Document Type : Original Article


1 Department of Clinical and General Psychology, Semnan University, Semnan, Iran

2 Department of Nutrition, School of Public Health, Iran University of Medical Science, Tehran, Iran, Psychiatrist, Tehran University of Medical Science, Tehran, Iran

3 Psychiatry and Psychology Research Center, Tehran University of Medical Science, Tehran, Iran, Department of Psychology, University of Science and Culture, Tehran, Iran

4 General Psychology (MSc), Department of Psychology, Tarbiat Modares University, Tehran, Iran

5 Department of Psychology, Kharazmi University of Tehran, Iran


BACKGROUND AND AIM: This study aimed to investigate and compare the efficacy of cognitive‑motor
rehabilitation (CMR) with methylphenidate on cognitive functions and behavioral symptoms of children
with attention deficit/hyperactivity disorder (ADHD) and specified the near‑transfer and far‑transfer
MATERIALS AND METHODS: The research was semiexperimental with posttest and follow‑up
assessments, in a single‑blind design. Forty‑eight boys with ADHD, aged 9–12, were selected
conveniently regarding the inclusion/exclusion criteria, matched base on severity and Intelligence
quotient (IQ) and were randomly assigned to CMR (n = 16), methylphenidate medication (MED,
n = 16), and placebo CMR groups (PCMR, n = 16). CMR and PCMR received 20 3‑h training
sessions, and the MED group received 20 or 30 mg/day methylphenidate. Tower of London (TOL),
Swanson, Nolan, and Pelham, Version IV Scale (SNAP‑IV), Wechsler’s digit span and mathematic
subscales, dictation test, and restricted academic situation scale (RASS) were completed at
posttest and follow‑up. The data were analyzed by repeated measures multivariate analysis of
RESULTS: CMR outperformed PCMR on forward digit span, backward digit span, ToL score at both
posttest, and follow‑up (P < 0.05). CMR scored lower than MED on ADHD‑PI and ADHD‑C at both
posttest and follow‑up (P < 0.05). Moreover, CMR outperformed MED on dictation at both assessment
phases (P < 0.01) and RASS at the follow‑up phase (P < 0.05). CMR outperformed PCMR on
mathematics at post‑test (P = 0.038) and also, in dictation and RASS, at both post‑test (P < 0.001)
and follow‑up (P < 0.05).
CONCLUSION: CMR Improves near‑transfer cognitive functions and behavior symptoms of ADHD
as much as MED, but only CMR has more generalizable and endurable improvement on complex
Efs and academic performance (far‑transfer effects).


1. Chawla G, JuyalR, Shikha D, Semwal J, Tripathi S, Bhattacharya S.
Attention deficit hyperactivity disorder and associated learning
difficulties among primary school children in district Dehradun,
Uttarakhand, India. J Educ Health Promot 2022;11:98.
2. Dovis S, Van der Oord S, Wiers RW, Prins PJ. Improving executive
functioning in children with ADHD: training multiple executive
functions within the context of a computer game. A randomized
double‑blind placebo controlled trial. PloS One 2015;10:e0121651.
Doi: 10.1371/journal.pone. 0121651.
3. Friedman LA, Rapoport JL. Brain development in ADHD. Curr
Opin Neurobiol 2015;30:106‑11.
4. Rapport MD, Orban SA, Kofler MJ, Friedman LM. Do programs
designed to train working memory, other executive functions, and
attention benefit children with ADHD? A meta‑analytic review
of cognitive, academic, and behavioral outcomes. Clin Psychol
Rev 2013;33:1237‑52.
5. Pozzi M, Carnovale C, Peeters GG, Gentili M, Antoniazzi S,
Radice S, et al. Adverse drug events related to mood and emotion
in paediatric patients treated for ADHD: A meta‑analysis. J Affect
Disord 2018;238:161‑78.
6. Langberg JM, Becker SP. Does long‑term medication use
improve the academic outcomes of youth with attention‑deficit/
hyperactivity disorder? Clin Child Fam Psychol Rev 2012;15:215‑33.
7. Bellar D, Judge L, Petersen J, Bellar A, Bryan C. Exercise
and academic performance among nursing and kinesiology
students at US colleges. J Educ Health Promot 2014;3:9. Doi:
8. Azami S, Moghadas A, Sohrabi‑Esmrood F, Nazifi M,
Mirmohamad M, Hemmati F, et al. A pilot randomized controlled
trial comparing computer‑assisted cognitive rehabilitation,
stimulant medication, and an active control in the treatment of
ADHD. Child Adolesc Ment Health 2016;21:217‑24.
9. Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P,
Dahlström K, et al. Computerized training of working memory in
children with ADHD‑a randomized, controlled trial. J Am Acad
Child Adolesc Psychiatry 2005;44:177‑86.
10. Sonuga‑Barke EJ. Causal models of attention‑deficit/hyperactivity
disorder: From common simple deficits to multiple developmental
pathways. Biol Psychiatry 2005;57:1231‑8.
11. Piepmeier AT, Shih C‑H, Whedon M, Williams LM, Davis ME,
Henning DA, et al. The effect of acute exercise on cognitive
performance in children with and without ADHD. J Sport Health
Sci 2015;4:97‑104.
12. Ziereis S, Jansen P. Effects of physical activity on executive
function and motor performance in children with ADHD. Res
Dev Disabil 2015;38:181‑91.
13. Strahler Rivero T, Herrera Nuñez LM, Uehara Pires E,
Amodeo Bueno OF. ADHD rehabilitation through video gaming:
A systematic review using PRISMA guidelines of the current
findings and the associated risk of bias. Front Psychiatry 2015;6.
Doi: 10.3389/fpsyt. 2015.00151.
14. Barkley RA. Attention‑Deficit/Hyperactivity Disorder. Guilford
Publications; 2006.
15. Halperin JM, Healey DM. The influences of environmental
enrichment, cognitive enhancement, and physical exercise on
brain development: Can we alter the developmental trajectory
of ADHD? Neurosci Biobehav Rev 2011;35:621‑34.
16. Mehren A, Reichert M, Coghill D, Müller HH, Braun N,
Philipsen A. Physical exercise in attention deficit hyperactivity
disorder–evidence and implications for the treatment of
borderline personality disorder. Borderline Personal Disord Emot
Dysregul 2020;7:1‑11.
17. Hattabi S, Bouallegue M, Yahya HB, Bouden A. Rehabilitation of
ADHD children by sport intervention: A tunisian experience. La
Tunis Med 2019;97:874‑81.
18. VysniauskeR, VerburghL, Oosterlaan J, MolendijkML. The effects
of physical exercise on functional outcomes in the treatment of
ADHD: A meta‑analysis. J Atten Disord 2020;24:644‑54.
19. Grassmann V, Alves MV, Santos‑Galduróz RF, Galduróz JCF.
Possible cognitive benefits of acute physical exercise in children
with ADHD: A systematic review. J Atten Disord 2017;21:367‑71.
20. Chang Y‑K, Labban JD, Gapin JI, Etnier JL. The effects of acute
exercise on cognitive performance: A meta‑analysis. Brain Res
21. Chang Y‑K, Liu S, Yu H‑H, Lee Y‑H. Effect of acute exercise on
executive function in children with attention deficit hyperactivity
disorder. Arch Clin Neuropsychol 2012;27:225‑37.
22. Baddeley A. The episodic buffer: A new component of working
memory? Trends Cogn Sci 2000;4:417‑23.
23. Stevens JP. Intermediate Statistics: A Modern Approach. Ed r,
editor. New York: Routledge; 2007. p. 472.
24. Sadeghi A, Rabiee M, Abedi MR. Validation and reliability of
the Wechsler intelligence scale for children‑IV. Dev Psychol 2011;7:377‑88.
25. Mashhadi A, Rasoulzadeh‑Tabatabaie K, Azadfallah P,
Soltanifar A. The comparison of response inhibition and
interference control in ADHD and normal children. J Clin Psychol
26. Sadrosadat S J HZ, Zamani R, Sadrosadat L. Determinatio of
psychometrics index of SNAP‑IV rating scale in parents execution.
Arch Rehabil (J Rehabil) 2008;8:59‑65.
27. Barkley RA. Tests and observational scales. Attention Deficit
Hyperactivity Disorder: A Handbook for Diagnosis and
Treatment. New York: The Guilford Press; 1990.
28. Grizenko N, Lachance M, Collard V, Lageix P, Baron C, Amor LB,
et al. Sensitivity of tests to assess improvement in ADHD
symptomatology. Can Child Adolesc Psychiatr Rev 2004;13:36‑9.
29. Shahim S. Norm finding for the Wechsler’s intelligence scales for
children in Shiraz. J Humanit Soc Sci Shiraz Univ 1991;7:31.
30. Mehren A, Özyurt J, Lam AP, Brandes M, Müller HH, Thiel CM,
et al. Acute effects of aerobic exercise on executive function
and attention in adult patients with ADHD. Front Psychiatry
31. Verret C, Guay MC, Berthiaume C, Gardiner P, Béliveau L.
A physical activity program improves behavior and cognitive
functions in children with ADHD: An exploratory study. J Atten
Disord 2012;16:71‑80.
32. Håkansson K, Ledreux A, Daffner K, Terjestam Y, Bergman P,
Carlsson R, et al. BDNF Responses in healthy older persons
to 35 minutes of physical exercise, cognitive training, and
mindfulness: Associations with working memory function.
J Alzheimers Dis 2017;55:645‑57.
33. He N, Li F, Li Y, Guo L, Chen L, Huang X, et al. Neuroanatomical
deficits correlate with executive dysfunction in boys with attention
deficit hyperactivity disorder. Neurosci Lett 2015;600:45‑9.
34. Camprodon‑Rosanas E, Pujol J, Martínez‑Vilavella G,
Blanco‑Hinojo L, Medrano‑Martorell S, Batlle S, et al. Brain
structure and function in school‑aged children with sluggish
cognitive tempo symptoms. J Am Acad Child Adolesc Psychiatry
35. Pontifex MB, Saliba BJ, Raine LB, Picchietti DL, Hillman CH.
Exercise improves behavioral, neurocognitive, and scholastic
performance in children with attention‑deficit/hyperactivity
disorder. J Pediatr 2013;162:543‑51.
36. Klingberg T. Training and plasticity of working memory. Trends
Cogn Sci 2010;14:317‑24.
37. Lufi D, Parish‑Plass J. Sport‑based group therapy program for
boys with ADHD or with other behavioral disorders. Child Fam
Behav Ther 2011;33:217‑30.