Play Therapy and Cognitive Training Both Boost Executive Functions in Children With Dyslexia

Dyslexia is far more than a reading problem confined to the classroom. Children who struggle to decode written words often carry a heavier cognitive burden: weaknesses in the brain’s executive functions, the suite of mental processes that governs attention, working memory, inhibition, and cognitive flexibility. A new quasi-experimental study published in the Journal of Autism and Developmental Disorders suggests that two very different therapeutic approaches—cognitive-behavioral play therapy and structured cognitive rehabilitation—can both meaningfully improve these executive skills in school-aged children with dyslexia, and that the gains hold up at least a month after treatment ends.

The research, conducted by Haniyeh Shakery Chenary, Kolsoum Akbarnataj Bisheh, and Ebrahim Mohammadian Akerdi, recruited 54 students with dyslexia aged 8 to 12 years from learning disorder centers in Babol, a city in northern Iran. The children, both boys and girls, were selected according to inclusion criteria using a convenience sampling method and then randomly assigned to one of three groups of 18 participants each: a cognitive-behavioral play therapy group, a cognitive rehabilitation group, and a control group that received no intervention. The study followed a pre-test, post-test design with a one-month follow-up, allowing the researchers to track not only whether the treatments worked immediately but whether their effects persisted.

To measure executive functions, the team used the Brief Executive Function Behavioral Rating Questionnaire, an instrument designed to capture everyday manifestations of executive control as observed in children’s behavior. Executive functions are typically broken down into core components: inhibitory control, the ability to suppress impulsive responses; working memory, the capacity to hold and manipulate information in mind; and cognitive flexibility, the skill of shifting between tasks or mental sets. In children with dyslexia, deficits in these domains are well documented and are thought to compound the phonological processing difficulties that define the disorder, making reading acquisition and academic performance even harder.

The results were striking in their symmetry. After the interventions, post-test scores for executive functions decreased significantly in both treatment groups—lower scores on this behavioral rating measure indicating fewer executive function problems, and therefore improvement. Statistical analysis using repeated-measures analysis of variance confirmed that these changes were highly significant, with p values below .001, and crucially, the improvements were maintained at the one-month follow-up. The control group, by contrast, showed no comparable change. In practical terms, both therapies appeared to equip children with better self-regulation, attention, and mental control, and those benefits did not evaporate once the sessions stopped.

Perhaps the most intriguing finding, however, was what the researchers did not find. When the two intervention groups were compared head to head, no statistically significant difference emerged between them (p > .05). Cognitive-behavioral play therapy, with its emphasis on emotional expression and behavioral learning through play, proved just as effective as cognitive rehabilitation, a more direct, exercise-based approach to training cognitive skills. This equivalence matters, because it suggests that clinicians and schools may be able to choose the modality that best fits a particular child, setting, or budget without sacrificing therapeutic benefit.

The mechanisms behind the two approaches differ in fascinating ways. Cognitive rehabilitation is grounded in neuropsychology: it involves repeated, structured practice on tasks designed to strengthen specific cognitive operations, much like physical therapy targets particular muscle groups. Modern implementations range from paper-and-pencil exercises to computerized and even virtual reality-based programs, and the approach has been applied across populations from stroke survivors to children with learning disabilities. The underlying premise is neuroplasticity—that targeted, progressive challenge can reshape the efficiency of the neural networks supporting attention and memory.

Cognitive-behavioral play therapy, by contrast, marries the principles of cognitive-behavioral therapy with the natural language of childhood: play. Rather than asking an 8-year-old to sit through abstract discussions of thoughts and feelings, the therapist embeds cognitive and behavioral strategies in games, stories, and imaginative scenarios. Through play, children rehearse self-control, practice problem-solving, learn to tolerate frustration, and internalize coping strategies. For children with dyslexia, who frequently experience academic failure, shame, and anxiety around reading, this format may address both the cognitive deficits and the emotional fallout that accompany them. Previous research has linked poor reading to elevated rates of internalizing problems such as anxiety and depression, and to diminished self-concept, making an intervention that works through an enjoyable, low-pressure medium particularly appealing.

The study’s authors frame their findings against a sobering backdrop. Many children with dyslexia face poor academic and career outcomes, and their difficulties extend beyond phonological processing to attention and executive functions. Executive dysfunction in dyslexia has been documented in neuropsychological studies across multiple countries, and deficits in working memory have been shown to correlate with reading performance. Because executive functions also predict broader academic achievement and classroom learning behaviors, improving them may yield dividends that go well beyond reading itself—better task completion, stronger self-regulation, and greater capacity to benefit from reading instruction.

The quasi-experimental design, while robust for a clinical field study, does carry limitations worth noting. The sample was drawn from learning disorder centers in a single city using convenience sampling, which may limit how broadly the findings generalize. The outcome measure relied on a behavioral rating questionnaire rather than direct neuropsychological testing, and the follow-up period was one month, leaving open the question of whether benefits persist over longer horizons. Still, the randomized assignment to groups, the inclusion of a control condition, and the follow-up assessment give the findings a credibility that many small clinical studies lack. The researchers also report that the study protocol and ethics code were approved by the Ethics Committee of Islamic Azad University, Sari Branch, and that caregiver consent and child assent were obtained before data collection.

For clinicians, educators, and parents, the takeaway is refreshingly practical: two effective, accessible, and fundamentally different treatments can improve the executive functions of children with dyslexia, and neither holds a decisive advantage. Cognitive rehabilitation offers a targeted, skills-drilling route for settings equipped with structured programs, while cognitive-behavioral play therapy offers a developmentally sensitive, emotionally attuned alternative that children may find inherently motivating. The authors conclude that both can be used as effective and accessible therapeutic approaches for treating students with dyslexia. In a field where families often face long waiting lists and expensive specialized services, evidence that two distinct pathways lead to the same destination is genuinely good news—and a reminder that the developing brain, given the right kind of support, can be nudged toward stronger self-regulation and control.

Subject of Research: Comparing cognitive-behavioral play therapy and cognitive rehabilitation for improving executive functions in students with dyslexia

Article Title: The Effectiveness of Cognitive-Behavioral Play Therapy and Cognitive Rehabilitation on Executive Functions in Students With Dyslexia

Article References: Shakery Chenary, H., Akbarnataj Bisheh, K., & Mohammadian Akerdi, E. (2026). The Effectiveness of Cognitive-Behavioral Play Therapy and Cognitive Rehabilitation on Executive Functions in Students With Dyslexia. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07548-1

Image Credits: AI Generated

DOI: 10.1007/s10803-026-07548-1

Keywords: dyslexia, executive functions, cognitive-behavioral play therapy, cognitive rehabilitation, working memory, inhibitory control, cognitive flexibility, learning disorders, child psychology, intervention study, neuropsychology, academic outcomes