Introduction
Children with Attention Deficit Hyperactivity Disorder are a good target group for cognitive rehabilitation Because their behavioral problems, including inattention, impulsivity, and hyperactivity, have a specific cognitive and cerebral origin. This adaptation of behavior to cognitive function provides an opportunity to repair behavior by strengthening cognitive function. Given that childhood is the most appropriate critical period of development, during which brain plasticity has the highest flexibility and cognitive training in this course can lead to the best results [16] and on the other hand, executive functions in the age range of 7-12 years show the highest growth rate [17] Therefore the need for cognitive rehabilitation to address children’s cognitive deficits is clear to professionals. 
This study aimed to compare the effectiveness of cognitive rehabilitation based on virtual reality technology as a new method and classical cognitive rehabilitation in improving the executive functions of children with attention deficit hyperactivity disorder. 
Materials and Methods
This research was a quasi-experimental study using a pre-test-post-test design with a control group. The statistical population included all children aged 7-12 years with Attention Deficit Hyperactivity Disorder in Tehran in 1398 who were selected by convenience sampling method and randomly divided into 3 groups of 12 people matched in terms of mean age and gender. Admission requirements: having a diagnosis of Attention Deficit Hyperactivity Disorder by a psychiatrist, having the same medication protocol, being 7-12 years old, lacking other disorders such as mental retardation and learning disabilities, and having a conscious agreement to participate in the research. So all these children received a diagnosis of the disorder from a psychiatrist and similar drug treatment. In the pre-test stage, participants were assessed with the Attention Deficit Hyperactivity Disorder Rating Scale and the Computer Integrated Visual and Auditory Test (IVA-2). The first group received a virtual reality-based cognitive rehabilitation package and the second group received a Captain Log computer cognitive rehabilitation package, 12 sessions twice a week. No intervention was performed in the control group during this period. Posttest was taken from all 3 groups after the intervention. Univariate analysis of covariance (ANCOVA) was used to analyze the data using SPSS software v. 26. 
Results
There was a significant difference in selective attention and sustained attention between the first experimental group (virtual reality rehabilitation) and the control group (P<0.01). also Comparing the means of selective attention and sustained attention between the second experimental group (classical cognitive rehabilitation) and the control group showed a significant difference (P<0.01). The results showed that both methods of cognitive rehabilitation intervention had a significant effect on cognitive functions (selective attention, sustained attention) of Attention deficit hyperactivity disorder (ADHD) children (P<0.01). This means that virtual reality-based and classical cognitive rehabilitation significantly increased selective attention and sustained attention in children with ADHD. But no significant difference was observed between the mean scores of selective attention and sustained attention in the first experimental group and the second experimental group (P>0.05). In other words, there is no significant difference between the effectiveness of these two interventions on the level of selective attention and sustained attention of children with ADHD. 
Discussion
The results of this study are consistent with the results of Steiner et al.) 2011) [38], Nazarbland et al. (2019) [6], Royatvand Ghiasvand and Amiri Majd (2018) [35], Behrooz Sarcheshmeh et al. (2017) [39] regarding the effectiveness of Captain Log computer program has been on executive functions. Also, in line with the results of Stephen Bioula et al. (2020) [40], Mühlberger et al. (2020) [29], Alexandra Negut et al. (2017) [41], Bashiri et al. (2017) [34], Shahmoradi et al. (2017) [28] regarding the effectiveness of virtual reality technology in improving mental disorders. 
Virtual reality-based cognitive rehabilitation is as effective as classical cognitive rehabilitation on selective attention and sustained attention in children with ADHD. Virtual reality-based cognitive rehabilitation can be used as a new approach to rehabilitating this disorder. The research findings show that virtual reality turns a passive learning experience into an active activity. The goal of virtual reality-based cognitive rehabilitation in cognitive rehabilitation of children with attention-deficit-hyperactivity disorder is to engage children fully in learning Items by immersing them in the learning experience. And this feature creates a lot of potential for use in teaching and learning. Given that the Captain Log computer rehabilitation program was selected as the classical rehabilitation approach in the study for comparison, And considering that this program has been used and approved in many studies to date as an effective program in improving executive functions and cognitive weaknesses; It can be hoped that the new approach to cognitive rehabilitation using virtual reality technology can lead to good results in cognitive rehabilitation of resilient and unmotivated children and open new horizons for professionals in line with modern technology. 

Ethical Considerations
Compliance with ethical guidelines
The Research Ethics Committee approved this study of the Central Tehran Branch, Islamic Azad University (Code: IR.IAU.CTB.REC.1400.001). 

Funding
This article is taken from the doctoral dissertation of the first author, Zahra Barati, in the Department of Psychology,  Central Tehran Branch, Islamic Azad University. According to the authors, there was no financial support for the research.

Authors' contributions
Conceptualization: Mojgan Sepah Mansour, Zahra Barati; Research and sampling method: Shokoofeh Radfar, Zahra Barati; Data analysis and text writing: Zahra Barati; Review: Mojgan Sepah Mansour, Shokoofeh Radfar.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
Thanks and appreciation for the cooperation and support of Atieh Sazan Rahavard Mobin Creative Company and the CEO of Sondos Kashani Khatib for her guidance through this research.
 


References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, D.C: American Psychiatric Pub; 2013. https://books.google.com/books/about/Diagnostic_and_Statistical_Manual_of_Men.html?id=-JivBAAAQBAJ
2. Dadsetan P. [Developmental pathological psychology from infancy through adulthood (Persian)]. Tehran: Samat Publications; 2010. https://opac.nlai.ir/opac-prod/search/briefListSearch.do?command=FULL_VIEW&id=572445&pageStatus=1&sortKeyValue1=sortkey_title&sortKeyValue2=sortkey_author
3. Barkley RA. Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychol Bull. 1997; 121(1):65-94. [DOI:10.1037/0033-2909.121.1.65] [PMID]
4. Bakhshayesh A. [Diagnosis and treatment of attention deficit hyperactivity disorder: (ADHD) with an emphasis on nervous feedback (Along with a practical guide to conducting treatment sessions) (Persian)]. Yazd: Yazd University Press; 2010. http://opac.nlai.ir/opac-prod/search/briefListSearch.do?command=FULL_VIEW&id=1927292&pageStatus=1&sortKeyValue1=sortkey_title&sortKeyValue2=sortkey_author
5. Nejati V, Aghaeesabet S, Khoshhalipanah M. [Social cognition in children with attention deficit hyperactivity disorder (Persian)]. J Soc Cogn. 2013; 2(2): 47-53. https://sc.journals.pnu.ac.ir/article_725_2.html
6. Nazarboland N, Nohegari E, Sadeghi Firoozabadi V. [Effectiveness of Computerized Cognitive Rehabilitation (CCR) on working memory, sustained attention and math performance in children with autism spectrum disorders (Persian)]. Q Appl Psychol. 2019; 13(2):271-93. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=682182
7. Barkley RA. Attention-deficit hyperactivity disorder. New York: Guilford Publications; 2018. https://www.google.com/books/edition/Attention_Deficit_Hyperactivity_Disorder/uB5rDwAAQBAJ?hl=en&gbpv=0
8. Hwang S, Meffert H, Parsley I, Tyler PM, Erway AK, Botkin ML, et al. Segregating sustained attention from response inhibition in ADHD: An fMRI study. Neuroimage Clin. 2019; 21:101677. [DOI:10.1016/j.nicl.2019.101677] [PMID] [PMCID]
9. Sadock BJ, Ruiz P, Sadock VA. Sinopsis de psiquiatra / Synopsis of psychiatry. 11th ed. Netherlands: Wolter Kluwer; 2015. https://books.google.com/books/about/Kaplan_and_Sadock_Sinopsis_de_Psiquiatr.html?id=__ywoQEACAAJ
10. Catalá-López F, Hutton B, Núñez-Beltrán A, Page MJ, Ridao M, Macías Saint-Gerons D, et al. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PloS One. 2017; 12(7):e0180355. [DOI:10.1371/journal.pone.0180355] [PMID] [PMCID]
11. Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, et al. Nonpharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry. 2013; 170(3):275-89. [DOI:10.1176/appi.ajp.2012.12070991] [PMID]
12. Hodgkins P, Shaw M, McCarthy S, Sallee FR. The pharmacology and clinical outcomes of amphetamines to treat ADHD. CNS Drugs. 2012; 26(3):245-68. [DOI:10.2165/11599630-000000000-00000] [PMID]
13. Dana A, Shams A. [The effectiveness of cognitive brain rehabilitation interventions on executive functions in children with attention deficit hyperactivity disorder (Persian)]. J Neuropsychol. 2018; 5(18):131-40. [DOI:10.30473/CLPSY.2020.46249.1440]
14. Eslami NM, Namazizadeh M, Aslankhani MA. [Effect of attention games and cognitive rehabilitation on attention and cognitive functions of children with ADHD (Persian)]. Sci J Rehabil Med. 2020; 9(1):201-8. [DOI:10.22037/jrm.2019.111196.1828]
15. Nuranijurjade R, Mashhadi A, Tabibi Z, Kheyrkhah F. [The effect of executive function training based on daily life on executive functions of children with attention deficit hyperactivity disorder (Persian)]. J Cogn Sci News. 2015; 18(1):68-78. https://www.sid.ir/fa/journal/ViewPaper.aspx?ID=288238
16. Bergen D, Woodin M. Brain research and childhood education: Implications for educators, parents, and society. 1th ed. New York: Routledge; 2017. [DOI:10.4324/9781315465173]
17. Goldstein S, Naglieri JA. Handbook of executive functioning. New York: Springer; 2014. [DOI:10.1007/978-1-4614-8106-5]
18. Nejati V. [Comprehensive textbook of cognitive rehabilitation in developmental disorders (Persian)]. Tehran: Culture Growth Publications; 2018. http://opac.nlai.ir/opac-prod/search/briefListSearch.do?command=FULL_VIEW&id=5435964&pageStatus=1&sortKeyValue1=sortkey_title&sortKeyValue2=sortkey_author
19. Nejati V, Salehinejad MA, Nitsche MA. Interaction of the left dorsolateral prefrontal cortex (l-DLPFC) and right orbitofrontal cortex (OFC) in hot and cold executive functions: Evidence from transcranial direct current stimulation (tDCS). Neuroscience. 2018; 369:109-23. [DOI:10.1016/j.neuroscience.2017.10.042] [PMID]
20. Yavari Barhaghtalab E, Asgary P, Naderi F, Heidarie A. [Effect of cognitive rehabilitation on executive function (response retention and scheduling) in children with attention deficit hyperactivity disorder (Persian)]. Sci J Rehabil Med. 2021; 10(1):146-57. [DOI:10.22037/JRM.2020.112304.2176]
21. Moin N, Asadi Gandomani R, Amiri M. [The effect of neurofeedback on improving executive functions in children with attention deficit/hyperactivity disorder (Persian)]. Arch Rehabil. 2018; 19(3):220-7. [DOI:10.32598/rj.19.3.220]
22. Maghsudloo M, Nejati V, Fathabadi J. [Effectiveness of ARAM cognitive rehabilitation package on improvement of executive function based on behavioral rating in preschool children with ADHD symptoms (Persian)]. Psychol Except Individ. 2019; 9(33):23-43. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=740989
23. Horowitz-Kraus T. Differential effect of cognitive training on executive functions and reading abilities in children with ADHD and in children with ADHD comorbid with reading difficulties. J Atten Disord. 2015; 19(6):515-26. [DOI:10.1177/1087054713502079] [PMID]
24. Shuai L, Daley D, Wang Y-F, Zhang J-S, Kong Y-T, Tan X, et al. Executive function training for children with attention deficit hyperactivity disorder. Chin Med J. 2017; 130(5):549-58. [DOI:10.4103/0366-6999.200541] [PMID] [PMCID]
25. Narimani M, Soleymani E, Tabrizchi N. [The effect of cognitive rehabilitation on attention maintenance and math achievement in ADHD students (Persian)]. J Sch Psychol. 2015; 4(2):118-34. http://jsp.uma.ac.ir/article_329.html?lang=en
26. Najafi M, Mohammadi M, Tehranidust M, Alaghbandrad J, Asaari SH. [The effect of two types of computer intervention on spelling scores of primary school children with Attention Deficit Hyperactivity Disorder (Persian)]. Adv Cogn Sci. 2003; 6(1-2):51-8. https://icssjournal.ir/article-1-34-fa.html
27. Velayati E. [Application of information and communication technology for students with special educational needs (Persian)]. J Except Educ. 2013; 14(6):30-9. http://ensani.ir/file/download/article/20150908175250-9991-137.pdf
28. Shahmoradi L, Almasi S, Mehrabanfar M. [Applications of virtual environment in the field of health (Persian)]. J Modern Med Inform. 2016; 3(1):56-66. http://jmis.hums.ac.ir/article-1-107-fa.html
29. Mühlberger A, Jekel K, Probst T, Schecklmann M, Conzelmann A, Andreatta M, et al. The influence of methylphenidate on hyperactivity and attention deficits in children with ADHD: A virtual classroom test. J Atten Disord. 2020; 24(2):277-89. [DOI:10.1177/1087054716647480] [PMID]
30. Sohrabi N, BehPajooh A, Ghobari Bonab B. [Psychometric properties of the Jordan’s attention deficit disorder indexes (Persian)]. Psychol Methods Models. 2010; 1(1):63-80. http://jpmm.miau.ac.ir/article_1155.html?lang=en
31. Jenaabadi H, Ghavidel M. [Comparative examination of attention and answer control rate in two groups of people with attention-deficit hyperactivity disorder and cognitive disorder (Persian)]. Bi Q J Cogn Strateg Learn. 2018; 5(9):1-11. [DOI:10.22084/J.PSYCHOGY.2017.1679]
32. Boojari S, Haghgoo H, Rostami R, Ghanbari S. [The relationship between cognitive functions and academic performance in children with attention deficit, hyperactivity disorder (Persian)]. J Paramed Sci Rehabil. 2015; 4(4):27-35. [DOI:10.22038/JPSR.2015.5397]
33. Bakhshi S. [Effect of selected attention-related tasks on sustained attention in children with attention deficit hyperactive disorder (Persian)]. Tehran: Iran; 2010. https://en.irct.ir/trial/4359?revision=4359
34. Bashiri A, Ghazisaeedi M, Shahmoradi L. The opportunities of virtual reality in the rehabilitation of children with attention deficit hyperactivity disorder: A literature review. Korean J Pediatr. 2017; 60(11):337-43. [DOI:10.3345/kjp.2017.60.11.337] [PMID] [PMCID]
35. Royatvand Ghiasvand N, Amiri Majd M. [Effectiveness of Captain Log’s cognitive software on working memory of students with learning disabilities (Persian)]. J Except Child Empower. 2018; 9(3):5-15. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=746964
36. Pumaccahua TT, Wong EH, Wiest DJ. Effects of computerized cognitive training on working memory in a school setting. Int J Learn Teach Educ Res. 2017; 16(3):88-104. https://www.semanticscholar.org/paper/Effects-of-Computerized-Cognitive-Training-on-in-a-Pumaccahua-Wong/5f2f17223939ad4672e2b33fd1bc6aebcac53bbe
37. Behrooz SS, Ashori M, Ansari SM. [The effect of cognitive training on the attention rate and working memory in children with attention deficit/hyperactivity disorder (Persian)]. J Except Child Empower. 2017; 8(21):6-15. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=550785
38. Steiner NJ, Sheldrick RC, Gotthelf D, Perrin EC. Computer-based attention training in the schools for children with attention deficit/hyperactivity disorder: A preliminary trial. Clin Pediatr. 2011; 50(7):615-22. [DOI:10.1177/0009922810397887] [PMID]
39. Riva G, Wiederhold BK, Mantovani F. Neuroscience of virtual reality: From virtual exposure to embodied medicine. Cyberpsychol Behav Soc Netw. 2019; 22(1):82-96. [DOI:10.1089/cyber.2017.29099.gri] [PMID] [PMCID]
40. Bioulac S, Micoulaud-Franchi J-A, Maire J, Bouvard MP, Rizzo AA, Sagaspe P, et al. Virtual remediation versus methylphenidate to improve distractibility in children with ADHD: A controlled randomized clinical trial study. J Atten Disord. 2020; 24(2):326-35. [DOI:10.1177/1087054718759751] [PMID]
41. Neguț A, Jurma AM, David D. Virtual-reality-based attention assessment of ADHD: ClinicaVR: Classroom-CPT versus a traditional continuous performance test. Child Neuropsychology. 2017; 23(6):692-712. [DOI:10.1080/09297049.2016.1186617] [PMID]
42. Tabrizi M, Manshaee G, Ghamarani A, Rasti J. Comparison of the effectiveness of virtual reality with medication on the memory of attention deficit hyperactivity disorder students. Int Arch Health Sci. 2020; 7(1):37-42. [DOI:10.4103/iahs.iahs_66_19]