Effects of Cognitive Behavioral Interventions on Core Symptom Dimensions of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Review and Meta-Analysis
Abstract
Background: Previous research on psychosocial interventions for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) has primarily focused on overall symptom severity, with less attention to treatment effects across core symptom dimensions. This systematic review and meta-analysis evaluated the effects of cognitive behavioral interventions on overall ADHD symptoms, inattention, and hyperactivity/impulsivity and explored the influence of intervention type, treatment duration, and weekly session frequency. Methods: PubMed, Web of Science Core Collection, Embase, and CENTRAL were searched from inception to 30 June 2026 for randomized controlled trials. Risk of bias was assessed using RoB 2. Effect sizes were calculated as Hedges’ g and pooled using random-effects models, with sensitivity and exploratory subgroup analyses conducted. The review was registered in PROSPERO (CRD420261376097). Results: Ten randomized controlled trials involving 849 participants were included. Cognitive behavioral interventions significantly reduced overall ADHD symptoms (g = −0.389, 95% CI −0.773 to −0.005), inattention (g = −0.415, 95% CI −0.749 to −0.082), and hyperactivity/impulsivity (g = −0.366, 95% CI −0.658 to −0.075). Inattention showed the numerically largest pooled effect. Exploratory subgroup analyses showed numerical differences across intervention type, treatment duration, and weekly session frequency, but formal moderator tests found no statistically significant between-subgroup differences. Conclusions: These findings support the potential benefits of cognitive behavioral interventions for ADHD symptom management, with the most consistent results observed for inattention. Future randomized controlled trials should compare intervention components and treatment schedules while assessing actual treatment exposure, including home practice, to inform more targeted cognitive behavioral interventions.