The Effectiveness Companion of Cognitive Behavioral Interventions and the Sensory Processing Styles Training on Behavioral Problems in Children Aged 7-12 Years

Background: Children’s health is very important in societies. Children’s behavioral problems result in efficiency rate reducing in educational performance. Therefore, solving these problems is necessary. This study aimed to compare the effectiveness of cognitive-behavioral interventions and sensory processing styles training on children’s behavioral problems (7-12 aged). Methods: The current study was quasi-experimental with the pretest-posttest design. The statistical population of this research included all elementary students of sari city in 2017-2018. Among them, 90 target students (30 students per intervention) were selected as samples by the clustering sampling method and were randomly assigned to control and experimental groups. Experimental groups received cognitive-behavioral interventions and sensory processing styles training orderly. Control group received no training. A child behavioral questionnaire was used to collect information. After scoring the questionnaire and extracting the data, SPSS-21 software used for statistical analysis of multivariate covariance and independent t test. Results: The findings showed that cognitive-behavioral interventions and the training of sensory processing styles have a significant effect on behavioral problems in children and have reduced the internalization and extraversion problems in experimental groups and the effectiveness of the cognitive-behavioral intervention in reducing behavioral problems in children is more significant than teaching sensory processing styles. Conclusion: We suggest that cognitive-behavioral therapy and sensory processing styles training are useful for parents. They help to thought control, ethical behavior and parents, mental health.

12 journals.sbmu.ac.ir/Neuroscience http current problems and finally removing inefficient believes are very important. 14 Cerel and colleagues studied in juveniles emotional disorders. 14 Rossell and colleagues studied in juveniles emotional problems and depression 15 ; Franklin and colleagues studied on obsessive children 16 ; Qutaiba 17 on conduct problems reducing, hyperactivity and aggression among juveniles; and Sarihi and colleagues 5 on preschool children behavioral problems have shown this method effectiveness.
Training of sensory processing styles is the other kind of intervention on children's behavioral problems. This style is one method that the neurological system receives neurological inputs, explains and responses to them. 18 Sensory processing sensitivity explains an individual's differences in the sensory processing style. This kind of sensitivity is known as the personality mood feature that is defined by sensitivity toward internal and external excitations such as emotional and social stimulants. 19 Individuals may be active or passive in responding to sensory stimulants. This state results in 4 styles of sensory processing that explain child behavior; these 4 styles are: sensitivity sensitive low threshold, and active strategy, sensory checker (high threshold and active strategy) and low recording (high threshold and passive strategy). 20 Therefore, sensory processing is important in human behavior. 21 Furthermore, the behavioral-emotional problem emerges through sensory and motor processing problems. 22 Sensory problems may result in using self-stimulation and avoidance. 23 Liss and colleagues 24 showed that sensory processing sensitivity might result in being vulnerable to environment stimulants and finally become excited rapidly. Pluess and Boniwell found that sensory processing sensitivity is an important predictor for responding to therapeutic interventions. Also, the individual's personality features are important for successful sensory processing. 25 Dehghan and colleagues found that there is significant difference between normal children scores average and autistic children in sensory item, excitation, low muscular tolerance, oral sense sensitivity, distraction, sensory register weakness and subtle movements and sensory-acceptance and excitation factors have the most relations with autistic children behavioral problems. 26 Molagholamreza Tabasi and colleagues showed that deficiency in sensory processing might result in ADHD children behavioral symptoms. 27 With regard to contradictory results and little research in this field, it is necessary to compare these two methods. Therefore this study aimed to compare the effectiveness of cognitive-behavioral interventions and the training of sensory processing styles on children's aged 7-12 years of behavioral problems.

Methods
The current study was quasi-experimental with the pretest-posttest design. The statistical population of this research includes all elementary students of Sari city. Among them, 90 target students with behavioral problems (30 students per intervention) were select by cluster sampling method and were randomly assigned to control and experimental groups. Entrance criteria to research are: identification of behavioral problems, 7-11 ages and exclusion criteria from research: disorder or illness that may result in creating problems on research, being absent more than 2 sessions, after executing pretest, mothers with children with behavioral problems, 10 cognitivebehavioral interventions session during 2 months (each week, one session 2 hours). The second experimental group received. Eight sessions from sensory processing styles training, while the control group received no intervention. After completing sessions, the posttest executed upon three groups. Data analysis completed by multivariate covariance test and independent t-test with SPSS-21.
The content of cognitive-behavior sessions has been shown in Table 1. 28 Also, the content of sensory processing styles training sessions has shown in Table 2.

Child Behavior Checklist
The used instrument in this research was the Child Behavior Checklist (CBCL). CBCL has been designed to define child adjustment way with the environment. 29 This questionnaire does not classify children with one particular syndrome. It classifies a set of child behaviors. Musical play executed upon participants (rotating music sound around the chair and sit down chair with finishing music sound, finding hidden thing by the child with changing music sound Session 6 There were executed some matches among them by manual work (colored paper scissor, cardboard, and glue). Children selected the best manual work, and finally, all manual works were encouraged. The primary respondent is the child's father or mother. He/she helps to identify child behavioral. Problem. This instrument consists of 116 items (yes, sometime, no) with 0-2 scores orderly. This questionnaire scores calculated for 2 entire fields including internalization and externalization problem. Coefficient α for all instrument and two fields, internalization & externalization problems have been reported 0.86, 0.85 and 0.87 orderly. Mothers completed this questionnaire at two stages including preintervention and past-intervention stages. 30 Predicting results, understanding concepts inside, outside and beside, tolerating failure/predicting action, coordination eye and hand, concentration/move mental control, discriminating among rapid, slow and stopping movements, listening to verbal signs-imitation from body movements, using energy/understanding rapid concept, understanding physical sense from stopping/identifying self in mirror, experiencing from self-reaction

Session 6
Learning different names of other persons, improving self-learning sense enjoying from new experiences/conjoint attention, eye coordination, spatial consciousness/controlling respiration, the group working, understanding actions results/paying attention to items, visual stimulation, spatial consciousness, increasing subtle move mental control/giving time, sorting Session 7 Playing, subtle move mental control, identification two-steps process/listening, identification, audial sense stimulating, group match/ playing with other, touch stimulating, touch sensitivity reducing/visual stimulating, naming things/touch defense reducing, touch consciousness increasing, subtle movements control.

Session 8
Reinforcing linguistic skills, stimulating, sense and giving time, listening to rhythm, oral control, following instruction, creativity encouragement.

70-10 11-12
Cognitive-behavioral therapy 19 11 Sensory processing styles training 17 13  Table 3 shows subjects age frequency at studied groups (cognitive-behavioral therapies & sensory processing styles training). As is seen, most subjects were in the age range of 7 to 10. Table 4 shows the mean and standard deviation of behavioral problems, externalization & internalization problems for experimental & control at pretest and posttest. As it is clear, experimental group scores are greater than control group scores in behavioral problems.

Results
According to Table 5, there is significant difference between experimental and control groups in behavioral problems dimension (P ≤ 0.000 F = 43.65, df = 1.28) and 2 subscales, externalization (P ≤ 0.000, F = 36.69, df = 1.28) and internalization (P ≤ 0.000, F = 33.88, df = 1.28). The effective rate in the behavioral problems dimension is 60, i.e., 60% difference between experimental and journals.sbmu.ac.ir/Neuroscience http control group scores at posttest is related to the cognitivebehavioral intervention effect. The effective rate in externalization subscale is 58, i.e., a 58% difference between experimental and control group score at posttest is related to the cognitive-behavioral intervention effect. The effective rate in internalization is 46, i.e., a 46% difference between experimental and control group score at posttest is related to the cognitive-behavioral intervention effect. Therefore research hypothesis, i.e., the effectiveness of cognitive-behavioral intervention problem on children's behavioral problem is approved. Table 6 shows that is significant difference between experimental and control group in behavioral problems dimension (P ≤ 0.000, F=32.64, df = 1.28) and 2 subtest externalization (P ≤ 0.000, F = 51.20, df = 1.28) and internalization (P ≤ 0.000, F = 11.70, df = 1.28). Results show that the effective rate in behavioral problems dimension is 53, i.e., 53% difference between experimental and control group score at posttest is related to the effect of sensory processing styles training. The effective rate in externalization subscale is 64 i.e., 64% difference between experimental and control groups score at posttest is related to the effect of sensory processing styles training. The effective rate in internalization is 29, i.e., 29% difference between experimental and control group scores at posttest is related to the effect of sensory processing styles training. Therefore, the research hypothesis based on the effectiveness of sensory processing styles training upon children's behavioral problems is approved.
It was used the independent t test to define the effectiveness of 2 therapy methods. Levene test results show that it is significant between the effective rate of cognitive-behavioral interventions and sensory processing styles training (P < 0.0001). The means show that cognitive-behavioral interventions that sensory processing training upon children's behavioral problem   (Table 7).

Discussion
Results showed that hypothesis 1 is approved. Cognitivebehavioral interventions are effective upon children's behavioral interventions. The most effect of cognitivebehavioral therapy shown in behavioral problems, externalization, and internalization with Zareh and Ahmadi research orderly. This finding is consistent. Results based on cognitive-behavioral therapy is effective upon children's behavioral problems. 28 Also, Cerel et al have confirmed the effect of cognitive-behavioral interventions on depression and emotional problems reducing among juveniles. 14 Qutaiba stated that cognitivebehavioral interventions effect upon conduct problems, hyperactivity and aggression reducing among juveniles. 17 Gallagher et al found the cognitive-behavioral therapy is effective on children's social fear reducing. 31 Spence and colleagues stated that the cognitive-behavioral problem is effective on behavioral problems internalized subscale reducing such as anxiety. 32 Cognitive-behavioral therapy is very important among psychological therapies. Based on cognitive-behavioral therapy, individuals experiences results in creating some schemes about self and world. These schemas effect on the perceptual organization, control, and behavior appraisal. This therapy removed cognitive from individual and used some behavioral techniques such as deviating attention and solvingproblem, this therapy teaches reviewing and self-regulation to the patient. Hypothesis 2, i.e., sensory processing styles training is effective in children's behavioral problems was approved. The most significant effect of processing styles training has been in behavioral problems, externalization and internalization dimensions, and these results are consistent with Baker and colleagues research about the effect of sensory processing styles for children with internalized behavioral problems (depressed & anxious). They found that depressed and anxious juveniles show conscious avoidance. 22 Also, they are consistent with Mahmoodi and colleagues research results 33 and Liss et al 24 study on children with behavioral problems. Children with behavioral disorders confront their families with different problems and make them vulnerable toward mental-social derangements. Training techniques are useful to solve them. According to the results, hypothesis 3 approved, i.e., there is a significant difference between the effective rate of cognitive-behavioral interventions and sensory processing styles training. Cognitivebehavioral interventions then sensory processing styles training has been more active on children's behavioral problems reducing. This finding is consistent with Rathod et al 34 research about the comparison of sensory integration interventions with cognitive-behavioral therapy among individuals with ADHD that have shown cognitive-behavioral therapy effect more than the sensory integration interventions. 34 Two of the most critical research limitations are studied case (students) and geographic research region (Sari city) that make difficult results generalization.

Conclusion
We can state that children's behavioral problems reduced by training equipment's, it is also suggested to teach cognitive-behavioral therapy periods and sensory processing styles training. This training helps to control thoughts and to create a parent's mental health. These effective supports may result in better understanding parent's feelings and performance toward their children and also better adjustment with these children conditions.