Introduction
Specific learning disorder (SLD) refers to a group of neurodevelopmental disorders that cause problems in daily life activities [2]. Math disorder is one of the types of SLD. Since the perception and performance of mathematical calculation depend on cognitive and executive functions, the disorder in these two components harms math performance [5]. SLD is associated with problems in cognitive processes [8] and executive functions. Executive functions include a wide range of cognitive abilities, including working memory, processing speed, and spatial processing [10]. A review of the literature [11, 12] reveals that the three components of working memory, cognitive flexibility, and cognitive inhibition are the main components of executive functions [14, 15]. Various studies have confirmed the effectiveness of working memory training [16, 17], response inhibition [18, 19, 20, 21], and the regulation of behavior and cognitive flexibility [22] on improving executive functions. However, some contradictory research findings indicate the lack of effectiveness of cognitive programs on executive functions [23] and math performance [24]. In recent decades, games have been used to treat various disorders [25] and cognitive problems [13]. Practicing cognitive games along with computer tasks improves cognitive skills and prepares children for entering school [6]. Cognitive games regulate attention and the level of provocation. With these games, the child experiences the surrounding world via simulated scenarios [26]. The attentive rehabilitation of attention and memory (ARAM) is one of the cognitive rehabilitation programs consisting of computer games and numerous practices. It is based on Baddeley’s model, working memory, and the hierarchical model of attention that works by using a computer and focusing on attention and working memory. ARAM practices are performed in a progressive and 10-step manner. It uses restorative and compensatory methods to strengthen and improve cognitive functions. Using the flexibility of neuroplasticity, it attempts to restore or improve the abilities of the damaged areas in the brain via continuous practices [27]. The effectiveness of the ARAM cognitive rehabilitation program has been confirmed in the attention and working memory of the elderly [27], children with attention-deficit/hyperactivity disorder [32], and deaf children with cochlear implants [33]. 
The high prevalence of SLD in the world (5.7%) [6] and Iran (between 1.13% and 6.1%) [7] and the negative impact of failure in executive functions on other behavioral, cognitive, and social aspects make it necessary to carry out research in this area. We should take steps toward developing children’s talents by designing multifaceted educational activities. Playing cognitive games and strengthening children’s attention helps them integrate verbal, visual, and auditory information and prevent weakness in academic performance (especially mathematics) in school years and its unpleasant psychological consequences (peer rejection, decreased self-confidence, anxiety, and depression) in the coming years. Therefore, the current research aims to investigate whether the ARAM cognitive rehabilitation program affects the executive functions of children. 
Materials and Methods
This quasi-experimental research has a pre-test-post-test design with a control group and a 5-week follow-up. The statistical population comprised children aged 8 to 12 years with math disorders living in Sanandaj City, Iran, in the 2020-2021 academic year. The sample size was determined to be at least 14 people in each group (28 people in total, including 15 boys and 13 girls) using similar studies [34, 36] considering the type I error of 0.05, the test power of 0.80, and the probability of dropping out of 20%. The samples were selected by the convenience sampling method from the learning disorder center. To measure mathematical skills, the Iran Key Math Test (IKMT) [35] was used, and the behavior rating inventory for executive function (BRIEF) [39] was used to measure executive functions.
IKMT measures the math skills of children aged 6 to 12 years in three main areas: basic math concepts, operations, and applications. The average standard score is 100, and its standard deviation is 15. By gaining score of one standard deviation lower than the average (85 and below), the subject receives a diagnosis of dyscalculia. This test has been standardized in Iran, and various studies have confirmed its validity. Also, its concurrent validity was reported between 0.55 and 0.67 and Cronbach alpha between 0.80 and 0.86 [38]. 
Gioia et al. designed BRIEF to evaluate the executive functions of children aged 6 to 12 years. It has 86 items and measures executive functions in eight scales in two indicators of behavior regulation (response inhibition, switch attention, and emotional control) and metacognition (working memory, plan/organize, initiate, organizing elements, and monitor). Gaining a score of 50 indicates problems, and a score above 65 indicates a defect in the index. The validity of the Persian version of BRIEF has been calculated as 0.80 to 0.98, and its reliability is in the range of 0.68 to 0.86 [39].
After obtaining the code of ethics and study permission, the research objectives were explained to the officials of learning disorder centers in Sanandaj City. After receiving the written consent of the parents, 28 children, according to the inclusion criteria of entry (score of 85 and below in IKMT, lack of other neurodevelopmental disorders) and exclusion criteria (absence of more than two sessions of the rehabilitation program) were selected with a convenience method. After matching based on age and gender, the children were randomly assigned to the experimental and control groups, and their parents completed the BRIEF. The students of the experimental group received the ARAM program in 10 individual sessions for 30 to 45 minutes, and the control group only participated in regular school programs. After the last training session and five weeks later, all subjects were evaluated using IKMT and BRIEF. The ARAM program protocol derived from its original version [27] includes 10 main exercises. The data were analyzed using the repeated measures analysis of variance (ANOVA). 
Results 
The average age of students in the experimental and control groups was 9.92 and 9.71 years. The significance levels (P=0.633; P=0.705) obtained from the independent t-test and the Chi-square test, respectively, for the age and gender variables, indicated the homogeneity of the groups. The number of participating boys (57%) was more than girls (43%). In addition, most people in the experimental and control groups (42% and 34%) were aged 11 years. Table 1 presents the mean and standard deviation of executive functions and their indicators in the experimental and control groups in pre-test, post-test, and follow-up situations. 


The results in Table 1 show that the average variable of executive functions, behavior regulation index, and metacognition index in the experimental group in the post-test and follow-up phases decreased compared to the pre-test phase. In contrast, such a noticeable change in the control group was not seen. 
To investigate the research hypothesis, i.e. «cognitive rehabilitation program improves the executive functions (behavior regulation and metacognition) of students with» the repeated measures ANOVA was used. Examining the assumptions of repeated measures ANOVA showed the quantitative assumption of dependent variable. The second assumption is established because the dependent variable was measured not only twice but thrice. Examining and observing the data showed no outliers in the data distribution; therefore, the third assumption is also established. Skewness and kurtosis indices were used to check the fourth assumption. If their absolute value is less than 2, the data have a normal distribution. Observing the value of the skewness and kurtosis index confirmed the normality of the distribution of scores. Also, Mauchly's sphericity assumption for executive function and the metacognitive index was not established (P<0.001); hence, Greenhouse correction values ​​were used. However, this assumption was established for the behavior adjustment index (P=0.14).
The repeated measures of ANOVA were used to compare the average scores of executive functions [behavior regulation and metacognition] of the experimental and control groups in the pre-test, post-test, and follow-up situations because all assumptions were established (Table 2). 


According to the results presented in Table 2, the mean executive functions (behavior regulation and metacognition) in the pre-test, post-test, and follow-up are significant in the two experimental and control groups. Based on the Eta squared values, 43%, 32%, and 43% of the changes in the variance of executive functions, behavior regulation, and metacognition of students with can respectively be explained via participation in the cognitive rehabilitation program. Therefore, the research hypotheses were confirmed. To investigate the effect of the group at different times, the independent t test was used at each time (Table 3). 


According to Table 3, the mean values of executive functions, behavior regulation, and metacognition of the two experimental and control groups in the pre-test had a significant difference (P<0.05), therefore the effect of the cognitive rehabilitation program on the improvement of executive functions (behavior regulation and metacognition) has remained even after five weeks of follow-up. 
Discussion
The first finding of the research indicated that the ARAM rehabilitation program had improved executive functions in children. The recent finding is consistent with the results of some types of research, including [41, 42, 43, 44, 45] but inconsistent with others [23, 24]. In the recent explanation, it is possible to refer to the underlying mechanisms of brain plasticity. Therefore, the hypothesis is that if the brain areas related to number processing in children [who usually have less activity] are stimulated repeatedly and appropriately, changes are expected to occur in the structure of the neurons of the mentioned areas that are stable over time [46]. Programs based on cognitive flexibility (including the ARAM rehabilitation program) are developed according to a specific method to target a specific structure of the brain to improve the function and action of that area. This program affects the inherent flexibility of the brain and gives it a new shape, and adjusts it in a way that ultimately increases the overall performance of the person [47]. The brain is changed based on the stimulation received from educational, social, and psychological environments [48]. Therefore, by performing educational and cognitive computer exercises, it can be expected that the function of a certain brain area related to executive functions improves. 
Other research findings indicate that the ARAM rehabilitation program had improved the indicators of behavior regulation and metacognition in students. This finding is consistent with the results of numerous studies [42, 44, 46]. One of the possible explanations is that cognitive rehabilitation programs are mostly presented in a computerized and entertaining form, which are designed and adjusted from simple to difficult, and this issue makes the child feel empowered and mastered in performing the task. Also, in most computer programs, the role of images is much more important than words because images give children the opportunity to follow a moving object and determine its position at different times, and become aware of reality. Also, computer-based programs significantly affect children's learning with their competitive characteristics, testability, complexity, adaptability, and dynamism. Therefore, the use of computer programs not only increases the necessary motivation in the student to carry out and continue it to achieve success but also improves characteristics, such as initiating in carrying out the program, response inhibition, and organizing [50]. In addition, it can be claimed that the ARAM rehabilitation program, which is actually a learning experience, is designed to adapt brain function to daily activities [51].
Based on the principle of the underlying mechanisms of brain plasticity, the brain is a dynamic organ with a high capacity for neurological reorganizing during life. The basis of behavioral and structural changes in the brain lies in dendritic and synaptic fibers, and it is possible to improve the behavioral function of neurons via cognitive exercises and structured brain stimulation [52]. Therefore, in the present research and other similar research, by performing suitable exercises, the ground is provided for neurological stimulation, and as a result, any change in cognitive functions will prepare the student to improve the learning conditions. 
Conclusion 
The research findings indicate that the executive functions and indicators of behavior regulation and metacognition in children increases and improve after receiving the ARAM rehabilitation program, and its effect is stable even five weeks after the program. Therefore, implementing cognitive rehabilitation exercises as an intervention program benefits students with a learning disorder. The research results can be useful for the practitioners and specialists of special education. These findings help them improve not only the children's cognitive capabilities but also prevent psychological problems (including depression and anxiety) caused by the inability to perform math calculations. These specialists can design cognitive rehabilitation programs based on computer games and include them in the programs of teaching children. 
Limitations 
One of the crucial limitations of the present study is the small sample size and not comparing the groups according to gender and age variables. Also, implementing the ARAM rehabilitation program during the COVID-19 epidemic affected the regular holding of sessions and the collection of information related to children's executive functions by completing questionnaires by parents and not performing functional tests (such as the Stroop test and the Tower of London test). So, the generalization of the findings is warranted. We suggest that future studies are conducted with larger sample sizes, and the role of gender and age will be considered. Functional tests (such as the Stroop test and Tower of London) can provide more accurate measurements of executive functions. 

Ethical Considerations
Compliance with ethical guidelines
This research was approved by the Ethics Committee of the University of Rehabilitation Sciences and Social Welfare (Ethical code: IR.USWR.REC.1399.150). To comply with ethical considerations, the officials of the learning disorder centers and children with specific learning disorders were fully informed about the research objectives. While obtaining written consent, they were assured that the information obtained from the questionnaires would remain confidential. Children's participation in the research does not imply any losses, and people who did not want to continue cooperation were free to withdraw from the research. While paying attention to the mental states and fatigue of the children, we attempted to respect their dignity and human rights during the research and after the completion of the ARAM rehabilitation intervention sessions. The people of the control group were familiarized with the content of the ARAM program in two intensive sessions and played its games. 

Funding
This article was extracted from the Master's thesis of Mohammad Ali Panah from the Department of Psychology and Education of Exceptional Children, University of Social Welfare and Rehabilitation Sciences.

Authors' contributions
Conceptualization: Mohammad Ali Panah, Masoume Pourmohamadreza-Tajrishi, and Vahid Nejati; Methods: Mohammad Ali Panah, Masoume Pourmohamadreza-Tajrishi, and Mohsen Vahedi; Validation: Mohammad Ali Panah, Masoume Pourmohamadreza-Tajrishi, Vahid Nejati, and Mohsen Vahedi; Research and investigation: Mohammad Ali-Panah; Supervision: Masoume Pourmohamadreza-Tajrishi, Vahid Nejati, and Mohsen Vahedi. Analysis and Sources, Writing the draft, editing and approval of the article: All authors. 

Conflict of interest
The authors declared no conflict of interest. 

Acknowledgments
We hereby thank the University of Social Welfare and Rehabilitation Sciences for their financial support of the research and all the people, especially the officials of learning disorder centers, teachers, counselors, students, and their parents in Sanandaj City, who helped us in this research.


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