“Which resilience factors are the most effective for which Outcomes?” A systematic review and Meta-Analysis of multisystemic resilience of children with ADHD

Resilience involves multisystemic processes that encompass both personal protective factors and supportive environments, enabling children with attention-deficit/hyperactivity disorder (ADHD) to achieve positive outcomes and thrive beyond expectations. However, ambiguities in the conceptualization and operationalization of resilience have hindered both theoretical and clinical research. This meta-analysis is the first to quantitatively delineate the specific relationship between multisystemic resilience factors and outcomes and propose a conceptual model. A search was conducted in August 2023 and repeated in April 2024 across six databases (PubMed, Scopus, Web of Science, PsycINFO, Embase, and MEDLINE). It identified 28 eligible articles involving 11,622 children aged 18 years or younger. Results indicated that six intrapersonal factors (cognitive functioning, emotional regulation, academic skills, social skills, proactive attitudes and behaviors, and prosocial behaviors) and four interpersonal factors (positive parenting and attachment, parental resources, peer relationships, and other support networks) are associated with improvements in specific outcomes (educational outcomes, wellbeing outcomes, relationship outcomes, internalizing symptoms, and externalizing symptoms) in children with ADHD. This review also revealed that existing literature, which often portrays resilience as lists of factors and focuses primarily on intrapersonal factors, may not adequately capture the dynamic, multisystemic nature and cultural relevance of the resilience process for children with ADHD. Based on our findings, we propose a comprehensive conceptual model to capture four key aspects of resilience: specific outcomes, multisystemic factors, the circularity of factors, and socio-cultural influences. PROSPERO registration number: CRD42023451246.