Effects of Cognitive Behavioural Therapy and Mindfulness-Based Interventions Combined With Structured Care on Executive Function, Emotion Regulation, and Impulsive Behaviour During Dental Treatment in Children With Attention-Deficit/Hyperactivity Disorder

Abstract

Background: Children with attentiondeficit/hyperactivity disorder (ADHD) experience difficulties with executive functions, emotional regulation and impulse control in medical institutions, and dental clinics can be particularly challenging environments. This study aimed to systematically evaluate the effects of cognitive behavioural therapy (CBT) combined with mindfulness-based interventions (MBIs) under structured care in children with ADHD on the following outcomes: executive function (Behavior Rating Inventory of Executive Function, Second Edition [BRIEF-2] and Conners Comprehensive Behavior Rating Scales, Third Edition [Conners-3]), emotion regulation (parent-reported Emotion Regulation Checklist [ERC]), impulsive behaviour during dental treatment (Frankl Behavior Rating Scale [FBRS] and Children’s Fear Survey Schedule-Dental Subscale [CFSS-DS]), core ADHD symptoms (Swanson, Nolan, and Pelham Rating Scale, Fourth Edition [SNAP-IV]), and parental stress (Parenting Stress Index, Fourth Edition [PSI-4]).

Methods: This single-centre retrospective cohort study included 115 children with ADHD who received dental treatment between March 2021 and June 2025. Patients were divided into a combined therapy group (CBT + MBI + structured care, n = 58) and a control group (routine dental behavioural guidance, n = 57) according to the treatment plan documented in routine clinical records. Outcomes were assessed at baseline and at 4, 8, and 12 weeks after treatment. The co-primary outcomes were the BRIEF-2 and Conners-3 scores. A Bonferroni-adjusted two-sided α level of 0.025 was used for these outcomes. Secondary outcomes included ERC, FBRS, CFSS-DS, SNAP-IV, and PSI-4 scores.

Results: Both co-primary outcomes met the multiplicity-adjusted significance threshold at week 12. Compared with the control group, the combined therapy group had lower BRIEF-2 scores (61.1 ± 4.8 vs. 70.5 ± 5.2; mean difference (MD) = −9.4, 95% confidence interval (CI): −11.3 to −7.6) and lower Conners-3 scores (57.8 ± 4.1 vs. 69.0 ± 4.4; MD = −11.2, 95% CI: −12.8 to −9.6; both p < 0.001), with lower scores indicating fewer executive-function and attention difficulties. Secondary outcomes showed higher ERC emotion-regulation and FBRS cooperation scores and lower ERC lability/negativity, CFSS-DS dental-fear, SNAP-IV symptom, and PSI-4 parenting-stress scores (all p ≤ 0.002), except for the prevalence of dental fear (p = 0.053). Covariateadjusted and sensitivity analyses were consistent with the primary findings.

Conclusions: In this single-centre retrospective cohort study, CBT combined with MBI under structured care was associated with better 12-week executive-function/attention, symptom, emotion-regulation, dental-cooperation, and parental-stress outcomes than routine guidance. The protocol may provide a structured management option for children with ADHD who have difficulty cooperating with dental care; however, causal effects and the contribution of each component cannot be established and require confirmation in prospective studies.