Research Paper
Jalil Babapour; maryam shkoohirad; Mostafa Zarean; Majid Mahmoodalilou
Abstract
AbstractThe present study aimed to evaluate the effectiveness of an integrated intervention program—comprising parent-child interaction, parent training, and family resilience—on challenging behaviors and sensory processing in children with high-functioning autism spectrum disorder (ASD). ...
Read More
AbstractThe present study aimed to evaluate the effectiveness of an integrated intervention program—comprising parent-child interaction, parent training, and family resilience—on challenging behaviors and sensory processing in children with high-functioning autism spectrum disorder (ASD). This research utilized a quasi-experimental pre-test/post-test design with a control group. The statistical population included high-functioning children with ASD (aged 5 to 8 years) residing in Tehran in 2024, from which 30 participants were selected via convenience sampling and randomly assigned to either an experimental or a control group (n = 15 per group). For the pre-test, participants completed the Challenging Behavior Questionnaire (CBQ) and the Short Sensory Profile (Dunn, 1999). The experimental group and their parents participated in an 8-session program over two months, consisting of one hour for the child and 30 minutes for the family, while the control group received no intervention. Data analyzed through multivariate analysis of covariance (MANCOVA) revealed that the mean scores for challenging behavior control significantly increased in the experimental group, while sensory processing problems significantly decreased. In conclusion, the integrated program of parent-child interaction, parent education, and family resilience is an effective approach for enhancing behavioral regulation and mitigating sensory processing challenges in children with high-functioning autism.Keywords: High-functioning Autism Spectrum Disorder; Challenging Behaviors; Sensory Processing, Parent-Child Interaction; Family Resilience. Extended AbstractIntroduction"Autism spectrum disorder (ASD) is defined as a neurodevelopmental condition arising from dysregulation in brain development, characterized by deficits in social interaction alongside restrictive, repetitive, and inflexible behavioral patterns. These patterns often include rigid routines, rituals, intensely focused interests, sensory sensitivities, and motor stereotypies (Skoz et al., 2024). Recent evidence indicates a significant positive correlation between ASD severity, the emergence of challenging behaviors, and deficits in sensory processing integration (Costescu et al., 2024). Furthermore, sensory processing abilities exhibit high variability among individuals across the autism spectrum (Shearer et al., 2024). Imbalances in sensory processing can lead to secondary complications, including anxiety, depression, and compromised physical health, while sensory disintegration interferes with psycho-emotional development and shapes the broader ASD phenotype (Machado et al., 2024). Despite these challenges, autistic children often struggle to generalize skills learned in clinical settings to real-world environments. Moreover, the prolonged nature of recovery means that many families do not receive adequate psychological training regarding their child's rehabilitation or the continuous support needed to enhance family resilience. Consequently, the Integrated Parent-Child Interaction, Parent Education, and Family Resilience Program has been developed as a holistic child-and-family treatment approach. The present study, therefore, aims to investigate the effectiveness of this combined intervention on challenging behaviors and sensory processing in children with high-functioning ASD."Research QuestionThe primary objective of this study is to determine the effectiveness of an integrated program—combining parent-child interaction therapy, parent education, and family resilience—on challenging behaviors and sensory processing in children with high-functioning autism. Methodology The intervention program was developed using a systematic thematic analysis approach. To design the curriculum, an initial pool of 140 articles—published within the last five years in peer-reviewed, high-impact journals—focusing on parent-child interaction, parent education, and family resilience was reviewed. Following a rigorous screening process based on relevance and methodological quality, 73 articles were selected for thematic synthesis. The extracted data were categorized into two primary domains: child-centered and family-centered interventions, resulting in the identification of 12 sub-components.To ensure the technical robustness of the program, its content validity was evaluated by a panel of experts and professors. The Content Validity Ratio (CVR) was assessed using a three-point scale, while the Content Validity Index (CVI) was measured on a four-point Likert scale. The analysis yielded a CVR of 0.91 and a CVI of 0.96, both of which exceed the minimum acceptable thresholds. These results confirm that the integrated treatment program, encompassing parent-child interaction, parent education, and family resilience, possesses high content validity and is professionally suitable for clinical application.Research Design: This study was an applied research project employing a quasi-experimental pre-test/post-test design with a control group.Participants and Sampling: The target population consisted of children aged 5 to 8 years diagnosed with high-functioning autism spectrum disorder (ASD) by a psychiatrist, residing in Tehran in 2024 (1403 SH). Participants were recruited through an online call offering eight complimentary training sessions for high-functioning autistic children. From the pool of volunteers, 30 participants who met the inclusion criteria (including verbal communication skills and specific age range) were selected via convenience sampling and randomly assigned to either the experimental group (n = 15) or the control group (n = 15).Procedure: Both groups underwent a pre-test assessment. The experimental group then participated in an integrated intervention program—combining parent-child interaction, parent education, and family resilience—consisting of eight sessions over a two-month period. During this interval, the control group received no intervention. Following the completion of the program, a post-test was administered to both groups to evaluate the changes.Instruments: Data were collected using the Challenging Behavior Questionnaire (CBQ) and the Short Sensory Profile (SSP; Dunn, 1999). ResultsTable 1. Results of univariate analysis of covariance to investigate the effectiveness of the treatment program on research variables.VariableSum of squaresDegree of freedomMean squaresFSignificance levelEffect sizeChallenging behaviors50/763150/76354/108001/0>83/0Sensitivity03/320103/32008/47001/0>67/0Sensory avoidance62/1123162/112371/96001/0>81/0Sensory sensitivity05/446105/44673/69001/0>75/0Sensory registration27/902127/90279/117001/0>84/0As presented in Table 4, the multivariate analysis of covariance (MANCOVA) revealed a significant difference between the experimental and control groups in the post-test phase regarding the mean scores of challenging behaviors and sensory processing subscales, including sensation seeking, sensory avoidance, sensory sensitivity, and sensory registration. An examination of the adjusted post-test means indicated that the experimental group demonstrated a significant improvement in challenging behavior control compared to the control group. Furthermore, children in the experimental group exhibited a significant reduction in sensory processing problems across all subscales relative to the control group. Consequently, these findings suggest that the integrated intervention program—incorporating parent-child interaction, parent education, and family resilience—is an effective approach for enhancing mothers' ability to manage challenging behaviors and mitigating sensory processing difficulties in children with high-functioning autism.5. DiscussionIn the current therapeutic landscape of Iran, families of children with autism often face a significant lack of comprehensive support, typically receiving only limited social welfare assistance. Furthermore, a substantial gap exists in clinical practice: parents are frequently excluded from the specifics of their child’s therapeutic sessions and often do not receive the specialized psychological training required to implement rehabilitation exercises at home. This lack of involvement hinders the generalization of learned skills from clinical settings to real-world environments. Additionally, while the child receives treatment, the psychological needs of the family—particularly the development of resilience—are often overlooked in continuous care models. Addressing these systemic gaps, the present study sought to evaluate the effectiveness of an integrated intervention program—combining parent-child interaction, parent training, and family resilience—on challenging behaviors and sensory processing in children with high-functioning autism. ConclusionThe findings of this study demonstrate that integrated parent-child interaction significantly improves challenging behaviors in children with autism, aligning with recent evidence suggesting that parent-focused counseling is a robust strategy for behavioral reduction (Fatima et al., 2025). Regarding sensory processing, our results corroborate the work of Krupa-Kutara et al. (2023), who posited that enhancing parents' sensory cognition enables them to decode the underlying causes of their child's behaviors, thereby fostering a more supportive environment.Furthermore, the effectiveness of the parent training component in our program is consistent with the seminal work of Scahill et al. (2016), which highlighted that because parents spend the most time with their children, their behavioral training is more effective in fostering adaptive skills. Similarly, Miller-Kuhaneck and Watling (2018) emphasized that family-centered coaching and training are highly effective for children with sensory integration challenges.Finally, the role of family resilience in our intervention was pivotal. As noted by Sun and Hong (2024), while raising a child with autism presents immense challenges, professional support and increased resilience empower parents to create a nurturing family ecosystem. Moreover, the link between resilience and sensory processing observed in our study is supported by Rizk-Mohammad Abolanan (2024), who found that parental resilience is intrinsically tied to their specialized knowledge of autism. Collectively, these results suggest that addressing the family unit as a whole—rather than focusing solely on the child—creates a synergistic effect that improves both behavioral and sensory outcomes.7.AcknowledgmentsThis article is derived from the first author’s PhD dissertation in Clinical Psychology at the University of Tabriz. The authors would like to thank the University of Tabriz for its support. This research was registered and approved by the Ethics Committee under the code: IR.TABRIZU.REC.1404.057.
Research Paper
Haifaa adil same jamel alkhdar; Mohammad taghi Aghdasi; Amir Ghiami Rad
Abstract
AbstractThe purpose of the present study was to investigate the effectiveness brain gym exercises on motor coordination, inhibitory control children with developmental coordination disorder (DCD). The research method was quasi-experimental with pre-test and post-test design with a control group. The ...
Read More
AbstractThe purpose of the present study was to investigate the effectiveness brain gym exercises on motor coordination, inhibitory control children with developmental coordination disorder (DCD). The research method was quasi-experimental with pre-test and post-test design with a control group. The statistical population of the present study was female children aged 7-10 years with or suspected of developmental coordination disorder in Urmia city. 36 of them were selected by purposeful random sampling and placed in two groups of 18: experimental and control. The motor coordination test (KTK) to measure motor coordination (Kiphard & Shilling, 2007) and the go-no-go test to measure inhibitory control were performed similarly in the pre-test and post-test. The experimental group did brain gym exercises 3 times a week for 8 weeks, during 30-minute sessions. The data was analyzed through one-way analysis of covariance in Spss software version 26. The results showed that by controlling the pre-test score, there is a significant difference between the scores of the motor coordination and inhibitory control of the two experimental and control groups in the post-test (p=0.001). Eight weeks of brain gym exercises improves inhibitory control and coordination in children with developmental coordination disorder; therefore, it is recommended that children with developmental coordination disorder participate in brain exercise-based exercise programs.Keywords: Brain Exercise; Motor Coordination; Inhibitory Control; Developmental Coordination Disorder. Extended AbstractIntroductionDevelopmental Coordination Disorder (DCD) is a neurodevelopmental condition that significantly impairs a child’s ability to execute coordinated motor movements, resulting in slow, clumsy, or inaccurate actions and difficulties in acquiring new motor skills (Smits-Engelsman et al., 2022). Critically, DCD does not arise from primary intellectual, sensory, or neurological impairments (Cavalcante-Neto et al., 2021), but is rather attributed to dysfunctions in brain regions responsible for motor information processing (Purcell et al., 2024). Children with DCD frequently exhibit deficits in both gross and fine motor skills, often manifesting as postural instability and poor coordination, which hinder daily activities such as grasping objects, dressing, and writing (Li et al., 2024). Furthermore, DCD is highly comorbid with other neurodevelopmental conditions, including developmental language disorders, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and specific learning disabilities (Blank et al., 2019; Landgren et al., 2021).Beyond motor impairments, a major challenge hindering the academic progress of children with DCD is a deficit in executive functions (Eyvazi et al., 2018). Executive functions encompass a set of higher-order cognitive processes, including working memory, inhibitory control, cognitive flexibility, and planning. Among these, inhibitory control is paramount, referring to the ability to suppress prepotent thoughts and actions. A lack of inhibitory control often leads to impulsive responding before task comprehension is achieved (Eyvazi et al., 2018). Drawing upon neuroscientific principles, Brain Gym has been introduced as an intervention designed to enhance various cognitive and functional domains. Specifically, Brain Gym exercises are hypothesized to facilitate executive functions—such as attentional control and cognitive flexibility—thereby promoting learning efficiency and academic performance (International Brain Gym, 2008). Therefore, the present study aims to investigate the effectiveness of an 8-week Brain Gym intervention on motor coordination and inhibitory control in children with DCD.Research QuestionExtensive research has demonstrated that structured Brain Gym programs can effectively mitigate cognitive and functional impairments, with observed improvements persisting for several months post-intervention. However, a notable gap remains in the local literature, as no studies within this context have yet examined the impact of Brain Gym on enhancing response inhibition and motor coordination specifically in children diagnosed with Developmental Coordination Disorder (DCD). Given the existing body of evidence, the significance and necessity of the present study are underscored by several critical factors:Prevalence and Impact: The documented prevalence of DCD, estimated to be between 11% and 14% among school-aged children (Sarıkül & Erdoğan, 2023), coupled with the frequent co-occurrence of cognitive, motor, and social deficits, mandates the adoption of innovative and effective motor interventions. Such programs are essential for engaging these children in physical activities, thereby mitigating the long-term, severe consequences of this disorder on their overall development.Enhancing Participation: Due to the pervasive motor and cognitive challenges experienced by children with DCD, there is a frequent withdrawal from sports and even routine daily motor activities. By proposing an engaging and evidence-based motor intervention, this study aims to facilitate the improvement of these essential skills, thereby fostering greater physical and social inclusion.Foundational Skill Development: Given the fundamental motor skill (FMS) deficits observed in children with DCD, and recognizing the critical role of FMS in the execution of advanced motor skills, sports participation, and social engagement, this research seeks to inform the development of effective interventions that promote these core motor abilities.Research Gap: There is currently a paucity of evidence regarding the specific interplay between motor coordination and inhibitory control in children with DCD. Consequently, a significant lack of research persists in investigating the subsequent effects of Brain Gym on this particular relationship.Literature ReviewDevelopmental Coordination Disorder (DCD) is a neurodevelopmental condition that significantly impairs a child’s ability to execute coordinated motor movements, resulting in slow, clumsy, or inaccurate actions and difficulties in acquiring new motor skills (Smits-Engelsman et al., 2022). Critically, DCD is not primarily caused by intellectual, sensory, or neurological impairments (Cavalcante-Neto et al., 2021), but is instead attributed to dysfunctions in brain regions responsible for processing motor information (Wilson et al., 2023). While the reported prevalence of DCD in children ranges from 2% to 20%, internationally accepted figures currently stand at approximately 5–6% (Blank et al., 2019). DCD is characterized by deficits in both gross and fine motor skills; children with this disorder often exhibit postural instability and poor coordination, struggling with daily activities such as grasping objects, dressing, and writing.Furthermore, DCD is frequently comorbid with other neurodevelopmental conditions, including developmental language disorders, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and specific learning disabilities (Green et al., 2019). Beyond primary motor impairments, the limited mobility stemming from these deficits can reduce opportunities for physical and social engagement. This, in turn, elevates the risk of secondary health issues, such as obesity, and may lead to social challenges, including isolation, reduced participation, and difficulties in peer relationships (Miller et al., 2021). Moreover, individuals with DCD often experience internalizing symptoms, such as anxiety and depression (Draghi et al., 2021), which can persist into adulthood and significantly impact adaptive behavior and long-term mental health outcomes (Harrowell et al., 2018). Consequently, early diagnosis and targeted interventions are crucial for improving the long-term prognosis for individuals with DCD.MethodologyThe present study employed a quasi-experimental design featuring a pre-test/post-test approach with a control group. The target population comprised female children aged 7 to 10 years, diagnosed with or suspected of having Developmental Coordination Disorder (DCD), who were referred to the Royan Rehabilitation Clinic in Urmia, Iran. A total of 36 participants meeting the DCD diagnostic criteria were selected via convenience sampling. Participants were subsequently matched and assigned to either an experimental or a control group based on their scores from the Movement Assessment Battery for Children (MABC) and their Intelligence Quotient (IQ). The required sample size was determined using GPower software (version 3.1.9.7). For a statistical power of 0.80 ($\beta = 0.20$) and a medium effect size ($f = 0.50$) for an Analysis of Covariance (ANCOVA), a minimum of 32 participants was required. To account for potential attrition, the final sample size was set at 36 participants. Since all data collection instruments were administered in person under the direct supervision of the researcher, no missing data were reported; consequently, all 36 participants were included in the final analysis.Data analysis was conducted at two levels: descriptive and inferential. Descriptive statistics, including means and standard deviations, were utilized to summarize the sample characteristics. Prior to conducting parametric tests, the Shapiro-Wilk test was employed to verify the normality of distributions, and Levene’s test was used to assess the homogeneity of variances. To determine the differences between groups in the post-test while controlling for pre-test scores, a one-way Analysis of Covariance (ANCOVA) was performed. In the event of significant main effects, Bonferroni’s post-hoc test was applied for pairwise comparisons. All statistical analyses were performed using SPSS (Version 26), with the alpha level for statistical significance set at p* ≤ 0.05.ResultsThe results indicated that the experimental group’s mean scores for motor coordination and inhibitory control significantly improved from pre-test to post-test, favoring the intervention group in the post-test phase. Regarding inhibitory control, ANCOVA results revealed a statistically significant difference between the experimental and control groups after adjusting for pre-test scores (p* <.05). Specifically, the Brain Gym intervention led to a more pronounced improvement in inhibitory control in the experimental group (*M* = 31.72) compared to the control group (*M* = 28.33). The calculated partial eta squared ($\eta_p^2 = 0.98$) indicated that 98% of the variance in inhibitory control scores was attributable to the intervention.Furthermore, a statistically significant difference was observed between the groups in *overall motor coordination (p* <.05). The Brain Gym exercises resulted in a significant enhancement of motor coordination in the experimental group (*M* = 48.27) relative to the control group (*M* = 41.50). The effect size ($\eta_p^2 = 0.81$) suggested that the intervention accounted for 81% of the variance in overall motor coordination, thereby supporting the research hypothesis.Additionally, highly significant differences were found across the four specific subcomponents of motor coordination (p* =.001): backward balancing, one-foot hopping (leaping), lateral jumping with feet together, and shifting wooden blocks. In all subcomponents, the experimental group demonstrated significantly higher mean scores than the control group, indicating that Brain Gym exercises effectively improved these specific motor abilities in children with DCD.Discussion The findings of the present study demonstrate that the Brain Gym exercise program led to a significant improvement in motor coordination among children with DCD. A review of the existing literature indicates that only a limited number of studies have specifically investigated the impact of Brain Gym on the DCD population, making these results particularly noteworthy. As a form of perceptual-motor training, Brain Gym has the potential to enhance both motor and cognitive domains simultaneously. According to perceptual-motor integration theories, individuals improve their performance by establishing greater synergy between visual, auditory, and kinesthetic information (Wilson et al., 2015).Furthermore, the results indicated that the Brain Gym intervention had a positive and significant effect on the participants' inhibitory control. This outcome may be interpreted through the lens of neuroplasticity; improvements in response suppression typically follow the modulation of neural activity within the prefrontal cortex and its associated executive networks (Zhu et al., 2024). The underlying mechanism likely involves an increase in hippocampal volume and elevated levels of Brain-Derived Neurotrophic Factor (BDNF), which collectively facilitate enhanced cognitive processing. Consequently, Brain Gym represents an innovative, feasible, and patient-centered intervention. It serves as a promising adjunctive therapy that may play a crucial role in mitigating cognitive and motor deficits in children with Developmental Coordination Disorder. ConclusionIn conclusion, the present study demonstrates that an eight-week Brain Gym intervention leads to significant improvements in both inhibitory control and motor coordination among children with DCD. These findings suggest that Brain Gym, through its focus on perceptual-motor integration, can effectively mitigate the core motor and cognitive deficits associated with this disorder. Therefore, it is strongly recommended that clinicians, educators, and physical therapists incorporate Brain Gym principles into regular exercise programs and rehabilitative protocols for children with Developmental Coordination Disorder to enhance their functional outcomes.AcknowledgmentsThe researchers wish to express their sincere gratitude to all the children and their families for their participation and cooperation. We also extend our special thanks and appreciation to the clinical staff of the Royan Rehabilitation Clinic in Urmia, Iran, for their invaluable support and assistance throughout the course of this study.
Research Paper
nafiseh rafiei; Marzieh Beygi Habib Abadi
Abstract
The present study was conducted with the aim of investigating the effect of teaching cognitive strategies on correcting the problems of written expression of blind elementary school students. This research was a quasi-experimental study with a pre-test-post-test design with a control group. The statistical ...
Read More
The present study was conducted with the aim of investigating the effect of teaching cognitive strategies on correcting the problems of written expression of blind elementary school students. This research was a quasi-experimental study with a pre-test-post-test design with a control group. The statistical population included all blind students of the second year of elementary school in Isfahan city in the academic year of 2023- 2024, which were 31 people. Using available sampling method, 20 blind students of fifth and sixth grade were selected as samples and replaced by random assignment in two experimental and control groups of 10 people. Cognitive strategies training was conducted in 40 sessions of 45 minutes and in five stages for the experimental group. In this research, the written expression questionnaire of Adamzadeh (2016) based on the program of educational sessions adapted from Englert (1990) was used. The data were analyzed by multivariate correlation analysis using spss 23 software. The results showed that the experimental and control groups had a significant difference in written expression (P<0.01) and the training program (power) had a positive and significant effect. Therefore, it can be concluded that the training of cognitive strategies improves the problems of written expression. Blind students has an effect and can be useful and effective as an efficient method in correcting the problems of written expression of blind students.
Research Paper
Abolghasem Yaghoobi; Mohammad Reza Roshanaei; Zeinab Ghorbany; Yarmohamadi Vasel Shahryar
Abstract
Abstract
The aim of this study was to investigate the effect of cerebellar training method on emotion regulation and attention maintenance in children with attention deficit-hyperactivity disorder. The present study was a pre-test-post-test semi-experimental with a control group. The statistical population ...
Read More
Abstract
The aim of this study was to investigate the effect of cerebellar training method on emotion regulation and attention maintenance in children with attention deficit-hyperactivity disorder. The present study was a pre-test-post-test semi-experimental with a control group. The statistical population included students aged 9 to 12 in Tehran, from whom 40 people with ADHD symptoms were selected by convenience sampling and randomly assigned to two experimental and control groups of 20 people. The instruments used included the Emotion Regulation Questionnaire (Shields, & Cicchetti, 1997), the Attention Maintenance/Continuous Performance Test (Rosold et al, 1956), and the Cerebellar Training Approach (Ayres, 1974). The experimental group underwent cerebellar training for 20 sessions and then a post-test was administered. The results of multivariate analysis of covariance showed that the difference in mean scores of emotion regulation and attention maintenance after cerebellar training compared to the control group was significant (P<0.01); So that cerebellar training method improved emotion regulation and attention maintenance in children with attention deficit hyperactivity disorder. Based on this, it can be said that the cerebellar training program, due to its reliance on direct sensory, physical, and motor experiences, affects the cerebellum and improves its function, and subsequently improves the function of the sensory, emotional, and attentional systems.
Keywords: Attention Deficit-Hyperactivity Disorder (ADHD); Attention Maintenance; Cerebellar Training; Emotion Regulation.
Extended Abstract
Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent childhood neurodevelopmental disorder characterized by persistent inattention and/or hyperactivity-impulsivity that can substantially impair social and academic functioning (Nourkojouri et al., 2024; Choi et al., 2022; Wang et al., 2024). Global prevalence in youth is estimated at 6–7%, with a higher reported incidence in boys than girls (Fang et al., 2024; Sadock, 2015). Symptoms typically become more evident during the school years and may persist into adulthood; disruptive behaviors, such as excessive motor activity, fidgeting, impulsivity, and excessive talking, can interfere with daily performance (Salari et al., 2023; Sharma & Couture, 2014).
In addition to core symptoms, many children with ADHD demonstrate difficulties in emotion regulation, which can intensify impairment and is associated with executive-function weaknesses (Groves et al., 2022). Emotion regulation involves processes shaping which emotions occur and how they are experienced and expressed (Gross, 2015); it is considered a key transdiagnostic factor in child and adolescent mental health (Hosseinjani & Zemestani, 2023). Evidence suggests that emotion-management deficits in ADHD may contribute to broader regulation problems, potentially reflecting overlapping cognitive-affective neural mechanisms affecting both emotional and impulse control (Javidipour & Dehghan, 2022; Nigg & Casey, 2005; Sanchez et al., 2019).
Children with ADHD also commonly struggle with sustaining attention (Frank, 2024). Because attention supports higher-level executive functions (Diamond, 2006; Goldstein & Naglieri, 2014), it remains a critical rehabilitation target (Nejati, 2021). Although medications and psychosocial interventions are widely utilized, adherence can be limited by side effects and resource demands (Briars & Todd, 2016; Kim et al., 2020). Cerebellar training is a feasible, school-based, game-like movement program integrating perceptual-motor, sensorimotor, and balance exercises (Kazemzadeh, 2021). Given evidence implicating fronto-cerebellar and attention networks in ADHD (Yadav et al., 2021), the present study examines whether cerebellar training can improve emotion regulation and sustained attention.
Research Question
Does cerebellar training significantly improve emotion regulation (specifically reducing lability/negativity) and sustained attention (measured via CPT indices) in 9–12-year-old children with ADHD compared to a control group, after controlling for pre-test scores?
Literature Review
Emotion dysregulation is increasingly recognized as a clinically significant aspect of ADHD, as it can exacerbate impairment and is closely linked to executive-function deficits (Groves et al., 2022). Emotion regulation—defined as the processes shaping how emotions arise, are experienced, and expressed—is also considered a key transdiagnostic factor in youth mental health (Gross, 2015; Hosseinjani & Zemestani, 2023). Research suggests that emotion-management weaknesses among children with ADHD may contribute to broader regulatory difficulties, potentially reflecting shared cognitive-affective neural mechanisms underlying both emotional and impulse-control deficits (Javidipour & Dehghan, 2022; Nigg & Casey, 2005; Sanchez et al., 2019).
Deficits in sustained attention are similarly fundamental to ADHD (Frank, 2024). Attention serves as a gateway to cognitive processing (Baddeley & Weiskrantz, 1993) and comprises hierarchical components, such as focused and sustained attention (Sohlberg & Mateer, 2001). Since attention underpins higher-level executive functions (Diamond, 2006; Goldstein & Naglieri, 2014), it remains a critical rehabilitation target (Nejati, 2021). Given the limitations of conventional treatments (Briars & Todd, 2016; Kim et al., 2020) and evidence implicating cerebellar and attention networks in ADHD (Yadav et al., 2021), cerebellar training—which integrates perceptual-motor, sensorimotor, and balance exercises—has been proposed as a feasible complementary approach (Kazemzadeh et al., 2021; Reynolds & Nicholson, 2007; Behmard et al., 2022; Heydari Fatsami et al., 2023).
Methodology
A quasi-experimental pre-test–post-test design with a control group was employed. The study population comprised students aged 9–12 years in Tehran. Forty children referred by schools to educational counseling centers in Districts 5 and 22 due to ADHD symptoms were selected via convenience sampling and randomly assigned to the experimental (n=20) and control (n=20) groups. Inclusion criteria consisted of a psychologist-confirmed ADHD diagnosis, absence of comorbid conditions, no physical impairments, and no history of psychological or pharmacological treatment for at least one year prior to the study. Exclusion criteria included absence from more than two intervention sessions and the occurrence of acute physical or family-related problems. Data were collected using the Emotion Regulation Checklist (ERC) and the Continuous Performance Test (CPT) to assess sustained attention, alongside a specialized cerebellar training protocol. Following informed parental consent, both groups completed pre-tests; the experimental group then participated in 20 cerebellar training sessions. Post-tests were subsequently administered to all participants. Data were analyzed using SPSS-26, employing descriptive statistics and Multivariate Analysis of Covariance (MANCOVA) to control for pre-test scores.
Results
The study participants consisted of 40 elementary students in Tehran (academic year 2023–2024), with a mean age of 10.58 years (SD = 0.93). Descriptive findings indicated marked post-test improvements in the experimental group regarding emotion regulation, lability/negativity, and all CPT indices (commission errors, omission errors, correct responses, and reaction time), whereas minimal change was observed in the control group. Statistical assumptions for MANCOVA were met: Shapiro–Wilk normality (p >.05), Levene’s test for homogeneity of error variances (p >.05), non-significant pre-test × group interaction (p >.05), and Box’s M test for homogeneity of covariance matrices (F = 1.195, p >.05). Multivariate tests revealed a significant overall group effect after controlling for pre-test scores (p <.05). Univariate ANCOVA results were significant for emotion regulation (F = 154.38, p =.000), lability/negativity (F = 137.14, p =.000), commission errors (F = 142.14, p =.000), omission errors (F = 326.12, p =.000), correct responses (F = 76.04, p =.000), and reaction time (F = 817.09, p =.000). Reported effect sizes indicated substantial intervention-related variance: 82% for emotion regulation, 81% for lability/negativity, and approximately 85% on average across sustained attention outcomes.
Discussion
The findings indicate that cerebellar training can effectively improve emotion regulation and sustained attention in children with ADHD. Improvements in emotion regulation are consistent with the view that ADHD-related impairment encompasses emotion dysregulation, which is closely tied to executive dysfunction (Groves et al., 2022). Furthermore, these results support the premise that emotion regulation is a critical mechanism influencing pediatric mental health (Gross, 2015; Hosseinjani & Zemestani, 2023). The findings align with prior research on cerebellar-focused interventions (Reynolds & Nicholson, 2007; Heydari Fatsami et al., 2023) and with evidence suggesting that cerebellar abnormalities are linked to emotional processing and regulatory difficulties in ADHD (Rinke et al., 2019). Moreover, coordination-based and cerebellar-relevant physical activities have been associated with enhanced self-regulation and socio-emotional skills in this population (Pillay et al., 2019).
Regarding sustained attention, the observed improvements in CPT indices support theoretical models positioning attention as foundational to executive functioning (Diamond, 2006; Goldstein & Naglieri, 2014) and are consistent with hierarchical attention frameworks (Sohlberg & Mateer, 2001). A plausible mechanism is that cerebellar-focused training strengthens timing and coordination processes that contribute to cognitive control and attentional regulation (Stoodley, 2012); this aligns with neuroimaging evidence implicating fronto-cerebellar and attention networks in ADHD (Yadav et al., 2021). Key limitations of the present study include the use of convenience sampling and the lack of a follow-up assessment to determine the long-term stability of the effects.
Conclusion
In conclusion, a 20-session cerebellar training program significantly improved emotion regulation, reduced lability/negativity, and enhanced sustained attention in children with ADHD compared to a control group, after controlling for pre-test scores. Given the barriers and limitations associated with conventional treatments (Briars & Todd, 2016; Kim et al., 2020), cerebellar training may serve as a practical and accessible complementary approach in educational and clinical settings aiming to enhance emotional stability and sustained attention in children with ADHD (Reynolds & Nicholson, 2007; Yadav et al., 2021).
Acknowledgments
The authors would like to express their sincere gratitude to all participating children and their families, as well as the educational counseling centers and school staff who facilitated the recruitment and implementation of this study. Furthermore, the authors acknowledge the scholars and practitioners whose ongoing contributions continue to advance the fields of child psychology and ADHD intervention research.
Research Paper
Zahra Abbasi Kerdabadi; Amir Ghamarani
Abstract
Developmental delays in brain growth significantly limit the academic, social, emotional, and behavioral abilities of individuals with intellectual disabilities. In recent years, Polyvagal Theory has emerged as a robust framework for addressing various psychological challenges. Therefore, the aim of ...
Read More
Developmental delays in brain growth significantly limit the academic, social, emotional, and behavioral abilities of individuals with intellectual disabilities. In recent years, Polyvagal Theory has emerged as a robust framework for addressing various psychological challenges. Therefore, the aim of this study was to investigate the effectiveness of Polyvagal Theory-based therapy on social skills and behavioral problems in students with developmental intellectual disabilities. This quasi-experimental research employed a pre-test, post-test design with a control group. A convenience sampling method was used to select 30 students with developmental intellectual disabilities, who were then assigned to either the experimental or control group. The experimental group underwent 10 sessions of 90-minute interventions (two sessions per week). The research tools included the Social Skills Rating Scale (SSRS) by Gresham and Elliott (1990) to assess social skills and behavioral problems. Data were analyzed using analysis of covariance (ANCOVA) in SPSS software. The results indicated that the Polyvagal Theory-based intervention package significantly improved social skills (F = 19.94, p = 0.001) and reduced behavioral problems (F = 16.43, p = 0.001) at a significance level of 0.05. According to the findings of this study, Polyvagal Theory-based therapy had a significant impact on enhancing social skills and reducing behavioral problems in students with developmental intellectual disabilities. These findings offer positive outcomes for children with special needs.
Research Paper
Hoda Faramarzi; Saeed Rezayi; Mehdi Dastjerdi Kazemi; Inayatullah Zamanpour
Abstract
One of the most obvious characteristics of children with dyslexia and attention deficit/hyperactivity disorder is difficulty in auditory processing, and failure to provide timely intervention for these children has irreparable consequences. The purpose of this research was to develop a cognitive rehabilitation ...
Read More
One of the most obvious characteristics of children with dyslexia and attention deficit/hyperactivity disorder is difficulty in auditory processing, and failure to provide timely intervention for these children has irreparable consequences. The purpose of this research was to develop a cognitive rehabilitation program fast for word and its effectiveness on the auditory processing of children with dyslexia and attention deficit/hyperactivity disorder. The statistical population includes all 7-9-year-old elementary school students in Tehran with dyslexia and attention deficit/hyperactivity disorder who were studying in the second semester of 1401 academic year, and 30 eligible volunteers were randomly divided into two experimental groups. 15 people) and witnesses (15 people) were appointed. The experimental group received the fast for word cognitive rehabilitation program in 10 sessions of 45 minutes. The research tools included the fourth version of the Wechsler IQ test, Moradi et al.'s reading and dyslexia test (2015), Connors-Parent Form questionnaire (1998) and Fisher's list of listening problems (1976). Data were analyzed using multivariate analysis of covariance. The findings showed that the fast for word cognitive rehabilitation program was effective and improved the auditory processing of children with dyslexia and attention deficit/hyperactivity disorder in the experimental group. According to these findings, the fast for word cognitive rehabilitation program is suggested to experts as an effective intervention.
Keywords: attention Deficit/Hyperactivity Disorder; Cognitive Rehabilitation; Dyslexia; Fast for Word.
Extended Abstract
Introduction
Children diagnosed with Dyslexia and Attention-Deficit/Hyperactivity Disorder (ADHD) display distinct functional and anatomical differences in specific components of the central auditory nervous system compared to their neurotypical peers. One of the most notable characteristics commonly seen in these children is difficulty in auditory processing. Children grappling with auditory processing issues typically encounter difficulties in accurately processing and interpreting auditory information, especially when dealing with multiple speech streams or environmental noises. These difficulties can encompass challenges in discerning words amidst background sounds and following verbal instructions when multiple sounds compete for attention.
Fast ForWord is a cognitive rehabilitation program recognized for its effectiveness in addressing language-based learning impairments. The program trains a broad array of cognitive functions related to language, encompassing sound decoding, content comprehension, and the formation of connections between learning and brain development (Doidge, 2007; Ghasemzadeh, 2014). Over the past 25 years, Fast ForWord has seen significant advancements in both research and clinical applications for language therapy. The first area involves using neuroimaging and behavioral techniques to examine individual differences in language development and the causes of language-based learning disorders. The second area explores neurobiological methods initially developed to study neural plasticity in animal models. Research indicates that children who have completed the Fast ForWord program exhibit significant improvements in standardized assessments of speech, language, and auditory processing (Doidge, 2007; Ghasemzadeh, 2014).
Delays in providing timely intervention for dyslexia and Attention-Deficit/Hyperactivity Disorder can lead to repercussions that are difficult to reverse. Such delays often trigger a cascade of academic failures and cause substantial harm to a child's self-esteem. These consequences underscore the critical importance of early and accurate diagnosis, coupled with innovative and prompt intervention. Research has shown that the earlier a child receives intervention, the more favorable the outcomes will be (Chiappedi et al., 2007).
The lack of research on the use of the "Fast ForWord" intervention for children with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder highlights a significant gap in the literature. Moreover, the limited availability of training programs for the "Fast ForWord" method in Iran further underscores this deficiency. The development of effective educational programs tailored to the unique needs of children with these co-occurring conditions is widely regarded as a significant educational priority. The principal objective of this research is, therefore, to design a cognitive rehabilitation program based on "Fast ForWord" and to assess its efficacy in improving the auditory processing abilities of children diagnosed with both dyslexia and Attention-Deficit/Hyperactivity Disorder.
Research Question
This study examines the effectiveness of the "Fast ForWord" cognitive rehabilitation program in improving the auditory processing abilities of children diagnosed with dyslexia and attention-deficit/hyperactivity disorder.
Literature Review
Gilam et al. (2008) conducted a study to assess the effects of the "Fast ForWord" intervention on children with language impairment. The findings demonstrated that the participants exhibited notable enhancements in their overall language scores and auditory background test performance. In another study, Camarata (2016) examined the efficacy of the Fast ForWord treatment in enhancing language abilities among children diagnosed with language impairments. The outcomes indicated that Fast ForWord significantly improved the participants' language scores.
Methodology
The research approach for this study involved both theoretical and methodological components. In the initial stage, the "Fast ForWord" program was developed and its content validity was assessed. In the subsequent stage, a quasi-experimental method was employed using a pre-test, post-test design with a control group and a follow-up period. The statistical population consisted of all 7- to 9-year-old elementary school students in Tehran diagnosed with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder (ADHD) in the second semester of the 1401-1402 academic year. From this population, 30 participants were selected and randomly assigned to two groups: an experimental group (n=15) and a control group (n=15).
Specific inclusion and exclusion criteria were established to ensure the selected subjects were appropriate for the study. The inclusion criteria were: (1) age between 7 and 9 years; (2) current enrollment in an elementary school in Tehran; (3) no documented history of other psychological disorders; and (4) a confirmed diagnosis of both dyslexia and Attention-Deficit/Hyperactivity Disorder (ADHD) by a specialist.
The exclusion criteria, designed to maintain the study's integrity, were: (1) concurrent participation in any other rehabilitation program; (2) voluntary withdrawal from the study; or (3) absence from more than two sessions. Informed consent was obtained from both the children and their families. Psychiatric records and diagnostic tests were used to validate the diagnoses.
Results
Table 1. The results of univariate covariance analysis of the difference between the experimental and control groups in the sand processing components
Variable
Source
Sum of Squares
Degree of Freedom
Mean Square
F
evel ofL Significance
Effect Size
Understanding
etweenB Groups
36.704
1
36.704
7.711
0.014
0.340
Error
71.396
15
4.760
You are harsh
Between Groups
37.787
1
37.787
5.415
0.034
0.265
Error
104.671
15
6.978
Attention
Between Groups
14.417
1
14.417
5.680
0.031
0.275
Error
38.074
15
2.538
Attention Span
Between Groups
24.344
1
24.344
8.666
0.010
0.366
Error
42.138
15
2.809
Hoarse voice
Between Groups
27.705
1
27.705
9.451
0.008
0.387
Error
43.972
15
2.931
Differentiation
Between Groups
146.470
1
146.470
11.265
0.004
0.429
Error
195.030
15
13.002
Short Term Memory
Between Groups
52.389
1
52.389
6.284
0.024
0.295
Error
125.049
15
8.337
Long Term Memory
Between Groups
115.237
1
115.237
15.494
0.001
0.508
Error
111.565
15
7.438
Stage Memory
Between Groups
46.230
1
46.230
7.595
0.015
0.336
Error
91.306
15
6.087
Speech Problems
Between Groups
30.782
1
30.782
5.891
0.028
0.282
Error
78.373
15
5.225
Coordination of Seeing and Hearing
Between Groups
61.205
1
61.205
12.515
0.003
0.455
Error
73.360
15
4.891
Stigma
Between Groups
25.422
1
25.422
8.443
0.011
0.360
Error
45.165
15
3.011
Performance
Between Groups
162.359
1
162.359
8.489
0.011
0.361
Error
286.874
15
19.125
The obtained data, as presented in the table, indicate a statistically significant difference in auditory processing levels between the control and experimental groups. Based on these results, it can be concluded that the "Fast ForWord" intervention was effective in improving the auditory processing abilities of children diagnosed with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder.
Discussion
The primary objective of this research was twofold: first, to develop a cognitive rehabilitation program based on "Fast ForWord," and second, to evaluate its efficacy in improving the auditory processing abilities of children diagnosed with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder.
This situation aligns with the perspective of experts who posit that children with language-based learning disabilities frequently encounter difficulties in recognizing and rapidly processing auditory information. This challenge is often described as a generalized processing deficit within the temporal region. In this context, the "Fast ForWord" program can be considered a targeted intervention method specifically designed to address the language-specific obstacles these children face.
This theoretical framework posits that language learning difficulties stem from a deficit in the temporal processing of auditory input. It is therefore proposed that intensive training with the "Fast ForWord" program—which adheres to behavioral principles and systematically increases temporal processing demands—can retrain the underlying neural mechanisms. This retraining, in turn, is expected to enhance language abilities and lead to subsequent improvements in auditory processing.
Conclusion
In conclusion, auditory processing deficits in children with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder significantly contribute to the challenges they face. The implementation of the "Fast ForWord" cognitive rehabilitation program, which emphasizes rapid auditory processing, represents an effective intervention. This program shows considerable potential for improving not only auditory processing skills but also the overall daily functioning of children with these conditions.
Acknowledgments
The authors extend their sincere gratitude to all the participants and their families whose involvement was essential to this study. We also thank the dedicated staff and administrators at Marjoui School for their invaluable cooperation and support throughout the research process. This work would not have been possible without their generous contribution of time and effort.
Research Paper
Kamyar Azimi; Manizheh Shehni Yailagh; Alireza Hajiyakhchali
Abstract
Abstract
Challenges with basic numerical skills at an early age can lead to substantial gaps in mathematical learning and performance, with detrimental long-term consequences. This study aimed to investigate the impact of a ThinkMath intervention program on the early numerical skills and mathematical ...
Read More
Abstract
Challenges with basic numerical skills at an early age can lead to substantial gaps in mathematical learning and performance, with detrimental long-term consequences. This study aimed to investigate the impact of a ThinkMath intervention program on the early numerical skills and mathematical performance of first-grade children at risk for mathematical learning difficulties. The current research is a field experiment. In total, 30 first-grade children at risk of mathematical learning difficulties who were studying in the 2022–2023 academic year were randomly assigned to experimental and control groups. The intervention program for children in the experimental group was delivered over 15 sessions of 30 to 45 minutes, while the control group received conventional classroom instruction. Compared to the control group, the experimental group showed significant improvements in early numerical skills (d = 0.73) and mathematical performance (d = 0.66), with medium effect sizes. These effects were also observable six weeks after the intervention (follow-up). Overall, the findings suggest that early numerical skills and mathematical performance in children at risk for mathematical learning difficulties are malleable and can be improved with appropriate mathematics intervention.
Keywords: Early Numerical Skills; Mathematical Performance; Interventions; at Risk; Mathematical Learning Difficulties.
Extended Abstract
Introduction
The cognitive epidemiology literature indicates that 5% to 14% of children in the early years of education (Grades 1 to 3) do not demonstrate age-appropriate mathematical performance (Outhwaite et al., 2024) and are identified as children at risk for mathematical learning difficulties (Hellstrand, 2021). The results of the Trends in International Mathematics and Science Study in 2019 show a significant decline in the performance of Iranian students in mathematics (Yaftiyan & Abbasi, 2024). Based on this evidence, addressing children at risk for mathematical learning difficulties in the Iranian education system has come under closer scrutiny (Ghafouri et al., 2024).
In this regard, a growing body of research suggests that the mathematical performance of children at risk for mathematical learning difficulties is predicted by early numerical skills (Doabler et al., 2019). Early numerical skills refer to a set of basic abilities, such as verbal counting, number relationships, and comparing numerical quantities (de Chambrier et al., 2021). Meta-analyses suggest that early numerical skills build on one another, such that children who start with the lowest levels of early numerical skills show the least growth in later mathematical performance in the absence of effective intervention (Outhwaite et al., 2024).
Currently, one of the timely math interventions is the ThinkMath intervention program, which was developed based on the theoretical model of Aunio and Räsänen (2016) to reduce the achievement gap and prepare children at risk for mathematical learning difficulties for success in math (Mononen & Aunio, 2014, 2016).
Despite the aforementioned considerations, the effectiveness of the ThinkMath intervention program as a supplementary curriculum has been tested in a few studies (Aunio et al., 2021; Lopez-Pedersen et al., 2023). However, the effectiveness of the ThinkMath intervention program in less developed countries, such as Iran, remains an unanswered question. Therefore, the present study aimed to investigate the effect of the ThinkMath intervention program on the early numerical skills and mathematical performance of Iranian first-grade children at risk for mathematical learning difficulties.
Research Questions
The research questions of this study included the following:
Does the ThinkMath intervention program lead to pre-test/post-test differences between the experimental and control groups in improving basic numerical skills and mathematical performance (immediate effect)?
Does the ThinkMath intervention program lead to pre-test/follow-up (6 weeks after training) differences in outcomes between the experimental and control groups (long-term effect)?
Methodology
The present study is a field experiment with a pretest, posttest, and follow-up design with a control group. The statistical population included first-grade children at risk for mathematical learning difficulties in Kuhdasht city during the 2022–2023 academic year. Thirty children were selected after preliminary screening using a multistage cluster sampling method. The screening process included two standard instruments: the Number Sense Brief Screener (Jordan et al., 2010) and the Number Knowledge Test (Griffin, 2009). Other data collection tools included Raven's Colored Progressive Matrices Test for Children (Raven et al., 1998), the Child Symptom Inventory, Fourth Edition (Gadow & Sprafkin, 1994), the Tests of Early Numeracy (Clarke & Shinn, 2004), and the Number Sets Test (Geary et al., 2009).
ThinkMath Intervention Program: The ThinkMath intervention program consists of 15 training sessions, each 30–45 minutes long, held three times a week over 5 weeks in small groups of 4 to 8 children, aiming to prevent mathematical learning difficulties in children aged 5 to 8.
Procedure: Ethical approval and research permission from the Ethics Committee of Ahvaz Shahed University (approval number: EE/1400.2.24.37358/Scu.ac.ir) were obtained. In November, the selected children were randomly divided into experimental and control groups. The pretest was conducted in December. The intervention was implemented in January and February, while the control group received conventional classroom instruction. Posttest assessments were conducted after the sessions in February, followed by a 6-week follow-up.
Results
Before performing the inductive data analysis, statistical assumptions for multivariate analysis of covariance were examined to ensure the validity of the results (Tabachnick & Fidell, 2019). A multivariate analysis of covariance was performed on the data, considering the basic statistical assumptions. The results from the MANCOVA analysis between the experimental and control groups, with pretest scores controlled, showed that these groups differed significantly from each other in at least one of the dependent variables, based on the Wilks's lambda statistic in the posttest. To determine this difference, a univariate analysis of covariance (ANCOVA) was conducted within the multivariate analysis of covariance (MANCOVA) on posttest scores and follow-up dependent variables, with the results presented in Table 4.
Table 1. ANCOVA results in the context of the MANCOVA on post-test and follow-up early numerical skills and mathematical performance
step
variable
Source
Sum of Squares
df
Mean Square
F
p
Effect size
Post-test
Early numerical skills
Group
2272.82
1
2272.82
71.098
0.0001
0.732
Mathematical Performance
Group
30.79
1
30.79
51.074
0.0001
0.663
Follow-up
Early numerical skills
Group
1118.710
1
1118.710
70.467
0.0001
0.730
Mathematical performance
Group
27.426
1
27.426
42.091
0.0001
0.618
Table 1 shows that the F-values of the univariate analysis of covariance (ANCOVA) for the posttest are statistically significant for both basic numerical skills and mathematical performance. In addition, Table 1 shows that the F-values of the univariate analysis of covariance (ANCOVA) for the follow-up stage are statistically significant for basic numerical skills and mathematical performance. The results indicate a significant difference in the dependent variable scores between the experimental group and the control group.
Discussion
This study aimed to examine the immediate and long-term effects of a ThinkMath intervention program on basic numerical skills and mathematical performance of first-grade children at risk for mathematical learning difficulties. A potential explanation for the effectiveness of the ThinkMath intervention program in improving children's basic numerical skills is explicit and regular instruction (Mononen et al., 2021). More specifically, explicit and regular instruction has the potential to deeply engage children in important mathematical knowledge content, such as understanding mathematical relationships and counting skills, and to tailor the intensity of the intervention through differentiated instruction matched to the child's needs (Aunio et al., 2021). Another promising finding of this study was that the mathematical performance of the children in the experimental group improved significantly during the intervention compared to the control group. A possible explanation is that improving children's basic numerical skills may have helped enhance their mathematical performance (De Leon et al., 2021). It has been identified that these features are useful educational elements for improving the mathematical performance of first-grade children at risk for mathematical learning difficulties (Nelson & McMaster, 2019; Clarke et al., 2023).
Conclusion
In summary, the research findings showed that a ThinkMath intervention program, by enhancing children's basic numerical skills at the beginning of the school year (first grade), can lead to improved mathematical performance. In other words, improved numerical skills can serve as a foundation for learning mathematics and enhancing mathematical performance in school.
Acknowledgments
This article is extracted from the first author's doctoral dissertation in the Psychology Department of Ahvaz Shahed Chamran University, with ethical code EE/1400.2.24.37358/Scu.ac.ir and support from the Institute for Cognitive Science Studies (ICSS).