اثر بخشي برنامه توان بخشي شناختي مبتني بر حافظه آينده‌نگر بر نيم رخ حافظه فعال كودكان با اختلال كاستي‌ توجه بيش‌ فعالي

Cognitive Rehabilitation Program Based on Prospective Memory on the Profile of Working Memory in Children with Attention Deficit/Hyperactivity Disorder

زمينه و هدف: اختلال كاستي‌ توجه بيش‌ فعالي، تمام جنبه‌هاي زندگي فرد را تحت‌ تأثير قرار مي‌دهد. هدف اين پژوهش، بررسي اثربخشي برنامۀ توان‌بخشي شناختي مبتني بر حافظۀ آينده‌نگر بر نيم‌رخ حافظۀ فعال كودكان با اختلال كاستي‌توجه بيش‌فعالي است. روش‌ بررسي: اين پژوهش، يك مطالعۀ نيمه‌‌آزمايشي با طرح پيش‌آزمون‌پس‌آزمون و گروه كنترل بود. جامعۀ آماري آن را تمامي كودكان دختر با اختلال كاستي‌توجه بيش‌فعالي شهر كرمانشاه در سال 1396 تشكيل دادند. تعداد 32 نفر به روش در دسترس از مدارس شهر كرمانشاه انتخاب شدند. آزمودني‌ها به روش تصادفي، به دو گروه آزمايش و كنترل تقسيم شدند كه اعضاي هر گروه 16 نفر بود. گروه آزمايش، برنامۀ توان‌بخشي شناختي مبتني بر حافظۀ آينده‌نگر را در 18 جلسه دريافت كردند؛ در حالي‌ كه به گروه كنترل اين آموزش ارائه نشد. ابزار پژوهش، مجموعه‌آزمون حافظۀ فعال براي كودكان ارجمندنيا بود. داده‌ها با آزمون‌ تحليل كوواريانس چندمتغيري تحليل شد. يافته‌ها: نتايج نشان داد كه برنامۀ توان‌بخشي شناختي مبتني بر حافظۀ آينده‌نگر، اثر معناداري بر مؤلفه‌هاي مجري‌مركزي، صفحۀ ديداري‌فضايي و حلقۀ واج‌شناختي در كودكان با اختلال كاستي‌توجه بيش‌فعالي دارد (0٫001>p). بر اساس مجذور اتا مي‌توان گفت به‌ترتيب 62درصد، 59درصد و 66درصد تغييرات هريك از مؤلفه‌هاي مجري‌مركزي، صفحۀ ديداري‌فضايي و حلقۀ واج‌شناختي، به‌علت تأثير شركت آزمودني‌ها در برنامۀ مداخله بوده است. نتيجه‌گيري: برنامۀ توان‌بخشي شناختي مبتني بر حافظۀ آينده‌نگر، نيم‌رخ حافظۀ فعال كودكان با اختلال كاستي‌توجه بيش‌فعالي را بهبود بخشيد. بنابراين، مي‌توان از اين برنامه به‌منظور بهبود حافظۀ فعال چنين كودكاني بهره برد و برنامه‌ريزي براي استفاده از اين برنامه اهميت ويژه‌اي دارد.

Background and Objective: Children with attention deficit/ hyperactivity disorder (ADHD) are one of the groups of children with special needs and this disorder is widely recognized as one of the most frequent disabilities. Professionals rely on diagnostic criteria of American psychiatric association (APA), The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM–5), and used it for diagnoses ADHD. In the DSM–5, three subtypes of ADHD are recognized: predominantly inattentive type, predominantly hyperactive–impulsive type and combined type. ADHD is widely recognized as one of the most frequent neurodevelopmental disorders and the most frequent reason of referral of children to clinics. Adding to their socialization problems, many children with attention deficit/ hyperactivity disorder also have memory problems. It seems that cognitive rehabilitation program could reduce memory problems of children with ADHD. The cognitive rehabilitation is one of the methods for treating children with ADHD, because these children are often facing problem in memory. Children with ADHD have serious problems in profile of working memory compered to normal children. In fact, ADHD affects all aspect of individual's life, while applying cognitive rehabilitation program based on prospective memory has been associated with effective outcomes. Therefore, present study was aimed to determine the effectiveness of cognitive rehabilitation program based on prospective memory on the profile of working memory in children with ADHD in Kermanshah city. Methods: The present research was a semi–experimental study with pre–test, post–test design and control group. The statistical population consisted of girls with ADHD aged 8 to 11 years in Kermanshah city (Kermanshah province, West of Iran) schools in 2017 academic years. The participants were 32 girls with ADHD from schools in Kermanshah city using convenient sampling method. Subjects were divided into experimental and control groups randomly, each group consisting of 16 children. The experimental group received 18 sessions of cognitive rehabilitation program based on prospective memory, while the control group did not. Control group at the end of research participated in two sessions, for moral considerations. The instrument used was The Working Memory Test Battery for children by Arjmandnia. Working memory test battery applied by researchers for all subjects’ pre–test and post–test. The obtained data before and after the training sessions were analyzed using Kolmogorov Smirnov test, M. Box test, Leven test, independent t test and multivariate analysis of covariance test with 23th version of SPSS. Results: First, normality of variables and contingency of variance and covariance assumptions were tested. The Kolmogorov Smirnov test showed that all variables were normal. In addition, box test confirmed contingency of variance–covariance assumption. Therefore, assumptions of MANCOVA test confirmed and can be used the MANCOVA test for analysis of data. The results of MANCOVA showed that cognitive rehabilitation program based on prospective memory had a significant effect on the profile of working memory of children with attention deficit hyperactivity disorder (p<0.001). In the other word, the results revealed that interventional program had a significant effect on central executive, phonological lop and visual spatial sketchpad in these children (p<0.001). It can be stated that according to Eta square 62%, 59% and 66% of variations in components such as central executive, phonological lop and visual spatial sketchpad, can be explained by the subjects’ participation in cognitive rehabilitation program based on prospective memory. Conclusion: According to the findings, cognitive rehabilitation program based on prospective memory improved profile of working memory in children with attention deficit/hyperactivity disorder. So, this program can be used to improve working memory of these children and planning for providing of cognitive rehabilitation program based on prospective memory for them have particular importance.