Transcript Herbert H.G. Wettig & Ulrike Franke Evaluation der Wirkung

Herbert H.G. Wettig & Ulrike Franke
Evaluation
of the Effectiveness of Theraplay
on Attention Deficit Disorder (ADD)
2 studies on the Effectiveness of Theraplay
on toddlers and preschool children
with dual diagnoses of receptive language disorder
and oppositional defiant or shy interaction behaviour
or an autistic-like lack of social mutuality in interaction.
January 2004
Overview
• Symptoms of Inattentiveness (Attention Deficit)
• Evaluation of the Effectiveness of Theraplay on ADD
– Total samples of both studies CLS and MCS
– Selected samples of the inattentive children
• Results of two Research Studies in Germany
– Degree of impairment of the symptoms of inattentiveness
– Reduction of the symptoms and the lasting effect
of the reduced symptoms of the inattentive children
• on inattentive, oppositional defiant children
• on inattentive, shy children
• on inattentive children with an an autistic-like lack of social mutuality
– Duration of Therapy in number of necessary sessions
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
2
Symptoms of Inattentiveness
Reference: Knölker, Mattejatt, Schulte-Markwort (2000), Remschmidt (2000)
• Inattentive Children Show Pathological Symptoms…
– for at least 6 months
– to such a degree, that is does not coincide
with the age and the developmental status of the child,
– and they show inattentiveness in situations which are inadequate.
• Typical Symptoms of Inattentiveness are:
–
–
–
–
–
–
–
–
The child is constantly distracted by external stimuli,
he or she is not unable to concentrate for longer periods of time,
he or she is inattentive towards details: has a lack of precision,
the child acts like he or she is not listening to what is being said,
the child defies instructions,
he or she is unable to comprehend instructions,
the child avoids activities that call for endurance,
and frequently loses important objects.
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The Effectiveness of Theraplay
on Attention Deficit Disorders
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Symptoms of Inattentiveness
in the Therapeutic Interaction
Reference: Doepfner et al, 1999
Clinical Assessment Scale for Child and Adolescent Psychopathology (CASCAP-D)
• 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.
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The Effectiveness of Theraplay
on Attention Deficit Disorders
4
Total Sample
of 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.
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The Effectiveness of Theraplay
on Attention Deficit Disorders
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Selected Samples
with Attention Deficit Disorder (ADD)
CLS
• N= 50 toddlers and preschool children in total
with Attention Deficit Disorder (ADD)
– N= 21 inattentive, oppositional defiant children
N= 18 inattentive, shy children
N= 13 inattentive children with an autistic-like lack of social mutuality
– N= 24 of these 50 children 2 years after treatment with Theraplay
• N= 30 clinically not symptomatic toddler and preschool
children of the same age and gender (matched)
MCS
• N=183 toddlers and preschool children in total
with Attention Deficit Disorder (ADD)
– N=105 inattentive, oppositional defiant children
N= 86 inattentive, shy children
N= 40 inattentive children with an autistic-like lack of social mutuality
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The Effectiveness of Theraplay
on Attention Deficit Disorders
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Socio-demographic Structure (1)
CLS- and MCS-Samples of toddlers and preschool children
with attention deficit 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 children
10% illegitimate, physical child
no adopted/foster children
• Child’s Upbringing
66% married mothers
8% unmarried living together
10% separated mothers
14% single mothers
• Child’s Family Status
79% legitimate children
17% illegitimate, physical child
4% adopted-/foster children
• Child’s Upbringing
85% both parents involved
15% single parent involved
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Theraplay Insitut
MCS:
• Mother’s Family Status
76% both parents involved
24% single parent involved
The Effectiveness of Theraplay
on Attention Deficit Disorders
7
Socio-demographic Structure (2)
CLS- and MCS-Sample of toddlers and preschool children
with attention deficit disorder
First contact with primary caretaker/diagnostic of children
N=50 or N=183 inattentive children with social interaction disorder = 100%
CLS:
• Language relevant Criteria
MCS:
• 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
• 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
• socially relevant Criteria
• 73% in Kindergarten
27% not yet in Kindergarten
• 76% in Kindergarten
24% not yet in Kindergarten
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The Effectiveness of Theraplay
on Attention Deficit Disorders
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Average Age of Children
toddlers and preschool children
with dual diagnoses of inattentiveness and other social interaction disorders
(years; months)
CLS:
•
average age
in years; months
MCS:
.
•
4;03 N=50 inattentive
children total
•
•
•
4;03 N=21 inattentive,
oppositional defiant
children
4;01 N=18 inattentive,
shy children
4;00 N=13 inattentive
children with autistic-like
lack of social mutuality
4;05 N=30 clinically not symptomatic
children (control group)
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Theraplay Insitut
•
•
•
•
.
4;06 N=183 inattentive
children total
of these:
•
average age
in years; months
of these:
4;06 N=105 inattentive,
oppositional defiant
children
4;04 N= 86 inattentive,
shy children
4;02 N= 40 inattentive
children with autistic-like
lack of social mutuality
4;05 N= 30 clinically not symptomatic
children (control group)
The Effectiveness of Theraplay
on Attention Deficit Disorders
9
Gender of children
toddlers and preschool children
with dual diagnoses of inattentiveness and other social interaction disorders
CLS:
% Boys; Girls
(general ratio 2.8 : 1)
• 74%;26% N=50 inattentive
children in total
MCS:
• 73%;27% N=183 inattentive
children in total
Sub samples of these:
Sub samples of these:
• 76%;24% N=21 inattentive,
•
•
•
oppositional
defiant children
67%;33% N=18 inattentive,
shy children
85%;15% N=13 inattentive
children with an
autistic-like lack
of social mutuality
70%;30% N=30 clinically
not symptomatic
children (controls)
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Theraplay Insitut
% Boys; Girls
(general ratio 2.7 : 1)
• 74%;26% N=105 inattentive,
•
•
•
oppositional
defiant children
72%;28% N= 86 inattentive,
shy children
70%;30% N= 40 inattentive
children with an
autistic-like lack
of social mutuality
70%;30% N= 30 clinically
not symptomatic
children (controls)
The Effectiveness of Theraplay
on Attention Deficit Disorders
10
Results
The Effectiveness of Theraplay
on toddlers and preschool children
with dual diagnoses of attention deficit disorder
and
(1) oppositional defiant interaction behaviour
(2) shy interaction behaviour
(3) an autistic-like lack of social mutuality.
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The Effectiveness of Theraplay
on Attention Deficit Disorders
11
Inattentiveness (Attention Deficit)
is a symptom combined with various disorders
• Attention Deficit Disorder
... with Hyperactivity and Impulsiveness (ADHD):
– with Hyperactivity as well as physical restlessness,
– with Impulsiveness as well as a lack of impulsive control.
• ... without Hyperactivity and Impulsiveness (ADD):
–
–
–
–
–
with oppositional defiant interaction behaviour,
with shy social interaction behaviour,
with affective disorders, e.g. depression or anxiety,
with pervasive developmental disorder, e.g. autism
with receptive language disorder, etc.
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The Effectiveness of Theraplay
on Attention Deficit Disorders
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Degree of Inattentiveness
varies depending on social interaction behaviour
Degree of impairment: 1=not symptomatic 2=slightly... 3=impaired... 4=strongly impaired
Degree of Inattentivenes
Sample of Controlled Longitudinal Study (CLS)
MEAN
1,2
3
3,1
2,7
3,7
1
1,5
2
2,5
3
3,5
4
N=30 clinically not symptomatic toddlers and preschool children (control group, matched sample)
N=50 inattentive toddlers and preschool children with behavioural disorders
N=21 oppositional defiant, inattentive toddlers and preschool children
N=18 shy, inattentive toddlers and preschool children
N=13 inattentive children with lack of social mutuality
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
13
Degree of Inattentiveness
varies depending on social interaction behaviour
Degree of impairment: 1=not symptomatic 2=slightly... 3=impaired... 4=strongly impaired
Degree of Inattentiveness
Sample of the Multi-Center-Study (MCS)
MEAN
1,2
3,2
3,3
3,1
3,6
1
1,5
2
2,5
3
3,5
4
N=30 clinically not symptomatic toddlers and preschool children (control group, matched sample)
N=183 inattentive toddlers and preschool children with behavioural disorders
N=105 oppositional defiant, inattentive toddlers and preschool children
N= 86 shy, inattentive toddlers and preschool children
N= 40 inattentive children with lack of social mutuality
Copyright 2004
Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
14
Degree of Uncooperative Behaviour
varies depending on social interaction behaviour
Degree of impairment: 1=not symptomatic 2=slightly... 3=impaired... 4=strongly impaired
Degree of Uncooperative Behavior
Sample of Controlled Longitudinal Study (CLS)
Mean
1,1
2,6
3,1
1,9
3,5
1
1,5
2
2,5
3
3,5
4
N=30 clinically not symptomatic toddlers and preschool children (control group, matched sample)
N=50 inattentive toddlers and preschool children with behavioural disorders total
N=21 oppositional defiant, inattentive toddlers and preschool children
N=18 shy, inattentive toddlers and preschool children
N=13 inattentive children with lack of social mutuality
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
15
Degree of Uncooperative Behaviour
varies depending on social interaction behaviour
Degree of impairment: 1=not symptomatic 2=slightly... 3=impaired... 4=strongly impaired
Degree of Uncooperative Behavior
Sample of the Multi-Center Study (MCS)
Mean
1,1
2,6
3
2,4
3,1
1
1,5
2
2,5
3
3,5
4
N=30 clinically not symptomatic toddlers and preschool children (control group, matched sample)
N=183 inattentive toddlers and preschool children with behavioural disorders
N=105 oppositional defiant, inattentive toddlers and preschool children
N= 86 shy, inattentive toddlers and preschool children
N= 40 inattentive children with lack of social mutuality
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The Effectiveness of Theraplay
on Attention Deficit Disorders
16
The Effectiveness of Theraplay
(part 1)
on inattentive toddlers and preschool children,
with
oppositional defiant interaction behaviour.
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The Effectiveness of Theraplay
on Attention Deficit Disorders
17
Characteristics of Oppositional Defiance
in the Therapeutic Interaction
Reference: Doepfner et al, 1999
Clinical Assessment Scale for Child and Adolescent Psychopathology (CASCAP-D)
• The child constantly refuses
to do what was requested by the therapist.
• The child constantly ignores therapist’s instructions.
• The child often talks back to the therapist.
• The child does not obey rules and regulations.
• The child breaks rules often.
• The child refuses to participate,
but without being dominant or aggressive in any way.
• Differential Diagnosis: aggression, dominance, irritability.
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The Effectiveness of Theraplay
on Attention Deficit Disorders
18
Reduction
of Oppositional Defiant Behaviour
of inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999), survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
4
N=21 oppositional defiant children
(TT-B: M=3.1,s=0.7) > (TT-E: M=1.3,s=0.5)
prob.<0.0001
3
3,3
3,1
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
N=105 oppositional defiant children
(TT-B: M=3.2,s=0.8) > (TT-E: M=1.4,s=0.5)
prob.<0.0001
2
N=30 clinically not symptomatic children
(CLS control group) (M=1.1; sd=0.3))
1,4
1,3
1,1
1
start of therapy (TT-B)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy (TT-E)
19
Reduction of Unwillingness to Cooperate
of inattentive children
with oppositional defiant behaviour
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
4
N=21 oppositional defiant children
(TT-B: M=3.1,s=0.9) > (TT-E: M=1.6,s=0.9)
prob.<0.0001
3
3,1
3,0
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
N=105 oppositional defiant children
(TT-B: M=3.0,s=1.0) > (TT-E: M=1.5,s=1.0)
prob.<0.0001
2
1,6
1,5
N=30 clinically not symptomatic children
(CLS control group) (M=1.1; sd=0.3)
1,1
1
start of therapy (TT-B)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy (TT-E)
20
Reduction of Inattentiveness
of inattentive children
with oppositional defiant behaviour
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
4
N=21 oppositional defiant children
(TT-B: M=3-1,s=0.6) > (TT-E: M=2.0,s=0.9)
prob<0.0001
3,3
3,1
3
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
N=105 oppositional defiant children
(TT-B: M=3.3,s=0.8) > (TT-E: M=2.0,s=0.7)
prob.<0.0001
2
2,0
N=30 clinically not symptomatic children
(CLS control group) (M=1.2; sd=0.4)
1,2
1
start of therapy (TT-B)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy (TT-E)
21
Improvement of Language Comprehension
of inattentive children
with oppositional defiant behaviour
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
start of therapy (TT-B)
1
N=21 oppositional defiant children
(TT-B: M=2.6,s=1.1) > (TT-E: M=2,0,s=1.0)
prob.=0.0244
2
N=105 oppositional defiant children
(TT-B: M=2.7,s=1.1) > (TT-E: M=1.9,s=0.8)
prob.<0.0001
end of therapy (TT-E)
1,0
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
1,9
2,0
2,6
2,7
3
N=30 clinically not symptomatic children
(CLS control group) (M=1,0; sd=0)
4
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The Effectiveness of Theraplay
on Attention Deficit Disorders
22
Clinical and Statistical Significance
Reduction of symptoms after 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
symptom
Symptoms
CLS
MCS
N=21
oppositional defiant,
inattentive children
N=105
oppositional defiant,
inattentive children
TT-BTT-E
M  M
s
prob.> F
TT-BTT-E
M  M
s
prob.> F
oppositional
defiant
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
receptive
language disorder
2.6  2.0 1.1
0.0244
2.7  1.9 0.9
0.0001
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The Effectiveness of Theraplay
on Attention Deficit Disorders
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The Lasting Effect
of the Treatment with Theraplay
on originally oppositional defiant,
inattentive children
2 years after treatment with Theraplay
A comparison
with the ‘norm’ of clinically not symptomatic children
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The Effectiveness of Theraplay
on Attention Deficit Disorders
24
Lasting Effect of Reduced Oppositional Defiance
of originally oppositional defiant, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999) ,
survey time period: start and end of therapy, 2 years based after treatment with Theraplay
Means
Average reduction of symptoms after Theraplay
4
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
Solely assessed in the longitudinal study!
N=21 oppositional defiant children
3
3,1
Statistical significance of change:
(TT-B>TT-E: prob.=0.0001, significant) 2
(TT-E:>2YaTT: change is insignificant
N=30 clinically not symptomatic children
(CLS control group) (M=1,0; sd=0)
1,3
1,0
1
start of therapy end of therapy
(TT-B)
(TT-E)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
1,3
2 years after
Theraplay
25
Lasting Effect of Reduced Uncooperative Behavior
of originally oppositional defiant, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999)
survey time period: start and end of therapy, 2 years based after treatment with Theraplay
Means
Average reduction of symptoms after Theraplay
4
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
Solely assessed in the longitudinal study!
N=21 oppositional defiant children
Statistical significance of change:
(TT-B>TT-E: prob.=0.0001)
(TT-E>2YaTT-E: change insignificant)
N=30 clinically not symptomatic children
(CLS control group) (M=1,0; sd=0)
3
3,1
2
1,6
1,0
1
start of therapy
(TT-B)
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Theraplay Insitut
1,5
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy
(TT-E)
2 years after
Theraplay
26
Lasting Effect of Reduced Inattentiveness
of originally oppositional defiant, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999)
survey time period: start and end of therapy, 2 years based on treatment with Theraplay
Means
Average reduction of symptoms after Theraplay
4
Solely assessed in the longitudinal study!
N=21 oppositional defiant children
3
Statistical significance of change:
(TT-B>TT-E: prob.=0.0001)
(TT-E>2YaTT-E: prob.=0.44 insignificant)
2
3,1
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
2,0
N=30 clinically not symptomatic children
(CLS control group) (M=1.2; sd=0.4)
1,4
1,2
1
start of therapy end of therapy
(TT-B)
(TT-E)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
2 years after
Theraplay
27
Duration of Therapy
of originally oppositional defiant, inattentive children
(Number of 30-minute therapeutic sessions)
Means
Average number of therapeutic sessions
with originally oppositional defiant, inattentive children
CLS: number of therapeutic sessions for N=21
originally oppositional defiant, inattentive toddlers
and preschool children
(M=19.1; s=7.8; Min=9; Max=43 sessions)
19,1
MCS: number of therapeutic sessions for N=105
originally oppositional defiant, inattentive toddlers
and preschool children
(M=21.2; s=12.6; Min=10; Max=61 sessions)
21,2
0
5
10
15
20
25
30
Average number of 30-minute therapeutic sessions
CLS: number of therapeutic sessions
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Theraplay Insitut
MCS: number of therapeutic sessions
The Effectiveness of Theraplay
on Attention Deficit Disorders
28
The Effectiveness of Theraplay
(part 2)
on inattentive toddlers and preschool children,
with
shy interaction behaviour.
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The Effectiveness of Theraplay
on Attention Deficit Disorders
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Characteristics of Shyness
in the Therapeutic Interaction
Reference: Doepfner et al, 1999
Clinical Assessment Scale for Child and Adolescent Psychopathology (CASCAP-D)
• The child seems to be very insecure, and
seems to be uncomfortable during diagnosis or therapy.
• The child does not make eye-contact with the therapist.
• The child always answers in a quiet, stuttering voice.
• The primary caretaker (e.g. mother) describes:
–
–
–
–
–
The child avoids certain social situations.
The child is shy and very insecure.
The child avoids contact to peers.
The child is unable to assert himself in situations.
The child is unable to defend itself
from peer’s demands and cannot assert its own demands or wishes .
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The Effectiveness of Theraplay
on Attention Deficit Disorders
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Reduction of Shy Interaction Behaviour
of shy, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999), survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
4
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
N=18 shy, inattentive children
(TT-B: M=2.3,s=06) > (TT-E: M=1.2,s=0.4)
prob.<0.0001
3
2,8
N=86 shy, inattentive children
(TT-B: M=2,8,s=0.8) > (TT-E: M=1.2,s=0.6)
prob.<0.0001
2,3
2
N=30 clinically not symptomatic children
(CLS control group) (M=1.2; sd=0.4)
1,2
1
start of therapy (TT-B)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy (TT-E)
31
Reduction of Unwillingness to Cooperate
of shy, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
4
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
N=18 shy, inattentive children
(TT-B: M=1.9,s=1.1) > (TT-E: M=1.3,s=0.6)
prob.=0.0007
3
N=86 shy, inattentive children
(TT-B: M=2.4,s=1.2) > (TT-E: M=1.3,s=0.5)
prob.<0.0001
2,4
2
1,9
N=30 clinically not symptomatic children
(CLS control group) (M=1.1; sd=0.3)
1,3
1,1
1
start of therapy (TT-B)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy (TT-E)
32
Reduction of Inattentiveness
of shy, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
4
N=18 shy, inattentive children
(TT-B: M=2.7,s=0.6) > (TT-E: M=2.1,s=0.7)
prob.=0.0017
3
3,1
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
2,7
N=86 shy, inattentive children
(TT-B: M=3.1,s=0.8) > (TT-E: M=1.9,s=0.8)
prob.<0.0001
2,1
1,9
2
N=30 clinically not symptomatic children
(CLS control group) (M=1.2; sd=0.4)
1,2
1
start of therapy (TT-B)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy (TT-E)
33
Improvement of Language Comprehension
of shy, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
start of therapy (TT-B)
1
N=18 shy, inattentive children
(TT-B: M=2.8,s=0.9) > (TT-E: M=2.3,s=1.0)
prob.=0.0242
2
end of therapy (TT-E)
1,0
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
1,7
2,3
N=86shy, inattentive children
(TT-B: M=2.6,s=1.2) > (TT-E: M=1.7,s=0.8)
prob.<0.0001
2,6
2,8
3
N=30 clinically not symptomatic children
(CLS control group) (M=1,0; sd=0)
4
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
34
Clinical and Statistical Significance
Reduction of symptoms after 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
CLS
MCS
N=18 shy,
inattentive children
N=86 shy,
inattentive children
TT-BTT-E
M  M
s
prob.> F
TT-BTT-E
M  M
s
prob.> F
shy
2.3  1.2
0.7
0.0001
2.8  1.2
0.8
0.0001
uncooperative
1.9  1.3
0.8
< 0.01
2.4  1.3
1.0
0.0001
inattentive
2.7  2.1
0.7
< 0.01
3.1  1.9
0.9
0.0001
receptive
language disorder
2.8  2.3
0.9
< 0.03
2.6  1.7
1.0
0.0001
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
35
Duration of Therapy
of originally shy, inattentive children
(Number of 30-minutes therapeutic sessions)
Means
Average number of therapeutic sessions
with originally shy and inattentive children
CLS: number of therapeutic sessions
of N=18 originally shy, inattentive children
(M=17.3; s=4.5; Min=11; Max=31 sessions)
17,3
MCS: number of therapeutic sessions
of N=86 shy, inattentive children
(M=18.9; s=10.8; Min=5; Max=52 sessions)
18,9
0
5
10
15
20
25
30
DAverage number of 30-minute therapeutic sessions
CLS: number of therapeutic sessions
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Theraplay Insitut
MCS: number of therapeutic sessions
The Effectiveness of Theraplay
on Attention Deficit Disorders
36
The Lasting Effect
of the Treatment with Theraplay
on originally shy, inattentive children
2 years after treatment with Theraplay
A Comparison
with the ‘norm‘ of clinically not symptomatic children
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
37
The Lasting Effect of Reduced Shyness
of originally shy, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999) ,
survey time period: start and end of therapy, 2 years based after treatment with Theraplay
Means
Average reduction of symptoms after Theraplay
4
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
Solely assessed in the longitudinal study!
3
N=18 originally shy, inattentive children
2,3
Statistical significance of change.
(TT-B>TT-E: prob.=0.0001, significant)
(TT-E>2YaTT-E: change insignificant)
2
N=30 clinically not symptomatic children
(CLS control group) (M=1,0; sd=0)
1,2
1,0
1
start of therapy end of therapy
(TT-B)
(TT-E)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
1,3
2 years after
Theraplay
38
The Lasting Effect
of Reduced Uncooperative Behaviour
of originally shy, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999)
survey time period: start and end of therapy, 2 years based after treatment with Theraplay
Means
Average reduction of symptoms after Theraplay
4
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
Solely assessed in the longitudinal study!
3
N=18 shy, inattentive children
Statistical significance of change:
(TT-B>TT-E: prob.<0.01, significant)
(TT-E>2YaTT-E: change insignificant)
2
1,9
1,3
1,0
N=30 clinically not symptomatic children
1
(CLS control group) (M=1,0; sd=0)
start of therapy end of therapy
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
1,1
2 years after
Theraplay
39
The Lasting Effect of Reduced Inattentiveness
of originally shy, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999)
survey time period: start and end of therapy, 2 years based on treatment with Theraplay
Means
Average reduction of symptoms after Theraplay
4
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
Solely assessed in the longitudinal study!
3
N=18 shy, inattentive children
2,7
Statistical significance of change:
(TT-B>TT-E: prob.<0.01, significant)
TT-E>2YaTT-E: prob.<0.04, significant)
2,1
2
1,4
N=30 clinically unobtrusive children
(CLS-control group) (M=1,2;s=0,4)
1,2
1
start of therapy end of therapy
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The Effectiveness of Theraplay
on Attention Deficit Disorders
2 years after
Theraplay
40
The Effectiveness of Theraplay
(part 3)
on inattentive toddlers and preschool children,
with an an autistic-like lack of social mutuality
CLS-Sample:
9 of 13 inattentive toddlers and preschool children
with an autistic-like lack of social mutuality
are diagnosed with “early childhood autism“
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The Effectiveness of Theraplay
on Attention Deficit Disorders
41
A Lack of Social Mutuality
in the therapeutic interaction
Reference: Doepfner et al, 1999
Clinical Assessment Scale for Child and Adolescent Psychopathology (CASCAP-D)
• It is impossible for the therapist to create an adequate
social interaction with the child within a therapy setting.
• The child avoids eye-contact with the therapist.
• The child does not show any reaction to others.
• Eye-contact , mimic, gesture and body language
are seldom shown in social interaction.
• The emotional reaction towards others is limited.
• The child is unable
to modulate his or her own behaviour in social situations.
• The child does not develop relationships with peers
that have the same interests and activities.
• These characteristics are shown in all situations.
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
42
The Reduction of the Lack of Social Mutuality
of originally autistic-like acting, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999), survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
4
CLS: N=13 inattentive toddler and preschool
children with a lack of social mutuality
(TT-B: M=3.2,s=0.8)>(TT-E: M=2.2,s=1.0)
prob.<0.002
3
3,2
3,1
MCS: N=40 inattentive toddler and preschool
children with a lack of social mutuality
(TT-B: M=3.1,s=0.8)>(TT-E: M=1.9,s=0.8)
prob.=0.0001
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
2,2
2
1,9
N=30 clinically not symptomatic children
(CLS control group) (M=1,0; sd=0)
1,0
1
start of therapy (TT-B)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy (TT-E)
43
The Reduction of Unwillingness to Cooperate
of originally autistic-like acting, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
4
CLS: N=13 inattentive toddler and preschool
children with a lack of social mutuality
(TT-B: M=3.5,s=0.8)>(TT-E: M=1.8,s=0.7)
prob.=0.0001
3,5
3
3,1
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
MCS: N=40 inattentive toddler and preschool
children with a lack of social mutuality
(TT-B: M=3.1,s=1.1)>(TT-E: M=1.6,s=0.6)
prob.=0.0001
2
1,8
1,6
N=30 clinically not symptomatic children
(CLS control group) (M=1.1; sd=0.3)
1,1
1
start of therapy (TT-B)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy (TT-E)
44
The Reduction of Inattentiveness
of originally autistic-like acting, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average Reduction of the Symptoms
after Theraplay
CLS: N=13 inattentive toddler and preschool
children with a lack of social mutuality
(TT-B: M=3.5,s=0.5)>(TT-E: M=2.8,s=1.0)
prob.=0.0076
MCS: N=40 inattentive toddler and preschool
children with a lack of social mutuality
(TT-B: M=3.6,s=0.6)>(TT-E: M=2.2,s=0.8)
prob.=0.0001
4
3,7
3,6
3
2,8
2,2
2
N=30 clinically not symptomatic children
(CLS control group) (M=1.2; sd=0.4)
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
1,2
1
start of therapy (TT-B)
Copyright 2004
Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
end of therapy (TT-E)
45
The Improvement of Language Comprehension
of originally autistic-like acting, inattentive children
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
start of therapy (TT-B)
1
CLS: N=13 inattentive toddler and preschool
children with lack of social mutuality
(TT-B: M=3.9,s=0.4) > (TT-E: M=3.0,s=0.7)
prob.<0.001
MCS: N=40 inattentive toddler and preschool
children with lack of social mutuality
(TT-B: M=3.2,s=1.1) > (TT-E: M=2.3,s=1.0)
prob.<0.0001
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
end of therapy (TT-E)
1,0
2
2,3
3,0
3
3,2
N=30 clinically not symptomatic children
(CLS control group) (M=1,0; sd=0)
4
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Theraplay Insitut
3,9
The Effectiveness of Theraplay
on Attention Deficit Disorders
46
Clinical and Statistical Significance
Reduction of symptoms after 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
CLS
MCS
N=13 inattentive children
with lack
an social Mutuality
N=40 inattentive children
with lack
an social Mutuality
TT-BTT-E
M  M
s
prob.> F
TT-BTT-E
M  M
s
prob.> F
lack of
social mutuality
3.2  2.2
0.8
<0.002
3.1  1.9
0.7
0.0001
uncooperative
3.5  1.8
0.9
0.0001
3.1  1.6
1.0
0.0001
inattentive
3.7  2.8
1.0
0.0076
3.6  2.2
0.9
0.0001
receptive
language disorder
3.9  3.0
0.7
0.0008
3.2  1.1
1.3
0.0001
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
47
Duration of Therapy
of inattentive children with a lack of social mutuality
(Number of 30-minute therapeutic sessions without preparation and follow-up)
Means
Average number of 30-minute therapeutic sessions
for inattentive children with a lack of social mutuality
CLS: number of therapeutic sessions
for N=13 inattentive toddler and preschool
children with a lack of social mutuality
(M=28.0; s=8.9; Min=17; Max=43 sessions)
28,0
MCS: number of therapeutic sessions
for N=40 inattentive toddler and preschool
children with a lack of social mutuality
(M=25.6; s=13.3; Min=13; Max=60 sessions)
25,6
0
5
10
15
20
25
30
Average number of 30-minute therapeutic sessions
CLS: number of therapeutic sessions
Copyright 2004
Theraplay Insitut
MCS: number of therapeutic sessions
The Effectiveness of Theraplay
on Attention Deficit Disorders
48
The Lasting Effect
of the Treatment with Theraplay
on originally inattentive children
with an autistic-like lack of social mutuality
2 years after treatment with Theraplay
A Comparison
with the ‘norm‘ of clinically not symptomatic children
Copyright 2004
Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
49
The Lasting Effect
of the Reduced Lack of Social Mutuality
of originally inattentive children
with an autistic-like lack of social mutuality
Assessment methods: CASCAP-D (Doepfner et al., 1999) ,
survey time period: start and end of therapy, 2 years based after treatment with Theraplay
Means
Average reduction of symptoms after Theraplay
4
Solely assessed in the longitudinal study!
3,2
3
CLS: N=13 inattentive toddler and
preschool children with lack of social
mutuality
Statistical significance of change:
(TT-B>TT-E: prob.y0.003, is significant)
(TT-E>2YaTT-E: change is insignificant)
N=30 clinically not symptomatic children
(CLS control group) (M=1,0; sd=0)
4 = stark ausgeprägtes
3 = deutlich
ausgeprägtes
2 = leicht ausgeprägtes
Symptom
1 = klinisch unauffällig
2,3
2,1
2
1,0
1
start of therapy end of therapy
(TT-B)
(TT-E)
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Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
2 years after
Theraplay
50
The Lasting Effect
of the Reduced Uncooperative Behaviour
of originally inattentive children
with an autistic-like lack of social mutuality
Assessment methods: CASCAP-D (Doepfner et al., 1999)
survey time period: start and end of therapy, 2 years based after treatment with Theraplay
Means
Average reduction of symptoms after Theraplay
4
Solely assessed in the longitudinal study!
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
3,5
3
CLS: N=13 inattentive toddler and preschool
children with lack of social mutuality
Statistical significance of change:
(TT-B>TT-E: prob.0.0001)
(TT-E>2YaTT-E: no change)
2
1,9
N=30 clinically not symptomatic children
1
(CLS control group) (M=1,0; sd=0)
1,0
start of therapy end of therapy
(TT-B)
(TT-E)
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Theraplay Insitut
1,9
The Effectiveness of Theraplay
on Attention Deficit Disorders
2 years after
Theraplay
51
The Lasting Effect of Reduced Inattentiveness
of originally inattentive children
with an autistic-like lack of social mutuality
Assessment methods: CASCAP-D (Doepfner et al., 1999)
survey time period: start and end of therapy, 2 years based on treatment with Theraplay
Means
Average reduction of symptoms after Theraplay
4
3,7
Solely assessed in the longitudinal study!
CLS: N=13 inattentive children with
an autistic-like lack of social mutuality
Statistical significance of change:
(TT-B>TT-E: prob.<0.008, is significant)
(TT-E>2YaTT-E: change is insignificant)
3,0
3
2
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
N=30 clinically not symptomatic children
(CLS control group) (M=1.2; sd=0.4)
2,8
1,2
1
start of therapy end of therapy
(TT-B)
(TT-E)
Copyright 2004
Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
2 years after
Theraplay
52
The Lasting Effect
of Improvement of Language Comprehension
of originally inattentive children
with an autistic-like lack of social mutuality
Assessment methods: CASCAP-D (Doepfner et al., 1999) , survey time period: start and end of therapy
Average reduction of symptoms after Theraplay
start of
end of therapy 2 years after
therapy (TT-B)
(TT-E)
end of therapy
1
Solely assessed in the longitudinal study!
CLS: N=13 inattentive toddler and preschool
children with an autistic-like lack of social
mutuality
Statistical significance of change:
(TT-B>TT-E: prob.<0.001, is significant)
(TT-E>2YaTT-E: change is not yet significant)
2
4 = strongly impaired
3 = impaired
2 = slightly impaired
symptom
1 = not noticeable
1,0
2,5
3,0
3
N=30 clinically not symptomatic children
(CLS control group) (M=1,0; sd=0)
4
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Theraplay Insitut
3,9
The Effectiveness of Theraplay
on Attention Deficit Disorders
53
Theraplay Institut
D-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. Wettig
Clinical Psychologist
Phone: +49-(0)7152-27062 Fax: +49-(0)7152-22602
e-Mail: [email protected]
® 1996 Theraplay is legally protected by 39518465 and 39518466
Copyright 2004
Theraplay Insitut
The Effectiveness of Theraplay
on Attention Deficit Disorders
54