The Effectiveness of Cognitive Rehabilitation Based on Prospective Memory on Attention Bias, Executive Functions and Academic Performance of Students with Attention Deficit/Hyperactivity Disorder

Hyperactivity and lack of attention can create difficult conditions for children and their families. These children need education and rehabilitation. Therefore, this study was conducted with the aim of the effectiveness of cognitive rehabilitation based on prospective memory on attention bias, executive functions, and academic performance of students with attention-deficit/hyperactivity disorder.

This was a semi-experimental study with a pre-test-post-test design and follow-up with a control group. 32 children were selected in a targeted way and randomly replaced in two groups of 16 people. The participants were evaluated before and after the intervention and one month later with attention bias questionnaires, executive functions, and academic performance. The intervention group received cognitive rehabilitation based on prospective memory for 16 sessions. The data were analyzed by repeated analysis of variance. This research is an experimental type with a semi-experimental design, pre-post-test-follow-up, and control group. All participants are evaluated before and after the intervention using the standard instrument of attention bias, executive functions, and academic performance. Then, the effectiveness of the intervention was investigated by comparing the experimental and control groups in different phases of the research. The current research population included all the students of the first secondary school in Tehran. The sample size was considered 16 people for each group based on JPower software; which included 32 people for two groups. The impact factor was extracted from Khaksarian et al.'s article (2019) equal to 0.56. The alpha error level was 0.05 and the confidence level was 95%. The sampling method was cluster random. First, one district was randomly selected from among the 22 districts of Tehran. Then the list of schools was received and four schools were randomly selected from among the schools. Sampling continued until reaching the limit of samples. The final sample (34 people) was randomly replaced by two groups of 16 people. The inclusion criteria included obtaining a score above the cut-off line in the Connors Hyperactivity Questionnaire, the willingness of the child and parents to cooperate, living with two parents, male gender, and receiving a diagnosis of one of the three types of attention deficit hyperactivity disorder (attention deficit, impulsive, and combined). Those suffering from intellectual, developmental, physical, or psychological debilitating diseases were included in the study. Absence of more than one session of training sessions, failure in previous semester exams (to control learning disorder), receiving a previous diagnosis of learning disorder, and confrontational disobedience were the criteria for dropping out of the study. The following questionnaires before, after, and one month later were used for evaluation

The results showed that the attention bias, executive functions, and academic performance of the intervention group had significantly improved compared to the control group. According to the results of variance analysis with repeated measures that show the scores of inhibition, inhibition, change, working memory, organization, and planning in the three stages of pre-test, post-test, and follow-up, there is a significant relationship between the subjects' scores in the three stages. Also, the effect size for inhibition, inhibition, change, working memory, and organization variables is equal to 23%, 24%, 34%, 17%, and 38% respectively, which means equal to 23%, 24%, and 34% respectively. 17% and 38% of the changes in the scores of inhibition, inhibition, change, working memory, and organization in the post-test and follow-up were related to the therapeutic intervention; Therefore, the research hypothesis is accepted. After confirming the normality of the data distribution, the homogeneity of variances for the research variables was examined, the results of the M-box test were not significant (Box M=12.16, P=0.09), so the condition of homogeneity of the variance-covariance matrices has been correctly met. Also, Levin's test, which is the condition of equality of variances between groups, is not significant in any of the steps, and the error variance of the dependent variables was equal in all groups. Finally, the results of Mochli's test showed that the assumption about the variable was met (Mochli's w = 0.79, x2 = 6.01, P = 0.06). The results of the analysis of variance with repeated measures are presented in the table below.

In explaining this finding, it can be said that attention bias is a type of cognitive bias in which a person involuntarily pays special attention to a specific stimulus or a sensory sign. Since this is more evident in children with attention deficit hyperactivity disorder, in this study, children underwent cognitive rehabilitation based on prospective memory. In explaining this finding, it can be said that the game and practice aspect of the tasks presented in the active memory training program causes students to become more involved and interested in doing the tasks and attach importance to getting the best results, which helps the students. Consider all aspects of the assignment and do the assignments in a more targeted and organized manner. This increases the focus on a topic in the participants. In explaining this finding, it should be said that in addition to this, the simplicity of the tasks and games and their successful solution also strengthens this process and ultimately helps to improve the planning ability, and also justify the effectiveness of the mentioned training program, it can be said that this training program is because the skills It teaches orientation, inhibition of response, multi-step order, and auditory and visual memory, which are essential in reading, and can also improve planning skills in these students. Also, this cognitive rehabilitation program presents tasks from simple to difficult, which provides the possibility for the hyperactive child to have more motivation to complete the tasks while mastering the basic skills to do more difficult tasks. This step-by-step mastery and success motivate hyperactive children who often have difficulty completing tasks and make them put more effort into doing exercises. The proposed mechanism for the effectiveness of cognitive rehabilitation exercises is neuroplasticity or brain flexibility. According to findings related to children's imaging, performing cognitive rehabilitation exercises can change synaptic connections in these children. According to the obtained results, cognitive rehabilitation based on prospective memory is effective on attention bias, executive functions, and academic performance of students with attention-deficit/hyperactivity disorder.