Effect of Play Based Exercises and Free Play on Cognitive Flexibility and Inhibitory Control using Attention Deficit Hyperactivity Disorder Rating Scale IV (Preschool Version)- A Comparative Study

·       Executive functions in early childhood are critical predictors of academic success, social development, and long-term mental health Notably, early childhood, specifically the ages of 3 to 7 is a period of notable and rapid development in Executive Functions Zelazo et al 2003.

·       Play is a natural engaging and developmentally appropriate medium for pre-schoolers. It fosters intrinsic motivation social interaction and cognitive engagement which are essential for EF improvement.

·       While playbased interventions have shown promise limited studies explore their structured application specifically for pre-schoolers with ADHD symptoms.

PROCEDURE:

•       Approval will be obtained from the Ethics committee and Review Board. Each parent or caregiver will be given detailed information and written informed consent will be taken prior to the study.

•       Subjects will be screened as per the inclusion and exclusion criteria.

•       Screening process will be done and consent will be taken from the Head of school and parents will be informed about the same during the school parents teachers meeting.

•       The data collection will be done in two rounds.

 ROUND 1

1A group of 15 to 20 parents or caregivers will be addressed the ADHD Rating Scale will be explained and given to the parents to fill details of specific components after which the scale will be returned to the Therapist.

2 The Parents will be informed that the scale will be scored and Parents will be informed regarding the outcome of the score.

 ROUND 2

Parents/caregivers of the children exhibiting ADHD symptoms will be contacted for the second data collection round. Day and Night Task and Dimensional Change Card Sort DCCS will be administered and scoring will be done.

Children will be randomly allocated in Play Based Exercise group and Free Play group for a period of 12 weeks after which post scores of the scales will be recorded.

 Intervention

•       Total time:

•       Duration 3 times a week for 12 weeks.

•       Group A Play Based Therapy Group

•       Play based exercises for 30 minutes followed by 15 minutes of free Play.

•       Week 1

•       Orientation & Engagement 1. Follow the Leader: Mimic leader’s actions to practice attention and inhibitory control.

2. Name Game: Memory exercise

•       Week 2 Working Memory Memory Match: Classic card game with animal pairs.

• Story Chain: Therapist creates a story with child and therapist adding one sentence alternatively.

•       Week 3 Inhibitory Control-Simon Says: Action following game.  Freeze Dance: Dance to music and freeze when it stops.

•       Week 4 Cognitive Flexibility Sorting Colors and Shapes Sort items based on changing criteria.

• Opposites Game Respond with opposite actions e.g clap when instructed to be still.

•       Week5  Combination Working Memory & Inhibitory Control Story Memory Game Listen to a story answer questions afterward. Obstacle Course with Rules Follow changing rules e.g stop at red

•       Week 6 Working Memory-Build & Recall Build structures with blocks and then replicate them.  Pattern Game Repeat sequences e.g clap tap clap.

•       Week 7 Inhibitory Control-Opposite Simon Says Adds complexity to Simon Says by using opposite commands. Balloon Tap Keep a balloon afloat without over-hitting or dropping it.

•       Week 8 Cognitive Flexibility Puzzle Hunt Solve puzzles requiring different approaches.

•       Week 9 Flexibility & Memory Rule Switch Dance Dance changes based on verbal instructions.  Treasure Hunt with Clues: Follow multi-step instructions to find a hidden object.

•       Week 10 Introduction to GroupCircle Recall Recall a sequence of actions from peers.  Stop and Go Run when Go is called freeze on Stop add memory based cues for variety

•       Week 11Reflection Group Challenges Group problem solving games like building towers.  Role Playing Scenarios Simulate tasks that require planning and decision making.

•       Week 12 Favorite Activity Replay Revisit favorite games from the protocol. Reflection Circle Share what they enjoyed most and learned.

•       Intervention Group B  Free Play will be given to the children during the same time.

  Consort Chart: