400 Section - Effectiveness of Physiotherapy Interventions for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Objectives : Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental condition in childhood, often accompanied by motor, cognitive and psychosocial difficulties. Concerns about adverse effects and incomplete response to stimulant medication have increased interest in non-pharmacological strategies, including physiotherapy. This systematic review examined the types and effectiveness of physiotherapy interventions for children and adolescents with ADHD.
 

 

Design: Eight electronic databases (MEDLINE, CINAHL, EMBASE, Web of Science Core Collection, Cochrane Library, PEDro, African Journals Online and Google Scholar) were searched from inception to 25 February 2024 for randomised controlled trials and non-randomised intervention studies involving physiotherapy-delivered interventions in participants ≤19 years with ADHD. Only English-language full-text articles were included. Methodological quality was assessed using the PEDro scale for randomised controlled trials and the Downs and Black checklist for non-randomised studies. Due to heterogeneity in interventions and outcomes, findings were synthesised narratively. The protocol was prospectively registered on PROSPERO (CRD42024515879).
 

 

Results: Nine studies (seven randomised controlled trials; two non-randomised controlled trials) with 435 participants (5–12 years) met the inclusion criteria. Interventions included aquatic/hydrotherapy programmes, treadmill training, whole-body vibration, manual and cranial therapy, table-tennis training, and physiotherapy combined with structured verbal communication. Most studies reported improvements in at least one ADHD-related outcome (e.g. inhibition, executive functions, motor skills, graphomotor performance, quality of life and academic-related measures). In contrast, task-oriented and therapist-guided game-based interventions showed limited effect on core ADHD symptoms. Study quality ranged from fair to good, with small samples and short follow-up periods in most trials.
 

 

Conclusion: Physiotherapy interventions show promising benefits for motor, cognitive and behavioural outcomes in children and adolescents with ADHD and may offer a useful adjunct or alternative to purely pharmacological management.