Group A will perform Image-Sand Play Therapy Group had 12 week the one to one intervention provided once a week 30 min in each.

Table Top training Program Duration: 12 week Patient perform twice a week each item 5 min with 1 min preparation between task

Over the course of seven sessions, the child initially engaged in chaotic sandbox play, showing difficulty in altering or organizing his scenes. By the fourth session, he began experimenting with different symbols, including familiar TV characters. From the fifth session onward, his play gained structure, evolving into strategic battle scenarios involving animals, loggers, and castles. By the seventh session, hero figures emerged, and the therapist noted improved classroom behavior and cooperation, though social challenges with peers remained.

The Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) is the gold standard for identifying difficulties in the coordination of visual and motor skills in adults and children. The Beery VMI based on the construction of test items, the Beery VMI has strong construct validity and strong predictive validity for academic outcomes. Visual motor Coordination takes around 10-15 min. The task is completed in three minutes. Excellent test-retest reliability (0.84-0.88)(16) Interrater reliability of (0.90 0.98). Internal consistency (0.81-0.82)

The Nine Hole Test (9HPT) is used to measure finger dexterity in patients with various neurological diagnoses(18, 19). Table (wooden or plastic): with 9 holes (diameter 10 mm, depth 15 mm) separated by 32 mm or 50 mm(20). Stick container: a square box (100 x 100 x 10 mm) separate from the boards or a shallow round container on top of the board. 9 pins (diameter 7 mm, length 32 mm)(21). Stopwatch Instruct the patient to remove the needles one by one from the container and insert them into the holes in the plate as quickly as possible, using only their hands. Ask the patient to remove the needles one by one from the holes and return them to the container. Excellent Test-retest reliability (ICC = 0.85). Excellent interrater reliability for the right hand (r = 0.984) and the left hand (r = 0.993) (22).