Middle Eastern Journal of Disability Studies

Abstract Background & Objectives: Attention deficit hyperactivity disorder is a neurodevelopmental disorder characterized by significant impairments in the brain's executive functions, particularly in three areas: self-control (response inhibition and emotional regulation), sustained attention (difficulty maintaining focused attention on tasks, especially in the absence of immediate rewards), and cognitive flexibility (difficulty effectively shifting between tasks and adapting to dynamic situations). These deficits not only disrupt children's academic performance and interpersonal relationships but, if left untreated, can lead to long-term negative outcomes such as academic failure and social adjustment problems. Cognitive rehabilitation training aims to reconstruct neural-cognitive networks by enhancing neural plasticity, presenting a promising solution. This intervention directly improves inhibition, attention, and flexibility mechanisms, targeting core symptoms of attention deficit hyperactivity disorder, and can lead to enduring structural and functional changes in the prefrontal and parietal regions of the brain. Therefore, examining the effectiveness of cognitive rehabilitation training considering its pivotal role in cognitive empowerment and reducing the burden of disabilities caused by attention deficit hyperactivity disorder is of high clinical and research significance. Accordingly, this study was conducted with the aim of evaluating the effectiveness of cognitive rehabilitation training on self-control, sustained attention, and cognitive flexibility in children with attention deficit hyperactivity disorder. Methodology: This study was a semi-experimental research with a pretest-posttest design, including a follow-up and a control group. The sample consisted of 30 male students with attention deficit hyperactivity disorder from Khorasan Razavi Province who voluntarily participated through non-random sampling. They were randomly assigned to two groups: an experimental group (15 participants) and a control group (15 participants). Inclusion criteria were: age between 8 and 12 years, average intelligence quotient (IQ 110 based on counseling center records), diagnosis of attention deficit hyperactivity disorder by a psychiatrist or clinical psychologist, no other psychological disorders based on clinical interview and DSM-5 diagnostic criteria, no medication use, no concurrent psychological interventions, informed consent from the child, and at least basic computer literacy. Exclusion criteria included: missing more than three consecutive therapy sessions, receiving psychological, behavioral, or pharmacological interventions during the study, failure to complete tests and tasks, and unwillingness to continue treatment. During the pretest, posttest, and two-month follow-up phases, participants completed self-control questionnaires (Tanjie et al., 2004). Their sustained attention was assessed using the Continuous Performance Test (CPT; Razoul et al., 1965), and cognitive flexibility was measured with the Wisconsin Card Sorting Test (Grant & Berg, 1984). Only the experimental group participated in eight sessions of 90 minutes each of the computerized N-Back task. Ethical principles such as obtaining informed consent and ensuring participants’ privacy and confidentiality were observed. Data were analyzed at both descriptive and inferential levels using repeated measures ANOVA. Findings: Data analysis of the pretest and posttest revealed that the experimental group showed significant improvements in executive functions specifically in sustained attention, cognitive flexibility, and self-control compared to the control group. The findings indicate that cognitive rehabilitation training effectively enhanced self-control, sustained attention, and cognitive flexibility in children with attention deficit hyperactivity disorder, and these treatment effects remained stable during the follow-up phase (p<0.01). Conclusion: It can be concluded that cognitive rehabilitation therapy is an effective treatment for improving executive functions in children with attention deficit hyperactivity disorder. Therefore, it is recommended that childhood health specialists utilize this intervention to improve the psychological, cognitive, and executive functioning of these children. 

Keywords:  Cognitive rehabilitation training, self-control, sustained attention, cognitive flexibility, children with attention deficit hyperactivity disorder

     

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