Middle Eastern Journal of Disability Studies

Background & Objective: Childhood is one of the most important stages of life in which one's personality is formed and shaped. One of the issues to be mentioned in childhood is psychiatric disorders. In the meantime, one of the mental disorders is related to attention deficit hyperactivity disorder. Attention, Deficit Hyperactivity Disorder, is a neurodevelopmental disorder characterized by incomplete and non-significant levels of inattention, hyperactivity, and impulsivity in various combinations at home, school, work, and the social environment. Attention Deficit Hyperactivity Disorder is one of the most important and most common psychiatric disorders affecting 8-9% of school-age children and 4-5% of adults. The most common treatment for these children is drug therapy. But the long-term side effects of this drug and the low or no effect of the drug in 20-30% of children, children's resistance and negative parental attitude to the drug are one of the main barriers to this treatment. Therefore, in recent decades, psychologists have tried to reduce the symptoms of this disorder with various therapies, including behavioral and cognitive-behavioral techniques. So, the purpose of this study was to develop and evaluate cognitive-social empowerment training on cognitive-executive functions, social skills, and language skills of preschool children with attention deficit hyperactivity disorder.
Methods: This research was quantitative and qualitative. This research designed in two stages: In the first stage, the researcher examined and identified the dimensions of cognitive empowerment using a qualitative design (Foundation Data from Open Coding Method) and tried to develop a program that fits this theoretical framework and developed the status of the research samples. At this stage, the purpose of the qualitative design, that was, the researcher used various studies in the past to find suitable components for education and to formulate a cognitive-social empowerment training program using these components. Secondly, the program implemented in a pilot project to evaluate its effectiveness on the variables of language proficiency and cognitive executive performance. In the quantitative part of the study, subjects were pre-tested to determine their current status according to inclusion and exclusion criteria. After the end of the educational program, the children tested for the post-test. To investigate the long-term impact of program implementation on research variables, using a pilot design with an experimental group and a control group with pretest-posttest and follow-up. A follow-up test performed after four weeks. The statistical population consisted of all children between 4-6 years of age in Tehran 14 who were educated in preschool centers in Tehran in 1977. The sampling method in this study was cluster random. In this way, district 14 of Tehran selected randomly. Then a list made of the preschool centers in the area (49 preschool centers). Subsequently, three centers chosen by lot from preschool centers in district 14 of Tehran and children from these preschools screened (to identify children with attention deficit hyperactivity disorder). Then, 60 children randomly selected from the identified children and randomly assigned into two groups of 30 experimental and control groups. The research tools were Conner’s Questionnaire (1998), Jiviya et al. Cognitive Executive Function Rating Questionnaire (2000), Matson Social Skills Questionnaire (1983), Nyusha Malaieri et al. Language Skills Test (2009). Educational intervention consisted of cognitive-social empowerment that administered to the experimental group during five sessions. Content of sessions include visual attention, flexibility, self-regulation, response inhibition, auditory attention and response set, tower, memory, behavioral control, motor exercises, maze, mental flexibility, grouping, problem-solving, storytelling, and speaking, Interpersonal skills were listening skills, group harmony, familiarity with social roles and expectations, auditory and motor coordination. Data analyzed by repeated-measures analysis of covariance and analysis of variance performed with repeated measures.
Results: Findings using covariance analysis showed that cognitive-social empowerment training is effective on executive-cognitive functions (p<0.001). Also, findings using covariance analysis showed that cognitive-social empowerment training is effective in language skills (p<0.001). Finally, using covariance analysis showed that there was no significant difference between the scores of executive-cognitive functions and language skills in the post-test and follow-up stages of the experimental group.
Conclusion: Therefore, the implementation of workshops called Cognitive-Social Interventions to improve the executive-cognitive functions and language skills is suggested to parents and educators of these children.

Background & Objectives: Distance education is a novel method of aural rehabilitation. Virtual rehabilitation is among the top approaches in providing new education. Educating parents is one of the main factors in the virtual aural rehabilitation of hearing-impaired children with cochlear implants. The vast size of Iran and the dispersion of the cochlear implanted population throughout the country; the lack of access to numerous cochlear implants by specialist rehabilitation centers in the city of residence; the importance of interventions at the youngest age; the long duration of rehabilitation (≥1 year); the inappropriate rehabilitation clinical settings for very young children; the increased use of online counseling and psychotherapy approaches, and the access of more individuals to the virtual world using a smartphone have led to the aural rehabilitation program developing using new technologies. Thus, this study aimed to determine the effect of the Navayesh family-based aural rehabilitation program of distance education on the development of language and communication skills in hearing-impaired children with a cochlear implant.
Methods: This was a quasi–experimental study with pretest–posttest–follow–up and a control group design. In total, 40 hearing–impaired children with the cochlear implant of the Cochlear Implant Center at Rasul Akram Hospital, Tehran City, Iran, in 2018 were selected using the purposive sampling method. The study subjects were randomly divided into two groups (experimental & control; n=20/group). The inclusion criteria of the study were age (1–9 years), the age of cochlear implant (not more than two years passed since cochlear implantation), the parents’ educational level (literacy), internet access, the possibility of attending monthly meetings, no history of receiving rehabilitation programs and having a smartphone. Parents with frequent absence from the program (virtually & in–person) sessions (n=10) were excluded from the current study. The experimental group mothers received the Navayesh family–based aural rehabilitation program by Portal (http://user.navayesh.ir) and the Channel of Messenger and Aparat (https://www.aparat.com/Navayesh) in 80 sessions (online-offline). In the first phase, the design of the online portal and assignment classification, i.e., based on the Navayesh program was presented in the form of multimedia (audio, image, text), online, and offline. In the second phase, a pilot study was performed in the experimental group. The purpose of this program was to improve communication and language skills. The Ages and Stages Questionnaires–Third Edition (ASQ–3) (Bricker, 2009) and the Speech Intelligibility Rating (SIR) (Allen et al., 1993) were used as the pretest and posttest scales to measure communication and language skills. The obtained data were analyzed using descriptive statistics (mean & standard deviation) and inferential statistics, i.e., repeated–measures Analysis of Variance (ANOVA) at the significance level of 0.05 in SPSS.
Results: The repeated–measures ANOVA data of speech intelligibility presented that in the source of the effect related to time, speech intelligibility was significant (p<0.001). Besides, the results were significant on the interaction of time and group (p<0.001).
According to the Eta squared of 0.62, approximately 62% of the intragroup changes were explained by auditory perception. The Eta squared of 0.55 indicated that about 55% of the changes in auditory perception were explained by grouping. There was a significant difference between the experimental and control groups in the between-group aspect (p<0.001).
The repeated–measures ANOVA data on social skill revealed that in the source of the effect related to time, the social skill was significant (p<0.001); the results were also significant about the interaction of time and group (p<0.001).
The Eta squared of 0.67 indicated that approximately 67% of the intragroup changes belonged to auditory perception; the Eta squared of 0.26 signified that almost 26% of the changes in auditory perception were induced by grouping. There was a significant difference between the experimental and control groups in the between-group dimension (p<0.001).
Conclusion: The present study results suggested the effects of the Navayesh family-based aural rehabilitation program of distance education on the language and communication performance in the explored hearing–impaired children with a cochlear implant. Therefore, it is recommended that this program be used at rehabilitation cochlear implant centers.