Effect of Thai traditional play protocol on working memory and inhibitory control in children with attention-deficit/hyperactivity disorder
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Abstract
Background: Children with attention-deficit/hyperactivity disorder (ADHD) commonly have problems with executive functions (EFs), especially working memory and inhibitory control. There are a growing number of appropriate EF interventions for children with ADHD. Since all aspects of occupational functioning can be affected, occupational therapists have much to offer in providing interventions for school-aged children with ADHD to improve their executive function skills.
Objectives: The aim of this research was to examine the effects of Thai traditional play protocol on working memory and inhibitory control in children with ADHD.
Materials and methods: The study was conducted with a one group-pretest-posttest research design. Seven school-aged children with ADHD, aged between 8 and 9 years with T-scores ≥ 65 on the Behavioral Rating Inventory of Executive Function (BRIEF), Parent Form: Thai version, participated in this study. The Thai traditional play protocol was designed and developed by researchers. Twenty Thai traditional play activities that had cognitive challenges focusing on working memory and inhibitory control skills were selected and analyzed. Self-regulatory strategies, heavy work activities, and parent education were also implemented. Children with ADHD participated in a 24-session protocol, across 8 weeks with 3 sessions per week, lasting 60 minutes per session. An outcome measure was the Stroop Color and Word Test (SCWT): Children Edition. Data was analyzed using descriptive and non-parametric statistics.
Results: By using the Wilcoxon Signed-Rank Test, a comparison of SCWT scores between before and after receiving a protocol showed a statistical difference of p<0.05 in working memory, whereas no statistically significant difference was found in inhibitory control (p>0.05).
Conclusion: The findings demonstrated the positive effect of Thai traditional play protocol on working memory in children with ADHD. Occupational therapists can apply this protocol as a prototype for planning intervention focusing on working memory for school-aged children with ADHD.
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Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
References
Kotkin RA, Fine AH. Chapter 1 - attention deficit hyperactivity disorder and learning disabilities: An overview for practitioners. In: Fine AH, Kotkin RA, editors. Therapist's guide to learning and attention disorders. San Diego: Academic Press; 2003. p. 1-42.
Biederman J, Faraone S, Milberger S, Guite J, Mick E, Chen L, et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry. 1996; 53(5): 437-46.
Barkley RA: Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol. Bull. 1997; 121(1): 65.
Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF: Validity of the executive function theory of attention-decit/hyperactivity disorder: a metaanalytic review. Biol. Psychiatry. 2005, 57(11): 1336-1346.
Diamond A. Executive Functions. Annu. Rev. Psychol. 2013; 64(1): 135-68.
Meltzer L. Executive function in education: From theory to practice: Guilford Publications; 2018.
Spencer-Smith M, Klingberg T. Benefits of a working memory training program for inattention in daily life: A systematic review and meta-analysis. PLoS One 2015; 10(3): e0119522.
Alloway TP, Alloway RG. Investigating the predictive roles of working memory and IQ in academic attainment. J Exp Child Psychol. 2010; 106(1): 20-9.
Sonuga-Barke EJ, Dalen L, Daley D, Remington B. Are planning, working memory, and inhibition associated with individual differences in preschool ADHD symptoms? Dev Neuropsychol. 2002; 21(3): 255-72.
McBurnett K, Pfiffner L. Attention deficit hyperactivity disorder: Concepts, controversies, new directions: CRC Press; 2007.
Moffitt TE, Arseneault L, Belsky D, Dickson N, Hancox RJ, Harrington H, et al. A gradient of childhood self control predicts health, wealth, and public safety. Proc Natl Acad Sci U S A 2011; 108: 2693 8. doi: 10.1073/pnas.1010076108.
Diamond A, Barnett WS, Thomas J, Munro S. Preschool program improves cognitive control. Science. 2007; 318(5855): 1387-8
Diamond A, Lee K. Interventions shown to aid executive function development in children 4 to 12 years old. Science. 2011; 333(6045): 959-64.
Hillman CH, Castelli DM, Buck SM. Aerobic Fitness and Neurocognitive Function in Healthy Preadolescent Children. Med. Sci. Sports Exerc. 2005; 37(11): 1967-74.
Diamond A, Ling DS. Aerobic-Exercise and resistance-training interventions have been among the least effective ways to improve executive functions of any method tried thus far. Dev. Cogn. Neurosci. 2019; 37: 100572.
Roley SS, Bissell J, Clark GF. Providing occupational therapy using sensory integration theory and methods in school-based practice. Am J Occup Ther. 2009; 63(6): 823-42.
Yang C-Y, Howe T-H. Motor performance of children with attention deficit hyperactivity disorder in fourth to sixth grades: Differences among subtypes. Am J Occup Ther. 2017; 71(4 Supp1): 7111505094 p1-p1.
Bodison SC, Parham LD. Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. Am J Occup Ther. 2017; 72(1): 7201190040 p1-p11.
Kim MJ, Park HY, Yoo EY, Kim JR. Effects of a cognitive-functional intervention method on improving executive function and self-directed learning in school-aged children with attention deficit hyperactivity disorder: A single-subject design study. Occup Ther Int. 2020; 2020: 1250801.
Diamond A, Ling DS. Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not. Dev. Cogn. Neurosci. 2016; 18: 34-48.
Landreth GL. Play therapy the art of the relationship. 3rd Ed. New York: Routledge; 2012
Lakes K, Hoyt W. Promoting self-regulation through school-based martial arts training. J. Appl. Dev. Psychol. 2004; 25: 283-302.
Johanna Calderon. Executive function in children why it matters and how to help [internet]. Cambridge: Hardvard Health Publishing; 2020 Dec - [cited 2021 June 5]. Available from: https://www.health.harvard.edu/blog/executive-function-in-children-why-it-matters-and-how-to-help-2020121621583.
Plookpedia. khwāmmāi khō̜ng kham wākān la lē nakha ʻong Thai [internet]. Bangkok: TruePlookpanya; 2017 April – [cited 2021 June 5]. Available from: https://www.trueplookpanya.com/blog/content/58006.
Department of Physical Education. kānlalēn phư̄nbān Thai. Bangkok: S off graphic design; 2557.
Somsri T, Haenjohn J, Supwirapakorn W. A development of inhibitory control based on Thai traditional game training program in elementary school students [internet]. 2019 June - [cited 2021 June 5]; 21(2): 222-30. Available from: https://he01.tci-thaijo.org.
Chu S, Reynolds F. Occupational therapy for children with attention deficit hyperactivity disorder (ADHD), part 2: A multicentre evaluation of an assessment and treatment package. Br J Occup Ther. 2007; 70(10): 439-48.
Shuai L, Daley D, Wang YF, Zhang JS, Kong YT, Tan X, et al. Executive function training for children with attention deficit hyperactivity disorder. Chin Med J (Engl). 2017; 130(5): 549-58.
Chaimaha N, Sriphetcharawut S, Lersilp S, Chinchai S. Effectiveness of therapeutic programs for students with ADHD with executive function deficits. J Occup Ther Sch Early Interv. 2017; 10(4): 436-56.
Lane SJ. Sensory modulation functions and disorders. In: Anita C. Bundy SJL, editor. Sensory integration theory and practice United States of America: F. A. Davis Company; 2020. p. 151-80.
DuPaul GJ, Stoner G. ADHD in the schools: Assessment and intervention strategies. 2nd Ed. New York: The Guilford Press; 2003.
Pfiffner LJ, Barkley RA. Treatment of ADHD in school settings. In: Barkley RA editor. Attention-deficit hyperactivity disorder—a handbook for diagnosis and treatment. 2nd Ed. New York: The Guilford Press; 1998. P 458-90.
Ayres AJ. Treatment of sensory integrative dysfunction. Aust. Occup. Ther. J. 1972; 19(2): 88.
Horowitz LJ & Röst C. Helping hyperactive kids? A sensory integration approach: Techniques and tips for parents and professionals. Canada: Hunter House; 2007.
Williams MS, Shellenberger S. How does your engine run? . Albuquerque NM USA: Therapy Works; 1994.
Wells AM, Chasnoff IJ, Schmidt CA, Telford E, Schwartz LD. Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: an adaptation of the Alert Program®. Am J Occup Ther. 2012; 66(1): 24-34.
Wilbarger J, Wilbarger P. The Wilbarger approach to treating sensory defensiveness. In A. C. Bundy, & S. J. Lane, editors. Sensory integration theory and practice. United States of America, USA: F. A. Davis Company; 1991. p. 426-32.
Gioia GA, Isquith PK, Kenworthy L, Barton RM. Profiles of everyday executive function in acquired and developmental disorders. Child Neuropsychol. 2002; 8(2): 121-37.
McCandless S, L OL. The clinical utility of the behavior rating inventory of executive function (BRIEF) in the diagnosis of ADHD. J Atten Disord. 2007;10(4): 381-9.
Smithson PE, Kenworthy L, Wills MC, Jarrett M, Atmore K, Yerys BE. Real world executive control impairments in preschoolers with autism spectrum disorders. J Autism Dev Disord. 2013; 43: 1967-75.
Golden CJ, Freshwater SM, Zarebeth G, Nova Southeastern University. Stroop color and word test children's version for ages 5-14: A manual for clinical and experimental uses. Wood Dale, Ill: Stoelting; 2003.
Madteh F. Effect of traditional games training on early childhood development [dissertation]. Pattani: Prince of Songkla University; 2014.
Bundy AC, Lane SJ, Murray EA. Sensory integration theory and practice. 2nd Ed. Philadelphia: F.A. Davis Company; 2002.
Williams MS, Shellenberger S. How does your engine run?: A leader's guide to the alert program for self-regulation. Albuquerque NM USA: Therapy Works; 1996.
Turner RC, Carlson L. Indexes of item-objective congruence for multidimensional items. Int. J. Test. 2003; 3(2): 163-71.
Baddeley A. Working memory. Current Biology. 2010; 20(4): R136-R40.
Baddeley A. Working Memory: Theories, models, and controversies. Annu. Rev. Psychol. 2012; 63(1): 1-29.
Baddeley A, Gathercole S, Papagno C. The phonological loop as a language learning device. Psychol Rev. 1998; 105(1): 158-73.
Khalili KF, Mohammadi MR, Yadegari F, Haresabadi F, Sadeghi SM. Working memory training in the form of structured games in children with attention deficit hyperactivity disorder. Iran J Psychiatry. 2016; 11(4): 224-33.
Guiney H, Machado L. Benefits of regular aerobic exercise for executive functioning in healthy populations. Psychon Bull Rev. 2013; 20(1): 73-86.
Tamm L, Nakonezny PA, Hughes CW. An open trial of a metacognitive executive function training for young children with ADHD. J Atten Disord. 2014; 18(6): 551-9.
Reynolds S, Lane SJ. Sensory overresponsivity and anxiety in children with ADHD. Am. J. Occup. Ther. 2009; 63(4): 433-40.
Dunn W. The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants & Young Children. 1997; 9(4): 23-35.
Karamali ES, Shafaroodi N, Hassani MA, Parand A, Zarei M, Akbari ZS. Effect of play-based therapy on meta-cognitive and behavioral aspects of executive function: A randomized, controlled, clinical trial on the students with learning disabilities. Basic Clin Neurosci. 2017; 8(3): 203-12.
Kaufman C. Executive function in the classroom: Practical strategies for improving performance and enhancing skills for all students. Michigan: Paul H. Brookes Publishing Co.,Inc; 2010. p. 79-94.
Clark C, Prior M, Kinsella G. The relationship between executive function abilities, adaptive behaviour, and academic achievement in children with externalising behaviour problems. J Child Psychol Psychiatry. 2002; 43(6): 785-96.
Dawson P, Guare R. Executive skills in children and adolescent: a practical guide to assessment and intervention. 2nd Ed. New York, NY: The Guilford Press; 2010.