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.