The key finding
A 2025 network meta-analysis of 42 studies involving 1,981 children and adolescents with ADHD (average age 10 years) found that physical exercise produced the strongest immediate improvements in inhibitory control—the ability to resist impulsive actions. Physical exercise ranked highest with an 85.9% probability of being the best treatment immediately after intervention. However, when researchers examined which benefits lasted over time, behavioral therapy emerged as the clear winner with a 95.1% probability of sustaining improvements, while the positive effects from physical exercise diminished and showed no significant long-term benefit. Cognitive training and neurofeedback also showed immediate benefits, though less pronounced than exercise.
What the study looked like
Researchers conducted a network meta-analysis—a statistical method that compares multiple treatments simultaneously—reviewing randomized controlled trials published through November 2024. The analysis included seven types of non-pharmacological interventions: physical exercise, cognitive training, behavioral therapy, neurofeedback, board games, EMG (muscle) biofeedback, and meditation. All 1,981 participants were children and adolescents diagnosed with ADHD, with ages averaging around 10 years old. The researchers examined how each intervention affected inhibitory control immediately after treatment and during follow-up periods. Inhibitory control was measured using standardized tests that assess a child’s ability to stop automatic responses and resist distractions—core challenges for individuals with ADHD.
Why researchers think this happened
The study authors suggest that different interventions work through distinct mechanisms, explaining why their immediate versus long-term effects vary. Physical exercise likely improves inhibitory control acutely by increasing dopamine and norepinephrine levels in the brain—neurotransmitters that help regulate attention and impulse control. However, these neurochemical changes may be temporary without continued exercise. Behavioral therapy, conversely, teaches children specific strategies and coping skills that become internalized habits, explaining its superior maintenance effect. Cognitive training strengthens neural pathways through repeated mental exercises, creating lasting structural changes that also persist over time. Neurofeedback showed immediate benefits by teaching real-time brain regulation, but these skills may fade without ongoing practice, similar to physical exercise effects.
How to read this carefully
This analysis has important limitations readers should consider. Network meta-analyses combine data from different studies with varying protocols, participant characteristics, and measurement tools, which can introduce inconsistency. The 42 included studies likely used different doses, frequencies, and durations of each intervention, making it difficult to identify optimal treatment parameters. The follow-up periods also varied across studies, so “long-term” meant different timeframes for different interventions. Additionally, this study examined group averages—individual children may respond differently based on ADHD subtype, severity, age, and personal preferences. The analysis focused solely on inhibitory control, one aspect of ADHD symptoms, and didn’t measure other important outcomes like academic performance, social functioning, or overall quality of life.
What this means for everyday life
For families navigating ADHD management, this research suggests that combining different non-pharmacological approaches might be worthwhile—using physical exercise for immediate support while building behavioral therapy skills for lasting change. Parents might consider incorporating regular physical activity into daily routines for acute symptom relief during challenging times like homework or transitions, while simultaneously working with therapists on behavioral strategies that children can carry forward. The finding that three interventions (board games, EMG feedback, and meditation) showed no significant benefits in this population doesn’t mean they’re useless, but suggests families might prioritize other approaches first. Given these are non-drug interventions, discussing a multimodal approach with healthcare providers could help tailor strategies to each child’s specific needs and family circumstances, recognizing that what works varies considerably between individuals.