Impact of Serum Ferritin on the Pathophysiology of Attention-Deficit/Hyperactivity Disorder: What Is the Evidence?

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurobehavioral disorders in childhood. Although its pathophysiology is not fully understood, growing interest has focused on potentially modifiable factors, including iron metabolism. Serum ferritin, a marker of peripheral iron status, has been widely investigated in relation to ADHD due to iron's role in dopamine synthesis and neurodevelopment. This narrative evidence-based review aims to critically synthesize and interpret current clinical and mechanistic evidence regarding the association between serum ferritin levels and the pathophysiology of ADHD in the pediatric population. A literature search was conducted using PubMed and reference lists of relevant articles to identify studies published in the last decade that evaluated serum ferritin in children with ADHD. The available evidence included a limited number of clinical trials, systematic reviews, and one meta-analysis, with heterogeneous methodologies and outcomes. While some studies reported lower serum ferritin levels in children with ADHD and associations with symptom severity, others did not confirm these findings. Overall, current evidence is inconsistent and insufficient to support a definitive association between low serum ferritin levels and ADHD pathophysiology or to recommend routine ferritin assessment in clinical practice. Further well-designed, longitudinal studies are needed to clarify the role of iron status in ADHD and its potential clinical implications.