طراحي برنامهٔ بازي‌درماني شناختي-‌رفتاري خانواده‌‌محور براي دانش‌آموزان با اختلال نارسايي توجه/فزون‌كنشي و اثربخشي آن بر نشانه‌هاي اين اختلال

Developing a Family Based Cognitive-Behavioral Play Therapy Program for Students with Attention Deficit Hyperactivity Disorder and Its Effectiveness on the Symptoms of This Disorder

زمينه و هدف: امروزه برخي پژوهش‌هاي حوزهٔ درمان اختلال نارسايي توجه/فزون‌كنشي بر درمان‌هاي غيردارويي و رويكردهاي خانواده‌محور متمركز شده است. باتوجه به اين مهم، پژوهش حاضر با هدف طراحي برنامهٔ بازي‌درماني شناختي-رفتاري خانواده‌محور براي دانش‌آموزان با اختلال نارسايي توجه/فزون‌كنشي و اثربخشي آن بر نشانه‌هاي اين اختلال انجام شد. روش‌بررسي: مطالعهٔ حاضر از نوع مداخله‌اي با طرح شبه‌آزمايشي و پيش‌آزمون و پس‌آزمون همراه با گروه گواه بود. جامعهٔ آماري اين پژوهش را دانش‌آموزان دورهٔ دوم ابتدايي با نشانه‌هاي اختلال نارسايي توجه/فزون‌كنشي تشكيل دادند. نمونهٔ آماري عبارت بود از 34 دانش‌آموز پسر با نوع تركيبي اين اختلال كه به‌صورت دردسترس از دو مدرسه انتخاب شدند. دانش‌آموزان يك‌مدرسه به‌طور تصادفي در گروه آزمايشي و دانش‌آموزان مدرسهٔ ديگر به‌شكل تصادفي در گروه گواه قرار گرفتند. پس از طراحي برنامهٔ بازي‌درماني توسط پژوهشگر، مادران دانش‌آموزان گروه آزمايشي هفت جلسه آموزش بازي‌هاي شناختي-رفتاري را دريافت كردند و به‌مدت شانزده جلسه در منزل روي فرزند خود اجرا نمودند؛ اما براي گروه گواه هيچ آموزشي ارائه نشد. يافته‌ها: نتايج پژوهش نشان داد كه برنامهٔ حاضر مي‌تواند نشانه‌هاي اختلال نارسايي توجه/فزون‌كنشي را به‌طور معنا‌داري كاهش دهد (0٫05˂p). اين پژوهش همچنين مشخص كرد كه تأثير برنامه در يك‌دورهٔ سه‌ماهه به‌قوت خود باقي مانده است. نتيجه‌گيري: باتوجه به يافته‌هاي پژوهش مي‌توان از برنامهٔ بازي‌درماني شناختي-رفتاري حاضر به‌عنوان ابزاري خانواده‌محور براي كاهش علائم اختلال نارسايي توجه/فزون‌كنشي سود جست.

Background & Objective: Attention Deficit and Hyperactivity Disorder (ADHD) is one of the common disorders that occurs in the early stages of childhood development. ADHD is one of the disorders that has a complex and multidimensional nature which can also derived from a variety of factors and affect the various dimensions of individual and social growth of the child. So treatment of this disorder consists of variety of approaches from medication to relaxation. Todays, some studies on attention deficit hyperactivity disorder focused on non–pharmacological therapies and family–based. Regarding this necessity, the goal of this study was to design a family–based cognitive–behavioral play therapy program for students with attention deficit hyperactivity disorder and its effectiveness on the symptoms of this disorder. Methods: The present study was interventional with quasi–experimental design and pre–test, post–test with control group. The sampling method was convenience. The statistical population of this study was the second–grade students of elementary school with symptoms of ADHD. A total of 34 male students of the second grade of elementary school with the symptoms of ADHD –combined type– were selected by convenience sampling method from two elementary schools with about 1000 population. Student of One randomly assigned to experimental group and students of another group randomly assigned to control group. Reviewing the existent literature, resulted in extraction of main components of program that was consist of self-instruction, problem solving, self-control, feelings discrimination, relaxation and attribution retraining. In the next step need assessment resulted in some behavioral problems such as aggression, social skills problems, problems in math and writing. Validation of program done by 3 University professors (for objectives of program) and 3 play therapists (for plays). After validation the protocol, pilot study done on 4 mothers with ADHD children and some corrections done in program. Then the program used in experimental phase. the mothers of the experimental group received 7 sessions (in seven weeks) of training on cognitive–behavioral plays then performed them on their children for 16 sessions (45 minutes) at home, while the control group did not receive any training. The program for training mothers consist of session 1: understanding ADHD; session 2: understanding cognitive–behavioral therapy; session 3: understanding CBPT for ADHD; session 4: training first to fourth plays of program; session 5: training fifth to eighth plays of program; session 6: training ninth to twelfth plays of program; session 7: training Thirteenth to Sixteenth plays of program. The plays in present program consist of: session 1: eye to eye and snowballs; session 2: bit the clock; session 3: electrocardiogram making and guidance; session 4: bit the clock and say, do, say; session 5: opposite pairs, snowballs and lax/iron doll; session 6: classmates; session 7: snowballs and coloring an snake; session 8: electrocardiogram making; session 9: post box and Treasure finding; session 10: color your life and corrective sentences; session 11: three whistle and Bubbling; session 12: making a film and Treasure finding; session 13: the feeling word and corrective sentences; session 14: be careful, exam and cooking; session 15: color your life and who arrive sooner; session 16: who arrive sooner and Bubbling. Results: After analyzing the data, the results showed that, the family–based cognitive–behavioral play therapy program significantly reduced symptoms of ADHD (p˂0.05). The results have showed that the program's impact has remained strong over a three–month period (P˂0.05). Conclusion: Cognitive–behavioral play therapy use for variety of behavioral problems in children. Goal of this study was to design a family– based cognitive–behavioral play therapy program for students with attention deficit hyperactivity disorder and its effectiveness on the symptoms of this disorder. Results of this study supported the efficacy of cognitive–behavioral play therapy program that performed by mother in home to decrease the symptoms of ADHD. According to the findings of the study, the present cognitive–behavioral play therapy program can be used as a family–based tool to reduce the symptoms of ADHD. Also mothers can be used as main agent of family–based treatments in childhood ADHD.