The Clinical Effects of School Group Sandplay Therapy (SGST) on Anxiety/Depression, Somatic Symptoms, Social Immaturity, and Rule-Breaking Behavior in Children at Risk for ADHD

<b>Objectives</b>: Attention-Deficit/Hyperactivity Disorder (ADHD) in children is a developmental disorder that has been rapidly increasing worldwide. Its core symptoms, which include inattention, impulsivity, and hyperactivity, are often accompanied by emotional and behavioral problems such as depression and aggression. These factors can significantly impair a child's development and functioning, making effective therapeutic intervention essential. This non-randomized controlled trial with parallel-group design examined the intervention effects of a 10-week school group sandplay therapy (SGST) program on internalizing and externalizing problems in children at risk for ADHD. <b>Methods</b>: This non-randomized controlled trial involved 101 fifth- and sixth-grade students (ages 11-12) from an elementary school in a mixed urban-rural area. Participants were divided into a control group (<i>n</i> = 47) and an intervention group (<i>n</i> = 54). The intervention group participated in a 10-session SGST program held once a week, while the control group received no intervention. The Korean Youth Self-Report (K-YSR) was used to evaluate the effects of the intervention, and a Repeated Measures ANOVA (RM-ANOVA) was conducted to analyze the program's effectiveness. <b>Results</b>: The results revealed significant interaction effects between group and time in the SGST intervention group for several K-YSR subscales. The intervention group showed statistically significant differences in the areas of anxiety/depression (<i>p</i> < 0.04; η² = 0.043), somatic symptoms (<i>p</i> < 0.04; η² = 0.040), social immaturity (<i>p</i> < 0.01; η² = 0.061), and rule-breaking behavior (<i>p</i> < 0.04; η² = 0.044). <b>Conclusions</b>: SGST was found to be associated with improving not only internalizing problems like anxiety/depression, somatic symptoms in children at risk for ADHD but also externalizing problem like rule-breaking behavior and social problem like social immaturity. These findings demonstrate that school sand play therapy can be used as a non-pharmaceutical intervention for school-age children at risk of ADHD, and suggest that it can also be useful in an educational context.