Abstract:
Introduction. Attention-deficit/hyperactivity disorder (ADHD) is a
common and heterogeneous neurodevelopmental disorder, for which
multimodal management (psychoeducation, psychosocial/educational
interventions and, when indicated, pharmacotherapy) represents the standard
of current clinical practice. In this context, nutritional supplements and
phytotherapy are increasingly used as adjunctive interventions, particularly
in situations of family preference for options perceived as “natural”,
incomplete clinical response, or the presence of specific targets, such as sleep.
The aim of this study is to critically synthesize the clinical evidence
(meta-analyses, systematic reviews, and randomized clinical trials) regarding
the efficacy and safety of the main nutritional supplements and
phytotherapeutic agents used as adjuncts in ADHD, integrating the findings
into a prudent, personalized, and monitored clinical approach.
Materials and methods. A critical, evidence-based narrative synthesis
was conducted, focused on sources with robust designs (metaanalyses/
systematic reviews and randomized clinical trials) evaluating
omega-3 (EPA/DHA), vitamin D, zinc, iron (particularly in the context of
deficiencies), phosphatidylserine, citicoline, L-theanine, melatonin, and
phytotherapeutic agents (saffron, Korean red ginseng, Bacopa monnieri).
Pediatric populations were analyzed and, where relevant data were available,
young adult populations.
Results. Overall, the evidence indicates small-to-moderate and
heterogeneous effects on core ADHD symptoms, with more evident utility in
specific subgroups (for example, in the presence of a documented nutritional
deficiency) and for associated targets, particularly sleep. Findings on omega-
3 are variable across meta-analyses; zinc may be associated with modest
reductions in total symptom scores, and vitamin D may confer modest benefits as an adjunct to stimulants. Phosphatidylserine shows a modest
signal for inattention; citicoline did not demonstrate clear clinical benefit in
a randomized pilot study. L-theanine and melatonin are associated with
improvements in sleep parameters. Within phytotherapy, saffron showed
results comparable to methylphenidate in a pilot study, ginseng demonstrated
favorable effects in a randomized study, and Bacopa monnieri has promising,
yet unconfirmed, data in the absence of controlled trials.
Conclusion. The interventions reviewed should be positioned as adjuncts,
not as alternatives to validated interventions. Their responsible integration
requires appropriate patient selection (nutritional profile, comorbidities,
functional targets), the establishment of realistic expectations, and systematic
monitoring of efficacy and safety.
