Razi Journal of Medical Sciences

fa بررسی مقایسه اثر بخشی آموزش توانبخشی شناختی و یکپارچگی حسی بر توجه و تکانشگری دانش آموزان بیش فعال Comparing the Effectiveness of Cognitive Rehabilitation Training and Sensory Integration on Attention and Impulsivity of Hyperactive Students روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;"> زمینه و هدف: در دنیای امروزه اختلال نقص توجه/ بیش فعالی را میتوان یکی از پرشمارترین و ناشناختهترین اختلالات دوران کودکی قلمداد نمود که دارای سه ویژگی تکانشگری، نقص در توجه و بیش فعالی میباشد. هدف تحقیق حاضر، بررسی مقایسه اثربخشی آموزش توانبخشی شناختی و یکپارچگی حسی بر توجه و تکانشگری دانش آموزان بیش فعال مراجعه کننده به مراکز آموزشی و بالینی ناحیه 5 شهر اصفهان بود. روش کار: تحقیق حاضر یک مطالعه نیمه آزمایشی با طرح پیش آزمون و پس آزمون با گروه کنترل با سه مرحله ارزیابی (پیش آزمون، پس آزمون و پیگیری) بود. جامعه¬اماری تحقیق کلیه¬ی دانش آموزان مراجعه کننده به مراکز آموزشی و بالینی شهر اصفهان در سه ماه سوم سال 1400 تعداد 200 نفر که دارای ملاک‌های ورود بودند به پرسشنامه کانرز والدین (بیش فعالی) پاسخ دادند. که تعداد 45 نفر از میان 60 نفر واجد شرایط جهت ورود به مطالعه بودند به عنوان نمونه انتخاب و در سه گروه به طور تصادفی قرار گرفتند و طی سه مرحله ارزیابی به پرسشنامه کانرز والدین، آزمون عملکرد پیوسته (CPT)، آزمون دسته بندی کارت ویسکانسین (WCST)، مقیاس تکانشگری بارات و خرده مقیاس فراخنای عددی مقیاس هوشی وکسلر کودکان- فرم تجدید نظر شده پاسخ دادند. یافته‌ها: نتایج حاصل از آمار توصیفی و آمار استباطی (تحلیل کواریانس چند متغیره، تحلیل کواریانس با اندازه گیری مکرر) با کمک نرم افزارآماری 26–SPSS نشان داد که میانگین سنی دانش آموزان شرکت کننده در تحقیق در گروه‌های توانبخشی شناختی 10.33، یکپارچگی حسی 9.86 و کنترل 10.46 سال سن دارند. همچنین، نتایج نشان داد که بین میزان اثربخشی آموزش توانبخشی شناختی و یکپارچگی حسی بر توجه، تکانشگری، در سه گروه (اثربخشی آموزش توانبخشی شناختی، یکپارچگی حسی و گروه کنترل) در پس آزمون و پیگیری دانش آموزان بیش فعال &rlm;تفاوت وجود دارد. که بین هر دو گروه مداخله با با گروه کنترل تفاوت معنادار وجود دارد ولی بین گروه¬های مداخله (آموزش توانبخشی شناختی و یکپارچگی حسی)&rlm; پس آزمون و پیگیری از نظر اثر بر توجه تفاوتی وجود ندارد. نتیجه‌گیری: دانش آموزان دچار بیش فعالی/ نقص توجه اغلب با مشکلات توجه، تکانشگری روبرو هستند. درمان یکپارچگی حسی و توانبخشی شناختی با درگیر کردن حواس مختلف، توجه و کاهش تکانشگری و انجام فعالیت‌های بازی گونه باعث انسجام و سازماندهی در سامانه های عصبی -مرکزی مغز شده و پردازش حواس و مدیریت رفتار را کنترل و تنظیم می‌کند.</div> <div style="text-align: justify;"> Background & Aims: In today's world, attention-deficit/hyperactivity disorder can be considered one of the most numerous and unknown childhood disorders, which has three characteristics impulsivity, attention deficit, and hyperactivity. The purpose of this research was to compare the effectiveness of cognitive rehabilitation and sensory integration training on the attention and impulsivity of hyperactive students referring to educational and clinical centers in District 5 of Isfahan City. Therefore, due to the high prevalence of these behaviors in children and adolescents and the lack of comprehensive understanding of these behaviors in Iranian culture and the current generation's Western treatment and disproportion with our culture, it is necessary to provide an effective and low-cost intervention. Considering that few efforts have been made in this field in Iran and most of the efforts remain limited to superficial and untested techniques; therefore, it is necessary to improve the behavioral and cognitive characteristics of hyperactive students with the use of interventions based on new and tested approaches to achieve educational goals. Given that a wide range of cognitive and psychiatric research has been conducted to investigate the effectiveness of Various treatments that have been used to improve the symptoms of this disorder and conflicting findings have been obtained in this field; It is necessary to carry out research to determine which of the treatment methods can be considered more effective for the treatment of people with hyperactivity disorder in the scope of current scientific developments. Methods: The current research was a semi-experimental study with a pre-test and post-test design with a control group with three stages of evaluation (pre-test, post-test, and follow-up). The statistical community of all students referring to the educational and clinical centers of Isfahan city in the third quarter of 1400, 200 people who met the entry criteria, responded to the Connors parent questionnaire (hyperactivity). 45 people out of 60 people qualified to enter the study were selected as a sample and were randomly placed in three groups, during three stages of evaluation, Connors Parent Questionnaire, Continuous Performance Test (CPT), Wisconsin Card Classification Test (WCST), Barat impulsivity scale and numeric span subscale of Wechsler IQ scale for children-revised form answered. In this plan, after selecting the subjects, they were randomly replaced into three groups, experimental group (1), experimental group (2), and control group. Then, before the implementation of the independent variable (1) (cognitive rehabilitation), and the independent variable (2) (sensory integration method), the subjects selected in all three groups were measured using a pre-test (attention, impulsivity). Experimental group 1 was exposed to the independent variable (cognitive rehabilitation) experimental group 2 was exposed to the independent variable (sensory integration method) and independent variables (cognitive rehabilitation and sensory integration) were not implemented in the control group. In the end, dependent variables (attention, impulsivity) were measured in all three groups using a post-test. One month later, all three groups were re-evaluated. Results: The results of descriptive statistics and inferential statistics (multivariate covariance analysis, covariance analysis with repeated measures) with the help of spss-26 statistical software showed that the average age of the students participating in the research in the cognitive rehabilitation groups 10.33, sensory integration 9.86 and control 10.46 years old. Also, the results showed that there is a difference between the effectiveness of cognitive rehabilitation and sensory integration training on attention, and impulsivity, in three groups (the effectiveness of cognitive rehabilitation training, sensory integration, and control group) in the post-test and follow-up of hyperactive students. There is a significant difference between the intervention groups and the control group, but there is no difference between the intervention groups (cognitive rehabilitation training and sensory integration) post-test and follow-up in terms of the effect on attention. Conclusion: Students with hyperactivity/attention deficit often face problems with attention and impulsivity. The treatment of sensory integration and cognitive rehabilitation by involving different senses, paying attention reducing impulsivity, and performing game-type activities causes coherence and organization in the central nervous system of the brain and controls and regulates the processing of senses and behavior management. The results have shown that there is a significant difference in the impulsivity variable and its components, i.e., cognitive impulsivity, motor impulsivity in the post-test phase and the follow-up phase. After examining and comparing the two groups using the Bonferroni test, the results have shown that the null hypothesis is confirmed and the negative hypothesis is rejected. Also, the results show that there is no significant difference between the two groups of cognitive rehabilitation and sensory integration in the post-test and follow-up stages in cognitive impulsivity, movement, and lack of planning. In other words, according to what has been mentioned in the explanation of these findings, it can be said that taking into account that in the cognitive rehabilitation approach, attention is paid to the compensation and repair of cognitive damage, it can be expected that children with hyperactivity due to lack of Concentrating on one subject and scattering the senses around different axes of aggression occurs, so it is expected that children cannot focus their attention. Therefore, in cognitive rehabilitation training, by repairing the mentioned damages and compensating them as a result of changes in habits and environment, these changes lead to improvement of impulsivity levels in children. Also, the approach of sensory integration helps to improve cognitive and perceptual problems in children with hyperactivity by focusing children's senses retrieving information in different ways, and helping children to organize information received from different senses. In other words, it can be expected that both of the proposed approaches can control the neurological level and perceptual damage, cause more concentration in hyperactive children, and reduce impulsivity in these children. Reducing cognitive impulsivity through sensory integration and increasing concentration, as well as reducing hyperactive activities, leads to a decrease in motor impulsivity, and thus leads to better planning in these vulnerable children.</div> <div style="text-align: justify;"></div> توانبخشی شناختی, یکپارچگی حسی, توجه, تکانشگری, اختلال کمبود توجه/بیش‌فعالی Cognitive Rehabilitation, Sensory Integration, Attention, Impulsivity, Attention-Deficit/Hyperactivity Disorder 1 8 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7759-1&slc_lang=fa&sid=1 Mohsen Jafari محسن جعفری 3900319475328460081226 3900319475328460081226 No PhD Student of Counseling, Department of Counseling, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran دانشجوی دکتری مشاوره، گروه مشاوره، واحد تنکابن، دانشگاه آزاد اسلامی، تنکابن، ایران. Maryam Mashayekh مریم مشایخ m.mashayekh@kiau.ac.ir 3900319475328460081227 3900319475328460081227 Yes Assistant Professor, Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran استادیار، گروه روانشناسی، واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران Arslan Khan Mohammadi Otaqhsara ارسلان خان محمدی اطاقسرا 3900319475328460081228 3900319475328460081228 No Assistant Professor, Department of Psychology, Ayat Allah Amoly Branch, Islamic Azad University, Amol, Iran استادیار، گروه روانشناسی، واحد آیت ا... آملی، دانشگاه آزاد اسلامی، آمل، ایران.