<p>Virtual reality (VR) interventions have emerged as innovative approaches increasingly used to manage attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. This systematic review included 22 randomized controlled trials, quasi-experimental, and open-label studies published between 2001 and 2025, comprehensively evaluating the feasibility of VR interventions, their effectiveness alone or combined with pharmacological treatment, the relative efficacy of different training modalities, and dosage-related factors. The results indicate that VR interventions, whether used independently or alongside medication, significantly improve core ADHD symptoms, executive functions, emotional regulation, and social skills, with long-term interventions (≥8 weeks) producing more pronounced and sustained benefits. Among the training modalities, interactive game training was the most frequently studied, followed by virtual scenario and exergaming, each demonstrating distinct effects on cognitive and behavioral outcomes. Overall, VR interventions generally demonstrated high adherence rates; however, adherence reporting was inconsistent across studies, and adverse effects were typically mild and transient. Future research should focus on large-scale randomized controlled trials employing standardized outcome measures and developing personalized VR protocols to further enhance treatment efficacy and clinical applicability for ADHD.</p>