Volume 25, Issue 2 (7-2023)                   Advances in Cognitive Sciences 2023, 25(2): 44-58 | Back to browse issues page

Ethics code: IR.UT.ICSS.REC.1399.010

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Rafiee Tari N, Moradi A, Rezapour T, Sadeghi M. Comparison of the effectiveness of mindfulness and transcranial direct current stimulation on social cognition (empathy) in children with attention deficit-hyperactivity disorder. Advances in Cognitive Sciences 2023; 25 (2) :44-58
URL: http://icssjournal.ir/article-1-1491-en.html
1- PhD Candidate in Cognitive Psychology, Shahid Beheshti University and Cognitive Sciences Research Institute, Tehran, Iran
2- Department of Clinical Psychology, Kharazmi University, Tehran, Iran
3- Department of Cognitive Psychology, Cognitive Sciences Research Institute, Tehran, Iran
Abstract:   (396 Views)

Attention Deficit/Hyperactivity Disorder (ADHD) is the most common childhood neurodevelopmental disorder associated with chronic attention deficit and hyperactivity symptoms. Its prevalence has been reported up to 8.9. Children with this disorder are at high risk and suffer from problems and defects in social skills, interpersonal problems, and conduct disorder. This disorder's adverse disorder are not only visible in the education process, but also cause irreparable personal and social damage to the child's relationships with others. Social cognition is the central core of social relations and the socialization of people, and empathy is one of its most essential aspects. Considering social cognition deficits such as empathy that exist in ADHD, timely rehabilitation interventions such as mindfulness and transcranial electrical stimulation seem necessary. The present study aims to compare the effectiveness of transcranial direct current stimulation and mindfulness on empathy in children with ADHD.
The current research was conducted as a multi-group experimental design with pre-test and post-test with control and follow-up. The population consisted of students with ADHD referred to rehabilitation and psychology clinics. Forty-five children aged 7-12 years with the initial diagnosis of ADHD by a psychiatrist, who were given a clinical interview and Conners assessment for more assurance, were simple randomly assigned to two experimental groups and one control group:15 students in the mindfulness experiment group with 15 training sessions, 15 students in the transcranial direct  current stimulation group 12 sessions every other day, by two narrow bands that are closed around the participant's head and the anode with the current intensity (1 milliampere). The duration (10 minutes) was fixed on the right dorsolateral prefrontal cortex, and the cathode electrode was placed on the left arm, and 15 students were included in the control group. The effectiveness of mindfulness intervention and transcranial direct current stimulation on empathy was investigated. The 55-question Empathy Questionnaire of Ayung et al.'s 2009 was used.
According to Table 1, the groups were almost homogeneous in gender and age variables. The results of the chi-square test also showed that the difference between the two groups in terms of gender and age was insignificant (P>0.05). The results of repeated measures analysis of variance to compare three groups in empathy in the three stages of pre-test and post-test and follow-up based on Greenhouse-Geisser correction are reported in Table 2.
Table 1. Demographic characteristics of the participants by group
Variables TDCS Mindfulness Control P-Value
Gender Boy 11 (3.18) 8 (3.13) 11 (3.18) 0.57
Girl 4 (7.6) 7 (7.11) 4 (7.6)
Age 7 to 9 years 8 (3.13) 7 (7.11) 8 (3.13) 0.98
10 to 12 years 7 (7.11) 8 (3.13) 7 (7.11)

According to the results of Table 2, the difference between the scores of the empathy component (P<0.001) was significant in the three stages of the research. Furthermore, the mean empathy scores in both experimental and control groups were significant (P<0.001). The results showed that nearly 21% of the individual differences in empathy are related to the differences between the three groups. In addition, the interaction between research stages and group membership was also significant in the empathy variable (P<0.001). In other words, the difference between empathy scores in the three stages of the research in three groups was significant. According to the results obtained in the table above, the difference between the pre-test, post-test, and follow-up stages was significant. Therefore, the results of pairwise comparisons of the averages of the three stages of the research using the Bonferroni test are reported in Table 3.
Table 2. The results of Mixed ANOVA to investigate the difference between groups in empathy in pre-test, post-test, and follow-up
Variable Time Time*Group Group
F(2, 84) P η2 F(2, 84) P η2 F(1, 43) P η2
Empathy 32.84 <0.001 44 20.38 <0.001 0.49 5.51 0.008 0.21
The results of this study indicate that two interventions (Table 3), mindfulness and transcranial direct current stimulation, are able to improve empathy in children with ADHD. However, transcranial direct electrical stimulation was more effective than mindfulness intervention in improving them. Similarly, the change in empathy scores continued in the follow-up phase compared to the pre-test phase and was significantly different, indicating the stable effect of these two treatments.
Table 3. The results of the post-hoc Bonferroni test to compare three groups of empathy
Group Stage I-J P
Control Pre-test-post-test 0.4 0.635
Pre-test-follow-up 0.867 0.058
Post-test-follow-up 0.467 0.268
Mindfulness Pre-test-post-test -2.067 0.002
Pre-test-follow-up -2 0.002
Post-test-follow-up 0.067 1
TDCS Pre-test-post-test -7.467 0.001
Pre-test-follow-up -6 1.024
Post-test-follow-up 1.467 0.71

In general, based on the results of this study and previous studies, it can be said that mindfulness intervention and transcranial direct electrical stimulation can be used as a complementary solution along with other intervention programs to improve social cognition functions such as empathy in children with ADHD. Nevertheless, therapists and researchers should remember that the success of these interventions can vary depending on the context. Therefore, it is recommended that the therapists who use these interventions pay enough attention to choosing the right place for the electrodes appropriately and in line with the treatment goals.
Ethical Considerations
Compliance with ethical guidelines
In implementing the research, ethical considerations were followed according to the instructions of the Faculty of Medical Ethics Committee, the Code of Ethics of the Research Institute of Cognitive Sciences No.13. IR.UT.ICSS.REC.1399.010 was received. Informed consent was obtained from the parents of all students before starting the study. Besides, the participants were coded, and the principle of confidentiality was respected.
This article is taken from the PhD dissertation of Neda Rafiei Tari, Department of Cognitive Psychology, Faculty of Cognitive Psychology, Shahid Beheshti University, Tehran, Iran. The university provided all the financial resources for this research.
Authors’ contributions
All authors contributed equally to preparing all parts of the research.
The authors would like to thank all students with ADHD and their parents for cooperating in the study. They would also like to thank and acknowledge the efforts of the teachers, clinicians, and specialists who helped during this study.
Conflict of interest
The authors declared no conflict of interest.
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Type of Study: Research |
Received: 2022/11/30 | Accepted: 2023/02/19 | Published: 2023/09/20

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