Herbert H.G. Wettig & Ulrike Franke Evaluation of the Effectiveness of Theraplay on Attention-Deficit-Hyperactivity Disorder (ADHD) 2 studies evaluating

Herbert H.G. Wettig & Ulrike Franke

Evaluationof the Effectiveness of Theraplay

on Attention-Deficit-Hyperactivity Disorder (ADHD)

2 studies evaluating the Effectiveness of Theraplayon toddlers and preschool children

with dual diagnoses of attention-deficit-hyperactivity disorder and developmental language disorder in coincidence

2004

Copyright 2004 Theraplay Institut

The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders

2

Overview• Symptoms of hyper kinetic disorders

– Attention-deficit (ADD)– Restlessness and/or Impulsiveness (HD)

• Research on the Effectiveness of Theraplay in HD– 2 total samples of a controlled longitudinal- and a multi-center study– Selected samples of inattentive hyperactive and/or impulsive children

• Results of Evaluating the Effectiveness of Theraplay– Symptoms’ degree of markedness of inattentiveness and hyperactivity– Reduction of the symptoms and the lasting effect

of the reduced symptoms of inattentive and hyperactive children• on inattentive toddlers and preschool children suffering ADHD• on impulsive ADHD-toddlers and preschool children suffering ADHD• on hyperactive, physically restlessness toddlers and preschool

children suffering ADHD– Duration of therapy in average number of necessary sessions



3

Symptoms of Inattentivenessin the Therapeutic Interaction

Reference: Doepfner et al, 1999 German version of Clinical Assessment Scale for Child and Adolescent Psychopathology

• The researcher/therapist observes,– that the child is often distracted during testing,

e.g. by irrelevant stimuli (sounds, objects, etc.),– e.g. that the child looks out of the window or to someone else,– e.g. that the child always needs to be brought back to the situation,– e.g. that the child always interrupts his or her exercises.

• The primary caretaker describes,– e.g. that the child is easily interrupted,– e.g. that the child is often imprecise,– e.g. that the child often loses things,– e.g. that the child easily forgets things that were said,– e.g. that the child is easily distracted when playing,– e.g. that the child is unable to concentrate.



4

Symptoms of Increased Impulsiveness(Lack of Impulse Control)

based on CASCAP-D (Döpfner et al., 1999) German version of Clinical Assessment Scale for Child and Adolescent Psychopathology

• Lack of control of cognitions and actions.• Inadequate reactions in social context

– They often answer without thinking first.– They often interrupt other in conversation.

• Impatience– Unable to wait until it’s their turn.– They often interrupt games or conversations.

• Often excessive language - Inadequate reactions to social restrictions.

• DD: lack of restraint, dominant, increased physical activity,• inattentive, irritated reactions, driven, etc.



5

Symptoms of Hyper Kinetic Disordersin physically restless children

based on CASCAP-D (Döpfner et al., 1999)

German version of Clinical Assessment Scale for Child and Adolescent Psychopathology

• Continuous, excessive physical activity.• Motoric restlessness until aimless activity.

(Movement of fingers, hands, arms, legs, constantly moving on chair, getting up, walking or running around).

• Unnecessary disturbance and restlessness while playing.• Uninfluenced by requests or restrictions.• The symptoms in context are shown in various disorders

(e.g. hyper kinetic disorders, affective disorders, Anorexia nervosa, reactive attachment disorders, lack of restraint, Autisms, mentally challenged).

• DD: dominant, oppositional defiant, impulsive, driven restless, etc.



6

Different Distributionof hyper kinetic disorders (HD)

in boys and girlsbased on Remschmidt (Hrsg.) (2000). children- and adolescent psychiatry, p. 144, or

based on Knölker, Mattejat, Schulte-Markwort (2000). children- and adolescent psychiatry

• Prevalence of hyper kinetic disorders– School Age Children 3% - 4% – During childhood 3% -10%

• Boys’ hyper kinetic disorders rate is higher than girls.– Boys’ rate (to suffer from hyper kinetic disorders)

is 3 x higher than girls.– Boys’ rate (to suffer from hyper kinetic disorders) in clinical samples

is 6 – 9 x higher than girls.



7

Total Sampleof both research studies CLS and MCS

CLS Total Sample of Controlled Longitudinal Study• N= 60 clinically conspicuous toddlers and preschool children

with dual diagnoses of developmental language disorder and social interaction disorders.

• N= 29 of these children 2 years after end of the therapy.• N= 30 clinically not symptomatic toddlers and preschool

children of the same age and gender (matched).

MCS Total Sample of the Multi-Center Study• N=251 clinically conspicuous toddlers and preschool

children with dual diagnoses of communication disorders and social interaction disorders.



8

Selected Samples of inattentive children

with different social interaction disorder* = 100%

CLS• N= 50 (about 83%) children* with attention deficit disorder (ADD)• N= 25 (about 42%) children* with hyper kinetic impulsiveness• N= 19 (about 32%) children* with hyper kinetic activity disorder (HD)

• N= 30 clinically not symptomatic toddlers and preschool children of the same age and gender (matched)

MCS• N=183 (rd. 73%) children* with attention deficit disorder (ADD)• N=106 (rd. 42%) children* with hyper kinetic impulsiveness• N= 80 (rd. 32%) children* with hyper kinetic activity disorder (HD)



9

Socio-demographic Structure (1)CLS- and MCS-Samples of toddlers and preschool children

with attention deficit hyper activity disorder First contact with primary caretaker/diagnostic of children

N=50 or N=183 inattentive children with social interaction disorder = 100%

CLS:• Mother’s Family Status

90% married mothers no unmarried living together 8% separated mothers 2% single mothers

• Child’s Family Status 90% legitimate children10% illegitimate, physical child no adopted/foster children

• Child’s Upbringing 85% both parents involved15% single parent involved

MCS:• Mother’s Family Status

66% married mothers 8% unmarried living together10% separated mothers 14% single mothers

• Child’s Family Status 79% legitimate children17% illegitimate, physical child 4% adopted-/foster children

• Child’s Upbringing 76% both parents involved24% single parent involved



10

Socio-demographic Structure (2)CLS- and MCS-Sample of toddlers and preschool children

with attention deficit hyper activity disorder First contact with primary caretaker/diagnostic of children

N=183 inattentive children with social interaction disorder = 100%

CLS:• Language relevant Criteria• 94% Country of birth is Germany

6% other Country of birth• 90% mother tongue is German

10% other mother tongue• 81% one language Upbringing

19% bilingual Upbringing

• socially relevant Criteria• 73% in kindergarten

27% not yet in kindergarten

MCS:• Language relevant Criteria• 88% Country of birth is Germany

12% other Country of birth• 93% mother tongue is German

7% other mother tongue• 85% one language Upbringing

15% bilingual Upbringing

• socially relevant Criteria• 76% in kindergarten

24% not yet in kindergarten



11

Average Age of Children toddlers and preschool children with dual diagnoses of

developmental language- and attention-deficit-hyperactivity disorders* (years; months)

CLS: Alter average in years; months .

• 4;04 N=60 children* of CLS total Sub samples of these:

• 4;03 N=50 inattentive children* total

• 4;03 N=25 impulsive children* with lack of control

• 4;03 N=19 hyperactive children* with excessive restlessness

• 4;05 N=30 clinically not symptomatic children (control group)

MCS: Alter average in years; months .

• 4;09 N=251children* of MCS total

Sub samples of these:• 4;06 N=183 inattentive children* total

• 4;07 N=106 impulsive children* with lack of control

• 4;05 N= 80 hyperactive children* with excessive restlessness

• 4;05 N= 30 clinically not symptomatic children (control group)



12

Gender of Children toddlers and preschool children with dual diagnoses of

developmental language disorder and attention-deficit-hyperactivity disorders*

CLS: %boys; girls (general ratio 2.8 : 1)

• 69%;31% N=60 children* of CLS total Sub samples of these:

• 74%;26% N=50 inattentive, children* total

• 80%;20% N=25 impulsive children* with lack of control

• 79%;21% N=19 hyperactive children* with

excessive restlessness

• 70%;30% N=30 clinically not symptomatic children (controls)

MCS: %boys; girls (general ratio 2.7 : 1)

• 69%;31% N=183 children* of MCS total Sub samples of these:

• 73%;27% N=183 inattentive, children* total

• 77%;23% N=106 impulsive children* with lack of

control• 76%;24% N= 80 hyperactive

children* with excessive restlessness

• 70%;30% N=30 clinically not symptomatic children (controls)



13

Anamnesis Presumed child’s disorder; Parents’ concerns

32

34

46

76

6

15

25

61

0 20 40 60 80 100

language developmental disorder

behavioral disorder

speech disorder

pervasive developmental disorder

Disorder presumed by parents in percent

CLS: N=50 ADHD-children MCS: N=183 ADHD-children

Degree of Parent’s concern over their child’s disorder (Average degree of concern on 6-point scale)

4,7

4,4

1 2 3 4 5 6

Degree of Concern

1=unconcerned 6=very concerned

CLS: N=50 ADHD-children MCS: N=183 ADHD-children



14

Results of Anamnesis

• In a large amount of children, especially those of the MCS, the parents’ anamnesis showed no evidence of developmental language disorders and behavioural disorders, e.g. shown in ADHD.

• In MCS children with interaction disorders through inattentiveness, impulsiveness or excessive increased restlessness mainly due to language developmental disorders, were presented.

• In LCS disorders of social interaction behaviour and on pervasive development disorders were often suspected, e.g. shown in autism.

• Possibly, behavioural disorders are often not considered worth treating.

• The parents were very concerned with their child’s language disorders.



15

Average Degree of Markednessof Inattentiveness (ADD) of ADHD-children

Assessment methods: CASCAP-D (Döpfner et al., 1999) German version of Clinical Assessment Scale for Child and Adolescent Psychopathology

Symptom’s average degree of markedness of clinically conspicuous children compared to clinically not symptomatic children

3,4

3,3

3,2

3,2

3,2

3,0

1,2

1,2

1,2

1 2 3 4

N=19/80 Hyperactive &increased physically restless

children CLS: 0.7s; MCS:s=0.7

N=25/106 Impulsive childrenCLS: s=0.7; MCS: s=0.9

N=50/183 Inattentive childrenCLS: s=0.7; MCS: s=0.8

Symptom's average degree of markedness1 = clinically not symptomatic strongly impaired symptom = 4

MCS-therapy group CLS-therapy group N=30 control group



16

Average Degree of Markedness of Inattentiveness (ADD) in various kind of children

Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)

Average Degree of Inattentiveness

2,4

2,8

3,0

2,4

2,9

2,9

1,2

1,2

1,2

1 2 3 4

N=22/125 shy children LSS: s=0.9; MZS: s=1.2

N=23/135 children withoppositional defiant

behavior CLS:s=0.8;MCS: s=1.2

N= 7/59 aggressive children CLS: s=0.7; MCS: s=1.1

Average Degree of Inattentiveness 1 = clinically not symptomatic strongly impaired symptom = 4

MCS-therapy groups CLS-therapy groups N=30 control group



17

Average Degree of Markedness of Inattentiveness in developmental language disorders

(coincidence: ADD and SES)Assessment methods: CASCAP-D German version of Clinical Assessment Scale

for Child and Adolescent Psychopathology (Döpfner et al., 1999)

Average degree of markedness of inattentive children

with receptive language disorder

3,0

2,7

1,2

1 2 3 4

N=57/80 inattentivechildren with receptive

language disorder CLS: s=1.0; MCS: s=1.1

Symptom's average degree of markedness 1 = clinically not symptomatic strongly impaired symptom = 4




18

Average Degree of Markednessof physical restlessness of children

(HD-Symptom) Assessment methods: CASCAP-D German version of Clinical Assessment Scale



3,1

3,0

2,1

3,0

2,9

1,9

1,2

1,2

1,2

1 2 3 4

N=19/80 hyperactive children

CLS: s=0.9; MCS: s=1

N=25/106 impulsive children CLS: s=0.9; MCS: s=0.9

N=50/183 inattentive children

CLS: s=1.1; MCS: s=1.2





19

Average Degree of Markednessof impulsiveness of children

(HD-Symptom)Assessment methods: CASCAP-D German version of Clinical Assessment Scale



3,2

2,7

2,0

3,0

2,5

1,8

1,1

1,1

1,1

1 2 3 4

N=19/80 Hyperactive children CLS: s=0.8; MCS: s=0.8

N=25/106 Impulsive children CLS: s=1.1; MCS: s=1.2

N=50/183 Inattentive children

CLS: s=1.1; MCS: s=1.2





20

Average Degree of Markednessof uncooperative social interaction behaviour

of ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale


Average degree of markedness of childs' uncooperative social interaction behaviour

3,0

3,0

2,6

2,8

2,9

2,5

1,1

1,1

1,1

1 2 3 4

N=19/80 Hyperactive children

CLS: s=1.1; MCS: s=1.2

N=25/106 Impulsive children CLS: s=1.0; MCS: s=1.1

N=50/183 Inattentive children CLS: s=1.2; MCS: s=1.2


N=183 MCS-therapy group N=50 CLS-therapy group N=30 control group



21

Average Degree of Markednessof oppositional defiant interaction behaviour

of ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale


Average degree of markedness of childs' oppositional defiant interaction behaviour

2,9

2,8

2,3

2,5

2,9

1,9

1,1

1,1

1,1

1 2 3 4

N=19/80 hyperactive children CLS: s=1.3, MCS: s=1.2

N=25/106 impulsive children CLS: s=1.2; MCS: s=1.2

N=50/183 inattentive children CLS: s=1.2; MCS: s=1.2





22

Average Degree of Markednessof receptive language disorders

of ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale


Average degree of markedness of receptive language disorders

2,7

2,7

2,6

2,7

2,8

2,9

1,0

1,0

1,0

1 2 3 4

N=19/80 hyperactivechildren with receptive


N=25/106 impulsivechildren with receptive


N=50/183 inattentivechildren with receptive






23

Therapeutic Goalof the Treatment with Theraplay

• A general goal of the treatment with Theraplay is to open children with social interaction disorders to functional therapy.

• A special goal of the treatment with Theraplay is to make inattentive, impulsive or hyperactive children emotionally conscious of themselves and socially competent when dealing with others.

• Theraplay helps in regulation of child’s emotions and actions.– Inattentive children get a feel for themselves,

their characteristics, abilities and skills.– Impulsive children improve their information processing.

After Theraplay, therapists are better able to reach them.– Increased physically restless children experience an improved

understanding for their bodies as well as feelings .



24

The Effectiveness of Theraplay

(1)on inattentive toddlers and preschool children

with dual diagnoses of attention-deficit-hyperactivity-syndrome and

developmental language disorders.



25

Change of Oppositional Defianceof inattentive ADHD-children


Reduction of oppositional defiant behaviour after Theraplay

1,9

1,21,31,1

2,3

1

2

3

4

start of therapy (t1) end of therapy (t6)

4 = strongly impaired3 = impaired

2 = slightly impaired symptom

1 = not symptomatic child

N=50 inattentive children CLS t1-t6: prob.=0.0001

N=183 inattentive children MCS t1-t6: prob.=0.0001

CLS-control group: clinically notsymptomatic children N=30



26

Reduction of Uncooperative Behaviourof inattentive ADHD-children


Reduction of uncooperative behaviour after Theraplay

2,6

1,5

2,6

1,4

1,11

2

3

4










27

Reduction of Inattentivenessof inattentive ADHD-children


Reduction of inattentive behaviour after Theraplay

3,0

2,22,1

1,2

3,2

1

2

3

4





N=50 inattentive children CLS t1-t6: prob=0.0001


CLS-control group: clinicallynot symptomatic children N=30



28

Reduction of Impulsivenessof inattentive ADHD-children


Reduction of impulsive behaviour after Theraplay

1,8

1,31,4

1,1

2,0

1

2

3

4










29

Reduction of Increased Physical Restlessnessof inattentive ADHD-children


Reduction of increased physical restlessness after Theraplay

1,9

1,41,5

1,2

2,1

1

2

3

4










30

Improvement of Receptive Language Disorderof inattentive ADHD-children


Average improvement of receptive language disorderafter Theraplay (in covariation)

2,9

2,3

1,9

1,0

2,6

1

2

3

4










31

Clinical and Statistical Significanceof reduction of symptoms based on Theraplay

M=means based on CASCAP-D, =change, s=Standard deviation4-point scale: 1=not symptomatic; Symptom: 2=slightly...,3=impaired, 4= strongly impaired

Symptoms

CLSN=50

inattentive children

MCSN=183


TT-BTT-EM M s prob.> F TT-BTT-E

M M s prob.> F

oppositionaldefiant 3.1 1.3 0.8 0.0001 3.3 1.4 0.8 0.0001

uncooperative 3.1 1.6 1.1 0.0001 3.0 1.5 1.0 0.0001

inattentive 3.1 2.0 0.9 0.0001 3.3 2.0 0.8 0.0001

impulsive 2.6 1.4 0.9 0.0010 1.8 1.3 0.8 0.0001

hyperactive 1.9 1.4 0.9 0.0003 2.4 1.5 0.9 0.0001receptive language disorder 2.6 2.0 1.1 0.0244 2.7 1.9 0.9 0.0001



32

The Lasting Effect of Therapeutic Successof Treatment with Theraplay

in originally inattentive childrenwith dual diagnoses of ADHD and

developmental language disorders 2 years after discharge of Theraplay treatment

A comparisonwith the ‚norm‘ of clinically not symptomatic children



33

The Lasting Effectof Reduced Oppositional Defiance

of originally inattentive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale


Average reduction of oppositional defiant behaviour after Theraplay

1,9

1,2 1,21,11

2

3

4

start of therapy(t1)

end of therapy (t6) 2 years afterdischarge from

therapy (t7)




N=50 inattentive children CLS t1-t6: prob.=0.0001 CLS t6-t7: prob.>0.05 (not significant)




34

The Lasting Effectof Reduced Uncooperative Behaviourof originally inattentive ADHD-children


Average reduction of uncooperative behaviour after Theraplay

2,6

1,51,3

1,11

2

3

4


end of therapy(t6)

2 years afterdischarge from

therapy (t7)








35

The Lasting Effectof Reduced Inattentiveness



Average Reduction of inattentiveness after Theraplay

3,0

2,22,0

1,21

2

3

4

start of therapy (t1) end of therapy (t6) 2 years afterdischarge from

therapy (t7)








36

The Lasting Effectof Reduced Impulsiveness



Average reduction of impulsiveness after Theraplay

1,8

1,3 1,31,11

2

3

4


end of therapy(t6)


therapy (t7)








37

The Lasting Effectof Reduced Physical Restlessness

of inattentive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale


Average Reduction of increased physical restlessness after Theraplay

1,9

1,4

1,7

1,21

2

3

4


end of therapy(t6)


therapy /t7)




N=50 inattentive children CLS t1-t6: prob. 0.003 CLS t6-t7: prob.>0.05 (not significant)




38

The Lasting Effectof Improved Receptive Language Disorder



Average Reduction of receptive language disorder after Theraplay (in covariation)

2,9

2,3 2,3

1,01

2

3

4


2 > years afterdischarge from

therapy (t7)




N=50 inattentive children CLS T1-t6: prob.=0.0002 CLS t6-t7: prob.>0.05 (not significant)




39

Necessary Duration of Theraplay Therapyto achieve therapeutic goalsin inattentive ADHD-children

(Average number of 30-minute therapeutic sessions)

19,6

19,1

0 5 10 15 20 25 30

N=183 inattentive children CLS: s=11.7; Min=4; Max=61

N=50 inattentive children CLS: s=11.7, Min=4; Max=61

Average number of 30-minute therapeutic sessions

MCS: number of therapeutic sessions CLS: number of therapeutic sessions



40


(2)on impulsive toddlers and preschool children,

with dual diagnosesattention-deficit-hyperactivity disorder

and developmental language disorder.



41

Reduction of Oppositional Defiant Behaviour

of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale



2,4

2,8

1,4

1,1

1,4

1

2

3

4





N=25 impulsive children CLS t1-t6: prob.=0.0002

N=106 impulsive children MCS T1-t6: prob.=0.0001




42

Reduction of Uncooperative Behaviourof impulsive ADHD-children



2,93,0

1,5

1,1

1,7

1

2

3

4






N=106 impulsive children MCS t1-t6: prob.=0.0001




43

Reduction of Inattentivenessof impulsive ADHD-children


Average reduction of inattentiveness after Theraplay

3,23,3

2,1

1,2

2,1

1

2

3

4










44

Reduction of Impulsivenessof impulsive ADHD-children



2,52,7

1,7

1,1

1,6

1

2

3

4










45

Reduction of Hyperactive & Physical Restlessness



Average reduction of increased physical restlessness after Theraplay

2,93,0

1,8

1,2

1,6

1

2

3

4










46

Reduction of Playing Disordersof impulsive ADHD-children


Average reduction of playing disorder after Theraplay

2,22,3

1,4

1,0

1,6

1

2

3

4






N=106 impulsive children MCS t1-t6: prob.0.0001




47

Covariant Reduction of Receptive Language Disorder



Average Reduction of receptive language disorder after Theraplay (in covariation)

2,82,7

1,9

1,0

2,2

1

2

3

4






MCS: impulsive children N=106; t1-t6: prob=0.0001




48

Clinical and Statistical Significanceof reduction of symptoms

based on treatment with Theraplay M=means based on CASCAP-D, =change, s=Standard deviation

4-point scale: 1=not symptomatic; Symptom: 2=slightly...,3=impaired, 4= strongly impaired

Symptoms

CLSN=18 scheue,


MCSN=86 scheue,



M M s prob.> F

opposit.defiant 2.4 1.4 1.3 0.0002 2.8 1.4 1.2 0.0001

uncooperative 2.9 1.7 1.0 0.0001 3.0 1.5 1.1 0.0001

inattentive 3.2 2.1 0.7 0.0001 3.3 2.1 0.9 0.0001

impulsive 2.5 1.6 1.0 0.0004 2.7 1.7 1.1 0.0001

hyperactive 2.9 1.6 0.7 0.0004 3.0 1.8 0.9 0.0001receptive language disorder 2.8 2.2 1.2 0.0033 2.7 1.9 1.0 0.0001



49

The Lasting Effect of Therapeutic Successof Treatment with Theraplay

on toddlers and preschool childrenwith dual diagnoses of impulsiveness and

developmental language disorders2 years after individual discharge of Theraplay treatment

A comparisonwith ‚norm‘ of clinically not symptomatic children



50

The Lasting Effectof Reduction of Oppositional Defiant Behaviour




2,4

1,4

1,1

1,4

1

2

3

4



therapy (t7)




N=25 Impulsive children CLS t1-t6: prob.=0.0002 CLS t6-t7: no change




51

The Lasting Effectof Reduction of Uncooperative Behaviour




2,9

1,5

1,1

1,7

1

2

3

4


end of therapy(t6)


therapy (t7)




N=25 Impulsive children CLS t1-t6: prob.=0.0001 CLS t6-t7: no significant change




52

The Lasting Effectof Reduction of Inattentiveness




3,2

2,2

1,2

2,1

1

2

3

4



therapy (t7)




N=25 Impulsive children CLS t1-t6: prob.=0.0001 CLS t6-t7: no significantstatistical change




53

The Lasting Effectof Reduction of Impulsiveness




2,5

1,6

1,1

1,6

1

2

3

4


end of therapy(t6)


therapy (t7)




N=25 impulsive children CLS t1-t6: prob.=0.0004 CLS t6-t7: no change




54

The Lasting Effectof Reduction of increased physical Restlessness




2,9

2,1

1,2

1,6

1

2

3

4


end of therapy(t6)


therapy (t7)




N=25 impulsive children CLS t1-t6: prob.=0.0004 CLS t6-t7: no significantstatistical change




55

The Lasting Effect of Reduction of Playing Disordersof impulsive ADHD-children



2,2

1,4

1,0

1,6

1

2

3

4


end of therapy(t6)


therapy (t7)




N=25 impulsive children CLS t1-t6: prob.=0.0025 CLS t6-t7: no significantstatistical change




56

The Lasting Effectof Reduction of Receptive Language Disorder



Average reduction of receptive language disorder after Theraplay (in covariation)

2,8

2,1

1,0

2,2

1

2

3

4


end of therapy(t6)


therapy (t7)



1 = not symptomatic childN=25 impulsive children CLS t1-t6: prob.=0.0033 CLS t6-t7:no significantstatistical change




57

Necessary Duration of Theraplay Therapyto achieve therapeutic goalson impulsive ADHD-children

(Average number of 30-minute therapeutic sessions)

21,4

18,7

0 5 10 15 20 25 30

N=106 impulsive children MCS: s=13.7; Min=4; Max=61

sessions

N=25 impulsive children CLS. s=8.4; Min=9; Max=36

sessions





58


(3)on hyperactive, physically restless

toddlers and preschool children with dual diagnoses of

attention-deficit-hyperactivity disorderand developmental language disorder.



59

Reduction of Oppositional Defiant Behaviourof hyperactive, physically restless ADHD-children



2,5

1,3

2,9

1,4

1,11

2

3

4





N=19 hyperactive children CLS t1-t6: prob.=0.0001

N=80 hyperactive children MCS t1-t6: prob.=0.0001




60

Reduction of Uncooperative Behaviourof hyperactive, physically restless ADHD-children



2,8

1,5

3,0

1,5

1,11

2

3

4










61

Reduction of Hyperactive Physical Restlessnessof hyperactive, physically restless ADHD-children



3,0

1,6

3,1

1,8

1,2

1

2

3

4





N=19 hyperactive children CLS t1-t6: porb.=0.0001





62

Reduction of Impulsivenessof hyperactive, physically restless ADHD-children



3,0

1,6

3,2

1,8

1,11

2

3

4










63

Reduction of Inattentiveness of hyperactive, physically restless ADHD-

children Assessment methods: CASCAP-D German version of Clinical Assessment Scale



3,2

2,1

3,4

2,2

1,21

2

3

4










64

Reduction of Playing Disorders of hyperactive, physically restless ADHD-


for Child and Adolescent Psychopathology (Döpfner et al., 1999) Average reduction of playing disorder

after Theraplay

2,2

1,6

2,3

1,4

1,01

2

3

4





N=19 hyperactive children CLS t1-t6: prob.<0.05





65

Reduction of Clowning Behaviour of hyperactive, physically restless ADHD-


for Child and Adolescent Psychopathology (Döpfner et al., 1999) Average reduction of clowning behaviour

after Theraplay

1,7

1,2

2,3

1,4

1,01

2

3

4





N=19 hyperactive children CLS t1-t6: prob.<0.05 (=0.0473)





66

Reduction of Receptive Language Disordersof hyperactive, physically restless ADHD-children



2,7

2,12,3

1,4

1,01

2

3

4





N=19 hyperactive children CLS t1-t6: prob.<0.04 (=0.0324)





67

Clinically and Statistical Significanceof reduction of symptoms

based on treatment with Theraplay M=means based on CASCAP-D, =change, s=Standard deviation

4-point scale: 1=not symptomatic; Symptom: 2=slightly...,3=impaired, 4= strongly impaired

Symptoms

CLSN=19 hyperactive,

increased restless children

MCSN=80 hyperactive,

increased restless children


M M s prob.> F

oppositional defiant 2.6 1.3 1.2 0.0001 2.9 1.4 1.1 0.0001

uncooperative 2.8 1.5 1.1 0.0001 3.0 1.5 1.1 0.0001

hyperactive 3.0 1.6 1.0 0.0001 3.1 1.8 1.0 0.0001

impulsive 3.0 1.6 0.9 0.0001 3.2 1.8 0.9 0.0001

inattentive 3.2 1.6 0.7 0.0001 3.4 2.2 0.9 0.0001

play disordered 2.2 1.6 0.9 < 0.05 2.3 1.4 1.2 0.0001

clowning behaviour 1.7 1.2 0.9 < 0.04 2.3 1.4 1.1 0.0001receptive language disorder 2.8 2.2 1.2 0.0033 2.7 1.9 1.0 0.0001



68

Results of ResearchD

The Effectiveness of Theraplay ininattentive, impulsive or hyperactive, restless ADHD-children

• In both studies the change of symptoms were very similar. Both studies show corresponding results.

• Both studies concur that attentiveness, impulsiveness and hyperactivity in toddlers and preschool children have shown clinically as well as statistically significant improvement based on Theraplay treatment.

• Based on Theraplay, children show significantly less impulsive and increased physical restlessness.

• Children are significantly more attentive as well as cooperative.• Moreover

other relevant symptoms show significant improvement.• Covariant improvement can also be shown

in receptive language disorder.• The reached therapeutic success is steady.

No noticed relapse. Two years after treatment with Theraplay improvement remains in general on reached therapeutic level.



69

The Lasting Effectof Reduction of Oppositional Defiant Behaviour

of hyperactive, physically restless ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale



2,5

1,3 1,4

1,11

2

3

4



therapy (t7)




N=19 hyperactive children CLS t1-t6: prob.=0.0001 LSS t6-t7: no significant statisticalchange




70

The Lasting Effectof Reduction of Uncooperative Behaviour




2,8

1,51,4

1,11

2

3

4


end of therapy(t6)


therapy (t7)




N=19 hyperactive children CLS t1-t6: prob.=0.0001 LSS t6-t7: no significant statisticalchange




71

The Lasting Effectof Reduction of Hyperactive, Physical Restlessness




3,0

1,6 1,6

1,21

2

3

4


end of therapy(t6)


therapy (7)




N=19 hyperactive children CLS t1-t6: prob.=0.0001 LSS t6-t7: no change




72

The Lasting Effectof Reduction of Impulsiveness




3,0

1,6 1,6

1,11

2

3

4


end of therapy(t6)


therapy (t7)




N=19 hyperactive children CLS t1-t6: prob.=0.0001 CLS t6-t7: no change




73

The Lasting Effectof Reduction of Inattentiveness




3,2

2,1

1,8

1,21

2

3

4



therapy (t7)




N=19 hyperactive children CLS t1-t6: prob.=0.0001 CLS t6-t7: no significantstatistical change




74

The Lasting Effectof Reduction of Playing Disorders

of hyperactive, physically restless ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale



2,2

1,6 1,5

1,01

2

3

4


end of therapy(t6)


therapy (t7)




N=19 hyperactive children CLS t1-t6: prob.<0.05 CLS t6-t7: no significantstatistical change




75

The Lasting Effectof Reduction of Clowning Behaviour



Average reduction of clowning behaviour after Theraplay

1,7

1,2 1,11,01

2

3

4


end of therapy(t6)


therapy (t7)




N=19 hyperactive children CLS t1-t6: prob.<0.05 (p=0.0473) CLSS t6-t7: no significantstatistical change




76

The Lasting Effectof Reduction of Receptive Language Disorder




2,7

2,12,0

1,01

2

3

4


end of therapy(t6)


therapy (t7)




N=19 hyperactive children CLS t1-t6: prob.<0.04 (p=0.0324) LSS t6-t7: no significantstatistical change




77

Necessary Duration of Theraplay Therapyto attain therapeutic goals

in hyperactive, physically restless ADHD-children (Number of 30-minute therapeutic sessions)

21,4

18,7

0 5 10 15 20 25 30

N=80 hyperactive children MCS: s=13.7; Min=4; Max=61

sessions

N=19 hyperactive children CLS: s=8.4; Min=9; Max=36

sessions





78

Theraplay InstitutD-71229 Leonberg (Germany) Obere Burghalde 42

Questions about Theraplay: Ulrike Franke

speech-language pathologist (SLP) reg. Play Therapist and Supervisor (RPT-S/APT)

certified Theraplay Therapist and Trainer (CTT-T/TTI)Phone: +49-(0)6202-54051, Office: +49-(0)6221-88-2055, Fax: +49-(0)6202-54958

e-Mail: [email protected]

Questions about the evaluation research: Herbert H.G. WettigClinical Psychologist

Phone: +49-(0)7152-27062 Fax: +49-(0)7152-22602e-Mail: [email protected]

® 1996 Theraplay is legally protected by 39518465 and 39518466

Documents

Herbert H.G. Wettig & Ulrike Franke Evaluation of the Effectiveness of Theraplay on Attention-Deficit-Hyperactivity Disorder (ADHD) 2 studies evaluating