Psychology of Exceptional Individuals

AbstractThis correlational study investigated the relationships between sensory processing, behavioral problems, and social interactions in children with autism spectrum disorder (ASD), examining anxiety as a mediating variable using structural equation modeling. Participants included 200 parents of ... Read More AbstractThis correlational study investigated the relationships between sensory processing, behavioral problems, and social interactions in children with autism spectrum disorder (ASD), examining anxiety as a mediating variable using structural equation modeling. Participants included 200 parents of children with ASD in Kermanshah (2023), selected through convenience sampling. Measures comprised the Dunn Sensory Profile (2014), Bellini and Hopf Social Skills Questionnaire (2007), Achenbach and Rescorla Child Behavior Checklist (2001), and Rogers Anxiety Scale (2016). Results revealed: (1) a significant negative relationship between sensory processing and behavioral problems mediated by anxiety (β = -., p <.01), and (2) a significant positive relationship between sensory processing and social interactions, again with anxiety mediation (β =., p <.01). These findings indicate that sensory processing difficulties substantially impact both communication skills and behavioral challenges in children with ASD through anxiety pathways. The study highlights the need for comprehensive interventions addressing sensory regulation, emotional control, and social communication differences in ASD populations.Keywords: sensory processing, behavioral problems, social interactions, anxiety, autism spectrum Extended AbstractIntroductionAutism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by persistent deficits in social communication and interaction, alongside restricted, repetitive patterns of behavior, interests, or activities (Siu et al., 2020). As one of the most prevalent neurodevelopmental disorders, ASD affects approximately 1 in 68 children worldwide (Agaz et al., 2018). Clinical presentations frequently include comorbid conditions such as intellectual disabilities (31%), epilepsy (20%), enuresis (15%), and attention-deficit/hyperactivity disorder (ADHD) in 30-50% of cases (Mohammadi et al., 2019). Core features typically manifest as atypical language comprehension, impaired social communication, and differences in nonverbal gestural interactions (O'Hearn et al., 2013).Communication and language impairments represent core challenges in Autism Spectrum Disorder (ASD), with many children initially referred for evaluation due to parental concerns about delayed language development. Research emphasizes the critical importance of early language acquisition, particularly achieving functional communication skills by age five, as this significantly predicts long-term developmental outcomes (DiStefano et al., 2016; Eigsti et al., 2011). The DSM-5 delineates two diagnostic criteria for ASD: (1) persistent deficits in social communication and social interaction across multiple contexts, and (2) restricted, repetitive patterns of behavior, interests, or activities (American Psychiatric Association, 2013; Özért & Alikak, 2018). These communication difficulties manifest across various domains, including verbal and nonverbal expression, social reciprocity, and pragmatic language use.Language development in children with ASD shows considerable heterogeneity in severity and progression. While some children acquire language without significant delays, approximately 25% fail to develop functional language skills over time (Klinger et al., 2003). These variations are clinically significant, as language concerns represent one of the most common reasons parents seek initial evaluations. Notably, early pragmatic language abilities - particularly the functional use of language in social contexts - serve as strong predictors of long-term developmental outcomes and adaptive functioning (Tager-Flusberg et al., 2005). Understanding this spectrum of language development is crucial for early identification and intervention planning.Atypical sensory processing - including both hyper-responsiveness (over-sensitivity) and hypo-responsiveness (under-sensitivity) - is a common feature of ASD that significantly impacts multiple developmental domains (Feldman et al., 2020; Williams et al., 2018). This fundamental neurological process organizes sensory information from internal and external environments, enabling appropriate behavioral responses. Hyper-responsiveness, characterized by heightened or aversive reactions to sensory stimuli (Siu et al., 2020), often co-occurs with other clinical challenges. Research consistently links sensory processing differences in ASD with sleep disturbances, impaired social-communication skills, reduced adaptive functioning, and elevated anxiety symptoms (Ben-Sasson et al., 2009; Mazurek et al., 2013). These associations underscore the cascading effects of sensory dysregulation on daily functioning and quality of life.According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ASD is characterized by two essential features: (a) persistent deficits in social communication and social interaction across multiple contexts, and (b) restricted, repetitive patterns of behavior. These characteristics typically appear early in childhood and result in challenges in daily life (Özçetin & Alıkak, 2018). Language development levels in children with ASD can vary greatly; while some children do not experience any language delays, functional language does not improve in 25% of cases (Klinger et al., 2003). Understanding the differences in language development in ASD is crucial, as parents often cite delayed language development as a primary concern. Additionally, early language pragmatics are closely tied to long-term outcomes (Tager-Flusberg et al., 2005).Research Question:Does anxiety mediate the relationship between sensory processing difficulties and (a) behavioral problems and (b) social interaction challenges in children with autism spectrum disorder?Literature ReviewAutism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by challenges in social interaction and restricted, repetitive patterns of behavior, interests, or activities (Siu et al., 2020). As one of the most prevalent neurodevelopmental conditions, it affects approximately 1 in 68 children (Agaz et al., 2018). Research indicates that 86% of individuals with ASD experience at least one comorbid condition, including intellectual disability, epilepsy, enuresis, or attention-deficit/hyperactivity disorder (Mohammadi et al., 2019). Characteristic features include differences in language comprehension, social communication difficulties, and atypical gestural interactions (O'Hearn et al., 2013). The acquisition of functional language skills by age five represents a critical developmental milestone that significantly influences long-term outcomes (DiStefano et al., 2016; Eigsti et al., 2011). Additionally, sensory processing differences, particularly hyper-responsiveness and hypo-responsiveness to environmental stimuli, are commonly observed in ASD and may substantially affect adaptive functioning (Feldman et al., 2020).Sensory processing difficulties in ASD are consistently associated with sleep disturbances, impaired social skills, reduced adaptive functioning, and elevated anxiety (Ben-Sasson et al., 2009; Mazurek et al., 2013). Existing research demonstrates that sensory challenges may adversely affect mental health outcomes, highlighting the need for further investigation in this domain (Ben-Sasson et al., 2009). Importantly, sensory differences show significant associations with both behavioral difficulties and anxiety symptoms, with evidence suggesting that sensory processing patterns and anxiety may mediate the relationship between core ASD symptoms and functional impairments (Green et al., 2012; Khaledi et al., 2022). The current study seeks to address critical gaps in the literature by examining the interrelationships among sensory processing, social interaction challenges, and behavioral problems, with particular emphasis on anxiety's mediating role in children with ASD.MethodologyThe present study is a descriptive-correlational investigation utilizing structural equation modeling (SEM). The statistical population includes all children with autism spectrum disorder (ASD) in Kermanshah in 2023, with a sample selected through convenience sampling. Accounting for a 10% dropout rate due to incomplete or damaged questionnaires, we distributed questionnaires to 200 participants. Sample size determination followed established guidelines: Stevens' analysis recommends 15 cases per predictor variable in regression analyses, while Loehlin suggests that models with 2-4 factors require at least 100 cases (preferably 200), confirming our sample's adequacy for path analysis (Momeni et al., 2022). Inclusion criteria were: (1) DSM-5 ASD diagnosis confirmed by a psychiatrist, (2) GARS-3 score >54, (3) parental consent, (4) untreated anxiety with no treatment in the past year. Exclusion criteria included visual impairment, hearing loss, and epilepsy. We administered four instruments: the Anxiety Scale for Children with ASD (ASC-ASD), Child Behavior Checklist (CBCL), Social Skills Inventory, and Sensory Profile 2.After obtaining ethical approval and confirming the study proposal, questionnaires were distributed across ASD rehabilitation centers. Participants received detailed information about research objectives, confidentiality protocols, and data anonymity. Researchers verified inclusion criteria through preliminary screening questions and medical record reviews, with ASD diagnoses confirmed using the GARS-3 scale. Collected data were analyzed using SPSS-26 and Amos-24 software. Four standardized measures were employed: (1) the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD) for anxiety symptom assessment, (2) the Child Behavior Checklist (CBCL) for evaluating emotional/behavioral problems, (3) the Social Skills Inventory for measuring social behaviors, and (4) the Sensory Profile 2 for assessing sensory processing patterns. This methodological approach facilitated comprehensive data collection and analysis to examine relationships between sensory processing, behavioral challenges, and anxiety symptoms in children with ASD.ResultsResearchers evaluate model-data fit using goodness-of-fit indices, with the chi-square statistic (χ²) serving as the primary indicator of discrepancy between the hypothesized model's covariance matrix and the observed sample's matrix. The null hypothesis assumes perfect fit between model and data. However, χ²'s sensitivity to sample size necessitates supplemental indices: χ²/degrees of freedom (χ²/df) ratio, Goodness-of-Fit Index (GFI), Adjusted GFI (AGFI), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Standardized Root Mean Square Residual (SRMR), and Root Mean Square Error of Approximation (RMSEA). Acceptable model fit is typically indicated by RMSEA/SRMR values <0.08 and CFI/TLI values >0.90. Following initial analysis, we improved model fit by adding covariance relationships between error terms, resulting in final fit indices demonstrating acceptable model specification.The path analysis revealed three key findings: First, sensory processing demonstrated a significant negative direct effect on anxiety (β = -0.056, p <.05) but no significant direct effect on behavioral problems (β = -0.032, ns). Second, sensory processing showed a significant positive direct effect on social interactions (β = 0.094, p <.05). Third, anxiety exhibited strong opposing effects - a significant negative impact on social interactions (β = -0.883, p <.001) and a significant positive effect on behavioral problems (β = 0.731, p <.001). Crucially, bootstrap analysis confirmed that sensory processing significantly influenced both behavioral problems (indirect effect = -0.041, 95% CI [-0.078, -0.012]) and social interactions (indirect effect = 0.049, 95% CI [0.018, 0.088]) through its mediation via anxiety, accounting for 56.2% and 34.3% of total effects respectively.DiscussionThis study examined anxiety's mediating role in relationships between sensory processing and both social skills and behavioral problems in children with ASD. Our results demonstrate that sensory processing influences behavioral and social outcomes primarily through anxiety pathways. These findings align with established literature, particularly regarding anxiety's mediation between sensory processing and social skills (Machado et al., 2024; Khaledi et al., 2022; Tsuji et al., 2022). Klynek et al. (2016) specifically found that children with ASD showing better sensory processing exhibited superior academic and communicative performance, with sensory scores positively correlating with most communication measures. Their work further revealed distinct sensory processing patterns in ASD that significantly correlate with communication impairments. Notably, social relationships showed strong positive associations with all sensory processing patterns, underscoring sensory processing's crucial role in shaping social communication abilities (Klynek et al., 2016). These collective findings, including supporting evidence from Watson et al. (2011) and Baker et al. (2008), substantiate that sensory processing patterns significantly contribute to ASD symptom severity profiles.The findings suggest a potential shared mechanism between sensory processing difficulties and communication challenges in children with ASD. Consistent with previous research (Lane et al., 2010), sensory hypo-responsiveness was associated with poorer communication and social functioning. Our results revealed significant negative correlations between social relationship scores and all anxiety subscales, indicating a bidirectional relationship where anxiety reduction may improve social functioning and vice versa - a finding that aligns with Davis et al. (2011). Green et al. (2012) proposed that anxiety stems from maladaptive sensory processing patterns; specifically, sensory avoidance behaviors may limit participation in daily activities, while hyper-responsiveness can create barriers to engagement (Miller et al., 2007; Lane et al., 2012). Notably, communication skills demonstrate complex relationships with anxiety, where increased communication deficits may either alleviate or exacerbate anxiety depending on individual profiles. These findings underscore the clinical importance of addressing both sensory processing patterns and social relationship factors in ASD interventions (Khaledi et al., 2022).ConclusionThe observed mediating role of anxiety in the sensory processing-behavioral problems relationship aligns with previous findings (Lane et al., 2012; Green et al., 2012; Wigham et al., 2015; Moore et al., 2021). Although behavioral problems frequently occur in children with ASD, their association with anxiety remains understudied. While existing research has established connections between behavioral problems, sensory difficulties, and anxiety in ASD populations, our study represents the first Iranian investigation employing cross-sectional methodology to examine these relationships. The characteristic link between sensory differences and behavioral problems - likely stemming from sensory processing challenges - constitutes a core feature of ASD (Siu et al., 2020). Our results demonstrated significant negative correlations between all sensory processing patterns/subscales and anxiety subscales, supporting Green et al.'s (2012) conclusion that sensory processing abnormalities directly contribute to anxiety development in this population.These findings suggest that clinical interventions for anxiety in children with ASD should prioritize assessment and modification of sensory processing patterns. This approach is supported by Delapiazza et al. (2018), who demonstrated significant negative correlations between overall sensory scores and all anxiety subscales in ASD. The results indicate that heightened anxiety levels in children with ASD are associated with exaggerated responses to sensory stimuli. Importantly, these children manifest anxiety through diverse behavioral presentations, including internalizing, externalizing, and non-social behaviors - a phenomenon that remains understudied in ASD populations. This study investigated the interrelationships among communication differences, behavioral problems, sensory processing difficulties, and anxiety in children with ASD. The results indicate that children with ASD experiencing communication and behavioral challenges often demonstrate impaired sensory modulation, with sensory processing deficits showing significant associations with heightened anxiety. Importantly, anxiety mediated the relationship between sensory processing issues and both communication differences and behavioral problems. These findings highlight the need for multimodal interventions addressing sensory regulation, emotional control, and communication development in ASD.Several study limitations warrant consideration. First, the exclusion of children receiving anxiety treatment limits generalizability to this population. Second, our reliance on volunteer participants with service access may not represent the broader ASD community. Third, the cross-sectional design precludes causal inferences about the observed relationships between sensory processing, anxiety, communication, and behavioral outcomes. Future longitudinal research could help establish temporal relationships and causal pathways among these factors.AcknowledgmentsThe authors extend their deepest appreciation to the participating families for their invaluable contribution to this research. We are equally grateful to the collaborating rehabilitation centers for their support and to the clinical professionals who generously shared their expertise throughout this study.

Research Paper

The Effectiveness of Emotional Schema Therapy on Cognitive Emotion Regulation, Intolerance of Uncertainty and Cognitive Flexibility in People with Generalized Anxiety Disorder

Kobra Ghanizadeh Balderloo; Naimeh Moheb; Marziye Alivandi Vafa; Masoumeh Azmoudeh

Volume 14, Issue 56 , December 2024, Pages 39-68

https://doi.org/10.22054/jpe.2025.73929.2577

Abstract

Abstract The aim of this study was to evaluate the effectiveness of emotional schema therapy on cognitive emotion regulation, intolerance of uncertainty and cognitive flexibility in people with generalized anxiety disorder. The research design was descriptive-survey, analytical and quasi-experimental. ... Read More Abstract The aim of this study was to evaluate the effectiveness of emotional schema therapy on cognitive emotion regulation, intolerance of uncertainty and cognitive flexibility in people with generalized anxiety disorder. The research design was descriptive-survey, analytical and quasi-experimental. The statistical population was all patients with generalized anxiety disorder who referred to psychiatric, psychological and health centers in Urmia in 2021-2022. Statistical sample, by available and targeted methods, 30 (15 controls and 15 experiments) were selected. Data with questionnaires, Pervasive Anxiety Disorder (Spitz et al., 2006), Pennsylvania State Concern (PSWQ) (May et al., 1990), Intolerance of ambiguity (Bahr and Dougas, 2002), Cognitive flexibility (Dennis and Wonderwall, 2010) and cognitive emotional regulation (Garnowski, Craig and Schinhon, 2001) during the emotional schema therapy method (Lee Hee, 2012), collect and with software (SPSS V. 28) were analyzed. The results showed that emotional schema therapy was effective on cognitive emotion regulation, intolerance of uncertainty (ambiguity) and psychological flexibility in patients with generalized anxiety disorder. With the help of emotional schema therapy, it is necessary to control emotions and anxiety in patients with generalized anxiety disorder and return them to a normal life with family and community. Keywords: emotional schema therapy, cognitive emotion regulation, intolerance of uncertainty, psychological flexibility, generalized anxiety disorder Extended Abstract Introduction Generalized anxiety disorder (GAD) represents a fundamental condition in psychopathology, characterized primarily by excessive, persistent, and uncontrollable worry. Emotion regulation, a specialized form of self-regulation, encompasses both external and internal processes that monitor, evaluate, and modify the initiation, intensity, and duration of emotional responses. Intolerance of Uncertainty (IU) constitutes a cognitive framework describing individuals' difficulty in enduring ambiguous or unpredictable situations. Cognitive flexibility refers to the capacity to adapt cognitive strategies in response to changing environmental demands. Schema Therapy (ST) primarily aims to foster psychological insight and enhance deliberate regulation of maladaptive schemas, with the ultimate objective of modifying these schemas and improving coping strategies. Research Question To what extent does Emotional Schema Therapy (EST) impact cognitive emotion regulation, intolerance of uncertainty (IU), and psychological flexibility in individuals diagnosed with generalized anxiety disorder (GAD)? Literature Review Empirical studies demonstrate Schema Therapy's transdiagnostic efficacy across various populations. Abbasi et al. (2019) found significant improvements in both cognitive emotion regulation and quality of life among asthma patients following schema therapy interventions. Supporting these findings, Mohammadi et al. (2019) documented enhanced cognitive flexibility and resilience in generalized anxiety disorder (GAD) patients treated with schema therapy. Furthermore, Khoshnavis et al. (2015) established that schema therapy-based interventions effectively reduced pervasive anxiety, intolerance of uncertainty (IU), and cognitive distortions in university student populations. Collectively, these studies underscore schema therapy's broad therapeutic potential for addressing cognitive-emotional dysregulation across diverse clinical and subclinical groups. Methodology This study employed a descriptive-survey, analytical, and quasi-experimental research design. The target population comprised all patients diagnosed with generalized anxiety disorder (GAD) who sought treatment at psychiatric, psychological, and health centers in Urmia during 1400 (2021-2022). Using a combination of convenience and purposive sampling techniques, we selected 30 participants (15 in the experimental group and 15 in the control group) for the study sample. Assessment instruments included: Spitzer et al.'s (2006) Generalized Anxiety Disorder Scale The Pennsylvania State Worry Questionnaire (PSWQ; Meyer et al., 1990) Buhr & Dugas' (2002) Intolerance of Uncertainty Scale Dennis & Vander Wal's (2010) Cognitive Flexibility Inventory Garnefski, Kraaij, & Spinhoven's (2001) Cognitive Emotion Regulation Questionnaire The experimental group received Leahy's (2012) Emotional Schema Therapy protocol, consisting of nine 90-minute sessions. All instruments demonstrated good reliability, with Cronbach's alpha coefficients of 0.801, 0.799, 0.811, 0.803, and 0.815 respectively. Data analysis was conducted using SPSS software (version 28). Results The Box test showed that the condition of homogeneity of the variance-covariance matrix was met in both pre-test and post-test conditions. Bartlett's test confirmed that the research data had a normal distribution. Levene's test indicated a significant difference between pre-test and post-test scores across research variables measuring the effectiveness of emotional schema therapy, and Wilks's lambda test further verified this difference. The multivariate analysis of variance revealed a significant difference between the two groups in their pre-test to post-test changes on the research variables assessing emotional schema therapy effectiveness. Chart 1: The difference between the investigated groups in the pre-test and post-test As shown in Chart 1, the experimental group's mean scores were higher than the control group's in both pre-test and post-test measurements. Furthermore, the post-test averages exceeded the pre-test values across all variables following emotional schema therapy implementation. These results demonstrate that emotional schema therapy effectively improves cognitive emotion regulation, reduces intolerance of uncertainty (ambiguity), and enhances psychological flexibility in patients with generalized anxiety disorder. Discussion The results demonstrated that emotional schema therapy effectively promotes cognitive emotion regulation and adaptive functioning, while enhancing tolerance of uncertainty (ambiguity) and psychological flexibility. This therapeutic approach helps patients maintain emotional equilibrium necessary for daily functioning while reducing stress, worry, and anxiety symptoms. The findings confirmed its significant efficacy for generalized anxiety disorder (GAD) patients. Emotional schema therapy proved particularly functional as it emphasizes emotional control - enabling anxious individuals to better manage distress. By regulating negative emotional responses, patients can achieve greater psychological stability. Conclusion Emotional schema therapy proves particularly effective for addressing cognitive emotion regulation, intolerance of uncertainty, and psychological flexibility in patients with generalized anxiety disorder (GAD). This therapeutic approach enables clinicians to help patients overcome negative emotions, reduce anxiety and stress, and ultimately restore normal functioning through enhanced emotional understanding and regulation. Acknowledgments The authors gratefully acknowledge all participants and individuals who contributed to this research study. We sincerely appreciate their valuable cooperation and involvement in making this investigation possible.

Research Paper

The Effect of Neuropsychological Intervention with and without Electrical Stimulation of the Brain on Executive Functions and Solving Mathematical Problems in Students with Mathematical Learning Disorders

shahram ,vahedi; Helen Serajian; gholamreza Chalabianloo

Volume 14, Issue 56 , December 2024, Pages 69-105

https://doi.org/10.22054/jpe.2023.70629.2505

Abstract

Abstract Mathematical disorder is one of the common learning disabilities among students, where, despite having normal intelligence and physical health, students do not perform well in mathematical calculations. The aim of the present study was to compare the effectiveness of neuropsychological intervention ... Read More Abstract Mathematical disorder is one of the common learning disabilities among students, where, despite having normal intelligence and physical health, students do not perform well in mathematical calculations. The aim of the present study was to compare the effectiveness of neuropsychological intervention with and without electrical brain stimulation on the executive functions and problem-solving abilities of students with mathematical learning disabilities. The research design was a factorial experimental design of the pretest-posttest type with a control group. The statistical population of the study included all male students aged 9 to 12 in the city of Tabriz during the academic year 2021-2022. The sample consisted of 60 students with mathematical learning disabilities (15 in each group), selected through convenience sampling based on entry criteria and diagnostic interviews for learning disabilities based on DSM-5. The research tools included the Kimmat Mathematical Test, Mathematical Problem Solving Test, and Barkley Executive Function Deficits Questionnaire. Data were analyzed using SPSS-24 software and multivariate covariance analysis, univariate analysis, and Bonferroni pairwise comparison tests. The results showed that there was a significant difference between the mean scores of the experimental groups (neuropsychological intervention with and without electrical brain stimulation) and the control group (p < 0.001). Bonferroni pairwise comparisons indicated that the scores of the interactive group were significantly higher than those of the other groups (p < 0.001). Mathematics plays an important role in the education and daily lives of individuals, and neuropsychological interventions with electrical brain stimulation are one of the essential tools for enhancing mathematical problem-solving skills and executive functions. Keywords: mathematical learning disorder, electrical brain stimulation, problem solving, executive functions, neuropsychological Intervention . Extended Abstract Introduction Specific learning disorder is a neurodevelopmental condition characterized by an individual's performance being lower than expected for their age. This disorder disrupts the proper development and evolution of the brain or central nervous system during childhood, negatively impacting the individual’s emotions, learning ability, and memory as they grow (Abedi, 2017). Experts classify learning disorders into three main categories: Dyslexia, Dysgraphia, and Dyscalculia (Hall, Hughes, Charles & Filbert, 2015). In British Columbia, students with mathematical learning disorders exhibit deficits in information processing, which includes language processing, visual-spatial processing, processing speed, memory, attention, and executive functions (American Psychiatric Association, 2017; Ahadi & Kakavand, 2019). Additionally, these students face challenges with number perception, understanding numerical facts, calculation, and problem-solving (Aghaei Sabet et al., 2018). Problem-solving is a cognitive-behavioral process that involves taking logical steps to find and implement solutions (Demayr et al., 2015). The primary goal of assessing learning disabilities is to identify strengths and weaknesses to provide an appropriate educational program. Mathematical learning disabilities often have a neurological origin. Neuropsychological tests can help study the characteristics of students with learning disabilities, and addressing these through intervention, treatment, and education can improve their symptoms. Given the numerous deficits in executive functions and problem-solving abilities among students with math disorders, focusing on the development and enhancement of neuropsychological skills can reduce the occurrence of these problems and aid in improving the disorder. Therefore, recognizing these challenges and providing solutions to mitigate them is essential. In addition to neuropsychological interventions, a treatment gaining traction among researchers in neurology is Transcranial Direct Current Stimulation (tDCS), which uses direct electrical current (San-Juan et al., 2015). The present study aims to investigate the effectiveness of neuropsychological interventions on executive functions and problem-solving in students with mathematical learning disorders. Despite various studies on the effectiveness of neuropsychological interventions for different student disorders, limited research has explored the combined effects of neuropsychological intervention and electrical brain stimulation on learning disorders. Thus, comparing the effectiveness of these interventions in improving mathematical learning disorders, which have multiple neuropsychological bases and neurological symptoms, is crucial. Research Question What is the effect of neuropsychological interventions with and without Transcranial direct current stimulation (tDCS) on executive functions and mathematical problem solving in students with mathematical learning disorders? Literature Review Cherrier et al. (2020) conducted a study investigating the impact of educational neuroscience on the academic performance of students through a self-awareness and autonomy approach using metacognitive strategies. While the study did not find a significant difference in academic performance, it highlighted that educational neuroscience enhances students' understanding of brain function, leading to greater autonomy and improved self-awareness. Fernanda et al. (2018) examined the effects of neuropsychological intervention in children with functional deficits in planning and control, finding significant improvements in planning, control, and academic performance. This underscores the necessity of child correction approaches in neuropsychology to foster psychological and neuropsychological development. Rashidi et al. (2020) conducted a meta-analysis on the effectiveness of neuropsychological interventions in improving academic performance among students with specific learning disabilities, demonstrating a significant positive impact. Dehghani and Hekmatianfard (2019) found that executive function training improved attention and response inhibition in students with math disorders, with effects remaining stable over a two-month follow-up. Zemestani et al. (2019) showed that tDCS improved attention and motor performance in students with learning disabilities. Abdollahi, Hassanabadi, and Samiie Sanjani (2015) found that transcranial brain stimulation using direct electric current positively affected executive functions. Similarly, Arjomandnia et al. (2018) reported that electrical brain stimulation interventions effectively improved working memory in students with math disorders. Methodology This research employed a quasi-experimental pre-test-post-test design with a control group. The statistical population consisted of male students aged 9 to 12 years during the second half of the 2021-2022 academic year. A total of 60 students were selected through convenience sampling based on inclusion criteria and randomly assigned to three experimental groups (neuropsychological intervention group, electrical brain stimulation group, and a combined intervention group) and a control group. The experimental groups underwent the designed interventions, while the control group continued their regular routine. Data collection tools included the Barkley Student and Adolescent Executive Function Deficits Questionnaire, which consists of 70 items across five subscales (time self-regulation, organization and problem-solving, self-control and inhibition, self-motivation, and emotion self-regulation), which measures executive function deficits. Another tool was the Mathematical Problem Solving Questions for Students with Mathematical Learning Disorder, adapted from the fifth grade mathematics textbook, consisting of 19 questions. Cronbach's alpha coefficient was used to confirm the validity from the experts' point of view and for reliability. Neuropsychological intervention was implemented in 10 sessions using the educational programs of Korkman (1998), Bley & Thornton (2001), and Geary (2010). Direct electrical brain stimulation was performed in accordance with the research of Feesera, Prehn, Kazzer, Mungee & Bajbouj (2014). In this method, the black electrode in the middle of the forehead and the red electrode on the left side of the skull were stimulated with a current intensity of two amperes. Descriptive and inferential statistics were used to analyze the data in the present study. Thus, the data obtained from completing the questionnaires after the intervention were analyzed by the SPSS-24 software version, and the statistical methods of analysis of covariance and Bonferroni paired comparison test were used. Results In order to conduct the analysis of covariance, all necessary assumptions were first made, including the test of data normality (non-significance of the Shapiro-Wilkstatistic), the assumption of homogeneity of variance (Leven's test), and the examination of the homogeneity of regression slopes. Multivariate analysis of covariance to examine the effect of neurological interventions with and without electrical brain stimulation in the post-test stage on all variables showed that the mean scores of the subscales of parental executive functions, students' executive function deficits, and problem solving in the post-test stage were significantly different in the experimental and control groups (P<0.001). The results indicate that the interventions had a significant effect on each of the variables separately. In terms of the effectiveness of the interventions, the effect size shows that the interventions had the greatest effect on self-regulation of time, self-motivation, problem-solving and organizational, and problem solving, respectively. The results of the Bonferroni test for pairwise comparison of students' executive functions and problem solving among groups show that there is a significant difference in the variables of students' executive functions deficit and problem solving in the post-test stage between the methods studied (P<0.001). According to the results, it can be seen that the greatest difference is observed in the combined intervention method, which indicates the better effectiveness of this method. Discussion and Conclusion The results showed that combined neuropsychological intervention along with electrical brain stimulation has a significant effect on improving students' executive function deficits and problem solving. In explaining the findings, neuropsychological interventions allow individuals to better manage and regulate in different situations and increase their planning and organizing abilities. Teaching effective memorization techniques and strategies allows students to use the information and problem-solving methods they have stored efficiently. The type of action of electrical brain stimulation on executive functions is such that the dorsolateral prefrontal cortex, which has a high capacity in specific cognitive functions in working memory, planning, goal-oriented behavior, concentration, and inhibitory control, is targeted and leads to increased cortical excitability in the left dorsolateral prefrontal cortex.

Research Paper

The Effectiveness of Cognitive Behavioral Play Therapy and Transcranial Direct-Current Stimulation on Emotional Regulation, Executive Functions, and Communication Skills in Children with Autism Spectrum Disorder

Mohammad Hatami Nejad; Mohammadreza Noroozi Homayoon; Esmaeil Sadri Damirchi

Volume 14, Issue 56 , December 2024, Pages 107-144

https://doi.org/10.22054/jpe.2025.80221.2710

Abstract

Abstract The purpose of this study was to evaluate the effectiveness of cognitive behavioral play therapy and Transcranial direct-current stimulation on emotional regulation, executive functions, and communication skills in children with autism spectrum disorder. This study was a quasi-experimental ... Read More Abstract The purpose of this study was to evaluate the effectiveness of cognitive behavioral play therapy and Transcranial direct-current stimulation on emotional regulation, executive functions, and communication skills in children with autism spectrum disorder. This study was a quasi-experimental design with pre-test, post-test, and control group. The statistical population consisted of all children aged 6-12 years with autism spectrum disorder who referred to special education schools, centers, and clinics in Ardabil city during the years 2022-2023. A total of 45 children with autism spectrum disorder were selected non-randomly and purposefully and randomly assigned to three groups (15 children in each group). The intervention included cognitive-behavioral play therapy and transcranial direct current stimulation. The tools of this study included the N-back computerized test, Wisconsin Card Sorting Test (WCST), Gross and John Emotion Regulation Questionnaire, and the Communication Skills Questionnaire. The findings considering the results of Bonferroni's post hoc test showed that in pairwise comparison of cognitive behavioral play therapy, Transcranial direct-current stimulation and the control group in the scores of executive functions, emotion regulation and communication skills variables, there was a significant difference between the cognitive behavioral play therapy group, Transcranial direct-current stimulation group and the control group (p<0.05). In conclusion, cognitive behavioral play therapy and Transcranial direct-current stimulation have an effect on emotional regulation, executive functions and communication skills in children with autism spectrum disorder. Keywords: cognitive behavioral play therapy, transcranial direct-current stimulation, emotional regulation, executive functions, communication skills, autism spectrum disorder Extended Abstract Introduction Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by persistent deficits in social communication and interaction, along with restricted and repetitive behaviors, which significantly impair children's daily functioning and family dynamics. These challenges typically manifest as difficulties in emotional regulation, executive functions, and communication skills - critical domains for social integration and personal development. The current study aimed to examine the effectiveness of cognitive behavioral play therapy (CBPT) and transcranial direct current stimulation (tDCS) in enhancing emotional regulation, executive functions, and communication skills in children with ASD, responding to the need for integrated, non-pharmacological interventions that target these core deficits concurrently. Research Questions What is the effectiveness of cognitive behavioral play therapy (CBPT) and transcranial direct current stimulation (tDCS) on emotional regulation, executive functions, and communication skills in children with autism spectrum disorder (ASD)? Is there a significant difference between CBPT and tDCS in their effectiveness for improving emotional regulation, executive functions, and communication skills in children with ASD? Literature Review Children with ASD frequently demonstrate significant impairments in emotional regulation, with studies suggesting that approximately 85% of individuals with ASD struggle with emotion management, leading to behavioral and social difficulties (Lee et al., 2022). Executive function deficits - particularly in working memory, cognitive flexibility, and impulse control - are commonly observed and associated with prefrontal cortex dysfunction and related neural network abnormalities (Costescu et al., 2024). Communication challenges, including problems with social cue interpretation, conversation initiation, and eye contact maintenance, often worsen social isolation (Clyde et al., 2024). Cognitive behavioral play therapy (CBPT) has demonstrated effectiveness in enhancing social and communication skills by creating a secure, play-based setting for emotional expression and social interaction practice, with research showing improved neural activity and social functioning (Chan & Ouyang, 2024; Kaur et al., 2024). Similarly, transcranial direct current stimulation (tDCS) has shown potential as an intervention, modulating prefrontal cortex activity to enhance cognitive and social outcomes in ASD (Kang et al., 2024; Han et al., 2023). Play therapy has been shown to significantly improve social skills in children with autism by offering a structured yet adaptable environment for emotional expression and social learning (Elbeltagi et al., 2023, p. 5). However, limited research has directly compared CBPT and tDCS to assess their relative effectiveness in addressing the complex challenges of ASD, underscoring the importance of comparative studies to guide clinical decision-making. Methodology This study utilized a quasi-experimental design incorporating pre-test and post-test assessments with a control group. The target population comprised children aged 6-12 years with ASD diagnoses who were enrolled in special education schools, centers, and clinics in Ardabil, Iran during the 2022-2023 academic year. Using non-random purposive sampling, 45 participants were selected and subsequently randomly allocated to three experimental groups (n=15 each: CBPT, tDCS, and control). Inclusion criteria consisted of: (1) formal ASD diagnosis confirmed by both psychiatrist and psychologist, (2) parental consent, (3) normal IQ range, and (4) absence of comorbid conditions. Exclusion criteria involved missing more than two intervention sessions or voluntary withdrawal. The CBPT intervention implemented Drewes' (2009) protocol through eight weekly 60-minute sessions, while tDCS administration comprised ten 10-minute sessions delivered twice weekly over five weeks using a 2NEUROSTIM device (1-2 mA current applied to prefrontal cortex). Primary outcome measures included: the N-back Computerized Test (working memory), Wisconsin Card Sorting Test (Berg et al., 1948; cognitive flexibility), Emotion Regulation Questionnaire (Gross & John, 2003), and Communication Skills Questionnaire (Matson, 1983). MANCOVA was performed with pre-test scores as covariates to examine between-group differences, following confirmation of normality, homogeneity of variance, and regression slope assumptions (α=0.05). Results Both intervention groups (CBPT and tDCS) showed statistically significant improvements across all measured domains - emotional regulation, executive functions (working memory and cognitive flexibility), and communication skills - when compared to the control group. The CBPT group demonstrated particular strengths in emotional regulation and communication skills, which may be attributed to its structured play-based methodology that facilitates social learning and emotional expression. Conversely, the tDCS group showed more pronounced improvements in executive functions and social communication, likely resulting from enhanced neural activation in prefrontal cortical regions. Bonferroni-adjusted post-hoc analyses confirmed the superiority of both interventions over the control condition (p < 0.05), while revealing no statistically significant differences between CBPT and tDCS outcomes. Table 1 Mean and Standard Deviation of Pre-test and Post-test Scores for Executive Functions, Emotional Regulation, and Communication Skills Group Variable Pre-test Mean (SD) Post-test Mean (SD) CBPT Executive Functions 45.12 (5.61) 52.34 (4.89) Emotional Regulation 38.76 (6.12) 46.89 (5.43) Communication Skills 42.45 (7.19) 50.67 (6.32) tDCS Executive Functions 44.89 (6.23) 53.12 (5.01) Emotional Regulation 39.12 (5.98) 47.23 (5.67) Communication Skills 41.89 (6.87) 51.34 (6.45) Control Executive Functions 45.67 (5.84) 46.12 (5.76) Emotional Regulation 38.45 (6.34) 39.01 (6.28) Communication Skills 42.12 (7.01) 42.89 (6.95) Note. Data reflect significant improvements in intervention groups compared to the control group (p < 0.05) Discussion These findings align with existing evidence showing CBPT improves emotional regulation and communication skills through amygdala modulation and prefrontal cortex reinforcement, thereby enhancing emotion management and social interaction capabilities (Chan & Ouyang, 2024; Kaur et al., 2024). Similarly, tDCS's positive impact on executive functions and social communication corroborates research demonstrating its efficacy in optimizing prefrontal neural network functioning (Kang et al., 2024; Noroozi Homayoon et al., 2024). The absence of significant between-group differences indicates comparable effectiveness of CBPT and tDCS, despite their divergent mechanisms—CBPT employing experiential learning approaches while tDCS utilizes direct neural modulation. These outcomes highlight the value of non-pharmacological interventions for core ASD symptoms. Study limitations include uncontrolled environmental and cultural variables, along with insufficient long-term follow-up to evaluate treatment effect persistence, potentially affecting result generalizability. Conclusion Both CBPT and tDCS demonstrated effectiveness in enhancing emotional regulation, executive functions, and communication skills in children with ASD, providing clinically valuable non-pharmacological treatment options for therapeutic and educational applications. Future studies should incorporate larger, more diverse samples and longitudinal designs to assess treatment effect maintenance and improve the generalizability of results. AcknowledgmentsThe authors gratefully acknowledge the valuable contributions of the children with ASD and their families in Ardabil who participated in this study, making this research possible through their time and commitment.

Research Paper

Bibliometric Analysis and Systematic Review of Executive Functions in the Field of Attention Deficit/Hyperactivity Disorder

Shahrooz Nemati

Volume 14, Issue 56 , December 2024, Pages 145-181

https://doi.org/10.22054/jpe.2025.81290.2725

Abstract

Abstract Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition marked by significant challenges that has led to extensive research on related constructs like executive functions, with this study aiming to explore the bibliometric landscape of executive functions in ADHD through ... Read More Abstract Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition marked by significant challenges that has led to extensive research on related constructs like executive functions, with this study aiming to explore the bibliometric landscape of executive functions in ADHD through analysis of Scopus data using the PRISMA model and the keywords "Attention Deficit/Hyperactivity Disorder" and "Executive Function," revealing publications spanning 1957 to 2024 across 27 subject areas primarily in medicine, psychology, and cognitive neuroscience, where only one document appeared between 1957-1982 compared to 7,995 in 2023, demonstrating a clear upward trend despite reduced output during 2015-2016, with English, Spanish, and Chinese emerging as dominant languages and the United States, United Kingdom, Germany, Canada, and China leading in contributions while Iran ranked 22nd, consistently showing that individuals with ADHD exhibit poorer executive functioning than peers particularly in working memory and self-regulation, supported by Barkley's theoretical framework suggesting ADHD involves greater self-regulation deficits rather than pure attention problems, thereby advocating for comprehensive treatment approaches incorporating behavioral interventions, environmental modifications, and emotional regulation strategies to address these core challenges. Keywords: attention deficit/hyperactivity disorder, executive functions, bibliometrics, systematic review Extended Abstract Introduction Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that typically emerges in childhood and frequently persists into adulthood (Farahani et al., 2024). The condition is characterized by chronic patterns of inattention and/or hyperactivity-impulsivity that significantly impair functioning or disrupt normal developmental trajectories during childhood (American Psychiatric Association, 2022). Executive functions represent a relatively recent conceptual development in neuroscience. Luria (1966, 1973, 1980, as cited in Ardila, 2008) pioneered the theoretical framework of executive functions, proposing three functional brain units: (1) arousal-motivation (mediated by limbic and reticular systems), (2) information reception, processing, and storage (involving post-Rolandic cortical areas), and (3) activity planning, control, and verification (dependent on frontal cortex function). Luria specifically identified this third unit as possessing executive control capabilities. Baddeley (1986) subsequently organized these behavioral components into distinct cognitive domains encompassing planning deficits, behavioral disorganization, inhibitory failures, perseveration, reduced behavioral dominance, and initiation impairments - collectively termed "dysexecutive syndrome." Contemporary conceptualizations of executive function incorporate mental flexibility, distractor filtering, goal-directed behavior maintenance, and action-consequence prediction (Ardila & Surloff, 2007). Research consistently demonstrates that individuals with ADHD perform significantly worse on executive function measures compared to neurotypical controls. Within this domain, executive dysfunction shows a strong association with inattention symptoms but no significant correlation with hyperactive-impulsive symptoms. This pattern persists in adolescent populations, where executive function deficits remain specifically linked to attention-related impairments (Martel et al., 2007). This study sought to systematically synthesize existing evidence on the relationship between executive functions and ADHD, with the dual objectives of (1) mapping current knowledge and (2) identifying critical research gaps. The findings illuminate persistent questions, methodological limitations, and testable hypotheses that can inform future investigations. Importantly, the analysis reveals key areas where extant evidence remains inconclusive, thereby delineating priority domains for targeted research to advance understanding of ADHD-related executive dysfunction. Method This applied research employs a dual methodological approach combining bibliometric analysis with systematic review methodology following the PRISMA framework. Data extraction focused specifically on ADHD-related literature sourced from the Scopus database, an authoritative bibliographic platform established by Elsevier in 2004. Scopus maintains international recognition as a comprehensive repository of scientific documents across disciplines, providing robust citation indexing and bibliographic metadata for research synthesis. Table 2: Most Cited Articles in the Field of ADHD Title Authors Source title Year Cited by 1 The Unity and Diversity of Executive Functions and Their Contributions to Complex "Frontal Lobe" Tasks: A Latent Variable Analysis A. Miyake; et al. Cognitive Psychology 2000 10748 2 Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data J. Kaufman; et al. Journal of the American Academy of Child and Adolescent Psychiatry 1997 7945 3 Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD R.A.Barkley. Psychological Bulletin 1997 5456 4 The worldwide prevalence of ADHD: A systematic review and metaregression analysis G.Polanczyk.; et al. American Journal of Psychiatry 2007 4046 5 Prevalence and development of psychiatric disorders in childhood and adolescence E.J. Costello; et al. Archives of General Psychiatry 2003 2962 6 The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication R.C.Kessler; et al. American Journal of Psychiatry 2006 2952 7 A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder Jensen P.S. Archives of General Psychiatry 1999 2881 8 Testing the efficiency and independence of attentional networks J. Fan.; et al. Journal of Cognitive Neuroscience 2002 2687 9 The nature and organization of individual differences in executive functions: Four general conclusions A. Miyake; et al.. Current Directions in Psychological Science 2012 2667 10 Working memory: Theories, models, and controversies Baddeley A. Annual Review of Psychology 2012 2569 11 The cerebellar cognitive affective syndrome J.D. Schmahmann; et al.. Brain 1998 2564 12 Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents G.V.Polanczyk; et al.. Journal of Child Psychology and Psychiatry and Allied Disciplines 2015 2468 13 Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample E.Simonoff; et al. Journal of the American Academy of Child and Adolescent Psychiatry 2008 2411 14 Neurocognitive deficit in schizophrenia: A quantitative review of the evidence R.W Heinrichs.; et al.. Neuropsychology 1998 2387 15 Identification of risk loci with shared effects on five major psychiatric disorders: A genome-wide analysis J.W. Smoller.; et al.. The Lancet 2013 2268 16 A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomised controlled trial T. Ngandu; et al. The Lancet 2015 2204 17 The World Health Organization adult ADHD self-report scale (ASRS): A short screening scale for use in the general population R.C. Kessler; et al. Psychological Medicine 2005 2203 18 Relating effortful control, executive function, and false belief understanding to emerging math and literacy ability in kindergarten C. Blair.; et al.. Child Development 2007 2196 19 Frontal-Subcortical Circuits and Human Behavior Cummings J.L. Archives of Neurology 1993 2043 20 Altered baseline brain activity in children with ADHD revealed by resting-state functional MRI Y.-F. Zang.; et al.. Brain and Development 2007 2029 21 Comorbidity A. Angola; et al.. Journal of Child Psychology and Psychiatry and Allied Disciplines 1999 1958 22 Long-term cognitive impairment after critical illness P.P.Pandharipande. et al.; New England Journal of Medicine 2013 1916 23 Diagnostic criteria for mild cognitive impairment in Parkinson's disease: Movement Disorder Society Task Force guidelines I, Litvan; et al.. Movement Disorders 2012 1894 24 Executive Function in Preschoolers: A Review Using an Integrative Framework N.Garon; et al. Psychological Bulletin 2008 1810 25 Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs S.H. Lee.; et al. Nature Genetics 2013 1763 26 Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 The Lancet Psychiatry 2022 1642 27 Functional topography in the human cerebellum: A meta-analysis of neuroimaging studies C.J. Stoodley; et al.. NeuroImage 2009 1614 28 Human catechol-O-methyltransferase pharmacogenetics: Description of a functional polymorphism and its potential application to neuropsychiatric disorders H.M. Lachman; et al.. Pharmacogenetics 1996 1597 29 The spectrum of disease in chronic traumatic encephalopathy A.C.McKee. et al.; Brain 2013 1588 30 Development of cognitive control and executive functions from 4 to 13 years: Evidence from manipulations of memory, inhibition, and task switching M.C. Davidson; et al.. Neuropsychologia 2006 1525 Discussion and Conclusion This study aimed to (1) establish the bibliometric positioning of executive functions research and (2) systematically review this construct's significance and key findings within ADHD studies. Analysis of Scopus data revealed the first ADHD-related document was indexed in 1995, with publication rates showing a general upward trend. Peak productivity occurred in 2023, while the period 1957-1982 showed minimal output. Our quantitative bibliometric approach enables comprehensive analysis of: research productivity trends, leading institutions/countries, prominent authors, high-impact journals, and frequently cited works in this domain. These analyses can foster enhanced scientific collaboration by mapping the field's intellectual structure. Barkley's (1997) behavioral inhibition theory posits that ADHD stems from a core deficit in self-regulation, where impaired behavioral inhibition disrupts executive functioning. This foundational impairment manifests as difficulties in: (1) non-verbal working memory (manipulating visual/spatial information), (2) verbal working memory (maintaining inner speech for self-guidance), (3) emotional self-regulation, and (4) goal-directed planning/problem-solving. Rather than constituting a simple attention deficit, ADHD emerges as a complex self-regulation disorder with cascading effects across cognitive and behavioral domains. The theory's clinical implications are threefold: First, it reorients intervention focus from symptom management to addressing underlying regulatory mechanisms. Second, it advocates for multimodal strategies combining behavioral training (e.g., cognitive-behavioral techniques), environmental adaptations (e.g., structured routines), and caregiver education. Third, it underscores the condition's chronicity, necessitating longitudinal, personalized treatment plans that evolve with developmental needs.

Research Paper

The Effect of Teaching Farsi with Gagne's Instructional Design Model on phonological Awareness and Problem Solving Ability of Students with Intellectual Disabilities

Nafise Masomi Sheijani; Sajjad Rezaie; azra zebardast; seyyed Waliullah Mousavi

Volume 14, Issue 56 , December 2024, Pages 183-211

https://doi.org/10.22054/jpe.2025.75850.2619

Abstract

Abstract The aim of this study was to investigate the effect of Gagné’s instructional design model on the phonological awareness and problem-solving abilities of students with intellectual disabilities. The research employed a quasi-experimental method, using a pretest-posttest design with ... Read More Abstract The aim of this study was to investigate the effect of Gagné’s instructional design model on the phonological awareness and problem-solving abilities of students with intellectual disabilities. The research employed a quasi-experimental method, using a pretest-posttest design with a control group. The study population consisted of all first- and second-grade students with intellectual disabilities in Khomam City during the 2022–2023 academic year. A sample of 30 students was randomly selected and assigned to either the experimental or control group, with 15 participants in each. Data were collected during the pretest and posttest phases using the Solaimani and Dastjerdi Phonological Awareness Test (2003–2004) and the London Tower Test (1982). Gagné’s instructional design model was implemented in ten 45-minute sessions for the experimental group, while the control group received traditional instruction from their teachers. Data analysis was conducted using SPSS-24 software through univariate and multivariate analysis of covariance (ANCOVA). The results indicated that the experimental group showed significantly higher post-test scores in phonological awareness compared to the control group (p < 0.05). Additionally, the experimental group demonstrated better problem-solving ability than the control group, though this difference was not statistically significant (p > 0.05). Based on these findings, it can be concluded that Gagné’s instructional design model – with its systematic, step-by-step approach to lesson design – enhances problem-solving skills and phonological awareness in students with intellectual disabilities by effectively utilizing their cognitive abilities and memory recall processes. Keywords: Gagné’s Instructional Design Model, phonological awareness, problem-solving ability, intellectual disabilities, special education Extended Abstract Introduction A significant subset of students in every educational community experiences substantial difficulties in academic performance and learning compared to their peers. As defined by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2022), intellectual disability represents a neurodevelopmental disorder of biological origin. This condition is characterized by: Clinically significant impairments in intellectual functioning (including deficits in reasoning, problem-solving, planning, abstract thinking, and judgment) Concurrent limitations in adaptive functioning across conceptual, social, and practical domainsThese developmental challenges must onset prior to 18 years of age to meet diagnostic criteria. Research Question This study aims to answer the following question: Does Gagné’s instructional design model significantly enhance phonological awareness and problem-solving abilities in students with mild intellectual disabilities? Literature Review Students with mild intellectual disabilities typically demonstrate significant challenges in reading and related literacy skills due to developmental delays (Hallahan & Kauffman, 1994). While typically developing children acquire reading skills with relative ease, this apparent simplicity can lead to the mistaken assumption that reading is not a cognitively demanding process. In reality, reading constitutes a sophisticated linguistic operation involving the decoding of written symbols that represent spoken language (Moats, 2020). This complexity explains why special education students and children with developmental impairments often exhibit reduced phonological awareness, a key factor underlying their reading difficulties. Research consistently demonstrates the efficacy of phonological awareness interventions for students with reading difficulties. Karimi et al. (2013) found that systematic phonological awareness instruction significantly enhances reading comprehension in students with reading disorders. Similarly, Mostaghimzadeh and Soleimani (2005) established that phonological awareness training effectively improves reading abilities among second-grade students with intellectual disabilities. The implementation of evidence-based instructional design models can substantially mitigate educational challenges for students with intellectual disabilities while providing crucial support for special education practitioners. Among these models, Gagné's instructional design framework offers particular promise due to its systematic approach to skill acquisition. Methodology Research consistently demonstrates the efficacy of phonological awareness interventions for students with reading difficulties. Karimi et al. (2013) found that systematic phonological awareness instruction significantly enhances reading comprehension in students with reading disorders. Similarly, Mostaghimzadeh and Soleimani (2005) established that phonological awareness training effectively improves reading abilities among second-grade students with intellectual disabilities. The implementation of evidence-based instructional design models can substantially mitigate educational challenges for students with intellectual disabilities while providing crucial support for special education practitioners. Among these models, Gagné's instructional design framework offers particular promise due to its systematic approach to skill acquisition. The study employed two standardized assessment tools: The Tower of London Test(Shallice, 1982) to evaluate problem-solving skills and executive functioning The Phonological Awareness Test(Soleimani & Dastjerdi Kazemi, 2010) to measure phonological awareness capabilities All assessments were administered individually in a controlled, quiet environment separate from instructional settings during both pretest and posttest phases. The researcher served as the primary interventionist for this study. Prior to implementation, the researcher completed a specialized online training program in instructional design based on Gagné's model to ensure treatment fidelity. The intervention content was developed following Gagné's (1985) instructional design principles, primarily derived from his seminal work The Conditions of Learning and Theory of Instruction. All instructional materials underwent rigorous review and received approval from the research supervisor and advisory committee before being implemented in the study. The assessment instruments were administered to both experimental and control groups during pretest and posttest phases. Following data collection, analyses were conducted using SPSS version 24, employing both univariate and multivariate analysis of covariance (ANCOVA and MANCOVA). Prior to conducting these analyses, all necessary statistical assumptions were verified. The Shapiro-Wilk test was used to evaluate the normality of data distribution. Pretest scores for phonological awareness were adjusted using corrected mean and standard deviation values (Myers, 2013) to account for baseline differences. The results confirmed that the data met the assumption of normality, thereby justifying the use of parametric statistical tests without modification. Results Table 1 presents the results of the univariate analysis of covariance (ANCOVA) comparing phonological awareness test scores between the experimental and control groups. Table 1: Results of Univariate Analysis of Covariance (ANCOVA) for the Phonological Awareness Test Between Experimental and Control Groups Sources SS df MS F P-value ή2 power Between Group 388.456 1 388.456 35.879 0.0001 0.580 1 Error 281.523 26 10.828 Total 17422.31 29 The ANCOVA results presented in Table 1 reveal a statistically significant difference in phonological awareness between the experimental and control groups (F (1, 28) = 35.87, p <.001, partial η² =.58). This finding demonstrates that Gagné's instructional design model significantly enhanced phonological awareness among students with mild intellectual disabilities. The large effect size (partial η² =.58) indicates that 58% of the variance in posttest scores, after controlling for baseline differences, was attributable to the experimental intervention. Multivariate analysis using Pillai's Trace further confirmed the intervention's significant effect on phonological awareness (V =.325, F (1, 28) = 6.026, p =.007). The substantial eta squared value (η² =.841) suggests that approximately 84% of the variance between groups can be explained by the treatment effect. Table 2: Results of Multivariate Analysis of Covariance (MANCOVA) for Problem-Solving Performance in Immediate and Delayed Conditions Sources Dependent Variable SS df MS F P-value ή2 power Group Posttest Delayed Time Posttest Immediate Execution 40207.705 99239.828 1 1 40207.705 99239.828 12.533 3.934 0.002 0.058 0.325 0.131 0.926 0.480 Error Posttest Delayed Time Posttest Immediate Execution 83411.835 655813.201 26 26 3208.147 25223.585 Total Posttest Delayed Time Posttest Immediate Execution 640515.00 6711750.00 30 30 Table 2 displays the MANCOVA results for problem-solving performance. Analysis revealed a statistically significant between-group difference in the delayed condition (F(1, 28) = 12.53, p =.002, partial η² =.32), indicating that 32% of the variance in posttest scores (after controlling for pretest performance) was accounted for by the experimental intervention. For immediate performance on the Tower of London test, results approached but did not reach statistical significance (F(1, 28) = 3.934, p =.058). This pattern of findings suggests that while Gagné's instructional model significantly improved response latency in delayed problem-solving, it did not yield statistically significant improvements in immediate task execution speed. Discussion The findings demonstrate that implementing Gagné's systematic instructional design model in Farsi language instruction significantly enhances phonological awareness among students with mild intellectual disabilities. This model's effectiveness stems from its comprehensive approach to both external and internal learning conditions, offering a logically sequenced framework for instructional delivery. A particular strength of Gagné's model lies in its initial focus on attention acquisition - a critical phase where educators apply pedagogical expertise to actively engage students and successfully initiate the learning process. The structured nature of this approach appears particularly beneficial for the target population, as it provides clear, scaffolded learning experiences that address their specific educational needs. Gagné's instructional model promotes deeper learning by systematically activating students' memory systems through explicit connections between new content and prior knowledge. This approach facilitates enhanced retention and recall of Farsi linguistic concepts. The model's effectiveness is further amplified by its provision of individualized feedback and reinforcement, carefully tailored to each student's learning profile, which appears instrumental in improving both Farsi proficiency and phonological awareness. A particularly impactful component involves the structured incorporation of generalization and transfer strategies. By deliberately practicing phonemic awareness across multiple contexts using varied lexical items, students developed the capacity to apply phonological knowledge flexibly. This targeted emphasis on skill transfer likely constituted a key mechanism underlying the observed improvements in phonological processing abilities. The study's findings further revealed that Gagné's instructional model significantly enhanced problem-solving abilities in students with mild intellectual disabilities. Comparative analysis demonstrated markedly higher posttest performance in the experimental group relative to controls. Notably, the experimental group exhibited reduced response latency and execution times on the Tower of London test during posttesting. These results carry particular theoretical significance given that problem-solving represents a complex cognitive process requiring individuals to generate solutions to novel challenges. While the inherent metacognitive limitations associated with intellectual disabilities might predict difficulties in acquiring such higher-order skills, our findings counter this assumption by demonstrating measurable improvement. The effectiveness of Gagné's approach appears rooted in its systematic engagement of learners through progressively challenging problem scenarios. By repeatedly situating students in contexts requiring strategic application of problem-solving techniques - both within instructional settings and simulated real-world situations - the model facilitates the development of these critical cognitive capacities. Conclusion Gagné's instructional design model demonstrated significant positive effects on both phonological awareness and problem-solving performance among students with mild intellectual disabilities. The model's efficacy stems from its systematic integration of research-based instructional sequences that actively engage learners' cognitive abilities, memory systems, and attentional processes. By incorporating these well-structured pedagogical approaches, Gagné's framework effectively supports the development of critical academic and cognitive skills in this student population. Acknowledgments This study received ethical approval from the Bio-Medical Research Ethics Committee of the University of Guilan (Approval Code: IR.GUILAN.REC.1401.095). The authors gratefully acknowledge the valuable contributions of the educators and administrative personnel at Isar School in Khomam. We extend our sincere appreciation to all participating students and their families for their cooperation throughout this research endeavor.

Research Paper

Quality of Life of Mothers of Deaf Children: Lived Experience with a Phenomenological Approach

maryam arfa; Mohammad Ashori

Volume 14, Issue 56 , December 2024, Pages 213-250

https://doi.org/10.22054/jpe.2025.79265.2692

Abstract

Abstract Having a disabled child may have a negative impact on the mental health of parents, especially mothers. The aim of the present study was to investigate the quality of life of mothers of adolescents with hearing impairment based on a phenomenological approach. The present research design was ... Read More Abstract Having a disabled child may have a negative impact on the mental health of parents, especially mothers. The aim of the present study was to investigate the quality of life of mothers of adolescents with hearing impairment based on a phenomenological approach. The present research design was based on a descriptive phenomenological approach. The research population included mothers of adolescents with hearing impairment in Rasht in 2023-2024. The research sample included 10 mothers of this group of adolescents who were selected through purposive sampling. The main criteria for selecting participants were: having a child with severe hearing impairment, age 35 to 50 years, the parents’ level of education from middle school to bachelor’s degree, and voluntary participation in the study. Semi-structured interviews were used to collect data, and the data were analyzed using the Collaizi method. After thematic extraction and classification, the interview results were classified into eight main categories: emotional cycle, parental factors, nature of the hearing impairment, acute issues outside the family, concerns about important decisions during youth, experiencing small successes, education and awareness, and having a purpose in life. Also, 25 subcategories were extracted. Based on the findings of this study, mothers of adolescents with hearing impairment experience numerous concerns. It may harm their quality of life. Therefore, it is necessary to pay attention to the emotional, sentimental, and psychological aspects of these mothers in rehabilitation programs. Keywords: hearing impairment, lived experience, phenomenology, quality of life Extended Abstract Introduction Hearing impairment, encompassing deafness and hard-of-hearing conditions, represents the most prevalent sensory disability (Hallahan et al., 2023). This impairment can significantly disrupt typical emotional development (Danadel & Ashori, 2025). Typically, the birth of a child with hearing impairment and subsequent concerns about their future may become sufficiently intense to compromise family stability and cohesion (Wu et al., 2024). Mothers in particular require substantial social support to access crucial information about their children's unique needs and health status (Marie et al., 2023). Research consistently demonstrates that parents of children with disabilities experience poorer quality of life compared to parents of typically developing children (Roberts & Fishbach, 2020; Kobosko et al., 2025). Parenting a child with hearing impairment involves numerous complex challenges. These challenges hold significance both from clinical perspectives (e.g., psychological stressors) and positive dimensions (e.g., personal growth, enhanced spirituality, and parenting fulfillment) (Eghbalnia & Ashori, 2024). As mothers typically shoulder the primary caregiving responsibilities for adolescents with hearing impairment, research has disproportionately overlooked their quality of life as a central focus. A deeper understanding of mothers' lived experiences could substantially improve support services and social provisions for these families. Research Question What are the lived experiences of mothers of adolescents with hearing impairment regarding their quality of life? Literature Review Kobosko et al. (2025) found significant relationships between quality of life and multiple factors - including general health, personality traits, speech understanding, and social factors - in individuals with hearing impairment, particularly cochlear implant users. Complementing these findings, Rosenzweig et al. (2024) demonstrated that maternal acceptance of adolescents with hearing impairment enhances psychological well-being and improves overall quality of life. Further supporting this framework, Aghaziarti and Ashori (2023) identified parental stress as a key predictor of various developmental outcomes in children. Methodology This qualitative study employed a phenomenological approach with descriptive strategy to explore the lived experiences of mothers of adolescents with hearing impairment regarding quality of life. Using purposive sampling, we recruited 10 participants (mothers of adolescents with hearing impairment) from Rasht Deaf Center's 2023-2024 service recipients, continuing interviews until theoretical saturation was achieved. Data collection involved 50-80 minute semi-structured in-depth interviews, analyzed manually via Colaizzi's phenomenological method. Results The analysis of interview data using Colaizzi's phenomenological method yielded eight core thematic categories with 25 associated subcategories, as detailed in Table 1. These emergent themes systematically capture the lived experiences of mothers regarding their quality of life. Table 1. Core Themes and Subcategories Emerging from Participants' Lived Experiences Main categories Subcategories The emotional cycle Feelings of shame and guilt The concept of God Psychological problems Parental factors Inability to communicate with the child Challenges in sex education Lack of cooperation between parents Weak marital relationships Excessive care Collapse of family roles The nature of the hearing impairment Medical and rehabilitation costs Self-care Abuse by others Acute issues outside the family Support from social institutions Social reaction Inability to communicate with others Non-acceptance Concerns about important decisions youth period Job opportunities Family formation Educating the next generation Experience small successes Enjoying the high Emphasizing the positive moments of the day Education and awareness Emotional and communication development Development of problem-solving skills Having a purpose in life Strengthening the spirit in life Strengthening independence Thematic analysis of interview data revealed eight primary categories characterizing maternal experiences: (1) emotional cycle, (2) parental factors, (3) nature of the hearing impairment, (4) acute extrafamilial challenges, (5) concerns about critical youth decisions, (6) small-success experiences, (7) education and awareness, and (8) purposeful living. Additionally, 25 supporting subcategories were identified through this phenomenological examination. Discussion This phenomenological study explored quality of life among mothers of adolescents with hearing impairment through their lived experiences. The analysis revealed eight primary themes, with the emotional cycle emerging as the first major category - a finding consistent with Aghaziarti et al.'s (2020) research. Within this category, mothers frequently reported experiencing shame and guilt related to their child's hearing impairment (Rosa & Angulo, 2021). The second key theme, parental factors, highlighted communication challenges within families. Findings indicated that many adolescents with hearing impairment develop in environments where conveying emotions, needs, and perspectives to hearing parents remains particularly difficult, creating unique familial dynamics. This finding is consistent with the results of Rosenzweig et al. (2024) that parental acceptance of adolescents with hearing impairment increases their psychological well-being and quality of life. One of the categories perceived by mothers of adolescents with hearing impairment is related to the nature of the hearing impairment. This finding is consistent with the results of Rosa and Angola (2021). The experiences of mothers of adolescents with hearing impairment showed that they were concerned about the heavy burden of rehabilitation and treatment costs for their child (Ashori & Erabi, 2019). The fourth major theme, acute extrafamilial challenges, aligned with Eghbalnia and Ashori's (2024) findings, reflecting mothers' prevalent worries about social rejection of their children with hearing impairment. The final thematic category, critical youth decisions, echoed Aghbalnia et al.'s (2020) results, encompassing three specific maternal concerns: (1) long-term future uncertainties, (2) marriage prospects, and (3) employment possibilities. Notably, mothers frequently emphasized the importance of secure government employment for their children, valuing both its stable working conditions and associated social support benefits. Conclusion The phenomenological analysis revealed that hearing parents of adolescents with hearing impairment experience multifaceted impacts from their child's condition. These findings highlight critical opportunities to develop targeted educational and psychological interventions addressing the identified challenges - particularly those affecting maternal mental health and quality of life. While this study provides valuable insights, its limitations include a participant pool restricted to mothers accessing deaf center services. Future research should incorporate more diverse samples. Practically, we recommend that mental health professionals integrate these evidence-based categories into therapeutic strategies to enhance family support systems and parental wellbeing. Acknowledgments We extend our deepest gratitude to the mothers who generously shared their experiences and made this research possible.

Research Paper

A Systematic Review on the Effect of the Picture Exchange Communication System (PECS) on the Development of Social and Communication Skills of Children with Autism Spectrum Disorder

saeid Hasan zadeh; sina shavaisy

Volume 14, Issue 56 , December 2024, Pages 251-302

https://doi.org/10.22054/jpe.2025.79046.2689

Abstract

Abstract This systematic review evaluates the efficacy of the Picture Exchange Communication System (PECS) in promoting communication and social skill development among children with autism spectrum disorder (ASD). Employing qualitative research methods, the study analyzed 51 peer-reviewed international ... Read More Abstract This systematic review evaluates the efficacy of the Picture Exchange Communication System (PECS) in promoting communication and social skill development among children with autism spectrum disorder (ASD). Employing qualitative research methods, the study analyzed 51 peer-reviewed international studies (2012-2024) selected from an initial pool of 77 articles across Google Scholar, PubMed, and Science Direct databases. The investigation specifically addressed whether PECS contributes to measurable improvements in communicative and social functioning for children with ASD. Results demonstrated consistent positive outcomes, including enhanced communication abilities, improved social interaction skills, and increased quality of life indicators. The findings provide robust empirical support for implementing PECS as an evidence-based intervention in special education curricula, underscoring its value for fostering critical developmental skills in ASD populations. Keywords: Autism Spectrum Disorder (ASD), Picture Exchange Communication System (PECS, social skills, communication skills, Augmentative and Alternative Communication (AAC), systematic review Extended Abstract Introduction Autism spectrum disorder (ASD) represents a complex neurodevelopmental condition characterized by: (1) persistent deficits in social communication and interaction across multiple contexts, and (2) restricted, repetitive patterns of behavior, interests, or activities (RRBs). The disorder exhibits remarkable phenotypic heterogeneity, manifesting in wide variations across individuals regarding symptom onset trajectories, severity gradients, clinical profiles, and comorbid psychiatric or medical conditions. While social communication impairments constitute a universal core feature, their specific behavioral manifestations and associated functional impacts demonstrate substantial interindividual variability, ranging from subtle pragmatic language difficulties to complete absence of verbal communication. The Picture Exchange Communication System (PECS) is an empirically supported augmentative and alternative communication (AAC) intervention that has become one of the most extensively implemented support methodologies for individuals with ASD. Grounded in applied behavior analysis (ABA) principles, this structured protocol employs a graduated six-phase instructional approach to systematically develop functional communication competencies. As a visually based system, PECS specifically addresses core communication challenges in ASD by: (1) circumventing verbal language demands through picture-based exchanges, (2) reinforcing spontaneous communication initiations, and (3) progressively building complex communication repertoires. The Picture Exchange Communication System (PECS) facilitates the development of both expressive and receptive communication skills. Rooted in behavioral theory, PECS incorporates Skinner's verbal operants (1957) within a pyramidal training framework to systematically teach functional communication. This approach mirrors natural language acquisition patterns, progressing from basic picture exchanges to constructing multi-phrase sentences using sentence strips. Empirical evidence confirms PECS's effectiveness in supporting communication development. Maj's (2018) study demonstrated that PECS implementation not only reduces speech acquisition difficulties but also enhances overall communication growth. Functioning as a dual-purpose intervention, PECS serves as both: A supplementary aid for developing verbal skills An alternative communication system for individuals with complex communication needs Notably, PECS facilitates functional communication—intentional, socially-directed exchanges that enable users to express needs and desires (Maj, 2018). This capacity for purposeful interaction constitutes a critical developmental milestone for nonverbal individuals or those with limited verbal abilities. Children with autism spectrum disorder (ASD) exhibit significant impairments in both communication and social skills. While these domains are distinct—with social skills involving appropriate behavioral responses in social contexts, and communication skills encompassing verbal and nonverbal expression of needs and intentions—they remain fundamentally interconnected. Improvements in one domain often lead to gains in the other (Gobro et al., 2021). Recent empirical studies (Pratama & Paramita, 2023; Tamanaha et al., 2023) have demonstrated the effectiveness of the Picture Exchange Communication System (PECS) in addressing these core deficits among children with ASD. Nevertheless, despite accumulating evidence supporting PECS efficacy, the literature has lacked a comprehensive systematic review synthesizing this research. This gap motivated our current systematic examination of PECS interventions targeting communication and social skill development in ASD populations. Research Question(s) In this article, we examine the role of the Picture Exchange Communication System (PECS) in developing communication and social skills among children with autism spectrum disorder (ASD), drawing upon both theoretical foundations and empirical evidence. Subsequently, through a systematic review of studies published between 2012 and 2024, we investigate the following research question: Does the Picture Exchange Communication System (PECS) effectively enhance social and communication skills in children with ASD? Literature Review Historically, therapeutic interventions for language and communication development in children with autism spectrum disorder (ASD) focused predominantly on speech production through response training. In contrast to nonverbal training approaches, this method demonstrated limited efficacy in developing functional communication abilities. Modern rehabilitation paradigms for nonverbal children with ASD now prioritize cultivating functional spontaneous communication (Lerna et al., 2012). Autism interventions commonly target both speech and social skills development, with treatment outcomes typically assessed through multiple behavioral indicators including: Eye contact frequency and duration Verbal output measures (e.g., number of spoken words) Appropriateness of motor movements Frequency and quality of social interactions Context-appropriate facial expressions Relevance and pragmatics of speech content Matheson and colleagues categorized these interventions into five primary approaches: (a) Modeling and reinforcement techniques (b) Mediated intervention strategies (c) Structured reinforcement programs and activities (d) Social scripts and narrative-based interventions (e) Miscellaneous intervention programs (including response-centered training and Picture Exchange Communication System implementation) (Mayharvid et al., 2021). Applied Behavior Analysis (ABA) is an evidence-based intervention designed to support communication skill development in children with autism spectrum disorder (ASD). This structured approach utilizes reinforcement-based learning principles to help children acquire essential language and communication abilities, including language comprehension, verbal fluency, interpretation of facial expressions and body language, and effective social communication. By systematically breaking down complex skills into manageable components and employing positive reinforcement, ABA facilitates meaningful progress in both verbal and nonverbal communication domains, ultimately promoting more successful social interactions for children with ASD. Empirical research has consistently demonstrated the efficacy of Applied Behavior Analysis (ABA) in promoting language and communication skill acquisition among children with autism spectrum disorder (ASD). ABA-based interventions systematically employ three core components: (1) structured instructional techniques, (2) positive reinforcement strategies, and (3) continuous progress monitoring. This comprehensive approach not only enhances fundamental communication capabilities but also enables children with ASD to develop the necessary skills for establishing meaningful social connections (Prattama & Pradhanaparamita, 2022). Within his theoretical framework, Skinner proposed that verbal behavior, like other behavioral domains, is acquired through fundamental principles of behavior modification. He argued that such verbal behavior can be methodically shaped and strengthened through structured intervention, wherein appropriate reinforcement contingencies serve to increase the probability of desired verbal responses. Skinner conceptualized verbal behavior as a broad behavioral category encompassing all forms of communication, including - but not limited to - spoken language, sign systems, pictorial representations, written expression, and alternative verbal response modalities. He introduced this comprehensive framework alongside his foundational theory of verbal operants in his seminal 1957 work Verbal Behavior, which established a systematic approach for analyzing language as learned behavior. The Pyramid Approach to Education is a comprehensive instructional framework that specifies the essential components for establishing effective learning environments. This three-dimensional model consists of two primary structural elements: (1) a foundational base addressing core pedagogical considerations ("what to teach" and "why students learn"), and (2) supporting pillars implementing instructional delivery. The base incorporates four critical elements: functional skills development, reinforcement systems, functional relationships, and challenging behavior prevention/management. The model's pillars comprise: (a) generalization - involving systematic, incremental modifications to produce measurable behavioral gains, and (b) effective lesson design - requiring deliberate planning of instructional variables for optimal skill acquisition (Maj, 2018). The Picture Exchange Communication System (PECS) is one of the most widely used augmentative and alternative communication (AAC) interventions for individuals with autism spectrum disorder. As an evidence-based AAC approach, PECS is specifically designed to enhance communication skills and facilitate participation across multiple domains, including academic settings, social relationships, and community interactions. This structured protocol follows a six-phase training sequence grounded in behavioral and developmental principles to teach functional communication skills. The intervention progresses systematically from teaching basic requesting behaviors (Phases I–V) using preferred items and activities. As learners master each phase, the program introduces increasingly sophisticated communication demands, such as: (1) initiating interactions with partners across varying distances, and (2) constructing simple sentence structures (Jassim Omar & Shiromaru, 2022). The Picture Exchange Communication System (PECS) is an augmentative and alternative communication (AAC) system that utilizes visual symbols to facilitate functional communication of wants and needs (Kasanen, 2020). Designed to promote rapid, independent, and functional communication skills in children with autism spectrum disorder (ASD), PECS begins with basic symbol exchange and systematically progresses to more complex sentence construction (Al-Dawaidah & Al-Amirah, 2013). While comprehensive meta-analyses have not yet conclusively established PECS efficacy across all ASD populations, multiple empirical studies demonstrate consistent positive outcomes in communication and social skill development. Key findings include: Pratama & Paramita (2023): Significant improvements in communication skills Kruger (2022): Enhanced social skills and functional independence Santos et al. (2021): Progress in social and functional skills among nonverbal children Mehravar et al. (2020): Particularly strong effects from Phases I–III of the six-phase protocol Mark (2019): Benefits for both communication and social skills in nonverbal individuals Mirnovati (2018): Effective communication skill acquisition This converging evidence from multiple research teams, using varied methodologies across different populations, substantiates PECS as an effective intervention for enhancing communication and social skills in children with ASD. Methodology This study was conducted with an applied purpose, adopting a qualitative approach and employing a systematic review as the research method. Data collection involved systematically reviewing articles available on Google Scholar, PubMed, and ScienceDirect using the following keywords: image exchange communication system, autism spectrum disorder, social skills, and communication skills. The inclusion criteria stipulated that article titles must contain at least one of the two key phrases: autism spectrum disorder and/or image exchange communication system. Additionally, the full text of the articles had to include references to image exchange communication system, autism spectrum disorder, social skills, and communication skills. An initial screening compiled a list of article titles and abstracts published between 2012 and 2024. Out of the 77 initially selected articles, 26 were excluded due to irrelevance to the research question or duplication across databases, leaving 51 articles for final analysis. The study's inclusion criteria were as follows: Exclusion of purely qualitative research, Requirement for full keywords (image exchange communication system, communication, and social skills) in the article title, Inclusion of qualitative studies, single-case studies, and case reports For analysis, key details including author names, publication year, and study results were examined. Results Research on the Picture Exchange Communication System (PECS) and autism spectrum disorder (ASD) demonstrates that this image-based intervention can significantly benefit children with ASD by increasing vocabulary, reducing maladaptive behaviors, and enhancing observational learning and skill generalization. PECS effectively promotes communication initiation—including requesting and expressing needs—while expanding expressive language through improved speech production. Educationally, it strengthens attention span, reduces distractions, and increases task completion, while also improving compliance with rules in both school and home settings. The system further encourages help-seeking behavior, reduces restricted or repetitive behaviors, and enhances language comprehension (including words, sentences, and contextual meaning). Additional observed benefits include decreased self-injury and tantrums, better instruction-following, and reduced screaming episodes. Collectively, these findings underscore PECS as a comprehensive intervention for addressing core ASD challenges. The reviewed studies collectively highlight the importance of the Picture Exchange Communication System (PECS) for children with autism spectrum disorder (ASD). All examined research consistently reported PECS's effectiveness in improving communication and social skills in this population. From an initial screening of 77 articles using predetermined inclusion/exclusion criteria, 51 studies were selected for final analysis of PECS's impact on ASD children's communication and social skills. These studies' key details - including authors, publication years, and main findings - are systematically organized in the table below. Discussion This study investigated both theoretical foundations and empirical evidence to answer a key research question: How effective is the Picture Exchange Communication System (PECS) in fostering communication and social skill development in children with autism spectrum disorder (ASD)? ASD is a lifelong neurodevelopmental condition marked by core symptoms including restricted/repetitive behaviors and profound challenges in communication and social interaction. These deficits significantly impair quality of life and independent functioning. Maladaptive behaviors like aggression and emotional outbursts often result in social exclusion, further restricting peer interactions and environmental engagement. Among various interventions designed to enhance communication skills in children with ASD, PECS has demonstrated particular effectiveness as a systematic approach. This review study demonstrates that the Picture Exchange Communication System (PECS) offers multifaceted benefits for children with autism spectrum disorder (ASD), including: (1) enhanced communication skills through vocabulary expansion, improved communication initiation, advanced expressive language (including speech production), and increased ability to request and express needs; (2) improved social functioning manifested through greater attention-seeking, help-seeking behaviors, and adherence to rules in both school and home environments; (3) reduction in maladaptive behaviors including diminished self-injury, tantrums, screaming episodes, and restricted/repetitive behaviors; and (4) cognitive and educational improvements such as enhanced observational learning, skill generalization, sustained attention, task completion, visual processing, and comprehension of verbal and written language. These robust findings collectively highlight PECS's substantial impact on improving core communication and social skills in children with ASD, as consistently evidenced across all examined studies. Conclusion The findings confirm that the Picture Exchange Communication System (PECS) serves as an effective intervention for developing social and communication skills in children with autism spectrum disorder (ASD). Implementation can be adapted to specific needs, ranging from individual stages to the complete six-stage protocol. While studies indicate that even partial implementation enhances communication abilities and social functioning, the most significant outcomes emerge from full protocol adherence. These evidence-based results advocate for wider adoption of PECS in special education contexts, specifically through: (1) broader implementation across specialized educational institutions and therapy centers, and (2) comprehensive training initiatives for both professionals and parents to ensure treatment fidelity. To advance research in this field, future studies should: (1) employ larger sample sizes with more comprehensive datasets to strengthen generalizability, and (2) examine broader applications across diverse demographic and clinical populations. Institutional support through education and welfare systems—particularly via professional development programs for practitioners—could substantially improve both the accessibility and implementation fidelity of PECS. While this systematic review offers meaningful insights, its scope was inherently constrained by existing literature, underscoring the necessity for more extensive empirical investigations in future research. Acknowledgments We express our profound gratitude to the professors and subject matter experts whose invaluable guidance and thoughtful recommendations greatly contributed to both the implementation and refinement of this study. Their specialized knowledge and insightful feedback were pivotal in shaping the research methodology and strengthening our findings.

Research Paper

The Mediating Role of Self-Efficacy in the Relationship Between Emotional Intelligence and Emotional-Behavioral Problems in Students with Learning Disabilities

bahare Rezaie; Sanaz eyni; Mehdi zemestani

Volume 14, Issue 56 , December 2024, Pages 303-332

https://doi.org/10.22054/jpe.2025.84141.2787

Abstract

Abstract Learning disabilities involve difficulties in reading, writing, listening, solving mathematical problems, and understanding or using spoken language, leading to challenges in academic performance and cognitive functioning. The present study aimed to examine the relationship between ... Read More Abstract Learning disabilities involve difficulties in reading, writing, listening, solving mathematical problems, and understanding or using spoken language, leading to challenges in academic performance and cognitive functioning. The present study aimed to examine the relationship between emotional intelligence and behavioral-emotional problems in students with learning disabilities, with self-efficacy serving as a mediating factor. This study was applied in terms of purpose and descriptive-correlational in terms of data collection method. The statistical population consisted of all students with learning disabilities attending learning disorder centers in Kermanshah during the 2023-2024 academic year, with a total of 282 participants selected through purposive sampling. Data were collected using the Rutter Emotional-Behavioral Problems Questionnaire (1975), the Bar-On Emotional Intelligence Questionnaire (2005), and the Sherer and Maddux Self-Efficacy Scale (1982). All analyses were conducted using SPSS 27 and LISREL 8.8 software. The findings revealed that emotional intelligence and self-efficacy have a significant negative effect on the behavioral-emotional problems of students with learning disabilities, with self-efficacy mediating the relationship between the variables. This indicates that emotional intelligence not only has a direct effect but also an indirect effect on behavioral-emotional problems through self-efficacy (p < 0.01). Based on these findings, it is recommended that counseling centers and psychological clinics provide training for parents and teachers on emotion regulation, emotional control, and self-efficacy strategies related to emotional intelligence to foster constructive interactions with children who have learning disabilities. Keywords: emotional behavioral problems, emotional intelligence, self-efficacy, learning disabilities Extended Abstract Introduction Learning disabilities encompass difficulties in areas such as reading, writing, listening, solving mathematical problems, and understanding or using spoken language (Donalto et al., 2022). Children with learning disabilities commonly face emotional and behavioral problems, which are defined as emotional and behavioral responses that deviate from cultural, age-related, and ethnic norms (Laganière et al., 2022). A significant contributing factor to behavioral problems in students with learning disabilities is deficits in emotional intelligence (Kousha et al., 2021). Emotional intelligence encompasses the ability to understand, process, and utilize emotions to effectively navigate life situations. This includes the capacity to employ both one's own emotions and those of others to achieve optimal outcomes with maximal satisfaction (Zhi et al., 2023). Students with well-developed emotional intelligence demonstrate greater responsibility, enhanced interpersonal skills, and stronger self-confidence, which are associated with fewer behavioral problems and improved academic performance (Kousha et al., 2021). Students with learning disabilities frequently demonstrate diminished self-efficacy, stemming from lowered self-esteem and reduced confidence in their capabilities (Nourizadeh, 2022). This impaired self-efficacy negatively impacts their capacity to manage challenges, consequently intensifying their difficulties. Self-efficacy represents an individual's conviction in their ability to organize and implement necessary actions to accomplish specific tasks successfully. As a fundamental psychological construct, it significantly influences cognitive processes, emotional responses, motivational levels, and behavioral patterns (Rahardjo et al., 2023). Research Question While previous studies have explored various aspects of learning disabilities, no comprehensive investigation has systematically examined the underlying factors contributing to emotional and behavioral problems in this student population. This represents a significant gap in the current literature. Consequently, the present study seeks to address this gap by investigating the mediating role of self-efficacy in the relationship between emotional intelligence and emotional-behavioral problems among students with learning disabilities. Literature Review Empirical research demonstrates that diminished emotional intelligence in students with learning disabilities correlates with increased behavioral problems (Aghdasi & Shekrollahpour, 2023). A growing body of evidence substantiates the predictive relationship between emotional intelligence and behavioral difficulties in this population, as demonstrated by multiple studies (Bashari Ghomi et al., 2024; Al-Olaywi, 2021; Dalash & Zubeidat, 2023). Due to recurrent academic setbacks, these students frequently experience both behavioral and motivational challenges. Notably, one of the most profound consequences of persistent academic struggles is the erosion of self-efficacy beliefs (Cumming et al., 2021). The research findings consistently underscore the pivotal role of self-efficacy in influencing emotional and behavioral outcomes among students with learning disorders (Nourizadeh, 2022; Cumming et al., 2021). Supporting this evidence, Ab-Halim et al. (2019) demonstrated that enhanced self-efficacy in students with special needs is associated with the adoption of more adaptive coping strategies and measurable improvements in overall performance. Methodology This applied research study adopted a descriptive-correlational design. The target population comprised all students with diagnosed learning disabilities attending specialized learning disorder centers in Kermanshah during the 2023-2024 academic year. Using a purposive sampling technique, we selected 282 participants who met the study criteria. Data collection employed three validated instruments: (1) the Rutter Emotional Behavioral Problems Questionnaire (1975), (2) the Bar-On Emotional Intelligence Questionnaire (2005), and (3) the Sherer and Maddux Self-Efficacy Scale (1982). We conducted statistical analyses using SPSS 24 and LISREL 8.8, applying Pearson correlation coefficients, Sobel test for mediation effects, and the Variance Accounted For (VAF) index. All analyses maintained a significance threshold of p < 0.05. Results The study included 282 students with diagnosed learning disabilities (mean age = 9.65 ± 2.78 years; range: 7-12 years). The sample comprised 60.6% males (n = 171) and 39.4% females (n = 111). Table 1 presents the correlation matrix of all study variables. Table 1. Correlation matrix of research variables Variables Emotional Behavioral Problems Emotional Intelligence Self-efficacy Emotional Behavioral Problems 1 Emotional Intelligence -0.40** 1 Self-efficacy -0.45** 0.51** 1 P**<0.01 p*<0.05 According to the results presented in Table 2, there is a significant negative correlation between emotional-behavioral problems and both emotional intelligence and self-efficacy (r = -0.45, p < 0.01) at the 99% confidence level. Table 2. Direct effects and indirect effects Variables Path Coefficients T-Value Standard Error Significance Emotional Intelligence Emotional Behavioral Problems -0.24 -3.88 0.078 P<0.01 Emotional Intelligence self-efficacy 0.50 9.87 0.022 P<0.01 self-efficacy Emotional Behavioral Problems -0.33 -4.37 0.039 P<0.01 Indirect Effects T-Sobel Standard Path Coeficient VAF Statistics Significance Emotional Intelligence self-efficacy Emotional Behavioral Problems 9.733 0.165 0.407 P<0.01 Table 4 demonstrates statistically significant path coefficients (p < 0.01) for all direct effects between study variables. The significant t-value for the indirect path confirms that emotional intelligence affects emotional-behavioral problems through both direct and indirect (mediated by self-efficacy) pathways. The Variance Accounted For (VAF) analysis revealed that self-efficacy mediates 40.7% of the total effect of emotional intelligence on emotional-behavioral problems, indicating substantial partial mediation. Discussion This study investigated the relationship between emotional-behavioral problems and emotional intelligence, with particular emphasis on self-efficacy's mediating role. Our results demonstrate that emotional intelligence exerts both direct and indirect effects (through self-efficacy) on emotional-behavioral problems among students with learning disabilities. These findings partially align with previous research by Cumming et al. (2021) and Ab-Halim et al. (2019). The observed mediation effect can be understood through the lens of emotional competence. Individuals with higher emotional intelligence demonstrate superior capacity for emotion understanding and regulation, facilitating environmental adaptation and social comprehension. Specifically, effective emotion regulation encompasses: (1) strategic engagement with or disengagement from emotional states, (2) continuous emotional monitoring and reflection, and (3) cognitive reappraisal of situational contexts. These regulatory processes share conceptual overlap with core self-efficacy attributes, particularly the capacity to manage unforeseen challenges and cultivate adaptive responses (Morton et al., 2014). Students with learning disabilities frequently experience significant challenges in establishing and maintaining positive peer relationships, often demonstrating maladaptive behaviors in social contexts (Ab-Halim et al., 2019). This pattern commonly results in peer rejection, which subsequently undermines emotional intelligence competencies—particularly self-awareness, self-regulation, and social awareness. When combined with low self-efficacy, these students tend to: (1) perceive minor challenges as insurmountable obstacles, (2) interpret routine difficulties as threatening situations, (3) catastrophize problems, and (4) engage in excessive worry about improbable negative outcomes. Such cognitive distortions typically lead to heightened anxiety and impaired academic and social functioning (Bishara & Kaplan, 2022). Conclusion Based on the findings, it is recommended that caregivers, parents, and educators adopt targeted motivational strategies to strengthen self-efficacy in students with learning disabilities. Integrating such interventions into family education programs, teacher training workshops, and student skill-building sessions can enhance awareness of how parent-child and teacher-child interactions contribute to behavioral challenges. This holistic approach will empower stakeholders to implement more effective, coordinated efforts to reduce behavioral difficulties and promote adaptive functioning in this vulnerable population.

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Volume & Issue: Volume 14, Issue 56, December 2024

The Relationship Between Sensory Processing and Behavioral Problems/Social Interactions in Children with Autism Spectrum Disorder: The Mediating Role of Anxiety

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The Effectiveness of Emotional Schema Therapy on Cognitive Emotion Regulation, Intolerance of Uncertainty and Cognitive Flexibility in People with Generalized Anxiety Disorder

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The Effect of Neuropsychological Intervention with and without Electrical Stimulation of the Brain on Executive Functions and Solving Mathematical Problems in Students with Mathematical Learning Disorders

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The Effectiveness of Cognitive Behavioral Play Therapy and Transcranial Direct-Current Stimulation on Emotional Regulation, Executive Functions, and Communication Skills in Children with Autism Spectrum Disorder

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Bibliometric Analysis and Systematic Review of Executive Functions in the Field of Attention Deficit/Hyperactivity Disorder

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The Effect of Teaching Farsi with Gagne's Instructional Design Model on phonological Awareness and Problem Solving Ability of Students with Intellectual Disabilities

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Quality of Life of Mothers of Deaf Children: Lived Experience with a Phenomenological Approach

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A Systematic Review on the Effect of the Picture Exchange Communication System (PECS) on the Development of Social and Communication Skills of Children with Autism Spectrum Disorder

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The Mediating Role of Self-Efficacy in the Relationship Between Emotional Intelligence and Emotional-Behavioral Problems in Students with Learning Disabilities

Abstract