The Efficacy of clay therapy on reducing the severity of symptoms of Attention Deficit

Hyperactivity Disorder (ADHD) in primary school female students

Soheila Etemadi
M.S. graduate student, clinical psychology, Islamic Azad University, Science and Research Fares

ABSTRACT
This study aimed to evaluate the efficacy of clay therapy in reducing attention deficit symptoms of in
elementary school female students with attention deficit disorder. In this study, the experiment was done in a
post and pre-test design with random assignment of participants in control and experiment groups.
The population includes the 7-10 years old female students with attention deficit hyperactivity disorder in
primary school education in four areas of Shiraz, Iran. 30 of them were selected purposefully after interviewing
parents and completion of Child Symptom Inventory CSI-4 by parents and teachers to screen those with
attention deficit and approval of a psychiatrist for final diagnosis and the dose of Ritalin as well as the Raven
test for the screening IQ of 90 to 109. They were randomly assigned to control and experiment groups. The
experiment group participated in 8 sessions of clay therapy and after therapeutic intervention; Child Symptom
Inventory CSI-4 was completed again by parents and teachers. The results of ANCOVA test showed that there
was a significant difference between two groups' intention deficits (> 0.0001). The results showed that clay
therapy is effective in reducing attention deficit symptoms of in elementary school female students with
attention deficit disorder.
Key words: clay therapy, attention deficit

INTRODUCTION
Attention deficit / hyperactivity is one of the most complex and the most common childhood disorders attention
deficit problems accompanied by excessive irritation, and inability to delay gratification need. This disorder is
associated with numerous factors that may cause symptoms individually or in combination. In general, a number
of variables such as nerve agents toxic reactions, biological and environmental factors can be considered as
factors resulting in this disease.
However, less attention has been paid to the causes of behavior or behavior and limited evidence regarding the
role of these factors and the results of some studies have shown that biological factors (neural - genetics) have
an important role at the onset of the disorder in a large number of children [3].
Common methods of treatment include medication, behavioral therapy and behavioral interventions treatments
which are too narrow each alone. But the use of a combination of treatment by parents, teachers, and
professionals in the coordination and acceptance of the child as someone, who needs help, leads to substantial
progress on children's behavior [3]. Studies show that drug treatment is the oldest and most complete treatment
in the field of attention deficit disorder;
However, medical treatments alone cannot be sufficient to treat a wide range of problems related to this
disorder. The family is not optimistic about the medications and their resistance to the use of drugs, particularly
steroids weight loss, headache and abdominal pain and above all the fear of families of drug addiction has
created the need for alternative therapies and complementary medicines.
Drug treatment may relieve symptoms, but may not affect performance which requires learning skills that
reduce school failure, the social adjustment, and behavior and reduction of negative thoughts as necessary
measures. In this study, clay therapy is used as a treatment method as a combination of art and game; because
despite the fact that many experts and psychotherapists recognized its influence on the treatment of many
disorders but few of them have used clay therapy as a tool in the treatment of attention deficit. Little research in
this area confirms this point. One of the advantages of using clay therapy in the present study is to make
children interested in treatment since they will enter into the process of treatment with enthusiasm and continue
treatment without being under parents pressure. And if the treatment is not attractive and lively for children,
they would not follow the sessions and clay because of the natural vitality, flexibility and plasticity is a proper

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Soheila Etemadi

tool for the children. As most of the studies in this regard, only considered on dimension of disorder, therefore it
is necessary to use clay therapy as a multi-dimensional method of treatment.
But in this study, the use of clay can be coordinated simultaneously different aspects of assessment and
management related to disorders such as attention and concentration disorders, hyperactivity, following the
instructions, improving memory and sensory-motor skills and a sense of competence, merit and confidence and
this suggests that the new study could provide affordable and accessible strategies for future prevention and
treatment of the attention deficit disorder.
Clay Therapy
Clay therapy is one method of play therapy and in fact, the game was considered an important factor in the
child's therapist interactions to facilitate a better understanding of the process and help more clients. Asking the
children to make shapes with clay or play symbolically important people, objects, feelings or issues of life make
them do storytelling.
The therapist helps a child to discover relationships and create insight during the clay therapy and using clay
therapy makes the child able to demonstrate external events to internal protests. Clay helps the child to bring up
issues, express his excitements and encourage them to be more active [2]. Clay is a tool which is not associated
with verbal statements, so it can be a useful tool in breaking the resistance and defense of client and when the
projection of feelings is referred to clay, the clients feel better and accept the therapy [7].
Clay is one of the tools to be used in play therapy. It helps to solve child's lack of self-organizing, self leads to
normalization [5, 8]. Clay therapy is a global play which helps children and most children who enter treatment
processes are happy to see their old friend and colleague. It is one of the most powerful tools of consulting that
has been ignored quietly. Clay therapy is a natural way for children to communicate and express their ideas [11].
One of the features of clay therapy is that this is stimulating and interesting for the child; children steeped in
emotion while playing with clay; it makes them creative and has refining effect on emotional issues. Scored as a
three-dimensional communication tool, cay therapy requires no special skills to work with. This causes the child
to feel sufficiently high when working with clay [2].
Attention Deficit Hyperactivity Disorder (ADHD)
One of the important topics in clinical psychology is the study of behavioral and affective disorders in children
and adolescents. Extensive research studies in this area left no doubt that describing the diagnosis and therapy of
these disorders are important areas of psychology. from among a variety of behavioral disorders and children, it
can be noted that the most common behavioral disorders, attention deficit hyperactivity disorder, and the largest
number of scientific research has been done on it.
The first description of this disorder is related to more than hundred and fifty years ago. in 1845, a German
psychiatrist Hirsch Hoffman in a poetic irony of a teenager named "Philip Restless" has used these words to
describe his behavior: Restless, wild, violent, turbulent, tight fit, and ridiculous. In fact, according to the
Diagnostic and Statistical Manual of Mental Disorders criteria, these are the main symptoms of ADHD. Clinical
symptoms should exist before age 7 and at least two environments. The main symptoms of the disorder are
appointed on the child's development in history and direct observation in situations that require attention [1].
Similar
studies
have
been
done
in
this
area,
here
are
some
of
them:
Ghorbani (2010) in a study entitled as "Impact of play therapy with the goal of reducing anxiety in orphaned
girls", selected 16 children and placed them in the test and control groups and a test was performed after play
therapy for 8 sessions, twice a week for 45 minutes. The results showed that using clay therapy interventions has
been led to the reduction of anxiety in orphaned girl.
Moghadam, Estaki , Pishiareh and Farahbud (2010) in the study entitled as "the influence of the visual arts
(pottery and painting) in children with ADHD dyscalculia", selected 30 children and divided them into three
groups. A painting group, a pottery group and the third group was the control. The study ran in 24 the visual arts
sessions. The results showed that the visual arts are effective in visual perception and eye-hand coordination and
knowledge of the field.
Bahrami (2012) studied the effectiveness of the ball Games and games without ball to reduce the symptoms of
attention
deficit
/
hyperactivity
in
9-11
years
old
boys
in
Arak,
Iran,
In this study, 60 children with attention deficit / hyperactivity were divided into three ball games, non-ball
games
and
controllers.
The
exercise
group
exercised
for
12
weeks.
the results showed that ball games and non-ball games had a positive effect on reducing the symptoms of
attention deficit / hyperactivity.
Given the importance of the subject, this study aimed to evaluate the efficacy of clay therapy in reducing
attention deficit symptoms of in elementary school female students with attention deficit disorder, in Shiraz,

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Iran. The research question is: is clay therapy effective in reducing attention deficit symptoms of in elementary
school female students with attention deficit disorder?
Methods and Materials
In the present study, the effect of clay therapeutic has been examined in reducing attention deficit symptoms of
in elementary school female students with attention deficit disorder, in Shiraz, Iran. Participants were divided
into two groups of control and experiment and experiment group spent 8 individual sessions and 2 group
sessions of clay therapy while no treatment was considered for the control group. This study is experimental
with pretest - posttest control group and random assignment.
The population and sample
The study sample included 10-7 years old children with attention deficit hyperactivity disorder in primary
school education, in four districts of Shiraz which were recognized and considered as the respective areas as
schools with the highest behavioral disorders, as well as most working parents, the school and the student's
parents.
The sample was selected regarding the target. after meeting with teachers and parents and presenting the
research project, the fourth and fifth grade students who had attention deficit hyperactivity disorder recognized
by the psychiatrist and received the Ritalin were identified. After doing the Raven's Progressive Matrices, first
60 students with IQs of 109 to 90 (regular) and attention deficit disorder taking Ritalin were selected. Then due
to the homogeneous distribution 30 students in four primary school (second to fifth) from four area were
selected as sample and then were randomly assigned to two experimental and control groups.
Data Analysis
In the present study, both descriptive statistics including the mean, standard deviation and correlation matrix and
inferential statistics including univariate analysis of covariance were used to analyze the collected data. So that,
the pre-test was considered as control variable and post-test scores as the dependent variable and groups
(experimental and control) were entered as independent variables.
Results
Descriptive statistics
The subjects of this study were selected from among 7-12 years old girls enrolled in second through fifth grade.
After aligning the four areas of education in Shiraz, the schools with the highest behavioral disorders and also
the family culture to continue and finish treatment were considered as the population of the study.
30 of them were selected purposefully after interviewing parents and completion of Child Symptom Inventory
CSI-4 by parents and teachers to screen those with attention deficit and approval of a psychiatrist for final
diagnosis and the dose of Ritalin as well as the Raven test for the screening IQ of 90 to 109. They were
randomly assigned to control and experiment groups. The experiment group participated in 8 sessions of clay
therapy and after therapeutic intervention; Child Symptom Inventory CSI-4 was completed again by parents and
teachers. Participants were divided into two groups of control (n-15) and experiment (n=15) and experiment
group spent 8 individual sessions and 2 group sessions of clay therapy while no treatment was considered for the
control group. This study is experimental with pretest - posttest control group and random assignment.
In order to prevent interference of the researcher in scoring the questionnaire, it was conducted by a psychology
graduate.
The following tables show the mean and standard deviation of the pre-test and post-test variables in the study
groups.
Table 1: Mean and standard deviation of teachers
group
N
mean
Standard
deviation
pre-test
Attention deficit
experiment
15
7. 4137
3. 42067
control
15
6. 1423
2. 50610
posttest
Attention deficit
experiment
15
3. 5061
2. 37021
control
15
4. 0383
3. 36067

Table 2: Mean and standard deviation of parents

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pre-test

posttest

Attention deficit

Attention deficit

Soheila Etemadi

group

mean

standard deviation

experiment

15

8. 5480

2. 05214

control

15

7. 2137

1. 28960

experiment

15

3. 3045

2. 48651

control

15

7. 9160

1. 14092

Table 3: Mean and standard deviation of teachers and parents

group
pre-test

Attention deficit

Post-test

Attention deficit

experiment
control
experiment
control

15
15
15
15

mean

standard
deviation

8. 1024
6. 8271
3. 0871
7. 0135

2. 15621
2. 64017
2. 14023
1. 90579

The results of the above tables show that the experimental group, the mean scores in all groups had a significant
reduction compared to the pre-test while was not any significant differences in the mean scores of the control
group.
Inferential Statistics
The following tables show the results of the post-test analysis of ANCOVA for teachers, parents, and teachers
and parents both.
Table 4: the ANCOVA scores for teachers' posttest
variable
Sum of
df
F
Sig.
Eta
Squares
P<
Attention deficit
Pre-test
50. 410
1
12. 483
0.000
0.312
group
99. 361
1
24.618
0.0031
0.463
error
109. 047
27

As it is shown in table 4,
ANCOVA test scores for teachers showed that
there was a significant difference between the experimental group and the control group in terms of attention
deficit (F = 24.618 and p <0/05). The effect ratio is 0.46. That is 46% of the change in the posttest was related to
the impact of clay therapy.
Generally, there was a significant difference among teachers between the control and experiment groups.
That is the experiment group had better quality than the control group in each variables.

variable
Attention deficit

Table 5: the ANCOVA scores for parents' posttest

Sum of
df
F
Squares
Pre-test
38.041
1
12. 996
group
201.154
1
68. 723
error

79.051

487

27

Sig.
P<
0.000
0.000

Eta
0.401
0.689

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Soheila Etemadi

As it is shown in table 5,
ANCOVA test scores for parents showed that
there was a significant difference between the experimental group and the control group in terms of attention
deficit (F = 68.723 and p <0/0001). The effect ratio is 0.68. That is 68% of the change in the posttest was related
to the impact of clay therapy.
Generally, there was a significant difference among parents between the control and experiment groups.
That is the experiment group had better quality than the control group in each variables.
Table 5: the ANCOVA scores for parents and teachers' posttest
variable
Attention deficit

df

Pre-test
group

Sum of
Squares
18.801
130.001

1
1

12. 660
87.542

error

40.104

27

Sig.
P<
0.000
0.000

Eta
0.362
0.772

As it is shown in table 6,
ANCOVA test scores for teachers and parents showed that
there was a significant difference between the experimental group and the control group in terms of attention
deficit (F = 87.542 and p <0/0001). The effect ratio is 0.77. That is 77% of the change in the posttest was related
to the impact of clay therapy.
Generally, there was a significant difference among teachers and parents between the control and
experiment groups. That is the experiment group had better quality than the control group in each variables.
Results and Discussion
This study aimed to evaluate the efficacy of clay therapy in reducing attention deficit symptoms of in
elementary school female students with attention deficit disorder. In this study, the experiment was done in a
post and pre-test design with random assignment of participants in control and experiment groups.
The population includes the 7-10 years old female students with attention deficit hyperactivity disorder in
primary school education in four areas of Shiraz, Iran. 30 of them were selected purposefully after interviewing
parents and completion of Child Symptom Inventory CSI-4 by parents and teachers to screen those with
attention deficit and approval of a psychiatrist for final diagnosis and the dose of Ritalin as well as the Raven
test for the screening IQ of 90 to 109. They were randomly assigned to control and experiment groups. The
experiment group participated in 8 sessions of clay therapy and after therapeutic intervention.
The findings of the study's gave a positive response to the questions and considered the detail and explain the
efficacy of therapy, provided useful information at the disposal which are presented below to define the
effectiveness of the independent variable (clap therapy) to reduce symptoms of attention deficit .The results
showed that clay therapy was effective on reducing the deficit in primary school girl students with attention
deficit disorder.
The results of the study were in line with the results of Moore (2000) and Pikitina et al (2012) in which the
watching practice increased the attention and decreased the impulsivity of children. And they are also in line
with research Shushtari et al. (1390), which showed that playing was a significant way to improve children's
attention.
The results of the study by Reza Zadeh et al (2007) also showed the impact of educational programs on reducing
attention deficit symptoms. The result of this research in the field of art education was in line with the results
Bowen and Russell (1989), Cook (1998) and McKenzie, Chisholm and Murphy (2000) that showed that the
individual and group art therapy could reduce feelings disable and symptoms of the child's learning problems;
Symptoms that
lead
their children
to
academic problems
and
learning
disabilities.
The results were also in line with the study of Smith and George R. Brown (1996) which showed the impact of
art activities on increased attention and focus of children. And also in line with the results of the study,
Moghadam and colleagues (2010) showed that teaching visual arts including pottery (with clay) was effective in
improving visual perception skills and increase attention and focus. However, in the present study, clay therapy

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was used in the context of the game which could indicate the effectiveness of play therapy and art therapy with
different ways on the improvement of attention in children. The results indicated the role of psychological
factors as a complementary treatment with drug therapy for attention deficit disorder. The results of this study
are important as a way to prevent and treat the disorder for psychologists, psychiatrists, pediatricians, educators
and all health professionals who work with children in a way.
It is suggested that future studies use, discussed and examined samples from other populations (gender, lack of
medication, social and cultural). In addition, it is suggested that a more accurate measure proposed to be used by
parents and teachers to have more coordinated assessment. It should be also mentioned that using the Research
Database about Art therapy especially clay therapy can be open the way for future research in the field and
reduce the concern of students from non-availability of previous research in this area to see further research in
this field.
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