Volume 22, Issue 6 (Feb - Mar 2019)                   J Qazvin Univ Med Sci 2019, 22(6): 178-189 | Back to browse issues page


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Barzegar M, Talepasand S, Rahimian boogar E. Comparison of Effectiveness of Nutrition and C-CRT on Improving Working Memory in Children With ADHD. J Qazvin Univ Med Sci. 2019; 22 (6) :178-189
URL: http://journal.qums.ac.ir/article-1-2764-en.html
1- Department of Educational Sciences, Faculty of Psychology & Educational Sciences, Semnan University, Semnan, Iran.
2- Department of Educational Sciences, Faculty of Psychology & Educational Sciences, Semnan University, Semnan, Iran. , stalepasand@semnan.ac.ir
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Extended Abstract
1. Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent neurobehavioral disorder among children. The clinical classification of ADHD is based on 6 signs or more of the following symptoms: unrest, the loss of personal belongings, impulsivity, high risk behaviors, excessive speaking, forgetfulness, interrupting conversations, difficulty in understanding homework before the age of 12 years, which lasts for 4 months and will adversely affect the social, occupational, educational and family skills. The symptoms are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, and substance intoxication). The prevalence of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) related ADHD disorders is reported to be between 2% and 21% and is more prevalent in boys [1].
Barkley’s theory focuses on one of the Executive Functions (EF) in general, with a clear application for ADHD. Barkley recognized a failure to inhibit responses as the cause of all other EF deficits observed in ADHD. EF is used to describe higher-order cognitive functions including inhibitory control and Working Memory (WM). WM is referred to the amount of short time memory engagement to support activity and skill [3, 4].
The nutritional ADHD evidence suggests that the mammalian brain is rich in unsaturated fatty acids that are not produced in the mammalian body and should be fed through dietary; the role of fatty acids is concerned with fluidity cortex and the function of vector. Among effective nutritional supplements, zinc is involved in the production of fatty acids and serotonin and is a dopamine inhibitor. Evidence suggests that adding omega-3, B vitamins, and iron to children’s nutrition program will improve their cognitive functions and reduce ADHD-related behavioral symptoms [6, 7].
There are various treatments available for ADHD, including pharmacotherapy, behavioral therapy, cognitive behavioral therapy, parent-based interventions, Nutritional Therapy (NT), Cognitive Rehabilitation Training (CRT), group therapy and self-esteem enhancement [8]. C-CRT and NT are modern treatments with relatively acceptable empirical support [11,12]. 
Due to the controversial results from C-CRT and NT studies, which are at a beginning stage, it seems necessary to further explore these therapeutic areas. Therefore, in the present study, in addition to reviewing C-CRT and NT, the effectiveness of combination of these two treatments was investigated on the improvement of WM in children with ADHD [13].

2. Methods and Materials
An experimental design with a control group was used with three pre-tests, post-test and follow-up measurements. Raven’s Progressive Matrices scores and the severity of disturbances were drawn in a coordinate axis. The students with similar scores of intelligence and the severity of ADHD were selected as quadruple blocks and randomly divided into 4 groups of 13 individuals (three interventional groups and one control group). 
Age variables were homogeneous in all groups. In group one, 22 sessions of 45-minutes of C-CRT were performed using Captain’s Log software. Zinc, B6 vitamin, and omega-3 were prescribed for 4 months in the second group. In the third group, the first phase of administrating zinc, B6 vitamin and omega-3 supplements was performed, and after 15 sessions, C-CRT sessions were conducted. Data were collected using the N-back test. Data were analyzed using repeated measures Analysis of Variance (ANOVA) by SPSS. 
3. Results
The obtained results represent the increased mean score on the improvement of WM in the intervention groups in comparison to control group. Although, there was no significant difference in WM scores between the intervention groups. Stability in Precision and promptitude in C-CRT group, NT group, and the combined group was observed in following. Additionally, findings suggest that the effect of time interaction is significant on precision and promptness (Table 1).
4. Conclusion
The obtained results indicate that WM in children with ADHD has been promoted in all experimental groups compared to the control group. In C-CRT group, the goal was to reinforce and rehabilitate cognitive components. These exercises provide prompt feedback, sequencing and locative calling, lead to learning new subjects, which improve cognitive abilities and self-control to achieve academic and cognitive success [23]. In addition, consistent with the effectiveness of NT in the present study, the positive effects of omega-3 have been reported in previous studies. Many studies have revealed the positive effects of vitamins and minerals such as iron and zinc on the growth and performance of neuropsychological skills. In explaining the effectiveness of NT, it can be argued that omega-3, vitamin B6 and zinc play roles in nerve growth and cognitive functions [24, 30]. 



 
The combined intervention had a significant effect on the improvement of WM, but did not have more efficacy than the other two experimental groups. Of course, the possible explanation is that the time of C-CRT and NT interventions in the combined group, was half the duration of each intervention proprietary, and the short period of time may have reduced the effectiveness of combined intervention. One of the limitations of this study is that the levels of supplementations in the blood of subjects were not measured before the onset of intervention to determine whether they were below the normal levels. 
According to this study, it is recommended that C-CRT and NT be used along with pharmacological treatments. It is feasible to perform C-CRT on children. It can even be amusing with the help of family members at home, and may improve attention and WM in them. In addition to improving memory, the use of NT has other advantages, such as strengthening the immune system, promoting health and it is relatively less costly than other treatment methods [31]. Finally, future studies are recommended on investigating the nutritional interventions by measuring the serum levels of these supplementations before and after consumption. 
Ethical Considerations
Compliance with ethical guidelines
The present research was approved by the Ethics Committee of Semnan University of Medical Sciences (code: IR.SEMUMS.REC.1397.008).
Funding
The present paper was extracted from the PhD. thesis of the first author, in Department of Educational Sciences, Faculty of Psychology & Educational Sciences, Semnan University.
Authors' contributions
All authors contributed in designing, running, and writing all parts of the research.
Conflict of interest
The authors declared no conflict of interest.
Type of Study: Research | Subject: Psychology

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