Comparing the Effectiveness of Cognitive and Metacognitive Strategies Education and Aerobic Education on Verbal Working Memory and Cognitive Flexibility in Patients With Written Disorder

Written disorder is the most complex and common language skill disorder during school. Patients with this disorder often have problems with executive functions, which are activities such as verbal working memory and cognitive flexibility, for organizing and managing cognitive, emotional, and behavioral information to achieve certain goals. Verbal working memory is a type of working memory that processes and stores verbal information. Cognitive flexibility is a method of mental processing, including changing and revisiting cognitive preparations when dealing with obstacles and adapting to challenges. Executive functions can be improved by cognitive and metacognitive strategies education and aerobic education. As a result, the present research was conducted to compare the effectiveness of cognitive and metacognitive strategies and aerobic education on verbal working memory and cognitive flexibility in patients with the written disorder.

This was a quasi–experimental study with a pretest–posttest design with two experimental groups and one control group. The study population was second and third–grade elementary school students with written disorder living and studying in Mashhad City, Iran, in the 2018–19 academic year. The research sample was 36 eligible volunteers selected by purposive sampling and randomly assigned into three equal groups (12 people in each group). The inclusion criteria included students with written disorders based on the clinical interview, studying in the second and third grade of elementary school, moderate IQ (91–110 on the Stanford–Binet test) based on counseling file, no rejection in previous year or years, living with parents, not having psychological disorders, and not taking psychiatric drugs. Also, the exclusion criteria included non–cooperation or low cooperation in the sessions and the absence of more than three sessions. The first experimental group participated in twenty 45–minute sessions of cognitive and metacognitive strategies education and the second experimental group participated in twenty 45–minute sessions in aerobics education, and the control group did not receive any training. To collect study data, we used Stanford–Binet verbal working memory test (Roid, 2003) and Wisconsin cognitive flexibility test (Grant and Berg, 1948) and to analyze them using the methods of the Chi–square, Kolmogorov–Smirnov test, Levene’s test, slope of the regression line, univariate analysis of covariance and Bonferroni post hoc test in SPSS–25 software at a significance level of 0.05.

The results showed that the experimental and control groups were comparable in terms of gender (p=1.000), educational level (p=0.710), age (p=0.638), and IQ (p=0.852). Investigate the assumptions showed that the data normality based on the Kolmogorov–Smirnov test, equality of variances based on Levene’s test, and equality of slope of regression lines based on the interaction between the group and pretest could not be rejected (p>0.05). Other findings showed that experimental and control groups significantly differed in verbal working memory and cognitive flexibility (p<0.001). In other words, both cognitive and metacognitive strategies education and aerobic education compared to the control group led to increased verbal working memory and cognitive flexibility in patients with the written disorder (p<0.001). In addition, the cognitive and metacognitive strategies education compared to aerobic education led to a further increase in verbal working memory (p<0.001) and cognitive flexibility (p=0.003).

Considering the effectiveness of both methods of cognitive and metacognitive strategies and aerobic education in increasing verbal working memory and cognitive flexibility and greater effectiveness of cognitive and metacognitive strategies education compared to aerobic education, planning is necessary to use both methods. As a result, consultants and therapists can use both methods, especially cognitive and metacognitive strategies education, to improve verbal working memory and cognitive flexibility in patients with written disorders.