INTRODUCTION
Attention-Deficit/Hyperactivity Disorder (ADHD) is among the most common neurodevelopmental disorders in childhood, significantly affecting academic performance, social interactions, emotional regulation, and overall quality of life. In recent decades, the global prevalence of ADHD has been rising, with Iranian studies reporting a wide range of 0.95%-17%, reflecting marked differences in diagnostic criteria, tools, and population contexts (Hassanzadeh et al., 2019). While genetic and neurobiological factors are traditionally emphasized in the etiology of ADHD, emerging evidence underscores the pivotal role of lifestyle variables, such as nutrition, physical activity, sleep, and environmental exposures, as risk or moderating factors in both the development and persistence of symptoms. Children with ADHD tend to follow less healthy lifestyle patterns compared to their peers, often irrespective of comorbidities or pharmacological/psychological interventions. In this context, Iranian Traditional Medicine (ITM) provides a unique conceptual model for health maintenance based on six essential principles: air, motion and rest, sleep and wakefulness, eating and drinking, retention and evacuation, and emotional states. In light of the aforementioned issues, the present study aimed to explore lifestyle challenges in children with ADHD through the lens of these six principles, using a structured qualitative approach.
METHODS
This qualitative study was conducted using the thematic analysis method based on the six-step method (Attride-Stirling, 2001). A total of 187 sources, including international and Iranian academic articles, books, and dissertations published between 2003 and 2023, were reviewed. After a rigorous screening process, 75 sources were selected for final analysis. Through iterative coding, 77 meaningful units were extracted and categorized into 56 basic themes, 6 organizing themes, and one global theme. These themes were subsequently matched with the six foundational principles of health in ITM and informed the design of an integrative intervention model.
RESULTS
The findings revealed that lifestyle problems among children with ADHD are multidimensional, overlapping, and deeply linked to the six principles of ITM. Summarized below:
Air (Hawa): Exposure to outdoor air pollution, household pollutants (e.g., cigarette smoke), and limited green space in urban environments was strongly associated with increased behavioral symptoms of ADHD. In ITM, clean air is vital for brain function, and chronic pollution is believed to impair temperaments and weaken cognitive faculties.
Motion and rest: Children with ADHD often exhibit low physical activity levels, higher screen time, and increased risk of obesity. ITM considers balanced motion crucial for humor regulation and detoxification, and physical inactivity may exacerbate neurobehavioral symptoms.
Sleep and wakefulness: Various sleep disturbances were prevalent, including insomnia, daytime drowsiness, disrupted circadian rhythms, restless leg syndrome, and poor sleep quality. From the ITM perspective, healthy sleep is essential for revitalizing bodily and mental capacities. Sleep imbalance is linked to cognitive and emotional dysregulation.
Eating and drinking: The children’s diets were characterized by high consumption of processed foods, refined sugars, saturated fats, and low intake of essential nutrients such as iron, zinc, magnesium, and omega-3 fatty acids. Skipping breakfast, food allergies, and unhealthy eating behaviors (e.g., emotional eating or use of food as a distraction) were also noted. These patterns correspond to a Western dietary model and are considered harmful, contributing to melancholic or choleric imbalances affecting brain function.
Retention and evacuation: High rates of constipation and fecal incontinence were documented. ITM emphasizes regular evacuation as vital to maintaining temperament balance. Impaired elimination processes can lead to the accumulation of waste products (e.g., black bile), triggering mood instability and behavioral disorders.
Emotional states (A'rāz-e-Nafsāni): Emotional and behavioral challenges, including anxiety, depression, anger, and irritability, were widely observed. In ITM, such imbalances in emotional states are closely tied to disturbances in cerebral temperament and are considered critical risk factors for mental health decline.
CONCLUSION
The study illustrated that lifestyle disturbances in children with ADHD are both consequences and potential aggravators of the disorder. Applying the six-principle model of ITM enables a more holistic interpretation of these disturbances, providing a foundation for designing culturally contextualized, multidimensional, and individualized interventions. These interventions can complement conventional medical and psychological treatments, offering pathways for improving life quality and symptom management. It is recommended that future studies incorporate mixed-method approaches, including interviews with parents and children, standardized questionnaires, and longitudinal designs to deepen understanding and enhance intervention design.
Ethical Considerations
Compliance with ethical guidelines
This study was extracted from the first author’s doctoral dissertation. It has been approved by the Research Ethics Committee of Islamic Azad University, Khomeinishahr Branch, under the ethics code IR.IAU.KHSH.REC.1402.101.
Funding
There is no funding support.
Authors' Contributions
All authors contributed to the design, data collection, analysis, and writing of the manuscript.
Conflict of Interest
The authors declare that they have no conflict of interest regarding the publication of this study.
Acknowledgments
We express sincere gratitude to the experts and researchers who contributed scientific insight and resource access during the research process.