Document Type : Original Article
Authors
1 MA in Clinical Psychology, Department of Psychology, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran.
2 Associate Professor of Psychology, Department of Psychology, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran.
Abstract
This study aimed to evaluate the effect of Neurofeedback (NFB) Therapy with Play Therapy in improving attention and cognitive function in students with Learning Disorder (LD). This study was a quasi-experimental research with a pre-test and post-test design. The statistical population of the research was about 600 elementary school students with LD in Lar city in 2017 (N=212). A sample of 60 LD children who were identified in schools was selected by multistage cluster random sampling and randomly divided into four groups fifteen-three experimental and one control group. The tools used in the study were the Wechsler Intelligence Scale for Children (WISC-R) (Wechsler, 2003) and integrated visual and auditory continuous performance (IVA) (Sandford and Turner, 1995). NFB training was done according to the guidelines recommended by Monastra et al. (2005) in 20 sessions and play therapy cognitive performance and attention therapy were done according to the guidelines recommended by Drewes (2009) in 20 sessions, while no intervention was performed in the control group. Data were analyzed by the covariance analysis method. The results showed that NFB and play therapy were effective in increasing cognitive performance (p<0.01) and attention (p<0.01) compared to the control group. The combination of play therapy and NFB intervention was more effective on cognitive performance and attention rather than the two interventions separately. According to the results, it is recommended that therapists and clinical psychologists use NFB and play therapy to increase the sustained attention and working memory of students with LD.
Keywords
Main Subjects
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Alvarez, J., Meyer, F. L., Granoff, D. L., & Lundy, A. (2013). The effect of EEG biofeedback on reducing postcancer cognitive impairment. Integrative Cancer Therapies, 12(6), 475-487.
American Psychiatric Association, A., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 10). Washington, DC: American psychiatric association.
Ansari H. (2014). Assessing the effectiveness of therapeutic games on increasing the social skills of anxious children. The First National Conference on Sustainable Development in Education and Psychology.
Bakhshayesh, A. R., Hänsch, S., Wyschkon, A., Rezai, M. J., & Esser, G. (2011). Neurofeedback in ADHD: a single-blind randomized controlled trial. European Child & Adolescent Psychiatry, 20, 481-491.
Becerra, J., Fernandez, T., Harmony, T., Caballero, M. I., Garcia, F., Fernandez-Bouzas, A., ... & Prado-Alcalá, R. A. (2006). Follow-up study of learning-disabled children treated with neurofeedback or placebo. Clinical EEG and Neuroscience, 37(3), 198-203.
Chabot, R. J., di Michele, F., Prichep, L., & John, E. R. (2001). The clinical role of computerized EEG in the evaluation and treatment of learning and attention disorders in children and adolescents. The Journal of Neuropsychiatry and Clinical Neurosciences, 13(2), 171–186.
Chan, G. H. (2020). Application and effectiveness of play therapy using an online-game intervention for hidden youth. The British Journal of Social Work, 50(7), 2116-2134.
Chiarenza, G. A. (2021). Quantitative EEG in childhood attention deficit hyperactivity disorder and learning disabilities. Clinical EEG and Neuroscience, 52(2), 144-155.
Drewes, A. A. (2009). Blending play therapy with cognitive behavioral therapy: Evidence-based and other effective treatments and techniques. John Wiley & Sons.
Esmaili, S. K., Mehraban, A. H., Shafaroodi, N., Yazdani, F., Masoumi, T., & Zarei, M. (2019). Participation in peer-play activities among children with specific learning disability: A randomized controlled trial. The American Journal of Occupational Therapy, 73(2), 7302205110p1-7302205110p9.
Fernández, T., Becerra, J., Roca, M., Espino, M., Bahlke, M., Harmony, T., ... & Diaz-Comas, L. (2008). Neurofeedback in healthy elderly humans with electroencephalographic risk of cognitive impairment. In Front. Hum. Neurosci. Conference Abstract: 10th International Conference on Cognitive Neuroscience, 9(1), 173.
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Fernandez, T., Herrera, W., Harmony, T. A., Diaz-Comas, L., Santiago, E., Sanchez, L., ... & Valdés, P. (2003). EEG and behavioral changes following neurofeedback treatment in learning disabled children. Clinical Electroencephalography, 34(3), 145-152.
Gallo-Lopez, L., & Schaefer, C. E. (2005). Play therapy with adolescents. Lanham, MD: Jason Aronson.
Gillberg, C., & Soderstrom, H. (2003). Learning disability. The Lancet, 362(9386), 811-821.
Grigorenko, E. L., Compton, D. L., Fuchs, L. S., Wagner, R. K., Willcutt, E. G., & Fletcher, J. M. (2020). Understanding, educating, and supporting children with specific learning disabilities: 50 years of science and practice. American Psychologist, 75(1), 37.
Hamidi, Sh. (2013). Investigating the effectiveness of neurofeedback therapy on brain wave patterns, attention and impulsivity in children with attention deficit hyperactivity disorder. Master's thesis, University of Tehran.
Healey, D. M., Marks, D. J., & Halperin, J. M. (2011). Examining the interplay among negative emotionality, cognitive functioning, and attention deficit/hyperactivity disorder symptom severity. Journal of the International Neuropsychological Society, 17(3), 502-510.
Heshmati, R., Onari Asl, R., & Shokrallah, R. (2016). The effectiveness of group play therapy techniques on state anxiety, positive emotions and general compatibility level in special students with learning disabilities. Journal of Learning Disabilities, 5(4), 7-24.
Hill, R.W., 8c Castro, E. (2002). Getting rid of ritalin. Charlottseville, VA: Hampton Roads Publishing Company
Jacobs, E. H. (2006). Neurofeedback treatment of two children with learning, attention, mood, social, and developmental deficits. Journal of Neurotherapy, 9(4), 55-70.
Jones, K. H., & Bender, W. N. (1993). Utilization of paraprofessionals in special education: A review of the literature. RASE: Remedial & Special Education, 14(1), 7–14.
Jubhari, R. R., Bandaso, T. D., Hidayah, N., Zabila, Z., Gizly, M. A., & Amal, A. J. (2022). Disability Play Therapy: Implementation of Traditional Japanese Game to Improve Creativity and Education in Public Special Needs Inclusive School (SLB) 1 Makassar. In Interdisciplinary Conference of Psychology, Health, and Social Science, Atlantis Press, 31-36.
Karami, J., & Lorestani, S. (2022). The intervention effect of cognitive-behavioral play theory (CBPT) on alexithymia and Academic burnout in children with special learning disabilities (severe). Rooyesh-e-Ravanshenasi Journal (RRJ), 10(10), 41-52.
Karande, S., Mahajan, V., & Kulkarni, M. (2009). Recollections of learning-disabled adolescents of their schooling experiences: A qualitative study. Indian Journal of Medical Sciences, 63(9), 382.
Khaghani, G., Dehghanmanshadi, S., Maleki, M. M., Hojjati, F. S., & Shakeri, S. (2022). The Effectiveness of Neurofeedback Therapy on Sustained Attention of Dyslexic Students. International Journal of Early Childhood Special Education, 1603-1610.
Kim, S. K., Yoo, E. Y., Lee, J. S., Jung, M. Y., Park, S. H., & Park, J. H. (2014). The EEG and behavior changes after neurofeedback training in children with attention deficit hyperactivity disorder. In Proceedings of the (3rd ed). International Workshop on Healthcare and Nursing, 15-18.
Landreth, G. L. (1991). Play therapy: The art of the relationship. Indiana: Accelerated Development Inc.
Landreth, G. L., Ray, D. C., & Bratton, S. C. (2009). Play therapy in elementary schools. Psychology in the Schools, 46(3), 281-289.
Linden, M., Habib, T., & Radojevic, V. (1996). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback and Self-regulation, 21(1), 35-49.
Alvarez, J., Meyer, F. L., Granoff, D. L., & Lundy, A. (2013). The effect of EEG biofeedback on reducing postcancer cognitive impairment. Integrative Cancer Therapies, 12(6), 475-487.
American Psychiatric Association, A., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 10). Washington, DC: American psychiatric association.
Ansari H. (2014). Assessing the effectiveness of therapeutic games on increasing the social skills of anxious children. The First National Conference on Sustainable Development in Education and Psychology.
Bakhshayesh, A. R., Hänsch, S., Wyschkon, A., Rezai, M. J., & Esser, G. (2011). Neurofeedback in ADHD: a single-blind randomized controlled trial. European Child & Adolescent Psychiatry, 20, 481-491.
Becerra, J., Fernandez, T., Harmony, T., Caballero, M. I., Garcia, F., Fernandez-Bouzas, A., ... & Prado-Alcalá, R. A. (2006). Follow-up study of learning-disabled children treated with neurofeedback or placebo. Clinical EEG and Neuroscience, 37(3), 198-203.
Chabot, R. J., di Michele, F., Prichep, L., & John, E. R. (2001). The clinical role of computerized EEG in the evaluation and treatment of learning and attention disorders in children and adolescents. The Journal of Neuropsychiatry and Clinical Neurosciences, 13(2), 171–186.
Chan, G. H. (2020). Application and effectiveness of play therapy using an online-game intervention for hidden youth. The British Journal of Social Work, 50(7), 2116-2134.
Chiarenza, G. A. (2021). Quantitative EEG in childhood attention deficit hyperactivity disorder and learning disabilities. Clinical EEG and Neuroscience, 52(2), 144-155.
Drewes, A. A. (2009). Blending play therapy with cognitive behavioral therapy: Evidence-based and other effective treatments and techniques. John Wiley & Sons.
Esmaili, S. K., Mehraban, A. H., Shafaroodi, N., Yazdani, F., Masoumi, T., & Zarei, M. (2019). Participation in peer-play activities among children with specific learning disability: A randomized controlled trial. The American Journal of Occupational Therapy, 73(2), 7302205110p1-7302205110p9.
Fernández, T., Becerra, J., Roca, M., Espino, M., Bahlke, M., Harmony, T., ... & Diaz-Comas, L. (2008). Neurofeedback in healthy elderly humans with electroencephalographic risk of cognitive impairment. In Front. Hum. Neurosci. Conference Abstract: 10th International Conference on Cognitive Neuroscience, 9(1), 173.
Fernández, T., Bosch-Bayard, J., Harmony, T., Caballero, M. I., Díaz-Comas, L., Galán, L., ... & Otero-Ojeda, G. (2016). Neurofeedback in learning disabled children: visual versus auditory reinforcement. Applied Psychophysiology and Biofeedback, 41(1), 27-37.
Fernández, T., Harmony, T., Fernández-Bouzas, A., Díaz-Comas, L., Prado-Alcalá, R. A., Valdés-Sosa, P., ... & García-Martínez, F. (2007). Changes in EEG current sources induced by neurofeedback in learning disabled children. An exploratory study. Applied Psychophysiology and Biofeedback, 32(3), 169-183.
Fernandez, T., Herrera, W., Harmony, T. A., Diaz-Comas, L., Santiago, E., Sanchez, L., ... & Valdés, P. (2003). EEG and behavioral changes following neurofeedback treatment in learning disabled children. Clinical Electroencephalography, 34(3), 145-152.
Gallo-Lopez, L., & Schaefer, C. E. (2005). Play therapy with adolescents. Lanham, MD: Jason Aronson.
Gillberg, C., & Soderstrom, H. (2003). Learning disability. The Lancet, 362(9386), 811-821.
Grigorenko, E. L., Compton, D. L., Fuchs, L. S., Wagner, R. K., Willcutt, E. G., & Fletcher, J. M. (2020). Understanding, educating, and supporting children with specific learning disabilities: 50 years of science and practice. American Psychologist, 75(1), 37.
Hamidi, Sh. (2013). Investigating the effectiveness of neurofeedback therapy on brain wave patterns, attention and impulsivity in children with attention deficit hyperactivity disorder. Master's thesis, University of Tehran.
Healey, D. M., Marks, D. J., & Halperin, J. M. (2011). Examining the interplay among negative emotionality, cognitive functioning, and attention deficit/hyperactivity disorder symptom severity. Journal of the International Neuropsychological Society, 17(3), 502-510.
Heshmati, R., Onari Asl, R., & Shokrallah, R. (2016). The effectiveness of group play therapy techniques on state anxiety, positive emotions and general compatibility level in special students with learning disabilities. Journal of Learning Disabilities, 5(4), 7-24.
Hill, R.W., 8c Castro, E. (2002). Getting rid of ritalin. Charlottseville, VA: Hampton Roads Publishing Company
Jacobs, E. H. (2006). Neurofeedback treatment of two children with learning, attention, mood, social, and developmental deficits. Journal of Neurotherapy, 9(4), 55-70.
Jones, K. H., & Bender, W. N. (1993). Utilization of paraprofessionals in special education: A review of the literature. RASE: Remedial & Special Education, 14(1), 7–14.
Jubhari, R. R., Bandaso, T. D., Hidayah, N., Zabila, Z., Gizly, M. A., & Amal, A. J. (2022). Disability Play Therapy: Implementation of Traditional Japanese Game to Improve Creativity and Education in Public Special Needs Inclusive School (SLB) 1 Makassar. In Interdisciplinary Conference of Psychology, Health, and Social Science, Atlantis Press, 31-36.
Karami, J., & Lorestani, S. (2022). The intervention effect of cognitive-behavioral play theory (CBPT) on alexithymia and Academic burnout in children with special learning disabilities (severe). Rooyesh-e-Ravanshenasi Journal (RRJ), 10(10), 41-52.
Karande, S., Mahajan, V., & Kulkarni, M. (2009). Recollections of learning-disabled adolescents of their schooling experiences: A qualitative study. Indian Journal of Medical Sciences, 63(9), 382.
Khaghani, G., Dehghanmanshadi, S., Maleki, M. M., Hojjati, F. S., & Shakeri, S. (2022). The Effectiveness of Neurofeedback Therapy on Sustained Attention of Dyslexic Students. International Journal of Early Childhood Special Education, 1603-1610.
Kim, S. K., Yoo, E. Y., Lee, J. S., Jung, M. Y., Park, S. H., & Park, J. H. (2014). The EEG and behavior changes after neurofeedback training in children with attention deficit hyperactivity disorder. In Proceedings of the (3rd ed). International Workshop on Healthcare and Nursing, 15-18.
Landreth, G. L. (1991). Play therapy: The art of the relationship. Indiana: Accelerated Development Inc.
Landreth, G. L., Ray, D. C., & Bratton, S. C. (2009). Play therapy in elementary schools. Psychology in the Schools, 46(3), 281-289.
Linden, M., Habib, T., & Radojevic, V. (1996). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback and Self-regulation, 21(1), 35-49.
Lubar, J. F., Bianchini, K. J., Calhoun, W. H., Lambert, E. W., Brody, Z. H., & Shabsin, H. S. (1985). Spectral analysis of EEG differences between children with and without learning disabilities. Journal of Learning Disabilities, 18(7), 403-408.
Madani, A. S., Heidarinasab, L., Yaghubi, H., & Rostami, R. (2015). Surveying effectiveness of neuro-feedback in reduction of attention and concentration deficit symptoms in ADHD adults. Clinical Psychology and Personality, 12(2), 85-98.
Madani, A., Heidarinasab, L., Yaghubi, H., Rostami, R. (2015). Surveying Effectiveness of Neuro-feedback in Reduction of Attention and Concentration Deficit Symptoms in ADHD Adults. Clinical Psychology and Personality, 12(2), 85-98.
Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & La Vaque, T. J. (2006). Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Journal of Neurotherapy, 9(4), 5-34.
Naimian, N., Hajebi, M. Z., & Nokani, M. (2022). Comparison of the efficacy of cognitive rehabilitation and neurofeedback on specific learning disorder among primary school children of Tehran, Iran. Journal of Basic Research in Medical Sciences, 9(2), 52-60.
National Joint Committee on Learning Disabilities. (1987). Learning disabilities: Issues on definition. A position paper. Journal of Learning Disabilities, 20, 1-107.
Nourizade, N., Mikeeli Manee, F., & Rostami, R. (2015). The effectiveness of neurofeedback training on cognitive processing in children with attention deficit hyperactivity disorder. Journal of School Psychology, 4(3), 119-136.
Oraki, M., Rahmanian, M., Tehrani, N., & Heydari, S. (2015). The effect of neuorofeedback instruction on the improvement of the working memory of children with attention deficit and hyperactivity disorder. Neuropsychology, 1(1), 41-51.
Ouherrou, N., Elhammoumi, O., Benmarrakchi, F., & El Kafi, J. (2019). Comparative study on emotions analysis from facial expressions in children with and without learning disabilities in virtual learning environment. Education and Information Technologies, 24(2), 1777-1792.
Pashler, H. (1998). The psychology of attention. Cambridge, MA: MIT Press.
Pirabasi, Z., & Safarzadeh, S. (2020). The Effectiveness of Group Play Therapy on Social Skills and Memory Performance of primary school girl students with Specific learning disorder, 5-12.
Rathnakumar, D. (2020). Play Therapy and Children with Intellectual Disability. Shanlax International Journal of Education, 8(2), 35-42.
Sanford, J. A., & Turner, A. (1995). Manual for the integrated visual and auditory continuous performance test. Richmond, VA: BrainTrain
Schaefer, C. E. (1993). The therapeutic powers of play. Jason Aronson.
Seilsepour, M., Hamounpeyma, E., & Pirkhaefi, A. (2015). The effect of Neurofeedback therapy sessions on female elementary students with attention deficit and hyperactivity in varamin city, in 2013. Navid No, 18(60), 24-33.
Soriano-Ferrer, M., Félix-Mateo, V., & Begeny, J. C. (2014). Executive function domains among children with ADHD: Do they differ between parents and teachers ratings?. Procedia-Social and Behavioral Sciences, 132, 80-86.
Therapy BAoP. Play therapy in school: British Association of Play Therapy; 2004
Thurm, A., Farmer, C., Salzman, E., Lord, C., & Bishop, S. (2019). State of the field: Differentiating intellectual disability from autism spectrum disorder. Frontiers in Psychiatry, 10, 526.
Vernon, D., Frick, A., & Gruzelier, J. (2004). Neurofeedback as a treatment for ADHD: A methodological review with implications for future research. Journal of Neurotherapy, 8(2), 53–82.
Wechsler, D. (1991). Wechsler Intelligence Scale for Children (3rd ed). (WISC-III): Manual. San Antonio, TX: The Psychological Corporation.
Wechsler, D. (2003). Wechsler Intelligence Scale for Children (4th Ed). Technical and interpretive manual. San Antonio, TX: Psychological Corporation.
Yildirim, N., & Varol, A. (2013). Developing educational game software which measures attention and meditation with brainwaves: matching mind math. In ICEE ICIT Conference, 325-332.
Ziereis, S., & Jansen, P. (2015). Effects of physical activity on executive function and motor performance in children with ADHD. Research in Developmental Disabilities, 38, 181-191.
Madani, A. S., Heidarinasab, L., Yaghubi, H., & Rostami, R. (2015). Surveying effectiveness of neuro-feedback in reduction of attention and concentration deficit symptoms in ADHD adults. Clinical Psychology and Personality, 12(2), 85-98.
Madani, A., Heidarinasab, L., Yaghubi, H., Rostami, R. (2015). Surveying Effectiveness of Neuro-feedback in Reduction of Attention and Concentration Deficit Symptoms in ADHD Adults. Clinical Psychology and Personality, 12(2), 85-98.
Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & La Vaque, T. J. (2006). Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Journal of Neurotherapy, 9(4), 5-34.
Naimian, N., Hajebi, M. Z., & Nokani, M. (2022). Comparison of the efficacy of cognitive rehabilitation and neurofeedback on specific learning disorder among primary school children of Tehran, Iran. Journal of Basic Research in Medical Sciences, 9(2), 52-60.
National Joint Committee on Learning Disabilities. (1987). Learning disabilities: Issues on definition. A position paper. Journal of Learning Disabilities, 20, 1-107.
Nourizade, N., Mikeeli Manee, F., & Rostami, R. (2015). The effectiveness of neurofeedback training on cognitive processing in children with attention deficit hyperactivity disorder. Journal of School Psychology, 4(3), 119-136.
Oraki, M., Rahmanian, M., Tehrani, N., & Heydari, S. (2015). The effect of neuorofeedback instruction on the improvement of the working memory of children with attention deficit and hyperactivity disorder. Neuropsychology, 1(1), 41-51.
Ouherrou, N., Elhammoumi, O., Benmarrakchi, F., & El Kafi, J. (2019). Comparative study on emotions analysis from facial expressions in children with and without learning disabilities in virtual learning environment. Education and Information Technologies, 24(2), 1777-1792.
Pashler, H. (1998). The psychology of attention. Cambridge, MA: MIT Press.
Pirabasi, Z., & Safarzadeh, S. (2020). The Effectiveness of Group Play Therapy on Social Skills and Memory Performance of primary school girl students with Specific learning disorder, 5-12.
Rathnakumar, D. (2020). Play Therapy and Children with Intellectual Disability. Shanlax International Journal of Education, 8(2), 35-42.
Sanford, J. A., & Turner, A. (1995). Manual for the integrated visual and auditory continuous performance test. Richmond, VA: BrainTrain
Schaefer, C. E. (1993). The therapeutic powers of play. Jason Aronson.
Seilsepour, M., Hamounpeyma, E., & Pirkhaefi, A. (2015). The effect of Neurofeedback therapy sessions on female elementary students with attention deficit and hyperactivity in varamin city, in 2013. Navid No, 18(60), 24-33.
Soriano-Ferrer, M., Félix-Mateo, V., & Begeny, J. C. (2014). Executive function domains among children with ADHD: Do they differ between parents and teachers ratings?. Procedia-Social and Behavioral Sciences, 132, 80-86.
Therapy BAoP. Play therapy in school: British Association of Play Therapy; 2004
Thurm, A., Farmer, C., Salzman, E., Lord, C., & Bishop, S. (2019). State of the field: Differentiating intellectual disability from autism spectrum disorder. Frontiers in Psychiatry, 10, 526.
Vernon, D., Frick, A., & Gruzelier, J. (2004). Neurofeedback as a treatment for ADHD: A methodological review with implications for future research. Journal of Neurotherapy, 8(2), 53–82.
Wechsler, D. (1991). Wechsler Intelligence Scale for Children (3rd ed). (WISC-III): Manual. San Antonio, TX: The Psychological Corporation.
Wechsler, D. (2003). Wechsler Intelligence Scale for Children (4th Ed). Technical and interpretive manual. San Antonio, TX: Psychological Corporation.
Yildirim, N., & Varol, A. (2013). Developing educational game software which measures attention and meditation with brainwaves: matching mind math. In ICEE ICIT Conference, 325-332.
Ziereis, S., & Jansen, P. (2015). Effects of physical activity on executive function and motor performance in children with ADHD. Research in Developmental Disabilities, 38, 181-191.
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