Developing Evidence-Based Program Recommendations for Children and Youth Impacted by ADHD: A Systematic Review of the Literature

Abstract

Background: Attention-Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder affecting executive functions such as impulse control, focus, and organization. This study addresses three research questions: current models and gaps in ADHD interventions, ways to enhance strengths and address weaknesses, and program recommendations for various ages. The aim is to develop a comprehensive framework to improve ADHD interventions, with a particular focus on youth and addressing existing gaps to enhance effectiveness. Methods: The current study systematically reviews the literature to answer these research questions. Sources were examined to identify existing intervention models, documented strengths and weaknesses, and recommendations relevant to different developmental stages. Results: Findings show that interventions for ADHD are varied and include psychological or behavioural therapy, family-school issues and parent involvement, school-based approaches, and medication. Key challenges include a lack of evidence-based practices, gaps in translational research, and insufficient teacher training. Notable strengths are family-school conference and family input, though there is less emphasis on building problem-solving capacity and family agency. Conclusions: Program recommendations highlighted in the literature include the need for family involvement, matching intervention intensity to individual needs, and ensuring professional education for special education. Addressing these gaps is essential for strengthening ADHD interventions and improving outcomes for children and youth.

1. Introduction

Attention-Deficit Hyperactivity Disorder (ADHD) is a complex developmental brain disorder that impairs the brain’s executive functioning/self-management system in ways such as impulse control, focus, and organization, and it has a direct negative impact on social, academic, or occupational functioning [1,2]. There are three subtypes of ADHD: Inattentive (ADHD-I), Hyperactive (ADHD-H), and combined (ADHD-C) [3].

Addressing ADHD demands a multifaceted approach due to the complexity of the disorder. While there are many types of interventions available, including skill-building, academic/school-based, family/attachment-based, technology-based, medical, and guided assessment-based, gaps persist within the realm of ADHD interventions, further highlighting the need for a comprehensive, multifaceted approach to treat ADHD symptoms.

Clients with ADHD face challenges such as scarcity of evidence-based practices [4], limited school-based research and practice [4], inadequate teacher training in both general and special education [5], and workforce gaps in training and knowledge [6]. These obstacles, however, offer opportunities for innovation and improvement, inspiring advancements in ADHD interventions. This systematic review is set out to provide recommendations to enhance current ADHD interventions to close these gaps.

Strengths in ADHD interventions include family–school conferences [7], input from family members [7], fostering problem-solving capacities in children and caregivers [7], and most crucially, recognizing a student’s unique pattern of strengths and limitations [8]. This understanding empowers stakeholders to tailor interventions to individual needs, enhancing the potential for successful outcomes.

The diverse needs of clients with ADHD necessitate a collaborative and multifaceted approach to ADHD programming. Recommendations to enhance current ADHD interventions include frequent, sustained, and personalized interactions to strengthen teacher–student relationships, active family involvement across all programming, and customizing intervention intensity to the specific needs of the student and family. This collaborative approach is essential for developing interventions that impact the lives of children and youth impacted by ADHD.

While the literature identifies various interventions, gaps, strengths, and program recommendations, this research aims to create a comprehensive systematic framework, offering valuable insights into different intervention models, addressing gaps in these interventions, highlighting model strengths that need attention, and outlining recommendations to improve current programming. Given that ADHD affects all ages, this study explicitly focuses on youth, providing significant implications for working with this demographic.

This study focuses on addressing three research questions:

• What current models of interventions exist for children and youth with ADHD, and what gaps exist for these children and youth?
• How can these model strengths and gaps be addressed to better serve clients with ADHD?
• What does a program require to be effective for clients at various ages based on models?

2. Materials and Methods

This systematic review used Google Scholar (Google LLC, Mountain View, CA, USA; accessed September 2023), to implement the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) research method (Figure 1) (See Supplementary Table S1). Articles must have been published between 2013 and 2023, divided into two sub-ranges (2013–2017; 2018–2023) to manage Google Scholar’s limitation of 1000 results per query. Focusing on the recent literature ensures relevance to current ADHD intervention practices and reflection on advancements in research, policy, and clinical approaches. An 11-year range effectively balances recency and depth to ensure a comprehensive evidence base for this review. Google Scholar was the only search engine used for this systematic review due to institutional access limitations as well as the time-sensitive nature of this project. Google Scholar was intentionally selected due to its broad coverage across disciplines. Diverse study types, such as dissertations and theses, were included in this review despite their lack of peer review. These study types were included in the review as the research team felt their content was relevant to our research and wanted to ensure that no important information was missed.

To be included in this review, articles must have been indexed under or include the search keywords “ADHD” AND “PARENTING” AND “CHILDREN” AND “YOUTH” AND “PROGRAMMING” AND “MODELS” AND “INTERVENTIONS” AND “EDUCATION” AND “GAPS” AND “STRENGTHS”. These keywords were selected to align with the three research questions (RQs). They target the literature addressing ADHD interventions (models, programming), contextual factors that relate to the effectiveness of interventions (parenting, education), and critical evaluation of current ADHD interventions (gaps, strengths). Additionally, the keywords “children” and “youth” were included to ensure that articles that are included are focused on the experiences of children and youth with ADHD as this systematic review does not discuss ADHD interventions for adults. All key words were included in the same search. Filters were applied to ensure that the articles were published between 2013 and 2023. With these keywords, the initial Google Scholar query yielded 1480 results, which was devised into the two sub-ranges (2013–2017: 514 articles; 2018–2023: 996 articles). Twenty duplicate records were removed prior to screening, leaving 1460 articles to be screened.

Articles were first screened independently based on their title’s relevance to the three RQs posed in this systematic review, yielding 201 articles to be included. Sequentially, articles were screened based on their abstracts’ relevance to the three RQs, yielding 81 articles to be included. The RQs posed are central to the goals of this systematic review. Requiring relevance ensures that studies contribute directly to the understanding of ADHD intervention models, their limitations, their strengths, and their practical recommendations.

With the remaining 81 articles, six field-related experts independently screened their contents to ensure that their content is relevant to the three RQs posed in this systematic review. These experts bring their own unique expertise in mental health and child development: one has a Registered Social Worker designation as an ADHD clinical service provider; two hold diplomas in Early Childhood Education, with experience in childcare centers, home-based care, and now as certified infant and child sleep consultants (currently pursuing ADHD training through PESI); one is a Registered Social Worker and member of the Canadian Association of Play Therapy, with 20 years of experience in children’s mental health, developmental services, and child welfare; one is a Mental Health and Addictions worker and serves as a program counselor guiding clients in skill-building and problem-solving strategies; and one actively leads research projects within a social innovation portfolio. All of the field-related experts received training on the inclusion and exclusion criteria and screening procedures prior to the review process. A standardized screening protocol, along with predefined inclusion and exclusion criteria, was applied consistently across all reviewers. Inter-rater reliability was not formally calculated; however, disagreements were discussed and resolved through consensus.

Thirty-seven articles remained after the final screening. To ensure simplified references for the field-related experts in the review’s later stages, the articles were numbered 1 through 37.

Table 1. Explicit inclusion criteria.

Inclusion Criteria	Description	Justification
Publication Date	Articles must have been published between 2013 and 2023.	Ensures recency as well as depth.
Relevance to Keywords	Articles must be indexed under or include the keywords “ADHD” AND “parenting” AND “children” AND “youth” AND “programming” AND “models” AND “interventions” AND “education” AND “gaps” AND “strengths” in a combined Google Scholar search	Aligns with RQs, targeting literature on ADHD interventions (i.e., models, programming) for youth (i.e., children, youth), contextual factors that relate to the effectiveness of interventions (i.e., parenting, education), and critical evaluation of current ADHD interventions (i.e., gaps, strengths)
Relevance to Research Questions	Articles must address at least one RQ	Ensures relevance to the aim of this review
Study Type and Content	Articles must be scholarly (i.e., peer-reviewed journals, theses, dissertations, book chapters) with empirical, theoretical, or review-based evidence on ADHD interventions, their gaps, their strengths, or their requirements	Ensures high-quality, credible evidence for a comprehensive synthesis
Population Focus	Studies must focus on children and youth with ADHD, including all subtypes and contextual factors (parenting, education)	Ensures relevance to the aim of this review
Language	Studies must be in English	Ensures accessibility for the research team

displays the explicit inclusion criteria. Articles were excluded if they did not adhere to the outlined criteria.

Two sheets in Microsoft Excel (Version 16.x; Mircosoft Corporation, Redmond, WA, USA) were used to lay out the findings from each article (See Supplementary Table S2). The first sheet was labeled “Extended”; this sheet had four columns. The first one was labeled “Articles/Citation,” which had the number labeled for the article from which the information came and the reference for the article. The remaining three columns were labeled on the three research questions of this study.

The second sheet was labeled “Condensed”. This sheet also had four columns, where the first research question was broken down into two themes: interventions and gaps. The third column was for strengths, and the last was for program requirements. From the 37 articles, there were many duplicates of authors mentioning the same themes, so there was lumping in terms of every category. Using the article’s respective number labels, researchers were able to combine similar themes to maintain conciseness.

The Microsoft Excel spreadsheet served as the basis for this study’s Section 3 (Results) and was used to easily access information regarding each of the research questions to ensure organization through the process of writing the final report.

A thematic analysis approach was utilized for data synthesis. Key findings from the included studies were extracted and coded systematically. Initially, codes were generated from the data, and similar codes were grouped into broader categories. These categories were then refined into themes and finalized through discussion among the research team.

Risk of bias (see Supplementary Material) and study quality were assessed using design-specific critical appraisal tools. AMSTAR 2 was used to appraise systematic reviews, AXIS was used for cross-sectional studies, SANRA was used to assess narrative reviews, and the CASP tools were used to evaluate cohort, qualitative, and randomized controlled studies. These tools were selected to ensure that risk of bias was evaluated using criteria applicable to each study design. Findings from these assessments informed the interpretation of results and contributed to the classification of evidence strength.

The strength of evidence for each intervention was assessed based on study design, sample size, consistency of findings across the included studies, and risk of bias. Information regarding study design and sample size can be found in

Table 2. Summarization of included studies.

Title	Design and Sample	Key Findings
Computer Enabled Neuroplasticity Treatment: A Clinical Trial of a Novel Design for Neurofeedback Therapy in Adult ADHD	Randomized Controlled Trial n = 54 Finnish adults mean age = 36	Neurofeedback improved self-reported ADHD symptoms compared to control No significant transfer of learning
Identifying and Providing Evidence-Based Services for Twice-Exceptional Students	Literature review focused on twice-exceptional students	Highlights complex cognitive, academic, and psychosocial needs of twice-exceptional students Emphasizes the need for comprehensive assessment Recommends increased training for professionals
Advancing Research to Improve Family–School Collaboration in School Mental Health	Literature review focused on families, schools, and students	Family–school collaboration is critical to student mental health There is a need for research-informed practices to improve implementation
Enhancing Teacher–Student Relationship Quality: A Narrative Review of School-Based Interventions	Narrative review discussing teacher–student relationships	Identified four key strategies: 1. Increasing closeness, 2. Reducing conflict, 3. Promoting social-emotional learning, and 4. relationship-driven classroom management
Teachers’ Knowledge of, Satisfaction with, and Familiarity with Supporting Students with ADHD	Survey Educational professionals in Ontario	Teachers report low confidence in their abilities to teach students with ADHD Special education teachers have more confidence in their abilities Further training for teachers regarding ADHD is needed
Optimizing Implementation of School-based Programming by Leveraging Motivational Interviewing	Literature review focused on the use of evidence-based practices within educational settings	Important aspects of motivational interviewing (MI) for educators to consider include (a) teaching and learning MI, (b) measuring MI fidelity, and (c) evaluating MI mechanisms of change
Pre-Service Teachers’ Perceptions of the Acceptability of Interventions for ADHD and Knowledge of Evidence-Based Practice	Survey n = 54 students in BEd program in Eastern Canada	Daily Report Card seen as the most acceptable, effective, and timely intervention Behavioural interventions are preferred over medication; there are concerns regarding potential side effects Self-reported knowledge of EBP was higher than attitudes and current use of EBP
Examining Positive Behavioural Supports for Children with Challenging Behaviours Across Culturally and Linguistically Diverse Head Start Settings	Quantitative survey and qualitative focus groups n = 356 Head Start personnel from 54 Head Start centers	Universal social-emotional strategies are used over individualized supports Negative practices are frequently used to manage classroom behaviors Teacher characteristics relate to strategy use and perceptions Inconsistent use and perceptions of targeted and evidence-based practices
Understanding the Contributions of Family Processes to Educational Outcomes for Children with ADHD: A Longitudinal Analysis	Quasi-experimental research study n = 6 preschoolers; 21 teachers	Family involvement in education and the parent–child relationship has significant impacts on classroom behaviors and academic outcomes These impacts can be both positive and negative, depending on the parenting
Mindfulness-Based Interventions for Adults with ADHD: A Systematic Review and Meta-Analysis	Systematic review of mindfulness-based interventions	Motivational interviewing (MI) can be effective in improving core ADHD symptoms and overall functioning but their effects on emotional well-being and mindfulness skills remains inconclusive
Childhood Attention Problems and the Development of Comorbid Symptoms at the Transition to High School: The Mediating Role of Parent and Peer Relationships	Longitudinal quantitative study n = 388 grade six students; 363 grade eight students; 340 grade nine students	Significant but indirect effects of grade 6 attention problems on grade 9 depressive symptoms through friendships quality and mother-child relationship Interventions targeting parent and peer relationships may be valuable
Including Parents in the Continuum of School-Based Mental Health Services: A Review of Intervention Program Research from 1995 to 2010	Literature review of student mental health interventions involving parents delivered in school settings	Interventions were grouped intro tiers: Universal, Selected, Targeted or Indicated Two interventions involved all three tiers Parents are mostly involved through group parent training
A Two-Site Randomized Clinical Trial of Integrated Psychosocial Treatment for ADHD-Inattentive Type	Randomized Controlled Clinical Trial n = 199 children	Child Life and Attention Skills (CLAS) showed improvements in inattention, organization, social skills, and global functioning Integrated approaches specifically for ADHD-I is superior Direct involvement of teachers and children in CLAS amplifies impacts
The Lived Experiences of Twice Exceptional Children: Narrative Perceptions of Disability and Giftedness	Qualitative narrative inquiry n = 8 gifted children with disabilities	Five themes emerged: Personal Interests; Negative Experiences; Support Networks; Stress, Coping, and Resilience; Sense of Self Twice exceptional children experience life in ways that may not be understood by others
How Parents, Teachers, Psychologists, and Educational Environments Influence Developmental Transitions of Preadolescent Twice-Exceptional Students	Collective case study Educators, parents, and one school psychologist	Communication can be a support and a barrier to successful transitions Providing an appropriate environment and teaching social-emotional learning contributes to successful transitions
Policy Considerations for Twice-Exceptional Students	Policy analysis	Lack of policies Modifying policies to utilize Gifted Individualized Education Plans in conjunction with Individualized Education Plans
Exploration of Effective Strategies for Children with Emotional Disorders as Identified by Helping Professionals in Schools	Qualitative interviews n = 9	There is a need for more time to develop relationships, more community, parent, and administrative participation, and more nurturing within schools
Non-Pharmacological Interventions for ADHD in School Settings: An Overarching Synthesis of Systematic Reviews	Overarching synthesis of systematic reviews 4 systematic reviews including 138 studies	Contextual issues may influence the effectiveness and implementation of interventions
Families Journeying Together: Exploring Resilience in Families with Adolescents with ADHD	Qualitative, constructivist grounded theory approach Adolescents with ADHD, their parents, and supportive professionals from 3 Canadian cities	Parents play a key role Family systems perspective and ecological approach must be addressed
Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation	Literature review focused on cognitive neuroscience of ADHD	Transcranial direct current stimulation (tDCS) appears to be promising to improve ADHD symptoms and cognitive functions, but further clinical trials are needed Neurotherapies seem attractive for ADHD, but they need to be thoroughly tested for short and long term clinical and cognitive efficacy
Evidence-Based Family Strengthening Training in Maine: A Resource Assessment and Proposal to Reduce Barriers	Mixed-methods study Participants include service providers and agencies offering programs	Interagency and intersectional collaboration and information-sharing need to be increased Additional training should be offered to providers
Improving Care for Families and Children with Neurodevelopmental Disorders and Co-occurring Chronic Health Conditions Using a Care Coordination Intervention	Longitudinal clinical intervention design n = 84 children and their families	Care coordination demonstrated positive impacts for children, families, and care teams and contributed clinical efficiencies Families reported that the program decreased their stress around coordinating care for their child
Summer Camp for Adolescents with Attention-Deficit/Hyperactivity Disorder: A Naturalistic Context for Enhancing Social Competence	Quantitative questionnaire n = 60 adolescents	Adolescents have significantly lower social competence when compared to their peers and can improve their social competence after attending a specialized summer camp These camps can be innovative, cost effective, and generalizable
Special Educators’ Perceptions on Effective Preparation and Practice for Student Success	A phenomenological study with 12 semi-structured interviews	There is a need for rich teacher–student relationships to advance student success Themes including applying classroom structure and technology and individual student instruction emerged
School-Based Mental Health Supports for Students with Special Needs	Literature review focused on the impacts of having mental health professional programs in schools 10 studies were included in the review	Having mental health staff in the educational setting is important Families are more willing to access mental health support when they are able to choose when and where they meet Most families prefer one-on-one sessions in their home after the workday When activities are offered at school, parent participation slightly increases
Impact of School-Based Mentorship Programs for Students with Disabilities	Qualitative research design High school students with behavioral disabilities	Mentorships in secondary schools can affect the course of students’ academic and personal life trajectories
Accessibility and Reliability of Early Childhood Mental Health Services	Qualitative research student that conducted interviews n = 7 professional	Nine themes emerged While resources may be available, accessibility to such services is problematic because of barriers such as transportation There is a need for more professional training in small communities
Family Background and Parent-School Interactions in Parent Involvement for At-Risk Preschool Children with Disabilities	Quantitative examination of secondary data n = 1350 survey respondents were analyzed	Parent involvement was greater for White compared to Black and Hispanic parents of all children Higher parental education related to greater involvement at the end of the year for parents of children with disabilities
Stakeholders’ Knowledge Impacting the Academic and Social-Emotional Needs of Twice-Exceptional Students in Kentucky	Quantitative survey n = 478 kindergarten to grade 8 educators	Higher levels of teacher training led to better outcomes for twice-exceptional students More training should be provided to educators
Mindfulness-Based Cognitive Therapy and the Adults ADHD Brain: A Neuropsychotherapeutic Perspective	Literature review of neuropsychotherapeutic interventions/perspectives	Mindfulness meditation employed as a neuropsychotherapeutic intervention can help individuals with ADHD regulate impaired brain functioning and reduce ADHD symptoms
Fostering Resilience with Students with Learning Disabilities: An Ecological Approach	Qualitative interviews Post-secondary students	The mesosystem level interactions included open and honest communication between the home and school environments so that the parents were able to seek out the appropriate supports in the community
Multiple Perspectives on Parent Involvement for Middle School Students Receiving Special Education Services	Thematic analysis of secondary data Compares the perspectives of 25 parents and 26 professionals from five middle schools	Four themes emerged: the quality of the school’s effort to engage and collaborate with parents, the frequency, variety, and effectiveness of communication, the quality of services, placement, and education, and beliefs and values about parent involvement
The Effect of exergaming on Executive Functions in Children with ADHD: A Randomized Clinical Trial	Parallel group randomized clinical trial n = 51 children	Exergaming may benefit two domains which frequent deficits can be observed in children with ADHD: executive functions and motor abilities Exergaming could serve as an individualized home-based intervention To maximize benefits, custom exergames are needed
The Important Role of Executive Functioning and Self-Regulation in ADHD	Conceptual paper	ADHD is primarily a disorder of executive functioning and self-regulation Effective support requires external structure and ongoing support
Classroom Accommodations for Children with ADHD	Educational report based on research and clinical expertise	Classroom accommodations can significantly improve academic performance and behavior Accommodations should be consistent and tailored to individual student needs
Executive Function/Cognitive Training for Children with ADHD: Do Results Warrant the Hype and Cost?	Meta-analysis 25 studies included with 913 children included across all studies	Cognitive training did not significantly improve ADHD symptoms, academic achievement, or cognitive skills Reported improvements were likely due to placebo effects and biases
Lived Experiences of Twice-Exceptional Students and Their Families: The Effects of Toxic Stress in Learning Environments	Qualitative comparative case study n = 5 twice-exceptional students	Schools fail to support both giftedness and disability, leading to underachievement, frustration, and feeling misunderstood Ongoing stress negatively impacts mental health, emotional regulation, and learning ability Better outcomes occur when students receive individualized, strengths-based support in safe and understanding environments

, and they are explored further in Supplementary Table S3. Studies utilizing more rigorous designs, such as randomized-controlled trials and experimental designs, were considered to provide stronger evidence, while observational and quasi-experimental studies were considered to provide moderate evidence. Qualitative, descriptive, and single-study findings were considered to provide limited evidence. Risk-of-bias assessments (see Supplementary Table S2) were also considered, with higher levels of bias influencing the interpretation and classification of evidence strength.

3. Results

This systematic review’s findings are based on four categories: interventions, gaps, strengths, and program recommendations. These results describe an extensive array of information to effectively relay the necessity of ADHD interventions as well as to convey what approached new ADHD interventions should consider when planning. Risk-of-bias assessments indicated variability in study quality across the included studies, with several studies demonstrating moderate-to-high risk of bias. Common sources of bias included selection bias, non-response bias, and limitations in study design and reporting. These findings informed the interpretation of the results and the classification of evidence strength.

3.1. Interventions

The results of the systematic review show that 42 interventions relate to ADHD for children and youth (see

Table 3. Intervention overview.

Category	Intervention	Strength of Evidence	Reference
Skill Building	Cognitive or Behavioral Therapy	Stronger	[8,9]
	Direct Skill Training/Building	Stronger	[9,10,11,12]
	Video Self-Modeling	Moderate	[8]
	The Incredible Years Training for Children with Developmental Delays	Stronger	[13]
	CLAS	Moderate	[11]
	Motivational Interviewing	Moderate	[4]
	Occupational Interventions	Moderate	[14]
	PATHS Program	Limited	[6]
	Tools of the Mind–Play Curriculum	Limited	[6]
	Individualized Incentive Program	Limited	[6]
	STP	Moderate	[15]
	Self-Determination	Moderate	[16]
	IY	Moderate	[17]
	Self-Management	Moderate	[18]
	Psychosocial Interventions	Moderate	[9]
	Mindfulness Skills	Moderate	[10]
	Ameliorating Skill and Performance Deficits	Moderate	[9]
	Swimming	Limited	[19]
Academic/School Based	DRC	Stronger	[5,10]
	School-Based Programming	Stronger	[5,9,10,20]
	Competency Drivers	Limited	[4]
	IYTTP	Moderate	[6]
	PBIS	Moderate	[17]
	Classroom Lottery	Limited	[5]
	Response Cost Technique	Moderate	[5]
	FSS	Moderate	[9]
	Homework Success	Moderate	[9]
	BCM	Stronger	[5]
Family/Attachment Based	Family–School and PI	Stronger	[8,9,13,21]
	Family Check Up	Moderate	[4,13]
	CARE	Moderate	[9]
	Circle of Security	Limited	[22]
	Trust-Based Relational Intervention	Limited	[22]
	Parent-Focused Interventions	Moderate	[9,13,21]
Technology Based	Neurofeedback	Moderate	[3,12]
	Transcranial Neuromodulation	Limited	[23]
Medical	Medication	Stronger	[5,11,19]
Guided Assessment Based	Response to Intervention	Moderate	[24,25]
	DSM-Based Evidence-Informed Interventions	Moderate	[5,8]
	Creating GIEPs in Conjunction with IEPs	Moderate	[19,24]
	Care Coordination	Moderate	[26]
	Positive Role Models	Limited	[19]

Note: Strength of evidence was determined based on study design, sample size, consistency of findings across included studies, and risk of bias.

). The 42 interventions are divided into six categories: skill-building, academic/school-based, family/attachment-based, technology-based, medical, and guided assessment-based interventions. Table 2 also provides the strength of evidence for each intervention. Classifications were determined based on study design, sample size, consistency of findings, and risk of bias, as outlined in the methods.

3.1.1. Skill-Building Interventions

Of the final 37 articles, 13 discussed skill-building interventions (see Figure 2). These interventions target behavioral, social, and academic deficits to help children and youth enhance their self-regulation and executive functioning. Research highlights the importance of behavioral and cognitive behavioral therapy [8]. Additionally, motivational interviewing (MI) has been noted as an important intervention [4]. Self-management has been shown to be effective at decreasing disruptive behavior among children and youth with ADHD [18]. There are psychosocial interventions for children and youth with ADHD; these include behavioral peer interventions, behavioral contingency management, and behavioral parent training [9]. Another example of effective skill-building interventions includes the development of mindfulness skills, training interventions, and individualized therapy to help children with ADHD build coping skills [10]. Video self-modeling is effective and involves having students watch recordings of their interactions to develop social and behavioral skills [8]. Direct skill-building interventions target academic, behavioral, and social deficits, often in school settings [9,10,11,12].

Other skill-building interventions include ameliorating skill and performance deficits, which can benefit children and youth with ADHD more long term than pharmacological interventions alone [9]; Incredible Years Training for Children with Developmental Delays, a system for supporting families of children with developmental disabilities [13]; Child Life and Attention Skills (CLAS), which combines group-based parent training, child life skills training, and teacher consultation for ADHD-I [11]; Summer Treatment Program (STP), an 8-week program using social skills training to address social functioning [15]; Promoting Alternative Thinking Strategies (PATHS), Tools of the Mind–Play curriculum, and Individualized Incentive Program, all targeting social, emotional, and school readiness through structured activities and rewards [6]; Incredible Years Small Group Dina Dinosaur Treatment Program (IY), for students needing behavioral support [17]; self-determination, addressing motivation and emotional development [16]; occupational interventions, focusing on non-pharmacological support to enhance daily functioning [14]; and swimming, which can help children and youth with ADHD regain focus [19].

3.1.2. Academic/School-Based Interventions

Among the reviewed articles, seven discussed academic/school-based interventions (see Figure 2). These interventions help to enhance educational outcomes through school-focused interventions. Targeting functional impairments in the educational realm is vital as it has a considerable overlap with two other core areas of functional impairments; how prevalent it is with students who have ADHD, and any adverse outcomes there may be [9]. School-based/academic interventions encompass four themes regarding teacher–student relationship quality; explaining the importance of classroom management focusing on the relationship, prioritizing social-emotional learning, decreasing conflict in the classroom, and increasing closeness between teachers and students [20].

School-based interventions include Daily Report Card (DRC), a structured tool where teachers and parents set daily behavioral and academic goals and provide rewards when goals are met to positively reinforce the behavior, Behavioural Classroom Management (BCM), an approach to reinforce positive behaviors in the classroom, Classroom Lottery, a reward system encouraging students to follow classroom rules, and Response Cost Technique, where a point system for rewards is in place and points are added to reinforce positive behavior and points are removed to discourage negative behavior [5]. Additional interventions include the Family School Success (FSS) program, where families and schools collaborate to support academic and behavioural goals, and the Homework Success program, which provides parent and children strategies for managing homework completion [9]. Frequently mentioned interventions include the use of DRCs and positive reinforcement, which includes token economies and time-outs [10].

Competency drivers provide support and guidance for school-based implementers that are essential when implementing an intervention as intended [4]. The Incredible Years Teacher Training Program (IYTTP) trains teachers to manage classroom behaviors as well as to help teach social-emotional skills [6]. Positive behavior interventions and supports (PBIS) help to create consistent teacher–student expectations and positive interactions to support student academic and behavioral success [17]. The outlined interventions above underscore the importance of structured school-based interventions for ADHD.

3.1.3. Family/Attachment-Based Interventions

Among the reviewed articles, seven discussed family/attachment-based interventions (see Figure 2). These interventions strengthen family relationships and involvement to support children with ADHD. Family–school issues and some types of Parent Involvement (PI) include parent interventions for successful high school transitions [21], parent interventions for improving academic outcomes (i.e., grades and attendance) [13], and parent self-efficacy to ensure their involvement in their child’s education [9]. Family Check Up (FCU) is an intervention using motivational interviewing (MI) to assess family dynamics and provide feedback to enhance parenting strategies [4,13]. Coping with ADHD to Improve Relationships and Education (CARE) educates parents about ADHD, offers peer support spaces, and tracks the progress of their children at home and school [9].

Circle of security is a visual map of secure attachments children have to strengthen the caregiver–child relationship [22]. Trust-based Relational Intervention supports healthy relationships for adoptive and foster families of children with ADHD to help them succeed and address past trauma [22]. These interventions emphasize the important roles families and attachment play in supporting children with ADHD.

3.1.4. Technology-Based Interventions

Three articles discussed the use of technology-based interventions (see Figure 2). Neurofeedback (NFB) is defined as training regimes using theta–beta (TB) and sensorimotor rhythm (SMR) to train self-regulation through EEG frequency and provide encouragement for children to increase their attention and impulse control through the visualization of their brain activity [3,12]. Transcranial neuromodulation (brain stimulation) is another important intervention. Transcranial neuromodulation is described as having two primary non-invasive therapies; these two being repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) [21]. rTMS uses brief, intense electrical current pulses through a coil on the participant’s head that creates an electric field in the brain. tDCS uses weak, painless, and persistent electric currents to specific regions in the cortex through electrodes in the scalp [23].

3.1.5. Medical Interventions

Among the reviewed articles, three explored medication (see Figure 2). Medications are considered evidence-based interventions for ADHD [11]. Stimulant medication such as Ritalin can reduce behavioral problems [5]. In one study, a child was prescribed medication to manage their ADHD, and their parent noted that everything changed for their child; even the child’s teachers noticed the changes, but importantly noted was that other types of interventions (i.e., behavioral) were also being used and the child was more receptive to those compared to the medication, meaning that using medication as the sole intervention is not as effective as combining interventions [19].

3.1.6. Guided Assessment-Based Interventions

Six articles discussed guided assessment-based interventions (see Figure 2). These interventions focus on tailoring interventions to the intervention users. Response to intervention (RtI) matches student needs with adjusted instructions to meet their needs based on their ongoing performance, and the process primarily examines a child’s academic needs [24,25]. Utilizing evidence-based interventions related to DSM diagnoses involves making conscientious clinical decisions and integrating evidence-based interventions such as cognitive behavioral therapy, video self-modeling, and developing advocacy skills [5,8]. Creating Gifted Individual Education Plans (GIEPs) in conjunction with Individualized Education Programs (IEPs) helps to prioritize the needs of twice-exceptional students [19]. It has been noted that GIEPs should include academic goals and performance indicators, and the school district should provide accommodations and services to help the student meet these goals [24]. Care coordination was noted as another intervention, and it provides social and educational support services that help with the development of client-centered care plans [26]. Additionally, it is important that children with ADHD have a positive role model as it allows them to practice positive behavior that has been modeled to them [19,27].

3.1.7. Synthesis of Interventions

Across the included studies, interventions for children and youth with ADHD predominantly focused on behavioral, skill-building, and school-based approaches, reflecting a consistent emphasis on improving functional, academic, and self-regulation outcomes. These approaches were often structured and targeted, particularly within behavioral and direct skill-building interventions, which demonstrated stronger evidence in comparison to other intervention types. In contrast, interventions such as technology-based approaches and certain emerging programs demonstrated more moderate or limited evidence, often reflecting variability in study design. Differences were also observed across intervention types, with medical and behavioral interventions generally showing clearer and more measurable outcomes, while more holistic and context-based approaches, such as family- and attachment-focused interventions, emphasized broader developmental and relational outcomes. However, despite these patterns, variability in study design, sample size, and the presence of moderate-to-high risk of bias across the included studies may limit the strength of evidence.

3.2. Gaps

Among the 37 articles included in this review, 29 gaps were identified spanning the six categories of interventions (see

Table 4. Gaps overview.

Category	Gaps	Reference
Skill Building	Lack of evidence-based practices	[6,28]
	Insufficient resources and training	[6,28]
	Limited staff understanding of practices for persistent behavioral challenges	[6,28]
	Poor real-world implementation of interventions	[4,5]
	Limited translation of research into school-based practice	[4,5]
	Limited behavioral principle knowledge leading to negative practices	[6]
	Limited exploration of resilience factors and underlying neuronal mechanisms	[14,29]
Academic/School Based	Insufficient teacher training (general and special education)	[5,28]
	Limited ADHD-specific training in teacher education programs	[5,28]
	Inconsistent staff perceptions and implementation practices	[6,15]
	Masking effects limiting identification and intervention	[19]
	Disruptions during developmental transitions	[19]
	Disparities between subgroups	[15,19,30]
	Lack of mandated interventions reduces implementation	[4]
Family/Attachment Based	Limited family and youth involvement in school decision-making	[7]
	Weak friendship and parent–child relationship quality	[21]
	Indirect links between attention problems and depressive symptoms via relationship quality	[21]
	Limited parent engagement due to access barriers	[28,31]
	Gaps between prevention and intervention services	[22]
	Separation between state-led and community-led initiatives	[22]
	Limited focus on resilience factors and services in adolescence	[14]
Technology Based	Limited understanding of underlying neuronal mechanisms to inform intervention development	[29]
Medical	Limited exploration of resilience factors in medication use	[14]
	Limited integration of family and ecological factors	[14]
	Medication-focused approaches reinforce deficit-based perspectives	[32]
	Service gaps lead to increased reliance on medication	[14]
Guided Assessment Based	Challenges in accurate behavioral and emotional needs identification	[8]
	Overgeneralization reduces the effectiveness of evidence-based practices	[16]
	Masking and unmet needs in twice-exceptional students	[19]

): skill-building, academic/school-based, family/attachment-based, technology-based, medical, and guided assessment-based interventions. These gaps highlight the challenges that exist when supporting children and youth with ADHD.

3.2.1. Skill-Building Intervention Gaps

Among the final 37 articles, 6 discussed gaps in skill-building interventions (see Figure 3). These gaps include a lack of evidence-based practices in psychological or behavioral therapy, PATHS, IYTTP, Tools of the Mind–Play, and individualized incentive programs [6,28]. Barriers due to insufficient resources and training were noted, alongside gaps in staff understanding of practices for children with persistent challenges [6,28]. Gaps in translational school-based research and practice were identified, particularly in applying evidence-based interventions related to DSM diagnoses, affecting interventions like psychological or behavioral therapy, and MI [4,5]. Effective interventions often fail to translate to real-world settings, and teachers lack preparedness to implement them [4,5]. Gaps in behavioral principle knowledge lead to reliance on negative practices, tied to PATHS, IYTTP, Tools of the Mind–Play, and individualized incentive programs [6]. Workforce enhancement through principle-based knowledge was emphasized for sustainability [6]. Gaps in exploring resilience factors, linked to psychological or behavioral therapy, occupational interventions, and self-determination, and understanding underlying neuronal mechanisms, tied to psychological or behavioral therapy, were also noted [14,29].

3.2.2. Academic/School-Based Intervention Gaps

Out of the final 37 articles, 7 addressed gaps in academic/school-based interventions (see Figure 3). These gaps include insufficient teacher training in general and special education, particularly for DRC and school-based programming [5,28]. Minimal ADHD training for teachers and a lack of specific training during Master’s programs were reported as gaps [5,28]. Inconsistent staff perceptions and poor real-world adaptation of interventions were noted as gaps [6,15]. A masking effect was discussed, leading to issues like lack of identification and challenges with school-based programming [19]. Developmental transitions can prevent progress [19]. Teachers are 14 times more likely to implement mandatory interventions, meaning that with the proper coaching of teachers, there were better odds of them implementing interventions [4]. Gaps also include the inability to set expectations for gifted and twice-exceptional students, standardized curricula and limited course offerings fail to engage students, affecting STP, school-based programming, and creating disparities between subgroups in school-based interventions [15,19,30].

3.2.3. Family/Attachment-Based Intervention Gaps

Among the final 37 articles, 6 focused on gaps in family/attachment-based interventions (see Figure 3). These gaps include limited family and youth support in school decisions, affecting achievement and discipline, tied to family–school and PI [7]. Gaps in friendship and parent–child relationship quality were identified, linked to family–school and PI [21]. Attention problems indirectly affect depressive symptoms via relationship quality [21]. Insufficient parent engagement due to limited home visits or meetings was noted, alongside lengthy waiting lists, gaps in care, funding restrictions due to transportation and cost issues, and insurance limitations, all tied to family–school and PI [28,31]. Family support gaps between prevention and intervention services were discussed, linked to circle of security and trust-based relational intervention [22]. Flexible funding was suggested to bridge these gaps [22]. A separation between state-led and community-led initiatives was noted, also tied to circle of security and trust-based relational intervention [22]. Gaps in resilience factors and services, particularly during adolescence, were identified, linked to family–school and PI [14].

3.2.4. Technology-Based Intervention Gaps

Out of the 37 articles, 1 discussed gaps in technology-based interventions (see Figure 3). A key gap is the lack of knowledge regarding underlying neuronal mechanisms that could enhance assessments and interventions related to neurofeedback and transcranial neuromodulation [29]. Understanding these mechanisms could improve intervention specificity [29].

3.2.5. Medical Intervention Gaps

Among the 37 articles, 2 discussed gaps in medical interventions (see Figure 3). These include a lack of exploration of resilience factors, including medication’s role in supporting students [14]. Gaps in understanding family and ecological factors alongside medication were noted [14]. Medication usually influences individuals with disabilities to focus on their negative behaviors about themselves rather than showing them that they are more complex in specific environments [32]. One final gap is the lack of services and support, particularly during adolescence, which leads to a heavier reliance on medication [14].

3.2.6. Guided Assessment-Based Intervention Gaps

Among the 37 articles, 4 addressed gaps in guided assessment-based interventions (see Figure 3). These include challenges in accurately identifying behavioral and emotional issues to ensure appropriate interventions that are related to a child’s DSM diagnosis are used [8]. The need for accurate identification of challenges children are facing was stressed [8]. Gaps between subgroups of students in RtI were noted, potentially exacerbating disparities for twice-exceptional students [30]. Evidence-based practices were found to yield insignificant results due to overgeneralization, linked to interventions such as self-determination, but are relevant to tailored assessments [16]. A masking effect and inability to set expectations for gifted and twice-exceptional children were noted and ties to GIEPs in conjunction with IEPs [19].

3.2.7. Synthesis of Gaps

Across the included studies, several consistent gaps were identified in the implementation and evaluation of interventions for children and youth with ADHD. A prominent pattern was the limited availability of evidence-based interventions, particularly within school and community settings. Additionally, challenges related to training, resource availability, and research to real-world translation were noted. Across studies, many interventions were supported by limited or inconsistent evidence, particularly those that were newer or less established. Due to this, these findings should be considered with caution, as variability in study design, sample size, and the presence of moderate-to-high risk of bias across the included studies may influence the identification and interpretation of these gaps.

3.3. Strengths

Among the 37 articles included in this review, 18 unique strengths were identified spanning the six categories of interventions (see

Table 5. Strengths overview.

Category	Strengths	Reference
Skill Building	Understanding individual strengths and limitations	[8]
	Dedication to child and family well-being	[6]
	Teamwork and staff collaboration	[6]
Academic/School Based	Development of student profiles	[18]
	Improved home–school communication	[5]
	Behavioral-first approaches reduce medication reliance	[5]
	Teacher training and professional development	[6]
	Transition planning across developmental stages	[6]
Family/Attachment Based	Family–school conferences	[7]
	Family members’ input and involvement	[7,13]
	Building child and caregiver problem-solving capacity	[7]
	Emphasizing family agency	[7]
	Strengths-based approaches	[7]
	Strong community networks and relationships	[22]
	Dedication to the child	[6]
	Connection to services	[6]
Technology Based	N/A	N/A
Medical	Behavior-first approaches reduce reliance on medication	[5]
Guided Assessment Based	Coordinated service delivery across systems	[26]

Note: N/A represents that there were no identified strengths in that domain within the included articles; therefore, there are no citations to attach.

): skill-building, academic/school-based, family/attachment-based, technology-based, medical, and guided assessment-based interventions. These strengths highlight the opportunities that exist when supporting children and youth with ADHD.

3.3.1. Skill-Building Intervention Strengths

Among the 37 articles, 3 discussed strengths in skill-building interventions (see Figure 4). These strengths include understanding a student’s unique patterns of strengths and limitations, linked to psychological or behavioral therapy, and video self-modeling [8]. Dedication to the child and family was highlighted, focusing on child well-being and communication with families, related to psychological or behavioral therapy, PATHS, Tools of the Mind–Play, and individualized incentive programs [6]. Teamwork and staff support among teaching staff, head teachers, and family support specialists were noted, tied to the same interventions [6].

3.3.2. Academic/School-Based Intervention Strengths

Out of the 37 articles, 3 addressed strengths in academic/school-based interventions (see Figure 4). These strengths include developing a student profile that includes behaviors, strengths, and weaknesses, allowing teachers to assess intervention effectiveness using DRC [18]. DRC was noted for increasing communication between home and school, producing more acceptable, effective, and swift behavioral changes compared to classroom lottery, response cost techniques, and medication [5]. Children receiving behavioral treatments like DRC first required less medication overall, with these treatments being most effective for addressing core ADHD symptoms such as inattention, hyperactivity, and impulsivity [5]. Teacher training was identified as a strength, focusing on up-to-date and relevant training to support children with ADHD, related to IYTTP and PBIS [6]. Appropriate transition planning as children move from toddler to pre-kindergarten classrooms was noted, emphasizing communication to achieve team goals [6].

3.3.3. Family/Attachment-Based Intervention Strengths

Among the 37 reviewed articles, 4 focused on strengths in family/attachment-based interventions (see Figure 4). These strengths include family–school conferences that value family members’ input to increase empowerment in school decision making, related to family–school and PI [7]. Family members’ input was noted as contributing to empowerment, with the timing of involvement impacting intervention success, tied to family–school and PI, Family Check Up, and Incredible Years Training for Children with Developmental Delays [7,13]. Building child and caregiver capacity to solve problems was highlighted, aiding resource access and family empowerment, linked to family–school and PI [7]. Emphasizing family agency was noted for supporting family dignity and family-centered services through partnerships, also tied to family–school and PI [7]. Emphasizing existing strengths and expertise was identified, with responsive school–family partnerships aligning with family culture, related to family–school and PI [7]. Strong community networks and trusting relationships built over time were emphasized, strengthening caregiver and family training, linked to family–school and PI, circle of security, and trust-based relational intervention [22]. In rural areas, dense social networks enable efficient collaboration among community leaders who buy into initiatives, improving service access, also tied to family–school and PI, circle of security, and trust-based relational intervention [22]. Dedication to the child and family, focusing on child well-being and communication, was noted, linked to family–school and PI [6]. The ability to connect families with appropriate services was emphasized, and also linked to family–school and PI [6].

3.3.4. Technology-Based Intervention Strengths

Out of the 37 articles, 0 discussed strengths in technology-based interventions (see Figure 4). No specific strengths were identified for these interventions, as the focus was on gaps like the lack of knowledge about underlying neuronal mechanisms [29].

3.3.5. Medical Intervention Strengths

Among the 37 reviewed articles, 1 addressed strengths in medical interventions (see Figure 4), which focus on medication. These strengths include children receiving behavioral treatments first requiring less medication overall, with treatments like Daily Report Cards being more effective for core ADHD symptoms such as inattention, hyperactivity, and impulsivity [5].

3.3.6. Guided Assessment-Based Intervention Strengths

Among the included articles, four explored strengths in guided assessment-based interventions (see Figure 4). These strengths include fulfilling service needs through activities like connecting with families, community agencies, schools, consultants, clinicians, and service providers was emphasized, linked to care coordination [26].

3.3.7. Synthesis of Strengths

Across the included studies, several consistent strengths were identified in the implementation of interventions for children and youth with ADHD. A key pattern was the emphasis on collaborative and multi-system approaches, particularly those that involve family and school support, which contributed to more comprehensive and holistic care. Interventions also demonstrated strengths in promoting the development of skills, improving behavioral outcomes, and supporting academic functioning. Differences were observed across intervention types, with some approaches focusing on measurable behavioral and academic outcomes while others focused on relational and developmental support. While many interventions demonstrated promising outcomes, the strength of evidence varied across studies, with some interventions supported by more rigorous designs and others by more limited or emerging evidence. With that, these strengths should be interpreted with caution due to the variability in study design, sample size, and the presence of moderate-to-high risk of bias across the included studies.

3.4. Program Recommendations

Among the 37 articles included in this review, there were 44 recommendations for ADHD programming identified spanning the six categories of interventions (see

Table 6. Program recommendations overview.

Category	Recommendation	References
Skill Building	Regular family check-ins for follow-up and monitoring	[6,26]
	Holistic understanding of each student’s strengths and needs	[19,33]
	School-based interventions increase accessibility and reduce costs	[11]
	Focus on developing skill and performance deficits	[9]
	Intervention targeting Central Executive working memory	[33]
	Targeted approaches for persistent behavior challenges	[6]
	Identification of psychosocial interventions for social competence	[15]
	Examination of social skills interventions	[15]
	Practice of learned skills in naturalistic environments with immediate feedback	[15]
	Interventions that reflect real-world contexts	[15]
	Emphasis on structure and consistency	[16]
	Effective and early screening	[13]
Academic/School Based	Professional training in special education identification	[5,18]
Academic/School Based	Parent training and workshops at school or district level	[34,35]
	Holistic understanding of each student’s strengths and needs	[19,36]
	Frequent, sustained, and personalized teacher–student interactions	[20]
	Interventions targeting academic and behavioral outcomes	[9]
	Ongoing reciprocal communication between and school	[34]
	Adaption of the physical learning environment	[19]
	Increased frequency of counseling for students with emotional needs	[25]
	Individualized approaches	[9]
	Teacher support (reducing class size for twice-exceptional students)	[19]
	Participation of school-based interventionists in training workshops	[4]
	Balanced use of proactive and reactive strategies in intervention planning	[18]
	Ongoing professional development (Min. 15 h)	[6,17]
	Continued development and evaluation of intervention research	[14]
Family/Attachment Based	Involvement of families across all stages of program services	[7,13,24,28]
	Regular family check-ins	[6,26]
	Individualized feedback and ongoing support	[4,36]
	Alignment of family involvement with school partnership approaches	[7]
	Interventions targeting skill and performance development	[9]
	Focus on prevention, early identification, and early intervention	[28]
	Awareness of programs and services across agencies	[22]
	Provide appropriate referrals	[22]
	Targeted approaches for persistent behavior challenges	[6]
Technology Based	Physical and cognitive training through “Exergaming”	[37]
	Consideration of individual, classroom, and socio-political contexts in interventions use	[12,36]
Medical	Application of structured principles for program planning and management	[38]
Guided Assessment Based	Involvement of families across all stages of program services	[7,13,24,28]
Guided Assessment Based	Matching the intensity of an intervention to the needs of the student and family	[4,13,24]
	Holistic perspective of each student’s strengths and weaknesses	[19,36]
	Integration of clinical expertise within evidence-based practice	[5]
	Coordinated care and collaboration with community support agencies	[26]

): skill-building, academic/school-based, family/attachment-based, technology-based, medical, and guided assessment-based interventions. Some program recommendations were discussed across multiple categories; therefore, some recommendations are repeated. These recommendations provide a foundation to improve ADHD programming for children and youth.

3.4.1. Skill Building-Based Intervention Recommendations

Among the reviewed articles, 10 discussed recommendations for improving skill-based interventions (see Figure 5). Articles considered regular check-ins with the family for follow-up and monitoring of family functioning [6,26]. A holistic perspective of each student’s strengths and weaknesses was highlighted [19,36]. Housing interventions within schools was suggested to increase accessibility and reduce cost [11]. Additionally, interventions that focus directly on ameliorating skill and performance deficits have shown to be beneficial [9].

It was noted how an intervention that successfully improves Central Executive (CE) working memory could have a broad impact on many, if not most, children with ADHD [33]. There is also a need for more targeted approaches for children with persistent behavior challenges to have an optimal impact on these children’s school readiness [6]. Further, the identification of psychosocial interventions that support the development of social competence in adolescents with ADHD is vital [15].

The examination of social skills interventions is needed to ensure that they are effective [15]. Practicing learned skills in naturalistic environments and receiving immediate social feedback as well as the context of interventions needing to accurately mimic real-world interactions was highlighted [15]. Children with ADHD require structure and consistency to be successful [17]. Effective and early screening was noted as important [13].

3.4.2. Academic/School-Based Intervention Recommendations

Out of the 37 articles, 14 discussed recommendations for academic/school-based interventions (see Figure 5). Articles discussed professional education to identify special education as a required component [5,18]. Offering training or workshops for parents at the school or district level so that parents can become knowledgeable could be beneficial [34,35]. A holistic perspective of each student’s strengths and weaknesses is needed to tailor interventions [19,36]. Interventions that involve frequent, sustained, and personalized adult interactions have positive impacts on teacher–student relationships [20].

No “one size fits all” approach was mentioned to ensure each individual student has their unique needs met [9]. Interventions that are designed to improve the educational outcomes of students with ADHD in terms of classroom behavior and academic performance are needed [9]. Reciprocal and ongoing communication between the home and school microsystems is essential for early intervention [34]. The physical learning environment may require modification to accommodate students struggling with hypersensitivity and distractions [12,19].

Increasing frequencies with which students with emotional disorders are seen in counseling can promote emotional regulation in children with ADHD [25]. It is critical that all teachers complete a minimum of 15 h of professional development and training each year to ensure their knowledge is current [6,17]. Teachers require support from their administrator, which could come in the form of reducing the class size when a teacher has two or more twice-exceptional students [19]. School-based interventionists to participate in didactic workshops was discussed to increase the efficacy of learning [4]. School intervention plans should be balanced between proactive and reactive strategies [18]. There is a need for interventional research that develops and tests interventions [14].

3.4.3. Family/Attachment-Based Intervention Recommendations

Of the 37 articles, 16 discussed recommendations for family/attachment-based interventions (see Figure 5). Involving families in all aspects of program services provides more holistic care to children [7,13,24,26,28]. Regular check-ins with the family for follow-up and monitoring of family functioning are crucial [6,26]. Individualized feedback and ongoing support are needed to gauge progress [4,36].

Families should accommodate school-preferred approaches for partnering with educators and supporting their children’s learning [7]. Interventions that focus directly on ameliorating skill and performance deficits are beneficial for children [9]. Professionals need to look towards prevention, early identification, and intervention in early childhood to reduce symptoms in adolescence [28].

Agencies must be aware of the programs and offerings of other agencies [22]. This is because referrals require provider familiarity with as many programs and their specialties as possible [22]. There is a need for more targeted approaches for children with persistent behavior challenges to have an optimal impact on these children’s school readiness [6].

3.4.4. Technology-Based Intervention Recommendations

Three articles discussed recommendations for technology-based interventions (see Figure 5). Contextual factors for a pupil with ADHD must be considered, including their classroom, school, and issues at the socio-political level, and this program’s recommendation is related to Neurofeedback [11,36]. Physical and cognitive training through “exergaming” is effective, which is completing training using video games, but they must be tailored to each individual child [37].

3.4.5. Medical Intervention Recommendations

Of the total reviewed studies, 1 article (see Figure 5) talked about recommendations for medical interventions. There are nine principles that need to be considered for the planning and management of programs for children and teens with ADHD, and this program recommendation is related to medication [38].

3.4.6. Guided Assessment-Based Intervention Recommendations

Among the 37 reviewed articles, 10 discussed recommendations to improve guided assessment-based interventions (see Figure 5). Involving families in all aspects of program services is critical to intervention success, and this program recommendation relates to response to intervention, and care coordination [7,13,24,26,28]. Matching the intensity of an intervention to the needs of the student and family is needed, and this program recommendation relates to response to intervention [4,13,24]. A holistic perspective of each student’s strengths and weaknesses was highlighted, and this program recommendation is related to Creating GIEPs in Conjunction with IEPs and Positive Role Models [19,36].

Evidence-based practices in psychology (EBPP) requires that psychologists apply their clinical expertise and judgement to address the challenges and needs of their clients, and this program recommendation is related to Utilizing Evidence-Based Interventions Related to Child’s DSM Diagnosis [5]. One paper also talked about extensive care conferencing and connection to multiple community support agencies and social services, purposeful collaboration with health, education, and social services, together with diverse pediatric services, and this program recommendation is related to care coordination [26].

3.4.7. Synthesis Program Recommendations

The research literature on ADHD demonstrates a growing interest in understanding this neurodiverse condition. Many interventions and treatment modules have been researched. Our review targeted interventions focusing on children, highlighting 42 individual interventions to support children with ADHD. A key highlight was that early intervention treatment and support were found to reduce the overall need for medication when used as a first-line approach. This highlights the need for early interventions matched with the child’s ADHD presentation to reduce reliance on pharmacological interventions. Building on these findings, the program recommendations identified in the literature can be understood across three interconnected domains: child-focused, caregiver-focused, and systems-focused approaches. Together, these categories reflect key trends in the literature and provide a framework for understanding how interventions can be designed to enhance outcomes for children with ADHD. Variability in study design, sample size, and the presence of moderate-to-high risk of bias across the included studies suggests that these recommendations should be interpreted with caution.

Child-Focused Interventions

The research highlighted several key interventions when working with children with an ADHD diagnosis. Interventions have historically been primarily reactive to managing behaviors; however, there should be a balance between proactive and reactive strategies [18].

First, it was mentioned that motivational interviewing (MI) is used to help build the individual’s motivation to change [13]. Also, finding ways to keep students with ADHD engaged in what they want to learn about or are interested in [15].

It is also important for accurate identification of behavioral and emotional problems to match the child/youth to the appropriate intervention [8]. Treatment should be tailored to the diverse types of ADHD and move from focusing on disruptive or acting-out problems in children to reducing impulsivity or defiance [11]. The intensity of the intervention needs to match the experience of the student and family. Only treating symptoms of ADHD does not make much of a difference for children [9].

Further, it was discussed that cognitive behavioral therapy (CBT) is an important intervention to target executive functions and develop self-management skills [18]. A thorough assessment is necessary, taking into account the unique presentations of ADHD, and targeting the specific deficits in the child. As CBT targets executive functioning skills, clinicians can effectively target functional deficits that are impacting the child. The use of direct skill training is also a technique that can improve executive functions [9]. Several skills are listed in the literature, such as self-modeling, advocacy skills, social skills, self-regulation, and educational functioning skills of O’Dell. This is seen to lead to decreased disruptive behaviors [18]. The need for positive reinforcement with the use of interventions is essential [5].

Further, daily report cards are used to increase communication between the teachers and home settings and increase positive reinforcements when the students reach their goals [11]. Additionally, CBT, self-modeling, and developing advocacy skills are seen as evidence-based interventions [24]. Skills should be practiced/learned in a naturalistic environment and receive immediate feedback [15].

Teaching mindfulness-based skills can support attention control and emotion regulation. In addition, mindfulness-based skills can successfully target and improve central executive working memory in children with ADHD [33].

Using attachment-focused strategies also has a significant impact on children impacted by ADHD. Several articles discussed focusing on the relationship between the teacher and the student and prioritizing social-emotional learning can decrease conflict and increase the closeness between the student and the teacher providing positive outcomes for both student and the teacher. It is highlighted that children with ADHD need positive role models and attachments in their lives to build resilience.

Medication is seen as an intervention to support after appropriate and individualized behavioral interventions have been explored. Medication usually influences individuals with disabilities to focus on their negative behaviors rather than an understanding of their individualized challenges [11]. Pharmacological and behavioral interventions have been helpful in reducing ADHD symptoms; however, interventions focusing on skills and performance deficits benefit students more long term [9]. Individuals who received behavioral treatments first required less medication overall [5].

Caregiver Focused Interventions

Many articles highlight the need to have family involvement in all aspects of program services which is vital to the students’ learning [31]. This includes regular check-ins and follow-ups with the family [26]. Families going to school events during the day and meeting with teachers individually is important [7]. It is key for the student’s success to have safe and supportive environments, at home and school, which can help when implementing interventions [36].

Additionally, it is necessary for caregivers to have primary education about ADHD [9] and parent training focusing on the problem, specifically the type of ADHD their child is experiencing [11]. It is also helpful to support parents with behavioral training sessions, which help build the caregiver’s capacity to solve problems and understand their child [7].

Further, programs such as circle of security and trust-based relational interventions target building secure attachments and healthy relationships [22]. In one article, a significant indirect effect of attention problems that also included depressive symptoms correlated with the quality of relationship with their mother and best friend [21]. Arnstein [19] found that the groups surrounding a child with ADHD are the most important aspect to support their success.

System-Focused Interventions and School Collaboration

An ongoing theme in the research continued to highlight the importance of family involvement. It is important to have a collaborative team approach which has the family working closely with the school. The interventions highlighted that parent involvement and school-based support provided a comprehensive program in supporting the neurodiverse child. Care coordination is broad because it has social and educational support services that help with child-focused care plans [26]. Two-way communication between parents and programming staff is needed to collaborate effectively with the family to identify the child’s and family’s needs and strengths [31]. School conferences should specifically value family members’ input relating to the child and increase family empowerment in the school’s decision-making process [7]. The school–family partnership is vital for the child’s success.

Further, support for the teacher that focuses on increasing teamwork and staff support is necessary. This may require administrators to focus on the number of children who have ADHD and reduce class sizes to allow teachers to have the time and resources to implement these interventions and partnerships [6]. It is important for teachers to have access to up to date, relevant, and ongoing training to help children with ADHD and their families [6]. Further, teachers must have the knowledge and ability to connect the family with the most appropriate services [6]. Teachers need to feel equipped and supported to care for and support students with ADHD. Administrators and teachers should have a good knowledge of the individual characteristics of a child to best support them, such as their abilities, diversity, and indicators of success [36].

Positive behavioral interventions and supports help to develop teaching supports for consistency in expectations between teachers and students while increasing their positive interactions [17]. Transitional planning is essential when children move to new environments, and administration needs to focus on communication between the environments to achieve goals [6]. This could include ensuring teachers are aware and understand individual education plans, the strengths of a student, what has been effective/ineffective in supporting the student, and recommendations to further support the student.

Community leaders need to invest in support, focusing on increased access to specialized evidence-informed services [22]. Community leaders should be aware of and reflective regarding barriers such as waiting lists, funding restrictions, and insurance limitations [28]. It would be helpful to establish funds, financial assistance [22], and implement sustainable interventions [6].

3.5. Conceptual Model

Figure 6 presents the conceptual model developed from the thematic analysis of the results. The model illustrates how existing intervention models have identifiable gaps and strengths, which interact with influencing factors and inform program recommendations. The model also includes the intended outcomes of effective programming, which are elaborated further in Section 4 (Discussion).

4. Discussion

This systematic review, using the PRISMA framework, identified 37 studies which were reviewed to identify findings, examined interventions for ADHD, strengths and gaps, and program requirements in the research. The findings highlighted a significant body of research on ADHD interventions targeting individual children, families, schools, and communities.

The findings of this review should be interpreted with caution due to variability in study quality, as reflected in the risk-of-bias assessments. While the included studies provide valuable insights into ADHD interventions, differences in methodological rigor may influence the strength and consistency of the evidence.

Beyond the overall study quality, several limitations and inconsistencies were evident across the studies. Many relied on small or non-representative samples, limiting the generalizability of findings, while others lacked longitudinal follow-up to assess the long-term effectiveness of interventions. Additionally, variability in reported outcomes was observed across intervention types and settings, with some studies demonstrating improvements in behavioral and academic outcomes, while others reported more limited or context-dependent impacts. These differences may be influenced by contextual factors, including variations in implementation environments such as school systems, access to trained professionals, and levels of family/community support. Together, these factors highlight the complexity of translating ADHD interventions into practice and underscore the importance of considering both methodological and contextual influences when interpreting outcomes.

The patterns identified in this review can also be understood through an ecological systems perspective. The findings consistently highlight the interconnected roles of individual, family, school, and broader community factors in shaping the effectiveness of ADHD interventions. For example, gaps in educator training reflect influences at the mesosystem level, while broader issues such as access to services and policy-related barriers align with macrosystem-level factors, both of which ultimately impact the child at the microsystem level. Variability in outcomes and challenges in implementation across studies reflect the influence of these multiple interacting systems. This perspective reinforces the importance of designing interventions that are responsive to the environments in which children exist as well as considering the dynamic relationship between individual needs and contextual factors.

These findings also highlight important considerations related to the application and effectiveness of interventions in practice. The interventions explored in the studies reviewed ranged from psychological therapies, neurological therapies, behavioral therapies, school-based and academic supports, family–school involvement strategies, and medication. Even with this selection, many interventions lacked adherence to evidence-based practices and were not sufficiently tailored to the unique presentations of ADHD, which vary widely among individuals [11]. This highlights that not one single intervention is enough to address the complexity of ADHD presentations and the necessity of a multifaceted approach. Notably, while behavioral and skill-based interventions demonstrated more consistent and measurable outcomes across studies, approaches that relied on broader contextual or systemic factors showed more variability in effectiveness, particularly when implementation supports were limited. This pattern suggests that while individual-level interventions may demonstrate stronger immediate outcomes, their long-term effectiveness is dependent on the broader systems in which they are implemented. Evidence-based practice interventions for students are not yielding results because of overgeneralization [16].

Additionally, significant gaps exist in the accurate identification of ADHD, adequate training for educators and clinicians, and the effective translation of research into practical applications. The absence of effective assessment and tailored individualized treatment approaches remains a barrier to optimizing outcomes for children with ADHD and their families. These challenges also reflect broader limitations within the current evidence, which are discussed in the following section.

4.1. Limitations

There are several critical limitations to this research that restrict the ability to develop and implement effective, individualized interventions for children and youth impacted by ADHD. The following limitations reflect both constraints of this systematic review and broader limitations within the existing literature:

• The use of Google Scholar as the sole search engine used in this systematic review limits the reproducibility of this systematic review, limits the comprehensiveness of this systematic review, and allows for more potential bias within the reviewed articles.
• The absence of a comprehensive, evidence-informed program that addresses the full spectrum of ADHD presentation and developmental needs across all domains of functioning.
• Current individualized interventions are typically matched only to the broad category of ADHD, without considering the heterogeneous subtypes, co-occurring conditions, or unique symptoms each child presents with.
• Insufficient evidence-based practices tailored to educational settings and persistent gaps in pre-service and in-service teacher training (both general and special education) regarding ADHD identification, evidence-based strategies, and classroom management.
• Deficits in knowledge and skills, resulting in inconsistent implementation of interventions.
• Lack of longitudinal studies tracking outcomes into adolescence and young adulthood, which restricts the understanding of developmental impacts, family resilience factors, and quality-of-life indicators for individuals with ADHD.
• Lack of emphasis on preventive approaches, early identification, and early interventions before symptoms become apparent.
• Limited exploration of family, ecological, and system protective factors that promote resilience in students with ADHD.
• Variability in risk of bias across the included studies may impact the strength and generalizability of the findings.

4.2. Future Research

To address the limitations, further research should prioritize the following:

• Utilizing a multi-database search strategy to maximize reproducibility and comprehensiveness as well as reduce the risk of bias.
• Development and evaluation of evidence-based interventions that can be individualized across settings.
• Large-scale longitudinal studies following children with ADHD from early childhood through young adulthood to better understand resilience processes, protective factors, and long-term functional outcomes.
• Emphasize prevention science, including universal screening, early identification protocols, and early intervention models in pre-school and early elementary school to reduce ADHD symptom severity.
• In-depth investigations of family-level and broader ecological factors that buffer risk and foster resilience in children with ADHD.
• Include more rigorous study designs, including larger and more representative samples, improved reporting practices, and more consistent evaluation of intervention outcomes to strengthen the evidence base.

4.3. Evidence-Informed Recommendations for Practice and Policy

Based on the findings of this systematic review, this study proposes a set of evidence-informed recommendations to improve ADHD services for children and youth, addressing key gaps, strengths, and implementation challenges identified across the literature. These recommendations reflect the need for coordinated, individualized, and developmentally responsive approaches to ADHD programming. These recommendations include the following:

• Intervention Approach

  1.1.

  Prioritize behavioral and skill-based interventions before medication where appropriate: The findings support an intervention-first approach, indicating that early behavioral and skill-building supports can reduce reliance on medication while promoting longer-term developmental outcomes.

  1.2.

  Adopt a multi-faceted approach to intervention: ADHD support should integrate behavioral, academic, family-based, and where appropriate, medical interventions, reflecting the complexity of ADHD and the need for comprehensive, coordinated care.

• Individualization of Supports

  2.1.

  Tailor interventions to the child’s ADHD presentation and executive-function profile: Given the variability in ADHD subtypes and functional challenges, interventions should be individualized rather than standardized, ensuring alignment with the child’s strengths and needs.

  2.2.

  Match intervention intensity and type to developmental stage and level of need: Effective programming requires flexibility, with intervention intensity adjusted based on the child’s responsiveness, environmental demands, and evolving developmental needs.

• Family Involvement and Capacity

  3.1.

  Embed meaningful and ongoing family involvement across all aspects of intervention: The findings highlight family engagement as a critical component of effective ADHD support, emphasizing collaboration between caregivers, educators, and service providers.

  3.2.

  Strengthen caregiver competence through education and skill development: Supporting caregivers in understanding ADHD (specifically their own child’s presentation), particularly through an executive-function lens, and equipping them with practical, evidence-informed strategies enhances consistency across environments and improves outcomes.

• Professional Training and Practice

  4.1.

  Enhance professional training and capacity in ADHD-informed practice: Identified gaps in educator and practitioner knowledge highlight the need for structured, ongoing training focused on evidence-based interventions, executive functioning, and practical implementation strategies.

  4.2.

  Shift from reactive behavior management to proactive skill-building approaches: Interventions should focus on anticipating challenges, supporting executive-function development, and promoting emotional regulation, rather than relying solely on reactive responses to behavior.

• Intervention Delivery

  5.1.

  Deliver interventions in naturalistic, real-world settings with immediate feedback: The findings emphasize that skill development is most effective when practiced in everyday environments such as home and school, allowing for greater generalizability and long-term sustainability.

  5.2.

  Integrate supports across systems (home, school, and community): Effective ADHD services require coordinated, multi-faceted approaches that reduce fragmentation and promote consistency across environments.

• Systemic Considerations

  6.1.

  Improve access to coordinated and equitable ADHD services: Identified gaps in service availability, accessibility, and coordination highlight the need for system-level approaches that ensure all children and families can access the supports they need.

  6.2.

  Strengthen the translation of research into practice: The review identified a disconnect between evidence and real-world implementation, indicating the need for systems that support knowledge mobilization, implementation reliability, and ongoing evaluation of interventions.

These recommendations have the potential to improve outcomes for children and families impacted by ADHD in many ways. Implementing these program recommendations could lead to enhanced executive functioning, better academic performance, improved social-emotional skills, reduced family stress, and increased access to support, all of which are needed for children with ADHD.

5. Conclusions

While advancements in ADHD interventions are evident, significant work remains necessary to bridge the gaps between research and practice. A more tailored, evidence-based approach to ADHD interventions is essential to ensure children and their families receive comprehensive, effective, and sustainable support. While this research sets out promising recommendations for practice and policy, expanding research to focus on holistic, individualized care and early intervention strategies will be critical in addressing these gaps and improving outcomes for individuals with ADHD. In addition, support for the caregivers and the system is crucial as they play a vital role in positive outcomes for the child. Overall, research has taken actionable steps to support children with ADHD and their families, but there are further enhancements needed to ensure that children and their families receive the support they need.