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This study aimed to examine the effectiveness of play therapy in improving sensory processing and distress tolerance in adolescents with mild intellectual disabilities. A randomized controlled trial was conducted with 30 adolescents aged 12 to 17 years, randomly assigned to either an intervention group (n = 15) receiving eight 90-minute sessions of play therapy or a control group (n = 15) receiving no intervention. Sensory processing and distress tolerance were assessed at baseline, post-intervention, and five-month follow-up using standardized measures. Data analysis was performed using repeated-measures analysis of variance (ANOVA) and Bonferroni post-hoc tests in SPSS-27 to evaluate within-group and between-group differences over time. The results indicated a significant main effect of time for both sensory processing (F(2, 84) = 92.32, p < 0.001) and distress tolerance (F(2, 84) = 111.60, p < 0.001), demonstrating substantial improvements across timepoints. The intervention group showed a notable increase in sensory processing scores from baseline (M = 48.72, SD = 5.91) to post-intervention (M = 64.15, SD = 6.38) and follow-up (M = 69.03, SD = 5.79), whereas the control group exhibited minimal change. Similarly, distress tolerance scores improved significantly in the intervention group (baseline: M = 42.85, SD = 6.27; post-intervention: M = 58.74, SD = 5.69; follow-up: M = 63.92, SD = 6.08), with no substantial improvement in the control group. The Bonferroni post-hoc test confirmed significant pairwise differences between baseline and subsequent assessments. Play therapy was found to be an effective intervention for enhancing sensory processing and distress tolerance in adolescents with mild intellectual disabilities, with improvements sustained at follow-up. These findings suggest that play-based interventions can be a valuable therapeutic approach for promoting sensory integration and emotional regulation in this population.