Effect of a Positive Discipline Parent Education Program on Executive Functions of Children With Attention Deficit Hyperactivity Disorder

Document Type : Original article


1 Department of Psychology and Education of Exceptional Children, Allameh Tabatabaei University, Tehran, Iran.

2 Department of Psychology, Allameh Tabatabaei University, Tehran, Iran.


Background and Aims: One of the major problems in children with Attention Deficit Hyperactivity Disorder (ADHD) is a deficiency in cognitive skills, especially executive functions. The present study aims to evaluate the effect of a positive discipline parent education program on the executive functions of children with ADHD.
Methods: The study population consists of the parents of all children aged 7-11 years with ADHD in Isfahan, Iran in 2018. Of these, 30 parents of children who met the Diagnostic and Statistical Manual of Mental Disorders criteria (fifth edition) were selected using a convenience sampling method and were randomly divided into intervention and control groups. The data collection tools were Attention Deficit Hyperactivity Disorder Diagnostic Questionnaire and the Coolidge Neuropsychological Inventory for Children (CPNI). The positive discipline program was presented at 8 sessions, each for 90 minutes.
Results: There was a significant difference in the decision making/planning (p < 0.001) and inhibition (p < 0.001) components of CPNI between the two study groups, but the difference was no difference in the organization component. The results of repeated measures ANOVA showed that program in post-test and follow-up phases was effective in terms of decision making/planning and inhibition components.
Conclusion: The positive discipline parent education program has a positive effect on executive functions of children with ADHD.


Main Subjects

  1. Chiu T, Ku W, Lee M, Sum W, Wan M, Wong C, et al. A study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong. Journal of Occupational Rehabilitation. 2002; 12(2):77-91. [DOI:10.1023/A:1015008513575] [PMID]
  2. Seidi F. The effect of a 12-week corrective exercises program on Forward head and shoulder deformities (Persian)]. Journal of Sport Medicine Studies. 2014; 5(14):31-44. https://smj.ssrc.ac.ir/article_163.html
  3. Farzane Alvandi, Amir Letafatkar. [The effect of respiratory exercises on pain, disability, proprioception and forward head angle in female patients with chronic neck pain (Persian)]. Journal of Anesthesiology and Pain. 2018; 9(1):44-54. http://jap.iums.ac.ir/browse.php?a_id=5356&slc_lang=fa&sid=1&printcase=1&hbnr=1&hmb=1
  4. Bakhtiary A, Hajihasani A, Hedaiati R, Aminianfar A. Investigation on the effect of stabilizer exercises on the forward head posture correction. Quarterly Annals of Military and Health Sciences Research. 2012; 10(2):111-7. https://www.sid.ir/en/journal/ViewPaper.aspx?id=254409
  5. Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: The Janda Approach. The Journal of the Canadian Chiropractic Association. 2012; 56(2):158. [PMCID]
  6. Yang DJ, Da HK. Comparison of muscular fatigue and tone of neck according to craniocervical flexion exercise and suboccipital relaxation in cervicogenic headache patients. Journal of Physical Therapy Science. 2017; 29(5):869-73. [DOI:10.1589/jpts.29.869] [PMID] [PMCID]
  7. Howard PD, Behrns W, Martino MD, DiMambro A, McIntyre K, Shurer C. Manual examination in the diagnosis of cervicogenic headache: A systematic literature review. Journal of Manual and Manipulative Therapy. 2015; 23(4):210-8. [DOI:10.1179/2042618614Y.0000000097] [PMID] [PMCID]
  8. Mingels S, Dankaerts W, van Etten L, Thijs H, Granitzer M. Comparative analysis of head-tilt and forward head position during laptop use between females with postural induced headache and healthy controls. Journal of Bodywork and Movement Therapies. 2016; 20(3):533-41. [DOI:10.1016/j.jbmt.2015.11.015] [PMID]
  9. Fleming R, Forsythe S, Cook C. Influential variables associated with outcomes in patients with cervicogenic headache. Journal of Manual and Manipulative Therapy. 2007; 15(3):155-64. [DOI:10.1179/106698107790819846] [PMID] [PMCID]
  10. Newcastle C. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. 2009; 8(10):959-68. [DOI:10.1016/S1474-4422(09)70209-1]
  11. Bodes-Pardo G, Pecos-Martín D, Gallego-Izquierdo T, Salom-Moreno J, Fernández-de-las-Peñas C, Ortega-Santiago R. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: A pilot randomized clinical trial. Journal of Manipulative and Physiological Therapeutics. 2013; 36(7):403-11. [DOI:10.1016/j.jmpt.2013.05.022] [PMID]
  12. Sremakaew M, Sungkarat S, Treleaven J, Uthaikhup S. Impaired standing balance in individuals with cervicogenic headache and migraine. Journal of Oral and Facial Pain and Headache. 2018; 32(3):321-8. [DOI:10.11607/ofph.2029] [PMID]
  13. Yu M, Wang X. Neck pain and proprioception deficit influence the cervical motion assessed by instantaneous axis of rotation. Acta Neurochirurgica. 2018; 160(6):1265. [DOI:10.1007/s00701-018-3546-4] [PMID]
  14. Chu ECP, Chu VKY, Lin AFC. Cervicogenic headache alleviating by spinal adjustment in combination with extension-compression traction. Archives of Clinical and Medical Case Reports. 2019; 3(5):269-73. [DOI:10.26502/acmcr.96550090]
  15. France S, Bown J, Nowosilskyj M, Mott M, Rand S, Walters J. Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension-type headache: A systematic review. Cephalalgia: An International Journal of Headache. 2014; 34(12):994-1003. [DOI:10.1177/0333102414523847] [PMID]
  16. Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine-systematic review and meta-analysis. Cephalalgia: An International Journal of Headache. 2016; 36(5):474-92. [DOI:10.1177/0333102415597889] [PMID]
  17. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002; 27(17):1835-43. [DOI:10.1097/00007632-200209010-00004] [PMID]
  18. Nobari M, Arslan SA, Hadian MR, Ganji B. Effect of corrective exercises on cervicogenic headache in office workers with forward head posture. Journal of Modern Rehabilitation. 2017; 11(4):201-8. https://jmr.tums.ac.ir/index.php/jmr/article/view/132
  19. Rani M, Kulandaivelan S, Bansal A, Pawalia A. Physical therapy intervention for cervicogenic headache: An overview of systematic reviews. European Journal of Physiotherapy. 2019; 21(4):217-23. [DOI:10.1080/21679169.2018.1523460]
  20. Whittaker R. The effectiveness of an electromechanical adjusting instrumental compared to cervical spine manipulation in the treatment of cervicogenic headaches [MSc. thesis]. KwaZulu-Natal: Durban University of Technology; 2018. https://www.semanticscholar.org/paper/The-effectiveness-of-an-electromechanical-adjusting-Whittaker/501e9c1706f23144f075c0a0ddd7e8fe356bd726
  21. Park SK, Yang DJ, Kim JH, Kang DH, Park SH, Yoon JH. Effects of cervical stretching and cranio-cervical flexion exercises on cervical muscle characteristics and posture of patients with cervicogenic headache. Journal of Physical Therapy Science. 2017; 29(10):1836-40. [DOI:10.1589/jpts.29.1836] [PMID] [PMCID]
  22. Balne NK, Ansari J, Gadde LP, Jabeen A, Waghray S. Role of cervical alignment-specific exercises in cervicogenic headache: An open label-comparative study. Indian Journal of Physiotherapy and Occupational Therapy. 2019; 13(3):74-81. https://medicopublication.com/index.php/ijpot/article/view/3660
  23. Kelly M. The difference in balance control between patients with cervicogenic headache and patients with neck pain: A pilot study [PhD. dissertation]. Florida: Florida Gulf Coast University; 2019. https://www.proquest.com/openview/1014c63f616782996fef0a29045ddeb8/1?pq-origsite=gscholar&cbl=18750&diss=y
  24. Creighton D, Gammons T, Monahan J. The effect of prepositioned upper cervical traction mobilization and therapeutic exercise on cervicogenic headache: A case study. Journal of International Academy of Physical Therapy Research. 2018; 9(3):1564-70. https://www.researchgate.net/publication/328904372_The_effect_of_prepositioned_upper_cervical_traction_mobilization_and_therapeutic_exercise_on_cervicogenic_headache_A_case_study
  25. Benoliel R, Svensson P, Evers S, Wang SJ, Barke A, Korwisi B, et al. The IASP classification of chronic pain for ICD-11: Chronic secondary headache or orofacial pain. Pain. 2019; 160(1):60-8. [DOI:10.1097/j.pain.0000000000001435] [PMID]
  26. Bahari M, Shafizadegan Z, Amani M, Heidari Z, Karimi A. [Assessment of head and trunk posture in men with cervicogenic headache via photogrammetry: A pilot study (Persian)]. Jurnal of Research in Rehabilitation Sciences. 2016; 12(4):227-34. http://jrrs.mui.ac.ir/index.php/jrrs/article/view/2753
  27. Seidi F, Rajabi R, Ebrahimi I, Alizadeh MH, Minoonejad H. The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle. Journal of Back and Musculoskeletal Rehabilitation. 2014; 27(1):7-16. [DOI:10.3233/BMR-130411] [PMID]
  28. Ylinen J, Nikander R, Nykänen M, Kautiainen H, Häkkinen A. Effect of neck exercises on cervicogenic headache: A randomized controlled trial. Journal of Rehabilitation Medicine. 2010; 42(4):344-9. [DOI:10.2340/16501977-0527] [PMID]
  29. Zandi Sh, Rajabi R, Alizadeh MH. Validity, intratester and intertester reliability of a noninvasive quantitative forward head posture assessment method. Journal of Research Sport Rehabilitation. 2016; 2(4):51-6. https://www.sid.ir/en/journal/ViewPaper.aspx?id=445482
  30. Karimi N, Ebrahimi I, Kharizi S, Torkaman G. Reliability of postural balance evaluation using the biodex balance system in subjects with and without low back pain. Journal of Postgraduate Medical Institute (Peshawar, Pakistan). 2008; 22(2). https://jpmi.org.pk/index.php/jpmi/article/view/227
  31. Seyedi M, Seidi F, Rahimi A, Minoonejad H. [An investigation of the efficiency of sensory systems involved in postural control in deaf athletes and non-athletes (Persian)]. Sport Medicine (Harakat). 2015; 7(1):111-27. https://www.sid.ir/en/journal/JournalList.aspx?ID=22080
  32. Makofsky HW, Douris P, Goldstein LB, Discepolo A, Grion K, Kushnir G, et al. The effect of the PostureJac on deep cervical flexor endurance: Implications in the management of cervicogenic headache and mechanical neck pain. The Journal of Craniomandibular and Sleep Practice. 2012; 30(1):187-93. [DOI:10.1179/crn.2012.009]
  33. Farmer PK, Snodgrass SJ, Buxton AJ, Rivett DA. An investigation of cervical spinal posture in cervicogenic headache. Physical Therapy. 2015; 95(2):212-22. [DOI:10.2522/ptj.20140073] [PMID]
  34. Shamsadidni Fard A, Daneshjoo A, Sahebozamani M. [The effect of 4 weeks corrective and elastic band exercises on craniovertebral angle and some selected factors of cervicogenic headache among female of Kerman (Persian)]. 2019; 2(4):349-59. http://ensani.ir/fa/article/423293/%D8%86
  35. Lederman E. Neuromuscular rehabilitation: summary. In: Neuromuscular rehabilitation in manual and physical therapy: Principles to practice. Elsevie: Churchill Livingstone; 2010. pp. 169-71. [DOI:10.1016/B978-0-443-06969-7.00014-0]
  36. Andersen P, Henriksson J. Training induced changes in the subgroups of human type II skeletal muscle fibres. Acta Physiologica Scandinavica. 1977; 99(1):123-5. [DOI:10.1111/j.1748-1716.1977.tb10361.x] [PMID]
  37. Sahrmann S. Diagnosis and treatment of movement impairment syndromes. Amsterdam: Elsevier Health Sciences; 2001. https://www.google.com/books/edition/Diagnosis_and_Treatment_of_Movement_Impa/3Z1sAAAAQBAJ?hl=en
  38. Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. Journal of Spinal Disorders. 1992; 5(4):383-9. [DOI:10.1097/00002517-199212000-00001] [PMID]
Volume 10, Issue 2
May and June 2021
Pages 246-257
  • Receive Date: 15 December 2019
  • Revise Date: 16 February 2020
  • Accept Date: 28 March 2020
  • First Publish Date: 22 May 2021