Abstract
Sometimes, the presence of impulsive behaviors in children with attention deficit/hyperactivity disorder increases their social problems, and the amount of interaction with their parents can increase their abilities. Based on this, the present study was conducted with the aim of determining the effectiveness of parent-child joint play on reducing impulsivity and increasing the social skills of children with attention deficit/hyperactivity disorder. In this research, a semi-experimental method was used with a pre-test and post-test design with a control group, and its statistical population consisted of all children with attention deficit/hyperactivity disorder in Bojnord city and their mothers in 2022, 30 of whom were selected by purposive sampling and were randomly placed in two groups of 15 people, experimental and control. For both groups, the pre-test, including Barth's impulsivity scale (1995) and Matson's social skills scale (1983), was implemented, and the experimental group had 8 two-hour weekly sessions under the joint game. The parent and the child were placed and the control group did not receive any intervention. Both groups completed the post-test again and the results were analyzed through analysis of covariance. The findings showed that Parent-child joint play is effective in reducing impulsivity and increasing the social skills of children with attention deficit/hyperactivity disorder. The results of this research show that parent-child joint play can be used to reduce behavioral problems and increase the social skills of children with attention deficit/hyperactivity disorder.
Keywords: Parent-Child Joint Play, Impulsivity, Social Skills, Children with Attention Deficit/Hyperactivity Disorder.
 
 
 
Extended Abstract

Introduction

Attention deficit/hyperactivity disorder in children is one of the most common neurodevelopmental disorders that causes many problems for children. The presence of this disorder causes many problems for these children, and impulsive and thoughtless behaviors are one of the major problems. Unmeasured and sudden behaviors in children with attention deficit/hyperactivity disorder cause them to be criticized and blamed by others, their interpersonal relationships face problems, and their social skills are weakened. The problems related to children with attention deficit/hyperactivity disorder have caused various educational and therapeutic theories and approaches to be used all over the world, and the use of game techniques has been more welcomed by children and therapists due to their diversity and high attractiveness. Some therapists have emphasized the role of parents' therapy in the form of games and stated that parents' participation in play therapy can play a facilitating role. In the joint game between parent and child, it is emphasized to create a strong relationship between parent and child regarding the game, and this advantage is used to improve the child's problematic behavior, which is planned by the therapist and the parent as a facilitator, creates a greater impact.
Research Question
Is parent-child joint play effective in reducing impulsivity and increasing the social skills of children with attention deficit/hyperactivity disorder?

Literature Review

In a research, Parlad et al. (2020) showed that the use of mutual play between parents and children is effective in improving children's social functions, and Cohen et al. (2022) also showed that joint play therapy between parents and children can be effective on children's social adaptation due to better interaction and increase their social ability. The research of Branovich and Han (2019) also shows that the use of joint play between parents and children can be effective on children's psychological abilities and provide the possibility of learning social skills and correcting negative behaviors. Also, Dietman et al. (2016) in their research mentioned the role of parent-child communication through play in reducing children's disobedience and stubbornness and stated that this kind of play therapy method provides the possibility of correcting negative behaviors due to the creation of better interactive conditions.

Methodology

In terms of the method of data collection, the present study was a semi-experimental type with a pretest-posttest design with a control group, and its statistical population was all children aged 4 to 7 years with attention deficit/hyperactivity disorder (predominant hyperactivity) and their mothers, who in 2022, were admitted to one of the private counseling centers in Bojnord city. In addition to obtaining a score higher than 34 in the Connors Attention Deficit/Hyperactivity Disorder diagnosis questionnaire (parent version), these children were also subjected to a clinical interview by the center's psychiatrist based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and a definitive diagnosis of Attention Deficit Disorder / had received hyper-activity. The research sample included 30 of these children along with their mothers, who were selected by purposeful sampling and randomly replaced in two experimental and control groups. Both groups completed the scale of impulsive behaviors and social skills about their child as a pre-test before any intervention in the same conditions. Then, for the experimental group, a joint parent-child game program was implemented; while the group did not receive a training certificate. Finally, after the end of the training sessions, the scale of impulsive behaviors and social skills was implemented again as a post-test for both groups. The data collection tools were: Children with Attention Deficit/Hyperactivity Disorder (CPRS), Impulsive Behavior Scale (BIS), and Social Skills Questionnaire (MESSY). Also, in this study, in the experimental group, the joint play program of parent and child was based on the model. Landreth (2006) was implemented as a group in 8 two-hour sessions for mothers and children of the experimental group.

Results

The mean and standard deviation of the research variable and their subscales according to the test and control groups in the pre-test and post-test situations are shown in Table 1.
Table 1. Mean and standard deviation of the research variable by test and control groups




posttest


Pretest


variables


group




SD


M


SD


M






2.28


59.75


2.24


74.06


Total impulsivity


experimental group




1.28


20.43


1.13


26/87


Lack of planning




1.49


24.22


1.45


28.60


Movement impulsivity




1.44


15.10


1.84


19.13


Cognitive impulsivity




3.64


132.56


3.88


110.45


Total Social skills


control group




2.06


29.22


2.12


26.12


Appropriate social skills




2.11


30.67


2.09


24.02


antisocial behaviors




2.04


24.30


2.19


18.11


Aggression and impulsiveness




2.11


20.17


2.18


18.26


Supremacy




2.09


28.20


2.11


24.14


Relationship with peers




The findings presented in the table show that in the experimental group, impulsivity and its components decreased in the post-test situation, while there was no significant change in scores in the control group. It can also be seen that social skills and their components increased in the post-test situation, while there was no significant change in scores in the test group. Before conducting the covariance analysis, the assumptions of using parametric statistics such as the Kolmogorov-Smirnov test, the Levin test, and the homogeneity of the regression slope were examined, and the results of the Kolmogorov-Smirnov test showed the level of significance in the test for each of the variables of impulsivity and social skills in the situation. The pre-test and post-test are more than 0.05 and as a result, it can be said that the normality of the distribution of the variables has been confirmed. Also, the assumption of homogeneity of variances was checked with Levine's test, and the results showed that the coefficient of the significance level of the test to check the homogeneity of variances for each of the research variables was more than 0.05, and as a result, it can be said that the variance of the groups has homogeneity. Also, the results of the regression slope investigation showed that the obtained value of both interaction effects is not significant at the 0.05 level, and the assumption of homogeneity of the regression slopes has been met, therefore, there is no problem with the presuppositions under investigation.
 The results of covariance analysis to determine the effectiveness of parent-child joint play on reducing impulsivity and increasing social skills of children with attention deficit/hyperactivity disorder are according to Table 2.
Table 2. Multivariate covariance analysis test




Test


value


F


df


df error


sign


eta






Pillai effect


0.88


18.67


2


26


0.001


0.92




Wilkes Lambda


0.84


6.87


2


26


0.001


0.92




Hetling effect


4.14


77.18


2


26


0.001


0.92




The largest root on


30.11


7


2


26


0.001


0.92




The results listed in Table 2 show that there is a significant difference between the control and experimental groups in the research variables. In order to investigate this change, the univariate covariance test was used, the results of which are presented in Table 3.
Table 3. Univariate covariance analysis test on impulsivity and social skills scores




Variable


Source of changes


SS


df


MS


F


sign


eta






impulsivity


Pre-test impulsivity


781.75


1


781.75


18.44


0.001


0.34




Group membership


5291.02


1


5291.02


124/81


0.001


0078




social skills


Pre-test impulsivity


793.84


1


793.84


26.97


0.000


0.43




Group membership


4714.23


1


4714.23


45.116


0.000


0.82




As can be seen in the above table, with the pre-test evidence, a significant difference can be seen between the test group and the evidence in the impulsivity variable. In this way, the average post-test scores of the experimental group are significantly lower than the control group; and the effect or difference is equal to 0.78, which means that 78% of the individual differences in impulsivity scores were related to the effect of parent-child joint play. It can also be seen that, with pre-test control, there is a significant difference between the experimental and control groups in the variable of social skills. In this way, the average post-test scores of the experimental group are significantly higher than the control group and the effect or difference is equal to 0.82, which means that 82% of individual differences in social skills scores were related to the effect of parent-child joint play.

Discussion

 It seems that the emphasis on the relationship between the parent and the child in regard to playing therapy has been able to provide a friendly and tension-free atmosphere for the child, which has led to listening more to the parent and imitating his positive behaviors, and in this way, the child has been able to manage impulsive behaviors and reflect on giving answers and develop his social skills. Since the focus of the parent-child joint game approach is on improving the parent-child relationship, the development of the intervention program by the therapist, which was carried out with the aim of correcting the child's problems and increasing his capabilities, has strengthened the child's inner self and his potential abilities to manifest positive behaviors and has helped the mother to better understand the child's emotional world and to gain an attitude be realistic and patient towards your child. This increase in insight and awareness has created a non-judgmental, accepting, and mutual understanding atmosphere and has influenced the behavior of children with attention deficit/hyperactivity disorder and has reduced their psychological problems, and increased their social skills.

Conclusion

The result of this research shows that parent-child joint play can be used to reduce behavioral problems and increase the social skills of children with attention deficit/hyperactivity disorder.
Acknowledgments
We are grateful to all colleagues and friends who helped us in the implementation of this research. Also, we are especially grateful to all the children and mothers who participated in this research.