Khadijeh Kaboli; Mohammad Reza Bardideh; Siamak Samani; Leila Khabir
Abstract
Abstract
The purpose of this research was the effectiveness of mentalization-based drama therapy on the sustained attention of children with attention deficit/hyperactivity disorder. The research method was semi-experimental with a pre-test-post-test design and follow-up with a control group. The statistical ...
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Abstract
The purpose of this research was the effectiveness of mentalization-based drama therapy on the sustained attention of children with attention deficit/hyperactivity disorder. The research method was semi-experimental with a pre-test-post-test design and follow-up with a control group. The statistical population of the research included all students aged 9 to 11 years old with attention deficit/hyperactivity disorder in Zanjan city in 2023. The sample size includes 30 subjects (15 subject in the experimental group and 15 subject in the control group) from the statistical population were selected by purposeful sampling and were placed in two control and experimental groups. For the experimental group, the developed drama-therapy package based on mentalization was implemented, while the control group remained on the waiting list. The research tools included Connors Attention Deficit Hyperactivity Disorder Questionnaire (2007) and integrated visual and auditory continuous performance test (1995). The results showed that the drama therapy package based on mentalization had a significant effect on improving sustained attention in the post-test and follow-up stages. The findings of this research provide useful information regarding the drama therapy package based on mentalization, and counselors and psychologists can use this intervention to improve sustained attention in children with attention deficit/hyperactivity disorder.
Keywords: drama therapy, mentalization, emotion regulation, attention deficit/hyperactivity disorder.
Extended Abstract
Introduction
Attention-deficit/hyperactivity disorder is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity (American Psychiatric Association, 2022). Sustained attention deficit is one of the major cognitive deficits of attention deficit/hyperactivity disorder that continues into adulthood (Ge et al., 2013). Sustained attention is a key cognitive ability that enables people to maintain their focus, control stimuli, not be easily distracted, and it improves significantly during the development of a person (Gallen et al., 2023). Sustained attention functions are a necessary condition for other abilities; without sustained attention, critical information for a subsequent behavior cannot be represented in the mind and will not be processed, therefore, deficits in sustained attention hinder cognitive performance, such as learning and memory (Fortenbaugh et al., 2017).
Therefore, in order to solve attention deficits in this group of people, it is felt necessary to use multidimensional treatments, which are usually a combination of drug therapy, psychological counseling, school-oriented intervention, behavioral therapy, family therapy, and social sufficiency training. It is used according to the needs of the individual and the family (Biyati et al., 2012). In recent years, one of the new methods of therapy that has received attention in this regard is drama therapy (Frydman and Mayor, 2023). Drama-based intervention is a creative form of psychotherapy that promotes psychological growth and transformation through the systematic and deliberate use of drama and theater techniques (Jiang et al., 2023). Another therapeutic intervention that has been used in recent years to improve children's problems is the Mentalization based treatment (Darabi et al., 2022). The main focus of this approach is to help the client to bring his mental experiences to the level of consciousness and to perceive himself as an integrated whole, therefore the goal of the treatment is to grow and strengthen the capacity of mentalization through the therapeutic relationship and increase the capacity of the person to recognize thoughts and feelings. It is what experiences (Choi-Kain, 2022).
Considering the research findings and the negative impact of sustained attention deficit on the lives of children with attention deficit/hyperactivity disorder, the use of appropriate interventions can lead to the improvement of these people's problems and significant changes in the way rehabilitation of people with attention deficit/hyperactivity disorder and on the other hand, looking at what has been reviewed, it can be said that play therapy and Mentalization based treatment solely on cognitive, emotional and behavioral components They are effective, but since adopting integrated and combined approaches is more efficient than single-factor approaches; Therefore, it seems that drama-therapy intervention based on mentalization can be more effective on children with attention deficit/hyperactivity disorder. Therefore, the current research was conducted with the aim of the effectiveness of drama-therapy intervention based on mentalization on the sustained attention of children with attention deficit/hyperactivity disorder.
Methodology
The research method was semi-experimental with a pre-test-post-test design and follow-up with the control group. The statistical population of the research is students aged 9 to 11 years old with attention deficit/hyperactivity disorder who were studying in Zanjan schools in the school year of 2023. Education consultants have received a diagnosis of attention deficit/hyperactivity disorder. For more accurate diagnosis, attention deficit/hyperactivity disorder questionnaire was completed and a semi-structured clinical interview was conducted with children. Finally, among these children, a sample of 30 people was selected based on the entry criteria and then they were replaced in two experimental and control groups (15 experimental people, 15 control people). For the experimental group, the drama-therapy intervention based on mentalization was implemented, while the control group remained on the waiting list. The research tools included Connors Attention Deficit Hyperactivity Disorder Questionnaire and integrated visual and auditory continuous performance test.
Results
In Table 1, the descriptive statistics of the variable scores of the research are reported by groups.
Table 1. Descriptive statistics of research variables by groups
Variable
Group
Pre-test
Post-test
Follow-up
M
SD
M
SD
M
SD
visual attention
experimental
52.53
4.45
58.40
3.66
57.26
3.75
Control
53.40
3.83
52.27
3.88
53.47
3.37
auditory attention
experimental
48.13
4.62
53.86
3.75
52.73
3.93
Control
48.86
3.80
47.80
3.82
48.73
4.45
According to the average scores of the pre-test, post-test and follow-up, the average scores of the stable attention components of children in the experimental group have increased. But in the control group, the scores in all three courses are not significantly different. In order to analyze the data, the analysis of variance test with repeated measurements was used.
Table 2. Variance analysis with repeated measures to Tests of Within-Subjects and Between-Subjects effects
Variable
Source of changes
SS
df
MS
F
P
Eta
visual attention
Time
113.62
1.31
86.57
16.83
0.01
0.69
Time × group
190.55
1.31
145.19
105.67
0.01
0.79
Group
205.51
1
205.51
4.84
0.03
0.14
auditory attention
Time
104.42
1.60
65.26
42.60
0.01
0.60
Group
182.28
1.60
113.93
74.38
0.01
0.72
Time × group
217.77
1
217.77
4.98
0.03
0.15
The results of Table 2 show that the F level of the interaction effect of stages and group is significant (P<0.001). Also, examining the results of the Bonferroni test showed that, in the components of sustained attention, the average of the experimental group in the post-test and follow-up is significantly higher than the pre-test stage (P<0.01), while the difference between the post- The test and the follow-up phase are not significant (P>0.01); But in the control group, there is no difference between pre-test, post-test and follow-up (P>0.01). This finding means that the drama-therapy intervention based on mentalization not only led to the improvement of the components of sustained attention in the experimental group, but this effect was also stable in the follow-up phase.
Discussion
The results showed that the drama-therapy intervention based on mentalization on sustained attention of children with attention deficit/hyperactivity disorder is effective. In explaining this finding, it can be said that drama therapy uses the child's natural tendencies to perform activities, so it can easily examine the child's activities, behavior and feelings, a child who Having problems in expressing and correct tone of words, refuses to pay attention and answer, shows more enthusiasm and willingness to pay attention by using the show and in some cases volunteers for this work (Biyati et al., 2012). On the other hand, in most drama therapy activities, such as activities that put children in different situations and ask them to display their reactions, the child actually faces some kind of problem and investigates it. There are different ways to deal with it by using intellectual skills. Also, during the performance, children should recognize the plan of the play, re-express and adjust the dialogues and scenes of the play, evaluate and criticize their own and each other's scenes, analyze the components that comprise the whole work. think again about their scenes, practice them and perform them again according to the changes and rewrites. All these factors lead to the creation of decision-making skills, reasoning, thinking and, accordingly, attention capacity (Sabouri et al., 2015).
Conclusion
Considering the effectiveness of the drama-therapy intervention based on mentalization on the sustained attention of children with attention-deficit/hyperactivity disorder, specialists and therapists should use this therapy package to improve the cognitive problems of children with attention-deficit/hyperactivity disorder.
Fatemeh Hosseinjani; Mehdi Zemestani
Abstract
Abstract
Autism spectrum disorder (ASD) is one of the important neurodevelopmental disorders that always has a high comorbidity with other psychiatric disorders. One of the ways to investigate this comorbidity is to identify the underlying mechanisms involved in this association. The aim of the present ...
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Abstract
Autism spectrum disorder (ASD) is one of the important neurodevelopmental disorders that always has a high comorbidity with other psychiatric disorders. One of the ways to investigate this comorbidity is to identify the underlying mechanisms involved in this association. The aim of the present study was to explore the mediating role of emotion regulation and intolerance of uncertainty in the development of externalizing disorders in children with ASD. The current research was a correlational study using structural equation modeling (pathway analysis). The statistical population included all children and adolescents with ASD in the age range of 8 to 18 years from autism schools and the autism society in Tehran, Tabriz, and Mianeh province. Using a convenience sampling method, a sample of 117 children was selected and the data were collected online from parents. Pearson correlation coefficient and pathway analysis were used for the statistical analysis of data by SPSS and AMOS software. The results of the present study showed that the symptoms of autism directly and significantly explain the symptoms of externalizing spectrum disorders. Also, emotion dysregulation and intolerance of uncertainty as mediating factors explain the severity of externalizing spectrum disorders impairments in children with autism disorder. According to these findings, it can be concluded that emotion dysregulation and intolerance of uncertainty as pathological transdiagnostic factors play an important mediating role in the exacerbation of the symptoms of externalizing disorders in children with ASD.
Keywords: Autism spectrum disorder, Transdiagnostic factors, Emotion regulation, Intolerance of uncertainty, Externalizing disorders.
Extended Abstract
Introduction
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by marked social and communication deficits, fixed interests, and repetitive behaviors (American Psychiatric Association, 2022). Children with ASD often have comorbid psychiatric disorders, including internalizing and externalizing disorders (Kaplan, Sadock, & Ruiz, 2019). Co-occurring externalizing problems (e.g. aggression, outburst behaviors, hyperactivity, and irritability) are very common in ASD across the lifespan and are often associated with poorer quality of life over and above the impact of ASD itself (Vaillancourt et al., 2017; Miller et al., 2019).
Considering the high prevalence of comorbid externalizing problems with ASD, the negative consequences of this comorbidity, identifying the underlying mechanisms involved in this comorbidity have important implications. Identifying and understanding the possible role of transdiagnostic mechanisms in the development and maintenance of externalizing pathologies in children with ASD have implications in the better explanation of the nature of comorbid disorders with ASD as well as in the modeling and developing effective treatment protocols for these children (Ozsivadjian et al., 2020).
Various transdiagnostic factors may play a mediating/moderating role in the development or maintenance of the symptoms of comorbid externalizing problems in children with ASD. Limited research has been conducted on transdiagnostic factors underlying the comorbidity of externalizing disorders in children with ASD. There is emerging empirical support for a number of cognitive-emotional mechanisms being implicated in the development and maintenance of high rates of externalizing problems in ASD (Mazefsky et al, 2013).
Among the important transdiagnostic factors that have been highly emphasized in recent studies on the externalizing problems in ASD, we can mention emotion regulation (Mazefsky et al, 2013; Morie et al., 2015) and intolerance of uncertainty (Neil, Olsson, & Pellicano, 2016; Vasa et al., 2018). These two constructs are among the important underlying transdiagnostic factors that have been emphasized in recent research on their influential and mediating role in the creation and continuation of comorbid disorders with autism spectrum disorder (Say et al., 2017; Saiz-Souanes et al., 2020).
The present study was conducted to explain the mediating role of emotion dysregulation and intolerance of uncertainty as transdiagnostic mechanisms in the development and maintenance of externalizing problems in children with ASD. The main question of the research was to what extent the two underlying and transdiagnostic constructs of emotion dysregulation and intolerance of uncertainty as mediating variables can explain the symptoms of externalizing symptoms in children with ASD?
Literature Review
Limited studies have been conducted on the role of emotion dysregulation and intolerance of uncertainty in the development of internalizing and externalizing problems in children with ASD. In this regard, Mazefsky et al. (2011) showed that children with ASD have problems in using adaptive emotion regulation strategies and they use maladaptive strategies to deal with negative daily tensions, which makes them prone to a wide range of internalizing psychopathologies including depression and anxiety. Morie et al. (2015) also showed that defect in emotion regulation plays an important role as a mediator in the development and exacerbation of anxiety and depressive symptoms in youth with ASD. Neil et al. (2016) and Vasa et al. (2018) showed that the high level of intolerance of uncertainty in children with ASD increases the level of tension and anxiety in them, and this tension in turn leads to the possibility of disruptive behaviors in them. Therefore, previous evidence shows that intolerance of uncertainty is an important element in the development and maintenance of internalizing pathologies in them. Therefore, previous pieces of evidence show that emotion dysregulation and intolerance of uncertainty in youth with ASD are among the important mediating risk factors for the development and maintenance of comorbid psychopathologies in them.
Methodology
A descriptive correlation research approach (structural equation model) is adopted in this study. The statistical population included all children and adolescents with ASD who were referred to exceptional children schools and autistic centers in Tehran, Tabriz, and Mianeh cities in 2019-2020. A convenience sampling method was used to select 117 children and adolescents with ASD as the study sample. The inclusion criteria were receiving ASD diagnosis based on the pediatric psychiatrics interview, ability to write and read, having ages between 8 and 18 years, and willingness to participate in the study. All participants were assessed by the Gilliam Autism Rating Scale-second edition (GARS-2), Strengths and Difficulties Questionnaire (SDQ), and Intolerance of Uncertainty Scale for Children (IUSC). To analyze the data, descriptive statistical metrics such as mean, standard deviation, and Pearson correlation and pathway analysis were employed using the SPSS-22 and Amos-24 software.
Results
The results of the matrix correlation showed a significant relationship between ASD symptoms, externalizing problems, emotion regulation strategies, and intolerance of uncertainty dimensions. The standardized direct effect of ASD symptoms on externalizing problems, emotion regulation strategies, and intolerance of uncertainty dimensions was significant (p> 0.05). Moreover, evaluation of indirect effects using the bootstrap method showed that the indirect effects of ASD symptoms on conduct problems, hyperactivity, emotion regulation strategies (i.e., suppression, reappraisal), and intolerance of uncertainty dimensions (prospective and inhibitory) were significant. Therefore, the indirect relationship between ASD symptoms and externalizing problems through emotion regulation and intolerance of uncertainty is significant (p> 0.05).
Conclusion
This study aimed to investigate the mediating role of transdiagnostic factors of emotion dysregulation and intolerance of uncertainty in the association between ASD symptoms and externalizing problems. The results of the present study showed that the symptoms of autism directly explain the externalizing problems in children with ASD. Also, emotion regulation and intolerance of uncertainty as mediating factors explain the severity of externalizing problems in children with ASD.
According to these findings, it can be said that emotion dysregulation and intolerance of uncertainty as pathologic transdiagnostic mechanisms probably play an important mediating role in explaining the development and maintenance of externalizing problems in children with ASD. Based on the results of this research, it can be said that the defect in emotional regulation and also the inability to tolerate ambiguous situations in autistic children and adolescents probably lead to the development of externalizing symptoms (conduct problems, hyperactivity) in them.
This study has limitations that should be considered in future research. Limitations related to the cross-sectional nature of the study, geographical region, small sample size, sampling method, and using self-reporting questionnaires as a data collection tool.
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.
Nasim Farnoodisn; nezam hashemi
Abstract
Purpose: Autism is a pervasive developmental disorder whose sufferers have three main characteristics: socialization disorder, impaired verbal and nonverbal communication, and limited and repetitive patterns of behavior. The aim of this study was to investigate the relationship between emotion regulation ...
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Purpose: Autism is a pervasive developmental disorder whose sufferers have three main characteristics: socialization disorder, impaired verbal and nonverbal communication, and limited and repetitive patterns of behavior. The aim of this study was to investigate the relationship between emotion regulation on hope and the empathetic relationship between mothers with autistic children. Materials: The research method was descriptive-correlational and the research population included all mothers with autistic children in District 5 of Tehran, who were referred to counseling centers. Using the available sampling method and according to the number of variables and components, 230 people were selected as the sample group. Research tools for data collection included Gross Emotion Regulation Questionnaire (2003), Schneider Hope Questionnaire (1991), and Davis Empathy Communication Questionnaire (1983). Results: The results of data analysis showed that there is a positive and significant relationship between emotion regulation and hope (p<0.05). Also, the results showed that there is a positive and significant relationship between emotion regulation and empathetic relationship (p<0.05). Discussion and conclusion: finally based on the results of regression analysis, the components of hope and empathetic communication were predicted based on the components of regulation. According to the findings, mothers with autistic children have a positive relationship with each other in the components of emotion regulation and hope, and empathetic communication.
Sahar Mohammadi; Leila Kashani Vahid; Hadi Moradi
Abstract
The purpose of this research was to determine the effectiveness of digital storytelling on emotion regulation of children with autism. Research design was a quasi-experimental that included a pretest and posttest that was conducted on both the experimental group, and control group. The statistical population ...
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The purpose of this research was to determine the effectiveness of digital storytelling on emotion regulation of children with autism. Research design was a quasi-experimental that included a pretest and posttest that was conducted on both the experimental group, and control group. The statistical population of the study included all children with autism spectrum in the Child-parent at a university clinic. For this purpose, 20 children with autism were selected and were assigned into two experimental and control groups randomly (each group 10 children). The experimental group received storytelling program for 12 sessions of 45 minutes and control group waited in the waiting list. All subjects completed Emotion Relation Checklist (Sheilds & Cicchetti, 1998) before and after the training. The obtained data were analyzed using Analysis of the Covariance. The findings showed significant differences between the experimental and the control group in emotion regulation. At the end, using digital storytelling program for improving emotion management was recommended.
zahra tarazi; Molok Khademi Ashkezari; Mahnaz Akhavan Tafti
Abstract
The aim of this research was to investigate and compare the effectiveness of attributional retraining program, emotion regulation and social-cognitive problem solving on Improvement of social adjustment in Students with Early Learning Disabilities in Tehran. This was a quasi-experimental study with pretest-posttest, ...
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The aim of this research was to investigate and compare the effectiveness of attributional retraining program, emotion regulation and social-cognitive problem solving on Improvement of social adjustment in Students with Early Learning Disabilities in Tehran. This was a quasi-experimental study with pretest-posttest, and follow-up.The participants consisted of 40 students with Learning Disability of 8 to 12 years old.They were selected through Simple random sampling and randomly divided into 3 experimental groups and a control group. attributional retraining, emotion regulation and social-cognitive problem solving training were presented in 8 sessions, each lasting 1 hours, in the 3 experimental groups.Sinha and Sing social adjustment Questionnaire was used in the pretest, posttest, and follow-up stages.The data were analyzed using MANCOVA,ANCOVA.The results showed that attributional retraining, emotion regulation and social-cognitive problem solving training caused a significant increase in social adjustment.emotion regulation training program and social-cognitive problem solving training with the same effect were more successful in social adjustment promotion than attributional retraining program.Educational programs that use the social cognitive approach of Bandura in designing educational packages have more significant effects.Therefore, the use of the present research results can be effective in the designing of preventive educational programs and improving educational achievements.