This protocol was developed for practitioners using Fullscript in the United States and the templates cannot be applied to accounts operating outside of the United States

Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through D-quality evidence.

Class
Qualifying studies
Minimum requirements
A
Systematic review or meta-analysis of human trials
 
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study
D
Non-RDBPC human or In-vivo animal trials
 

Introduction

Whole-person care is a person-centered approach to medicine. It goes beyond treating symptoms or isolated conditions, focusing on the interconnectedness of bodily systems and addressing a wide range of factors. These include biological makeup, behavioral habits, environmental factors, and a patient’s personal beliefs, values, and goals. By tailoring care to align with these unique aspects, healthcare providers can create highly personalized treatment plans that address not only physical health, but also emotional and mental well-being.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. (National Institute of Mental Health 2024) The global prevalence of ADHD has been estimated to be 8% in children and 2.6–6.8% in adults. (Ayano 2023) ADHD can significantly affect academic achievement, occupational performance, and social relationships, contributing to emotional distress and reduced quality of life. (Ben-Dor Cohen 2021) 

This template aims to offer healthcare providers practical suggestions for labs, supplements, and lifestyle strategies, helping them design personalized, whole-person care plans for children and adults who want to address the mechanisms and concerns of inattention and hyperactivity.

Comprehensive lab testing helps healthcare providers explore the potential root causes of ADHD. Food sensitivity tests can help identify foods that elicit inflammatory immune responses so that elimination diets—shown to reduce ADHD symptoms in some individuals—can be prescribed. (Yorgidis 2021) Heavy metal tests quantify exposure to lead or mercury, which can negatively impact neural development and function. (Lee 2018) Hormone and neurotransmitter panels can help providers identify imbalances associated with ADHD symptoms. (Roberts 2018)(da Silva 2023) Micronutrient panels can be ordered to screen for deficiencies common in people with ADHD that can interfere with brain development and neurotransmitter synthesis. (Villagomez 2014) 

Evidence-based ingredients can be recommended alongside other treatments to support ADHD management by replenishing deficient nutrients, supporting neurotransmitter levels, and reducing systemic inflammation. The ingredients summarized in this protocol have been selected based on evidence that supports their ability to provide clinically relevant outcomes in patients with ADHD.

Lifestyle modifications should be considered as first-line interventions for supporting neurocognitive health. Foundational habits like balanced nutrition, regular physical activity, stress management, and adequate sleep help ameliorate ADHD symptoms and holistically target common comorbidities—such as anxiety and sleep disturbances—observed in patients with ADHD.

Labs

Food Sensitivity Testing

P88 Dietary Antigen Test by Precision Point Diagnostics

Heavy Metal Testing

Heavy Metals Panel, 24-Hour Urine by Quest Diagnostics

Hormone Testing

Estradiol

Progesterone, LC/MS

Sex Hormone Binding Globulin (SHBG)

Testosterone, Free, Bioavailable and Total, MS

Micronutrient Testing

Iron, TIBC, and Ferritin Panel

Magnesium, RBC

Omega-3 Index Complete

Vitamin B6

Vitamin D, 25-Hydroxy, Total, Immunoassay

Zinc, RBC

Neurotransmitter Testing

Comprehensive Neurotransmitter Profile (FMV/Random) by Doctor’s Data

Ingredients

Omega-3 Fatty Acids (Eicosapentaenoic Acid [EPA] and Docosahexaenoic Acid [DHA])

Dosing: 

  • Pediatric: 500–1,000 mg EPA and 200–650 mg DHA, once per day, for a minimum of 8–16 weeks (Bos 2015)(Chang 2018)
  • Adult: 5 g daily (total omega-3 polyunsaturated fatty acids [PUFAs]) for at least one month (Lundbergh 2022)

Supporting evidence:

  • Omega-3 PUFAs and the ratio of omega-3 to omega-6 PUFAs in blood and plasma are lower in children, adolescents, and adults with ADHD than in age-matched controls. (Königs 2016) 
  • Children and adolescents with ADHD have lower levels of DHA, EPA, and total omega-3 PUFAs. Evidence from seven randomized controlled trials (RCTs) including 534 youths with ADHD demonstrates that omega-3 monotherapy improved ADHD clinical symptom scores and cognitive performance/attention. (Chang 2018)
  • A small randomized crossover trial in 26 adults with autism spectrum disorder and comorbid ADHD found that fish oil supplementation helped improve attention and working memory. (Lundbergh 2022)

Zinc

Dosing: 10–55 mg total per day (as zinc sulfate or zinc oxide) in 1–2 divided doses for up to six months (Zamora 2011)(El-Baz 2019)

Supporting evidence:

  • Evidence suggests that people with ADHD are more likely to have low levels of circulating zinc. (Ghoreishy 2021) 
  • In a double-blind RCT, increased attention was observed in children with ADHD (n=60) when zinc was concomitantly administered with methylphenidate (MPH) compared to MPH alone. (Noorazar 2020)
  • A 2022 systematic review and meta-analysis of six RCTs found that zinc supplementation helped significantly improve total ADHD scores in school-aged children (n=489), though not specifically on hyperactivity or inattention subscales. (Talebi 2022)
  • In a prospective study, correcting zinc deficiency with supplementation was correlated to improved attention, hyperactivity, emotional lability, and impulsivity in children with ADHD. Among those who were also iron-deficient, combined zinc and iron supplementation additionally helped improve verbal and total intelligence quotient (IQ). (El-Baz 2019)
  • Meta-analyses and reviews suggest that zinc may be among the more effective antioxidant therapies for improving ADHD rating scale scores, especially in children at high risk for deficiency. (Lange 2017)(Zhou 2024)

Vitamin D 

Dosing: Vitamin D3 (cholecalciferol) 2,000 IU per day for a minimum of 8–12 weeks, or 50,000 IU per week for a minimum of six weeks (Mohammadpour 2018)(Dehbokri 2019)(Seyedi 2019)

Supporting evidence:

  • In a randomized double-blind placebo-controlled (RDBPC) trial, high-dose, weekly vitamin D improved all subscales of symptoms in children with ADHD (n=96), with a notable improvement in inattention when used as an adjunct to MPH. (Dehbokri 2019)
  • A systematic review and meta-analysis of four RCTs found that vitamin D supplementation helped reduce ADHD total, inattention, hyperactivity, and behavior scores. It also increased serum vitamin D levels, which were typically lower in children with ADHD than in controls. (Gan 2019)
  • A clinical trial found that daily vitamin D supplementation for 12 weeks was associated with increased serum dopamine levels in 86 children with ADHD, suggesting a potential influence on catecholaminergic signaling, which plays a key role in executive function and attention regulation. (Seyedi 2019)
  • After eight weeks of supplementation, vitamin D, in combination with MPH, was associated with increased serum vitamin D levels, reduced evening symptoms, and improvements in the Weekly Parent Ratings of Evening and Morning Behavior (WPREMB) in children with ADHD. (Mohammadpour 2018)

Pycnogenol (Pine Bark Extract)

Dosing: 

Supporting evidence:

  • Results from a small RDBPC cross-over study indicate that Pycnogenol ameliorates inattention and impulsivity in children with ADHD (n=20) based on Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) scores. Additionally, Pycnogenol was associated with improved antioxidative status, based on measurable improvements in the erythrocytic reduced glutathione/oxidized glutathione ratio and reductions in thiobarbituric acid reactive substances (a measurement of oxidative stress). (Hsu 2021)
  • A 10-week randomized, double-blind trial compared Pycnogenol, MPH, and placebo in 88 children with ADHD. Teacher ratings showed that both Pycnogenol and MPH significantly improved total ADHD scores and hyperactivity/impulsivity compared to placebo, though only MPH improved inattention. Pycnogenol was well-tolerated with fewer side effects than MPH. (Weyns 2022)
  • An older RCT suggests that Pycnogenol may help reduce hyperactivity in children with ADHD by lowering elevated catecholamine levels. After one month of supplementation, levels of adrenaline, noradrenaline, and dopamine—initially measured to be about five times higher in children with ADHD than in controls—were significantly reduced. (Dvoráková 2007)
  • A small 12-week study of 30 healthy adults aged 35–55 found that Pycnogenol supplementation helped improve cognitive function, attention, mental performance, and mood. Participants showed small but statistically significant gains on cognitive tests, including the Paced Auditory Serial Addition Test (PASAT), pattern recognition memory, and spatial working memory. The study also reported a 30.4% reduction in plasma-free radicals, suggesting decreased oxidative stress associated with Pycnogenol use. (Belcaro 2014)

Bacopa (Bacopa monnieri)

Dosing: 

  • Pediatric: 160–225 mg daily for 4–6 months (Al Shahab 2025)
  • Adult: 300 mg (containing 90 mg of total bacosides) daily for 12 weeks (Eraiah 2024)

Supporting evidence:

  • Evidence suggests that Bacopa monnieri may support attention and focus through combined cholinergic- and monoaminergic-modulating, acetylcholinesterase-inhibiting, antioxidant-neuroprotecting, and anti-inflammatory effects. (Aguiar 2013)(Simpson 2015)(Jeyasri 2022) 
  • A recent meta-analysis identified four RCTs that collectively demonstrated consistent benefits of bacopa for attention, hyperactivity, memory, and cognitive performance in children with ADHD. (Al Shahab 2025)
  • In an RDBPC trial of 80 healthy adults aged 18–55, Bacopa monnieri extract (BME) was evaluated for its effects on cognition, stress, and mood. Using the Creyos cognitive test battery, Beck Anxiety Inventory, Pittsburgh Sleep Quality Index, and serum biomarkers for brain-derived neurotrophic factor (BDNF) and cortisol, researchers found that BME significantly improved multiple domains of memory—including verbal, spatial, working, and episodic memory—along with attention, alertness, and reasoning. Participants also demonstrated reduced anxiety, improved sleep quality, lower cortisol levels, and increased BDNF by week 12 compared to placebo. (Eraiah 2024)

 

Probiotics

Dosing: Variable depending on formula. For children and adults, most studies use at least 10 billion colony-forming units (CFU) per day of Lactobacillus and Bifidobacterium species for a minimum of 1–6 months. (Kumperscak 2020)(Schwartz 2024)

Supporting evidence:

  • In a 13-year follow-up study, Lactobacillus rhamnosus GG (LGG) supplementation during the first six months of life was associated with a decreased risk of neuropsychiatric disorders, including ADHD and Asperger’s syndrome (AS). (Pärtty 2015)
  • A systematic review of seven studies found that children were at a reduced risk of developing ADHD or AS when their mothers took LGG, beginning one month before delivery and continuing through six months postpartum while they breastfed. (Rianda 2019)
  • A pilot RCT found that LGG supplementation helped improve health-related quality of life in children and adolescents with ADHD. Additionally, the probiotic supplementation was associated with significant reductions in inflammatory cytokines interleukin-10 (IL-10), interleukin-12 (IL-12), and tumor necrosis factor-α (TNF-α). (Kumperscak 2020)
  • A double-blind RCT of 60 young adults (ages 19–30 years) found that taking a daily multi-strain probiotic (containing Lactobacillus helveticus, Bifidobacterium animalis spp., Enterococcus faecium, B. longum, and Bacillus subtilis) daily for three months significantly improved hyperactivity and academic performance compared to placebo. (Schwartz 2024) 
  • A multicenter RCT evaluated the effects of a 10-week daily synbiotic supplement (containing L. casei spp paracasei F19, L. plantarum 2362, Leuconostoc mesenteroides 77:1, and a combination of prebiotic fibers) in 180 adults aged 18–65 with ADHD and/or borderline personality disorder who exhibited high irritability. Compared to the placebo group, the synbiotic group showed significantly greater reductions in irritability, emotional dysregulation, inattention, and perceived stress, as measured by Affectivity Reactivity Index (ARI-S) and Clinical Global Impression-Severity Scale (CGI-S) scores. (Arteaga-Henríquez 2024) 

Lifestyle Recommendations

Nutrition

Recommend an anti-inflammatory diet, such as the Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diets. “Healthy” dietary patterns that favor increased consumption of the following foods and nutrients have been shown to decrease the risk of ADHD by 37%:

  • Fruits
  • Vegetables
  • Omega-3 PUFAs: Low-mercury fatty fish, flaxseeds, chia seeds, and walnuts
  • Magnesium: Green leafy vegetables, beans, whole grains, nuts, and tofu
  • Zinc: Oysters, meat, lentils, cashews, and pumpkin seeds (Pinto 2022) 

 

Counsel on avoiding foods that are common trigger foods for patients with ADHD and have been correlated to increased hyperactivity:

Movement

Regular exercise provides cognitive, behavioral, and physical benefits to patients with ADHD. (Ng 2017) Mixed exercise programs have been reported to provide the most benefit to patients, including: 

  • Open-skill activities (e.g., team sports, martial arts, and surfing) (Zhu 2023) 
  • Closed-skill aerobic exercise (e.g., walking, running, and cycling) (Li 2025) 
  • High-intensity interval training (HIIT) can be recommended to patients who can tolerate vigorous-intensity activity, as it may offer superior benefits for attention deficits compared to moderate-intensity continuous training (MICT). (Sabaghi 2025)

Behavioral and Cognitive Support

Stress

Because stress is both a risk factor and modulator of ADHD severity and course, addressing stress and its sources is important in helping manage ADHD and prevent adverse ADHD trajectories. (Koppelmaa 2024)(Robinson 2024)

 

Evidence supports using these stress-reducing techniques for managing ADHD symptoms:

  • Mindfulness-based interventions—including meditation and deep breathing—may help reduce stress, improve attention, and regulate mood. (Modesto-Lowe 2015)(Kim 2025)
  • Neurofeedback is an intervention intended to regulate brain waves to increase arousal in the frontal lobe, enhance attention, and decrease impulsive and hyperactive behavior. (Baena 2021)
  • Cognitive behavioral therapy (CBT) can improve core ADHD symptoms, reduce anxiety and depression, and provide patients with practical skills for managing stress, organizing tasks, and coping with emotional challenges. (Nimmo-Smith 2020) 

Sleep

Children and adults with ADHD are more likely to experience sleep disturbances such as insomnia, poor sleep quality, prolonged sleep latency, and reduced sleep efficiency. (Surman 2021)(Sciberras 2022) These sleep problems can both precede and exacerbate ADHD symptoms, creating a cycle in which attention and behavioral difficulties further worsen sleep over time. (Hvolby 2014) 

 

Recommendations: 

  • Integrate sleep assessment and management into routine ADHD care. (Hvolby 2014)
  • Behavioral sleep interventions are first-line therapy for sleep problems in ADHD. These include sleep hygiene education (consistent bedtime/wake time, limiting screen time before bed, creating a quiet sleep environment), positive bedtime routines, and cognitive-behavioral strategies. (Nikles 2020)(Keuppens 2023)(Cortese 2024)
  • Consider pharmacological interventions, including melatonin, for persistent sleep-onset delay or circadian rhythm disorders when behavioral strategies are insufficient. (Cortese 2013) 
  • Review and adjust ADHD medications if sleep problems emerge or worsen, considering dose timing, formulation, or alternative agents as appropriate. (Stein 2012)

 

Psychotherapy and Coaching

  • Cognitive behavioral therapy (CBT): Helps patients recognize and modify unhelpful thought patterns, improve time management, and reduce impulsivity. (Yang 2025) 
  • ADHD coaching: Focuses on executive functioning skills—organization, prioritization, and follow-through—tailored to real-life goals. (Chan 2023) 
  • Mindfulness-based cognitive therapy (MBCT): Improves attention regulation, self-awareness, and emotional control. (Yang 2025)
  • Couples or Family Therapy: Supports better communication, reduces conflict, and helps family members understand ADHD-related behaviors. (Babinski 2022) 

Occupational Therapy (OT)

  • Skill-building and routine formation: OTs can help patients develop personalized systems for daily structure, transitions, and task management.
  • Sensory regulation: Especially for children, OTs can address sensory processing challenges that contribute to distractibility or emotional dysregulation.
  • Environmental modifications: Recommendations for workspace setup, adaptive tools (e.g., planners, fidget devices, timers), and home/school accommodations. (Ianni 2020)(Adamou 2021)

Educational and Workplace Accommodations

Social and Emotional Skill Development

  • Social skills training: Helps individuals navigate peer and professional interactions more effectively. (Storebø 2019) 
  • Emotional regulation strategies: Techniques for impulse control, frustration tolerance, and self-soothing (can be taught through behavioral therapies or other specialized programs). (Soler-Gutiérrez 2023)(Nordby 2024)

Integrative and Community-Based Resources

  • Support groups: Peer-led and professionally-moderated groups can improve accountability and reduce feelings of isolation. (Attention Deficit Disorder Association 2025b) 
  • Digital tools: ADHD-friendly apps (for time tracking, reminders, or focus) may help reinforce behavioral goals.
  • Parent or Partner Education: Programs and toolkits, available through organizations like the Centers for Disease Control and Prevention, teach loved ones strategies to effectively support individuals with ADHD. (Centers for Disease Control and Prevention 2024b) 

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

View protocol on Fullscript
References
  1. Adamou, M., Asherson, P., Arif, M., Buckenham, L., Cubbin, S., Dancza, K., Gorman, K., Gudjonsson, G., Gutman, S., Kustow, J., Mabbott, K., May-Benson, T., Muller-Sedgwick, U., Pell, E., Pitts, M., Rastrick, S., Sedgwick, J., Smith, K., Taylor, C., … Young, S. (2021). Recommendations for occupational therapy interventions for adults with ADHD: A consensus statement from the UK adult ADHD network. BMC Psychiatry, 21, 72. https://doi.org/10.1186/s12888-021-03070-z
  2. ADDA Editorial Team. (2025a, February 4). ADHD accommodations at work: Effective tips for a more supportive workplace. Attention Deficit Disorder Association; Attention Deficit Disorder Association. https://add.org/adhd-workplace-accommodations/
  3. ADDA Editorial Team. (2025b, October 9). ADHD support groups: How peer support helps adults thrive. Attention Deficit Disorder Association; Attention Deficit Disorder Association. https://add.org/how-adhd-support-groups-help-adults-thrive/
  4. Aguiar, S., & Borowski, T. (2013). Neuropharmacological review of the nootropic herb Bacopa monnieri. Rejuvenation Research, 16(4), 313–326. https://doi.org/10.1089/rej.2013.1431
  5. Al Shahab, S., Al Balushi, R., Qambar, A., Abdulla, R., Qader, M., Abdulla, S., & Jahrami, H. (2025). Efficiency of different supplements in alleviating symptoms of ADHD with or without the use of stimulants: A systematic review. Nutrients, 17(9), 1482. https://doi.org/10.3390/nu17091482
  6. Arteaga-Henríquez, G., Ramos-Sayalero, C., Ibañez-Jimenez, P., Rosales-Ortiz, S. K., Kilencz, T., Schiweck, C., Schnorr, I., Siegl, A., Arias-Vasquez, A., Bitter, I., Fadeuilhe, C., Ferrer, M., Lavebratt, C., Matura, S., Reif, A., Réthelyi, J. M., Richarte, V., Rommelse, N., & Ramos-Quiroga, J. A. (2024). Efficacy of a synbiotic in the management of adults with attention-deficit and hyperactivity disorder and/or borderline personality disorder and high levels of irritability: Results from a multicenter, randomized, placebo-controlled, “basket” trial. Brain Behavior and Immunity, 120, 360–371. https://doi.org/10.1016/j.bbi.2024.06.012
  7. Ayano, G., Demelash, S., Gizachew, Y., Tsegay, L., & Alati, R. (2023). The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses. Journal of Affective Disorders, 339, 860–866. https://doi.org/10.1016/j.jad.2023.07.071
  8. Babinski, D. E., & Sibley, M. H. (2022). Family‐based treatments for attention‐deficit/hyperactivity disorder: A review of family functioning outcomes in randomized controlled trials from 2010 to 2019. Journal of Marital and Family Therapy, 48(1), 83–106. https://doi.org/10.1111/jmft.12572
  9. Baena, L. S., Fuente, G. A. C., Martos-Cabrera, M. B., Gómez-Urquiza, J. L., Albendín-García, L., Romero-Bejar, J. L., & Suleiman-Martos, N. (2021). Effects of neurofeedback in children with attention-deficit/hyperactivity disorder: A systematic review. Journal of Clinical Medicine, 10(17), 3797. https://doi.org/10.3390/jcm10173797
  10. Belcaro, G., Luzzi, R., Dugall, M., Ippolito, E., & Saggino, A. (2014). Pycnogenol® improves cognitive function, attention, mental performance and specific professional skills in healthy professionals aged 35-55. Journal of Neurosurgical Sciences, 58(4), 239–248. https://pubmed.ncbi.nlm.nih.gov/24675223/
  11. Ben-Dor Cohen, M., Eldar, E., Maeir, A., & Nahum, M. (2021). Emotional dysregulation and health related quality of life in young adults with ADHD: a cross sectional study. Health and Quality of Life Outcomes, 19(1), 270. https://doi.org/10.1186/s12955-021-01904-8
  12. Bos, D. J., Oranje, B., Veerhoek, E. S., Van Diepen, R. M., Weusten, J. M., Demmelmair, H., Koletzko, B., de Sain-van der Velden, M. G., Eilander, A., Hoeksma, M., & Durston, S. (2015). Reduced symptoms of inattention after dietary omega-3 fatty acid supplementation in boys with and without attention deficit/hyperactivity disorder. Neuropsychopharmacology, 40(10), 2298–2306. https://doi.org/10.1038/npp.2015.73
  13. Centers for Disease Control and Prevention. (2024a, October 22). ADHD in the classroom: Helping children succeed in school. Centers for Disease Control and Prevention; Centers for Disease Control and Prevention. https://www.cdc.gov/adhd/treatment/classroom.html
  14. Centers for Disease Control and Prevention. (2024b, November 4). ADHD across the lifetime: A toolkit for partner organizations. Centers for Disease Control and Prevention; Centers for Disease Control and Prevention. https://www.cdc.gov/adhd/communication-resources/adhd-across-the-lifetime-partner-toolkit.html
  15. Chan, E. S. M., Gaye, F., Cole, A. M., Singh, L. J., & Kofler, M. J. (2023). Central executive training for ADHD: Impact on organizational skills at home and school. A randomized controlled trial. Neuropsychology, 37(8), 859–871. https://doi.org/10.1037/neu0000918
  16. Chang, J. P.-C., Su, K.-P., Mondelli, V., & Pariante, C. M. (2018). Omega-3 polyunsaturated fatty acids in youths with attention deficit hyperactivity disorder: A systematic review and meta-analysis of clinical trials and biological studies. Neuropsychopharmacology, 43(3), 534–545. https://doi.org/10.1038/npp.2017.160
  17. Cortese, S., Brown, T. E., Corkum, P., Gruber, R., O’Brien, L. M., Stein, M., Weiss, M., & Owens, J. (2013). Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(8), P784-796. https://doi.org/10.1016/j.jaac.2013.06.001
  18. Cortese, S., Veronesi, G. F., Gabellone, A., Margari, A., Marzulli, L., Matera, E., Petruzelli, M. G., Piarulli, F. M., Tarantino, F., Bellato, A., Parlatini, V., Rietz, E. D., Larsson, H., Hornsey, S., Hill, C., & Margari, L. (2024). The management of sleep disturbances in children with attention-deficit/hyperactivity disorder (ADHD): an update of the literature. Expert Review of Neurotherapeutics, 24(6), 585–596. https://doi.org/10.1080/14737175.2024.2353692
  19. da Silva, B. S., Grevet, E. H., Silva, L. C. F., Ramos, J. K. N., Rovaris, D. L., & Bau, C. H. D. (2023). An overview on neurobiology and therapeutics of attention-deficit/hyperactivity disorder. Discover Mental Health, 3(1), 2. https://doi.org/10.1007/s44192-022-00030-1
  20. Dehbokri, N., Noorazar, G., Ghaffari, A., Mehdizadeh, G., Sarbakhsh, P., & Ghaffary, S. (2019). Effect of vitamin D treatment in children with attention-deficit hyperactivity disorder. World Journal of Pediatrics, 15(1), 78–84. https://doi.org/10.1007/s12519-018-0209-8
  21. Del-Ponte, B., Quinte, G. C., Cruz, S., Grellert, M., & Santos, I. S. (2019). Dietary patterns and attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis. Journal of Affective Disorders, 252, 160–173. https://doi.org/10.1016/j.jad.2019.04.061
  22. Dvoráková, M., Jezová, D., Blazícek, P., Trebatická, J., Skodácek, I., Suba, J., Iveta, W., Rohdewald, P., & Duracková, Z. (2007). Urinary catecholamines in children with attention deficit hyperactivity disorder (ADHD): modulation by a polyphenolic extract from pine bark (pycnogenol). Nutritional Neuroscience, 10(3-4), 151–157. https://doi.org/10.1080/09513590701565443
  23. Dvořáková, M., Sivoňová, M., Trebatická, J., Škodáček, I., Waczuliková, I., Muchová, J., & Ďuračková, Z. (2006). The effect of polyphenolic extract from pine bark, Pycnogenol®on the level of glutathione in children suffering from attention deficit hyperactivity disorder (ADHD). Redox Report, 11(4), 163–172. https://doi.org/10.1179/135100006×116664
  24. El-Baz, F. M., Youssef, A. M., Khairy, E., Ramadan, D., & Youssef, W. Y. (2019). Association between circulating zinc/ferritin levels and parent Conner’s scores in children with attention deficit hyperactivity disorder. European Psychiatry, 62, 68–73. https://doi.org/10.1016/j.eurpsy.2019.09.002
  25. Eraiah, M. M., Shekhar, H. C., Joshua, L., & Thomas, J. V. (2024). Effect of Bacopa monnieri extract on memory and cognitive skills in adult humans: A randomized, double-blind, placebo-controlled study. Journal of Psychiatry and Cognitive Behaviour, 8, 168. https://doi.org/10.29011/2574-7762.000068
  26. Gan, J., Galer, P., Ma, D., Chen, C., & Xiong, T. (2019). The effect of vitamin D supplementation on attention-deficit/hyperactivity disorder: A systematic review and meta-analysis of randomized controlled trials. Journal of Child and Adolescent Psychopharmacology, 29(9), 670–687. https://doi.org/10.1089/cap.2019.0059
  27. Ghoreishy, S. M., Ebrahimi Mousavi, S., Asoudeh, F., & Mohammadi, H. (2021). Zinc status in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis of observational studies. Scientific Reports, 11, 14612. https://doi.org/10.1038/s41598-021-94124-5
  28. Honar, N., Radanfar, R., Ghanizadeh, A., Barkhordarian, M., & Javaherizadeh, H. (2022). Is attention-deficit hyperactivity disorder increased in patients with celiac disease? Middle East Current Psychiatry, 29(33). https://doi.org/10.1186/s43045-022-00201-4
  29. Hsu, C., Hsieh, L., Chen, Y., Lin, I., Chen, Y., Chen, C., Shirakawa, H., & Yang, S. (2021). Complementary effects of pine bark extract supplementation on inattention, impulsivity, and antioxidative status in children with attention‐deficit hyperactivity disorder: A double‐blinded randomized placebo‐controlled cross‐over study. Phytotherapy Research, 35(6), 3226–3235. https://doi.org/10.1002/ptr.7036
  30. Hvolby, A. (2014). Associations of sleep disturbance with ADHD: Implications for treatment. ADHD Attention Deficit and Hyperactivity Disorders, 7(1), 1–18. https://doi.org/10.1007/s12402-014-0151-0
  31. Ianni, L., Mazer, B., Thomas, A., & Snider, L. (2020). The role of occupational therapy with children with attention deficit hyperactivity disorder (ADHD): A Canadian national survey. Journal of Occupational Therapy, Schools, & Early Intervention, 14(2), 1–22. https://doi.org/10.1080/19411243.2020.1822259
  32. Jeyasri, R., Muthuramalingam, P., Adarshan, S., Shin, H., & Ramesh, M. (2022). Assessing the anti-inflammatory effects of Bacopa-derived bioactive compounds using network pharmacology and in vitro studies. ACS Omega, 7(44), 40344–40354. https://doi.org/10.1021/acsomega.2c05318
  33. Jones, S. K., McCarthy, D. M., Stanwood, G. D., Schatschneider, C., & Bhide, P. G. (2023). Learning and memory deficits produced by aspartame are heritable via the paternal lineage. Scientific Reports, 13(1), 14326. https://doi.org/10.1038/s41598-023-41213-2
  34. Keuppens, L., Marten, F., Baeyens, D., Boyer, B., Danckaerts, M., & van der Oord, S. (2023). Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA)-Blended CBT sleep intervention to improve sleep, ADHD symptoms and related problems in adolescents with ADHD: Protocol for a randomised controlled trial. BMJ Open, 13(4), e065355. https://doi.org/10.1136/bmjopen-2022-065355
  35. Kim, H.-H., & Jung, N.-H. (2025). Mindfulness-based interventions for adults with ADHD: A systematic review and meta-analysis. Medicine (Baltimore), 104(37), e44308. https://doi.org/10.1097/md.0000000000044308
  36. Königs, A., & Kiliaan, A. J. (2016). Critical appraisal of omega-3 fatty acids in attention-deficit/hyperactivity disorder treatment. Neuropsychiatric Disease and Treatment, 12, 1869–1882. https://doi.org/10.2147/ndt.s68652
  37. Koppelmaa, K., Marie, C., Walter, N., Walitza, S., & Grünblatt, E. (2024). Stress as a mediator of brain alterations in attention-deficit hyperactivity disorder: A systematic review. Comprehensive Psychiatry, 130, 152454. https://doi.org/10.1016/j.comppsych.2024.152454
  38. Kumperscak, H. G., Gricar, A., Ülen, I., & Micetic-Turk, D. (2020). A pilot randomized control trial with the probiotic strain Lactobacillus rhamnosus GG (LGG) in ADHD: Children and adolescents report better health-related quality of life. Frontiers in Psychiatry, 11, 181. https://doi.org/10.3389/fpsyt.2020.00181
  39. Lange, K. W., Hauser, J., Lange, K. M., Makulska-Gertruda, E., Nakamura, Y., Reissmann, A., Sakaue, Y., Takano, T., & Takeuchi, Y. (2017). The role of nutritional supplements in the treatment of ADHD: What the evidence says. Current Psychiatry Reports, 19(2), 8. https://doi.org/10.1007/s11920-017-0762-1
  40. Lange, K. W., Lange, K., Nakamura, Y., & Reißmann, A. (2023). Nutrition in the management of ADHD: A review of recent research. Current Nutrition Reports, 12(3), 383–394. https://doi.org/10.1007/s13668-023-00487-8
  41. Lee, M.-J., Chou, M.-C., Chou, W.-J., Huang, C.-W., Kuo, H.-C., Lee, S.-Y., & Wang, L.-J. (2018). Heavy metals’ effect on susceptibility to attention-deficit/hyperactivity disorder: Implication of lead, cadmium, and antimony. International Journal of Environmental Research and Public Health, 15(6), 1221. https://doi.org/10.3390/ijerph15061221
  42. Li, H., Meng, Q., Zhang, P., & Zhen, Z. (2025). Is there an ideal exercise prescription? Network meta-analysis of the impact of exercise intervention on inhibitory control in children with ADHD. Journal of Psychiatric Research, 191, 294–305. https://doi.org/10.1016/j.jpsychires.2025.09.044
  43. Lundbergh, B., Enevoldsen, A. S., Stark, K. D., Ritz, C., & Lauritzen, L. (2022). Fish oil supplementation may improve attention, working memory and attention-deficit/hyperactivity disorder symptoms in adults with autism spectrum disorder: a randomised crossover trial. British Journal of Nutrition, 1–11. https://doi.org/10.1017/s0007114522000393
  44. Modesto-Lowe, V., Farahmand, P., Chaplin, M., & Sarro, L. (2015). Does mindfulness meditation improve attention in attention deficit hyperactivity disorder? World Journal of Psychiatry, 5(4), 397–403. https://doi.org/10.5498/wjp.v5.i4.397
  45. Mohammadpour, N., Jazayeri, S., Tehrani-Doost, M., Djalali, M., Hosseini, M., Effatpanah, M., Davari-Ashtiani, R., & Karami, E. (2018). Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial. Nutritional Neuroscience, 21(3), 202–209. https://doi.org/10.1080/1028415x.2016.1262097
  46. National Institute of Mental Health. (2024). Attention-deficit/hyperactivity disorder (ADHD). National Institute of Mental Health; U.S. Department of Health & Human Services. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd
  47. Ng, Q. X., Ho, C. Y. X., Chan, H. W., Yong, B. Z. J., & Yeo, W.-S. (2017). Managing childhood and adolescent attention-deficit/hyperactivity disorder (ADHD) with exercise: A systematic review. Complementary Therapies in Medicine, 34, 123–128. https://doi.org/10.1016/j.ctim.2017.08.018
  48. Nikles, J., Mitchell, G. K., de Miranda Araújo, R., Harris, T., Heussler, H. S., Punja, S., Vohra, S., & Senior, H. E. J. (2020). A systematic review of the effectiveness of sleep hygiene in children with ADHD. Psychology, Health & Medicine, 25(4), 497–518. https://doi.org/10.1080/13548506.2020.1732431
  49. Nimmo-Smith, V., Merwood, A., Hank, D., Brandling, J., Greenwood, R., Skinner, L., Law, S., Patel, V., & Rai, D. (2020). Non-pharmacological interventions for adult ADHD: a systematic review. Psychological Medicine, 50(4), 529–541. https://doi.org/10.1017/s0033291720000069
  50. Noorazar, S. G., Malek, A., Aghaei, S. M., Yasamineh, N., & Kalejahi, P. (2020). The efficacy of zinc augmentation in children with attention deficit hyperactivity disorder under treatment with methylphenidate: A randomized controlled trial. Asian Journal of Psychiatry, 48, 101868. https://doi.org/10.1016/j.ajp.2019.101868
  51. Nordby, E. S., Guribye, F., Schønning, V., Andersen, S. W., Kuntsi, J., & Lundervold, A. J. (2024). A blended intervention targeting emotion dysregulation in adults with attention-deficit/hyperactivity disorder: Development and feasibility study. JMIR Formative Research, 8, e53931. https://doi.org/10.2196/53931
  52. Office of Environmental Health Hazard Assessment. (2021). Health effects assessment potential neurobehavioral effects of synthetic food dyes in children. In State of California Office of Environmental Health Hazard Assessment. Office of Environmental Health Hazard Assessment. https://oehha.ca.gov/sites/default/files/media/downloads/risk-assessment/report/healthefftsassess041621.pdf
  53. Pärtty, A., Kalliomäki, M., Wacklin, P., Salminen, S., & Isolauri, E. (2015). A possible link between early probiotic intervention and the risk of neuropsychiatric disorders later in childhood: a randomized trial. Pediatric Research, 77(6), 823–828. https://doi.org/10.1038/pr.2015.51
  54. Pinto, S., Correia-de-Sá, T., Sampaio-Maia, B., Vasconcelos, C., Moreira, P., & Ferreira-Gomes, J. (2022). Eating patterns and dietary interventions in ADHD: A narrative review. Nutrients, 14(20), 4332. https://doi.org/10.3390/nu14204332
  55. Rianda, D., Agustina, R., Setiawan, E. A., & Manikam, N. R. M. (2019). Effect of probiotic supplementation on cognitive function in children and adolescents: a systematic review of randomised trials. Beneficial Microbes, 10(8), 873–882. https://doi.org/10.3920/bm2019.0068
  56. Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015
  57. Robinson, L. R., Bitsko, R. H., O’Masta, B., Holbrook, J. R., Ko, J., Barry, C. M., Maher, B., Cerles, A., Saadeh, K., MacMillan, L., Mahmooth, Z., Bloomfield, J., Rush, M., & Kaminski, J. W. (2024). A systematic review and meta-analysis of parental depression, antidepressant usage, antisocial personality disorder, and stress and anxiety as risk factors for attention-deficit/hyperactivity disorder (ADHD) in children. Prevention Science, 25(Suppl 2), 272–290. https://doi.org/10.1007/s11121-022-01383-3
  58. Sabaghi, A., Ebrahimi, B., Yousofvand, N., & Hoseini, R. (2025). Comparative effects of moderate-intensity continuous training and high-intensity interval training on ADHD symptoms and behavioral inhibition in children. European Journal of Pediatrics, 184(2), 183. https://doi.org/10.1007/s00431-025-06022-x
  59. Schwartz, M. L., Magzal, F., Yehuda, I., & Tamir, S. (2024). Exploring the impact of probiotics on adult ADHD management through a double-blind RCT. Scientific Reports, 14(1), 26830. https://doi.org/10.1038/s41598-024-73874-y
  60. Sciberras, E. (2022). Sleep in individuals with ADHD: Prevalence, impacts, causes, and treatments. Current Topics in Behavioral Neurosciences, 57, 199–220. https://doi.org/10.1007/7854_2022_336
  61. Seyedi, M., Gholami, F., Samadi, M., Djalali, M., Effatpanah, M., Yekaninejad, M. S., Hashemi, R., Abdolahi, M., Chamari, M., & Honarvar, N. M. (2019). The effect of vitamin D3 supplementation on serum BDNF, dopamine, and serotonin in children with attention-deficit/hyperactivity disorder. CNS & Neurological Disorders – Drug Targets, 18(6), 496–501. https://doi.org/10.2174/1871527318666190703103709
  62. Simpson, T., Pase, M., & Stough, C. (2015). Bacopa monnierias an antioxidant therapy to reduce oxidative stress in the aging brain. Evidence-Based Complementary and Alternative Medicine, 2015, 615384. https://doi.org/10.1155/2015/615384
  63. Soler-Gutiérrez, A.-M., Pérez-González, J.-C., & Mayas, J. (2023). Evidence of emotion dysregulation as a core symptom of adult ADHD: a Systematic Review. PLoS One, 18(1), e0280131. https://doi.org/10.1371/journal.pone.0280131
  64. Stein, M. A., Weiss, M., & Hlavaty, L. (2012). ADHD treatments, sleep, and sleep problems: Complex associations. Neurotherapeutics, 9(3), 509–517. https://doi.org/10.1007/s13311-012-0130-0
  65. Storebø, O. J., Elmose Andersen, M., Skoog, M., Joost Hansen, S., Simonsen, E., Pedersen, N., Tendal, B., Callesen, H. E., Faltinsen, E., & Gluud, C. (2019). Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database of Systematic Reviews, 2019(6), CD008223. https://doi.org/10.1002/14651858.cd008223.pub3
  66. Surman, C. B. H., & Walsh, D. M. (2021). Managing sleep in adults with ADHD: From science to pragmatic approaches. Brain Sciences, 11(10), 1361. https://doi.org/10.3390/brainsci11101361
  67. Talebi, S., Miraghajani, M., Ghavami, A., & Mohammadi, H. (2022). The effect of zinc supplementation in children with attention deficit hyperactivity disorder: A systematic review and dose-response meta‑analysis of randomized clinical trials. Critical Reviews in Food Science and Nutrition, 62(32), 9093–9102. https://doi.org/10.1080/10408398.2021.1940833
  68. Trebatická, J., Kopasová, S., Hradečná, Z., Činovský, K., Škodáček, I., Šuba, J., Muchová, J., Žitňanová, I., Waczulíková, I., Rohdewald, P., & Ďuračková, Z. (2006). Treatment of ADHD with French maritime pine bark extract, Pycnogenol®. European Child & Adolescent Psychiatry, 15(6), 329–335. https://doi.org/10.1007/s00787-006-0538-3
  69. Villagomez, A., & Ramtekkar, U. (2014). Iron, magnesium, vitamin D, and zinc deficiencies in children presenting with symptoms of attention-deficit/hyperactivity disorder. Children, 1(3), 261–279. https://doi.org/10.3390/children1030261
  70. Weyns, A.-S., Verlaet, A. A. J., Breynaert, A., Naessens, T., Fransen, E., Verhelst, H., Van West, D., Van Ingelghem, I., Jonckheere, A. I., Beysen, D., Kenis, S., Moens, E., van Roest, A. P. J., Savelkoul, H. F. J., De Bruyne, T., Pieters, L., Ceulemans, B., & Hermans, N. (2022). Clinical investigation of French maritime pine bark extract on attention-deficit hyperactivity disorder as compared to methylphenidate and placebo: Part 1: Efficacy in a randomised trial. Journal of Functional Foods, 97, 105246. https://doi.org/10.1016/j.jff.2022.105246
  71. Yang, X., Zhang, L., Yu, J., & Wang, M. (2025). Short-term and long-term effect of non-pharmacotherapy for adults with ADHD: a systematic review and network meta-analysis. Frontiers in Psychiatry, 16, 1516878. https://doi.org/10.3389/fpsyt.2025.1516878
  72. Yorgidis, E., Beiner, L., Blazynski, N., Schneider-Momm, K., Clement, H.-W., Rauh, R., Schulz, E., Clement, C., & Fleischhaker, C. (2021). Individual behavioral reactions in the context of food sensitivities in children with attention-deficit/hyperactivity disorder before and after an oligoantigenic diet. Nutrients, 13(8), 2598. https://doi.org/10.3390/nu13082598
  73. Zamora, J., Velásquez, A., Troncoso, L., Barra, P., Guajardo, K., & Castillo-Duran, C. (2011). [Zinc in the therapy of the attention-deficit/hyperactivity disorder in children. A preliminary randomized controlled trial]. Archivos Latinoamericanos de Nutrición, 61(3), 242–246. https://pubmed.ncbi.nlm.nih.gov/22696891/
  74. Zhou, P., Yu, X., Song, T., & Hou, X. (2024). Safety and efficacy of antioxidant therapy in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. PloS One, 19(3), e0296926. https://doi.org/10.1371/journal.pone.0296926
  75. Zhu, F., Zhu, X., Bi, X., Kuang, D., Liu, B., Zhou, J., Yang, Y., & Ren, Y. (2023). Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. Frontiers in Public Health, 11, 1133727. https://doi.org/10.3389/fpubh.2023.1133727