herbert h.g. wettig & ulrike franke evaluation of the effectiveness of theraplay on...
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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
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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
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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.
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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.
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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.
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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.
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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.
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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)
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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
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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
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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)
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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)
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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
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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.
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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
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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
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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
MCS-therapy groups CLS-therapy groups N=30 control group
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Average Degree of Markednessof physical restlessness of children
(HD-Symptom) Assessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Symptom’s average degree of markedness of clinically conspicuous children compared to clinically not symptomatic children
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
Symptom's average degree of markedness 1 = clinically not symptomatic strongly impaired symptom = 4
MCS-therapy groups CLS-therapy groups N=30 control group
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Average Degree of Markednessof impulsiveness of children
(HD-Symptom)Assessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Symptom’s average degree of markedness of clinically conspicuous children compared to clinically not symptomatic children
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
Symptom's average degree of markedness 1 = clinically not symptomatic strongly impaired symptom = 4
MCS-therapy groups CLS-therapy groups N=30 control group
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Average Degree of Markednessof uncooperative social interaction behaviour
of ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
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
Symptom's average degree of markedness 1 = clinically not symptomatic strongly impaired symptom = 4
N=183 MCS-therapy group N=50 CLS-therapy group N=30 control group
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Average Degree of Markednessof oppositional defiant interaction behaviour
of ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
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
Symptom's average degree of markedness 1 = clinically not symptomatic strongly impaired symptom = 4
MCS-therapy groups CLS-therapy groups N=30 control group
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Average Degree of Markednessof receptive language disorders
of ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
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
language disorder CLS: s=1.2; MCS: s=1.2
N=25/106 impulsivechildren with receptive
language disorder CLS: s=1.1; MCS: s=1.2
N=50/183 inattentivechildren with receptive
language disorder CLS: s=1.0; MCS: s=1.2
Symptom's average degree of markedness 1 = clinically not symptomatic strongly impaired symptom = 4
MCS-therapy groups CLS-therapy groups N=30 control group
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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 .
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The Effectiveness of Theraplay
(1)on inattentive toddlers and preschool children
with dual diagnoses of attention-deficit-hyperactivity-syndrome and
developmental language disorders.
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Change of Oppositional Defianceof inattentive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
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
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Reduction of Uncooperative Behaviourof inattentive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Reduction of uncooperative behaviour after Theraplay
2,6
1,5
2,6
1,4
1,11
2
3
4
start of therapy (t1) end of therapy (t6)
44 = 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
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Inattentivenessof inattentive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Reduction of inattentive behaviour after Theraplay
3,0
2,22,1
1,2
3,2
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: clinicallynot symptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Impulsivenessof inattentive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Reduction of impulsive behaviour after Theraplay
1,8
1,31,4
1,1
2,0
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.=0.0010
N=183 inattentive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
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Reduction of Increased Physical Restlessnessof inattentive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Reduction of increased physical restlessness after Theraplay
1,9
1,41,5
1,2
2,1
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.=0.0003
N=183 inattentive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
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Improvement of Receptive Language Disorderof inattentive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average improvement of receptive language disorderafter Theraplay (in covariation)
2,9
2,3
1,9
1,0
2,6
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.=0.0002
N=183 inattentive children CLS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
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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
inattentive children
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
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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
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The Lasting Effectof Reduced Oppositional Defiance
of originally inattentive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
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)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=50 inattentive children CLS t1-t6: prob.=0.0001 CLS t6-t7: prob.>0.05 (not significant)
CLS-control group: clinically notsymptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effectof Reduced Uncooperative Behaviourof originally inattentive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of uncooperative behaviour after Theraplay
2,6
1,51,3
1,11
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=50 inattentive children CLS t1-t6: prob.=0.0001 CLS t6-t7: prob.>0.05 (not significant)
CLS-control group: clinically notsymptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effectof Reduced Inattentiveness
of originally inattentive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
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)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=50 inattentive children CLS t1-t6: prob.=0.0001 CLS t6-t7: prob.>0.05 (not significant)
CLS-control group: clinically notsymptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effectof Reduced Impulsiveness
of originally inattentive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of impulsiveness after Theraplay
1,8
1,3 1,31,11
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=50 inattentive children CLS t1-t6: prob.=0.0010 CLS t6-t7: prob.>0.05 (not significant)
CLS-control group: clinically notsymptomatic children N=30
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The Lasting Effectof Reduced Physical Restlessness
of inattentive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average Reduction of increased physical restlessness after Theraplay
1,9
1,4
1,7
1,21
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy /t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=50 inattentive children CLS t1-t6: prob. 0.003 CLS t6-t7: prob.>0.05 (not significant)
CLS-control group: clinically notsymptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effectof Improved Receptive Language Disorder
of originally inattentive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average Reduction of receptive language disorder after Theraplay (in covariation)
2,9
2,3 2,3
1,01
2
3
4
start of therapy (t1) end of therapy (t6)
2 > years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=50 inattentive children CLS T1-t6: prob.=0.0002 CLS t6-t7: prob.>0.05 (not significant)
CLS-control group: clinically notsymptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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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
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The Effectiveness of Theraplay
(2)on impulsive toddlers and preschool children,
with dual diagnosesattention-deficit-hyperactivity disorder
and developmental language disorder.
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Oppositional Defiant Behaviour
of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of oppositional defiant behaviour after Theraplay
2,4
2,8
1,4
1,1
1,4
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=25 impulsive children CLS t1-t6: prob.=0.0002
N=106 impulsive children MCS T1-t6: prob.=0.0001
CLS-control group: clinically notsymptomatic children N=30
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Uncooperative Behaviourof impulsive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of uncooperative behaviour after Theraplay
2,93,0
1,5
1,1
1,7
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=25 impulsive children CLS t1-t6: prob.=0.0001
N=106 impulsive children MCS t1-t6: prob.=0.0001
CLS-control group: clinically notsymptomatic children N=30
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Inattentivenessof impulsive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of inattentiveness after Theraplay
3,23,3
2,1
1,2
2,1
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=25 impulsive children CLS t1-t6: prob.=0.0001
N=106 impulsive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Impulsivenessof impulsive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of impulsiveness after Theraplay
2,52,7
1,7
1,1
1,6
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=25 impulsive children CLS t1-t6: prob.=0.0004
N=106 impulsive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Hyperactive & Physical Restlessness
of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of increased physical restlessness after Theraplay
2,93,0
1,8
1,2
1,6
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=25 impulsive children CLS t1-t6: prob.=0.0004
N=106 impulsive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Playing Disordersof impulsive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of playing disorder after Theraplay
2,22,3
1,4
1,0
1,6
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=25 impulsive children CLS t1-t6: prob.=0.0025
N=106 impulsive children MCS t1-t6: prob.0.0001
CLS-control group: clinicallynot symptomatic children N=30
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Covariant Reduction of Receptive Language Disorder
of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average Reduction of receptive language disorder after Theraplay (in covariation)
2,82,7
1,9
1,0
2,2
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=25 impulsive children CLS t1-t6: prob.=0.0033
MCS: impulsive children N=106; t1-t6: prob=0.0001
CLS-control group: clinicallynot symptomatic children N=30
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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,
inattentive children
MCSN=86 scheue,
inattentive children
TT-BTT-EM M s prob.> F TT-BTT-E
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
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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
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The Lasting Effectof Reduction of Oppositional Defiant Behaviour
of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of oppositional defiant behaviour after Theraplay
2,4
1,4
1,1
1,4
1
2
3
4
start of therapy(t1)
end of therapy (t6) 2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=25 Impulsive children CLS t1-t6: prob.=0.0002 CLS t6-t7: no change
CLS-control group: clinically notsymptomatic children N=30
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The Lasting Effectof Reduction of Uncooperative Behaviour
of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of uncooperative behaviour after Theraplay
2,9
1,5
1,1
1,7
1
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=25 Impulsive children CLS t1-t6: prob.=0.0001 CLS t6-t7: no significant change
CLS-control group: clinically notsymptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effectof Reduction of Inattentiveness
of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of inattentiveness after Theraplay
3,2
2,2
1,2
2,1
1
2
3
4
start of therapy(t1)
end of therapy (t6) 2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=25 Impulsive children CLS t1-t6: prob.=0.0001 CLS t6-t7: no significantstatistical change
CLS-control group: clinically notsymptomatic children N=30
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effectof Reduction of Impulsiveness
of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of impulsiveness after Theraplay
2,5
1,6
1,1
1,6
1
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=25 impulsive children CLS t1-t6: prob.=0.0004 CLS t6-t7: no change
CLS-control group: clinically notsymptomatic children N=30
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The Lasting Effectof Reduction of increased physical Restlessness
of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of increased physical restlessness after Theraplay
2,9
2,1
1,2
1,6
1
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=25 impulsive children CLS t1-t6: prob.=0.0004 CLS t6-t7: no significantstatistical change
CLS-control group: clinically notsymptomatic children N=30
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effect of Reduction of Playing Disordersof impulsive ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of playing disorder after Theraplay
2,2
1,4
1,0
1,6
1
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=25 impulsive children CLS t1-t6: prob.=0.0025 CLS t6-t7: no significantstatistical change
CLS-control group: clinically notsymptomatic children N=30
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effectof Reduction of Receptive Language Disorder
of impulsive ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of receptive language disorder after Theraplay (in covariation)
2,8
2,1
1,0
2,2
1
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
44 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic childN=25 impulsive children CLS t1-t6: prob.=0.0033 CLS t6-t7:no significantstatistical change
CLS-control group: clinically notsymptomatic children N=30
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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
Average number of 30-minute therapeutic sessions
MCS: number of therapeutic sessions CLS: number of therapeutic sessions
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The Effectiveness of Theraplay
(3)on hyperactive, physically restless
toddlers and preschool children with dual diagnoses of
attention-deficit-hyperactivity disorderand developmental language disorder.
Copyright 2004 Theraplay Institut
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Reduction of Oppositional Defiant Behaviourof hyperactive, physically restless ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of oppositional defiant behaviour after Theraplay
2,5
1,3
2,9
1,4
1,11
2
3
4
start of therapy (t1) end of therapy (t6)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.=0.0001
N=80 hyperactive children MCS t1-t6: prob.=0.0001
CLS-control group: clinically notsymptomatic children N=30
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Reduction of Uncooperative Behaviourof hyperactive, physically restless ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of uncooperative behaviour after Theraplay
2,8
1,5
3,0
1,5
1,11
2
3
4
start of therapy (t1) end of therapy (t6)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.=0.0001
N=80 hyperactive children MCS t1-t6: prob.=0.0001
CLS-control group: clinically notsymptomatic children N=30
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Reduction of Hyperactive Physical Restlessnessof hyperactive, physically restless ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of increased physical restlessness after Theraplay
3,0
1,6
3,1
1,8
1,2
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=19 hyperactive children CLS t1-t6: porb.=0.0001
N=80 hyperactive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Impulsivenessof hyperactive, physically restless ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of impulsiveness after Theraplay
3,0
1,6
3,2
1,8
1,11
2
3
4
start of therapy (t1) end of therapy (t6)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.=0.0001
N=80 hyperactive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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Reduction of Inattentiveness of hyperactive, physically restless ADHD-
children Assessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of inattentiveness after Theraplay
3,2
2,1
3,4
2,2
1,21
2
3
4
start of therapy (t1) end of therapy (t6)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.=0.0001
N=80 hyperactive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
Copyright 2004 Theraplay Institut
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Reduction of Playing Disorders of hyperactive, physically restless ADHD-
children Assessment methods: CASCAP-D German version of Clinical Assessment Scale
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
start of therapy (t1) end of therapy (t6)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.<0.05
N=80 hyperactive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
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Reduction of Clowning Behaviour of hyperactive, physically restless ADHD-
children Assessment methods: CASCAP-D German version of Clinical Assessment Scale
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
start of therapy (t1) end of therapy (t6)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.<0.05 (=0.0473)
N=80 hyperactive children MCS t1-t6: prob.=0.0001
CLS-control group: clinically notsymptomatic children N=30
Copyright 2004 Theraplay Institut
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Reduction of Receptive Language Disordersof hyperactive, physically restless ADHD-children
Assessment methods: CASCAP-D German version of Clinical Assessment Scalefor Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of receptive language disorder after Theraplay (in covariation)
2,7
2,12,3
1,4
1,01
2
3
4
start of therapy (t1) end of therapy (t6)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.<0.04 (=0.0324)
N=80 hyperactive children MCS t1-t6: prob.=0.0001
CLS-control group: clinicallynot symptomatic children N=30
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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
TT-BTT-EM M s prob.> F TT-BTT-E
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
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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.
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The Lasting Effectof Reduction of Oppositional Defiant Behaviour
of hyperactive, physically restless ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of oppositional defiant behaviour after Theraplay
2,5
1,3 1,4
1,11
2
3
4
start of therapy(t1)
end of therapy (t6) 2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.=0.0001 LSS t6-t7: no significant statisticalchange
CLS-control group: clinically notsymptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effectof Reduction of Uncooperative Behaviour
of hyperactive, physically restless ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of uncooperative behaviour after Theraplay
2,8
1,51,4
1,11
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.=0.0001 LSS t6-t7: no significant statisticalchange
CLS-control group: clinically notsymptomatic children N=30
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The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders
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The Lasting Effectof Reduction of Hyperactive, Physical Restlessness
of hyperactive, physically restless ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of increased physical restlessness after Theraplay
3,0
1,6 1,6
1,21
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.=0.0001 LSS t6-t7: no change
CLS-control group: clinically notsymptomatic children N=30
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The Lasting Effectof Reduction of Impulsiveness
of hyperactive, physically restless ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of impulsiveness after Theraplay
3,0
1,6 1,6
1,11
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.=0.0001 CLS t6-t7: no change
CLS-control group: clinically notsymptomatic children N=30
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The Lasting Effectof Reduction of Inattentiveness
of hyperactive, physically restless ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of inattentiveness after Theraplay
3,2
2,1
1,8
1,21
2
3
4
start of therapy(t1)
end of therapy (t6) 2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.=0.0001 CLS t6-t7: no significantstatistical change
CLS-control group: clinically notsymptomatic children N=30
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The Lasting Effectof Reduction of Playing Disorders
of hyperactive, physically restless ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of playing disorder after Theraplay
2,2
1,6 1,5
1,01
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.<0.05 CLS t6-t7: no significantstatistical change
CLS-control group: clinically notsymptomatic children N=30
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The Lasting Effectof Reduction of Clowning Behaviour
of hyperactive, physically restless ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of clowning behaviour after Theraplay
1,7
1,2 1,11,01
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.<0.05 (p=0.0473) CLSS t6-t7: no significantstatistical change
CLS-control group: clinically notsymptomatic children N=30
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The Lasting Effectof Reduction of Receptive Language Disorder
of hyperactive, physically restless ADHD-childrenAssessment methods: CASCAP-D German version of Clinical Assessment Scale
for Child and Adolescent Psychopathology (Döpfner et al., 1999)
Average reduction of receptive language disorder after Theraplay (in covariation)
2,7
2,12,0
1,01
2
3
4
start of therapy(t1)
end of therapy(t6)
2 years afterdischarge from
therapy (t7)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not symptomatic child
N=19 hyperactive children CLS t1-t6: prob.<0.04 (p=0.0324) LSS t6-t7: no significantstatistical change
CLS-control group: clinically notsymptomatic children N=30
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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
Average number of 30-minute therapeutic sessions
MCS: number of therapeutic sessions CLS: number of therapeutic sessions
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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: Franke.Theraplay@t-online.de
Questions about the evaluation research: Herbert H.G. WettigClinical Psychologist
Phone: +49-(0)7152-27062 Fax: +49-(0)7152-22602e-Mail: Herbert.Wettig@t-online.de
® 1996 Theraplay is legally protected by 39518465 and 39518466
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