The Effectiveness of Floortime Play Therapy on Improving Executive Functions and Cognitive Emotion Regulation in Children with Attention Deficit / Hyperactivity Disorder (ADHD)

Document Type : Original Article

Authors

1 PhD, student of general Psychology, Department of Psychology, Islamic Azad University, Kish, Branch, Tehran, Iran.

2 Assistant Professor of Islamic Azad University, Karaj Branch, Tehran, Iran.

3 Associate Professor, Department of Psychology, Islamic Azad University, Ghods Branch, Tehran, Iran

Abstract

This study aimed to determine the effectiveness of Floor time play therapy on improving executive actions and cognitive emotion regulation in children with attention deficit/hyperactivity disorder (ADHD). The research design was quasi-experimental with a pretest-posttest design and control group. The statistical population included all the 9-11 years-old boys with attention deficit/hyperactivity disorder (ADHD) who were referred to Counseling Centers and Psychological Services for Children in Tehran in the first half of 2018.. Data collection tools were Conners Parent Rating of Childhood Behavior Problems (CPRCBP) scale, Structured Clinical Interview, Barkley Deficits in Executive Functioning Scale-Children and Adolescents (BDEFS-CA), and Cognitive Emotion Regulation Questionnaire-Kids-Persian (CERQ-K-P). After performing the pre-test, the control group waited and the Floortime play therapy for the experimental group was performed in 10 sessions of 45 minutes in a group manner and then, at the end of the treatment interventions,. Research data were analyzed using Descriptive Statistics and Multivariate Analysis of Covariance (MANCOVA) and one-way analysis of covariance in the Manco context. The results showed that after the intervention, there was a significant difference between the experimental group and control group in the rate of increase in adaptive cognitive emotion regulation strategies of positive refocus and refocus on planning, and the rate of decrease in maladaptive cognitive emotion regulation strategies and insufficiency of executive actions (p<0.05), but there was no significant difference between the experimental group and control group in terms of adaptive strategies for cognitive regulation of emotional acceptance, positive re-evaluation and viewpoint acceptance (p> 0.05).

Keywords


Alink, L.R.A, Cicchetti, D., Kim, J., Rogosch, F.A. (2009). Mediating and moderating processes in the relation between maltreatment and psychopathology: Mother-child relationship quality and emotion regulation. Journal of Abnormal Child Psychology, 37, 831–843.
Ambuabunos, E.A., Ofovwe, E.G., Ibadin, M.O. (2011). Community survey of attention-deficit/hyperactivity disorder among primary school pupils in Benin City, Nigeria. Annals of African Medicine, 10(2), 91-96.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (Fifth Edition) (DSM-5). Washington, DC: APA.
Anastopoulos, A. D., Sommer, J. L., & Schatz, N. K. (2009). ADHD and family functioning. Current Attention Disorders Reports, 1(4), 167-170.
Asherson, P. (2017). ADHD across the lifespan. Medicine, 44 (11), 683-686.
Barkley, R.A. (1997). Behavioral inhibition sustained attention and Executive Functions constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65-94.
Barkley, R.A. (2012). Barkley Deficits in Executive Functioning Scale-Children and Adolescents (BDEFS-CA). New York: Guilford Press.
Barkley, R.A., Fischer, M. (2010). The Unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. J Am Acad Child Adolesc Psychiatry,  49(5), 503–513.
Biederman, J., Petty, C.R., Doyle, A.E., Spencer, T., Henderson, C.S., Marion, B., et al. (2008). Pediatric psychopharmacology program of the psychiatry department. Developmental Neuropsychological, 33, 44-61.
Biederman. J., Spencer, T., Lomedico, A., Day, H.,  Petty, C.R., Faraone, S.V. (2012). Longitudinal course of deficient emotional self-regulation CBCL profile in youth with ADHD: prospective controlled study.  Neuropsy Disease Treat, 8, 267–76.
Brotman, A., Rich, A., Guyer, E., Lunsford, R., Horsey, E., Reising, M., et al. (2011). Amygdala Activation During Emotion Processing of Neutral Faces in Children With Severe Mood Dysregulation Versus ADHD or Bipolar Disorder. Am J Psychiatry, 167(1), 61–9.
Chang, Y.K., Hung, C.L., Huang, C.J., Hatfield, B.D., Hung, T.M. (2014). Effects of an aquatic exercise program on inhibitory control in children with ADHD: A preliminary study. Archives of Clinical Neuropsychology, 29(3), 217-23.
Chorniy, A., Kitashima, L. (2016). Sex, drugs, and ADHD: The effects of ADHD pharmacological treatment on teens' risky behaviors. Labour Economics, 43, 87-105.
Dionne, M., Martini, R. (2011). Floortime play with a child with autism: A single-subject study. Can J Occup Ther, 78, 196-203.
Forslund, T., Brocki, K., Bohlin, J., Granqvist, P., Eninger, L. (2016). The heterogeneity of attention-deficit/hyperactivity disorder symptoms and conduct problems: Cognitive inhibition, emotion regulation, emotionality, and disorganized attachment. British Journal of Developmental Psychology, 34(3), 371-87.
Garnefski, N., Kraaij, V., Spinhoven, P. (2001). Negative life events, cognitive emotion regulation and emotional problems. Pers Individ Dif, 30, 1311-27.
Garnefski, N., Kraaij, V., Spinhoven, P. (2002). CERQ: Manual for the use of cognitive emotion regulation questionnaire. Leiderdorp, Netherlands: DATEC.
Garnefski, N., Rieffe, C., Jellesma, F., Terwogt, M.M., Kraaij, V. (2007). Cognitive emotion regulation strategies and emotional problems in 9-11-year-old children: The development of an instrument. Eur Child Adolesc Psychiatry, 16, 1-9.
Gau, S. S. F., & Chang, J. P. C. (2013). Maternal parenting styles and mother–child relationship among adolescents with and without persistent attentiondeficit/hyperactivity disorder. Research in Developmental Disabilities, 34(5), 1581-1594.
Gil, E. (1991). Healing power of play working with abused children. New York: the Guilford press.
Graham, S. (2017). Attention-deficit Hyperactivity Disorder (ADHD), Learning Disabilities (LD), and executive functioning: Recommendations for future research. Contemporary Educational Psychology, in press, corrected proof, Available online.
Greenspan, S.I., DeGangi, G., Wieder, S. (2001). The Functional Emotional Assessment Scale for Infancy and Childhood, FEAS. Bethesda, MD: Interdisciplinary Council on Developmental and Learning Disorders, 3-57, 167-187.
Hannesdottir, D.K., Ingvarsdottir, E., Bjornsson, A. (2017). The OutSMARTers Program for Children With ADHD. Journal of Attention Disorders, 21(4), 353-364.
Huber, J, S. (2010). The medical effect of sibling warmth on parental stress in families with children who have attention deficit hyperactivity disorder. Ph.D. thesis in psychology. The Floridastate University. College of Human Sciences.
Izadpanah, S., Schumacher, M., Arens, E. A., Stopsack, M., Ulrich, I., Hansenne,  M., Grabe, H. G., Barnow, S. (2016). Adolescent harm avoidance as a longitudinal predictor of maladaptive cognitive emotion regulation in adulthood: The mediating role of inhibitory control. Journal of Adolescence, 52(2), 49-59.
Kidron, M., &Landreth, G. (2010).Intensive child-parent relationship therapy with Israeli parents in Israel.International Journal of Play Therapy, 19, 64-78.
Knouse, L.E., Barkley, R.A., Murphy, K.R. (2013). Does executive functioning (EF) predict depression in clinic-referred adults? EF tests vs. rating scales. Journal of Affective Disorders,  145(2), 270-275.
Matza, L. M., Mary, K., Deal, L., Kimberly, F., & Erder, H. (2017). Challenges of Developing an Observable Parent-Reported Measure: A Qualitative Study Of Functional Impact Of ADHD In Children. Journal Value in Health, 20, 828 – 833.
Milton, H. (2010). Effects of a Computerized Working Memory Training Program On Attention, Working Memory, and Academics, In Adolescents with Severe ADHD/LD. Psychology journal, 1(14), 120–122.
Musser, E., Backs, W., Schmitt, F., Ablow, J., Measelle, R., Nigg, J. (2012). Emotion Regulation via the Autonomic Nervous System in Children with Attention-Deficit/Hyperactivity Disorder (ADHD). J Abnorm Child Psychol, 39(6), 841–52.
Nigg, J.T. (2009). What causes ADHD?:  Understanding what  goes wrong and why. New York: The Guilford Press.
Potthoff, S., Garnefski, N., Miklósi, M., Ubbiali, A., Domínguez-Sánchez, F. J.,  Martins, E. C., Witthöft, M., Kraai, V. (2016). Cognitive emotion regulation and psychopathology across cultures: A comparison between six European countries. Personality and Individual Differences, 98(1), 218-224.
Ríos-Hernández, A., Alda, J. A., Farran-Codina, A., Ferreira-García, E., & Izquierdo-Pulido, M. (2017). The Mediterranean diet and ADHD in children and adolescents. Pediatrics, 139(2), 2016-2027.
Samuelson, K. W., Krueger, C. E., & Wilson, C. (2012). Relationships between maternal emotion regulation, parenting, and children’s executive exposed to intimate functioning in families partner violence. Journal of Interpersonal Violence, 27 (17), 3532–3550.
Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The triple P positive parenting program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review, 34, 337-357.
Sidlauskaite, J., Sonuga-Barke, E., Roeyers, H., Wiersema. J.R. (2016).  Default mode network abnormalities during state switching in attention deficit hyperactivity disorder. Psychological Medicine, 46(3), 519-28.
Spencer, T., Faraone, S.V., Surman, C., Petty, C., Clarke, A., Batchelder, H., et al. (2011). Towards defining deficient emotional self-regulation in youth with attention deficit hyperactivity disorder using the child behavior check list: A controlled study.  Postgrad Med, 123(5), 50–59.
Vance, A., Winther, J., & Rennie, K. (2012). Management of Attention-Deficit/ Hyperactivity Disorder:  The importance of psychological and medication treatment. Journal of Pediatrics and Child Health, 48 (2), 33-37.
Ontology-Based Side-Effect Prediction Framework (OSPF) and Deep Learning. : Journal of Ethnopharmacology 2021, 2020020230 (doi: 10.20944/preprints202002.0230.v1).
Philippe Barboza.” Cholera”.2021  https://www.who.int/topics/cholera/impact/en
Zarei J, Dastoorpoor M, Jamshidnezhad A, Cheraghi M, Sheikhtaheri A. Regional COVID-19 registry in Khuzestan, Iran: A study protocol and lessons learned from a pilot implementation. Inform Med Unlocked. 2021;23:100520. doi: 10.1016/j.imu.2021.100520.