Serum ferritin in children with Attention Deficit Hyperactivity Disorder (ADHD): A systematic review and meta-analysis
- 1Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
- 2Department of Sport Science, College of natural Science, Woldia University, Woldia, Ethiopia
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neurodevelopmental disorder of uncertain etiology. Iron is crucial for brain function and dopamine regulation, but prior studies examining its association with ADHD have produced inconsistent results. This systematic review and meta-analysis aimed to compare serum ferritin concentrations in children with ADHD versus healthy controls. Method: This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, Science Direct, and Google Scholar to identify eligible studies. Statistical analyses were performed using STATA version 17, and a random-effects model was applied to estimate the pooled mean difference (MD) and standardized mean difference (SMD). Heterogeneity across included studies was assessed using Higgins’ I2 test. Publication bias was evaluated visually using funnel plots and statistically via Egger’s weighted regression test. Results: A total of 7643 articles were identified, of which 21 studies (including 4,058 ADHD cases and 4,533 controls) were included in the final meta-analysis. The pooled mean difference (MD) in serum ferritin levels between children with ADHD and healthy controls was −9.74 (95% CI: −16.50, −2.98). Subgroup analyses were conducted to explore heterogeneity. By continent, the highest pooled MD was observed in Africa (−19.28, 95% CI: −40.73, 2.17) and the lowest in North America (−1.42, 95% CI: −6.98, 4.13). By publication year, studies published before 2015 showed a pooled MD of −1.94 (95% CI: −2.31, −1.58), compared to −19.43 (95% CI: −34.37, −4.49) for those published after 2016. By sample size, smaller studies (<199 participants) yielded a higher MD (−12.12, 95% CI: −21.91, −2.34) than larger studies (≥200 participants; −7.64, 95% CI: −17.33, 2.05). By study design, the pooled MD was −1.95 (95% CI: −2.31, −1.59) for case-control studies and −14.85 (95% CI: −27.07, −2.63) for comparative cross-sectional studies. In the subgroup analysis based on ADHD diagnostic criteria, the DSM-IV-TR criteria yielded the largest mean difference (−16.56, 95% CI: −28.23, −4.89). Conclusion: Lower serum ferritin levels (pooled MD: −9.74) are associated with ADHD in children. Accordingly, screening for serum ferritin and enhanced iron supplementation should be considered in this population. Future longitudinal studies are needed to clarify the causal relationship between iron deficiency and ADHD severity.
Related
- The ADHD advantage: Comorbid attention-deficit/hyperactivity disorder is associated with earlier diagnosis and better academic outcomes in children with specific language disorder
- Food allergy and attention-deficit/hyperactivity disorder in children: evidence and implications for pediatric allergy practice
- Dissociable Oscillatory Alpha and Aperiodic Neural Dynamics Underlie Atypical Attentional Control in Children With Attention-Deficit/Hyperactivity Disorder (ADHD)
- Incidence of Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder in Japan.
- An explainable machine learning model based on multidimensional task-state electroencephalography for identifying attention-deficit/hyperactivity disorder comorbid developmental dyslexia
BibTeX
@article{gedfie2026serum,
title = {{Serum ferritin in children with Attention Deficit Hyperactivity Disorder (ADHD): A systematic review and meta-analysis}},
author = {Solomon Gedfie and Muluken Gashaw and Abebe Adisu and Alembante Bazezew and Abdu Jemal and Mengistu Tesfa Alula and Bewuketu Belete Alemu and Marye Nigatie and Zewdu Tefera and Bayih Ejigu Yimer and Yalewayker Gashaw and Agenagnew Ashagre and Wagaw Abebe and Woldeteklehaymanot Kassahun},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359790},
url = {https://doi.org/10.1371/journal.pone.0359790},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Serum ferritin in children with Attention Deficit Hyperactivity Disorder (ADHD): A systematic review and meta-analysis
AU - Solomon Gedfie
AU - Muluken Gashaw
AU - Abebe Adisu
AU - Alembante Bazezew
AU - Abdu Jemal
AU - Mengistu Tesfa Alula
AU - Bewuketu Belete Alemu
AU - Marye Nigatie
AU - Zewdu Tefera
AU - Bayih Ejigu Yimer
AU - Yalewayker Gashaw
AU - Agenagnew Ashagre
AU - Wagaw Abebe
AU - Woldeteklehaymanot Kassahun
PY - 2026
DA - 2026/10/05
JO - PLOS One
DO - 10.1371/journal.pone.0359790
UR - https://doi.org/10.1371/journal.pone.0359790
AB - Background: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neurodevelopmental disorder of uncertain etiology. Iron is crucial for brain function and dopamine regulation, but prior studies examining its association with ADHD have produced inconsistent results. This systematic review and meta-analysis aimed to compare serum ferritin concentrations in children with ADHD versus healthy controls. Method: This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, Science Direct, and Google Scholar to identify eligible studies. Statistical analyses were performed using STATA version 17, and a random-effects model was applied to estimate the pooled mean difference (MD) and standardized mean difference (SMD). Heterogeneity across included studies was assessed using Higgins’ I2 test. Publication bias was evaluated visually using funnel plots and statistically via Egger’s weighted regression test. Results: A total of 7643 articles were identified, of which 21 studies (including 4,058 ADHD cases and 4,533 controls) were included in the final meta-analysis. The pooled mean difference (MD) in serum ferritin levels between children with ADHD and healthy controls was −9.74 (95% CI: −16.50, −2.98). Subgroup analyses were conducted to explore heterogeneity. By continent, the highest pooled MD was observed in Africa (−19.28, 95% CI: −40.73, 2.17) and the lowest in North America (−1.42, 95% CI: −6.98, 4.13). By publication year, studies published before 2015 showed a pooled MD of −1.94 (95% CI: −2.31, −1.58), compared to −19.43 (95% CI: −34.37, −4.49) for those published after 2016. By sample size, smaller studies (<199 participants) yielded a higher MD (−12.12, 95% CI: −21.91, −2.34) than larger studies (≥200 participants; −7.64, 95% CI: −17.33, 2.05). By study design, the pooled MD was −1.95 (95% CI: −2.31, −1.59) for case-control studies and −14.85 (95% CI: −27.07, −2.63) for comparative cross-sectional studies. In the subgroup analysis based on ADHD diagnostic criteria, the DSM-IV-TR criteria yielded the largest mean difference (−16.56, 95% CI: −28.23, −4.89). Conclusion: Lower serum ferritin levels (pooled MD: −9.74) are associated with ADHD in children. Accordingly, screening for serum ferritin and enhanced iron supplementation should be considered in this population. Future longitudinal studies are needed to clarify the causal relationship between iron deficiency and ADHD severity.
SN - 1932-6203
ER -