Clinical evidence on Ayurvedic Management of Attention-Deficit/Hyperactivity Disorder in children
and adolescents: A systematic review

H. P. B. R.  Weerasinghe1, W. A. S. S.  Weerakoon1

1Faculty of Indigenous Medicine, University of Colombo, Colombo, Sri Lanka

Corresponding author: W. A. S. S.  Weerakoon, Faculty of Indigenous Medicine, University of Colombo, Colombo, Sri Lanka.

Email: dr.sarojaweerakoon@fim.cmb.ac.lk

DOI: https://doi.org/10.47811/jtmsr.0031070611

Copyright © The Authors. Journal of Traditional Medicine and Sowa Rigpa published by the Faculty of Traditional Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan. Formerly published as Bhutan Sorig Journal.

This is an open access article under the CC BY-NC-ND license.

ABSTRACT

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. Ayurveda proposes several therapeutic approaches, including Medhya Rasayana formulations and Panchakarma procedures, for managing ADHD symptoms. This systematic review evaluated the evidence on Ayurvedic management for ADHD in children and adolescents.

Method: A systematic review was conducted following PRISMA guidelines. Electronic databases were searched for studies published between January 2014 and June 2024. Clinical trials, observational studies, case series and open label studies involving Ayurvedic management in children and adolescents with ADHD were included, and methodological quality was assessed using the Jadad scale.

Results: Of 231 identified records, eight studies met the inclusion criteria. Interventions included Bacopa monnieri, Withania somnifera, Saraswatarista, Brahmi Churna, Mandukaparni Churna, and Mentosoothe formulations, Mahapaishacika Ghrta, and Shirodhara-based therapies. Bacopa monnieri improved attention, impulse control, and cognitive performance, with reductions in attention-deficit symptoms reported in up to 85% of children. Saraswatarista significantly improved scholastic performance and interpersonal relationships. Brahmi Churna and Mandukaparni Churna showed benefits in hyperactive-impulsive and inattentive symptoms, respectively, while Withania somnifera reduced anxiety and social concerns. Combined interventions, particularly Vallarai Khiritha with Shirodhara, demonstrated improvements in overall ADHD symptoms. However, methodological quality was limited, with five studies classified as high risk of bias, two as moderate risk, and only one as low risk.

Conclusion: Ayurvedic management show potential benefits in improving behavioural and cognitive symptoms of ADHD; however, larger, high-quality randomized controlled trials are required to establish their efficacy and safety.

Key words: Adolescent; Ayurvedic Medicine; Child; Complementary Therapy; Plant Extracts; Phytotherapy


INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children, affecting academic performance, behaviour, and social functioning [1]. Global prevalence of ADHD in children and adolescents is approximately 7.6% (95%: CI 6.1 – 9.4%) [2]. Although pharmacological therapies such as stimulants are widely used [3], concerns regarding long-term lifesafety, side effects, adherence, and variable treatment response in some children have led some parents and caregivers to explore complementary approaches, including Ayurveda, as adjuncts to standard care.

The diagnosis of ADHD is primarily standardized through two major classification systems: the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization’s International Classification of Diseases (ICD). While the DSM-IVTR and DSM-5 define ADHD by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development [4], the ICD-10 traditionally classified similar presentations as Hyperkinetic Disorders, requiring both inattention and hyperactivity to be present [5]. The ICD-11 has aligned more closely with the DSM-5 framework, acknowledging ADHD as a singular diagnostic entity with various presentations [6].

In Ayurveda, ADHD has no direct diagnostic equivalent; however, based on symptom similarity, it can be correlated with disturbances of the channels carrying the mind (Manovaha Srotas) and conditions such as mental derangement (Unmada) [7]. ADHD symptoms such as inattention, hyperactivity, and impulsivity can be interpreted through concepts such as disturbed mental control (Mano Vibhrama), impaired cognition and decision-making (Buddhi Vibhrama) and memory disturbances (Smriti Vibhrama). These manifestations are considered to arise from an imbalance of Vital Life Force (Prana Vata), mental and cognitive functions (Sadhaka Pitta), and nourishment and protection of nervous system (Tarpaka Kapha), along with disturbances of dynamic energy (Raja Guna) and inertial energy (Tama Guna). Therefore, Ayurvedic management focusing on brain tonics (Medhya Rasayana), purification therapies (Panchakarma), and lifestyle modifications may help improve the cognitive and behavioural symptoms associated with ADHD.

Ayurvedic management of ADHD includes avoidance of causative factors (Nidana Parivarjana), pharmacological and procedural interventions (Yuktivyapashraya Chikitsa), and psychological and behavioural approaches (Satvavajaya Chikitsa) [8]. Several Medhya Rasayana herbs, including Bacopa monnieri (Brahmi), Withania somnifera (Ashwagandha), Mandukaparni, and Shankhapushpi, are traditionally used to improve cognition, attention, memory, and behavioural regulation [9,10]. In addition, Panchakarma procedures and lifestyle management such as dietary regulation, yoga, and meditation have been advocated in managing ADHD symptoms.

Despite increasing interest in Ayurvedic management for ADHD, the available evidence remains fragmented and consists primarily of small clinical studies using heterogeneous interventions and outcome measures. To date, there has been limited synthesis of the clinical evidence regarding the effectiveness and methodological quality of Ayurvedic therapies for ADHD in children and adolescents. Therefore, this systematic review was conducted to evaluate clinical evidence on the effectiveness of Ayurvedic management for reducing ADHD symptoms in children and adolescents and to assess the methodological quality of the included studies using the Jadad scoring system.

METHODS

Study design

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. The review aimed to synthesize evidence regarding the effectiveness of Ayurvedic management in children and adolescents diagnosed with ADHD.

Search strategy

A comprehensive literature search was performed in Google Scholar, PubMed, ResearchGate, Science- Direct, and the AYUSH Research Portal for studies published between January 2014 and June 2024. Search terms included combinations of Medical Subject Headings (MeSH) and free-text keywords such as “Attention Deficit Hyperactivity Disorder”, “ADHD”, “Ayurveda”, “Ayurvedic management”, “Children”, and “Adolescent” using Boolean operators (“AND”, “OR”). Reference lists of eligible studies were also manually screened to identify additional relevant publications.

Eligibility criteria

Research articles were selected under eligibility assessment based on the following criteria: children and adolescents (≤18 years) diagnosed with ADHD based on DSM-IV/DSM-5 or ICD diagnostic criteria; Ayurvedic management including internal medications (e.g. Medhya Rasayana formulations), Panchakarma therapies, and Ayurveda-based lifestyle modifications; placebo, no intervention, conventional therapy, or other Ayurvedic management; and ADHD-related symptoms such as inattention, hyperactivity, impulsivity, behavioural changes, cognitive performance, scholastic outcomes, and validated rating scale outcomes (e.g., Conners’ Rating Scale). The selection of articles for this systematic review is reported using PRISMA guidelines [11]. Selected articles included randomized controlled trials, non-randomized clinical trials, open-label studies, and case series.

Study selection

The inclusion criteria were as follows: clinical trials, observational studies (including randomized controlled trials, non-randomized clinical trials, open-label trials) evaluating Ayurvedic management of ADHD; participants with children/adolescents diagnosed with ADHD; studies published between January 2014 and June 2024; studies published in English; and full-text articles available.

The exclusion criteria were as follows: review articles, systematic reviews, meta-analyses, conceptual papers; case reports/single case studies (except case series if relevant); studies involving adults only; theses/ dissertations not available as full-text published articles; and animal studies or in-vitro studies.

Data extraction and management

All records retrieved from databases were exported into Microsoft Excel. Duplicate records were identified and removed manually. Two reviewers independently screened titles and abstracts for eligibility. Full-text articles were then assessed independently by both reviewers. Any disagreements were resolved through discussion and mutual consensus.

Extracted information included author and year of publication, country, study design, sample size and participant characteristics, diagnostic criteria, type and duration of intervention, comparator, outcome measures, main findings and adverse events

Risk of bias assessment

Methodological quality was assessed using the Jadad scale, which evaluates randomization, blinding, and reporting of withdrawals and dropouts. Scores range from 0 – 5, with higher scores indicating superior methodological quality. Studies scoring 0 – 2 were considered high risk of bias, scores of 3 – 4 represented moderate risk, and scores of 5 indicated low risk of bias. Assessment was conducted independently by two reviewers, and discrepancies were resolved by consensus [12].

Data analysis

Owing to substantial heterogeneity in interventions, outcome measures, and study designs, quantitative meta-analysis was not considered appropriate. Therefore, a qualitative synthesis was conducted by extracting and summarizing data from the included studies, including study design, sample size, participant characteristics, Ayurvedic management, treatment duration, outcome measures, and key findings. The studies were grouped according to the type of Ayurvedic intervention, such as Medhya Rasayana formulations, herbal extracts, and Panchakarma therapies, and their clinical outcomes were compared narratively.

RESULTS

Studies selected

The literature search identified 231 records from electronic databases. After removal of eight duplicate records, 223 studies underwent title and abstract screening. Of these, 109 full-text articles were assessed for eligibility, and 101 studies were excluded because they were review articles, conceptual papers, pilot studies, or non-clinical studies. Ultimately, eight studies met the eligibility criteria and were included in the qualitative synthesis. Among the included studies, three evaluated single herbal extracts, three investigated Ayurvedic compound formulations, one examined Panchakarma-based interventions, and one assessed combined Ayurvedic therapeutic approaches. The PRISMA flow diagram for the selection of studies is depicted in Figure 1. The characteristics of the eight included studies are provided in Table 1.

Characteristics of included studies

The eight included studies were published between 2014 and 2023 and were conducted in India (n = 5), Sri Lanka (n = 1), Australia (n = 1), and Iran (n = 1) as shown in Table 1. Sample sizes ranged from 5 to 120 participants, with study durations varying from 30 days to 6 months. Six studies included only children, while two studies included both children and adolescents. ADHD diagnosis was primarily based on DSM-IV or DSM-5 criteria. Study designs included randomized controlled trials (n = 5), randomized placebo-controlled studies (n = 2), one open-label trial, and one case series. Outcome measures varied considerably and included the Conners’ Parent Rating Scale, DSM-based assessments, cognitive performance measures, scholastic performance indicators, and behavioural assessments.

Table 1. Characteristics of studies that reported on the Ayurvedic management of attention-deficit/hyperactivity disorder in children and adolescents

Author, year, country Type of study design, study setting Sample size Intervention Control Follow up Duration Method of Measurement Results/Findings
Dave et al.
2014, India [13]		 Open-labelled, Centre for Research in Mental Retardation (CREMERE), Mumbai n = 31; aged 6 – 12 years Standardized Bacopa monnieri extract at a dose of 225 mg/d - 6 months Dropouts = 4 Symptom scores for restlessness were reduced in 93% of children, improvement in self-control was observed in 89% of the children. The attention-deficit symptoms were reduced in 85% of children. Symptom scores for learning problems, impulsivity, and psychiatric problems were reduced in 78%, 67%, and 52% of children, respectively. Observed that 74% of the children exhibited up to a 20% reduction, while 26% of children showed between a 21% and a 50% reduction in the total subtests scores, except for social problems. Standardized extract of Bacopa monnieri was well tolerated by the children.
Anpuchelvi et al.
2014, Sri Lanka [14]		 Randomized Placebo, Hospital-based OPD study n = 48; aged 6 – 15 years

Group A: n = 12
Group B: n = 12
Group C: n = 12
Group D: n = 12 		Group A: Vallarai Khiritha (200 mg/kg/day) in 2 divided doses Group B: Vallarai Khiritha + Shirodhara Group D: Shirodhara
    Group C: placebo (Honey doses to that of study drugs)
3 months Dropouts = 8 Both drug & Shirodhara were effective in alleviating the symptoms of ADHD.
Kean et al. 2015, Australia [15] Randomized, placebo-controlled, double-blind trial, Swinburne Centre for Human Psychopharmacology, Swinburne University Victoria n = 120; male
children aged 6 – 14 years 		Visit 1, Week 0: placebo capsules for 7 days

Visit 2, Week 1: CDRI08 or placebo 14 weeks

Visit 3 & 4: same outline of CDRI08 or placebo till week 15

Visit 5, Week 16: placebo for 1 week (CDRI08- Bacopa extract) 		- 16 weeks 20% Dropouts rate Reduction of the level of hyperactivity and inattention measured by the Conners’ Parent Rating Scale. Cognitive function, mood, sleep quality, and electroencephalographic parameters were assessed.

The results of the study suggest that Bacopa monnieri extract (CDRI 08) may improve brain and cognitive function.
Kumar et al. 2015, India [16] Randomized, double blind, placebo-control Out-patient Department of PG Department of Gopabandhu Ayurveda Mahavidyalaya, Puri & Schools in Puri n = 35; aged 7 – 13 years Diagnostic screening of children DSMIV Criteria Group A: n = 15; treated with Saraswatarista; 01 mL/ kg/day two divided doses with equal amount of water Group B: n = 15; given only placebo syrup 12 weeks 5 Dropouts Group A: Patients showed highly significant improvement in overall scholastic performance, participation in organized activities, writing skills, mathematical aptitude, and relationships with parents and siblings and reading ability.

Group B: Changes were not statistically significant.
Deokar et al. 2023, India [17] Randomized, open-labelled clinical trial study Out-patient Department and In-patient Department of Kaumarabhritya Department, Parul Institute of Ayurveda, Vadodara n = 20 Diagnostic screening of children DSMIV Criteria Group A: n = 10; Brahmi Churna 3 g in 3 divided doses before meals, anupana-madhu

Group B: n = 10; Mandukaparni Churna 3 g in 3 divided doses before meals, anupanamadhu		 - 45 days - Brahmi had significant results on Inattention as well as Hyperactive-Impulsive type of (ADHD).

Mandukaparni showed significant results on both criteria, especially in inattention type.
Hosseini et al. 2017, Iran [18] Randomized, double blind, placebo control Ibn Sina Hospital Mashhad n = 31 Based on DSM- 5 diagnostic criteria Control group; n = 15; placebo Intervention group; n = 16; consumed 10 mg Withania somnifera once daily for 6 weeks. - 6 weeks 6 dropouts Reduced the symptoms of physiological anxiety, sensitivity, and social concerns.
Kumawat et al. 2023, India [19] Randomized, double blind, comparative Out-patient Department and In-patient Department of balaroga/ kaumarabrtya Deptartment of N.I.A. Jaipur & Associated Hospital n = 40 Based on DSM- 5 criteria of diagnosis Group A: n = 20; Mentosoothe compound A (Tagar, Vacha, Brahmi, Ashwagandha, Trikatu) dose - 250 mg BD, route - oral

Group B: n = 20; Mentosothe compound B (Jatamansi, Shankapushpi, Guduchi, Chitrak, Trikatu) dose - 250 mg BD, route - oral		 - 3 months(2 months clinical trial + 1 month post clinical period) - Reduced the symptoms of physiological anxiety, sensitivity, and social concerns. Both formulations showed clinically significant improvement, with comparative differences observed between groups.
Aboobacker et al. 2023, India [20] Case series Five diagnosed cases of ADHD as per DSM-5 criteria Manassanthi Out-patient Department of VPSV Ayurveda College Kottakal n = 5 Case 1: 6-year-old male
Case 2: 8-year-old male
Case 3: 9-year-old male
Case 4: 7-year-old male
Case 5: 7-year-old female Treated with Mahapaishacika Ghrta, twice daily 1 h after food, with lukewarm water		 - 30 days - 36% relief on hyperactivity domain and 20% relief on inattention domain in the Conner’s Revised Rating Scale after Ayurvedic management and follow up.

Effects of Ayurvedic management

Bacopa monnieri demonstrated improvements in attention, impulse control, restlessness, learning problems, and cognitive performance [15]. One study reported reductions in restlessness in 93% of participants, improvements in self-control in 89%, and reductions in attention-deficit symptoms in 85% of children [13]. Saraswatarista showed significant improvements in scholastic performance, participation in organized activities, reading ability, writing skills, and interpersonal relationships [16]. Brahmi Churna and Mandukaparni Churna demonstrated beneficial effects on hyperactive-impulsive and inattentive symptoms, respectively [17]. Withania somnifera reduced physiological anxiety and social concerns among children with ADHD [18]. Furthermore, combined interventions such as Vallarai Khiritha with Shirodhara and Mentosoothe formulations reported clinically significant improvements in overall ADHD symptomatology [14]. Mahapaishacika Ghrta demonstrated a 36% reduction in hyperactivity scores and a 20% reduction in inattention scores following treatment and follow-up [20].

No serious adverse events attributable to Ayurvedic management were reported in the included studies; however, adverse event reporting was inconsistent across studies.

Heterogeneity of outcome measures

Considerable heterogeneity was observed among the studies with respect to interventions, outcome measures, treatment durations, and study designs. Assessment tools included the Conners’ Parent Rating Scale, DSM-IV/5 criteria, scholastic performance indicators, cognitive assessments, and investigator-developed symptom scores. Due to this clinical and methodological heterogeneity, quantitative synthesis was not feasible.

Quality assessment of studies

The overall methodological quality of the included trials was predominantly low to moderate, with five of the eight studies (62.5%) being classified as having a high risk of bias, two studies (25.0%) demonstrating moderate risk, and only one study (12.5%) exhibiting a low risk of bias (Table 2).


Table 2. Jadad scores for assessing Risk of Bias in the included studies

Author, Year (Reference) Randomization Double Blinding Description of Randomization Description of Double Blinding Description of Withdrawal Total Points Risk of Bias Interpretation
Dave et al.
2014, India [13]		 - - - - 01 point 01 point High Risk
Anpuchelvi et al.
2014, Sri Lanka [14]		 01 point - - - 01 point 02 points High Risk
Kean et al. 2015, Australia [15] 01 point 01 point 01 point 01 point 01 point 05 points Low Risk
Kumar et al. 2015, India [16] 01 point 01 point - - 01 point 03 points Moderate Risk
Deokar et al. 2023, India [17] 01 point - 01 point - - 02 points High Risk
Hosseini et al. 2017, Iran [18] 01 point 01 point - - 01 point 03 points Moderate Risk
Kumawat et al. 2023, India [19] 01 point 01 point - - - 02 points High Risk
Aboobacker et al. 2023, India [20] - - - - - 00 points High Risk


DISCUSSION

This systematic review summarizes clinical evidence on Ayurvedic management for ADHD in children and adolescents. Synthesis of the included studies suggests that brain tonic (Medhya Rasayana) formulations and Panchakarma-based interventions may contribute to improvement in core symptoms of inattention, hyperactivity, and behavioural outcomes [14,16,18]. However, the overall evidence remains limited due to methodological weaknesses, including small sample sizes (n < 50), inadequate blinding, and limited use of placebo controls.

The use of Bacopa monnieri was evaluated across several trials for its effect on inattention and cognitive processing and studies reported that Bacopa is well-tolerated in children aged 6 – 12 years [15,17]. Clinical results using the (CDRI) 08 extract—a standardized Bacopa formulation—demonstrated reduced symptoms based on the Conners' Parent Rating Scale [21]. Similarly, Saraswatarista improved scholastic performance and interpersonal relationships using the Diagnostic and Statistical Manual of Mental Disorders [16]. While Brahmi Churna showed significance in hyperactive-impulsive symptoms, Mandukaparni Churna demonstrated a focus on inattention, though these findings are limited by small sample sizes and short durations of 45 days.

The clinical improvements observed across these studies are grounded in the distinct pharmacological and physiological effects of the interventions on the central nervous system. Bacopa monnieri, a primary Medhya Rasayana, have been shown to facilitate the repair of damaged neurons and promote synaptic activity [22]. This neurological restoration improves nerve impulse transmission, which is directly linked to increased attention span and memory retention in children with ADHD [15].

Interventions targeting the physiological stress response and impulsivity utilized herbs like Withania somnifera (Ashwagandha). Ashwagandha reduces physiological anxiety and social concerns as measured by DSM-5 criteria. Ashwagandha exerts a calming effect that helps mitigate the impulsivity and restlessness characteristic of ADHD [18]. Mahapaishacika Ghrta, containing Nardostachys jatamansi (Jatamansi) as a key ingredient, resulted in a 36% improvement in hyperactivity and 20% improvement in inattention [20].

The combination of internal medicine and external procedures showed a synergistic advantage in symptom management. The combination of Vallarai Khiritha and Shirodhara—an Ayurvedic therapy involving a steady, rhythmic stream of warm herbal oil poured onto the forehead, resulted in significant improvements in the Intelligence Quotient (IQ), Coefficient of Division of Attention, and Reaction Time [14]. The therapeutic effect of Shirodhara is attributed to the induction of a parasympathetic state via continuous tactile stimulation of the forehead, which lowers autonomic arousal and improves self-control.

Considerable heterogeneity was observed among the included studies regarding study design, diagnostic criteria, interventions, outcome measures, and duration of follow-up. Such variability limited direct comparisons between studies and precluded quantitative meta-analysis. Furthermore, the use of non-standardized formulations and varying dosages poses challenges for establishing evidence-based treatment recommendations for their use in clinical settings. Therefore, these interventions should not currently be considered substitutes for established evidence-based treatments until further robust evidence becomes available.

Limitation

The findings of this review should be interpreted in light of several limitations. Challenges commonly arise when conducting systematic reviews in this field, including the limited availability of high-quality data, studies not being published as full articles, and a general scarcity of large-scale clinical trials. Furthermore, the individual studies included in this review often suffered from insufficient randomization and small sample size, a lack of robust control groups, and short duration of management. Future research should prioritize larger cohorts, randomized controlled designs, and longer duration of follow-up to validate these findings and establish standardized treatment protocols.

CONCLUSION

By conceptualizing the condition as an imbalance of the brain doshas and qualities of mind, Medhya Rasayanas like Bacopa monnieri and Withania somnifera, alongside procedural therapies such as Shirodhara, have demonstrated improvements in attention span, cognitive function, and the regulation of hyperactive- impulsive behaviours. However, the scientific validation of these findings is limited by methodological weaknesses, including small sample sizes, short study durations, and a lack of replicable evidence comparing standardized formulations against conventional treatments or placebos. The challenges in standardizing traditional preparations, combined with the complexity of evaluating multi-modal Panchakarma therapies, underscore a critical gap in the current research framework.


Declarations

Ethics approval and consent to participate.

Not applicable

Consent for publication

Not applicable


Competing interests

The authors declare no competing interests.

Funding

There was no funding for this article.


Availability of data materials

All available data sources are cited in this article.


Declaration of Artificial Intelligence Use

AI-based tools are used only for minor language editing. All scientific content, data interpretation, and conclusions are the work of the authors.

Author contribution

Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Writing - original draft: HPBRW

Conceptualization, Methodology, Validation, Formal analysis, Resources, Writing – review & editing, Supervision, Project administration: WASSW

Received: 05 March, 2026   Revised: 25 July, 2026   Accepted:25 July, 2026   Published online: 07 August, 2026

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