Razi Journal of Medical Sciences

fa اثربخشی آموزش بازتوانی شناختی رایانه‌ای بر توجه و حافظه‌کاری کودکان مبتلا به اختلال نقص-توجه/بیش‌فعالی The Effectiveness of Computerized Cognitive Rehabilitation Training on Attention and Working Memory of Children with Attention-Deficit Hyperactivity Disorder روانشناسی بالینی Clinical Psychiatry پژوهشي Research <a name="_Hlk184301929">زمینه و هدف:</a> راهبردهای درمانی در دسترس برای درمان نارسایی توجه/ بیش‌فعالی شامل روش‌های دارویی و غیر دارویی است. پژوهش با هدف اثربخشی بازتوانی شناختی رایانه ای بر توجه و حافظه کاری کودکان مبتلا به اختلال نقص توجه/بیشفعالی انجام شد. روش کار: روش پژوهش از نوع نیمهآزمایشی بود. تعداد 30 کودک 7 تا 11 سال مبتلا به اختلال نقص‌توجه/بیشفعالی مراجعه کننده به روانپزشکان اطفال و روانشناسان کودک شهر تهران در ماههای فروردین تا شهریور سال 1401 با روش هدفمند انتخاب و به صورت تصادفی در دو گروه 15 نفری قرار گرفتند. برای جمعآوری اطلاعات از نرم افزار IVA و آزمون حافظه‌کاری وکسلر (WISC-R) بهره برده شد. برای تحلیل دادهها از نرمافزار SPSS و آزمونهای تحلیل کوواریانس چند متغیره استفاده شد. یافته ها: نتایج نشان داد که آموزش بازتوانی شناختی رایانه ای بر توجه و حافظه کاری کودکان مبتلا به اختلال نقص توجه/بیش فعالی اثربخش بود (01/0p<). نتیجه‌گیری: با توجه به نتایج، آموزش بازتوانی شناختی رایانهای میتواند رویکرد درمانی موثری در جهت بهبود توجه و حافظه کاری کودکان مبتلا به اختلال نقص توجه/بیش فعالی باشد.   <div style="text-align: justify;">Background & Aim: Attention-deficit/hyperactivity disorder predicts various degrees of destruction in academic, cognitive, social, and developmental performance in the future. This disorder causes many problems for affected people, and affects the social, academic, and emotional development of sick people (4). One of the main concerns associated with this disorder is the disorder in executive functions, which can affect almost all areas of cognition, including working memory and attention (6). These functions are the product of a set of higher-level skills that converge to enable a person to adapt and grow in complex psycho-social environments (7). Researches indicate the very important and decisive role of working memory in learning and performing complex cognitive tasks (9). In order to enter information from the sensory memory to the active memory, one must pay attention to the information so that it is transferred to the long-term memory. Attention is the first step in information processing and means the ability to select a part of environmental information for further processing, based on which concentration and awareness are formed. Children with attention deficit hyperactivity disorder do not have the ability to pay close attention to details or have problems in doing homework or other activities (10). Sustained attention is a process that enables the maintenance of response continuity and sustained effort over a long period of time and is the core of attentional control (11). Defects in children's attention take the opportunity to process, store and recall information. Children with this disorder do not have the ability to pay close attention to details or make mistakes in doing homework or other activities carelessly (6). Treatment strategies available for the treatment of attention deficit/hyperactivity disorder include pharmacological and non-pharmacological methods. Among the treatment methods that have been used for this disorder, drug treatment, behavioral therapy and cognitive behavioral modification are more useful and important than other methods (13). One of the treatments used in recent years to improve cognitive functions is computerized cognitive rehabilitation therapy. There are studies that show that cognitive interventions are effective (16). Cognitive rehabilitation is a complex set of methods designed to improve understanding, comprehension, attention, learning, recall and problem solving in people with disorders in these areas. There is considerable evidence to support the cognitive rehabilitation method to improve executive functions (17). In the context of the effectiveness of the computer rehabilitation method, many studies have shown the effect of this method on working memory and continuous attention. Akbari et al. (2019) in a research entitled the effect of assisted working memory rehabilitation on executive functions and reading progress, concluded that computer-assisted training had a positive effect on the functions of attention, organization, inhibition, working memory and reading performance (9 ). Also Mahler et al. (2015) showed that computer intervention in a period of three months had a positive effect on the visual-spatial plane of working memory (18). In recent decades, due to the pervasiveness of the consequences of hyperactivity disorder and the irreversibility of many cognitive defects, computerized cognitive rehabilitation strategies that can compensate for the defects and increase the quality of life of these children; Special attention has been paid. But the findings in this case are not yet conclusive and in some cases have led to contradictory results. Therefore, it is very important to try to disambiguate and clarify the possible reasons for obtaining these research contradictions in the field of the effectiveness of cognitive rehabilitation interventions on improving the cognitive abilities of children with hyperactivity disorder; The present study was formed in response to the question that is there a difference between computerized cognitive rehabilitation on attention and working memory of children with attention deficit/hyperactivity disorder? Methods: The research method was semi-experimental. 30 children (7 to 11 yr) with attention deficit/hyperactivity disorder referred to pediatric psychiatrists and child psychologists in Tehran in the months of April to September 1401 were selected by a purposeful method and randomly divided into two groups of 15. IVA software and Wechsler working memory test (WISC-R) were used to collect data. SPSS software and multivariate covariance analysis tests were used for data analysis. Results: The results showed that the effectiveness of computerized cognitive rehabilitation training was effective on the attention and working memory of children with attention deficit/hyperactivity disorder (p<0.01). Conclusion: The results of the present research showed that computerized cognitive rehabilitation training has an effect on the attention of children with attention deficit/hyperactivity disorder. According to these results, it can be said that computer cognitive rehabilitation training was effective in children with attention deficit/hyperactivity disorder. The results obtained from the present study are in line with the results of Kessler et al. (2018) and Bryant (2015) (19, 20). In the explanation of the findings of the present study, it can be said that the delay in the development of the frontal lobe of these children causes defects in executive functions (23). At the theoretical level, these findings can be explained based on the underlying mechanisms of brain plasticity. One of the mechanisms is modification of synaptic connection. In this mechanism, the activity of neuronal mechanisms is activated in people with functional impairments like normal people and contribute to improving their attention performance. On the other hand, evidence shows that cognitive rehabilitation stimulates the areas of the frontal lobe (27); therefore, it can be concluded that attention improves with cognitive rehabilitation. Other results of the research showed that computerized cognitive rehabilitation training has an effect on the working memory of children with attention deficit/hyperactivity disorder. Cognitive rehabilitation methods are based on the retraining of cognitive functions through practice, adaptation, implicit and explicit learning of coping strategies (32). The basis of this method is based on the information processing system and it displays a feedback of individual capabilities and self-efficacy; therefore, it is possible to design a suitable educational program according to a person's capabilities (33). Computerized cognitive training programs provide tools through which a person can be helped to master the basic mental processes that are important in high-level learning; improve (34), on the other hand, executive functions in the age range of 7 to 12 years show the highest growth rate (36). Therefore, it can be considered that the effective results of cognitive rehabilitation with the computer program Captain Log (2000) in this study are also the result of using this method in childhood (37). The limitation of this research is related to external validity, because the statistical population of the research is a special group of society, that is, children aged 7 to 11 with attention deficit/hyperactivity disorder who refer to pediatric psychiatrists and child psychologists in Tehran, so it is possible to generalize the results to the whole. Society is facing limitations. Considering the limitations of inter-group research methods (experimental research), it is suggested that researchers use single-subject experimental designs to check the effectiveness of education in the future. In summary, the results of the present study showed that computerized cognitive rehabilitation training is effective on the attention and working memory of children with attention deficit/hyperactivity disorder. Therefore, computerized cognitive rehabilitation training can be an effective therapeutic approach to improve attention and working memory of children with attention deficit/hyperactivity disorder. </div> بازتوانی شناختی رایانه‌ای, توجه, حافظه‌کاری, اختلال نقص‌توجه/بیش‌فعالی Computerized Cognitive Rehabilitation, Attention, Working Memory, Attention-Deficit Hyperactivity Disorder 1 16 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7696-1&slc_lang=fa&sid=1 Mahsa Ostadpour مهسا استادپور 3900319475328460088062 3900319475328460088062 No PhD Student, Department of General Psychology, Sari Branch, Islamic Azad University, Sari, Iran دانشجوی دکتری، رشته روانشناسی عمومی، واحد ساری، دانشگاه آزاد اسلامی، ساری، ایران Seyedah Olia Emadian سیده علیا عمادیان emadian2012@yahoo.com 3900319475328460088063 3900319475328460088063 Yes Assistant Professor, Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran استادیار، گروه روانشناسی، واحد ساری، دانشگاه آزاد اسلامی، ساری، ایران Mohammad Kazem Fakhri محمدکاظم فخری 3900319475328460088064 3900319475328460088064 No Assistant Professor, Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran استادیار، گروه روانشناسی، واحد ساری، دانشگاه آزاد اسلامی، ساری، ایران