Atiye Kheyrkhah; mahnaz khosrojavid; Abbas Abolghasemi
Abstract
The birth of a child with an intellectual disability can significantly challenge parents' psychological well-being. Therefore, it is essential to implement approach-oriented, short-term, and cost-effective interventions to improve the specific psychological conditions of these parents. In this regard, ...
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The birth of a child with an intellectual disability can significantly challenge parents' psychological well-being. Therefore, it is essential to implement approach-oriented, short-term, and cost-effective interventions to improve the specific psychological conditions of these parents. In this regard, the current study aimed to investigate the effectiveness of emotional-cognitive resilience training on parenting stress, emotion regulation, and resilience in parents of children with mild intellectual disability. The statistical population consisted of parents of 8 to 12-year-old boys with mild intellectual disability at the Marjoei School for Exceptional Children (2) in Karaj. Using available (convenience) sampling, a sample of 30 parents who met the study criteria was selected and randomly assigned to either an experimental or a control group. The research instruments included the Parenting Stress Index (Abidin, 1995), the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), and the Connor-Davidson Resilience Scale (2003). The experimental group received Smith and Ascoff's (2016) emotional-cognitive resilience training program, which was conducted in six 50- to 60-minute weekly group sessions. The data were analyzed using univariate and multivariate analysis of covariance (ANCOVA/MANCOVA). The findings indicated that the training program had a significant effect on reducing parenting stress, improving emotion regulation, and increasing resilience among parents of children with intellectual disabilities (p < 0.05). Therefore, it appears that this approach-oriented, short-term, and interaction-focused program, which combines cognitive-behavioral strategies with relaxation training, mindfulness, and other techniques, was able to enhance the cognitive-emotional flexibility of parents in their interactions with their children.
Keywords: Emotional-Cognitive Resilience, Parenting Stress, Emotion Regulation, Mild Intellectual Disability
Extended Abstract
Introduction
Intellectual disability is a neurodevelopmental disorder characterized by significant impairments in intellectual functioning and adaptive behavior across conceptual, practical, and social domains. This disability originates during the developmental period and is considered present before the age of 22 (Schalock et al., 2021; American Psychiatric Association, 2023). Children with mild intellectual disability—who represent approximately 85% of this population and typically have an IQ range of 50-55 to 70—often demonstrate difficulties in acquiring complex language skills and a limited ability to understand social norms and interactions. However, with appropriate support, they can improve their basic functional abilities (World Health Organization, 2020). A diagnosis of intellectual disability in a child can trigger a wide range of emotional responses within the entire family system, particularly for parents, which is associated with increased psychosocial difficulties (Singh & Lohum, 2023; Kumar et al., 2020; Giallo et al., 2015). One of the primary emotional challenges faced by these parents is parenting stress (Hsiao, 2017).
Parenting stress is a set of distressing psychological and physical reactions arising from a perceived mismatch between the demands of parenting and an individual's available resources (Fu et al., 2023). It is the product of the interactive effects of characteristics within the parent, the child, and the broader context of their relationship (Deng et al., 2018; Díaz-Herrero et al., 2011). Another significant challenge for parents of a child with intellectual disability is difficulty in emotion regulation (Littlewood et al., 2018). According to Gratz and Roemer (2004), emotion regulation encompasses several dimensions: a) awareness and understanding of emotions; b) acceptance of emotions (i.e., accepting emotional responses and related events in a non-evaluative manner, often linked to cognitive reappraisal); c) the ability to engage in goal-directed behavior and refrain from impulsive actions when experiencing negative emotions; and d) access to and flexible use of effective emotion regulation strategies.
Given the documented emotional and affective challenges faced by parents of children with intellectual disabilities, it is evident that the issues and concerns related to these children can also impact parental resilience. The importance of resilience lies in its role as a predictor of better health outcomes and higher self-esteem (Luo et al., 2021). Conceptually, resilience enables an individual to enhance social competence and overcome adversity, even when exposed to significant stressors and risk factors (Masten, 2018). Therefore, resilience training appears to be an effective intervention for increasing the quality of life and reducing stress among parents of children with intellectual disabilities (Shadi Zavareh et al., 2024; Hosseini Ghomi & Jahanbakhshi, 2021).
In this context, one recommended program grounded in resilience theory and designed for the context of parent-child interaction is Cognitive-Affective Stress Management Training (CASMT) with an emphasis on strengthening emotional resilience. Derived from the Smith and Ascough (2016) treatment program, this intervention promotes cognitive-emotional flexibility by integrating cognitive-behavioral strategies with relaxation training, mindfulness, and other techniques. Key characteristics that distinguish CASMT from other resilience programs include: 1) its foundation in the cognitive-behavioral approach; 2) its focus on teaching self-management skills, generalization, and relapse prevention; and 3) its short-term (6 sessions), interactive format. Essentially, this intervention emphasizes the practical application of skills needed by parents and caregivers during interactions with their child. By providing multidimensional training and supplementary materials in addition to the core sessions, the program enhances the practical utility and comprehensiveness of the training process.
Research Question
The main research question was whether cognitive-emotional resilience training is effective in reducing parenting stress, improving emotion regulation, and increasing resilience in parents of boys with mild intellectual disability.
Literature Review
To the best of the researcher's knowledge, the Cognitive-Emotional Resilience Training program by Smith and Ascough (2016) has not yet been implemented in Iran. Relevant background research is summarized as follows. Studies have shown that mothers of children with intellectual disabilities under the age of 12 experience more parenting stress than mothers of typically developing children (Biabani et al., 2019; Kumar et al., 2018; Patra et al., 2016). Furthermore, Alidoosti et al. (2019) found that mothers of children with intellectual disabilities had significantly higher scores for emotion regulation difficulties, anxiety, and depression compared to a control group. In a comparison of parents of children with and without special needs, Priego-Ojeda and Rusu (2023) demonstrated that the relationship between emotional dysregulation and relationship satisfaction is mediated by parental stress and conflict. Finally, research indicates that the level of resilience in parents of children with intellectual disabilities is often low due to sustained psychological pressure (Hassanein et al., 2021; Mohan & Kulkarni, 2018).
Hosseini Ghomi and Jahanbakhshi (2017) examined the effectiveness of resilience training based on the Kumpfer model (1999), as detailed by Pan and Sánchez (2021), for reducing stress in 30 mothers of children with intellectual disabilities in Tehran. The training, conducted in eight one-hour sessions, covered three dimensions: 1) familiarity with the concept of resilience, 2) familiarity with internal and external supportive factors (e.g., optimism, self-esteem, locus of control, social support systems), and 3) familiarity with strategies to build resilience (e.g., establishing relationships, purposefulness, hope for the future, and accepting change). Separately, Moradikia et al. (2017) investigated the effect of resilience training on the psychological well-being of mothers of students with intellectual disabilities in Arak.
Methodology
This study was applied in nature and utilized a quasi-experimental design with a pre-test, post-test, and a control group. The statistical population consisted of 30 parents of 8 to 12-year-old boys with mild intellectual disability from the Marjoui Exceptional Children's School in Karaj during the 2021-2022 academic year. The research instruments were the Connor-Davidson Resilience Scale (CD-RISC), the Parenting Stress Index-Short Form (PSI-SF; Abidin, 1995), and the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). The cognitive-emotional resilience training sessions were adapted from the manual Cognitive-Emotional Stress Management Training: Promoting Emotional Resilience by Smith and Ascough (2016).
Results (Times New Roman 12 bold)
The effect of emotional-cognitive resilience training on dependent variables in parents of children with mild intellectual disability was investigated using univariate and multivariate analysis of covariance. The results of the multivariate analysis of covariance test for parenting stress components showed that the difference between the two groups was significant in terms of the dependent variable components, and the effect size for the parenting stress variable combination was 0.856; that is, 85.6 percent of the variance in the parenting stress variable was due to the intervention effect. The results of the multivariate analysis of covariance test for emotion regulation difficulty components indicated a significant difference between the two groups in terms of the dependent variable components, and the amount of this difference was 0.920 for the emotion regulation variable combination; that is, 92.0 percent of the variance in the emotion regulation variable was due to the intervention effect. The results of the multivariate analysis of covariance test for resilience components indicated that the difference between the two groups was significant in terms of the dependent variable components, and the amount of this difference was 0.429 for the resilience variable combination; that is, 42.9 percent of the variance in the resilience variable was due to the intervention effect.
Discussion (Times New Roman 12 bold)
The present study aimed to investigate the effectiveness of emotional-cognitive resilience training on parenting stress, emotion regulation, and resilience in parents of children with mild intellectual disability. The results demonstrated that this training had a significant effect on all three variables and their components. This finding aligns with previous studies, including those by Shadi Zavareh et al. (2024), Hosseini Ghomi and Jahanbakhshi (2021), Luo et al. (2021), Hassanein et al. (2021), Biabani et al. (2019), Mohan and Kulkarni (2018), and Moradikia et al. (2017).
One key result was the effectiveness of the training on parenting stress. The effect can be explained by three primary mechanisms. First, within the training program, parents learned through the ABC model how the stress experienced in various life situations—particularly concerning their children—results from the interaction between an Activating event, their Beliefs (thoughts), and the resulting emotional Consequences. Second, the intervention successfully modified parents' attributional styles. Instead of attributing events to factors such as their own inadequacy in parental duties, their child's weaknesses, or a loss of control, they learned to approach problems with optimism, self-assertion, and self-confidence.
Third, the training sessions focused on attracting social support. As the sessions were held in groups with both parents present, they provided a space for parents to realize they were not alone in their journey and that others shared similar experiences.
Another finding was the effect of emotional-cognitive resilience training on improving emotion regulation. During the sessions, parents learned about the critical role emotions play in guiding their thoughts and behaviors. They were taught that emotion regulation is a fundamental and generalizable skill, directly and indirectly linked to a wide range of positive health outcomes, and that it can influence functioning in both personal and interpersonal contexts. Parents also learned that their interactive environment—with each other and with their child—plays a significant role in both the emergence and regulation of emotions.
Finally, the emotional-cognitive resilience training was effective in increasing parental resilience. The training enabled parents to adopt a problem-oriented approach when facing unpleasant life events. Consequently, instead of feeling unworthy and inadequate towards themselves and their child, parents learned to focus on their abilities and strengths, foster intimacy in their relationships with their spouse and child, accept that relationships have the capacity to change, and experience greater personal confidence and competence—all of which are skills that can be learned.
Conclusion
Parents of children with neurodevelopmental disorders face significant challenges, stress, and negative emotions in their caregiving roles, which consequently reduces their resilience. Therefore, cognitive-emotional resilience training, based on a cognitive-behavioral approach, aims to teach parents how to enhance their capabilities when facing various challenges. By using methods such as situation assessment, cognitive coping skills (e.g., identifying irrational thoughts), inducing skills (e.g., induced forgiveness), mindfulness, acceptance-based control, and desensitization, the training helps parents develop a more positive sense of competence in their parenting interactions with their children.
Acknowledgments
The authors extend their sincere appreciation to the administration and staff of Marjoui School for their essential collaboration. We are also grateful to the parents and children whose participation was fundamental to this research.
Seyyedeh Zahra Seyyed Noori; abbasali hossein khanzadeh; Abbas Abolghasemi; Iraj Shakerinia
Abstract
The present study aimed to effectiveness of simultaneous training of various executive functions (hot and cool; focused on simultaneous parent-child training) on improving the empathy of children with attention deficit hyperactivity disorder. This research was a quasi-experimental study with pretest-posttest ...
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The present study aimed to effectiveness of simultaneous training of various executive functions (hot and cool; focused on simultaneous parent-child training) on improving the empathy of children with attention deficit hyperactivity disorder. This research was a quasi-experimental study with pretest-posttest control group design. The statistical population of the present study consisted of all 9 to 12-year-old children with ADHD in Rasht who referred to medical-educational-research centers in 2021. The sample consisted of 26 mothers and children with ADHD from the statistical population who were selected through convenience sampling, based on the inclusion criteria. They were then equally assigned to two (control and experiment) groups. The children in the experimental group and their mothers each received the intervention program in 10 sessions. The instruments used included Cognitive demographic questionnaire, Canners Parent Rate Scale, Empathy Questionnaire. data were analyzed using analysis of covariance. Findings showed that training of various executive functions (hot and cool; focused on simultaneous parent-child training), had a significant effect on improving the total score of empathy (P<0.01), empathy subscales of social motivation (P< 0.01), cognitive empathy (P< 0.05), emotional empathy of friend’s orientation (P< 0.01), effective empathy of family orientation (P< 0.05) on children with ADHD. These results suggest that multifaceted interventions that target executive actions in children with attention deficit / hyperactivity disorder can be a promising approach to improving empathy in these children.
Keywords: Hot and Cool Executive Functions, Parent and Child, Attention Deficit Hyperactivity Disorder, Empathy.
Extended Abstract
Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders, characterized by symptoms of inattention, hyperactivity, and impulsivity (Mechler, Banaschewski, Hohmann, & Hage, 2021). Beyond its core symptoms, empirical evidence suggests that children with ADHD often struggle with emotional expression, facial recognition, prosody perception, theory of mind, and empathy (Singh, Arun, & Bajaj, 2021). Empathy refers to the ability to understand and emotionally resonate with others’ experiences (Bugatti, 2021). Among various factors influencing empathy, executive functions (EFs) play a foundational role (Friesen, 2019).
Executive functions are typically categorized into two domains: "cool" and "hot." Cool EFs encompass cognitive, emotionally neutral processes such as metacognition, cognitive flexibility, inhibition, working memory, planning, and problem-solving, which are primarily associated with lateral prefrontal regions. In contrast, hot EFs involve emotionally and motivationally salient processes such as behavioral regulation, emotional control, and decision-making, linked to medial and anterior prefrontal areas (Zelazo, 2020; Nemeth & Chustz, 2020).
Neuroimaging and neuroscientific studies indicate that dysfunctions in the prefrontal cortex among individuals with ADHD may be associated with reduced empathy—precisely the region implicated in executive functioning (Taiwo, 2018; Ronel, 2018). Research by Li, Liu, Yan, & Feng (2020) demonstrated that EF training can enhance emotional competence in preschoolers, with inhibitory control and working memory significantly predicting emotional development. Similarly, findings by Ghadiri & Soleimani (2021) revealed that EF training improved empathy in children with high-functioning autism.
Developmental psychology literature also highlights the pivotal role of parents in shaping children’s executive functions (Motamed Yeganeh, Afrooz, Shokoohi-Yekta, & Weber, 2019). O'Neill, Rajendran, & Halperin (2012) emphasized the importance of parental involvement in ADHD interventions, particularly through play-based neurodevelopmental and social facilitation. Despite these insights, prior studies have predominantly focused on cool EFs, neglecting the hot dimension. Moreover, most interventions have been child-centered, with limited use of simultaneous parent-child approaches.
Given this research gap, the present study aimed to investigate the effectiveness of a simultaneous parent-child training program targeting both hot and cool executive functions on improving empathy in children with ADHD.
Methodology
This quasi-experimental study employed a pretest-posttest control group design. The statistical population included all children aged 9–12 diagnosed with ADHD in Rasht, Iran, who attended educational-therapeutic centers during the first half of 2021. A sample of 26 children who met the inclusion and exclusion criteria was selected via convenience sampling and randomly assigned to an experimental group and a control group. Both the children and their mothers in the experimental group received a 10-session intervention program. The instruments included the 48-item Conners Rating Scale and the Empathy Questionnaire for Children and Adolescents.
Results
Based on the findings presented in Table 5, the F-value for the empathy subcomponent of social motivation was 28.412, which was statistically significant (p <.01). The F-value for cognitive empathy was 5.649 (p <.05). Affective empathy with peer orientation yielded an F-value of 10.999 (p <.01), while affective empathy with family orientation showed an F-value of 5.915 (p <.05). These results indicate statistically significant differences between the experimental and control groups across all four empathy dimensions.
Table 1: ANOVA Results Comparing Experimental and Control Groups on Children's Empathy Components
Empathy Component
SS (Between)
SS (Error)
MS (Between)
MS (Error)
F
p
Effect Size
Power
Social Motivation Empathy
38.603
27.174
38.603
1.359
28.412
0.001
0.587
0.999
Cognitive Empathy
2.639
9.343
2.639
0.467
5.649
0.05
0.22
0.619
Affective Empathy (Peer Orientation)
6.164
11.208
6.164
0.56
10.999
0.01
0.355
0.884
Effective Empathy (Family Orientation)
3.602
12.178
3.602
0.609
5.915
0.05
0.228
0.638
Discussion
The present study aimed to examine the effectiveness of a simultaneous parent-child training program targeting both hot and cool executive functions on improving empathy in children with Attention-Deficit/Hyperactivity Disorder (ADHD). The findings indicated that this training significantly improved empathy in children with ADHD. These results are consistent with previous research conducted by Friesen (2019) and Ghadiri & Soleimani (2021).
One possible explanation for these findings is that improved executive functioning enhances children's ability to decode social and emotional cues, thereby positively influencing their interpersonal relationships (Ghadiri & Soleimani, 2021). Moreover, repetition and practice play a crucial role in strengthening executive functions, which in turn support emotional regulation and empathic behavior. Repeated tasks and games facilitate the maturation of prefrontal inhibitory mechanisms, gradually enabling children to regulate emotional impulses. The more children engage in prosocial play, the more rapidly and effectively their prefrontal regulatory systems develop, allowing them to inhibit impulsive motivations (Panksepp, 2007).
Research also highlights the importance of parental involvement in improving the functioning of children with ADHD (Motamed Yeganeh, Afrooz, Shokoohi-Yekta, & Weber, 2019; O'Neill, Rajendran, & Halperin, 2012). In fact, parental warmth, cooperation, and acceptance contribute to reduced behavioral problems, decreased egocentrism, and an enhanced capacity for understanding and accepting others.
Due to limitations imposed by the COVID-19 pandemic, follow-up assessments could not be conducted in this study. Therefore, it remains unclear whether the observed improvements in hot and cool executive functions—and their impact on empathy—are sustained over time. Future research is recommended to include follow-up phases and to extend the investigation to other age groups and psychological conditions, such as learning disorders and anxiety disorders. It is also suggested that the effectiveness of this intervention be compared with other therapeutic approaches.
Conclusion
The findings of this study revealed that simultaneous training of various executive functions—both hot and cool—in joint parent-child sessions had a positive impact on enhancing empathy in children with ADHD. These results may pave the way for developing more effective interventions in the field of cognitive and emotional rehabilitation for these children.
Acknowledgments
We extend our sincere gratitude to all the individuals who participated in this research.
Setare Haddad kashani; abbasali hossein khanzadeh; Abbas Abolghasemi
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) are two prevalent behavioral disorders among children, with the inclusion of these children within a family typically having a significant impact on the functioning of other family members. When the psychological ...
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Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) are two prevalent behavioral disorders among children, with the inclusion of these children within a family typically having a significant impact on the functioning of other family members. When the psychological well-being of parents of children with developmental disorders is compromised, it can lead to adverse outcomes such as feelings of deprivation and increased levels of anxiety, stress, and depression among parents of typically developing children (Sheikhul Islami et al., 2015; Chen et al., 2017). The distinct characteristics and needs of children grappling with psychological difficulties often lead to parents experiencing a sense of stress and feeling ill-equipped in terms of parenting skills. Research indicates that mothers of children with Attention Deficit/Hyperactivity Disorder (ADHD) tend to endure higher levels of parenting stress compared to mothers of typically developing children (Yousfi et al., 2018; Kazemi, 2015; Ershad Sarabi et al., Kurdistan, 1394). Research findings indicate that when parents' mental health is compromised, their levels of hope, optimism, tolerance, and resilience diminish, affecting their capacity to effectively handle challenges. This, in turn, reduces their self-efficacy in parenting and can have negative effects on the individual's psychological well-being. Studies have demonstrated that families with children with special needs often display lower levels of psychological capital and its components, as asserted by Birami et al. Previous research has focused on the impacts of Attention Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder or training interventions aimed at enhancing parental skills. However, studies to date have not concurrently examined the effects of these disorders on two components relevant to parents that can simultaneously exhibit positive and negative consequences derived from the disorder when compared to parents of typically developing children. The objective of this research is to investigate the following question: Is there a significant difference in parenting stress and psychological capital between parents of children with Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and typically developing children?Keywords: Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Parental Stress, Psychological Capital. Extended AbstractMethodThe research methodology adopted in this study is of a comparative scientific nature. The study's statistical population consists of the parents of elementary school boys (grades 1 to 3) during the academic year 1997-1998 in Kashan City.This study utilized a comparative scientific approach, drawing a sample of 57 parents of children with Attention Deficit/Hyperactivity Disorder, 50 parents of children with Oppositional Defiant Disorder, and 42 parents of typically developing children from the aforementioned statistical population. Individuals from the identified statistical population who met the eligibility criteria for the study were thoughtfully selected. Subsequently, the parents were provided with Parenting Stress and Psychological Capital questionnaires to complete. The collected data was subsequently analyzed using the SPSS software, employing both the multivariate analysis of variance and the Kruskal-Wallis statistical methods.Findings The Shapiro-Wilk test results indicated that the data distribution for the stress variable was normal, while the distribution for the psychological capital variable was non-normal. Consequently, parametric tests were applied for analyzing the stress variable data, while non-parametric tests were employed for assessing the psychological capital variable data. Based on the significance of the F statistic from the Multivariate Analysis of Variance (MANOVA) test for the parenting stress component (Box's: 369.36, p < 0.00), it can be inferred that the covariance matrix for the stress variable is not equivalent across the groups. Furthermore, due to the significance of Bartlett's chi-square statistic for the parenting stress component (1104.698, p < 0.00, x^2 = 2), it can be deduced that a significant relationship exists among the components. Due to these findings, it is appropriate to employ a multivariate analysis of variance (MANOVA) test in this situation.The Multivariate Analysis of Variance (MANOVA) Test was utilized to investigate parenting stress among parents of children with Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and typically developing children. The outcomes of the test exhibit a substantial effect of group on the linear combination of the dependent variable. This suggests that there is a remarkable divergence between the typical parenting challenges, Attention Deficit Hyperactivity Disorder, and Oppositional Defiant Disorder in terms of the stress experienced by parents. Additionally, the non-parametric Kruskal-Wallis test was deployed to investigate the psychological capital component among the three groups of parents, uncovering a significant divergence in psychological capital levels across the groups.DiscussionThe findings demonstrated that parenting stress varied significantly across three groups. Additionally, the results indicated that parents of typically developing children display higher levels of psychological capital compared to parents of children with Attention Deficit/Hyperactivity Disorder and those with Oppositional Defiant Disorder. It is important to note the complicated relationship between these individuals, wherein a shift in one individual can swiftly impact the other. When a child within the family struggles with behavioral disorders, it can pose significant challenges for all individuals who interact with them. One of these challenges involves enduring high levels of stress (Talebi et al., 2017). Consequently, it can be deduced that the distinctive characteristics of children with emotional behavioral disorders have considerable unfavorable impacts on both the children themselves and their close relationships, particularly their parents. Parents who lack the necessary communication skills to effectively engage with these children face substantial challenges, and in addition to the intrinsic stresses of parenting, these parents also suffer from additional strain.The parenting stress endured by these parents exacerbates the children's behavior, further intensifying parental stress, ensuing in a cascading series of emotional behavior. This cyclical pattern generates a vicious cycle that exacerbates the inherent issues for both parents and children. Additionally, the research indicated that parents of children diagnosed with Oppositional Defiant Disorder (ODD) showcased lower levels of psychological capital compared to parents of typically developing children and those with Attention Deficit/Hyperactivity Disorder (ADHD).The components of psychological capital, such as hope, optimism, self-efficacy, and resilience, play a crucial role in the parent-child relationship, as demonstrated by the findings. 1. Raising a child with an emotional behavioral disorder significantly impacts the perceptions, emotions, perspectives, and values of their parents, resulting in experiences that diminish the psychological well-being of parents with children who have Oppositional Defiant Disorder compared to parents of typically developing children. Consequently, they experience diminished capacity to use appropriate techniques while dealing with these children, resulting in an inability to effectively diffuse conflicts. A decrease in parents' psychological capital can result in increased negative behaviors in children, which exacerbates the issue and leads to elevated self-displeasure and disillusionment due to mishandling the situation. Therefore, this problem persists indefinitely because of its cyclic nature.Ethical ConsiderationsThis study strictly adhered to ethical guidelines, in accordance with the Master's thesis by Setara Haddad Kashani from the Department of Psychology at Gilan University, dated 04/2018. Ethical considerations, including maintaining confidentiality, obtaining informed consent from participants' parents, and protecting the identity information, were thoroughly upheld throughout the entire research process.AcknowledgementI sincerely thank all the friends, professors, and parents who have cooperated with us in undertaking this research.
Somayeh Mohammadi kashka; Abbas Abolghasemi; seyyed mosa Kafi Masooleh
Abstract
Abstract
Research has shown that children with separation anxiety disorder often struggle with self-regulation and emotional regulation. The purpose of this study was to investigate the impact of group play therapy, specifically painting-based therapy, on the emotional skills of children with separation ...
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Abstract
Research has shown that children with separation anxiety disorder often struggle with self-regulation and emotional regulation. The purpose of this study was to investigate the impact of group play therapy, specifically painting-based therapy, on the emotional skills of children with separation anxiety disorder. The study utilized a quasi-experimental design with a pre-test-post-test approach and a control group. The study population included all sixth-grade female students with separation anxiety disorder in Ghaemshahr city during the academic year 1400. Thirty children were selected for the study and randomly assigned to either the experimental or control group. Data were collected using the Separation Anxiety Questionnaire (March et al., 1997) and Zeiman's (2001) emotion management scale. The experimental group received ten 45-minute sessions of painting-based group play therapy, while the control group received no intervention. The data were analyzed using univariate and multivariate analysis of covariance. The results showed that painting-based group play therapy significantly improved the emotional skills of children with separation anxiety disorder (P<0.001). Based on these findings, it can be concluded that group play therapy based on painting is an effective treatment method for promoting mental health and preventing psychological problems in children with separation anxiety disorder.
Extended Abstract
Introduction
Separation anxiety disorder is one of the types of anxiety disorders that can be indicative of anxiety disorders starting in childhood (Hoffman, Sterkenburg & Van Rensburg, 2019). This type of anxiety is so intense and serious that it prevents daily activities and causes severe disruption in a child's academic and social performance (Maltese & colleagues, 2018). If this anxiety continues until the end of childhood or adulthood, it can lead to an ineffective understanding of oneself and others (Tamman and colleagues, 2017). Additionally, separation anxiety disorder may be associated with various mental disorders and problems that can develop in adulthood, as reported by Agebati and colleagues (2020).
Children with separation anxiety disorder consistently use maladaptive emotional regulation strategies and use adaptive emotional regulation strategies less. In fact, maladaptive emotional regulation in children can be an important factor in maintaining their separation anxiety (Naseri, Gasempour & Mahmoudimogadam, 1394). Children with anxiety disorders tend to use more maladaptive strategies compared to those without anxiety. Identifying efficient or ineffective patterns of emotional regulation can improve anxiety (Rodrigues et al., 2021). Schneider et al. (2018) concluded that emotion dysregulation can be a potential risk factor in the development of anxiety symptoms in children and adolescents. Play therapy has a positive effect on reducing separation anxiety and avoiding harm in children (Yazdani, 2018) and is an effective intervention in improving the psychological symptoms of children suffering from separation anxiety disorder (Sidi Andi, Najafi and Rahimian Bogar, 2014). One of the other therapeutic methods used to treat children's disorders is art therapy based on painting (Mohammadi and Radin, 2016). Painting is the spontaneous drawing of pictures that provides opportunities for non-verbal communication and expression (Erickson and Blok, 2013). The research of Malekpour, Vahedi and Mirnesab (2013) showed that the implementation of painting therapy program is effective in increasing the emotional regulation of elementary school boys. Nan, Hinz and Loesbrink (2021) found that art therapy is effective in reducing stress, depression and improving the level of emotions and improving general health. Mabing-Barz, Hestercht and Ponstine (2019) concluded that art therapy reduces anxiety and improves emotion regulation and executive functioning. In general, group play therapy training based on drawing can help children to deal with their anxiety. Also, the combination of these two treatments can be a safe and useful way to promote mental health and improve the child's emotional skills. Therefore, the aim of the present study is to determine the effect of group play therapy training based on drawing on the emotional skills of children with separation anxiety disorder.
Method
The current study used a semi-experimental design with a pre-test and post-test, and a control group. The population studied consisted of all female students who were in the sixth grade and had been diagnosed with separation anxiety disorder in Ghaemshahr city during the 2019 academic year. Thirty individuals were then selected and randomly assigned to either an experimental or control group, with 15 participants in each group. The control group did not receive any intervention, while the experimental group received group play therapy training based on drawing. The study aimed to determine the effectiveness of group play therapy training on reducing separation anxiety in young girls with separation anxiety disorder.
Separation anxiety questionnaire: The separation anxiety questionnaire was developed by March et al. (1997) and contains 39 items. Mashhadi (2011) reported the reliability of this tool using Cronbach's alpha of 0.81 and a favorable face validity. Pirzadi (2017) reported a higher reliability coefficient for this questionnaire via Cronbach's alpha, with a value of 0.80.
Emotion Management Questionnaire: It was completed by Ziman et al. in 2001 and consists of 38 questions graded on a three-point Likert scale. Hashmipour and Mohammadi's research (2017) found a reliability coefficient of 0.73 and 0.86 using two-halves and retesting, respectively, for this scale.
Group play therapy based on drawing: The intervention program used in this research was a combined package of drawing therapy (Zadeh Mohammadi, 2007; quoted by Rezaei et al., 2014) and play therapy (Mohammed Ismail, 2010; quoted by Yazdani, 2018).
Results
The sample of students participating in the study was matched in terms of age, sex, and educational level.
Table 1. Pre-test and post-test descriptive indices of variables by groups
Post test
M±SD
Pre test
M±SD
Group
Variable
Post test
M±SD
Pre test
M±SD
Group
Variable
81/1±47/24
50/3±13/20
Experiment
Sadness
04/2±80/22
2±00/18
Experiment
Anger
66/2±07/22
96/3±67/21
Control
14/3±13/19
40/3±87/18
Control
22/5±33/83
60/7±80/66
Experiment
Emotion Management (total score)
77/1±00/23
61/3±20/27
Experiment
Anxiety
09/7±60/71
96/9±93/69
Control
88/2±53/28
93/3±53/27
Control
Table 1 presents the means and standard deviations of the research variables in both the control and experimental groups. To test the research hypothesis, the Multivariate covariance Analysis test was employed. Box and Levin's test and the test of effects between subjects indicated that the assumptions of the covariance analysis were met.
Table 2. Results of Multivariate covariance Analysis to investigate the effect of painting-based group play therapy training on emotional Skills
SS
Df
MS
F
P
Eta
OP
Variable
83/100
1
83/100
40/14
001/0>
340/0
96/0
Anger
20/43
1
20/43
36/8
001/0>
230/0
80/0
Sadness
63/149
1
63/149
23/26
001/0>
484/0
10/0
Anxiety
99/1255
1
99/1255
66/53
001/0>
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Emotion
management
The results of the Multivariate covariance Analysis, as presented in Table 2, indicate a statistically significant difference between the experimental and control groups in the component of emotion management.
Discution
The aim of this study was to investigate the effect of group play therapy based on drawing on improving the emotional skills of children with separation anxiety disorder. The findings suggest that emotional dysregulation leads to difficulties with identifying, understanding, accepting, and adjusting emotions, and can result in a person being cognitively and emotionally helpless and confused. Drawing-based group play therapy training aims to improve the control of negative emotions in children with separation anxiety disorder, which can be effective in reducing it along with other treatments. Artistic activities have also been found to encourage healthy activities, emotional regulation, and the integration of the child's brain. This can help to reduce behavioral and emotional problems.
Final Results
In general, it can be concluded that group play therapy training based on drawing improves emotional skills. Since children with separation anxiety disorder have difficulty in regulating their emotions as well as in recognizing and describing their emotions, this causes problems in interpersonal relationships and interaction with others; therefore, group play therapy training based on drawing helps children to increase their emotional skills and also reduces their anxiety and worry.
Keywords: Separation Anxiety, Play Therapy, Emotional Skills, Painting Therapy.
Sepideh Nayebzadeh; Abbas Abolghasemi; seyyed mosa Kafi Masooleh; mahnaz khosrojavid
Abstract
The purpose of the present study was to investigate the effectiveness of emotion regulation training on adaptive/social behaviors of adolescents with separation anxiety disorder. The research method was quasi-experimental with pre-test and post-test design with a control group. Participants in the study ...
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The purpose of the present study was to investigate the effectiveness of emotion regulation training on adaptive/social behaviors of adolescents with separation anxiety disorder. The research method was quasi-experimental with pre-test and post-test design with a control group. Participants in the study were 20 adolescents with separation anxiety who were identified among the adolescents studying in the first and second grades of Tehran School of Art and Literature in the academic year 2019-2020 and were randomly assigned to two experimental and control groups of 10 adolescents. The experimental group received the Gross model emotion regulation training in 8 sessions of 90 minutes individually, but the control group did not receive any intervention. Data were collected using March et al.'s (1997) Separation Anxiety Inventory and Spence et al.'s (2002) Adaptive / Social Performance Questionnaire, in pretest and post-test. Research data were analyzed by univariate and multivariate analysis of covariance. The results of the analysis of covariance showed that emotion regulation training was effective in increasing adaptive/social behaviors in adolescents with a separation anxiety disorder (ρ <0.001). According to the findings, it seems that emotion regulation training can be used to manage anxiety and increase adaptive behaviors in adolescents with separation anxiety disorder as a complementary education program along with other treatment methods.
maryam zeinali; mahnaz khosrojavid; Abbas Abolghasemi; Maryam Kousha
Abstract
Given the problems faced by children with neurodevelopmental disorders in sensory processing; the aim of this study is to compare visual-spatial and auditory temporal processing in children with special learning disorders, nonverbal learning disorders, and attention-deficit / hyperactivity disorder. ...
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Given the problems faced by children with neurodevelopmental disorders in sensory processing; the aim of this study is to compare visual-spatial and auditory temporal processing in children with special learning disorders, nonverbal learning disorders, and attention-deficit / hyperactivity disorder. The research method is Exe-Post Facto and its statistical population included girls and boys aged 9 to 12 years who were referred to the Child Psychiatry Center, Learning Disabilities Centers, and primary schools in the academic year 1399-400 in Rasht. 79 of these children were divided into three groups of specific learning disorders with dyslexia, nonverbal learning disorder, and attention-deficit/hyperactivity disorder by convenience sampling. Data were collected using, the Test of Visual-Perceptual Skills, (non-motor)-Revised (Gardner, 1996), Auditory Perception Test (Allen& Serwatka, 1994), and Auditory Problems checklist (Fisher, 1996). Research data were analyzed by univariate and multivariate analysis of variance. The results show that children with a nonverbal learning disorder in all components of visual, and auditory processing components had lower performance than the other two groups. Children with dyslexia also achieved in the component (rotation and inversion) of visual processing and the component (duration) of auditory processing. Based on results and the existence of more deficiencies in children with a nonverbal learning disorder in sensory processing skills (visual and auditory) it is necessary to pay more attention to the signs and symptoms of this disorder in education to reduce the problems of these children by early interventions.
Pegah Azadimanesh; abbasali hossein khanzadeh; Abbas Abolghasemi
Abstract
The aim of this study was to determine the combined effect of executive functions training to children with attention deficit /hyperactivity disorder, behavior change strategies to parents, and communication skills to peers on relationship with parents. the statistical population of the study was all ...
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The aim of this study was to determine the combined effect of executive functions training to children with attention deficit /hyperactivity disorder, behavior change strategies to parents, and communication skills to peers on relationship with parents. the statistical population of the study was all boys with symptoms of Attention Deficit / Hyperactivity Disorder, 6 to 9 years old in Kermanshah in the academic year of 2019. that among them, 30 students who were diagnosed with Attention Deficit / Hyperactivity Disorder based on a questionnaire and clinical interview were selected by random cluster sampling method and were divided into two groups of 15 people (experimental group and control group). the instruments used in this study were the Attention Deficit / Hyperactivity Disorder Diagnostic Questionnaire based on the information provided in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (Sadock and Sadock, 2005) and Parent-child Relationship Scale (Fine, Moreland, and Schwebel, 1983). data were analyzed using analysis of covariance. the results showed that integrated multidisciplinary education improved relationship between parents and child with attention deficit / hyperactivity disorder. creating the right context through family and peer education and the simultaneous teaching of executive functions has contributed to the effectiveness of this integration. based on the results of this study, it is suggested that in the treatment of children with Attention Deficit / Hyperactivity Disorder, multifaceted methods be used with emphasis on different levels of parents and peers.