Nutrients · 2026
Probiotic Supplementation in Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of ADHD-Related and Emotional-Behavioral Outcomes.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Yan Yizhen, Wu Haotian, Han Mengke, Zhao Li, Mao Shan-Shan
Аннотация
BACKGROUND: Dysregulation of the microbiota-gut-brain axis has been implicated in attention-deficit/hyperactivity disorder (ADHD), but randomized controlled trial evidence for probiotic supplementation remains inconsistent.
OBJECTIVE: This systematic review and meta-analysis evaluated the effects of probiotic supplementation on ADHD-related clinical outcomes and emotional-behavioral outcomes in children and adolescents.
METHODS: PubMed, Embase, Cochrane CENTRAL, Web of Science, PsycINFO, and EBSCO were searched from database inception to October 2025. Randomized controlled trials including participants under 18 years of age with DSM-defined ADHD were eligible. Pooled effects were calculated using standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) under random-effects models.
RESULTS: Nine RCTs involving 482 participants were included, with intervention durations ranging from 8 to 12 weeks. In the broad exploratory synthesis of ADHD-related clinical outcomes, probiotic supplementation did not show a clear benefit (SMD = -0.25, 95% CI: -0.57 to 0.07; p = 0.131). Because this analysis combined conceptually heterogeneous instruments, greater interpretive weight was placed on domain-specific analyses. No clear effects were observed for more specific core symptom-related measures, including SNAP-IV inattention scores and CPT-derived attention-related performance measures. In domain-specific exploratory analyses, CPRS total scores showed a small reduction following probiotic supplementation (SMD = -0.33, 95% CI: -0.65 to -0.01; p = 0.041), whereas CBCL total scores did not show a statistically significant effect under the random-effects model (MD = -1.93, 95% CI: -6.30 to 2.44; p = 0.386). The SNAP-IV hyperactivity finding was statistically significant but was largely driven by a single study and should be interpreted cautiously.
CONCLUSIONS: Current 8-12-week RCT evidence does not demonstrate a clear benefit of probiotic supplementation for ADHD core symptom-related measures. However, exploratory findings suggest that probiotic supplementation may have potential for improving broad parent-reported emotional-behavioral outcomes, particularly CPRS-assessed behavioral symptoms. This potential benefit should be interpreted cautiously because it was based on a small number of heterogeneous trials and was not consistently supported by CBCL outcomes. Larger, rigorously designed trials are needed to confirm these broad parent-reported behavioral and emotional findings and clarify their clinical relevance.
OBJECTIVE: This systematic review and meta-analysis evaluated the effects of probiotic supplementation on ADHD-related clinical outcomes and emotional-behavioral outcomes in children and adolescents.
METHODS: PubMed, Embase, Cochrane CENTRAL, Web of Science, PsycINFO, and EBSCO were searched from database inception to October 2025. Randomized controlled trials including participants under 18 years of age with DSM-defined ADHD were eligible. Pooled effects were calculated using standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) under random-effects models.
RESULTS: Nine RCTs involving 482 participants were included, with intervention durations ranging from 8 to 12 weeks. In the broad exploratory synthesis of ADHD-related clinical outcomes, probiotic supplementation did not show a clear benefit (SMD = -0.25, 95% CI: -0.57 to 0.07; p = 0.131). Because this analysis combined conceptually heterogeneous instruments, greater interpretive weight was placed on domain-specific analyses. No clear effects were observed for more specific core symptom-related measures, including SNAP-IV inattention scores and CPT-derived attention-related performance measures. In domain-specific exploratory analyses, CPRS total scores showed a small reduction following probiotic supplementation (SMD = -0.33, 95% CI: -0.65 to -0.01; p = 0.041), whereas CBCL total scores did not show a statistically significant effect under the random-effects model (MD = -1.93, 95% CI: -6.30 to 2.44; p = 0.386). The SNAP-IV hyperactivity finding was statistically significant but was largely driven by a single study and should be interpreted cautiously.
CONCLUSIONS: Current 8-12-week RCT evidence does not demonstrate a clear benefit of probiotic supplementation for ADHD core symptom-related measures. However, exploratory findings suggest that probiotic supplementation may have potential for improving broad parent-reported emotional-behavioral outcomes, particularly CPRS-assessed behavioral symptoms. This potential benefit should be interpreted cautiously because it was based on a small number of heterogeneous trials and was not consistently supported by CBCL outcomes. Larger, rigorously designed trials are needed to confirm these broad parent-reported behavioral and emotional findings and clarify their clinical relevance.