28 [1.01, 1.62], p = 0.05 |
Chen 2012 [15] | 120 86/34 | 8.6/8.8 2.1/2.3 | (A) AT (2–3 times a week for 12 weeks, n = 40), plus B | (B) CM (methylphenidate hydrochloride ER tablets, once a day, n = 40) (C) Behavioral therapy, plus B (n = 40) | EM2, DU23, DU20, PC6, LI4, DU26, ST36, KI3, SP6, LV3 | (1) PSQ score (2) Treatment efficacy | (1) A vs. B: hyperactivity: MD −5.83 [−7.02, −4.64], p < 0.00001 (2) A vs. B: RR 1.13 [0.92, 1.38], NS |
Tse 2016 [16] | 60 35/25 | 8.4/9.5 2.5/2.0 | (A) AT (5 times per week for 24 weeks, n = 30), plus B | (B) CM (methylphenidate hydrochloride ER tablets, twice a day, n = 30) | Fang’s scalp acupuncture: Bregma, Lambda, Fuxiang tou, Fuzang shangjiao, Siwei, Jiyi, Yunping | (1) PSQ score (2) SNAP-IV score (3) CRT score (4) Treatment efficacy | (1) Inappropriate reporting (2) MD −3.37 [−5.92, −0.82], p = 0.010 (3) MD 7.85 [5.43, 10.27], p < 0.00001 (4) RR 1.30 [0.97, 1.74], NS |
Yu 2021 [17] | 103 92/11 | 9.5/9.5 3.2/4.3 | (A) AT (3 times per week for 4 weeks, n = 52), plus B | (B) CM (venlafaxine, once daily, n = 51) | DU20, DU24, GB13(bil), EM1, PC6, HT7, SP6, KI3, LV3 | (1) PSQ score (2) Treatment efficacy | (1) Anxiety: MD −0.06 [−0.68, 0.56], NS; conduct problems: MD −1.47 [−2.26, −0.68], p = 0.0002; hyperactivity: MD −1.81 [−2.51, −1.11], p < 0.00001; hyperactivity–impulsivity: MD −1.22 [−1.79, −0.65], p < 0.0001; learning problems: MD −1.04 [−1.68, −0.40], p = 0.001; psychosomatic: MD −0.05 [−0.20, 0.10], NS (2) RR 1.17 [1.01, 1.36], p = 0.04 |
Zhang 2019 [18] | 40 27/13 | 8.5 n.r. | (A) AT (1 or 2 times per week for 30 therapies, n = 20), plus B | (B) CM (methylphenidate hydrochloride ER tablets, once daily, n = 20) | EM1, DU24, GB13(bil), EM2, GB14 (bil) | (1) Treatment efficacy (2) Behavioral score * (3) Hyperactivity index * | (1) RR 0.95 [0.79,1.13], NS (2) MD 9.11 [7.19, 11.03], p < 0.00001 (3) MD 2.25 [0.81, 3.69], p = 0.002 |
Liu 2013 [19] | 200 131/69 | 6–14 n.r. | AT (3 times per week for 12 weeks, n = 120) | CM (methylphenidate hydrochloride ER tablets, twice a day, n = 80) | PC6, DU26, SP6, Du20, EM2, DU23, HT7, PC7 | (1) Treatment efficacy (2) Symptom disappearance rate | (1) RR 1.13 [0.99, 1.29], NS (2) Inappropriate reporting, NS |
Huang 2015 [20] | 68 35/33 | 6–13 0.5–<1 | AT (3 times per week for 8 weeks, n = 34) | CM (methylphenidate hydrochloride ER tablets, once a day, n = 34) | DU14, DU1, CV15 | (1) SNAP-IV score (2) CRT score (3) Treatment efficacy | (1) Total: MD −8.61 [−10.59, −6.63], p < 0.00001; hyperactivity–impulsivity: MD −4.98 [−6.60, −3.36], p < 0.00001; inattention: MD −5.16 [−6.94, −3.38], p < 0.00001; others: MD −2.25 [−4.38, −0.12], p = 0.04 (2) MD −0.70 [−4.72, 3.32], NS (3) RR 1.17 [0.89, 1.52], NS |
Ji 2018 [21] | 60 36/24 | 7.6/8.4 0.2–4 | AT (10 times, n = 30) | CM (methylphenidate hydrochloride ER tablets, twice per day, n = 30) | DU20, DU17, EM1, DU24, EM2, ST36 | Treatment efficacy | RR 1.21 [1.00, 1.46], p = 0.05 |
Zhou 2013 [22] | 84 64/20 | 8.9/8.8 1.9/1.8 | AT (3 times per week for 12 weeks, n = 42) | CM (methylphenidate hydrochloride ER tablets, twice a day, n = 42) | PC6, DU24, SP6, HT7, PC7 | (1) PSQ score (2) Treatment efficacy | (1) Conduct problems: MD 8.25 [4.76, 11.74], p < 0.00001; hyperactivity: MD −4.50 [−6.06, −2.94], p < 0.00001; hyperactivity–impulsivity: MD −5.28 [−6.85, −3.71], p < 0.00001; learning problems: MD 9.70 [5.44, 13.96], p < 0.00001 (2) RR 1.11 [0.95, 1.31], NS |
Wei 2011 [23] | 70 38/32 | 10.8 n.r. | AT (3 times per week for 4 weeks, n = 35) | CM (methylphenidate hydrochloride ER tablets, twice a day, n = 35) | DU14, CV8 | (1) Rating score * (2) Treatment efficacy | (1) Inappropriate reporting, p < 0.05 (2) Inappropriate reporting, NS |
Che 2017 [24] | 72 11/7 * | 9.2/7.6 0.8–3.2 | AT (once daily for 4 weeks, n = 36) | CM (Methylphenidate hydrochloride ER tablets, n.r., n = 36) | LV3, KI3, SP6, GB34, LI4, Dacha, HT7, GB-20, EM5, EM2, EM1 | (1) PSQ score (2) Treatment efficacy | (1) Hyperactivity: MD −1.55 [−2.84, −0.26], p = 0.02 (2) RR 1.29 [0.99, 1.68], NS |
Zheng 2022 [25] | 57 40/17 | 11/11 3.0/3.1 | EA (5 times per week for 12 weeks, n = 30) | Methylphenidate hydrochloride ER tablets, once a day (n = 30) | DU26, EM2, DU20, DU14, BL15 (bil), BL17 (bil), BL18 (bil), BL20 (bil), BL23 (bil), ST25 (bil), CV6, CV4, ST29 (bil) | Treatment efficacy | RR 1.27 [0.95, 1.70], NS |
Moharreri 2018 [26] | 90 57/7 | 10.4/10.9 n.r. | AT (3 times per week for 4 weeks, n = 51), plus CM ✝ | Sham acupuncture (3 times per week for 4 weeks, n = 39), plus CM ✝ | BL18, BL20, BL23, KI3, LV3, SP6, LI4, CV17, CV12, DU24, DU20, EM2 | (1) ADHD-RS score (2) Visual CPT score | (1) Total: MD −1.06 [−6.28, 4.16], NS; hyperactivity–impulsivity: MD 0.88 [−1.94, 3.70], NS; inattention: MD −1.95 [−4.90, 1.00], NS (2) Correct hit: MD 3.24 [−3.05, 9.53], NS; omission error: MD −4.30 [−7.68, −0.92], p = 0.01; commission error: MD 1.06 [−3.65, 5.77], NS; reaction time: MD −24.06 [−88.96, 40.84], NS |
Hong 2016 [27] | 93 78/15 | 10.9/11.1 n.r. | AT (twice per week for 6 weeks, n = 46) | Waitlist (n = 47) | DU20, EM1, LI4 (bil), LI11 (bil), SP6 (bil), LV3 (bil) | (1) ADHD-RS score ‡ (2) PSQ score ‡ (3) IOWA-RS score ‡ (4) CGI-S score ‡ (5) FAIR score ‡ (6) CBCL score ‡ (7) CNT score ‡ (8) CPT ‡ (9) CCPT ‡ | (1) Total: NS; Hyperactivity–impulsivity: NS; inattention: NS (2–3) NS (4) p = 0.012 (5) P: NS; Q: p = 0.022; C: NS (6) Total: NS; ADHD subscale: NS; external subscale: NS (7) Digit span test: forward: NS, backward: p = 0.027; visual span test: forward: NS, backward: p = 0.03; verbal learning test: p = 0.007 (8) Auditory—correct hit: NS; omission error: NS; commission error: NS; reaction time: p = 0.011; visual—correct hit: NS; omission error: NS; commission error: NS; reaction time: p = 0.004 (9) Auditory: Correct hit: NS, Omission error: NS, Commission error 1: NS, Commission error 2: NS, Reaction time: NS; Visual: Correct hit: NS, Omission error: NS, Commission error 1: NS, Commission error 2: NS, Reaction time: NS |
Study ID | AEs |
---|---|
Meng 2012 [14] | n.r. |
Chen 2012 [15] | Loss of appetite (AT, 2; CM, 7), headache (AT,1; CM, 1), insomnia (AT, 1; CM, 5), abdominal pain (CM, 2) |
Tse 2016 [16] | n.r. |
Yu 2021 [17] | n.r. |
Zhang 2019 [18] | Vomiting, hallucinations, agitation, hyperreflexia, muscle twitches, convulsions, euphoria, tremor, confusion, delirium, sweating, flushing, headache, high fever, tachycardia, palpitations, hypertension, mydriasis, arrhythmia, dry mouth, etc. (AT/CM: n = 5/6) n.r. in details |
Liu 2013 [19] | Nausea, dry mouth, constipation, loss of appetite, etc. (n = 15) Not differentiated according to intervention |
Huang 2015 [20] | n.r. |
Ji 2018 [21] | n.r. |
Zhou 2013 [22] | n.r. |
Wei 2011 [23] | n.r. |
Che 2017 [24] | n.r. |
Zheng 2022 [25] | Loss of appetite (CM, 6), insomnia (CM, 4), headache (CM, 3), abdominal pain (CM, 1), muscle twitches (CM, 1) |
Moharreri 2018 [26] | None |
Hong 2016 [27] | Mild headaches (AT, 3) |
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Ang, L.; Kim, J.T.; Kim, K.; Lee, H.W.; Choi, J.-Y.; Kim, E.; Lee, M.S. Acupuncture for Treating Attention Deficit Hyperactivity Disorder in Children: A Systematic Review and Meta-Analysis. Medicina 2023, 59, 392. https://doi.org/10.3390/medicina59020392
Ang L, Kim JT, Kim K, Lee HW, Choi J-Y, Kim E, Lee MS. Acupuncture for Treating Attention Deficit Hyperactivity Disorder in Children: A Systematic Review and Meta-Analysis. Medicina. 2023; 59(2):392. https://doi.org/10.3390/medicina59020392
Chicago/Turabian StyleAng, Lin, Jung Tae Kim, Kibong Kim, Hye Won Lee, Jun-Yong Choi, Eunseop Kim, and Myeong Soo Lee. 2023. "Acupuncture for Treating Attention Deficit Hyperactivity Disorder in Children: A Systematic Review and Meta-Analysis" Medicina 59, no. 2: 392. https://doi.org/10.3390/medicina59020392