Group counseling compared with alternative non-pharmacological interventions and standard care for subthreshold ADHD in children and adolescents: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effect of group counseling compared to other non-pharmacological interventions and standard care on functional outcomes in children and adolescents with subthreshold attention deficit hyperactivity disorder (sADHD). INTRODUCTION: sADHD refers to children and adolescents who exhibit clinically relevant symptoms of attention deficit hyperactivity disorder (ADHD) without meeting the full diagnostic criteria. Although these individuals often show impairments across academic, social, and emotional domains, they are frequently under-identified and underserved in clinical settings. While group counseling has demonstrated benefits in full-syndrome ADHD, its specific impact on the sADHD population remains unclear. ELIGIBILITY CRITERIA: This review will include children and adolescents aged 6 to 18 years with sADHD, defined by subclinical symptoms that do not meet full diagnostic criteria. Studies using offline, face-to-face group counseling interventions aimed at improving functional outcomes in this population will be included. Comparators include other non-pharmacological interventions or standard care. Studies where sADHD data cannot be separated, where pharmacological treatments are primary, or that target caregivers without addressing child outcomes will be excluded. METHODS: PubMed, Embase, PsycINFO, ERIC, ProQuest, and Cochrane CENTRAL will be searched without publication date restrictions for studies in English. Two independent reviewers will screen studies, assess quality, extract data, and conduct the synthesis. Where feasible, a meta-analysis will be performed; otherwise, a narrative synthesis will be provided in cases of substantial heterogeneity. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). REVIEW REGISTRATION: PROSPERO CRD420251110113.