{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:45:24Z","timestamp":1792215924320,"version":"4.4.0"},"reference-count":84,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"crossref","award":["2022YFC3600201"],"award-info":[{"award-number":["2022YFC3600201"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100005236","name":"Chinese Universities Scientific Fund","doi-asserted-by":"crossref","award":["2024JNPD001"],"award-info":[{"award-number":["2024JNPD001"]}],"id":[{"id":"10.13039\/501100005236","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Dysregulation of the microbiota\u2013gut\u2013brain axis has been implicated in attention-deficit\/hyperactivity disorder (ADHD), but randomized controlled trial evidence for probiotic supplementation remains inconsistent. Objective: This systematic review and meta-analysis evaluated the effects of probiotic supplementation on ADHD-related clinical outcomes and emotional\u2013behavioral outcomes in children and adolescents. Methods: PubMed, Embase, Cochrane CENTRAL, Web of Science, PsycINFO, and EBSCO were searched from database inception to October 2025. Randomized controlled trials including participants under 18 years of age with DSM-defined ADHD were eligible. Pooled effects were calculated using standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) under random-effects models. Results: Nine RCTs involving 482 participants were included, with intervention durations ranging from 8 to 12 weeks. In the broad exploratory synthesis of ADHD-related clinical outcomes, probiotic supplementation did not show a clear benefit (SMD = \u22120.25, 95% CI: \u22120.57 to 0.07; p = 0.131). Because this analysis combined conceptually heterogeneous instruments, greater interpretive weight was placed on domain-specific analyses. No clear effects were observed for more specific core symptom-related measures, including SNAP-IV inattention scores and CPT-derived attention-related performance measures. In domain-specific exploratory analyses, CPRS total scores showed a small reduction following probiotic supplementation (SMD = \u22120.33, 95% CI: \u22120.65 to \u22120.01; p = 0.041), whereas CBCL total scores did not show a statistically significant effect under the random-effects model (MD = \u22121.93, 95% CI: \u22126.30 to 2.44; p = 0.386). The SNAP-IV hyperactivity finding was statistically significant but was largely driven by a single study and should be interpreted cautiously. Conclusions: Current 8\u201312-week RCT evidence does not demonstrate a clear benefit of probiotic supplementation for ADHD core symptom-related measures. However, exploratory findings suggest that probiotic supplementation may have potential for improving broad parent-reported emotional\u2013behavioral outcomes, particularly CPRS-assessed behavioral symptoms. This potential benefit should be interpreted cautiously because it was based on a small number of heterogeneous trials and was not consistently supported by CBCL outcomes. Larger, rigorously designed trials are needed to confirm these broad parent-reported behavioral and emotional findings and clarify their clinical relevance.<\/jats:p>","DOI":"10.3390\/nu18142357","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T02:32:08Z","timestamp":1784514728000},"page":"2357","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Probiotic Supplementation in Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of ADHD-Related and Emotional\u2013Behavioral Outcomes"],"prefix":"10.3390","volume":"18","author":[{"given":"Yizhen","family":"Yan","sequence":"first","affiliation":[{"name":"Beijing Key Laboratory of Sports Performance and Skill Assessment, Beijing Sport University, Beijing 100084, China"},{"name":"School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China"},{"name":"Key Laboratory for Performance Training and Recovery of General Administration of Sport, Beijing Sport University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haotian","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengke","family":"Han","sequence":"additional","affiliation":[{"name":"School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7049-880X","authenticated-orcid":false,"given":"Li","family":"Zhao","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Sports Performance and Skill Assessment, Beijing Sport University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1778-002X","authenticated-orcid":false,"given":"Shan-Shan","family":"Mao","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Sports Performance and Skill Assessment, Beijing Sport University, Beijing 100084, China"},{"name":"School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"(2022). 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