|Year : 2018 | Volume
| Issue : 1 | Page : 52-58
Effectiveness of the cool-down game in reducing emotional and behavioral problems of hyperactive children
Ezzat Hajimohammadi1, Mostafa Najafi2, Mozhgan Arefi1
1 Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
2 Faculty of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||3-Apr-2018|
Dr. Mostafa Najafi
Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
AIM: The goal of this study is to overview the effectiveness of cool-down game and the reduction of emotional and behavioral problems. The population of the study include 7–13-year-old kids living in Isfahan.
Methods: The research method was experimental with pretest, posttest, and control group. Forty-four children of 7–13 years old were selected through simple random sampling method from the clients who had referred to the psychiatrists' clinics and were diagnosed of having hyperactivity disorder/attention deficit by the super specialist of child and adolescent psychiatrist, and they were randomly divided into two groups of control and experiment, each with 22 individuals. The experiment group was under sixteen 60 min training sessions by the help of cool-down game. The research tool was the Persian questionnaire of the strengths and difficulties (parent and teacher form) that all participants complete it as pretest and posttest. The data were analyzed by covariance analysis.
RESULTS: The results showed that from the parent's and the teacher's point of view, the cool-down game has been effective in significant decrease of emotional and behavioral problems.
CONCLUSION: Therefore, this method can be used to reduce emotional and behavioral problems of hyperactive children.
Keywords: Behavioral problems, cool-down game, emotional problems, hyperactive children
|How to cite this article:|
Hajimohammadi E, Najafi M, Arefi M. Effectiveness of the cool-down game in reducing emotional and behavioral problems of hyperactive children. Int J Educ Psychol Res 2018;4:52-8
|How to cite this URL:|
Hajimohammadi E, Najafi M, Arefi M. Effectiveness of the cool-down game in reducing emotional and behavioral problems of hyperactive children. Int J Educ Psychol Res [serial online] 2018 [cited 2020 Jul 4];4:52-8. Available from: http://www.ijeprjournal.org/text.asp?2018/4/1/52/204122
| Introduction|| |
Attention deficit/hyperactivity disorder is perhaps the most common or the most general used term for a kind of psychological disorder in childhood that technically is known as attention deficit and hyperactivity disorder. According to the results of the Center for Control and Prevention of Disease in the United States, in 2005, almost 404 million of 4–17-year-old children were diagnosed with attention deficit/hyperactivity disorder. High frequency of psychiatric disorders along with this disorder has been reported in clinical and epidemiology studies, as well as children with attention deficit/hyperactivity disorder face problems in various fields, including learning disabilities, social problems, cognitive insufficiency, emotional–physical problems, and academic problems. Attention deficit/hyperactivity disorder causes disorder in the students' performance and interferes with their academic performance. The chronic form of this disorder seriously disrupts the children's performance at school. This disorder is associated with adjustment problems at school, also causes many problems including impulsivity, aggression, and immature interact with siblings and peers, and if left untreated, continues to adulthood and appears in the form of delinquency problems, alcohol and drug abuse, and communication problems. Due to the high frequency of this disorder, it is expected that in each class there exists at least one student with sufficiency from attention deficit/hyperactivity disorder. The medical treatment of this disorder includes stimulants of central nervous system; however, medicine consumption, in addition to its side effects, cannot meet the medical needs of children with this disorder, alone, and it needs to be combined with psychological interventions. The ultimate goal of treating the attention deficit/hyperactivity disorder is to enable children to overcome the problems that they face during their life, and this aim cannot be achieved by medical treatment or forcing children to respect the results; rather, the only way to accomplish it, is training strategies about the methods of dealing with people and tasks that are useful in daily operation of the child. Trainings of self-regulation of the behavior to hyperactive children lead to their emotional management and self-efficacy and make them successful in controlling the negative emotions. Furthermore, trainings that are given to hyperactive children, if be practiced and receive feedback will decrease their behavioral problems. Educational game is one of those psychological interventions that can be very enjoyable and effective for hyperactive children. Educational games are a planned, competitive activity that has a specific purpose, and it is a set of roles and designs that is done in a special condition and provides a competitive environment for the child to achieve the goal. Educational games promote learning and increase the students' motivation. Results of the study show that the games are powerful in conveying the concepts in learning environments. Training of the child is the first goal of each educational game, the entertainment aspect of these games for children is also intended, because if an activity does not provide the child's consent, it is not considered a game. Educational games, primarily, are noticed because of having goal, and the value of these games is that it compels the children to search for and understand his role in the interaction patterns.
Attention to game in the matter of education has been started from long time ago. Plato believed that the education of children must be accompanied with game, and game is a delightful device and one of the factors of the child's education. In the 1960s, research on the use of game in military and governmental environments started and very soon it drew the attention of educational leaders, and they observed the value of the experiential learning approach in increasing the invitation and understanding of the students in educational settings. Wakefeild, in a study, stated that use of games in education results in the students' improvement in social skills, better learning of the course concepts, and increase in the students' creativity and innovation. Lach and Sakshaug  stated that the use of educational games improves the students' social and communicational skills; further, using educational games causes the students to learn self-regulation and self-efficacy. Much research has been done in Iran on educational games including a research by a teacher titled as “The impact of educational toys on learning of some mathematical concepts in educable mentally retarded students in pre-school” which showed that these children had better performance than those students who had not been trained with educational toys. A research titled as “The impact of educational game on language learning of the pre-school children” was conducted by Mozafari in 2002, and the results showed that there was a significant difference between the amount of language learning of preschool boys in two groups of control and experiment, and this significance was in favor of the experiment group. Farhoudi (2007) showed that educational computer games have had a positive impact on the creativity of the third-grade high school students. The results of Akhavast et al. showed that the use of educational games increases the students' motivation and understanding in educational settings. Abdolrezaei et al. showed in a study that group training computer games can be used as one of the modern educational methods in schools to develop the emotional intelligence. Since attention deficit disorder and hyperactivity cause several problems for the child, family, and the society, it seems necessary to deal with it to reduce and possibly eliminate its symptoms. Accordingly, due to the negative impact of this disorder, particularly the emotional and behavioral problems of hyperactive children on different aspects of life, according to what the literature shows, no study has been conducted so far in Iran on the effectiveness of the computer games in controlling the emotion and behavior of the hyperactive children. In this study, the effectiveness of the cool-down game, as a new way of controlling the emotion of 7–13-year-old hyperactive children, has been over-viewed to check its effect on the suffering children. Since it is going to be used as a treatment technique in the future and partly fill  the existing vacuum in this field; Therefore kids, by use of the game that in addition to its educational aspect, is engaging and enjoyable, and does not cause the parents' concern about the side effects of taking medicine, will be able to reduce the related problems and feel more competent and efficient, and to have better performance in their family, academic life and in their social relations.
- Determining the effectiveness of the cool-down game in controlling the emotion of 7–13-year-old children of Isfahan from the perspective of the teacher and the parent
- Determining the effectiveness of the cool-down game in reducing the behavioral problems of 7–13-year-old hyperactive children of Isfahan.
| Methods|| |
The method of this study was experimental with pretest, posttest, and control group. The statistical population included all 7–13-year-old children of Isfahan. The sampling method was of simple random type, and based on this, the psychiatric clinics and offices of Isfahan were used that from among clients who had been diagnosed by the specialist psychiatrist of child and adolescent to have hyperactivity/attention deficit and were eager to participate in the study (after obtaining the children's and their parents' consent), sixty children of 7–13 years old (15 girls and 45 boys) were selected and were randomly assigned into two groups of control and experiment (thirty kids for the experiment and thirty for the control group). However, due to the drop in the children, the final number for each group (experiment and control) reached 22, that in each group, there were 6 girls and 16 boys, and based on the psychiatrist's opinion both groups were selected homogeneous in terms of their medicines. Before intervention of the strengths and difficulties questionnaire, the parent and the teacher form was given to both control and experiment groups, and the experiment group had a 1 h game for 8 weeks and two sessions in each week, based on the syllabus; however, there was not any game for the control group; then, after this period, the strengths and difficulties questionnaire, the parent and the teacher form, was again given to them.
As it is shown in [Figure 1] An example of learning cool-down game to children and it is shown in [Figure 2] Board cool-down game.
The tool used was the Persian version of strengths and difficulties questionnaire, which the two forms of 4–16 years old; parent and teacher were used in this study. This questionnaire evaluates the children's difficulties and strengths in 25 questions. Each question is classified into options of completely true, partially true, and incorrect that the reporter must choose one of them. Each option is scored from 0 to 2 (0, 1, 2) unless I questions number 7, 11, 14, 21, and 25 in that scoring is opposite (2, 1, 0 for not true, partially true, and it must be true). The scales of this questionnaire include five subscales (each scale with 5 items); these scales include emotional symptoms, behavioral problems, hyperactivity, peer problems, and desirable social behavior. From the total of the first four scales, overall problems are gained. In this study, only the emotional scales (including questions 3, 8, 13, 16, and 24) and behavioral problems (questions 5, 7, 12, 18, and 22) have been used that the cut scores of this questionnaire for abnormality of emotional symptoms were to be 5–10 in the parent form and 6–10 in the teacher form; for abnormality of the behavioral problems, the cut scores were to be 4–10 in parent and teacher forms. The aforementioned questionnaire has been developed by Goodman (1997) and currently has been translated into different languages including Persian. The used version was first translated into Persian by Karimi Saedi (2001) under Goodman's supervision in London Institute of Psychiatry, and then it was again translated into English by Sanati (2001). This questionnaire is now one of the accepted tools for assessing children's emotional and behavioral problems and has versions special for parents and teachers of 4–16-year-old kids and, a self-report version for children of 11–16 years old. Goodman et al. (2000) in a study evaluate this questionnaire as an important way to improve the detection of children's psychiatric disorders in the society. They compared the prediction power and nonpsychiatric diagnoses in a sample of 7984 English children with an age range of 5–15 years. The results showed that several reporting questionnaires (parents, teachers, and the children themselves) for diagnosis of people with psychiatric problems had specificity of 94 and sensitivity of 63. The questionnaire could diagnose more than 70 behavior and hyperactivity disorders.
In Iran, too, Tehranidoost et al. in 2007 determined the validity of the Persian versions of parent and teacher questionnaire of strengths and difficulties in a sample of 6000 children for 6–12-year-old Iranian kids that its results showed the numbers of 0.74 and 0.95 in the strengths and difficulties questionnaire and that had a large consistent with the findings of Goodman. Further, the cutoff points obtained from Tehranidoost et al.'s study were equal or very close to the points declared by Goodman. Finally, it is concluded that the Persian version of the strengths and difficulties questionnaire has acceptable psychometric properties and can be a useful screening tool for diagnosing Iranian children's emotional and behavioral problems.
After determining the experiment and control groups, and implementing of pretest for the two groups, the cool-down game was conducted on the experiment group for 8 weeks and each week for 2 sessions while the control group did not receive training. Then, the posttest was administered to both groups. The game equipment included:
- One bead for each player
- One dice
- Twenty-four cool-down cards (that each card gives an order for becoming calm, and these cards are divided into three categories in terms of its content):
- Ways by which the hyperactive kids are able to control their impulsivity (e.g., draw ten circles and draw each circle slower than the previous one and before drawing its circle take a deep breath.)
- Ways by which hyperactive children be able to calm down their thoughts (e.g., close your eyes for a minute and imagine you are a bird flying in the sky, now open your eyes and explaining about your dreams)
- Ways for making children noninsensitive to their anger and emotion factors (e.g., what makes you so angry and what you can do to not get angry about it).
- Tokens (are red plastic coins that act as the award so that when the child does the order of card for getting calm correctly, he receives this token.).
In [Table 1], summary of the training sessions of the cool-down game is given.
| Results|| |
In this study, to analyze the data obtained from the questionnaires, the descriptive and inferential statistics part, regarding the normal distribution of data and the groups' homogeneity of variance, the covariance analysis test was used to compare the control and experiment groups, and to do the calculations, the SPSS version 22 (IBM Corp, 2013. IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp) software was used. Descriptive data of the control and experiment group in pretest and posttest showed that of the 44 children in this study (22 children of the control group and 22 of the experiment), in each group, there were 16 boys (72.7%) and 6 girls (27.3%).
[Table 2] shows the research sample disaggregated by the age that the age averages of the sample in control group and experiment group are equal to 10.27 and 9.59 years, respectively.
According to [Table 3], from the parent's viewpoint, in the experiment group, the mean values of excitement component before and after the cool-down game were 4.45 and 2.95, respectively; however, the mean values of excitement component in the control group before and after the cool-down game were 5.23 and 4.68, respectively, from the parent's point of view. Thus, it shows that from the parent's point of view, the cool-down game has been effective in controlling the emotions of hyperactive children. In addition, the mean values of excitement component from the viewpoint of teacher in the experiment group before and after the cool-down game were 3.73 and 2.86, respectively; however, the mean values in the control group from the teacher's viewpoint before and after the game were 4.41 and 4.55, respectively, which shows that from the teacher's point of view too, control of the hyperactive children's emotions in the experiment group has been higher compared to the control group.
|Table 3: The mean and the standard deviation of the excitement component, before and after the cool-down game, from viewpoints of the parent and the teacher|
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[Table 4] shows the effect of the cool-down game on the emotion component by use of the covariance analysis and from the viewpoint of parent and teacher. According to this table, the cool-down game (the group's variable) is significant at 0.01 for the excitement component from the parent and teacher point of view, meaning that the cool-down game is effective in controlling the emotion of children in experiment group from the parent and teacher point of view and it has led to significant reduction of the emotion component in the experiment group.
|Table 4: Analysis of the covariance of the sample groups comparison, regarding the component of excitement, from the parent's and teacher's point of view|
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[Table 5] shows the mean and the standard deviation of the behavioral problems component of hyperactive children before and after the cool-down game. Based on this table, the averages of behavioral problems for the experiment group in parent's view, before and after the cool-down game are 6.55 and 3.36, respectively, but in the control group, from parent's point of view, is 5.59 before and 4.05 after the cool-down game; further, from the teacher's point of view, the averages of behavioral problems in the experiment group were 3.05 and 2.82 before and after the cool-down game, respectively. However, in the control group, from the teacher's point of view, the mean values were 4.55 and 4.68 before and after the cool-down game, respectively.
|Table 5: The mean and the standard deviation of the component of behavioral problems, before and after the cool-down game, in the view of the parent and the teacher|
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In [Table 6], by use of covariance analysis, the effect of cool-down game on the hyperactive children's changes of behavioral problems from the parent's and teacher's point of view is evaluated. According to this table, it is observed that the effect of the cool-down game (the group's variable) on the changes of the behavioral problems has been significant at 0.05 level, from the parent's point of view, meaning that from the parent's point of view, the cool-down game has been effective in decreasing of the behavioral problems of the children in the experiment group and has led to its significant reduction. Further, based on this table, it is observed that the effect of the cool-down game (the group variable) on the changes of the behavioral problems, from the teacher's point of view, has been significant at 0.01 level, meaning that the cool-down game has been effective in reducing the behavioral problems of the children in the experiment group, from the teacher's view, and it has led to its significant reduction in the experiment group.
|Table 6: The covariance analysis for comparison of the two sample groups according to behavioral problems from the parent's and teacher's point of view|
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| Discussion and Conclusion|| |
The cool-down game is effective in controlling of the 7–13-year-old hyperactive Isfahani children's emotions from the view of the teacher and parent.
Based on [Table 3] and [Table 4], the emotion control of hyperactive children from the teacher and parent view in the experiment group was more than the control group. This shows that the effect of intervention method of cool-down game in hyperactive children under study was in a way that the reduction of their emotional problems was obvious, from both teacher and parent's viewpoint, and that drug therapy to some extent was effective in controlling the hyperactive children's emotion, but medication together with the educational aspect of cool-down game has been greatly effective in controlling of the hyperactivity of children's emotions.(Type and amount of medication in both the experiment and control groups were chosen to be homogeneous.) In explaining the emotional self-efficacy in this study, it must be said that training the self-regulation of behavior has been a cognitional–behavioral method that is part of training of the cool-down game and has caused behavioral inhibition; as a result, it reduces inappropriate emotional behaviors and has had a favorable effectiveness on emotional symptom of the child's behavior. This emotional management and self-efficacy leads to flexibility in thoughts and creation of positive thoughts and causes the children to consider these problems as a challenge, not as a threat. In addition, flexibility in thoughts causes a person to be successful in controlling negative emotions. The results of this study, from the aspect of the effect of training on the control of emotion, were in line with the studies of Caprara et al.
From the viewpoint of parent and teacher, cool-down game is effective in reducing the behavioral problems of 7–13-year-old hyperactive children.
According to [Table 5] and [Table 6], the findings show that the cool-down game, in the parent's and teacher's view, has been significantly effective in reducing the behavioral problems of hyperactive children under study. This states that the use of drug therapy, alone, has been slightly effective in reducing the behavioral problems of hyperactive children, but medication together with the cool-down educational game has been highly effective in reducing the behavioral problems of the hyperactive children. The evidence has shown that training of self-control strategies to children and adolescents with attention-deficit/hyperactivity disorder leads to an increase in internal control and subsequently the amount of compatibility increases and their behavioral problems decreases and it helps them in acceptance of this problem and more logical deal with it. In addition, trainings that were provided during the cool-down game and operating them and getting feedback have led to improvement of the intervention effectiveness and receiving better strategies to reduce behavioral problems of these children. Results obtained from behavioral self-control training to children, in this study, are in line with the findings from studies of Ashtarizade and Alipour, Rajabi et al., and Tsai et al.
- It is suggested that the researchers, in the future research, compare the cool-down game with other interactional methods from different perspectives
- To review strengths and weaknesses of this article, as well as evaluating continuity and effect of this intervention in the long term, the implementation of follow-up test in logical intervals is strongly recommended.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]