| Abstract|| |
Introduction: As ever play therapy using a special toy which is produced with therapeutic target in children with attention deficit hyperactivity disorders (ADHDs) has not been conducted, this study was carried out with the aim to determine the effect of space face games on the attention of children with ADHDs. Materials and Methods: In this research, 72 children with ADHDs referred to Isfahan's Noor psychiatric clinic were randomly placed in two test and control groups. Attention level of both groups was evaluated using continuous performance test before and after the intervention. The space face games in the test group were used for 16 sessions. Statistical analysis of data was conducted using descriptive and analytical statistics in SPSS Software Version 18. Findings: The average score of attention had no significant difference between the two groups before the intervention, but the number of correct answer in the test group was significantly more than the control group and the number of provided errors and the number of removed errors were significantly lower than the control group immediately after the intervention. Conclusion: Space face games are effective in the promotion of attention in children with ADHDs.
Keywords: Attention, attention deficit hyperactivity disorders, space face game
|How to cite this article:|
Shahmoradi Z, Maghsoudi J, Najafi M, Pahlavanzadeh S. The effect of space face games on the amount of children attention with attention deficit hyperactivity disorders. Ann Trop Med Public Health 2017;10:1341-4
|How to cite this URL:|
Shahmoradi Z, Maghsoudi J, Najafi M, Pahlavanzadeh S. The effect of space face games on the amount of children attention with attention deficit hyperactivity disorders. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Jan 28];10:1341-4. Available from: http://www.atmph.org/text.asp?2017/10/5/1341/217506
| Introduction|| |
Studies show that a large number of children and adolescents have emotional and behavioral problems which are reported to be up to 30%. One of the most common mental health disorders that affect children is attention deficit hyperactivity disorder (ADHD). The prevalence of this disorder in the United States  and Iran , has been reported to be about 2%–20%, whereas the latest Diagnostic and Statistical Manual of Mental Disorders 5th Edition reported it to be 2.5% for adults and 5% for children. During the past 50 years, due to its great impact on the performance of adulthood, this disorder has become one of the most commonly studied issues of childhood. Due to the chronic nature of this disorder, people suffering are at the risk of other psychiatric disorders such as antisocial personality, alcoholism, addiction, interpersonal, and psychological problems in adulthood.
In other words, ADHD makes social status of the suffering person vulnerable. Thus, today ADHD is not considered just a sickness of childhood. In the clinical setting, attention problems are of common disorders that have been reported between 3% and 5%. Attention deficit affects children's interaction with their parents as well as parents' responding to children  and can create problems for the child in learning, reading, writing, and academic activities. Drug and nondrug treatments are applied to treat this disorder. Among nondrug treatments employed in these children are play therapy. Today, play therapy, executive function, and attention are the focus of the recent neuropsychological theories of children at risk of disability, especially children with ADHD and learning disabilities. The study by Kim et al. to determine the effectiveness of Baduk (the game of Go) on cognitive function and brain activity of children with ADHD showed that the level of attention and the total ADHD Rating Scale (ARS) score of children improved after 16 sessions of practicing. Various toys are used in play therapy. One of these toys is plate or board game toys. Board games involve numerous aspects of cognitive performance., In board games, we can see when and how the children make their decisions and flout the rules, and we can also see what makes them experience turmoil or by invading their self-confidence makes them powerless. The results of the study by Nouraldau and Ebrahim Alshamieh to assess the impact of chess on the concentration of students with ADHD showed that training chess affects the children's concentration and focus skills.
Since in children with ADHD, play therapy with special toys manufactured for the purpose of treatment is not used so far, the researchers decided to conduct a study to examine the effect of spatial boards plays on the attention of children with ADHD.
| Materials and Methods|| |
This study is a clinical trial study with code IRCT2016012226139N1 derived from the Nursing Graduate Thesis number 394 469.
The sampling was through convenience method. With the beginning of the study and researcher's referral to the psychiatric clinic for children and adolescents in Noor Hospital, Isfahan in October 2015, all children with ADHD referred to this center participated in the study at their own will. The sample size was determined as 72 according to the statistician's opinion and similar studies.
Allocation of participants to experimental and control groups was random. Inclusion criteria included a diagnosis of ADHD by the psychiatrist, children, and parents with interest and positive incentive to participate in the study, age 7–12 years, lack of mental and physical disabilities and other psychiatric disorders by the psychiatrist, nonuse of other rehabilitation services, and nonuse of games similar to board games. The exclusion criteria included the lack of cooperation of the child or family, absence in research during two sessions, the use of other rehabilitation services during the intervention phase, and using other games like board games during the study.
Data collection tool in this study was computer version of continuous performance test (CPT). The purpose of this test is to assess sustaining attention and focused attention. In all forms of this test, the subjects had to retain their attention to a relatively simple stimuli, visual or aural, for a while and when the target stimulation emerges give their answer with the push of a button (in the test used in this study only visual stimulus was presented). The test is scored based on four indices of giving response, omission errors, reaction time, and correct search. Omission errors occurred when the child did not respond to the target stimulus (difficulty in maintaining attention). Presenting error occurs when the child responds to nontarget stimulus (lack of inhibition of momentum). Correct search is the number of times when the child pushes the intended key on seeing the target stimulus on the computer. Reaction time was the time between the appearance of stimulus and response by pressing the button on the computer. The reliability and validity of CPT have been assessed in Iran, and retest reliability coefficients for different parts of the test are reported in a range from 0.59 to 0.93. Validity of the test is tested through criterion validity by comparing the normal and ADHD groups where the statistical comparison of the means of two groups in different parts of the test showed a significant difference in performance between the two groups. The toy used in this study was space faces game with 9361223/1 code from the Supervisory Council for Toys. The toy is designed to improve children with ADHD. The game included a board, four spaceships colored red, blue, yellow, green, and many small parts as aliens with almost similar faces with different colors in components of their faces and an hourglass, produced for children over 4-year-old. After selecting children who fulfilled the inclusion criteria, an initial assessment was made during which their attention level was measured using CPT. As the game is for groups, children of the experimental group were randomly divided into groups of four. Description of the game and the rules were presented to the child in the first session. One-hour sessions of the game with toys were carried out under the supervision of researchers over 8 weeks. Overall, with holding two sessions per week, 16 sessions of intervention took place.
Simultaneous to the sessions of the experimental group, sessions of playing with nonboard toys (Lego, balls, etc.) were held in the control group. At the end of 8 weeks, the attention of children was measured with CPT test.
The two groups were similar in age, sex, birth rank, history of hospitalization, and family economic status (P > 0.05). In the primary comparison of the factors of attention in the experimental and control groups, the independent t-test was used and there were no significant differences: the average number of correct responses (P = 0.90), the number of presentation errors (P = 0.76), the number of omission errors (P = 0.97), and speed (P = 0.95). The average change of attention factors after the intervention compared to before in the experimental group is given in [Table 1] and in the control group in [Table 2]. In comparing the results of the experimental group before and after the intervention, the factor of the number of correct responses (P = 0.004), the number of presentation error (P < 0.001), and the number of omission errors (P = 0.009) show a significant difference.
|Table 1: Average of score changes of children's attention components before and after the intervention in test group|
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|Table 2: Average of score changes of children's attention components before and after the intervention in control group|
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| Discussion|| |
The aim of conducting this study was to determine the effect of board game space faces on the attention of children with ADHD. So far, little research has been conducted on studying the effect of board games on children with ADHD, limiting the comparison between previous research and the present study. Most studies in the field of play therapy of children with ADHD have dealt with studying the impact of computer games and motion games in these children, and no research has been conducted so far to study a specific toy produced for therapy. Assessing the level of attention of children in the intervention group after 2 months of practice with selected toy showed that the number of omission errors and presentation errors reduced in this group. Reduction in the number of presentation errors and the number of errors of omission are justified given that during playing with space faces toy, the children were responsible to recognize differences and find the proper form and were removed from the game in case of wrong recognition. Smith also believes that chess leads to obtain patience, perseverance, concentration, and creativity due to the continuous changes that arise on the screen during the game. Children learn to focus their attention on different aspects of an assignment so that they can be involved in the proper processing of the required task. The results of the study by Nouraldau and Alshamieh showed that chess affects the children's concentration and focus skills. The results of the study by Kim et al. aimed to determine the effectiveness of Baduk board game (the game of Go) on cognitive function and brain activity of children with ADHD conducted in South Korea showed that the total ARS score and ARS neglect subscore after 16 sessions of practice improved. The similarity of the rules for space faces game with the process of structural play therapy provides the possibility of comparing the results of the present study with the results of the study by Moheb, Amiri, and Behravesh. The results of the study by Moheb et al. showed that short-term structural play therapy reduces the symptoms of ADHD. In the process of structural play therapy, appropriate feedback is applied to children's behavior through the implementation of token economy program. Thus, children can have better consciousness behavior from the results and achieve pleasing results by having more control. Moreover, in different parts of structural play therapy, directions are given to the child requiring the child's attention to the game process to be able to react in a timely manner. In the game of space faces as well, different emoticons are considered at each stage and using the dummies designed, feedback is given children's successful efforts. Therefore, improving the level of attention of children in the experimental group is in line with the results of the above study. It has been argued that the process of structural play therapy, a kind of cognitive-behavioral play therapy, takes place due to the participation of children at play through attention to issues such as, control, command, and taking responsibility for changing their own behavior.
Since the number of children with attention problems at schools is very high and in some cases, half of the children who are referred for evaluation are eventually diagnosed to have a kind of ADHD, applying training methods to improve the performance of children are necessary that based on the results of this study and the ease of use of board toys, this type of toys can be used in school health curriculum. On the other hand, due to board toys' being a group game, this type of toys can be used to strengthen the relationship of the children with ADHD with peers and to include them in group activities.
Like other research, this study had its limitations. The most important limitation of this study was the lack of 2-month or several-month follow-up to assess intervention effects due to the time limit. Follow-up provides the ground for the understanding that changes are not short-term and their effects resist time. Thus, it is suggested that in future studies short-term and long-term follow-up period should be used. Moreover, there were problems of coordination with the children and the interference of the hours of sessions of play therapy with children's presence at school or attending in extracurricular classes.
| Conclusion|| |
Finally, it is concluded that board game of space faces has been effective in promotion of attention in children with ADHD. Thus, considering the effectiveness, ease, and low cost of board game of space faces, psychiatric nurses, as key members of the health-care team and other team members, can use the findings of this study to design effective therapeutic program for children with ADHD.
This article is derived from a Psychiatric Nursing Master's thesis in Isfahan University of Medical Sciences. Hereby, all those who helped us in conducting this research, especially families and children participating in the study and the esteemed professors are thanked and appreciated.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]