Education EDF 621 Week 1 Assignment

Research Article Cognitive Therapy for Children with Intellectual Disabilities: A New Look at Social Adaptation Skills and Interpersonal Relationships

Gulnaz Kulnazarova , Zhamiliya Namazbaeva, Laura Butabayeva , and Lazzat Tulepova

Department of Special Education, Abai Kazakh National Pedagogical University, Almaty 050010, Kazakhstan

Correspondence should be addressed to Gulnaz Kulnazarova; [email protected]

Received 12 November 2022; Revised 26 January 2023; Accepted 4 March 2023; Published 3 April 2023

Academic Editor: Marta Pérez-de-Heredia-Torres

Copyright © 2023 Gulnaz Kulnazarova et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The purpose of the study is to consider the factors influencing the development of the culture of interpersonal relationships and the effectiveness of the influence of cognitive therapy on improving social adaptation skills. The method of cognitive therapy included several types of activities. The first type of activities included group sessions, during which the weaknesses of the interaction and their correction were identified. The second type was conducted in the format of teaching standard models of interaction between people. The third type of activity aimed to teach children to build a dialogue with each other and express their desires and emotions. Classes were held 3 times a week throughout the year. The study was attended by pupils of 5-7 grades of Zhanuya boarding school and special correctional boarding school No. 7 for children with intellectual disabilities. The results of a randomized study demonstrated an increase in the indicators of teamwork skills, self-control, emotional stability, and independent decision-making. The indicators of cheerfulness, openness, sociability, and logical thinking also improved. But the factor of antisocial behavior decreased. All of these indicators directly affect socialization. This strategy can be applied in practice in various specialized boarding schools and schools for children with intellectual disabilities.

1. Introduction

The study of the behavior of children with intellectual dis- abilities is a rather relevant topic today. A decrease in intel- lectual abilities can occur due to various diseases and factors. The basis of pathogenesis is central nervous system disorders [1]. These can be chromosomal pathologies such as Down, Patau, and Edward syndromes. Also, chromosomal abnor- malities include Angelman syndrome and Prader-Willi syn- drome. The features of chromosomal abnormalities include not only delayed intellectual development but also somatic abnormalities. These include sinistral immunity, visual problems, and abnormalities of the nervous system [2]. Abnormalities in mental development can also occur due to complications during pregnancy and childbirth, as well as due to external factors, for example, if the mother had TORCH infections during pregnancy or was exposed to high ionizing radiation doses. Quite often, birth trauma and fetal

asphyxia can be the causes of developmental delay. A nega- tive factor can be the mother’s use of alcohol and drugs dur- ing pregnancy [3]. Also, a decrease in the level of intelligence is observed in the absence of proper education and training of children in their first years of life, this often happens in dysfunctional families [4]. These children often have com- munication problems with the people around them. First, due to a decrease in intelligence, children are not always able to formulate and express their thoughts clearly, which often leads to misunderstandings [5]. Secondly, emotional adapta- tion is impaired, which is characterized by the inability of children to adequately respond to various situations and can also be manifested through isolation and avoidance of social contacts [6]. Due to these factors, most children with intellectual disabilities have problems with socialization and self-realization in society. To help these children, pro- grams are often used to develop their social and communica- tion skills. They are usually implemented at specialized

Hindawi Occupational erapy International Volume 2023, Article ID 6466836, 8 pages https://doi.org/10.1155/2023/6466836

schools [7]. Due to the fact that the problem is global, there are quite a lot of options for such training. Various cognitive behav- ioral practices are very often used to teach interpersonal rela- tionships [8]. For example, there are real-time play therapy techniques: each participant must build a dialogue and learn to solve various problems together with another person or a group of people under the supervision of a teacher or psychol- ogist [9]. Cognitive therapy options using various mobile appli- cations are also being considered. These can be simple games with cards that help children communicate with others and by choosing one or another card, to show their emotions and desires. This makes it easier to understand the needs of children [10]. There are applications that simulate certain situations, teach reactions, and, through repetition, reinforce the acquired skill. For example, there are mobile phone applications that match a word to an object or colour [11]. Currently, consider- ation is being given to introducing a virtual universe using com- puter technology. This makes it possible to expand the variability of tasks and enhance visual fixation during trainings [12]. Despite the positive dynamics and all possible options for the socialization of children with intellectual disabilities, it should be borne in mind that most studies have certain gaps. Many of them require additional research in various focus groups to obtain new results [13]. The problem of the culture of relationships among people with intellectual disabilities is quite relevant. Their inability to build social relationships reduces the quality of life and prevents them from becoming full-fledged members of society. Therefore, new training and psychological assistance programs are constantly being devel- oped in the world. This not only provides an opportunity for socialization but also helps to change the attitude of society towards people with impaired intellectual functions. More research is required to understand the effectiveness of the impact of cognitive techniques on interpersonal culture. It is necessary to introduce similar experimental methods in schools and boarding schools for children with intellectual disabilities.

2. Literature Review

Scientists from Sydney (Australia) conducted research on impaired social interaction skills among children with intel- lectual disabilities. They concluded that the main problem lies in the impairment of the neuropsychological profile as such children often have affective and comorbid disorders. This leads to impaired memory, learning, and expression of one’s own thoughts and emotions. In most cases, atten- tion deficit hyperactivity disorder occurs. Due to this, com- munication becomes difficult. It was also concluded that there are very few methods for helping such children and the best choice is cognitive behavioral therapy. However, the data on the effectiveness of the influence turned out to be rather controversial [14]. There was an experiment con- ducted in the UK to introduce cognitive programs to help people with congenital disabilities. The concept was to learn to distinguish between behaviors, thoughts, feelings, and emotions and to relate them to different situations. It was a randomized study involving people with mild to moderate mental retardation. These training sessions significantly improved understanding of one’s own emotions, as well as

the ability to respond correctly to various life situations [15]. Swedish researchers considered the impact of cognitive group training on the socialization of children with autism spectrum disorders. As part of the experiment, the effective- ness of this method has been confirmed [16]. Studies by South Korean researchers on the issue of socialization and improvement of communication skills among people with intellectual disabilities also confirmed their effectiveness. The methodology aimed to teach people the rules of com- munication, etiquette, and cultural characteristics of the region. An intragroup study demonstrated a fairly high effi- ciency [17]. In Victoria (Australia), researchers considered the effects of cognitive behavioral therapy on the social skills of children and adolescents. A randomized experiment, which confirmed the positive impact of behavioral interven- tions on children with socialization deficits, was carried out [18]. Scientists from Maribor (Slovenia) considered play intervention for children with developmental disabilities. All games were built on the development of cognitive skills, fine motor skills, social skills (adequate interpretation of emotions), and expansion of vocabulary. All games were played in a digital environment. The experiment studied children with autism and attention deficit disorder. How- ever, the results were controversial. While the serious play method reduced anxiety and stress indicators and contrib- uted to the recognition and management of emotions, clini- cal evidence of the benefits of this strategy was not revealed [19]. In Ireland, a strategy for the development of communi- cation and language skills in children with Down syndrome was considered. The study said that the development of the social abilities in these children should start at a very early age. This is associated with the fact that contact and commu- nication with people around them affects the level of com- munication skills of people with a similar disorder. Thus, it was concluded that social skills should be improved not only by the teacher but also by the parents or guardians. This requires that parents are taught to find contact with their children [20]. Indian researchers have studied the preoccu- pation with activities in children with intellectual disabilities. The experiment involved two focus groups, one of which consisted of absolutely healthy children, and the second one included children with various types of intellectual dis- abilities. The researchers let the children play in the class- room with ordinary toys (construction kits, figurines, cars, dolls) and watched the process. As a result, they noticed that the immersion and enthusiasm of children with mental dis- abilities in the game is much higher than that of healthy chil- dren. This should be taken into account as a psychological feature of children with intellectual disabilities in order to properly select a correction program [21]. Based on the data obtained, some conclusions can be drawn about teaching communication skills to people with intellectual disabilities. First, it should be borne in mind that the main socialization problems mainly occur due to the presence of comorbid and affective disorders. It should be taken into account that ear- lier development will determine the effectiveness of the selected strategy. Secondly, there is a need to choose the right approach for these children. One of the best options is cognitive therapy. There are a lot of cognitive therapy

2 Occupational Therapy International

options: from individual sessions with a specialist to ready- made mobile applications and computer games. Thirdly, it is worth noting that most of the experiments are randomized studies. Therefore, precisely accurate results cannot be con- firmed and such strategies require further research.

2.1. Setting Objectives. The motivation is to conduct more studies on the impact of cognitive therapy on the culture of interpersonal relationships among children with intellec- tual disabilities to understand the degree of effectiveness. Cognitive therapy has not yet been completely studied, and more research is needed. In the course of the study, it is also worth finding out in which areas this technique can be applied and how appropriate it is. The main goal was to study the influence of cognitive behavioral therapy on the socialization of children with intellectual disabilities aged 11-13. A randomized study was conducted at specialized (correctional) boarding school No. 7 and Zhanuya boarding school. A total of 350 children took part in the study. The objectives included the introduction of cognitive therapy in the education of children with intellectual disabilities. Also, to clarify the degree of socialization problems and test the effectiveness, specialized testing was used to assess commu- nicative competence. This test was implemented to evaluate the effectiveness of the integrated methodology. Further prospects of using the cognitive therapy strategy were also assessed. Specialized testing was used to analyze progress in the study. This was carried out and evaluated by a special- ist in psychology.

3. Methods

3.1. Research Design and Sample. A randomized study was conducted to assess the impact of cognitive behavioral therapy on children with intellectual disabilities. This study looked at the uncontrolled before-after design. There was no control group in the study. The experiment involved students of specialized boarding school No. 7 and Zhanuya boarding school (Almaty). These were 5-7 grade students. The age of the respondents was 11-13 years old. The experimental group consisted of 350 participants. There were 180 boys and 170 girls among the respondents. The objectives of the experiment were to introduce cognitive therapy into the education of children with intellectual dis- abilities. A specialized test to assess communicative compe- tence was also used to clarify the extent of socialization problems and to verify effectiveness. This questionnaire was administered to evaluate the effectiveness of the com- prehensive methodology. Further perspectives of the cogni- tive therapy strategy were also evaluated. Specialized testing was used to analyze the progress of the study. It was conducted and evaluated by a specialist in psychology. Outside the study, the children attended school in accor- dance with their timetable. No additional psychological therapy was performed.

3.2. Experiment. Prior to the experiment, all respondents were tested to evaluate their communicative and social com- petence. This is a multifactorial questionnaire that makes it

possible to assess the position of the individual in society and make a probable forecast of their further social activity. It includes 100 questions and the assessment of such criteria as factor A (openness, sociability), factor D (assessment of cheerfulness), factor K (desire to work in a team), factor P (propensity for antisocial behavior), factor M (independence and independence of other people’s opinions), factor N (self- control), and factor V (developed logical thinking). Each indicator is assessed on a 20-point scale except for factor P that is evaluated on a 40-point scale. Psychometric proper- ties of this test include reliability (0.94-0.90), validity (0.85- 0.8), and discriminability (0.33) [22]. The participants were tested at the beginning, in the middle, and at the end of the study. The experiment took place over four months. The therapy sessions were carried out 3 times a week. Each session lasted 3 hours. All training sessions were conducted under the guidance of a psychologist and a supervisor. Each of the three sessions that were carried out during the week had its own specifics. As part of the first type of training, col- lective therapy aimed at identifying the weaknesses of the interaction and their correction was carried out. This involved group sessions. Thus, a small group of children was selected to find a way out of a simulated situation through interaction with each other and teamwork. All respondents had to solve at least one case problem, after which they had to tell what emotions they experienced and analyze them [23]. The second type of activity was held in a training format. The children were shown standard models of interaction between people in various situations and had to repeat them to consolidate the material while acting out the scenario with each other [9]. The third type of session aimed to teach children to build a dialogue with each other by expressing their emotions and requests with the simula- tion of certain situations [24]. During these sessions, the respondents were divided into pairs. At the end of each month of the experiments, groups and pairs were disbanded and new ones were created to increase the level of adaptation of the respondents.

3.3. Statistical Processing and Data Analysis. The analysis was carried out using a questionnaire on communicative and social competence. It is a multifactor questionnaire which includes a measurement on eight criteria. The test itself consists of 100 questions. Seven of the criteria were assessed on a scale of 0 to 20 points, and only factor P (propensity for antisocial behavior) was assessed on a 40- point scale. Psychometric properties of this test include reliability (0.94-0.90), validity (0.85-0.8), and discriminabil- ity (0.33) The multifactor questionnaire is validated by Nikolai Petrovich Fetiskin (vice president of the Interna- tional Academy of Psychological Sciences). This question- naire was administered to all respondents three times: before the experiment, in the middle (interim testing), and at the end of the study.

To process the data of this study, a specialized program for statistical analysis SPSS 26.0 was used. The results were interpreted and visualized with the help of the Microsoft Excel 2019 software package. Student’s t-test was used to compare the effectiveness of the proposed teaching approach.

3Occupational Therapy International

To compare the mean result of the initial test with the results of the posttest to identify significant differences in the learn- ing process. The level of significance was set at (p ≤ 0:05). 95% confidence intervals (CI) were calculated for median analysis.

3.4. Research Limitations. It should be noted that the degree of intellectual disability was not taken into account; all children were treated equally during the experiment. How- ever, it should be taken into account that due to the vary- ing degrees of intellectual disability, this therapy may not affect the participants in the same way. Also, the disease, which led to intellectual impairment, and its specificity were not taken into account. The experiment involved children with various pathologies. It should be noted that this is a completely randomized trial, the purpose of which is to determine the impact of cognitive behavioral therapy on the socialization of children with intellectual disabilities and teaching them communication skills. The results of the study will be considered in terms of the arithmetic mean of the sample. All these factors should be taken into account when considering the results of the experiment. It should also be noted that the study was not carried out after the experiment had ended. It is therefore not possible to say with certainty that the result remains at a static level.

3.5. Ethical Issues. Such experiments require the consent of the respondents. Due to the fact that the prospective par- ticipants have not yet reached the age of majority, the official decision can only be made by the persons respon- sible for them. Parents and guardians were informed ver- bally and in writing about the format of the experiment and all its details. After that, they gave their written con- sent for their children’s participation in the study. The children gave their verbal consent to take part in the study after having been told about the essence of the experiment.

4. Results

Before the experiment began, a communicative competence test was carried out. All the results of the respondents have an average value for the study group and are described as points and percentages. The preliminary result for factor A (openness and sociability) was 8 points (40%)—the lowest indicator of the average level of sociability. The result for factor D (cheerfulness) was 13 points (65%). The indicator of factor K (teamwork) turned out to be rather low -5 points (25%). Factor P (propensity for antisocial behavior) result was equal to 12 points out of 40 possible (30%). The score for factor M (independent decision-making) turned out to be rather low -6 points (30%). Factor N (self-control) also showed a low value of -5 points out of 20 possible (25%). Factor V (logical thinking) was equal to 4 points (20%). The result of factor C (emotional stability) is 6 points (30%), which is also a rather low indicator. The result is shown in Table 1.

Intermediate testing was carried out 2 months after the start of the experiment. The factor A results (openness and sociability) were 11 points (55%). This indicates an increase in sociability in the study group. In turn, factor D (cheerful- ness) changed insignificantly; it increased by 1 point (70%). The factor K indicator (teamwork) increased by 3 points; thus, it was equal to 8 (40%). In two months, this indicator moved from the low level to the average level. Factor P (pro- pensity for antisocial behavior) decreased to 10 points out of 40 possible (25%). The result of factor M (independent decision-making) increased to 9 points (45%). Factor N increased by two points and was equal to 7 points (35%). Logical thinking (factor V) also increased by 2 points and was equal to 6 points out of 20 possible (30%). Emotional stability (factor C) changed its value in a positive direction -8 points (40%). The result of intermediate testing is shown in Table 2.

At the end of the experiment, the final test was carried out. According to its results, factor A (openness and sociabil- ity) reached 13 points (65%). The factor D result (cheerful- ness) was 15 points (75%)—the upper limit of the average level. Factor K (teamwork) amounted to 10 points (50%). The results of factor P (propensity to antisocial behavior) were equal to 8 points out of 40 (20%). The factor M indica- tor (independent decision-making) was 11 points (55%). The factor N indicator (self-control) was equal to 9 points out of 20 possible (45%). The result of factor V (logical thinking) was 8 points (40%). Factor C (emotional stability) reached 10 points (50%).

The result of the final testing is shown in Table 3. After the final test was calculated, it was compared with

the preliminary results using Student’s t-tests (Table 4). The significance level of A, K, and M is 0.008 (p ≤ 0:01). This result demonstrates the exclusion of the null hypothesis and acceptance of the alternative hypothesis. That is, it shows that there is a sufficient statistical difference between the “before” and “after” figures. The significance level of fac- tor D is 0.005 (p ≤ 0:01). The significance level of factors P, V, and C is equated to 0.011 (p ≤ 0:05). And factor N has a significance level of 0.001 (p ≤ 0:001). It follows that all cri- teria underwent statistically significant changes in the course of the experiment.

Based on the data above, we can conclude that cognitive therapy sessions have a positive effect on the development of social skills in children with intellectual disabilities. This is evidenced by an increase in the indicators of teamwork, independent decision-making, self-control, logical thinking, and emotional stability. The criteria, such as “cheerfulness,” “openness,” and “sociability” also improved. It is worth not- ing that the factor of the propensity for antisocial behavior decreased due to the sessions of cognitive therapy. Also, changes in the behavior of the students who took part in the experiment began were noticed by their teachers. According to one of the supervisors, the children have really become more open in communication with each other and teachers, in particular. They are more actively involved in learning and open up to everything new with great interest. It is also worth noting that their academic performance has improved.

4 Occupational Therapy International

However, it should be considered that the study is completely randomized and was conducted in a large focus group. Also, the disease that provoked intellectual disability

and its degree were not taken into account. Therefore, the absolute reliability of the results cannot be stated. In the future, additional research may be required.

Table 2: Intermediate results.

Name of factor Points Standard deviation %

Factor A (openness, sociability) 11 points 1.1 55%

Factor D (cheerfulness) 14 points 1.4 70%

Factor K (teamwork) 8 points 1.2 40%

Factor P (propensity for antisocial behavior) 10 points 1.3 25%

Factor M (independent decision-making) 9 points 1.0 45%

Factor N (self-control) 7 points 0.8 35%

Factor V (logical thinking) 6 points 1.1 30%

Factor C (emotional stability) 8 points 1.0 40%

Table 3: Final results.

Name of factor Points Standard deviation %

Factor A (openness, sociability) 13 points 0.7 65%

Factor D (cheerfulness) 15 points 0.6 75%

Factor K (teamwork) 10 points 1.1 50%

Factor P (propensity for antisocial behavior) 8 points 0.9 20%

Factor M (independent decision-making) 11 points 1.0 55%

Factor N (self-control) 9 points 0.7 45%

Factor V (logical thinking) 8 points 0.6 40%

Factor C (emotional stability) 10 points 0.9 50%

Table 1: Preliminary results.

Name of factor Points Standard deviation %

Factor A (openness, sociability) 8 points 1.3 40%

Factor D (cheerfulness) 13 points 1.6 65%

Factor K (teamwork) 5 points 1.2 25%

Factor P (propensity for antisocial behavior) 12 points 1.8 30%

Factor M (independent decision-making) 6 points 1.5 30%

Factor N (self-control) 5 points 1.1 25%

Factor V (logical thinking) 4 points 1.2 20%

Factor C (emotional stability) 6 points 1.4 30%

Table 4: Comparison of the results.

Scales Preliminary results. Final results Empirical value Significance level (p value)

Factor A 8 ± 0:141 13 ± 0:283 -22.361 0.008∗∗

Factor D 13 ± 0:141 15 ± 0:141 -14.142 0.005∗∗

Factor K 5 ± 0:283 10 ± 0:141 -22.361 0.008∗∗

Factor P 12 ± 0:141 8 ± 0:283 17.889 0.011∗

Factor M 6 ± 0:283 11 ± 0:141 -22.361 0.008∗∗

Factor N 5 ± 0:141 9 ± 0:141 -28.284 0.001∗∗∗

Factor V 4 ± 0:141 8 ± 0:283 -17.889 0.011∗

Factor C 6 ± 0:283 10 ± 0:141 -17.889 0.011∗

∗p < 0:05; ∗∗p < 0:01; ∗∗∗p < 0:001.

5Occupational Therapy International

5. Discussion

In 2019, a study on the thinking and behavior of chil- dren with intellectual disabilities was conducted in the Netherlands. The emphasis was placed on the assump- tion of the flexibility of behavior and personality factors. A randomized trial was conducted. The results showed that children with intellectual disabilities have more fixed think- ing in terms of emotions and behavior. This suggests that teaching positive attitudes towards the development of the emotional sphere can be used to correct behavior and improve mental state [25]. It is impossible to fully compare this study with the present paper. This is due to the fact that the experiment, which was carried out in the Nether- lands, does not involve cognitive therapy. However, the result obtained in the course of the Dutch research describes and confirms the positive dynamics that were obtained during the experiment described above in this study. In 2018, Canadian scientists conducted an experi- ment and studied the effect of cognitive behavioral therapy on the behavior of children with autism. The study was randomized. As a result, the scientists concluded that the indicators of emotional state and socialization skills improved in the focus group [26]. Comparing the results obtained by Canadian scientists with the results of this study, we can say that in both cases, there is a positive trend. The only difference is that in Canada, the focus group consisted exclusively of children with autism while this study looked at intellectual spectrum disorders more extensively. In 2018, there was an American study of the effect of cognitive therapy on children with self-regulation problems, namely, with social, executive dysfunction, and emotional spectrum disorders. The results proved the effec- tiveness of the impact of cognitive behavioral therapy on these areas of life [27]. This also confirms the feasibility of the application of this type of therapy to solve the prob- lem of socialization in children with intellectual disabilities. Scientists from the UK have studied the effect of cognitive behavioral therapy on people with intellectual disabilities. They conducted a randomized trial. The results showed improved cognitive functions and improved quality of life [28]. The experiment by British researchers has confirmed the results of this study. Joint developments of scientists from China and the United States were based on studying the effectiveness of the use of cognitive therapy for resis- tance to various social situations in people with neurocog- nitive disorders. The results were ambiguous. Resistance to various social factors increased, but this did not affect neuropsychiatric behavioral symptoms [29]. However, the authors of this study argue that there could be various inac- curacies in the course of the experiment; therefore, absolute results cannot be claimed. Due to the fact that most studies in this area have positive dynamics, we can talk about con- firmation of the effectiveness of this strategy, but it is also worth considering all the nuances associated with the design and conduct of these experiments. It is worth men- tioning the fact that most studies are randomized; as a result of this, there may be certain gaps. It is impossible to identify the criteria for the effectiveness of the influence

of cognitive therapy on people with certain disabilities as specific diseases and the degree of their development are not taken into account in most cases.

The results obtained can be explained in terms of the fact that cognitive therapy is a learning factor. During the ses- sions, people work out new patterns of behavior reinforcing them by repetition. As people with various intellectual dis- abilities are able to learn the expression of various emotions and their manifestation in different situations, we can talk about an increase in acquired social skills.

The results described in this study are also randomized and cannot claim absolute accuracy; therefore, additional research is required in this area. During the comparison of this work with other articles, no fully similar methodology was found. It follows that this strategy may be a unique development.

The application of the knowledge gained gives us the understanding of the effectiveness of cognitive therapy in the development of a culture of interpersonal relationships in people with intellectual disabilities. This strategy can be used in the context of learning and developing social skills. This provides a prospect for new discoveries in the field of interpersonal relationships, as well as changing and improv- ing the cognitive techniques aimed at people with a narrower specificity of intellectual disabilities.

However, it must be kept in mind that the degree of mental retardation was not taken into account; all children were treated equally in the experiment. Because of the vary- ing degrees of mental retardation, the therapy may not affect the participants in the same way. The illness that led to men- tal retardation and its specifics were also not taken into account. Children with different pathologies participated in the experiment. This is a fully randomized study that aims to determine the effects of cognitive behavioral therapy on the socialization of children with intellectual disabilities and their learning of social skills. It should also be noted that the study was not carried out after the experiment had ended. It is therefore not possible to say with certainty that the result remains at a static level.

6. Conclusions

The results of this study showed that the use of cognitive therapy for the development of a culture of interpersonal relationships in children with intellectual disabilities has proven to be effective. This conclusion can be made based on the improvement of the indicators of self-control, team- work, independent decision-making, logical thinking, and emotional stability. The indicators moved from the low level to the average one, which indicates an improvement in socialization skills. It is also worth noting a slight increase in the indicators of cheerfulness and sociability. The factor of antisocial behavior, in turn, decreased, which indicates a positive trend in the study. This leads to the conclusion that it is advisable to use cognitive therapy for the socialization of children with intellectual disabilities.

The scientific value of this experiment lies in the applica- bility of the results for further research and the improvement of the methods of cognitive therapy in this area. It should be

6 Occupational Therapy International

borne in mind that the study was based on a randomized sample method; therefore, this strategy requires additional experiments to obtain more accurate results. However, the method of cognitive therapy can be used to develop a culture of interpersonal relationships in people with intellectual dis- abilities. It should be used in schools and specialized institu- tions for children with intellectual disabilities. Also, the method of cognitive therapy can be used for preschool chil- dren with intellectual disabilities; however, it should be con- sidered that this strategy may need to be adapted for this age group. Cognitive therapy can also help adults with intellec- tual disabilities socialize. Therefore, this strategy can be applied in private psychological practice.

When assessing the prospects for further research, it is worth pointing out the gaps in this research. The disadvan- tage is a rather large focus group of respondents, which does not give an absolute specificity of the results. It should be noted that due to the large number of participants, all results are considered in the mean value system. Also, intellectual disorders and the degree of their severity were not consid- ered and were not taken into account. Standard cognitive therapy methods were chosen to promote socialization. Therefore, further research should examine the impact of such a strategy on a small group of respondents. Cognitive therapy to specific cases of intellectual disability, such as Down syndrome or autism, can also be applied. To obtain more accurate results, the sample should include respon- dents with the same severity of specific diseases. Other methods of cognitive therapy can also be applied. The results of such studies will make it possible to correct various cogni- tive methods in accordance with the degree and form of intellectual disabilities. This will contribute to the develop- ment of an individual approach and increased efficiency.

Data Availability

The data will be available on request.

Conflicts of Interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

References

[1] S. V. Grechanyi, “Autism and comorbid mental disorders in children,” Medicine: Theory and Practice, vol. 4, pp. 163-164, 2019.

[2] P. Chiurazzi, A. K. Kiani, J. Miertus et al., “Genetic analysis of intellectual disability and autism,” Acta Bio-Medica: Atenei Parmensis, vol. 91, article e2020003, Supplement 13, 2020.

[3] B. Ostrander and J. F. Bale, “Congenital and perinatal infec- tions,” Handbook of Clinical Neurology, vol. 162, pp. 133– 153, 2019.

[4] V. des Portes, “Intellectual disability,” Handbook of Clinical Neurology, vol. 174, pp. 113–126, 2020.

[5] O. Purugganan, “Intellectual disabilities,” Pediatrics in Review, vol. 39, no. 6, pp. 299–309, 2018.

[6] C. Reynoso, M. J. Rangel, and V. Melgar, “Autism spectrum disorder: etiological, diagnostic and therapeutic aspects,”

Revista Médicadel Instituto Mexicano del Seguro Social, vol. 55, no. 2, pp. 214–222, 2017.

[7] S. Iwase, N. G. Bérubé, Z. Zhou et al., “Epigenetic etiology of intellectual disability,” Journal of Neuroscience, vol. 37, no. 45, pp. 10773–10782, 2017.

[8] C. Burt, L. Graham, and T. Hoang, “Effectiveness of computer- assisted vocabulary instruction for secondary students with mild intellectual disability,” International Journal of Disability, Development and Education, vol. 69, no. 4, pp. 1273–1294, 2022.

[9] M. S. Yazici and B. McKenzie, “Strategies used to develop socio-communicative skills among children with autism in a Turkish special education school and implications for develop- ment of practice,” International Journal of Disability, Develop- ment and Education, vol. 67, no. 5, pp. 515–535, 2020.

[10] C. Y. Sng, M. Carter, and J. Stephenson, “Teaching on-topic conversational responses to students with autism spectrum disorders using an iPad app,” International Journal of Disabil- ity, Development and Education, vol. 69, no. 2, pp. 415–434, 2022.

[11] V. I. Moskvina and D. V. Valko, “Digital learning system for the development of social interaction skills in children with special needs,” Management in Modern Systems, vol. 2, no. 22, pp. 32–35, 2019.

[12] S. N. V. Yuan and H. H. S. Ip, “Using virtual reality to train emotional and social skills in children with autism spectrum disorder,” London Journal of Primary Care, vol. 10, no. 4, pp. 110–112, 2018.

[13] C. Koh, “A qualitative meta-analysis on the use of serious games to support learners with intellectual and developmental disabilities: what we know, what we need to know and what we can do,” International Journal of Disability, Development and Education, vol. 69, no. 3, pp. 919–950, 2022.

[14] A. Hronis, L. Roberts, and I. I. Kneebone, “A review of cogni- tive impairments in children with intellectual disabilities: implications for cognitive behaviour therapy,” British Journal of Clinical Psychology, vol. 56, no. 2, pp. 189–207, 2017.

[15] L. Vereenooghe, L. Gega, S. Reynolds, and P. E. Langdon, “Using computers to teach people with intellectual disabilities to perform some of the tasks used within cognitive behavioural therapy: a randomised experiment,” Behaviour Research and Therapy, vol. 76, pp. 13–23, 2016.

[16] N. C. Olsson, O. Flygare, C. Coco et al., “Social skills training for children and adolescents with autism spectrum disorder: a randomized controlled trial,” Journal of the American Acad- emy of Child & Adolescent Psychiatry, vol. 56, no. 7, pp. 585– 592, 2017.

[17] M. Oh, E. Laugeson, J. H. Kim et al., “A randomized controlled trial of the Korean version of the program for the education and enrichment of relational skills for young adults (PEERS®-YA-K) with autism spectrum disorder: a pilot study,” Frontiers in Psy- chiatry, vol. 12, article 730448, 2021.

[18] S. J. Darling, M. Goods, N. P. Ryan, A. K. Chisholm, K. Haebich, and J. M. Payne, “Behavioral intervention for social challenges in children and adolescents: a systematic review and meta-analysis,” JAMA Pediatrics, vol. 175, no. 12, article e213982, 2021.

[19] P. Kokol, H. B. Vošner, J. Završnik, J. Vermeulen, S. Shohieb, and F. Peinemann, “Serious game-based intervention for chil- dren with developmental disabilities,” Current Pediatric Reviews, vol. 16, no. 1, pp. 26–32, 2020.

7Occupational Therapy International

[20] C. O'Toole, A. S. Y. Lee, F. E. Gibbon, A. K. van Bysterveldt, N. J. Hart, and Cochrane Developmental, Psychosocial and Learning Problems Group, “Parent-mediated interventions for promoting com-munication and language development in young children with Down syndrome,” Cochrane Database of Systematic Reviews, vol. 2018, no. 10, article CD012089, 2018.

[21] A. Johry and R. Poovaiah, “Playfulness through the lens of toy design: a study with Indian preschool children with intellectual disability,” International Journal of Play, vol. 8, no. 3, pp. 255– 275, 2019.

[22] O. A. Kovaleva, “The problem of determination, assessment and formation of social and communicative competence of the individual,” Bulletin of Pedagogy and Psychology of South- ern Siberia, vol. 2, pp. 111–127, 2017.

[23] B. P. V. Ho, J. Stephenson, and M. Carter, “Teacher under- standing and application of cognitive–behavioural approaches for students with autism spectrum disorder and intellectual disability,” Australasian Journal of Special and Inclusive Edu- cation, vol. 43, no. 1, pp. 12–26, 2019.

[24] O. M. Alegre de la Rosa and L. M. Villar Angulo, “Attitudes of children with hearing loss towards public inclusive education,” Education Sciences, vol. 9, no. 3, p. 244, 2019.

[25] F. Verberg, P. Helmond, R. Otten, and G. Overbeek, “Mindset and perseverance of adolescents with intellectual disabilities: associations with empowerment, mental health problems, and self-esteem,” Research in Developmental Disabilities, vol. 91, article 103426, 2019.

[26] J. A. Weiss, K. Thomson, P. Burnham Riosa et al., “A random- ized waitlist-controlled trial of cognitive behavior therapy to improve emotion regulation in children with autism,” Journal of Child Psychology and Psychiatry, vol. 59, no. 11, pp. 1180– 1191, 2018.

[27] B. Pfeiffer, G. F. Clark, and M. Arbesman, “Effectiveness of cognitive and occupation-based interventions for children with challenges in sensory processing and integration: a sys- tematic review,” The American Journal of Occupational Ther- apy, vol. 72, no. 1, pp. 7201190020p1–7201190020p9, 2018.

[28] A. Ali, E. Brown, A. Spector, E. Aguirre, and A. Hassiotis, “Individual cognitive stimulation therapy for people with intellectual disability and dementia: protocol of a feasibility randomised controlled trial,” BMJ Open, vol. 8, no. 12, article e022136, 2018.

[29] Y. Wang, I. Chi, Y. Zhan, W. Chen, and T. Li, “Effectiveness of resilience interventions on psychosocial outcomes for persons with neurocognitive disorders: a systematic review and meta- analysis,” Frontiers in Psychiatry, vol. 12, article 709860, 2021.

8 Occupational Therapy International

Copyright of Occupational Therapy International is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.