Document Type : Research Article (s)


1 Department of Psychology, Tabriz Branch, Islamic Azad University, Tabriz, Iran

2 Department of Cognitive Neuroscience, Department of Physiology, Tabriz Branch, Islamic Azad University, Tabriz, Iran

3 Adib Mazandaran Institute of Higher Education, Sari, Iran


Background: Special Learning Disorder is a neurodevelopmental disorder which is considered to be from biological origin and causes abnormalities at the cognitive level. This study aimed to compare the effectiveness of emotion regulation-based cognitive therapy and transcranial direct current stimulation on impulsivity of students with special learning disorders.
Methods: This study was quasi-experimental and based on a pretest-posttest design with a control group. The participants were the second elementary school (fourth, fifth, and sixth grades) pupils with particular learning difficulties and were enrolled in Tabriz schools, Tabriz, Iran during the academic year 2019–2020. 54 students with unique learning difficulties who were randomly chosen from among those with exceptional learning disorders and allocated to three groups made up the study sample. The first experiment group underwent cognitive regulation therapy based on the emotion regulation for eight sessions of 45 minutes per week; the second experiment group received 20 sessions of direct transcranial Current stimulation on a daily basis, and the control group did not receive any treatment. Colorado Learning Disorder Questionnaire and the Barratt Impulsivity Scale were used to collect data. The collected data were analyzed using a Univariate analysis of covariance with SPSS version 22.
Results: Based on the demographic findings, the mean age and standard deviation of the cognitive therapy group based on emotion regulation was 11.05±0.872, in the direct transcranial electrical stimulation group was 10.83±0.83 and in the control group was 11.11±0.8. The results showed that both cognitive emotion regulation treatments and transcranial direct electrical stimulation had an effect on the components of impulsivity, motor impulsivity (P=0.012), impulsivity Cognitive (P=0.001), and lack of planning (P=0.001). However, transcranial direct electrical stimulation had a greater effect on the cognitive impulsivity component of students with specific learning disorders.
Conclusions: It can be concluded that direct transcranial stimulation can have a greater effect on cognitive impulsivity.


  1. Grigorenko EL, Compton DL, Fuchs LS, Wagner RK, Willcutt EG, Fletcher JM. Understanding, educating, and supporting children with specific learning disabilities: 50 years of science and practice. Am Psychol. 2020;75(1):37-51. doi: 10.1037/amp0000452. PubMed PMID: 31081650; PubMed Central PMCID: PMC6851403. ##
  2. American Psychiatric Association. DSM-5: Diagnostic and Statistical Manual of Mental Disorders. 5th Ed. Washington DC, American Association; 2013. doi: 10.1176/appi.books.9780890425596. ##
  3. National center for Learning Disabilities. Dyscalculia: A Quick Look Center for Learning Disabilities, Inc. Available from: ##
  4. Gullo MJ, Dawe S. Impulsivity and adolescent substance use: rashly dismissed as "all-bad"? Neurosci Biobehav Rev. 2008;32(8):1507-18. doi: 10.1016/j.neubiorev.2008.06.003. PubMed PMID: 18588911. ##
  5. Lopez-Morinigo JD, Boldrini M, Ricca V, Oquendo MA, Baca-García E. Aggression, Impulsivity and Suicidal Behavior in Depressive Disorders: A Comparison Study between New York City (US), Madrid (Spain) and Florence (Italy). J Clin Med. 2021;10(14):3057. doi: 10.3390/jcm10143057. PubMed PMID: 34300222; PubMed Central PMCID: PMC8303717. ##
  6. Al-Dababneh KA, Al-Zboon EK. Understanding Impulsivity Among Children With Specific Learning Disabilities in Inclusion Schools. Learning Disability Quarterly. 2018;41(2):100-112. doi: 10.1177/0731948717726497. ##
  7. Marín-Navarrete R, Toledo-Fernández A, Villalobos-Gallegos L, Roncero C, Szerman N, Medina-Mora ME. Latent Impulsivity Subtypes in Substance Use Disorders and Interactions with Internalizing and Externalizing Co-Occurring Disorders. Front Psychiatry. 2018;9:27. doi: 10.3389/fpsyt.2018.00027. PubMed PMID: 29479323; PubMed Central PMCID: PMC5811514. ##
  8. Romer D. Adolescent risk taking, impulsivity, and brain development: implications for prevention. Dev Psychobiol. 2010;52(3):263-76. doi: 10.1002/dev.20442. PubMed PMID: 20175097; PubMed Central PMCID: PMC3445337. ##
  9. Fenneman J, Frankenhuis WE. Is impulsive behavior adaptive in harsh and unpredictable environments? A formal model. Evolution and Human Behavior. 2020;41(4):261-73. doi: 10.1016/j.evolhumbehav.2020.02.005. ##
  10. Jiménez TI, Estévez E. School aggression in adolescence: Examining the role of individual, family and school variables. Int J Clin Health Psychol. 2017;17(3):251-260. doi: 10.1016/j.ijchp.2017.07.002. PubMed PMID: 30487900; PubMed Central PMCID: PMC6220901. ##
  11. Venkatesan S, Lokesh L. Impulsivity in students with specific learning disabilities. International Journal of Indian Psychology. 2019;7(4):37-47. doi: 10.25215/0704.005. ##
  12. Marriott LK, Coppola LA, Mitchell SH, Bouwma-Gearhart JL, Chen Z, Shifrer D, et al. Opposing effects of impulsivity and mindset on sources of science self-efficacy and STEM interest in adolescents. PLoS One. 2019;14(8):e0201939. doi: 10.1371/journal.pone.0201939. PubMed PMID: 31454349; PubMed Central PMCID: PMC6711531. ##
  13. Goulème N, Lions C, Gérard CL, Peyre H, Thai-Van H, Bucci MP. Vertical disconjugacy during reading in dyslexic and non-dyslexic children. Neurosci Lett. 2018;671:82-87. doi: 10.1016/j.neulet.2018.02.016. PubMed PMID: 29444444. ##
  14. FragaGonzález G, Karipidis II, Tijms J. Dyslexia as a Neurodevelopmental Disorder and What Makes It Different from a Chess Disorder. Brain Sci. 2018;8(10):189. doi: 10.3390/brainsci8100189. PubMed PMID: 30347764; PubMed Central PubMed PMCID: PMC6209961. ##
  15. Gross JJ. Emotion regulation: Current status and future prospects. Psychological Inquiry. 2015;26(1):1-26.‏ doi: 10.1080/1047840X.2014.940781. ##
  16. Rottenberg J, Gross JJ. When emotion goes wrong: realizing the promise of affective science. Clinical Psychology Science and Practice. 2017;10(2):227-232. doi: 10.1093/clipsy.bpg012. ##
  17. Fletcher K, Parker G, Bayes A, Paterson A, McClure G. Emotion regulation strategies in bipolar II disorder and borderline personality disorder: differences and relationships with perceived parental style. J Affect Disord. 2014;157:52-9. doi: 10.1016/j.jad.2014.01.001. PubMed PMID: 24581828. ##
  18. Gratz KL, Gunderson JG. Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behav Ther. 2006;37(1):25-35. doi: 10.1016/j.beth.2005.03.002. PubMed PMID: 16942958. ##
  19. Byramy M, Hashemy T, Ashory M. Effectiveness of Emotional Regulation Training on Students Social Adaptation and Interpersonal Sensitivity. Quarterly Social Psychology Research. 2017;7(27):1-14. Persian. ##
  20. D'Acquisto F. Affective immunology: where emotions and the immune response converge. Dialogues Clin Neurosci. 2017;19(1):9-19. doi: 10.31887/DCNS.2017.19.1/fdacquisto. PubMed PMID: 28566943; PubMed Central PMCID: PMC5442367. ##
  21. Gross JJ, Muñoz RF. Emotion regulation and mental health. Clinical psychology: Science and practice. 1995;2(2):151-64. doi: 10.1111/j.1468-2850.1995.tb00036.x. ##
  22. Thair H, Holloway AL, Newport R, Smith AD. Transcranial Direct Current Stimulation (tDCS): A Beginner's Guide for Design and Implementation. Front Neurosci. 2017;11:641. doi: 10.3389/fnins.2017.00641. PubMed PMID: 29213226; PubMed Central PMCID: PMC5702643. ##
  23. Schestatsky P, Morales-Quezada L, Fregni F. Simultaneous EEG monitoring during transcranial direct current stimulation. J Vis Exp. 2013;17(76):50426. doi: 10.3791/50426. PubMed PMID: 23851401; PubMed Central PMCID: PMC3727533. ##
  24. Fregni F, Liguori P, Fecteau S, Nitsche MA, Pascual-Leone A, Boggio PS. Cortical stimulation of the prefrontal cortex with transcranial direct current stimulation reduces cue-provoked smoking craving: a randomized, sham-controlled study. J Clin Psychiatry. 2008;69(1):32-40. doi: 10.4088/jcp.v69n0105. PubMed PMID: 18312035. ##
  25. Ke Y, Wang N, Du J, Kong L, Liu S, Xu M, et al. The Effects of Transcranial Direct Current Stimulation (tDCS) on Working Memory Training in Healthy Young Adults. Front Hum Neurosci. 2019;13:19. doi: 10.3389/fnhum.2019.00019. PubMed PMID: 30774590; PubMed Central PMCID: PMC6367257. ##
  26. Ferrucci R, Mameli F, Guidi I, Mrakic-Sposta S, Vergari M, Marceglia S, et al. Transcranial direct current stimulation improves recognition memory in Alzheimer disease. Neurology. 2008;71(7):493-8. doi: 10.1212/01.wnl.0000317060.43722.a3. PubMed PMID: 18525028. ##
  27. Thomson JM, Doruk D, Mascio B, Fregni F, Cerruti C. Transcranial direct current stimulation modulates efficiency of reading processes. Front Hum Neurosci. 2015;9:114. doi: 10.3389/fnhum.2015.00114. PubMed PMID: 25852513; PubMed Central PMCID: PMC4360704. ##
  28. Rajaiepour M, Saeidmanesh M. The Effectiveness of Transcranial Direct Current Stimulation (tDCS) from the Skull on Memory Students with Especially Learning Disorders. Neuropsychology. 2018;4(13):67-84. Persian. ##
  29. Bandeira ID, Guimarães RSQ, Jagersbacher JG, Barretto TL, de Jesus-Silva JR, Santos SN, et al. Transcranial Direct Current Stimulation in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder (ADHD): A Pilot Study. J Child Neurol. 2016;31(7):918-24. doi: 10.1177/0883073816630083. PubMed PMID: 26879095. ##
  30. Lovakov A, Agadullina ER. Empirically derived guidelines for effect size interpretation in social psychology. European Journal of Social Psychology. 2021;51(3):485-504. doi: 10.1002/ejsp.2752. ##
  31. Willcutt EG, Boada R, Riddle MW, Chhabildas N, DeFries JC, Pennington BF. Colorado Learning Difficulties Questionnaire: Validation of a Parent-Report Screening Measure. Psychol Assess. 2011;23(3):778-91. doi: 10.1037/a0023290. PubMed PMID: 21574721; PubMed Central PMCID: PMC3164385. ##
  32. Hajloo N, Rezaie Sharif A. Psychometric properties of Colorado Learning Difficulties Questionnaire (CLDQ). Journal of Learning Disabilities. 2011;1(1):24-43. doi: jld-1-1-90-7-2. Persian. ##
  33. Barratt E. Impulsivity: integrating cognitive, behavioral. Biological and environmental data. In Mccwn W, Johnson J, editors: The Impulsive Client: Theory, Research, and Treatment, American Psychological Association, Washington DC; 1994. ##
  34. Ekhtiari H, Rezvanfard M, Mokri A. Impulsivity and its Different Assessment Tools: A Review of View Points and Conducted Researches. IJPCP. 2008;14(3):247-257. Persian. ##
  35. Barlow H. Clinical Handbook of Psychological Disorders. 5th ed; 2014. ##
  36. Moslemi B, Azmodeh M, Tabatabaei M, Alivandi Vafa M. The Effect of Transcranial Direct Current Stimulation on Dorsolateral Prefrontal Cortex: a Review of its Role on Cognitive Functions. Shefaye Khatam. 2019;8(1):129-144. doi: 10.29252/shefa.8.1.129. Persian. ##
  37. Sergiou CS, Woods AJ, Franken IHA, van Dongen JDM. Transcranial direct current stimulation (tDCS) as an intervention to improve empathic abilities and reduce violent behavior in forensic offenders: study protocol for a randomized controlled trial. Trials. 2020;21(1):263-273. doi: 10.1186/s13063-020-4074-0. PubMed PMID: 32169111; PubMed Central PMCID: PMC7069186. ##
  38. Narimani M, Abassi M, Bagiyan MJ, Rezaie A. The Effectiveness of Impulse Control and Attention Training on Emotional Processing, Impulsiveness and Distractibility in Students with Dyscalculia. Research in Cognitive and Behavioral Sciences. 2016;5(2):1-22. Persian. ##
  39. Wiener J. Do peer relationships foster behavioral adjustment in children with learning disabilities? Learning Disability Quarterly. 2004;27(1):21–30. doi: 10.2307/1593629. ##
  40. Chen WL, Liao WT. Emotion Regulation in Close Relationships: The Role of Individual Differences and Situational Context. Front Psychol. 2021;12:697901. doi: 10.3389/fpsyg.2021.697901. PubMed PMID: 34393930; PubMed Central PMCID: PMC8355482. ##
  41. Gilmore CS, Dickmann PJ, Nelson BG, Lamberty GJ, Lim KO. Transcranial Direct Current Stimulation (tDCS) paired with a decision-making task reduces risk-taking in a clinically impulsive sample. Brain Stimul. 2018;11(2):302-9. doi: 10.1016/j.brs.2017.11.011. PubMed PMID: 29174303. ##
  42. Choy O, Raine A, Hamilton RH. Stimulation of the Prefrontal Cortex Reduces Intentions to Commit Aggression: A Randomized, Double-Blind, Placebo-Controlled, Stratified, Parallel-Group Trial. J Neurosci. 2018;38(29):6505-6512. doi: 10.1523/JNEUROSCI.3317-17.2018. PubMed PMID: 29967006; PubMed Central PMCID: PMC6705949. ##
  43. Miller PH. Theories of developmental psychology. 6th ed. New York: Worth Publishers; 2016. ##
  44. Monastra VJ, Monastra DM, George S. The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback. 2002;27(4):231-49. doi: 10.1023/a:1021018700609. PubMed PMID: 12557451. ##
  45. Mahmood Aliloo M, Hashemi Nosratabad T, Karimpour Vazifehkhorani A. The Role of Impulsivity, Sensitivity to Reward and Anhedonia in Distinction People With Symptoms of Borderline Personality Disorder From Ordinary People. IJPCP. 2018;24(2):136-147. doi: 10.32598/ijpcp.24.2.136. ##
  46. Dambacher F, Schuhmann T, Lobbestael J, Arntz A, Brugman S, Sack AT. Reducing proactive aggression through non-invasive brain stimulation. Soc Cogn Affect Neurosci. 2015;10(10):1303-9. doi: 10.1093/scan/nsv018. PubMed PMID: 25680991; PubMed Central PMCID: PMC4590530. ##