تدوین برنامه توان بخشی شناختی یافتن سریع کلمه و اثربخشی آن بر پردازش شنیداری کودکان با اختلال های عصب تحولی: مطالعه موردی کودکان با نارساخوانی و اختلال نارسایی توجه/ بیش فعالی (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
یکی از بارزترین ویژگی های کودکان با نارساخوانی و اختلال نارسایی توجه/ بیش فعالی، مشکل در پردازش شنیداری است و عدم ارائه مداخله به موقع برای این کودکان عواقب جبران ناپذیری را به همراه دارد. هدف از این پژوهش تدوین برنامه توان بخشی شناختی یافتن سریع کلمه و اثربخشی آن بر پردازش شنیداری کودکان با نارساخوانی و اختلال نارسایی توجه/ بیش فعالی بود. جامعه آماری شامل تمامی دانش آموزان دوره ابتدایی 7 تا 9 ساله شهر تهران با تشخیص نارساخوانی و اختلال نقص توجه / بیش فعالی که در سال نیمسال دوم تحصیلی 1401 مشغول به تحصیل بودند که 30 نفر داوطلب واجد شرایط به شیوه تصادفی در دوگروه آزمایش (15 نفر) و گواه (15 نفر) گمارش شدند. گروه آزمایش در 10 جلسه 45 دقیقه ای برنامه توان بخشی شناختی یافتن سریع کلمه را دریافت کرد. ابزارهای پژوهش شامل نسخه چهارم آزمون هوش وکسلر، آزمون خواندن و نارساخوانی مرادی و همکاران (1395)، پرسشنامه کانرز-فرم والدین (1998) و سیاهه مشکلات شنیداری فیشر (1976) بود. داده ها با استفاده از تحلیل کوواریانس چند متغیره تحلیل شد. یافته ها نشان داد که برنامه توان بخشی شناختی یافتن سریع کلمه مؤثر بوده و موجب بهبود پردازش شنیداری کودکان با نارساخوانی و اختلال نارسایی توجه/ بیش فعالی در گروه آزمایش شده است. با توجه به این یافته ها برنامه توان بخشی شناختی یافتن سریع کلمه به عنوان یک مداخله مؤثر به متخصصان پیشنهاد می شود.Development of a Fast ForWord Cognitive Rehabilitation Program and Its Effect on Auditory Processing in Children with Neurodevelopmental Disorders: A Case Study of Dyslexia and Attention-Deficit/Hyperactivity Disorder
It is widely recognized that children with dyslexia and Attention-Deficit/Hyperactivity Disorder (ADHD) often experience significant auditory processing difficulties, and delayed intervention can lead to long-term academic and social consequences. This study aimed to design a cognitive rehabilitation program based on "Fast ForWord" and evaluate its effectiveness in improving auditory processing in children diagnosed with comorbid dyslexia and ADHD. The statistical population consisted of all 7- to 9-year-old elementary students in Tehran during the second semester of the 1401 academic year who had a formal diagnosis of both conditions. From this population, 30 participants were selected and randomly assigned to either an experimental group (n=15) or a control group (n=15). The experimental group received the "Fast ForWord" cognitive rehabilitation program over ten 45-minute sessions. Assessment tools included the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), the Moradi et al. (2015) Reading and Dyslexia Test, the Conners Parent Rating Scale (1998), and Fisher's Auditory Problems Checklist (1976). Data were analyzed using Multivariate Analysis of Covariance (MANCOVA). The results indicated that the "Fast ForWord" program produced significant improvements in the auditory processing abilities of children in the experimental group. These findings suggest that this program can be an effective intervention for specialists working with children with neurodevelopmental disorders.
Keywords: Attention Deficit Hyperactivity Disorder, Cognitive Rehabilitation, Dyslexia, Fast ForWord
Extended
Introduction
Children diagnosed with Dyslexia and Attention-Deficit/Hyperactivity Disorder (ADHD) display distinct functional and anatomical differences in specific components of the central auditory nervous system compared to their neurotypical peers. One of the most notable characteristics commonly seen in these children is difficulty in auditory processing. Children grappling with auditory processing issues typically encounter difficulties in accurately processing and interpreting auditory information, especially when dealing with multiple speech streams or environmental noises. These difficulties can encompass challenges in discerning words amidst background sounds and following verbal instructions when multiple sounds compete for attention.
Fast ForWord is a cognitive rehabilitation program recognized for its effectiveness in addressing language-based learning impairments. The program trains a broad array of cognitive functions related to language, encompassing sound decoding, content comprehension, and the formation of connections between learning and brain development (Doidge, 2007; Ghasemzadeh, 2014). Over the past 25 years, Fast ForWord has seen significant advancements in both research and clinical applications for language therapy. The first area involves using neuroimaging and behavioral techniques to examine individual differences in language development and the causes of language-based learning disorders. The second area explores neurobiological methods initially developed to study neural plasticity in animal models. Research indicates that children who have completed the Fast ForWord program exhibit significant improvements in standardized assessments of speech, language, and auditory processing (Doidge, 2007; Ghasemzadeh, 2014).
Delays in providing timely intervention for dyslexia and Attention-Deficit/Hyperactivity Disorder can lead to repercussions that are difficult to reverse. Such delays often trigger a cascade of academic failures and cause substantial harm to a child's self-esteem. These consequences underscore the critical importance of early and accurate diagnosis, coupled with innovative and prompt intervention. Research has shown that the earlier a child receives intervention, the more favorable the outcomes will be (Chiappedi et al., 2007).
The lack of research on the use of the "Fast ForWord" intervention for children with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder highlights a significant gap in the literature. Moreover, the limited availability of training programs for the "Fast ForWord" method in Iran further underscores this deficiency. The development of effective educational programs tailored to the unique needs of children with these co-occurring conditions is widely regarded as a significant educational priority. The principal objective of this research is, therefore, to design a cognitive rehabilitation program based on "Fast ForWord" and to assess its efficacy in improving the auditory processing abilities of children diagnosed with both dyslexia and Attention-Deficit/Hyperactivity Disorder.
Research Question
This study examines the effectiveness of the "Fast ForWord" cognitive rehabilitation program in improving the auditory processing abilities of children diagnosed with dyslexia and attention-deficit/hyperactivity disorder.
Literature Review
Gilam et al. (2008) conducted a study to assess the effects of the "Fast ForWord" intervention on children with language impairment. The findings demonstrated that the participants exhibited notable enhancements in their overall language scores and auditory background test performance. In another study, Camarata (2016) examined the efficacy of the Fast ForWord treatment in enhancing language abilities among children diagnosed with language impairments. The outcomes indicated that Fast ForWord significantly improved the participants' language scores.
Methodology
The research approach for this study involved both theoretical and methodological components. In the initial stage, the "Fast ForWord" program was developed and its content validity was assessed. In the subsequent stage, a quasi-experimental method was employed using a pre-test, post-test design with a control group and a follow-up period. The statistical population consisted of all 7- to 9-year-old elementary school students in Tehran diagnosed with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder (ADHD) in the second semester of the 1401-1402 academic year. From this population, 30 participants were selected and randomly assigned to two groups: an experimental group (n=15) and a control group (n=15).
Specific inclusion and exclusion criteria were established to ensure the selected subjects were appropriate for the study. The inclusion criteria were: (1) age between 7 and 9 years; (2) current enrollment in an elementary school in Tehran; (3) no documented history of other psychological disorders; and (4) a confirmed diagnosis of both dyslexia and Attention-Deficit/Hyperactivity Disorder (ADHD) by a specialist.
The exclusion criteria, designed to maintain the study's integrity, were: (1) concurrent participation in any other rehabilitation program; (2) voluntary withdrawal from the study; or (3) absence from more than two sessions. Informed consent was obtained from both the children and their families. Psychiatric records and diagnostic tests were used to validate the diagnoses.
Results
Table 1. The results of univariate covariance analysis of the difference between the experimental and control groups in the sand processing components
Variable
Source
Sum of Squares
Degree of Freedom
Mean Square
F
evel of L Significance
Effect Size
Understanding
etweenB Groups
36.704
1
36.704
7.711
0.014
0.340
Error
71.396
15
4.760
You are harsh
Between Groups
37.787
1
37.787
5.415
0.034
0.265
Error
104.671
15
6.978
Attention
Between Groups
14.417
1
14.417
5.680
0.031
0.275
Error
38.074
15
2.538
Attention Span
Between Groups
24.344
1
24.344
8.666
0.010
0.366
Error
42.138
15
2.809
Hoarse voice
Between Groups
27.705
1
27.705
9.451
0.008
0.387
Error
43.972
15
2.931
Differentiation
Between Groups
146.470
1
146.470
11.265
0.004
0.429
Error
195.030
15
13.002
Short Term Memory
Between Groups
52.389
1
52.389
6.284
0.024
0.295
Error
125.049
15
8.337
Long Term Memory
Between Groups
115.237
1
115.237
15.494
0.001
0.508
Error
111.565
15
7.438
Stage Memory
Between Groups
46.230
1
46.230
7.595
0.015
0.336
Error
91.306
15
6.087
Speech Problems
Between Groups
30.782
1
30.782
5.891
0.028
0.282
Error
78.373
15
5.225
Coordination of Seeing and Hearing
Between Groups
61.205
1
61.205
12.515
0.003
0.455
Error
73.360
15
4.891
Stigma
Between Groups
25.422
1
25.422
8.443
0.011
0.360
Error
45.165
15
3.011
Performance
Between Groups
162.359
1
162.359
8.489
0.011
0.361
Error
286.874
15
19.125
The obtained data, as presented in the table, indicate a statistically significant difference in auditory processing levels between the control and experimental groups. Based on these results, it can be concluded that the "Fast ForWord" intervention was effective in improving the auditory processing abilities of children diagnosed with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder.
Discussion
The primary objective of this research was twofold: first, to develop a cognitive rehabilitation program based on "Fast ForWord," and second, to evaluate its efficacy in improving the auditory processing abilities of children diagnosed with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder.
This situation aligns with the perspective of experts who posit that children with language-based learning disabilities frequently encounter difficulties in recognizing and rapidly processing auditory information. This challenge is often described as a generalized processing deficit within the temporal region. In this context, the "Fast ForWord" program can be considered a targeted intervention method specifically designed to address the language-specific obstacles these children face.
This theoretical framework posits that language learning difficulties stem from a deficit in the temporal processing of auditory input. It is therefore proposed that intensive training with the "Fast ForWord" program—which adheres to behavioral principles and systematically increases temporal processing demands—can retrain the underlying neural mechanisms. This retraining, in turn, is expected to enhance language abilities and lead to subsequent improvements in auditory processing.
Conclusion
In conclusion, auditory processing deficits in children with comorbid dyslexia and Attention-Deficit/Hyperactivity Disorder significantly contribute to the challenges they face. The implementation of the "Fast ForWord" cognitive rehabilitation program, which emphasizes rapid auditory processing, represents an effective intervention. This program shows considerable potential for improving not only auditory processing skills but also the overall daily functioning of children with these conditions.
Acknowledgments
The authors extend their sincere gratitude to all the participants and their families whose involvement was essential to this study. We also thank the dedicated staff and administrators at Marjoui School for their invaluable cooperation and support throughout the research process. This work would not have been possible without their generous contribution of time and effort.
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