The Effects of Play Therapy Based on Executive Functions in Promoting Executive Functions in Children with Attention-Deficit Hyperactivity Disorder

Attention–Deficit Hyperactivity Disorder (ADHD) is among the pervasive disorders in childhood, which influences various aspects of life, such as education, social relations, and life satisfaction. Executive Functions (EFs) are impaired in individuals with ADHD. EF is defined as a coordinated function of different processes, i.e., occurring concurrently, and includes procedures, such as selective attention, inhibition, and cognitive flexibility. Various pharmacotherapies are currently being implemented. Medications present short–term effects; accordingly, symptoms will re–generate. Psychological interventions can be employed instead of pharmacological treatment. Play Therapy (PT) is among such interventions. In PT, children express their feelings and learn more adaptive strategies. Thus, the current study aimed to evaluate the effects of PT based on EFs in enhancing the Efs of children with ADHD.

This was a quasi–experimental research with a pretest–posttest and a control group design. The statistical population of the study included all male primary schoolers in Semnan City, Iran, in 2019–2020. In total, 30 students within the age range of 7 to 11 years were selected by cluster sampling method; subsequently, they were randomly assigned to two groups of EFs–based PT and control (n=15/group). The inclusion criteria of this research were as follows: being in the age range of 7–11 years; receiving ADHD diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) criteria, not consuming psychiatric drugs (this criterion was investigated during the interview with the study subjects’ parents), the provision of written informed consent by the study participants’ parents. The EFs–based PT group received twelve 50–minute group intervention sessions (n=7–8 students/group). However, the control group received no treatment. The parent version of Child Symptom Inventory–4 (CSI–4) (Gadow & Sprafkin, 1997), as well as the soft versions of Stroop Color–Word Test, Go/No–Go Test, and Wisconsin Card Sorting Test, developed by Sinai Psychological Institute (www.sinapsycho.com) were administered in the study groups. The PT intervention is based on impaired EFs in individuals with ADHD. In this research, a protocol of PT (Asghari Nekah & Ebadi, 2014) was employed, i.e., based on the EFs. The obtained data were analyzed using descriptive statistics (mean & standard deviation) and inferential statistics, including Multivariate Analysis of Covariance (MANCOVA) and one–way Analysis of Covariance (ANCOVA) in SPSS at the significance level of 0.05.

The one–way ANCOVA data concerning selective attention suggested a significant difference between the PT and control groups in incongruence reaction time (p=0.001), congruence error (p=0.028), incongruence error (p=0.012), and congruence correct (p=0.011); however, there was no significant difference between the study groups in congruence reaction time (p=0.177) and incongruence correct (p=0.852). The one–way ANCOVA data respecting the cognitive flexibility variable indicated a significant difference between the PT and control groups in the correct responses (p=0.001) and the frequency of responses on the conceptual level (p<0.001). However, there was no significant difference between the study groups in perseverative errors (p=0.150) and total problem–solving time (p=0.134). Furthermore, the one–way ANCOVA data regarding the inhibition variable revealed a significant difference between PT and control groups in commission error (p<0.001), omission error (p<0.001), and inhibition (p<0.001).

The current research findings demonstrated that presenting the interventions, i.e., focused on promoting EFs in children with ADHD could improve EFs, such as selective attention, inhibition, and cognitive flexibility in them, to some extent. Therefore, it is recommended to present the comprehensive programs of EFs–based PT in individuals with ADHD.