Empowering Exceptional Children

Empowering Exceptional Children

Comparison of the Effectiveness of Working Memory Intervention and Perceptual-Spatial Ability Training on Behavioral Symptoms in Children with Attention-Deficit/Hyperactivity Disorder (ADHD)

Document Type : Original Article

Authors
azam zadehnour 1
vahid nejati 2
majid ebrahimpour 3
samira vakili 3
mohammad parsa azizi 4
1 PhD student of Department of Psychology and Education of Exceptional Children, Science and Research Branch, Islamic Azad University, Tehran, Iran
2 Professor, Department of Cognitive Neuroscience (Brain and Cognition), Shahid Beheshti University, Tehran, Iran
3 Assistant Professor, Department of Psychology and Education of Exceptional Children, Science and Research Branch, Islamic Azad University, Tehran, Iran
4 Assistant Professor, Department of Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran
10.22034/ceciranj.2026.554210.1995
Abstract
The purpose of this study was to compare the effectiveness of a working memory intervention program and a perceptual-spatial ability training program on behavioral symptoms in children with attention-deficit/hyperactivity disorder (ADHD). The study employed a quasi-experimental pretest-posttest control group design with a two-month follow-up. The statistical population comprised all children with ADHD in Tehran during the 2025–2026 academic year. A convenience sample of 45 children with ADHD was selected and randomly assigned to either the first experimental group (n=15), the second experimental group (n=15), or the control group (n=15). The first experimental group received the working memory training program in 13 sessions of 45 minutes over two and a half months (twice a week), while the second experimental group received the perceptual-spatial ability training program in 10 sessions of 45 minutes over the same period (twice a week). The research instrument was the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) by Swanson et al. (1981). Data were analyzed using repeated-measures analysis of variance (ANOVA) via SPSS-24. The results revealed a significant difference across the pretest, posttest, and follow-up stages in behavioral symptoms (attention deficit and hyperactivity-impulsivity) between the experimental groups and the control group (p<.001). Both the working memory and perceptual-spatial interventions significantly reduced behavioral symptoms, including inattention and hyperactivity-impulsivity, and these therapeutic effects remained stable during the follow-up phase (p<.05). Furthermore, the findings indicated that the working memory intervention was significantly more effective in reducing behavioral symptoms than the perceptual-spatial training program (p<.05). Based on these results, both working memory and perceptual-spatial interventions can be utilized effectively to alleviate behavioral symptoms in children with ADHD, and it is recommended that clinicians incorporate these training programs alongside other therapeutic interventions.
Keywords
Attention-Deficit/Hyperactivity Disorder (ADHD)
Behavioral Symptoms
Perceptual-Spatial Ability
Working Memory
Subjects
Baddeley, A. (1986). Working memory. Clarendon Press/Oxford University Press. [link]
Bellato A, Perna J, Ganapathy PS, Solmi M, Zampieri A, Cortese S, & et al. (2023). Association between ADHD and vision problems. A systematic review and meta-analysis. Mol Psychiatry. 28, 410–22.  [link]
Coghill, D. R., Seth, S., & Matthews, K. (2014). A comprehensive assessment of memory, delay aversion, timing, inhibition, decision making and variability in attention deficit hyperactivity disorder: Advancing beyond the three-pathway models. Psychological Medicine. 44(9), 1989–2001.  [link]
Faraone, S.V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry. 24, 562–575. [link]
Graham, J., & Coghill, D. (2008). Adverse effects of pharmacotherapies for attention-deficit hyperactivity disorder: Epidemiology, prevention and management. CNS Drugs. 22(3), 213–237. [link] 
Hartman, C. A., Larsson, H., Vos, M., Bellato, A., Libutzki, B., Solberg, B. S., & Reif, A. (2023). Anxiety, mood, and substance use disorders in adult men and women with and without attention-deficit/hyperactivity disorder: a substantive and methodological overview. Neuroscience & Biobehavioral Reviews. 151, 105209. [link]
Janmohammadi, S., Allah Haghgoo, H., Farahbod, M., Overton, P. G., & Pishyareh, E. (2020). Effect of a visual tracking intervention on attention and behavior of children with attention deficit hyperactivity disorder. J Eye Mov Res. 22, 12(8), 10. [link]
Mohr-Jensen, C., Steinhausen, H.C. (2016). A meta-analysis and systematic review of the
risks associated with childhood attention-deficit hyperactivity disorder on long-term outcome of arrests, convictions, and incarcerations. Clin Psychol Rev. 48:32-42. [link]
Nejati, V., & Derakhshan, Z. (2023). Attention Training Improves Executive Functions and Ameliorates Behavioral Symptoms in Children with Attention-Deficit Hyperactivity Disorder: Implication of Tele-Cognitive-Rehabilitation in the Era of Coronavirus Disease. Games for Health Journal. [link]
Nejati, V., Moradkhani, L., Suggate, S., & Jansen, P. (2021). The impact of visual-spatial abilities on theory of mind in children and adolescents with autism spectrum disorder. Research in Developmental Disabilities. 114, 103960. [link]
Nejati, V., Zahra Derakhshan, Z., & Mohtasham, A. (2023). The effect of comprehensive working memory training on executive functions and behavioral symptoms in children with attention deficit-hyperactivity disorder (ADHD). Randomized Controlled Trial Asian J Psychiatry, 81, 103469. [link]
Ojinna, B. T., Parisapogu, A., Sherp, M. L., Choday, S., Ravi, N., Giva, S., Kumar, V. S., Shrestha, N., Tran, H.H.V., & Sai Sri Penumetcha, S.S. (2022). Efficacy of Cognitive Behavioral Therapy and Methylphenidate in the Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents: A Systematic Review. Cures. 17, 14(12), e32647. [link]
Planton, M., Lemesle, B., Cousineau, M., Carlier, J., Milongo-Rigal, E., Carle-Toulemonde, G., Salles, J., & Pariente, J. (2021). The role of neuropsychological assessment in adults with attention deficit/hyperactivity disorders. Revue Neurologique. 177 (4), 341-348. [link]
Příhodová, K. (2024). The Multidimensional Analysis of Impulsivity in Incarcerated Offenders with the antisocial personality disorder and the attention deficit hyperactivity disorder. Department of Psychiatry First Faculty of Medicine Charles University and General University Hospital in Prague thesis. [link]
Rubia, K., Westwood, S., Aggensteiner, P.M., & Brandeis, D. (2021). Neurotherapeutics for Attention Deficit/Hyperactivity Disorder (ADHD): A Review. Neurotherapeutics for Attention Deficit/Hyperactivity Disorder (ADHD): A Review. Cells. 21, 10(8), 2156. [link]
Sharma, B., Kumar, A. and Sarin, J. (2016) Academic Stress, Anxiety, Remedial Measures Adopted and Its Satisfaction among Medical Students: A Systematic Review. International Journal of Health Sciences and Research. 6, 368-376. [link]
Sohlberg, M.M. and & Mateer, C.A. (2001) Cognitive Rehabilitation: An Integrative Neuropsychological Approach, Guilford Press, New York. [link]  
Swanson, J., Deutsch, C., Cantwell, D., Posner, M., Kennedy, J., Barr, C., Moyzis. R., Schuck, S., Flodman, P., & Spence, A. (2001). Genes and attention-deficit hyperactivity disorder. Clinical Neuroscience Research. 1, 207–216. [link] 
Swanson, J., Nolan, W., &Pelham, W. E. (1981). The SNAP rating scale for the diagnosis of attention deficit disorder. Paper presented at the meeting of the American Psychological Association; Los Angeles. [link]
Thapar, A., Livingston, L. A., Eyre, O., & Riglin, L. (2023). Practitioner Review: Attention‐deficit hyperactivity disorder and autism spectrum disorder–the importance of depression. Journal of Child Psychology and Psychiatry, 64(1), 4-15. [link]
Zhao, D., & Zhang, J. (2024). The effects of working memory training on attention deficit, adaptive and non-adaptive cognitive emotion regulation of Chinese children with Attention Deficit/Hyperactivity Disorder ADHD. BMC psychology, 12(1), 59. [link]
Zhu, F., Zhu, X., Bi, X., Kuang, D., Liu, B., Zhou, J., & Ren, Y. (2023). Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. Frontiers in Public Health, 11, 1133727. [link]

  • Receive Date 19 October 2025
  • Revise Date 06 June 2026
  • Accept Date 09 June 2026