Document Type : Research Paper
Authors
1 Ph.D. Student in Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran.
2 Professor, Department of Psychology, University of Guilan, Rasht, Iran
3 Associate Professor, Department of Psychology, University of Guilan, Rasht, Iran
Abstract
The present study aimed to effectiveness of simultaneous training of various executive functions (hot and cool; focused on simultaneous parent-child training) on improving the empathy of children with attention deficit hyperactivity disorder. This research was a quasi-experimental study with pretest-posttest control group design. The statistical population of the present study consisted of all 9 to 12-year-old children with ADHD in Rasht who referred to medical-educational-research centers in 2021. The sample consisted of 26 mothers and children with ADHD from the statistical population who were selected through convenience sampling, based on the inclusion criteria. They were then equally assigned to two (control and experiment) groups. The children in the experimental group and their mothers each received the intervention program in 10 sessions. The instruments used included Cognitive demographic questionnaire, Canners Parent Rate Scale, Empathy Questionnaire. data were analyzed using analysis of covariance. Findings showed that training of various executive functions (hot and cool; focused on simultaneous parent-child training), had a significant effect on improving the total score of empathy (P<0.01), empathy subscales of social motivation (P< 0.01), cognitive empathy (P< 0.05), emotional empathy of friend’s orientation (P< 0.01), effective empathy of family orientation (P< 0.05) on children with ADHD. These results suggest that multifaceted interventions that target executive actions in children with attention deficit / hyperactivity disorder can be a promising approach to improving empathy in these children.
Keywords: Hot and Cool Executive Functions, Parent and Child, Attention Deficit Hyperactivity Disorder, Empathy.
Extended Abstract
Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders, characterized by symptoms of inattention, hyperactivity, and impulsivity (Mechler, Banaschewski, Hohmann, & Hage, 2021). Beyond its core symptoms, empirical evidence suggests that children with ADHD often struggle with emotional expression, facial recognition, prosody perception, theory of mind, and empathy (Singh, Arun, & Bajaj, 2021). Empathy refers to the ability to understand and emotionally resonate with others’ experiences (Bugatti, 2021). Among various factors influencing empathy, executive functions (EFs) play a foundational role (Friesen, 2019).
Executive functions are typically categorized into two domains: "cool" and "hot." Cool EFs encompass cognitive, emotionally neutral processes such as metacognition, cognitive flexibility, inhibition, working memory, planning, and problem-solving, which are primarily associated with lateral prefrontal regions. In contrast, hot EFs involve emotionally and motivationally salient processes such as behavioral regulation, emotional control, and decision-making, linked to medial and anterior prefrontal areas (Zelazo, 2020; Nemeth & Chustz, 2020).
Neuroimaging and neuroscientific studies indicate that dysfunctions in the prefrontal cortex among individuals with ADHD may be associated with reduced empathy—precisely the region implicated in executive functioning (Taiwo, 2018; Ronel, 2018). Research by Li, Liu, Yan, & Feng (2020) demonstrated that EF training can enhance emotional competence in preschoolers, with inhibitory control and working memory significantly predicting emotional development. Similarly, findings by Ghadiri & Soleimani (2021) revealed that EF training improved empathy in children with high-functioning autism.
Developmental psychology literature also highlights the pivotal role of parents in shaping children’s executive functions (Motamed Yeganeh, Afrooz, Shokoohi-Yekta, & Weber, 2019). O'Neill, Rajendran, & Halperin (2012) emphasized the importance of parental involvement in ADHD interventions, particularly through play-based neurodevelopmental and social facilitation. Despite these insights, prior studies have predominantly focused on cool EFs, neglecting the hot dimension. Moreover, most interventions have been child-centered, with limited use of simultaneous parent-child approaches.
Given this research gap, the present study aimed to investigate the effectiveness of a simultaneous parent-child training program targeting both hot and cool executive functions on improving empathy in children with ADHD.
Methodology
This quasi-experimental study employed a pretest-posttest control group design. The statistical population included all children aged 9–12 diagnosed with ADHD in Rasht, Iran, who attended educational-therapeutic centers during the first half of 2021. A sample of 26 children who met the inclusion and exclusion criteria was selected via convenience sampling and randomly assigned to an experimental group and a control group. Both the children and their mothers in the experimental group received a 10-session intervention program. The instruments included the 48-item Conners Rating Scale and the Empathy Questionnaire for Children and Adolescents.
Results
Based on the findings presented in Table 5, the F-value for the empathy subcomponent of social motivation was 28.412, which was statistically significant (p <.01). The F-value for cognitive empathy was 5.649 (p <.05). Affective empathy with peer orientation yielded an F-value of 10.999 (p <.01), while affective empathy with family orientation showed an F-value of 5.915 (p <.05). These results indicate statistically significant differences between the experimental and control groups across all four empathy dimensions.
Table 1: ANOVA Results Comparing Experimental and Control Groups on Children's Empathy Components
Empathy Component
SS (Between)
SS (Error)
MS (Between)
MS (Error)
F
p
Effect Size
Power
Social Motivation Empathy
38.603
27.174
38.603
1.359
28.412
0.001
0.587
0.999
Cognitive Empathy
2.639
9.343
2.639
0.467
5.649
0.05
0.22
0.619
Affective Empathy (Peer Orientation)
6.164
11.208
6.164
0.56
10.999
0.01
0.355
0.884
Effective Empathy (Family Orientation)
3.602
12.178
3.602
0.609
5.915
0.05
0.228
0.638
Discussion
The present study aimed to examine the effectiveness of a simultaneous parent-child training program targeting both hot and cool executive functions on improving empathy in children with Attention-Deficit/Hyperactivity Disorder (ADHD). The findings indicated that this training significantly improved empathy in children with ADHD. These results are consistent with previous research conducted by Friesen (2019) and Ghadiri & Soleimani (2021).
One possible explanation for these findings is that improved executive functioning enhances children's ability to decode social and emotional cues, thereby positively influencing their interpersonal relationships (Ghadiri & Soleimani, 2021). Moreover, repetition and practice play a crucial role in strengthening executive functions, which in turn support emotional regulation and empathic behavior. Repeated tasks and games facilitate the maturation of prefrontal inhibitory mechanisms, gradually enabling children to regulate emotional impulses. The more children engage in prosocial play, the more rapidly and effectively their prefrontal regulatory systems develop, allowing them to inhibit impulsive motivations (Panksepp, 2007).
Research also highlights the importance of parental involvement in improving the functioning of children with ADHD (Motamed Yeganeh, Afrooz, Shokoohi-Yekta, & Weber, 2019; O'Neill, Rajendran, & Halperin, 2012). In fact, parental warmth, cooperation, and acceptance contribute to reduced behavioral problems, decreased egocentrism, and an enhanced capacity for understanding and accepting others.
Due to limitations imposed by the COVID-19 pandemic, follow-up assessments could not be conducted in this study. Therefore, it remains unclear whether the observed improvements in hot and cool executive functions—and their impact on empathy—are sustained over time. Future research is recommended to include follow-up phases and to extend the investigation to other age groups and psychological conditions, such as learning disorders and anxiety disorders. It is also suggested that the effectiveness of this intervention be compared with other therapeutic approaches.
Conclusion
The findings of this study revealed that simultaneous training of various executive functions—both hot and cool—in joint parent-child sessions had a positive impact on enhancing empathy in children with ADHD. These results may pave the way for developing more effective interventions in the field of cognitive and emotional rehabilitation for these children.
Acknowledgments
We extend our sincere gratitude to all the individuals who participated in this research.
Keywords
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