Middle Eastern Journal of Disability Studies

Abstract
Background and objective: All citizens have the right of easy access to health and treatment services without any discrimination and irrespective of their physical health status, whereabouts, and their type of illness or time of access to the services. Hospitals and treatment centers are the main and pivotal service centers that must be easily accessible to all people, the fact that is among the most principal objectives of social development and justice. The research in areas of disability services, human respect and esteem among citizens especially those suffering from disabilities are considered of utmost importance which can lead to valuable information in this regard. The present research aims to study the status of access to health and treatment centers and its relation to disability services in the city of Shiraz.
Methods: The population under study included all public and private health centers in the city of Shiraz in 1392. The number of statistical sample was determined through Cochran formula and from 120 centers. Also, 120 individuals with disabilities including hard of hearings, blinds and those with physical problems residing in Shiraz who referred to these centers were selected in non-probability sampling method. To observe the status of samples' access, a check list whose validity was previously confirmed was used. Also, in order to determine the disabled individuals' views about improvement of conditions as well as providing service in health centers a questionnaire with 10 items was used. The validity of this questionnaire was previously determined. For statistical analysis SPSS 19 and Spearman's Correlational Test was used to compare the relationship among the acquired data.
Results: The amount of improvement in 120 centers was calculated 50.55 according to the checklist and opinions of the disabled. In this study and in all aspects, no significant correlation was found between the improvement of health centers and giving services. The correlation between services and parking space, stairs, elevator and other administrative sections was significant (p=0.05).
Conclusion: According to the results of this study, the most suitable sections of health centers were elevators, pathways and passages, patients' waiting salon, public furniture, administrative sections, steep levels, rest rooms, gates and windows, stairs, lobby and parking space which had the worst status of improvement. According to the views and opinions of those individuals who filled the disabled questionnaire it can be concluded that elevators had the best improvement status (75.01%) regarding the improvement while parking spaces had the worst situation.
 

Background & Objective: The term "learning disorder" describes a group of disorders characterized by inadequate development of specific academic, language, and speech skills. One type of the learning disorder is dyslexia. It is a specific learning disability in reading. Dyslexic children have trouble reading accurately and fluently. They may also have trouble with reading comprehension, spelling and writing. This study was aimed to investigate the effect of cognitive and metacognitive strategies on reading performance and academic self-efficacy in dyslexic boys.
Methods: A two group pretest-posttest quasi-experimental design was used in this study. The study population included all male students with reading disabilities of third and fourth grades in primary school in the school year 96-1395 of Tehran.  Multi-stage cluster sampling was used to recruit 40 students with reading disorder. The participants were assigned to experimental and control groups in equal numbers. The research instruments were the Wechsler Intelligence Scale for children and Bandura's academic self-efficacy questionnaire. The experiment group received 10 sessions of Cognitive- metacognitive strategies training. Cognitive strategies included: Strategies to repeat or review: repeated recitation, repeated coding, repeating key terms aloud, retelling stories, underlining the contents, memorizing the easy content and annotations, highlighting the key words, marking and transcription the difficult subjects. Strategies for developing and making meaning: the use of intermediaries, imagery, locations, keyword, using the acronym for the easy content and notes, analogy, summarizing, applying the learned material. Metacognitive strategies included: strategic planning: Determining the purpose of study, predicting time to study and learn, determining the speed of study, analyzing how to deal with the subject of learning, selecting cognitive strategies.
Results: The results showed that the experimental and control groups performed differently on the components of reading performance (error, understanding and speed) and self-study group after testing.
Conclusion: Cognitive and metacognitive strategies instruction improves the reading performance and academic self-efficacy in students with dyslexia. So, based on the findings of this study, it can be concluded that intervention based on the cognitive and metacognitive strategies improves the reading performance of dyslexic children.

Abstract
Background & Objectives: A learning disability is a defect generally affecting academic performance and progress in skills such as reading and writing. Learning disability problems manifest usually asymmetrically in different areas, such as information processing, motor coordination patterns, drawing shapes, and writing. A learning disability is a chronic incapacity that affects the development of multiple basic functions, including academic, psychological, and neuropsychological. Neuropsychological deficits are observed in poor accuracy, visual–auditory attention, motor coordination, executive functions, and non–verbal memory. The academic problems affect reading comprehension, reasoning in math, arithmetic calculations, and writing. A learning disability is a neurological disorder that affects one or more of the main psychological processes involved in learning.
Methods: Our research method was quasi–experimental with a pretest–posttest design including three experimental groups. The statistical population comprised all female students of the second and third grades of Chalus City, Iran, who had learning disabilities based on the Colorado Learning Difficulties Questionnaire (Willcutt et al., 2011). A total of 43 qualified volunteer students were selected using random sampling and were divided into 3 experimental groups: vision (14 students), virtual reality (15 students), and motor (14 students). The inclusion criteria were as follows: female students of second– and third–grade elementary school students and residents in Chalus City. The exclusion criteria were as follows: a history of illness, failure to comply with research rules, and not participating in training. Writing Performance Test (Fallahchai, 1995) was used to measure the writing skills of the subjects. An analysis of covariance was used to check the effectiveness of exercises and the differences between research groups in the posttest. The LSD post hoc test was used to examine the groups in pairs. Next, to explore the changes within the group from the pretest to the posttest, the paired t test was used. Statistical analyses were performed in SPSS software version 26 at a significance level of 0.05.
Results: After controlling for the effect of the pretest, the covariance analysis showed a significant difference between the three experimental groups in the average writing skill in the posttest (p<0.001). The results of the LSD post hoc test showed that the vision training group obtained higher scores in the writing skill in the posttest compared to the other two groups (p<0.001). However, there was no significant difference in writing skills in the posttest between the two virtual and moving reality groups (p=0.459). The paired t test results showed that all three training groups significantly obtained higher scores in the posttest in writing skills compared to the pretest (p<0.001).
Conclusion: Based on the research results, game–based interventions can be used to improve writing skills. Vision games are also more effective than other interventions used in the study.

Abstract
Background & Objectives: Psychological distress can disrupt a person's daily functioning. Cognitive flexibility is one of the important variables that has a special role in mental health and has a vital role in suffering from depression, stress, and psychological problems. People with high levels of ego strength are more flexible and better equipped to handle life's challenges. However, individuals with low levels of ego strength may be more vulnerable to psychological distress. According to research, religiousness and spirituality have a significant effect on the mental and physical health of people. Multidimensional spiritual therapy can be an essential aspect of caring for people with psychological distress. Spiritual therapies can provide a sense of meaning and purpose, a sense of connection with something higher than oneself, and a source of comfort and support in difficult times. Therefore, this research aims to determine the effectiveness of multidimensional spiritual therapy focused on emotional regulation on the cognitive flexibility and ego strength of people with psychological problems.
Methods: The current research method was quasi-experimental, using a pretest-posttest design with control and experimental groups. The statistical population of this research included people with psychological distress referred to counseling and psychology clinics in Tehran City, Iran, in 2021. The sample size was determined through G*Power software so that the study has the necessary power to detect a difference of at least 1 unit in the level of self-esteem and mental well-being between the experimental and control groups. Assuming the probability of the first type of error is 5%, the probability of the second type of error is 20%, and a standard deviation of 0.9, the number of samples equals 15 people for each group. Therefore, among the statistical population, 30 qualified volunteers were entered by available sampling into the study and randomly divided into experimental and control groups (each group contains 15 people). The inclusion criteria include an interview based on the criteria of the fifth diagnostic and statistical guide for mental disorders, a score higher than 20 on the psychological distress scale, which was conducted by an expert in the field of clinical psychology, a minimum level of education diploma, not participating in other psychological interventions at the same time, and lack of debilitating mental illnesses that were diagnosed by the researcher using a clinical interview. The exclusion criteria included an absence of more than three sessions, non-observance of group therapy rules, and suffering from a mental illness that did not exist before the treatment and was identified during the implementation. After selecting the people of the sample group and before starting the treatment program, the Cognitive Flexibility Inventory (Dennis & Vander Wal, 2010) and the Psychosocial Inventory of Ego Strengths (Markstrom et al., 1997) were distributed between both groups. Then, multidimensional spiritual therapy was performed on the experimental group (in the form of 12 sessions of 90 minutes, each session once a week), and the control group was not subjected to any treatment program. In the end, the posttest was done again from both groups. Also, after the end of the research, the treatment programs implemented in this research were implemented in the control group to maintain ethical standards. Data analysis was carried out in two parts: descriptive statistics and inferential statistics. At the level of descriptive statistics, frequency, mean, and standard deviation were used, and at the level of inferential statistics, univariate covariance analysis was used. Data analysis was done using SPSS software version 24, and the significance level of the tests was considered to be 0.05.
Results: The results showed that in the variable of cognitive flexibility for the subscales of perception of evidence (p<0.001) and alternative to human behavior (p<0.001) and the variable of ego strength for the subscales of hope (p<0.001), will (p<0.001), goal (p=0.008), love (p=0.002) and wisdom (p<0.001), there was a significant difference between the experimental and control groups in the posttest, after removing the effect of the pretest.
Conclusion: Based on the findings of the research, multidimensional spiritual therapy focused on emotion regulation can be effective in increasing cognitive flexibility and ego strength in people with psychological distress.

Abstract
Background & Objectives: Oppositional defiant disorder is a persistent pattern of hostile, negative, and deviant behavior associated with extensive psychosocial problems. Considering the signs and symptoms such as anger outbursts, not following norms, and inability to control behavior in people with oppositional defiant disorder, there is a possibility of cognitive distortions and irrational beliefs in these people. Irrational beliefs are false and inconsistent thoughts about oneself and the world. Accordingly, it is essential to use effective interventions to improve irrational beliefs. So, the present study aimed to determine the effectiveness of social-emotional skills training on the irrational beliefs of junior high school male students with oppositional defiant disorder.
Methods: This quasi-experimental study employed a pretest-posttest design with a control group. The statistical population consisted of all the boys with oppositional defiant disorder in the first year of high school in Babolsar County, Iran, in 2023. Among the statistical population, 30 qualified volunteers were selected by purposive sampling based on the Oppositional Defiant Disorder Rating Scale (Hommersen et al., 2006). They entered the study and were randomly assigned to the experimental and control groups (each group included 15 people). The inclusion criteria were as follows: having oppositional disobedience disorder, being in the first year of high school, providing parental consent to participate in the research, and lacking other acute and chronic psychological disorders. The exclusion criteria for teenagers to leave the research included not attending two training sessions and not cooperating or not performing specified tasks during the training period. This research observed ethical standards including obtaining informed consent and guaranteeing privacy and confidentiality.
Also, the participants were free to withdraw or provide personal information during the research. They were assured that the information would remain confidential and that it would be fully respected. After the end of the research, social-emotional skills training was implemented for the people in the control group. Both groups completed the Irrational Beliefs Test-Ahvaz (Motamedin et al., 2012). The social-emotional skills training program was implemented for the experimental group in 12 60-minute sessions, and every session was held once a week. However, the control group did not receive any treatment plan. Data analysis was carried out in two parts: descriptive statistics and inferential statistics. At the level of descriptive statistics, frequency, mean, and standard deviation were calculated. For the inferential statistics, an analysis of covariance was used. Data analysis was done in SPSS software version 27, and the significance level of the tests was considered to be 0.05.
Results: The analysis of the data showed that the score of the irrational beliefs in adolescent boys with oppositional defiant disorder in the intervention group and after receiving treatment decreased significantly compared to the control group (p<0.001). The results related to the effect size showed that 60% of the difference between the intervention group and the control group in the irrational beliefs was due to the implementation of social-emotional skills training.
Conclusion: Based on the results of this research, social-emotional skills training can be used as a complementary treatment to improve irrational beliefs in people with oppositional defiant disorder.