Efficacy of mindfulness-based interventions for children and adolescents with attention deficit hyperactivity disorder: a systematic review and meta-analysis

Background and objective Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. Although mindfulness-based interventions (MBIs) have been proposed as promising non-pharmacological treatments, evidence regarding their efficacy in children and adolescents with ADHD remains inconsistent.

Methods: A systematic search of PubMed, Embase, the Cochrane Library, Scopus, and Web of Science was conducted up to December 31, 2025, supplemented by manual screening of reference lists. Eligible studies were randomized controlled trials (RCTs) in which mindfulness-based intervention was the primary treatment for children or adolescents with ADHD, even alongside other therapies. Study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the Cochrane RoB 1.0 tool. Meta-analyses employed random-effects or fixed-effects models based on heterogeneity.

Results: Fourteen randomized controlled trials were included in the meta-analysis. The results demonstrated that MBIs significantly alleviated core ADHD symptoms in children (standardized mean difference (SMD) = -1.30; 95% confidence interval (95% CI) [-2.14, -0.45]; p = 0.003). However, the heterogeneity was considerably high ( I² = 91%), and publication bias could not be excluded (as suggested by funnel plot/Egger’s test, if available). Regarding neurocognitive functions, MBIs showed potential benefits in improving attention network function (SMD = 0.44; 95% CI [0.01, 0.87]; p = 0.04; I² = 88%) and executive function (SMD = 0.45; 95% CI [0.02, 0.88]; p = 0.04; I² = 84%), though the high heterogeneity ( I² > 75%) and possible publication bias warrant cautious interpretation. No significant effects were observed on emotional problems, social problems, externalizing behavioral problems (including oppositional defiant, disruptive, and aggressive behaviors), or mindfulness skills.

Conclusions: This systematic review suggests that MBIs may improve core ADHD symptoms and neurocognitive functions (including attention and executive functions) in children and adolescents. Yet, effects on emotional health, social relationships, externalizing behaviors, and mindfulness skills remain inconclusive. While suggesting that MBIs hold promise as a potential adjunctive intervention alongside standard treatments, significant heterogeneity underscores the need for further high-quality research to confirm these therapeutic benefits. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251171407 , identifier CRD420251171407.