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Development of Executive Function in ADHD Preschool And Primary Schoolchildren Course (5 - 12) Years of Age In Isfahan
Ameneh Karamshahi , Ahmad Abedi , Ahmad Yarmohamadian ,
Volume 16, Issue 1 (4-2014)
Abstract
Introduction: This study was conducted to determine the process of executive functions development amongst 5-12 year-old ADHD children in preschools and primary schools across the city of Isfahan.
Method: The Conners' Parent Rating Scale-48 (CPRS-48) was administered to 210 (105 girls and 105 boys) pre- and primary schoolers aging 5-12 years. To determine the evolution of the executive functions, the Tower of London (ToL) test was applied. Data were analyzed using descriptive statistics, two-way ANOVA and Scheffe post-hoc test.
Results: Our findings suggested increased scores of ADHD children's executive functions by age. A significant difference in the average of scores of executive functions among different age-groups was noted. There was no significant difference in the average scores for executive function between boys and girls.
Conclusion: Based on our finding, the development process of executive functions in boys and girls with ADHD follows an upward trend by age. Moreover, based on ToL test results, there was no significant difference in executive functions between girls and boys with ADHD, aging 5-12 years.
The Effect of Autonomy Supportive Teaching Style on Creativity in Preschoolers
Mohammad Hosein Sharifian, Shahriar Shahidi , Jalil Fathabadi , Zoha Saeedi ,
Volume 16, Issue 4 (1-2015)
Abstract
Introduction: With reference to the significance of self-determination theory in education, the present study was designed to investigate the effects of autonomy-supportive teaching style on creativity in preschoolers. Autonomy- supportive teachers versus control teachers, attempt to facilitate intrinsic motivation with their acts in the classroom and beyond.
Methods: The teaching style of teachers was examined using the Problems in School questionnaire (PIS). In addition, one hundred preschool students in four preschool centers in Tehran were assigned to four quasi-experimental groups over a 6 month period. Creativity was examined by Torrance Test of Creativity in Action and Movement (TCAM).
Results: According to our findings, participants in autonomy-supportive teaching style groups demonstrated higher creativity compare to the control group.
Conclusion: As hypothesized, the present study provided additional evidence on the effect of autonomy-supportive teaching style on educational achievements including the creativity capacity.
comparison of attentional abilities of preschool children aged 5 to 7 years
Alireza Hafezi, Ahmad Yarmohamadian, Amir Ghamarani,
Volume 19, Issue 4 (1-2018)
Abstract
Introduction: The purpose of this study was to investigate the evolution of the types of attention in preschool children aged 5 to 7 years. Method: In this descriptive cross-sectional study, 200 preschool children (100 girls and 100 boys) aged between 5 and 7 were selected through random cluster sampling from the city of Tabriz, Iran, in 2016. To determine the evolution process of the types of attention, the test developed by Hafezi et al. (2016) was employed and the data analysis was carried out using a two-way ANOVA. Results: The results showed that the scores of the attention in girls and boys were increased with regard to age except for auditory, Selective, divided, focused and Total score of attention. In terms of both genders, except for flexible, selective and   divided attention, other types of attention showed meaningful differences between boys and girls. With the exception of selective, divided and Centralized attention, there was a significant interaction between genders and age in other types of attention (p≤0.05). Conclusion: Attention in preschool children aged 5 to 7 years has  complex dimensions of evolution, which necessitates further studies.

A systematic review of programs improving executive functions and social-emotional skills of preschoolers
Mohsen Mir Mohammad Sadeghi, Mohammad Javad Fahimifar, Fatemeh Azad Manjir,
Volume 22, Issue 4 (1-2021)
Abstract
Introduction: The high importance of preschool in activating children's cognitive capacities, executive functions and social-emotional skills is evident to researchers in this area. Regarding this matter, the present study, to obtain an overview of the existing studies in this area, aimed to conduct a systematic review of the existing intervention programs to improve preschools’ the level of executive functions and social-emotional skills.
Methods: In this systematic review, English-language research in the fields of the effectiveness of educational programs to enhance executive functions, and social-emotionalskills in preschool children indexed in the Google Scholar, Springer, and ScienceDirect databases from 1990 to 2019, have been searched using the following keywords: "Executive functions in preschoolers", "Executive functions training programs in preschoolers", "Social-emotional competence in preschoolers", "Social-emotional skills in preschoolers", "Executive functions and academic achievement or performance in preschoolers", "The effectiveness of Social-emotional training programs on preschoolers", and "The effectiveness of cognitive training programs on preschoolers". In addition, Persian-language studies that have been uploaded in Magiran, Noormags, and Scientific Information Database (SID) from 2001 to 2019 have been searched using the following keywords: "Social-emotionalSkills", "Functions" "Executive", "Academic Achievement", "Academic Performance", "Academic Success", "Preschool Children" and "Children 4 to 6 years old".
In total, more than 200 studies in this field were reviewed and evaluated, and 66 articles were selected. After the initial selection, credible studies in which educational interventions were conducted only to improve executive functions and social-emotionalskills in preschool children and solve their behavioral problems were selected. Among these, studies in which the educational program’s purpose was to improve the level of children's academic performance were excluded from the study. Then, from the selected articles, information was collected, classified, and summarized in three areas of executive function training, social-emotionalskills training, and simultaneous training of these two to preschool children. Due to systematic review method, no ethical issues were faced during this study’s conduction.
Results: The results of current research revealed that most of the studies were conducted to improve students’ executive functions and social-emotional skills. Moreover, despite the effectiveness of various curricula in improving preschoolers’ cognitive, social-emotional and academic skills, a comprehensive curriculum in which executive functions and social-emotional skills are being trained together does not exist.
Conclusion: It is suggested that developers of educational programs for preschool children pay attention to more areas of children's development based on the present study’s findings. Namely, they should try to teach executive functions and social-emotionalskills to children in a combined way. Also, educational programs should include programs for training teachers and school staff to implement their school and classroom programs better. Moreover, classroom management techniques and improving the teacher-student relationship, as well as attracting parental involvement, and training parents to improve parent-child relationships are essential. To this end, it is suggested that programs for teaching executive functions and social-emotionalskills to preschool children should be developed and implemented at three levels of education for parents, teachers, and children. Future studies in this field and focusing on implementing the program on children with low cognitive, emotional, and behavioral skills, should also consider improving the level of these skills in normal children. In addition, educational programs can lead to better learning and the consolidation of skills in children if they are designed to be implemented for at least one academic year. Finally, it is suggested that domestic developers of programs and be more transparent in reporting on the implementation method and details of their programs so that these interventions can be more accurately evaluated and compared with foreign programs.

Investigation of the evolution of attention-related abilities in preschool and primary school children with normal development
Mahtab Norouzian, Vahid Nejati, Fariborz Bagheri,
Volume 24, Issue 3 (10-2022)
Abstract
Introduction
The foundations of knowledge, skills, and attitudes are formed from the preschool age. Hence, it is necessary to pay attention to any educational development and innovation from the early years of childhood. One of the main factors of teaching and learning is the level of attention of learners to the subject of the lesson. Indeed, attention includes information selection, integration of selected information, memory processes, and scheduling of responses. Deficiency in attention function will lead to deficiency in all purposeful activities from the simplest to the most complex. As psychologists emphasize that the initial stage of any learning begins with attention and insufficient attention to the learning impairs individual learning. Numerous studied have been done on the attention abilities in preschool and elementary school children. However, so far, a comprehensive study has not examined the evolution of the mentioned abilities in preschool and elementary school children with natural development, and in this regard, a gap in research is felt. Thus, such research helps examine the evolution of children's attention, executive function, and emotional recognition. The current study aimed to investigate the evolution of attention-related abilities in preschool and elementary school children with normal development.
Methods
The present study was descriptive and comparative. The study population included all preschool and elementary school students in schools in districts 1, 2, and 3 of Tehran and the 2018-2019 academic year. Four hundred children were selected from these children using the cluster multi-stage random sampling method. In order to select the sample, first from preschool and elementary school centers in Tehran, three districts were randomly selected, and then from among these three districts, three schools were randomly selected. Then, two classes were randomly selected from each school in each grade. After that, according to the inclusion and exit criteria of the research, 410 students from these classes were selected as a sample group with natural evolution. Inclusion criteria in this group were: being a pre-school and elementary school student in the selected area, conscious satisfaction, and desire to participate in research. The N-Back test, which is a task of measuring cognitive performance related to executive actions and was first introduced in 1985 by Kirchner, was administrated. Since this task involves storing and manipulating cognitive information, it is well-known for measuring working memory performance. It is done using simple visual stimuli such as letters of the alphabet or shapes. Reliability coefficients in the range of 0.54 to 0.84 showed the high validity of this test. The validity of this test is also very acceptable as an indicator of working memory performance were used to collect data. One-way analysis of variance and Tukey post hoc test by SPSS-22 was used to analyze the data.
Results
Findings from demographic data showed that among 410 subjects, 199 (48.5%) were girls, and 211 (51.5%) were boys. The study subjects had an age range of 5 to 11 years, among which eight years had the highest frequency (15.6%). In order to determine evolution attention abilities in preschool and elementary school children with normal and abnormal development, an analysis of variance test was used. Before presenting the results of the analysis of variance, the assumptions of parametric tests (normality of data distribution, homogeneity of variance, and equality of variances assumption) were evaluated. First, the normality of data distribution was checked and confirmed using the Kolmogorov-Smirnov test (P>0.05). The Levene’s test also tested the assumption of homogeneity of variance, which showed the results for the variables of ability to attention (F=2.56, P=0.194) were not significant. Thus, the assumption of homogeneity of variance was observed. Besides, the results of the Mauchly's sphericity test showed that the equality of variances assumption was observed in the variables of ability to attention (P<0.05). The results showed attention abilities in children with normal development as they age. The results of the analysis of variance showed that participants with different ages have different attention abilities and differences between different ages in all components of attention abilities, including first-stage reaction time, second-stage reaction time, third-stage reaction time, first-stage error, second-stage error, the third-stage error is significant at the level of 0.001. Tukey post hoc test was used to compare ages in each component (first-stage reaction time, second -stage reaction time, third-stage reaction time, first-stage error, second-stage error, and third-stage error). The post hoc test results showed that older age groups show significantly higher accuracy and less reaction time than lower age groups.
Conclusion
The results of this study indicated that attentional abilities in students are age-dependent and, with age increase, attentional abilities grow and develop. According to the present study’s results, students' attention ability has an essential role in improving their social relationships and academic performance. Therefore, examining and strengthening it in elementary school ages, around four to eight years old and even up to 12 years old when the development of forehead parts is complete, has a vital role in academic success. On the other hand, it is suggested that attention abilities be examined through standardized tests and the results be recorded in the students' files. Like other studies, the present study has some limitations. Among the limitations of the present study, we can mention the present study’s design and the use of cross-sectional methods, which will not lead to the stability of results. Besides, among the other limitations of the present study, we can mention the limited research on preschool and elementary school students in Tehran, Iran, so it is suggested that other similar research be done with different occupational groups in other cities and with different cultures to remove the limit of generalizability of the results.
Ethical Considerations
Compliance with ethical guidelines
This research meets guidelines for ethical conduct and report of research. The participants signed the informed consent form and had the right to leave the study at any time. They were assured that all information would remain confidential and would only be used for research purposes. All subjects received information about the study at any time could leave the study. For privacy reasons, the subjects' details were not recorded.

Authors’ contributions
Mahtab Norouzian and Vahid Nejati: Defined the concepts in choosing the subject and designing the study. Mahtab Norouzian: Collected and analyzed data. Fariborz Bagheri: Writing and drafting. All authors performed a search of the research literature and background and discussed the results and participated in preparing and editing the article’s final version.
Funding
This research did not receive any specific grant from the public, commercial, or non-profit funding agencies. This research was extracted from the PhD Dissertation of the first author, in the Department of Psychology, faculty of psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran.
Acknowledgments  
The authors are grateful to all participants in the research and those who have facilitated the implementation of the present research.
Conflict of Interest
The author declared no conflict of interest
 
Validity and reliability of executive function tests for preschoolers: Pilot study
Samineh S. Pourtakdoust, Javad Hatami, Alireza Moradi,
Volume 25, Issue 1 (3-2023)
Abstract
Introduction 
Executive functions organize thoughts toward purposeful behaviors (1). Defects in these functions can indicate damage to the prefrontal cortex. Early assessment can detect defects in this area in the early stages and consider rehabilitation programs for children (7). A wide variety of tests have long been available to evaluate executive functions. Among those that assess executive functions in children, it can be found the Fish Flanker Task, Dots Task (Hearts & Flowers), and the Form Span Task, designed by Adele Diamond.
These three tests examine the three basic components of executive functions: inhibitory control, cognitive flexibility, and working memory. Considering the usefulness of these tests, the importance and necessity of studying executive functions in children, and the lack of valid and special tools for preschool children to directly measure executive functions in the country, known tests in this area need to be translated and standardized. Therefore, this study was conducted with the aim of a preliminary study of three questions: 1- validity, 2- differential power, and 3- reliability of the mentioned tests to provide a tool for measuring executive functions in preschool children.
Methods
Seventy-four children aged 4 to 6 years in Tehran were evaluated in this study. After obtaining parental consent, they completed the Behavior Rating Inventory of Executive Function Preschool version (BRIEF-P), the Child Behavior Checklist Preschool version (CBCL-P), and the demographic information form. After collecting and scoring the questionnaires, based on the scores of subscales of DSM of CBCL, the subjects were divided into normal and clinical groups. Then, Flanker task, Hearts & Flowers task and Form Span were taken from children in two sessions of 10-15 minutes. The data were analyzed using a correlation test to evaluate the simultaneous criterion validity. Then, to measure the differentiation power of the test, the mean scores of the normative and clinical groups were compared using the independent t-test. The tests were repeated five weeks apart for half of the subjects to check their reliability. Data were analyzed by Excel 2016 and SPSS-22.
Results 
Spearman correlation was calculated between the results of the BRIEF questionnaire and the results of the Diamond tests to evaluate the validity of the tests. The correlation rate in the working memory component of the two tests was 0.63, the inhibitory control component was 0.87, and the flexibility component was 0.89.
Accordingly, a significant relationship was found between the components of executive function tests and BRIEF subscales.
In the next step, to evaluate the differentiation power of the tests, the scores of the subjects in the clinical group (n=15) were compared with 15 subjects in the normal group using the independent t-test. 
The findings of Table 1 show that there is a significant difference in all components between the scores of normal and clinical groups (P<0.01). These differences indicate the optimal diagnostic validity of executive function tests.
1. Results of independent t-tests to compare normal and clinical children for executive function components
 
Normal
 
Clinical
 
Tasks
 
Mean
 
Standard Deviation
 
Mean
 
Standard Deviation
 
T Score
 
Working memory
 
51.02
 
9.60
 
43.65
 
9.24
 
2.67
 
Inhibitory control
 
52.36
 
7.83
 
43.41
 
7.62
 
3.97
 
Cognitive flexibility
 
52.45
 
7.49
 
42.29
 
7.73
 
4.46
 
Five weeks after the initial test, a retest was performed for half of the subjects to evaluate the reliability of the test. The correlation rate was 0.71 in the working memory component of the test and retest, 0.80 in the inhibitory control component, and 0.78 in the flexibility component. Accordingly, there is a good correlation between the scores of the components of executive function tests in the test and retest. Therefore, these tests have the desired reliability.
Conclusion
The presence of these tasks in preschool age is essential for early detection of defects in the prefrontal cortex. Seemingly, due to the use of color shapes and game format, the child communicates better with the tasks and provides more realistic results of the child's ability than the interview and paper-pencil tests. Another advantage of these tasks is that they are specific to the task area. In many questionnaires, the terms used to score several abilities are common or overlapping. However, in these tasks, according to the possibility of calculating the score in each part of the task, the score of selective attention, shifting, inhibition, and flexibility can be obtained separately. Furthermore, since the reaction time is recorded in computer tests, scores can be calculated and compared separately regarding accuracy and speed. This feature allows therapists to design appropriate interventions and exercises according to the subject's needs. These tests can be used in various cases, such as measuring and diagnosing executive function disorders in clinical groups, such as attention deficit/hyperactivity disorder, coping disorder, anxiety disorders, and depressive disorders. These tests also can be used for designing children's interviews.
In a similar study in Canada on 42 children aged 3-5 years, there was a strong correlation between the components of inhibitory control, working memory, and flexibility in a set of tests designed to measure executive function and BRIEF questionnaire scores. These findings confirm the results of the present study. One of the limitations of this study is the impossibility of sampling in other cities and larger samples.
Ethical Considerations
Compliance with ethical guidelines 
All participants participated in the study with their consent and their parents' consent. The children were free to leave the room whenever they did not want to continue the assessment or felt tired. Individuals' information is protected. In performing the test, the examiner behaved in such a way that the child did not feel defeated or weak, and participating in this study did not cause any psychological or physical harm.
Authors' contributions 
Samineh S. Pourtakdoust, Javad Hatami & Alireza Moradi: Designed and conceived the presented idea. Samineh S. Pourtakdoust: performed experiments and analyzed data. Samineh S. Pourtakdoust: Performed testing section during the experiment. All authors supervised the research & provided critical feedback, and reviewed the initial and final versions.
Funding 
This research received no financial support from any funding agency in the public, commercial, or not-for-profit sectors.
Acknowledgments 
The authors thank all the participants, colleagues, and experts who helped us conduct this study.
Conflicts of interest 
The authors acknowledged no potential conflicts of interest regarding this article's research, authorship, and/or publication.

Design and validation of an attention and concentration training program and its impact on visual perception in preschool children
Alireza Sebghati, Alireza Kiamanesh, Valiollah Farzad,
Volume 26, Issue 2 (8-2024)
Abstract
Introduction
Childhood is considered as a pivotal period for developing fundamental cognitive skills (1). Research indicates that the first five years of a child's life are critical for cognitive skill development (2). Among the essential abilities necessary for learning in preschool children is attention. Attention is conceptualized as an integral component in all cognitive processes (3). Studies suggest that, like other skills, attention can be enhanced through education and practice (9). An example of an approach to improving cognitive structure is attention training using the Sohlberg and Mateer 2001 method (10). These exercises aim to address deficiencies in attention dimensions through specific attention exercises, thereby enhancing attention-related abilities, including visual perception in children (12). Visual perception is the process of integrating sensory-based data from experiences to make accurate judgments about objects’ size, shape, color, and spatial relationships (13). Recognizing the role of education in preventing learning difficulties in preschool children and the importance of providing timely preschool education to prevent such problems, this research aimed to develop an educational package on attention and concentration and assess its effectiveness on the visual perception of preschool children.
Methods
The present study employed an experimental design with pre-test and post-test control groups and a follow-up period. The statistical population included preschool children aged five to six in Tehran, Iran, who were enrolled in preschool centers in the years 2022-2023. Sampling was conducted by randomly selecting District 10 among the educational districts, and two preschools from this district were randomly chosen one as the experimental group and the other as the control group. Twenty students were randomly selected from each preschool, totaling 40 participants in the research. The primary objective was to investigate the validity and reliability of the “Attention and Concentration” educational package developed and its effectiveness on the visual perception of preschool children. The following four stages were undertaken to achieve this:
First Stage: Conducting literature studies and reviewing the research premise.
Second Stage: Designing an educational exercise package to improve visual perception and assess content validity. Content validity was evaluated using the Lawshe method, with supervision from 10 experts in the field of executive functions. Content validity ratio (CVR) and content validity index (CVI) were assessed, and the content was modified based on expert opinions.
Third Stage: Pilot program development
Ten students available at the time participated in a 30-session training program, each lasting 1 hour per day and conducted three days per week. Upon re-evaluation, the session count was adjusted to 20, maintaining the same duration and frequency.
Fourth Stage: Implementation of educational intervention
Before the intervention, both the experimental and control groups underwent a pre-test using the TVPS visual perception test. Subsequently, the educational program was implemented for the experimental group, consisting of 20 sessions lasting 1 hour per day, conducted three days per week. The control group did not receive this educational intervention. After completing the program, the TVPS test was administered again to both groups. A follow-up test was conducted after a 2-month interval from the pre-test, where students from both groups completed the TVPS questionnaire. The collected data was then analyzed.
Results
In the first stage, ten experts assessed the content validity of the attention and concentration educational package, confirming its adequacy through CVR and CVI. Therefore, the validity of the educational package was established. Descriptive statistics, including mean, standard deviation, and skewness, were examined for both the experimental and control groups to describe the average performance and dispersion of participants’ scores in visual perception variables.
In the experimental group, visual perception showed an increasing trend from pre-test (80.8) to post-test (85.11) and follow-up (87.12). However, in the control group, the mean visual perception scores decreased from the pre-test (70.17) to the post-test (60.01), and follow-up showed a mean of 59.95, indicating a decreasing trend.
After ensuring assumptions such as the continuity of the dependent variable, normality of data distribution, homogeneity of covariance among groups, and independence of individuals, a mixed analysis of variance (ANOVA) was conducted (within-subjects factor and between-subjects factor). The visual perception score variable was analyzed across three levels (pre-test, post-test, and follow-up) and two groups (experimental and control).
Mauchly’s sphericity test was employed to verify the homogeneity of covariances. As the calculated Mauchly’s sphericity value was less than 0.05 (0.008<0.05, χ² (2)=59.9, W=77), indicating a violation of the assumption of covariance homogeneity, the correction methods such as epsilon estimation or multivariate tests were considered.
The summary of within-group ANOVA analysis revealed a significant interaction effect between visual perception and group (P<0.001, F (15.191)=15.191). This interaction implies that different results were obtained from the combination of levels of visual perception (pre-test, post-test, and follow-up) and group levels (control and experimental). The between-group ANOVA analysis showed a significant difference between the two groups (P<0.001, F (38.127)=38.127), indicating a meaningful distinction between the experimental and control groups.
The results of the mixed ANOVA showed that the main effect of time on visual perception is significant (F (2, 37)=71.14, P<0.001, η²=0.64). This result indicates that, regardless of the experimental and control groups, the mean visual perception scores significantly changed from pre-test to post-test and follow-up. Furthermore, the interaction effect between time and group is also significant (F (2, 37)=7.66, P<0.001, η²=0.27). This means that the changes in the mean visual perception scores across the three stages of pre-test, post-test, and follow-up differ significantly between the experimental and control groups. Finally, the main effect of the group is also significant.
Table 4 indicates that the experimental intervention significantly impacted the experimental group. Finally, to determine which two periods among the mean scores of the three test phases differed, the Bonferroni post-hoc test was utilized. The results indicated a significant difference between pre-test scores and both post-test (P<0.001) and follow-up (P<0.001) scores, confirming the second hypothesis of the research regarding the effect of the attention and concentration educational package on the visual perception of children between the pre-test and post-test phases.
Table 4. Result of within-group and between-group analysis of variance
Change of sources Sum of Squares DF Mean Squared F P
Between-group Visual Perception 153.63 1.736 88.51 205.10 0.001
Visual Perception Group 143.18 1.736 82.49 191.15 0.001
Error 28.64 65.95 0.43
Group 21.27 1 21.27 27.33 0.001
Error 29.56 38 0.77

Conclusion
The primary aim of this research was to develop an educational package to enhance attention and concentration and determine its effectiveness on the visual perception of preschool children. As per the studies conducted, the first five years of a child's life mark a crucial developmental stage for cognitive skill growth, laying the foundational groundwork for a child's initial learning experiences during this golden period. One of the most vital and necessary factors influencing education and learning is attention. Attention is the process of directing processing resources toward a particular stimulus, playing a crucial role in advanced mental activities such as planning, problem-solving, and reasoning.
This research focused on the content of an educational program based on Frostig’s perceptual approach and emphasized exercises related to attention, concentration, and visual perception. Exercises such as visual clarity, shape stability, spatial visual perception, shape discrimination against a background, visual completion, and visual-auditory memory sequence were highlighted. The research results distinctly indicate the effectiveness of the educational intervention. Additionally, the content validity of the educational package was confirmed by ten experts in the field of executive functions and learning disabilities. However, what ensures the sustained positive effects of cognitive interventions beyond the continuity of educational exercises is the role of age. Therefore, age plays a crucial role alongside the continuous practice in educational interventions. Ensuring the long-term effects of visual perception-related exercises relies not only on consistent practice post-education but also on adapting exercises according to the increasing age of children.
Ethical Considerations
The conditions of this research were such that no mental or physical damage existed to the study participants. Besides, the current research has followed the ethical principles that include obtaining informed consent and the principle of secrecy of the participants for the confidentiality of their information. Furthermore, in this research, the subjects were given sufficient information about conducting the research, and the participants were free to withdraw from the study.
Authors’ contributions
All authors were involved in topic selection, study design, concept definition, data collection, analysis, writing, and drafting of the article. The article’s final version was also studied and approved by all authors.
Funding
The authors received no financial support for the present research, authorship, and/or publication of this article. This research is extracted from the first author’s PhD dissertation at the Faculty of Humanities and Social Sciences, Tehran Azad University of Science and Research.
Acknowledgments
The authors are grateful to all participants in the research and all those who have facilitated the re-research’s implementation.
Conflict of interest
The author declared no conflict of interest.
 
Design, validation, and efficacy of an executive function training program on response inhibition in preschool children
Sahar Shariati, Alireza Kiamanesh, Valiollah Farzad,
Volume 26, Issue 3 (11-2024)
Abstract
Introduction
Executive functions refer to an individual’s actions for self-regulation, controlled and purposeful behavior, and maximizing future outcomes. In recent years, with significant growth in preschool centers, particularly in urban areas, parents and educators have become increasingly aware of the role of executive functions in learning. According to Miyake’s three-component model classification, fundamental executive functions include updating working memory, inhibitory control, and flexibility. Therefore, inhibitory control is recognized as a foundational component in executive functions. According to Barkley, inhibitory control aids in delaying responses and controlling interference, playing a crucial role in behavior regulation. Given the significance of executive functions, extensive studies have been conducted to evaluate the effectiveness of educational programs aiming to strengthen children and adolescents’ executive functions, both domestically and internationally. However, a considerable portion of these studies has focused on investigating executive functions in preschool children or children with special needs. Additionally, despite the importance of executive functions in learning and individual life, studies focused on skills associated with executive functions are limited. This limitation highlights the need to formulate and implement programs to strengthen executive functions, leading to the current research that aims to develop an educational package to enhance executive functions and determine its impact on inhibitory control in preschool children.

Methods
The present study followed an experimental pre-test-post-test design with a control group and a follow-up period. The statistical population included preschoolers aged 5-6 in Tehran, Iran, who were enrolled in preschool centers in the 2022-2023 academic year. Among educational districts, Area 8 was randomly selected, and from the preschool centers in this area, two pre-schools were randomly chosen: One as the experimental group and one as the control group. Twenty students were randomly selected from each pre-school, and a total of 40 students participated in the research. Eventually, due to incomplete data from one student in the control group, data from 19 students in both the control and experimental groups were analyzed. The primary objective of this research was to examine the validity and reliability of the developed executive functions educational package and investigate its effectiveness on inhibitory control in preschool children. The following 4-stage experiment was conducted to achieve this goal:
First Stage: Conducting a literature review for the research background.
Second Stage: Designing an educational package - training to enhance inhibitory response skills and assessing content validity. To assess content validity using the Lawshe method, the content was evaluated by ten specialists in executive functions evaluated the content. The content validity ratio (CVR) and content validity index (CVI) were evaluated, and the content was modified based on the experts' opinions.
Third Stage: Pilot study. Ten available students underwent 12 one-hour sessions over two days per week. After a reassessment, the number of sessions was ultimately adjusted to 20 one-hour sessions conducted thrice weekly.
Fourth Stage: Main study. Before the experiment, parents of the students in both the experimental and control groups responded to the inhibitory response section of the Brief questionnaire. Then, the educational package was implemented for 20 one-hour sessions over three days per week with the students in the experimental group. The control group students did not receive this training. After the experiment, parents of both groups responded to the Brief behavioral questionnaire as a post-test. After a two-month interval from the pre-test, a follow-up test was conducted, and parents of both groups answered the Brief questionnaire again, and the collected data was analyzed.

Results
To understand the average performance and distribution of test scores in the inhibitory response variable, statistical descriptions of inhibitory response variables for both the experimental and control groups were examined, including means, standard deviations, and skewness. In the control group, the total scores for inhibitory response were 35 in the pre-test, 34.84 in the post-test, and 34.78 in the follow-up, indicating very slight changes. In the experimental group, the average scores were 35.42 in the pre-test, 28.52 in the post-test, and 25.5 in the follow-up, showing a decreasing trend. The average performance in the control group compared to the experimental group had an imperceptible difference in the pretest (0.42), a difference of 6.32 scores in the post-test favoring the control group, and reduced to 11.11 in the follow-up. This trend suggests a decrease in inhibitory response scores and an improvement in inhibitory response skills in the experimental group compared to the control group. At the same time, no significant difference was observed in the control group in the scores between pre-test, post-test, and follow-up.
Additionally, to investigate the homogeneity of the variables’ covariance, Mauchly’s sphericity test was utilized. Given that Mauchly’s sphericity test is less than 0.5, indicating a significant violation of homogeneity assumption (P<0.05; χ²=6.62; ε=0.03), suggesting that covariance homogeneity is questioned. Therefore, adjustments for the violation of assumptions were made using the Huynh-Feldt Epsilon correction due to the adequate sample size in this study.
The summary of the within-group analysis of variance indicates a significant effect on inhibitory response (P< 0.001; F=145.83). Moreover, there is a significant interaction effect between inhibitory response and group (P<0.001; F=135.16). This interaction suggests that different results are obtained from combining levels of inhibitory response (pre-test, post-test, and follow-up) and group levels (control and experimental). The between-group analysis of variance, based on observed means, reveals a significant difference between the two groups (P<0.001; F=95.36), indicating a significant effect of the experiment on the experimental group.
Finally, a Bonferroni follow-up test was employed to determine which two intervals differ significantly among the three-test means.

Table 1. Bonferroni Analysis Result of Inhibitory Response
Group Group Average different P
Pre-test Post-test 3.53 0.001
Follow-up 5.77 0.001
Post-test Follow-up 2.24 0.001

The analysis revealed significant differences between pre-test and post-test scores (P<0.001), pre-test and follow-up scores (P<0.001), and post-test and follow-up scores (P<0.001). Therefore, the research hypothesis regarding the impact of executive functions on inhibitory response in preschool children was confirmed for both the post-test and follow-up periods.
Conclusion
The primary objective of this research was to develop an executive functions educational package and determine its impact on inhibitory response in 5-6-year-old preschool children. Improvements in executive functions during the pre-school years occur due to physiological changes in the brain, specifically in the pre-frontal cortex, and this region’s increased connectivity and integration with other brain areas. While the physiological reasons behind the development of executive abilities have been somewhat clarified, less attention has been paid to the influence of environmental factors on the development of these skills during this age period. Additionally, limited studies have focused on developing educational packages targeting executive functions and examining their effect specifically on the preschool age group.
In this research, the program content is based on Barkley’s approach, emphasizing exercises such as emotional recognition, appropriate expression and management, understanding others’ perspectives, proper interaction in social situations, and ultimately, exercises in inhibitory response and thinking before acting. The research results indicate the effectiveness of the educational intervention. Moreover, ten experts in the executive function field have endorsed the educational package’s validity. However, the role of age ensures the sustained positive effects of cognitive interventions, in addition to the continuation of educational exercises. Vas et al.’s research findings have shown that the effectiveness of cognitive training is more impactful and enduring when children are in the early stages of growth and early childhood.
Ethical Considerations
Compliance with ethical guidelines
The conditions of this research were such that no mental or physical damage existed to the study participants. Besides, the current research has followed the ethical principles that include obtaining informed consent and the principle of secrecy of the participants for the confidentiality of their information. Furthermore, in this research, the subjects were given sufficient information about conducting the research, and the participants were free to withdraw.
Authors’ contributions
All authors were involved in topic selection, study design, concept definition, data collection, analysis, writing, and article drafting. All authors also studied and approved the article’s final version.
Funding
The present research received no funding from any financing organization.
Acknowledgments
In the end, the authors are grateful to all participants in the research and to all those who have facilitated its implementation.
Conflict of interest
The author has not reported any conflict of interest.
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