Abstract
Background & Objectives: Attention–deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders seen in early childhood. A common disorder associated with ADHD is developmental dyslexia. It is a learning disorder characterized by difficulties in reading, writing, spelling, and word pronunciation despite normal intelligence, adequate education, and no sensory impairments. In general, the coexistence of ADHD with developmental dyslexia may cause several problems in the academic progress and overall functioning of children and have a significant impact on their mental health. In addition, in most cases, only one of these disorders is diagnosed in these children; that is, either ADHD or a learning disability. According to the research background, the majority of treatments for these children are drug therapy, play therapy, and cognitive consciousness therapy alone. Proper identification of both child disorders and timely treatment of common cognitive deficits can have a significant impact on academic achievement. Therefore, the present study aimed to determine the effectiveness of a phonological awareness program combined with rhythmic music on executive functions in children with ADHD comorbid with developmental dyslexia.
Methods: The present study was a quasi–experimental study with a pretest–posttest design with a control group. The statistical population included all children with the diagnosis of ADHD comorbid with developmental dyslexia in Yazd City, Iran, in 2023. Among these children, 30 people who met the entry requirements were selected from specialized child consulting centers in Yazd by sampling, with a minimum sample of 15 in each group. Participants were randomly assigned to the experimental and control groups (15 people each). The criteria for children to enter the study were the absence of psychological disorders such as anxiety and depression in the child (through a comprehensive interview and assessment by researchers) and the absence of physical disabilities. The criterion for excluding children from the study was the absence of more than 2 sessions in the educational intervention. The Barkley Deficits in Executive Functioning Scale–Children and Adolescents (BDEFS–CA) (Barkley, 2012) was used for pretest and posttest for two groups. For the experimental group, the phonological awareness program combined with music rhythm was held twice a week during 90–minute sessions. There was no treatment for the control group. To comply with research ethics, the present study obtained written consent from the subjects and provided them with the necessary information about the research in writing. The subjects also participated voluntarily in the study and were assured of the confidentiality of their information. At the end of the study, to maintain ethical standards, the treatment programs implemented in the experimental group were also applied to the control group. Data were analyzed in SPSS version 24 using descriptive statistics (percentage, frequency, mean, and standard deviation) and inferential statistics (multivariate and univariate analysis of covariance tests), with a significance level of 0.05.
Results: The results showed that the intervention (phonological awareness training with music rhythm) was effective on time self–management (p=0.022), self–organizing/problem solving (p=0.010), self–control/inhibition (p=0.017), self–motivation (p=0.016), emotional self–regulation (p=0.014), and overall executive functions (p=0.008) in the posttest of the experimental group. In addition, according to the eta square, the average increase values for time self–management, self–organizing/problem solving, self–control/inhibition, self–motivation, emotional self–regulation, and overall executive functions were equal to 0.878, 0.974, 0.929, 0.937, 0.949, and 0.951, respectively, which showed the effect of the experimental intervention. Also, the greatest effectiveness was in self–organization/problem–solving, with a score of 0.97.
Conclusion: The results of the present study showed that phonological awareness training using musical rhythm improves executive functions in children with ADHD comorbid with developmental dyslexia, and this program can be used in schools and learning disability centers.
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