Razi Journal of Medical Sciences

Background & Aims: Autism spectrum disorder is a neurodevelopmental condition that affects communication, social interaction, learning, and several cognitive, emotional, and behavioral domains required for daily functioning. Children with autism often experience difficulties in self-regulation, language-related abilities, attention, working memory, and the speed with which they process information. These difficulties may reduce academic progress, limit adaptive functioning, and increase emotional and behavioral problems. In recent decades, deficits in working memory and attention have been considered important cognitive factors associated with autism-related learning and behavioral problems. Working memory, as a central component of executive functioning, allows children to hold, manipulate, update, and use information for goal-directed behavior. Because verbal fluency and information processing speed are related to cognitive flexibility, reading accuracy, language performance, and everyday problem solving, strengthening working memory may provide a useful pathway for improving broader cognitive and behavioral outcomes in children with autism. Cognitive rehabilitation is a structured intervention approach designed to improve cognitive abilities through repeated, targeted, and progressively challenging exercises. It is grounded in neuroplasticity, according to which repeated cognitive practice can strengthen neural connections and support improved functioning. The present study aimed to investigate the effect of cognitive rehabilitation based on strengthening working memory on self-control, verbal fluency, and information processing speed in children with autism spectrum disorder.
Methods: This study used a quasi-experimental pre-test, post-test, and follow-up design with a control group. The statistical population consisted of children with autism spectrum disorder in Sabzevar, Iran. From this population, 40 children were selected through convenience sampling and randomly assigned to an experimental group or a control group, with 20 participants in each group. Inclusion criteria included a confirmed diagnosis and medical record of autism spectrum disorder, age between 8 and 16 years, ability and consent to participate in training sessions, and absence of other severe psychological disorders. Participants who were simultaneously involved in other educational interventions, received incompatible individual counseling or drug treatment, missed more than two sessions, or did not cooperate were excluded. Before the intervention, all participants completed the Williams et al. Self-Control Scale, the Wechsler Intelligence Scale for Children, verbal fluency tasks based on letter and category cues, and the Coding and Symbol Search subtests of the Wechsler scale, which assess information processing speed. The experimental group then received a working-memory-based cognitive rehabilitation program in 18 one-hour sessions, held twice per week. The sessions included therapeutic rapport building, parent orientation, spatial-motor games, shape and image classification, missing-part exercises, reverse response tasks, rapid naming, word repetition, direct and reverse number and word tasks, categorization, verbal memory activities, synonym and antonym exercises, sentence recall, picture sequencing, card sorting, and review exercises. The control group did not receive this intervention during the same period. Both groups were assessed immediately after the intervention and three months later during follow-up. Data were analyzed using repeated-measures analysis of variance with SPSS version 23.
Results: The findings showed that cognitive rehabilitation based on strengthening working memory had a significant positive effect on all three main outcome variables: self-control, verbal fluency, and information processing speed. In the experimental group, scores improved significantly from pre-test to post-test, indicating that the intervention enhanced children’s ability to regulate behavior, produce words more fluently, and process visual and cognitive information more rapidly. In contrast, the control group showed no significant improvement between pre-test and post-test, suggesting that the observed changes were related to the cognitive rehabilitation program rather than to the passage of time or repeated testing alone. The follow-up results also indicated that the difference between post-test and three-month follow-up scores in the experimental group was not significant, showing that the positive effects were maintained over time. These findings support the view that structured cognitive exercises targeting working memory and attention can improve executive and language-related functioning in children with autism. The results are consistent with neural plasticity explanations, in which repeated cognitive tasks increase synaptic efficiency and challenge the central executive system of working memory. By improving attention, updating, monitoring, and manipulation of information, the intervention may have helped children allocate more cognitive resources to self-regulation, verbal retrieval, and rapid processing. Improvements in self-control may also be explained by the interaction between cognition and emotion: when children become better able to manage cognitive demands and maintain attention, they may regulate emotional and behavioral responses more effectively in stressful situations. Similarly, enhanced working memory and attention may support verbal fluency by improving access to phonological and semantic knowledge, while processing speed may improve through practice in rapid visual scanning, symbol recognition, sequencing, and response selection.
Conclusion: The results confirm that cognitive rehabilitation based on strengthening working memory is an effective intervention for improving self-control, verbal fluency, and information processing speed in children with autism spectrum disorder. The program appears to produce immediate gains and stable improvements that persist for at least three months after the intervention. Given the importance of working memory and attention in academic learning, language performance, emotional regulation, and adaptive behavior, this approach can be considered a practical and beneficial method for educational and clinical settings. However, because the study used convenience sampling and did not examine the separate effects of age and gender, caution is required when generalizing the findings. Future studies are recommended to use larger samples, individual clinical designs, and longer follow-up periods. Overall, cognitive rehabilitation programs focused on working memory should be considered useful interventions for supporting children with autism and helping them achieve better cognitive, behavioral, and communicative functioning.