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Background Gut microbiota has been implicated in attention-deficit/hyperactivity disorder (ADHD). This study aimed to evaluate the effectiveness of washed microbiota transplantation (WMT), the new method of fecal microbiota transplantation (FMT), for ADHD and relevant comorbidities.Methods This was a prospective observational study involving patients from April 2024 to May 2025. The primary endpoint was the Clinical Global Impressions-Improvement (CGI-I) responder rate at 1 month after WMT (CGI-I of 1 or 2 = treatment responder). The secondary endpoints included Swanson, Nolan, and Pelham-IV (SNAP-IV), Conners’ Parent Rating Scale-Revised (CPRS-R), the Sleep Disturbance Scale for Children (SDSC), Gastrointestinal Symptom Rating Scale (GSRS), and the Autism Behavior Checklist (ABC) at 1 month and 3 months after WMT.Results Sixty-eight patients (33 ADHD alone, and 35 ADHD + ASD) were included. The response rate in ADHD alone and ADHD + ASD was 42.4% and 31.4% at 1 month, and 33.3% and 28.6% at 3 months after WMT. The SNAP-IV and subscales scores, including inattention and hyperactivity-impulsivity, were reduced 1 month and 3 months after WMT (all P < 0.05) (IDDF2026-ABS-0455 Figure 1. The effectiveness of WMT on core ADHD symptoms in all children; IDDF2026-ABS-0455 Figure 2. The effectiveness of WMT on ADHD symptoms in children with ADHD alone and ADHD + ASD). The CPRS-R, SDSC, and GSRS were decreased post-WMT intervention, both in children with ADHD alone and ADHD + ASD (all P < 0.05) (IDDF2026-ABS-0455 Figure 3. The effectiveness of WMT on sleep disorders and gastrointestinal symptoms in all children). In children with ADHD + ASD, WMT also markedly reduced the ABC scores at 1 month and 3 months (all P < 0.001). Baseline hyperactivity-impulsivity scores were an independent predictor of clinical response 1 month after WMT (OR 0.27 [95% CI = 0.08-0.90]; P = 0.034).Conclusions WMT could improve inattention and hyperactivity symptoms, sleep disturbances, and gastrointestinal symptoms in children with ADHD and ADHD + ASD. It could also ameliorate core ASD symptoms in children with ADHD + ASD. WMT may be an effective and integrated treatment for complex neurodevelopmental disorders.Abstract IDDF2026-ABS-0455 Figure 1Abstract IDDF2026-ABS-0455 Figure 2Abstract IDDF2026-ABS-0455 Figure 3