יעילות התערבות קוגניטיבית תפקודית (Cog-Fun) בריפוי בעיסוק לילדים עם הפרעת קשב וריכוז בגיל קדם בית ספר: מחקר חלוץ מבוקר
Effectiveness of a Cognitive- Functional Intervention (Cog- Fun) in Occupational Therapy for Preschool Children with Attention Deficit Hyperactivity Disorder: A Controlled Pilot Study
אורית פישר, ד"ר רותי טראוב, נעמי בועז, עדי שורץ, ד"ר יעל לנדאו, ד"ר עדינה מאיר
Orit Fisher, MSc. OT; Ruti Traub, PhD; Naomi Boas, OT; Adi Schwartz PT; Yael Landau, PhD;. Adina Maeir, PhD
בית הספר לריפוי בעיסוק של הדסה והפקולטה לרפואה, האוניברסיטה העברית, ירושלים
Attention deficit hyperactivity disorder (ADHD) is a prevalent and persistent neurodevelopmental disorder with long term implications on occupational outcomes and quality of life. There is a strong relationship between executive functions (EFs) and ADHD, and central neuropsychological theories of ADHD understand the EFs to be the primary core mechanism of the disorder (Barkley, 1997; Brown, 2006). There is little evidence for interventions that address executive dysfunction in occupation among children with ADHD. The Cognitive-Functional intervention (Cog-Fun) is an occupation based intervention designed to impart executive strategies within a functional-ecological context. One study showed effectiveness of Cog-Fun for school aged children with ADHD (Hahn-Markowitz, Manor, & Maeir, 2011).The purpose of this study is to examine the effectiveness of Cog-Fun in Occupational Therapy (OT) for preschoolers with ADHD
The sample included 19 children with ADHD, mean age =5.97 (SD=0.66). This study was a pilot controlled experimental study with a crossover design. The 19 participants were consecutively assigned to Cog-Fun research group (n=10) or to a waitlist control group (n=9). Twelve weeks following treatment, both groups were followed up to determine the stability of occupational gains. Outcome measures included the Canadian Occupational Performance Measure (COPM) and the Behavioral Rating Inventory of Executive Functions (BRIEF).
Significant interaction effects were found on the COPM (F=18.5; p=.000) and BRIEF (F=5.16; p=.008) before crossover. Both groups demonstrated significant, moderate to large treatment effects on both the COPM (F=110; p=.000) and BRIEF
(F = 3.798; p=.023). COPM scores were maintained at follow up with no significant changes between post treatment and follow up (p>0.1).
The results of the study provide preliminary supporting evidence for the effectiveness of the Cog-Fun for preshoolers with ADHD. Further research will examine Cog-Fun in a larger sample with a randomized controlled design.
Barkley, R. (1997). Behavioral inhibition, sustained attention, and executive functions constructing a unifying theory of ADHD. Psychological Bulletin 121, 65-94.
Brown, T. E. (2006). Executive functions and attention deficit hyperactivity disorder: Implications of two conflicting views. International Journal of Disability, Development and Education 53, 35-46.
Hahn- Markowitz, J., Manor, I., & Maeir, A. (2011). Effectiveness of cognitive functional (Cog-Fun) intervention with children with attention deficit hyperactivity disorder: A pilot study. American Journal of Occupational Therapy 65, 384-392.