Mapping the Mind: A Network Meta-Analysis of Mindfulness and Traditional and Digital Interventions for Cognitive and...

Pharmacological and behavioral interventions are commonly used to manage attention-deficit/hyperactivity disorder (ADHD). This disorder is highly prevalent among children and adolescents. New non-pharmacological approaches, including mindfulness-based therapies (MBT), neurofeedback, and working memory training (WMT), may represent potential alternatives. This network meta-analysis aims to assess the comparative effectiveness of various nonpharmacological interventions for pediatric ADHD. Electronic databases were searched to identify clinical trials that compared different treatments in ADHD to each other, usual care, or waiting list from inception to March 22, 2025. Sixteen studies representing 806 participants were included in this study. The network compared several intervention types: MBT, neurofeedback, cognitive-behavioral therapy (CBT), WMT, and behavioral parent training (BPT) versus control or active comparators. Primary outcome measures were child behavior checklist (CBCL), Conners' rating scale (CRS), inattention and impulsivity measurement, ADHD rating scale-IV, SWAN (strengths and weaknesses of ADHD symptoms and normal behaviors), and parenting stress index-short form (PSI-SF). The ranking of treatment efficacy was based on the surface under the cumulative ranking curve (SUCRA). Family MBT was the most effective intervention for reducing CBCL scores (mean difference (MD) = -5.49, 95% confidence interval (CI): -8.65 to -2.33, p = 0.001) and inattention symptoms (MD = -8.88, 95% CI: -13.50 to -4.26, p < 0.001), ranking highest in effectiveness. BPT (face-to-face) showed the greatest improvement in CRS scores, though not statistically significant (MD = -6.15, 95% CI: -14.49 to 2.19, p = 0.148). Concerning parenting and family outcomes, BPT had the highest probability (65.9%) of reducing parental stress, while usual care was the least effective (69.2%). SUCRA values indicated MBT interventions (family MBT, online MBP, family-based mindfulness intervention (FBMI)) consistently ranked among the most effective treatments for ADHD symptoms, while control groups consistently ranked lowest. This network meta-analysis supports MBT and BPT as effective non-pharmacological treatments for ADHD. Family MBT was particularly effective for inattention and hyperactivity, while BPT significantly reduced parenting stress. However, the findings need to be confirmed through further research with larger sample sizes and longer follow-up periods.