Background & Objectives: Cognitive skills deficits, including visual–spatial working memory, spatial–verbal working memory, and spatial recognition memory, which underlie complex reasoning, are problematic in children with attention–deficit/hyperactivity disorder (ADHD). Neurofeedback training is an appropriate treatment method to reduce ADHD and increase concentration in these children. Neurofeedback training, based on increasing beta wave activity and suppressing theta wave activity, has shown that after training, reduction of inattentive behaviors and improvement in attention is observed in the cognitive function of children with ADHD. Children with ADHD have poor motor coordination, which is a double problem with ADHD. These children also perform worse on static and dynamic balance tests than normal children. Because of the relatively high prevalence of ADHD in the world, including Iran, on the one hand, we are witnessing the adverse effects of this disorder on family mental health and the educational environment of children with ADHD. So, this study aimed to compare the effectiveness of neurofeedback training interventions and perceptual–motor integration on increasing cognitive skills in children with ADHD.
Methods: The method of the present study was a quasi–experimental study with a pretest–posttest and 45 days follow–up design with a control group. The study’s statistical population was 7 to11 years old students with symptoms of ADHD studying in primary school in Mashhad City, Iran, in 2019. By the available sampling method, 36 students were randomly chosen and assigned in 3 groups of neurofeedback training, perceptual–motor integration, and control. The inclusion criteria in this study included age (7–11 years), average IQ (80–109) (based on the initial assessment test of students at the beginning of school entry) and not using medication (according to the physician). Lack of regular and appropriate cooperation to participate in training sessions, as well as the absence of more than three sessions and the presence of comorbidities such as behavioral problems or coping disregard (based on diagnostic criteria in DSM–5) were considered as criteria for students' withdrawal from the study. The study data were gathered via Conners Teacher Rating Scale (Conners et al., 1998), Conners Parent Rating Scale–Short Form (Conners et al., 1998), the software version of Continuous Performance Test (Original Test by Rosvold et al., 1956) and Tehran–Stanford–Binet Intelligence Test (Afrooz & Kamkari, 2006). Neurofeedback and perceptual–motor integration training were performed in 36 sessions for the experimental groups. The control group did not receive any special training during this period. For data analyses, we used descriptive statistics (frequency, percentage, mean, standard deviation) and inferential statistics (repeated measures analysis of variance). Paired comparison of groups was based on the Tukey test and paired comparison of measurement steps on the Bonferroni test. Data analysis was performed in SPSS software version 23. The significance level of all tests was considered 0.05.
Results: The results showed that in nonverbal intelligence (p<0.001), verbal intelligence (p<0.001) and general intelligence (p<0.001), the differences within the group were significant over time. The interaction between the measurement stage and the group was also significant in all three variables (p<0.001). There were significant differences between non–verbal intelligence (p=0.012) and general intelligence (p=0.046) between groups. But in verbal intelligence, there were no significant differences between groups (p=0.312). There was a significant difference in the mean scores of nonverbal intelligence in the neurofeedback training group with the perceptual–motor integration group (p=0.035) and the control group (p=0.018). But there was no significant difference between the neurofeedback training group and the perceptual–motor integration training group in the mean scores of verbal intelligence (p=0.411) and general intelligence (p=0.127). Also, in both experimental groups, there was a significant difference in the mean scores of all three research variables, namely nonverbal intelligence, verbal intelligence, and general intelligence in the stages of pretest with posttest (p<0.001), pretest with follow–up (p<0.001) and posttest with follow–up (p<0.001).
Conclusion: According to the findings of the study, except in nonverbal intelligence where neurofeedback training is more effective than perceptual–motor integration, both neurofeedback training and perceptual–motor integration approaches as alternative and complementary therapies, in the posttest and follow–up stages are effective in increasing the cognitive abilities of children with ADHD.