Middle Eastern Journal of Disability Studies

Background & objective: Children with attention-deficit/hyperactivity disorder are diagnosed with three main symptoms which are attention deficit, hyperactivity and impulsiveness. In addition to these main symptoms, they also have other comorbid problems. One of the most important of them is a defect in emotion regulation. Emotion regulation problems are seen in these children continuously throughout their life and it affects their relationship with their parents and peers, too. In explaining emotion regulation, Gross process model has a significant empirical background. This model has some strategies which are based on their initial effect on the emotion generation process. It is used widely for adults in researches and in this study is adopted for children. In addition, sand tray therapy is an evidence- based treatment for emotional problems of children. So, the purpose of this research was to develop an emotion regulation program based on the Gross model with sand tray therapy and its effectiveness on emotional self-regulation and relationship with peers and parents in primary school children with attention deficit/hyperactivity disorder.

Methods: The research method was quasi–experimental with a pretest- posttest- follow up design and a control group. The statistical population includes all children from the first to the sixth grade of primary school with the diagnosis of attention deficit/hyperactivity disorder in the academic year of 2023-2024 in the schools of Gilan province, Iran. Sampling was done with the cooperation of school personnel and psychiatrists from clinics, and 27 children were placed in two experimental (14 children) and control (13 children) groups according to the results of the

Conners parent rating scale–Revised Form (Conners et al, 1998) and the satisfaction of the parents. Research tools include Connors parent rating scale–revised form (Conners et al, 1998), emotion regulation scale (Shields & Cichetti, 1997), social skills questionnaire (Matson et al, 1983) and parent-child relationship scale (Driscoll & Pianta, 2011). The pre-tests were taken and then the program was administered to the intervention group in ten 45-minute sessions. After that, the post tests were taken and after two months the follow-up were done. Data analysis was done by analysis of variance with repeated measurements in SPSS version 26 software. A significance level of 0.05 was considered.

Results: The findings of the study showed a significant difference between two groups from pre-test to post- test which means the intervention was effective in experimental group. The differences were in emotion regulation (p=0/001) and lability/ negativity (p=0/001) (emotion regulation components), peer relationship (p=0/034) and child- parent relationship components (conflict: p=0/001, closeness: p=0/010). Also, there is no significant difference in post- test to follow- up (p > 0/05), which means that the intervention effect has been stable in experimental group over time. 

Conclusion: The findings of this study indicate that the emotion regulation program based on Gross model and with sand tray therapy can be an intervention for emotion regulation problems and relationship with peers and parents of primary school children with attention deficit/hyperactivity disorder. Using such interventions can be suitable for these children.