Volume 32, Issue 1 (3-2025)
RJMS 2025, 32(1): 1-13 |
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Research code: ندارد
Ethics code: IR.UMA.REC.1402.057
Clinical trials code: ندارد
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Golestani E, Atadokht A, Mikaeili N, Hajloo N. Compare the Effectiveness of Educational Board Games and Sandplay Therapy on Symptoms of Hyperactivity and Visual-Spatial Memory in Children with ADHD. RJMS 2025; 32 (1) :1-13
URL: http://rjms.iums.ac.ir/article-1-8912-en.html
URL: http://rjms.iums.ac.ir/article-1-8912-en.html
Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran , AK_atadokht@yahoo.com
Abstract: (400 Views)
Background & Aim: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity, which significantly impair a child’s functioning across various domains. First identified in 1845 by German physician Henry Fouman, ADHD has since been recognized as one of the most prevalent childhood disorders. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the global prevalence of ADHD is approximately 5% in children and 2.5% in adults. Boys are more frequently diagnosed than girls, with a male-to-female ratio ranging from 2.1 to 9.1. In boys, the disorder often presents with prominent hyperactive and impulsive symptoms, whereas girls are more likely to exhibit inattentive behaviors. Children with ADHD face numerous challenges in academic, social, and emotional settings. They struggle with maintaining attention, organizing daily tasks, and interacting with peers, often leading to social rejection, low self-esteem, and poor academic performance. Moreover, cognitive deficits, particularly in executive functions such as working memory, are prevalent in children with ADHD. Visuospatial memory, a subset of working memory responsible for processing and recalling visual and spatial information, is notably impaired in these children. Given these challenges, early intervention is crucial. While pharmacological treatments remain the first line of intervention due to their rapid efficacy, concerns about side effects and limited long-term benefits have prompted interest in non-pharmacological approaches. Among these, play therapy, including sandplay therapy and educational board games, has emerged as a promising alternative. Sandplay therapy allows children to express emotions and experiences through symbolic play, facilitating emotional regulation and cognitive development. On the other hand, educational board games target executive functions by engaging children in structured tasks that require planning, attention, and memory. This study aims to compare the effectiveness of these two interventions in reducing ADHD symptoms and enhancing visuospatial memory in children aged 7 to 9 years.
Methods: This quasi-experimental study employed a pre-test, post-test, and one-month follow-up design with a control group. The study was conducted in Baharestan County, Tehran, during 2023, involving children aged 7 to 9 years diagnosed with ADHD. A total of 60 children were initially selected through cluster and purposive sampling from two elementary schools. Participants were screened using the SNAP-IV Rating Scale, a validated tool for assessing ADHD symptoms, and randomly assigned to three groups: educational board games (n=20), sandplay therapy (n=20), and a control group (n=20). Due to attrition, the final sample size consisted of 55 participants. Inclusion criteria were a confirmed diagnosis of ADHD, absence of comorbid physical or psychiatric conditions, and parental consent. Exclusion criteria included missing more than three sessions and receiving concurrent treatments for ADHD. The interventions were conducted over 15 sessions, with each session lasting 45 minutes. Educational Board Games: The sessions involved cognitive tasks that required participants to follow rules, complete tasks, and engage in problem-solving activities. The games were designed to enhance attention, memory, and executive functions. Sandplay Therapy: This intervention involved tactile interaction with sand, where children created shapes, built structures, and engaged in storytelling using miniature objects. The therapy aimed to facilitate emotional expression and improve sensory integration. Data were analyzed using repeated measures ANOVA and Bonferroni post hoc tests to evaluate the effectiveness of the interventions across different phases (pre-test, post-test, and follow-up).
Results: The analysis revealed significant improvements in both ADHD symptoms and visuospatial memory for the experimental groups compared to the control group. ADHD Symptoms: The repeated measures ANOVA showed a significant reduction in ADHD symptoms across the three phases (F=162.150, p<0.001, η²=0.757). Post hoc comparisons indicated significant differences between the experimental groups and the control group, while no significant difference was found between the educational board game and sandplay groups. Visuospatial Memory: The intervention significantly improved visuospatial memory scores (F=112.096, p<0.001, η²=0.683). Similar to ADHD symptoms, the improvements were maintained during the follow-up phase, suggesting the stability of the interventions. The Bonferroni post hoc test further confirmed that the interventions had a lasting impact, with significant improvements observed from the pre-test to the follow-up phase.
Conclusion: The findings of this study align with previous research highlighting the efficacy of play-based interventions in managing ADHD symptoms and improving cognitive functions. Educational board games and sandplay therapy, despite their distinct mechanisms, demonstrated comparable efficacy in reducing hyperactivity, impulsivity, and enhancing visuospatial memory. These results underscore the potential of non-pharmacological interventions as viable alternatives or complementary treatments for ADHD. The effectiveness of these interventions can be attributed to their ability to engage children in structured, goal-oriented activities that require sustained attention and cognitive effort. Sandplay therapy, in particular, facilitates emotional expression and sensory integration, which are crucial for children with ADHD who often struggle with emotional regulation. Educational board games, on the other hand, target executive functions by promoting strategic thinking, problem-solving, and memory recall. Research by Pels and Klein (2020) supports the use of combined interventions, suggesting that integrating cognitive and sensory-based therapies can yield greater benefits than single-method approaches. Similarly, a study by Johnson et al. (2022) demonstrated that combining educational board games with sandplay therapy resulted in significant improvements in self-regulation and social behaviors in children with ADHD. This study highlights the effectiveness of educational board games and sandplay therapy in reducing ADHD symptoms and enhancing visuospatial memory in children aged 7 to 9 years. Both interventions demonstrated significant and sustained improvements, suggesting their potential as complementary or standalone treatments for ADHD. The findings underscore the importance of integrating cognitive and sensory-based therapies to address the multifaceted challenges faced by children with ADHD. Future research should explore the long-term impact of these interventions and investigate their applicability across diverse cultural and educational contexts. Additionally, studies examining the effects of combining different therapeutic modalities may provide further insights into optimizing treatment outcomes for children with ADHD. By providing a holistic approach that addresses both cognitive and emotional needs, educational board games and sandplay therapy offer a promising pathway for improving the quality of life for children with ADHD and their families.
Methods: This quasi-experimental study employed a pre-test, post-test, and one-month follow-up design with a control group. The study was conducted in Baharestan County, Tehran, during 2023, involving children aged 7 to 9 years diagnosed with ADHD. A total of 60 children were initially selected through cluster and purposive sampling from two elementary schools. Participants were screened using the SNAP-IV Rating Scale, a validated tool for assessing ADHD symptoms, and randomly assigned to three groups: educational board games (n=20), sandplay therapy (n=20), and a control group (n=20). Due to attrition, the final sample size consisted of 55 participants. Inclusion criteria were a confirmed diagnosis of ADHD, absence of comorbid physical or psychiatric conditions, and parental consent. Exclusion criteria included missing more than three sessions and receiving concurrent treatments for ADHD. The interventions were conducted over 15 sessions, with each session lasting 45 minutes. Educational Board Games: The sessions involved cognitive tasks that required participants to follow rules, complete tasks, and engage in problem-solving activities. The games were designed to enhance attention, memory, and executive functions. Sandplay Therapy: This intervention involved tactile interaction with sand, where children created shapes, built structures, and engaged in storytelling using miniature objects. The therapy aimed to facilitate emotional expression and improve sensory integration. Data were analyzed using repeated measures ANOVA and Bonferroni post hoc tests to evaluate the effectiveness of the interventions across different phases (pre-test, post-test, and follow-up).
Results: The analysis revealed significant improvements in both ADHD symptoms and visuospatial memory for the experimental groups compared to the control group. ADHD Symptoms: The repeated measures ANOVA showed a significant reduction in ADHD symptoms across the three phases (F=162.150, p<0.001, η²=0.757). Post hoc comparisons indicated significant differences between the experimental groups and the control group, while no significant difference was found between the educational board game and sandplay groups. Visuospatial Memory: The intervention significantly improved visuospatial memory scores (F=112.096, p<0.001, η²=0.683). Similar to ADHD symptoms, the improvements were maintained during the follow-up phase, suggesting the stability of the interventions. The Bonferroni post hoc test further confirmed that the interventions had a lasting impact, with significant improvements observed from the pre-test to the follow-up phase.
Conclusion: The findings of this study align with previous research highlighting the efficacy of play-based interventions in managing ADHD symptoms and improving cognitive functions. Educational board games and sandplay therapy, despite their distinct mechanisms, demonstrated comparable efficacy in reducing hyperactivity, impulsivity, and enhancing visuospatial memory. These results underscore the potential of non-pharmacological interventions as viable alternatives or complementary treatments for ADHD. The effectiveness of these interventions can be attributed to their ability to engage children in structured, goal-oriented activities that require sustained attention and cognitive effort. Sandplay therapy, in particular, facilitates emotional expression and sensory integration, which are crucial for children with ADHD who often struggle with emotional regulation. Educational board games, on the other hand, target executive functions by promoting strategic thinking, problem-solving, and memory recall. Research by Pels and Klein (2020) supports the use of combined interventions, suggesting that integrating cognitive and sensory-based therapies can yield greater benefits than single-method approaches. Similarly, a study by Johnson et al. (2022) demonstrated that combining educational board games with sandplay therapy resulted in significant improvements in self-regulation and social behaviors in children with ADHD. This study highlights the effectiveness of educational board games and sandplay therapy in reducing ADHD symptoms and enhancing visuospatial memory in children aged 7 to 9 years. Both interventions demonstrated significant and sustained improvements, suggesting their potential as complementary or standalone treatments for ADHD. The findings underscore the importance of integrating cognitive and sensory-based therapies to address the multifaceted challenges faced by children with ADHD. Future research should explore the long-term impact of these interventions and investigate their applicability across diverse cultural and educational contexts. Additionally, studies examining the effects of combining different therapeutic modalities may provide further insights into optimizing treatment outcomes for children with ADHD. By providing a holistic approach that addresses both cognitive and emotional needs, educational board games and sandplay therapy offer a promising pathway for improving the quality of life for children with ADHD and their families.
Type of Study: Research |
Subject:
Clinical Psychiatry
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