Saudi Cultural Missions Theses & Dissertations
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Item Restricted Published evidence for effectiveness of cognitive-behavioral therapy (CBT) in improving symptoms for individuals with attention deficit hyperactivity disorder (ADHD)(University College London, 2024) Alhuwaimani, Wid; Selai, Carolin; Petrochilos, PanayiotaAttention Deficit Hyperactivity Disorder (ADHD) is a chronic neurodevelopmental disorder that affects a significant portion of the population across the lifespan. Cognitive Behavioural Therapy (CBT) is widely recognized as an effective non-pharmacological intervention for ADHD, particularly in reducing symptoms and improving overall functioning. Objective: This systematic review aims to evaluate the effectiveness of CBT in treating ADHD symptoms, particularly when combined with pharmacological treatments, and to explore the potential benefits of adapted CBT approaches, including digital interventions.9 0Item Restricted Regulation of excitation and inhibition in early stages of neuronal differentiation and arborisation(King's College London, 2024) Jelani, Rose; Stolp, HelenNeurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD), schizophrenia (SCZ) and attention deficit hyperactivity disorder (ADHD), have been extensively linked to early-life excitatory/inhibitory (E/I) imbalances. These imbalances are particularly associated with alterations in the GABAergic inhibitory system. Numerous studies in neurodevelopmental research have reported a decreased expression of cortical GABAergic interneurons, which are responsible for releasing gamma-aminobutyric acid (GABA), in patients with NDDs. However, the precise mechanisms underlying this reduction in GABAergic interneurons remain unclear. This study investigated the effects of early-life prolonged GABA-a receptor activation on cortical GABAergic interneuron development in mice. Muscimol, a GABA-a receptor agonist, was injected intraperitoneally (0.5 mg/kg) to mice on post-natal days 3 to 5 (P3-P5). At P10, we employed immunohistochemistry and imaging analyses to assess three distinct GABAergic interneuron populations in the somatosensory cortex: parvalbumin-expressing (PV+), somatostatin-expressing (SST+), and calretinin-expressing (CR+). Our main results revealed a significant increase in PV+ interneuron density (cells/layer) within cortical layer V following muscimol treatment. Additionally, non-significant but consistent trends towards elevation were observed for all interneuron population densities (cells/mm²). These findings suggest that early-life GABA circuit disruption may initially increase GABAergic interneuron expression, potentially offering insight into the trajectory leading to the eventual decrease observed in NDDs. While limited by sample size, this research contributes to understanding the developmental processes that may lead to GABAergic deficits in NDDs. Further research with larger samples and longitudinal designs is needed to elucidate the long-term impacts of early GABAergic perturbations on interneuron populations and their potential relevance to NDD pathology.12 0Item Restricted Characterisations of inclusivity for children with ADHD in the school environment in Saudi Arabia(Cardiff Univerity, 2024-04) Albdairi, Ahmad; Whitcombe, SteveThe focus of this qualitative study was to investigate special education teachers' views and experiences in Saudi Arabian schools regarding teaching children with attention deficit hyperactivity disorder (ADHD) in universal classrooms. Background The background of the study is to focus on the perceptions of special education teachers about children with ADHD. The various challenges experienced by learners with ADHD may face challenges such as: attention deficit, hyperactivity, violence impulsiveness, weak executive functioning, poor academic performance and social issues. These may affects the general physical condition. Methodology The study embraced the qualitative descriptive design that yields data from six participants (head teachers) regarding views, challenges, and opportunities for students with ADHD. Findings The findings of the research indicated that the use of assistive technologies, classroom accommodations, and the creation of a supportive environment should occur for the benefit of learners with health disorders. The discussed strategies and accommodations that are effective are with the adjustment of the classroom, positive reinforcement, behaviour management techniques, and assistive technologies usage. Nevertheless, the teachers themselves encountered obstacles such as resource insufficiency and poor training in e-learning, and these topics were raised by most teachers. Another finding of the study was the positive outcomes and success stories of the students who got support in their school academically and socially and who have now improved. Recommendations Recommendations include teacher professional growth, cross-functional cooperation, widespread awareness, sequential implementation, and contextually appropriate studies. This study endorses a neurodiversity strategy that respects and encourages the special talents of students with ADHD within a fair and wholesome learning environment.20 0Item Restricted Exploring and Understanding Teachers' Perceptions and Practices of The Early Intervention Programme for Children with ADHD in Saudi Arabian Inclusive Kindergarten Classrooms(University of Exeter, 2024-06-11) Alzahrani, Samirah; Norwich, Brahm; Moor, DarrenAims and rationale: This study explores teachers’ perceptions and practices in using the early intervention programme Assessment, Evaluation and Programming System (AEPS) that was recently implemented in Saudi kindergartens and involves children from 3 to 6 years old with hyperactivity and attention problems (ADHD). The study endeavours to explore and provide insight into how special education teachers (SET) practised early intervention programmes for children with ADHD in their inclusive classrooms from September 2019 to April 2020. In addition, it is mostly focused on how the teaching and behaviour modification was practised with children identified as having ADHD. Although the Saudi educational system has focused significantly on establishing an inclusive learning environment, there is a lack of in-depth case study research in Saudi Arabia on this field. Case study methodology can contribute by providing in-depth insights into this field and challenges in terms of time, class size, the equitable environment of the class, inclusive implementation of learning and teaching methodology, and parental involvement. So, the research looked into teachers’ attitudes towards inclusion and the inclusive classroom, teachers’ knowledge of early intervention and ADHD, teacher self-efficacy and how children with ADHD responded to this intervention. This study used a multiple case study approach on four different inclusive classrooms in Saudi kindergartens that were implementing the AEPS. Two cases were in Jeddah city and two cases were in Riyadh city. Questionnaires were conducted with the four special education teachers who implemented the Early Intervention Programme (EIP), which included three scales: knowledge about ADHD intervention, attitudes towards inclusion of a child with ADHD, and inclusive teaching efficacy. Semi-structured interviews were conducted with the four special education teachers (SETs) and also with class teachers (CT), an assistant teacher (AT) and a psychologist i who worked in the early intervention programme with children with ADHD in inclusive public kindergartens. This was to collect data about their perceptions and practices of the early intervention programme with children with ADHD and to assess the children’s responses to this programme to identify any proposals that could improve the practices in their work. The study found that AEPS was clear and easy to understand and implement, and helpful for parents to track and contribute to their children’s progress. However, it was not enough for the children having ADHD, because AEPS was not the most comprehensive EIP to use for them. For example, AEPS did not include any goals related to modifying the child’s behaviour. Also, teachers faced some challenges, for example, the inflexibility of adjusting the AEPS, the number of children in the inclusive classroom, and the lack of training and preparation about EIP (AEPS), and ADHD. Moreover, there was a lack of a supporting team and behavioural strategies, and family collaboration. Also, it was found that there were some factors affecting the child's response, such as medication, level of disability, and acceptance. The practical implications of this study were mainly about providing a support team in all kindergartens, providing specialised training for teachers, providing regular meetings and seminars to develop their practical skills, and create formal communication channels to ensure effective collaboration between teachers and parents. Further research is recommended with different groups of children with disabilities; in different regions of Saudi Arabia; other contexts and cultures; replicating with a more sizeable sample, including parents and principals. Using a different methodology and methods to examine this and other early interventions could also be considered. Further research could examine the necessary competencies for early intervention teachers working in inclusive classrooms in kindergarten.13 0Item Restricted Design Of Positive Behaviour Support Module To Reduce Behavioural Problems Among Children With Adhd In Saudi Arabia(Saudi Digital Library, 2023-10-16) Hakami, Mona Hassan M; CHE AHMAD, AZNANChildren with Attention Deficit Hyperactivity Disorder (ADHD) and their associated issues have become a hot topic among educators and specialists. Challenging behaviours is one of the most closely connected difficulties among them. This study aims to present an evidence-based curriculum to help ADHD students in Saudi to deal with this difficulty. The suggested module is based on positive behaviour support strategies, which have been found to significantly improve children's behaviour. The researcher focused on the acceptance and potential effectiveness of proposed module based on teachers and heads of school perspective. This dissertation follows the design and development research (DDR), with in-depth analysis which involves three phases. The results indicate that there is a need of the proposed module as there is no such program in schools and the knowledge of teachers are rarely sufficient in Positive Behaviour Support (PBS). In Phase I, 30 respondents responded to the questionnaire which indicated that there is a need to have the module. 60% of respondents say they need more training in evidence-based tactics such as PBS. In phase II, ten experts had evaluated the module. Using Fuzzy Delphi, results showed a threshold score of less than 0.2 which mean that the experts agreed with the Positive Behaviour Support Module. In Phase III, the result shows that the instructors and school heads accepted the proposed module. In this phase, 35 teachers and 5 principals responded to the online questionnaire. The result shows that there is a high degree of acceptant to content quality, potential effectiveness as well as overall satisfaction based on positive support strategies to reduce some behaviour problems on Children with ADHD. The results supported that all three tiers in the PBS could be effectively implemented where applicable. The current study revealed that paying close attention to the methods for dealing with behavioural difficulties had a positive impact on how the pupils adopted them. Given that PBS is a suitable module that should be enhanced, everyone involved in the field of behavioural issue management, including researchers and teachers, should explore methods to implement the module by emphasizing teaching children "how" as well as "what." Future research therefore must concentrate on how to implement a process-oriented approach to PBS modules.22 0Item Restricted The relationship between emotion dysregulation and ttention Deficit Hyperactivity Disorder(Saudi Digital Library, 2023-07-17) Albesisi, Siham; Overton, PaulAttention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder diagnosed in both children and adults, characterised by the ‘classical’ symptoms of inattention, impulsivity, and hyperactivity. However, it not only causes deficits to manifest in these core symptoms but also affects emotional regulation. This thesis aimed to investigate the relationship between emotion dysregulation and ADHD-like traits in non-clinical groups of adults. The first chapter reviewed the background of ADHD and emotion dysregulation as a new core symptom of ADHD, leading to the first study which examined the core ADHD-like traits and emotion dysregulation using self-report measures - the Adult ADHD Self-Report Scale (ASRS) and the Difficulties in Emotion Regulation Scale (DERS). The total ASRS scale scores (as well as with both ASRS subscales) showed a highly significant positive association with the DERS scale, and correspondingly the overall ASRS was a strong independent predictor of the DERS scores. These findings confirm the hypothesis that emotional dysregulation is linked to the typical core symptoms of adult ADHD. However, self-report measures have a number of drawbacks, and so in the second and third study, we used cognitive tasks (rather than the ASRS alone) to measure ADHD-like traits. The second study looked at the relationship between emotion dysregulation and an aspect of inattention, namely distractibility. We employed a new paradigm to measure distractibility - a modified version of the Sustained Attention to Response Test (SART), with task-irrelevant distractors on some trials. The result shows that the reaction times (RTs) on trials with distractions were faster than those without distractions, and there was no statistically significant variation depending on whether participants were in the High or Low ASRS groups. Furthermore, accuracy was higher on trials with distractors. In other words, the modified SART did not distract; instead, the distractions paradoxically helped with performance, and that facilitation did not differentially affect those with participants depending on their levels of ADHD-like traits. As a consequence, we could not draw conclusions about the relationship between emotion dysregulation and task-based inattention. The third study looked at the relationship between emotion dysregulation and impulsivity, using two cognitive tasks: the Iowa Gambling Task and the Go-No/go Task. For the Iowa Gambling Task, both High and Low ASRS groups chose low risk strategies and there were no differences between both groups. In terms of inhibitory control, there was no statistically significant difference between groups. However, for the Go-No/go task, the difference in commission and omission error rates between the High and Low ASRS groups suggests that participants in the High ASRS group had poorer reaction inhibition (faster reaction times), and lower accuracy, indicating that the High group was sacrificing accuracy for speed. In terms of the DERS, the DERS subscales scores (clarity, goal and strategy) were associated with Go reaction times in the Low ASRS group but not in the High ASRS group. Overall, the result suggests that emotion dysregulation may not be related to the classical symptom of impulsivity, at least when the latter is measured using a cognitive task rather than a self-report scale. The final chapter summarises the finding of this thesis. Overall, the thesis offers evidence of some aspects of the classical symptoms of ADHD do overlap with emotion dysregulation when participants are asked to recount their experiences, but that connection is lost when ADHD-like symptoms are assessed experimentally.36 0Item Restricted Using Digital Training to Support the Wellbeing and Management Skills of Teachers of Children With ADHD Symptom(https://eprints.nottingham.ac.uk/etheses/, 2023-05-31) Aldabbagh Reem Ali; Daley David; Glazebrook Cris; Sayal KapilThe current research aim was to determine the feasibility and acceptability of a digital intervention to assist primary school teachers in managing ADHD symptoms in the classroom. The thesis also aimed to provide preliminary evidence of the effectiveness of such digital interventions in decreasing teachers’ stress and enhancing children’s outcomes. The needs of children with ADHD are a significant concern for teachers, with around 5% of children meeting the threshold for clinical diagnosis and an additional 5% of school children having symptoms but not reaching diagnostic threshold. The manifested behaviours of ADHD not only affect the child, but also the teacher and the overall classroom atmosphere. Teachers in the United Kingdom have reported high levels of stress, and approximately 20% of new teachers in England leave the profession within the first three years due to a variety of factors, including student misbehaviour. In addition to often complex workloads, teachers are also expected to meet the needs of students with, or at risk of, developing ADHD. This has led to the belief that early interventions from teachers targeting young children with ADHD behaviour may reduce any ongoing adverse effects and can change the trajectory of the disorder while at the same time reducing stress levels on teachers. Interventions to support teachers’ management skills could break the cycle of disadvantage for both teachers and children with ADHD symptoms. An additional point of investigation in this thesis is to understand how, given the limited available free time teachers 3 have to engage with an intervention, a digital tool may offer an accessible intervention that supports reduction in teacher stress.The purpose of this thesis was to assess the feasibility and acceptability of a digital intervention to help primary school teachers in supporting children with ADHD symptoms. The thesis also aimed to provide preliminary evidence of the perceived effectiveness of digital interventions in reducing teacher stress and improving children's outcomes, thus, the doctoral research was divided into four studies. Study 1 is a systematic review and meta-analysis to investigate the effectiveness of teacher-delivered interventions for child externalising behaviours based on teacher and child outcomes. Five electronic databases were used in a systematic search. The findings support the role of teacher interventions for teachers who work with children who exhibit externalising behaviours. Study 2 describes a qualitative study using reflexive thematic analysis of semi-structured interviews with 17 teachers of children aged four to eight years in the United Kingdom (UK) to develop an understanding of their experiences of teaching children with ADHD symptoms in the UK and their unmet needs for support. The analysis revealed that teachers working with children with ADHD symptoms can feel overwhelmed and require more training in supporting those children. Study 3 is a qualitative study that sought to evaluate the feasibility and acceptability of using the ADHD Behavior Toolbox application to support 4 teachers of children with ADHD behaviours aged four to eight years using reflexive thematic analysis of 15 teacher interviews. The teachers were generally very satisfied with the suggested strategies, and the idea, usability, and functionality of the app. However, most participants provided suggestions to improve application functionality from their perspective. The analysis also revealed that the application was seen to support both new and experienced teachers. Study 4 outlines a study protocol for a single arm pre-post study to assess the feasibility of the ADHD Behavior Toolbox application with a target child, using a sample size of between 30 and 40 teachers. Participants would be asked to complete an online survey at baseline with validated measures of self-efficacy, depression, anxiety and stress, and child externalising behaviour for a target child. Participants would then use the ADHD Behavior Toolbox within their classroom practice before completing the measures post-intervention and completing a usability questionnaire. The need for teachers’ intervention for children with ADHD symptoms is revealed in the first three chapters of this thesis. The thesis also investigates the feasibility and acceptability of the ADHD Behavior Toolbox app for reducing teacher stress and supporting teachers of children with ADHD. Teachers were generally pleased with the application and provided feedback on how it could be improved to be more beneficial and appropriate to their needs. Overall, the study findings are promising, indicating that digital intervention may be an acceptable option. More research is needed to 5 investigate the potential efficacy of the Behavior Toolbox application using quantitative data, as well as to pilot recruitment and outcome measures prior to conducting a randomised controlled trial. We aim to develop and improve the ADHD Behavior Toolbox by following the (MRC) framework until we reach the implementation phase. At this phase, the app can be implemented in wide areas of the UK in schools in an effort to create a positive climate that supports children with ADHD symptoms and reduces stress for teachers.22 0Item Restricted Neural Mechanisms of Treatment for Mental Disorder(2023-06) Shalabi, Abdulrhman; Liddle, Peter; Liddle, Elizabeth“Cognitive control” refers to the ability to regulate thoughts and actions in the service of goals or plans (Braver, 2012). Coordination between the central and peripheral autonomic nervous systems (ANS) maintains arousal and attention levels, which are essential for effective cognitive control. Diamond (2013) proposed a cognitive control model that builds on three core cognitive functions: cognitive flexibility, inhibitory control, and working memory. Abnormality in active inhibitory cognitive control is implicated in a broad range of psychiatric and personality disorders, including schizophrenia, attention deficit hyperactivity disorder (ADHD), impulsivity, and substance abuse, among many others. Transcranial direct current stimulation (tDCS) and cognitive training are two neuromodulation techniques which have the potential to modulate cortical functions to introduce long-lasting neuronal plasticity. The antisaccade task is a visual inhibitory control task frequently used to assess cognitive control. It requires the participant to suppress an automatic stimulus-driven saccadic eye movement and instead make a goal-driven saccade in the opposite direction. In this thesis, by conducting two separate studies, we used the antisaccade task to examine the effect of tDCS and computerised cognitive training on inducing neuroplastic changes for the oculomotor control network (OCN). Chapter 1¢introduces relevant concepts to the subject of this thesis with a technical account of the methods used. The details of the first study are discussed in Chapter 2 - Chapter 4, where we used eye-tracking during antisaccade performance with the continuous assessment of cortical activity using Magnetoencephalography (MEG). Chapter 2 will discuss the short-term neuroplastic changes introduced by the tDCS on the functional connectivity within the resting state networks assessed using MEG. We found evidence of increased connectivity following the engagement in the antisaccade task for both active tDCS and sham conditions, but with different spatial patterns. Following tDCS delivered over the frontal cortex, there was increased connectivity with the frontal cortex. In contrast, in the sham condition there was increased connectivity with the posterior cortex. The effects of tDCS stimulation on the ANS activity during the task performance were further assessed via pupillometry as a measure of Locus Coeruleus (LC) activity in Chapter 3. Our results showed that faster pupil dilation, reflecting increased arousal and sympathetic activity, was associated with faster saccade reaction times. In Chapter 4, we investigated the immediate effects of tDCS stimulation on the cerebral cortex during active cognitive inhibition followed by a correct saccadic response. The tDCS introduced neuromodulatory changes in the putative Alpha and low-Beta band during the anticipatory and post-stimulus periods, reflecting enhanced cortical engagement in a task-beneficial pattern. Chapter 5 reports on the second study in which we used functional magnetic resonance imaging (fMRI) to evaluate the neuromodulatory effects of prolonged computerised cognitive training games (RECOGNeyes) on the resting state functional connectivity of the OCN and pupil dilation. Following gaze-control training, the connectivity within the left hemisphere was strengthened, while the intra-right hemisphere and the interhemispheric connectivity were diminished. Chapter 6 provides a summary of the findings and concluding remarks. Our result furthers our knowledge of the processes involved in the performance of the antisaccade task, the mechanisms of action and the neuroplastic effects of two neuromodulation techniques. However, the exact mechanisms underlying these methods' beneficial effects demand further exploration.33 0