Background: Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder characterized by inattention, hyperactivity, and impulsivity. However, it is uncertain whether the use of acupuncture in children with ADHD is supported by current evidence. This review aimed to provide updated evidence of the effectiveness of acupuncture in children with ADHD.Methods: Nine databases were searched from their inception to 28 July 2022. The quality assessment of the selected studies was performed using Version 2 of the Cochrane risk-of-bias tool(RoB 2) for randomized trials. The characteristics of the included studies were presented in a tabular form, and meta-analyses were performed on the treatment effects of acupuncture on improving ADHD symptoms.Results: Fourteen studies involving 1,185 patients evaluating the efficacy of acupuncture for ADHD treatment were included in this review. Compared to conventional medicine alone, the meta-analyses indicated that acupuncture as an add-on to conventional medicine has a positive effect on improving conduct problems, learning problems, hyperactivity-impulsivity, and hyperactivity symptoms in ADHD patients. Similarly, acupuncture alone was found to improve learning problems, hyperactivity-impulsivity, and hyperactivity symptoms in ADHD patients, and exhibited better total treatment efficacy than conventional medicine alone. No major adverse events were identified. The risk of bias of the included studies was generally concerning.Conclusion: Evidence on the effectiveness of acupuncture for ADHD patients is currently limited to provide recommendations for its usage. More studies with proper methodology are needed for the validation of acupuncture interventions in treating children with ADHD.