overview

Herbert H.G. Wettig & Ulrike Franke

Evaluation of the Effectiveness of Theraplay

on Receptive Language Disorder

2 Studies evaluating the Effectiveness of Theraplayon toddlers and preschool children

with dual diagnoses of both receptive language disorder, and oppositional defiant behaviour, or shy interaction behaviour

or autistic-like-like lack of social mutuality in interaction.

January 2004

Copyright 2004 Theraplay Institut

The Effectiveness of Theraplay on receptive language disorders

2

Overview

• Statements on Language Comprehension disorder• Selected Samples (with Receptive Language Disorder)

• The Effectiveness of Theraplay– in toddlers and preschool children with

dual diagnoses of receptive language disorder and oppositional defiant interaction behaviour,

– in toddlers and preschool children with dual diagnoses of receptive language disorder and shy interaction behaviour,

– in toddlers and preschool children withdual diagnoses of receptive language disorder and autistic-like-like lack of social mutuality in interaction.



3

Statements on Language Comprehensionand Receptive Language Disorder:

Until now little research is availableReference: B. Zollinger, 1995. Disorder of Language Comprehension. Edition SZH, 109-122

• A large number of authors describe how and when children speak their first words and sentences.

• But, there are only isolated publications on the development of language comprehension disorder. – What are the reasons?

• Language comprehension can not be directly observed due to only being a reaction.

• If the hypothesis were true that language comprehension is followed by speech production than developmental language and speech production disorders as well as language comprehension need to be clarified.

• But this is seldom the case.• Specific therapeutic approaches on language comprehension

or receptive language disorder do not exist.



4

Statements on Language Comprehensionand Receptive Language Disorder:

Receptive Language disorder

• Language Comprehension is closely connected to the total development of the child.

• The development of language comprehensionis embedded in the development of thought.(K. Sarimski, 1984, 29, cited. in Mathieu, 1995, 37)

• A child’s lack of language comprehension limits important experiences and therefore makes developmental progress impossible.(S. Mathieu, 1995. Vergleichende Untersuchung. In: VHN 64, 36-52)



5

Receptive Language DisorderReference. CASCAP-D (Doepfner et al., 1999), German version of the Clinical Assessment Scale for Child and Adolescent Psychopathology

• Fundamental characteristics:• … a lack of language comprehension,

especially marked within the child’s vocabulary.

• …when in ratio to age and intelligence the degree of markedness is beyond the norm.

• ...when a child does not comprehend a large portion of what the primary caretaker says.

• DD: Receptive language disorder differs from expressive language disorder as well as from autistic-like spectrum disorder.



6

Selected Sampleswith receptive language disorder

(language comprehension disorder)

CLS• N= 52 children with receptive language disorder* total

N= 19 children* with oppositional defiant behaviour N= 20 children* with shy interaction behaviour N= 14 children* with an autistic-like lack of social mutuality

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

• N=164 children with receptive language disorder* totalN= 95 children* with oppositional defiant behaviour N= 82 children* with shy interaction behaviour N= 42 children* with an autistic-like lack of social mutuality



7

The Effectiveness of Theraplayon toddlers and preschool children

with dual diagnoses ofOppositional Defiant Behaviour

and Receptive Language Disorder



8

Oppositional Defiant BehaviourReference: CASCAP-D (Doepfner et al., 1999)

Clinical Assessment Scale for Child and Adolescent Psychopathology

• The child provokes confrontation.• The child hits, kicks and bites others.• The child intentionally tries to hurt others.• The child tortures animals and others.

• (DD: Behaviour differs from Aggression, Dominance, hot-tempered Irritability)



9

Gender, Age and Statusof toddlers and preschool children with dual diagnoses

of receptive language disorder and oppositional defiant behaviour

• CLS: N=19 children• 79% boys (N=15)

21% girls (N=4) 3,75 :1 ratio boys:girls

• 4;03 average age in years 4;01 years - boys5;03 years - girls

• Social Status:79% 15 legitimate children16% 3 illegitimate children 5% 1 adopted child (1 no answer)

• MCS: N=95 children• 72% boys (N=68)


• 4;05 average age in years • 4;04 years - boys

4;08 years - girls• Social Status

74% 68 legitimate children24% 22 illegitimate children 2% 2 foster children (3 no answer)



10

Status of the Mother and Upbringing of the Child of toddlers and preschool children with dual diagnoses

of receptive language disorder and oppositional defiant behaviour

• CLS: N=19 children• 83% 15 married mothers

no unmarried mothers living together with p.

17% 3 separated mothers no widowed or single mothers (1 no answer)

• 88% 15 both parents involved 12% 2 single parent (2 no answer)

• 95% 18 born in Germany• 95% 18 German as mother tongue

17% 3 bilingual upbringing • 63% 12 are in Kindergarten

• MCS: N=95 children• 53% 50 married mothers

12% 11 unmarried mothers living together with a partner

13% 12 separated mothers 1% 1 widowed mother20% 18 single mothers (3 no answer)

• 67% 63 both parents involved 33% 31 single parent (1 no answer)

• 87% 81 born in Germany• 94% 89 German as mother tongue

15% 14 bilingual upbringing • 77% 73 are in Kindergarten



11

Degree of Markedness of the Symptoms of Social Interaction Disorder

as well as Receptive Language disorder of children with oppositional defiant behaviour

A Comparison of clinically conspicuous toddlers and preschool children

with clinically not symptomatic children



12

Oppositional Defiant Behaviourof children with receptive language disorder

Average of Degree of MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999)

Comparing the average degree of markedness of symptoms of the clinically conspicuous children

with the control group of clinically unobtrusive children

3,2

3,2

1,1

1 2 3 4

N=30 clinically not symptomatic children (control group: M=1,1; sd=0.3)

N=95 toddlers and preschool children with oppositional defiant behaviour

(MCS: M=3.2; s=0.8)


(CLS: M=3.2; s=0.6)

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

CLS therapy group MCS therapy group CLS control group



13

Unwillingness to Cooperate of children with dual diagnoses of receptive language disorder

and oppositional defiant behaviourAverage Degree of Markedness of receptive language disorder

Assessment Method: CASCAP-D (Doepfner et al., 1999)



3,1

3,0

1,1

1 2 3 4



(MCS: M=3.0; s=1.1)


(CLS: M=3.1; s=0.8)

Symptom's average degree of markedness1 = not noticeable markedly impaired symptom = 4




14

Inattentivenessof children with dual diagnoses of receptive language disorder

and oppositional defiant behaviourAverage Degree of Markedness of receptive language disorder




2,9

3,1

1,2

1 2 3 4



(MCS: M=3.1; s=1.1)


(CLS: M=2.9; s=0.9)

Symptom's average degree of markedness1 = not noticeable strongly marked symptome = 4




15

Degree of Receptive Language Disorderof children with dual diagnoses of receptive language disorder

and oppositional defiant behaviourAverage Degree of Markedness




2,9

3,0

1,0

1 2 3 4

N=30 clinically not symptomatic children (control group: M=1,0; sd=0)


(MCS: M=3.0, s=0.8)


(CLS: M=2.9; s=0.9)





16

Reductionof Social Interaction Disorders

as well as Receptive Language Disorderof children with oppositional defiant behaviour

after Treatment with Theraplay

A Comparisonof clinically conspicuous toddlers and preschool children

with the ‘norm‘ of clinically not symptomatic children



17

Reduction of Oppositional Defiant Behaviour of children with dual diagnoses of receptive language disorder

and oppositional defiant behaviour Assessment Method: CASCAP-D (Doepfner et al., 1999)

Average reduction of symptom after Theraplay

3,2

1,4

3,2

1,0

1,6

1

2

3

4

start of therapy (TT-B) end of therapy (TT-E)

4 = strongly impaired3 = impaired

2 = slightly impaired symptom

1 = not noticeable

N=19 toddlers and preschool children with oppostional defiant behavior (TT-B: M=3.2, s=0.9)>(TT-E: M=1.4; s=0.8) (CLS: prob. 0.0001)

N=95 toddlers and preschool children with oppositional defiant behaviour (TT-B: M=3.2; s=0.8)>(TT-E: M=1.6; s=0.7) (MCS: prob.=0.0001)

N=30 clinically not symptomatic children (control group: M=1.0; sd=0)



18

Reduction of Unwillingness to Cooperate of children with dual diagnoses of receptive language disorder

and oppositional defiant behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)


3,1

1,4

3,0

1,5

1,01

2

3

4




1 = not noticeable

N=19 toddlers and preschool children with oppositional defiant behaviour (TT-B: M=3.1; s=0.8)>(TT-E: M=1.4; s=1.1) (CLS: prob.=0.0001)





19

Reduction of Inattentivenessof children with dual diagnoses of receptive language disorder



2,9

1,9

3,1

1,2

2,0

1

2

3

4




1 = not noticeable



N=30 clinically not symptomatic children (control group: M=1,2; s=0.4)



20

Reduction of Receptive Language Disorderof children with dual diagnoses of receptive language disorder



2,9

2,1

3,0

1,0

2,0

1

2

3

4




1 = not noticeable


N=95 toddlers and preschool children with oppositional defiant behaviour (TT-B: M=3.0; s=0.8)>(TT-E: M=2.1; s=0.7) (MCS. prob.=0.0001)




21

Clinical and statistical Significanceof Reduction of Symptoms

after Treatment with TheraplayG=Mean after CASCAP-D, =Change, s=Standard deviation

4-point scale: 1=not noticeable; Symptom: 2=slight...,3=marked, 4= strong

Symptoms

CLSN=19 oppos. defiant

MCSN=95 oppos. defiant

TT-BTT-E

G Gs prob.> F

TT-BTT-E

G Gs prob.> F

oppositionaldefiant

3.2 1.4 0.9 0.0001 3.2 1.6 0.8 0.0001

uncooperative 3.1 1.4 1.1 0.0001 3.0 1.5 1.1 0.0001

inattentive 2.9 1.4 1.1 0.0025 3.1 2.0 1.0 0.0001

receptive language disorder

2.9 2.1 0.9 0.0010 3.0 2,0 0.8 0.0001



22

Duration of Therapyof children with dual diagnoses of receptive language disorder

and oppositional defiant behaviour (Number of therapeutic 30-minute sessions)

Means

Average number of therapeutic sessions with children originally showing oppositional defiant behaviour and receptive languange disorder

16,2

21,1

0 5 10 15 20 25 30

N=95 originally oppositional defiant children with receptive language disorder MCS: Number of sessions M=21.1; min=5, max=61

N=19 originally oppositional defiant children with receptive language disorder

CLS: Number of sessions M=16.2; min=9, max=25

Average number of 30-minute sessions

CLS: Number of theapeutic sessions MCS: Number of therapeutic sessions



23

Lasting Effects of the Therapeutic Success2 years after treatment of children

with dual diagnoses of receptive language disorder and oppositional defiant behaviour

with Theraplay


with of ‘norm‘ of clinically not symptomatic children



24

Lasting Effects of the Reduced Oppositional Defiant Behaviour of children with dual diagnoses of receptive language disorder


Means


3,2

1,41,2

1,01

2

3

4

start of therapy(TT-B)

end of therapy(TT-E)

2 years afterTheraplay


2 = slightly impaired symptom1 = not noticeable

Solely assessed in the longitudinal study!

N=19 receptive language disordered childrenoriginally with oppositional defiant behaviour

Statistical significance of change: (TT-B > TT-E: prob.=0.0001, is significant) (TT-E > 2YaTT-E: change is not yet significant)




25

Lasting Effectsof the Reduced Unwillingness to Cooperate

of children with dual diagnoses of receptive language disorder and oppositional defiant behaviour

Assessment Method: CASCAP-D (Doepfner et al., 1999)Means

Average reduction of symptoms after Theraplay

3,1

1,41,2

1,01

2

3

4






1 = not noticeable


N=19 receptive language disordered childrenoriginally with oppositional defiant behaviour





26

Lasting Effects of the Reduced Inattentivenessof children with dual diagnoses of receptive language disorder


Means


2,9

1,9

1,5

1,21

2

3

4

start of therapy end of therapy 2 years afterTheraplay



1 = not noticeable


N=19 toddlers and preschool children with oppositional defiant behaviour (TT-B: M=2.9, s=0.9)>(TT-E: M=1.9; s=1.0) (CLS: prob.=0.0025)


N=30 clinically not symptomatic children (control group: M=1,2; s=0.4)



27

Lasting Effectsof the Reduced Receptive Language Disorder

of children with dual diagnoses of receptive language disorder and oppositional defiant behaviour



2,9

2,1

1,7

1,01

2

3

4






1 = not noticeable


Statistical significance of change: (TT-B > TT-E: prob.=0.0010, change is significant) (TT-E > 2YaTT-E: change is not yet significant)




28

Improvement of Language Comprehensionof children with dual diagnoses of receptive language disorder

and oppositional defiant behaviourAssessment Method: Pizzamiglio-Sprachverständnistest after B. Zollinger

Means

Improvement of Language Comprehension in children originally with oppositional defiant behaviour

through treatment with Theraplay

22,3

19,2

23,5

25,3

18

20

22

24

26

start ofwaiting time

(WT-B)

start oftherapy

(TT-B)

end oftherapy

(TT-E)



N=19 toddlers and preschool children with oppositional defiant behaviour and receptive language disorder

Statistical significance of change: (WT-B > TT-B: change is insignificant) (TT-B > TT-E: prob.=0.0198 change is significant) (TT-E > 2YaTT-E: is not yet significant)



29


with dual diagnoses of Shy Interaction Behaviour

and Receptive Language Disorder



30

Shy Social Interaction BehaviourReference: CASCAP-D (Doepfner et al., 1999)

• The child feels evidently very insecure and unpleasant in many situations.

• The child nearly always speaks – if any – quietly, stutters and blushes shyly.

• The child avoids making eye-contact.• Due to his insecurity

the child avoids almost every contact with peers.• The child

rarely opposes unjustified wishes or demands of peers.

• DD: Shy social behaviour differs from over adaption, social seclusion, social phobia, low self-esteem and disinterest.



31

Gender, Age and Status of toddlers and preschool children with dual diagnoses

of shy interaction and receptive language disorder



• 4;01 years average age4;05 years - boys3,06 years – girls

• 74% 14 legitimate children21% 4 illegitimate child 5% 1 adopted child (1 no answer)



• 4;03 years average age 4;03 years - boys4;02 years – girls

• 73% 58 legitimate children20% 16 illegitimate child 6% 5 adopted/foster child (3 no answer)



32

Status of Mother and Upbringing of toddlers and preschool children with dual diagnoses

of shy interaction and receptive language disorder • CLS: N=20 children• 90% 17 married mothers

5% 1 separated 5% 1 single mother (1 no answer)

• in upbringing88% 15 both parents involved 6% 1 single parent mother 6% 1 single parent father (3 no answer)

• 95% 19 born in Germany• 95% 19 German mother tongue

11% 2 bilingual upbringing• 75% 15 are in Kindergarten


10% 8 unmarried mothers living together with a partner

5% 4 separated 19% 15 single mothers (1 no a.)

• in upbringing• 75% 61 both parents involved

25% 20 single parent (1 no answer)

• 80% 63 born in Germany• 89% 72 German mother tongue

19% 15 bilingual upbringing• 75% 60 are in Kindergarten



33


as well as Receptive Language disorder of children with shy interaction behaviour





34

Degree of Shyness of toddlers and preschool children with dual diagnoses

of shy interaction and receptive language disorder of shy children with Average Degree of Markedness

Assessment Method: CASCAP-D (Doepfner et al., 1999) Comparing the average degree of markedness of symptoms

of clinically conspicuous children with the control group of clinically unobtrusive children

2,5

2,9

1,2

1 2 3 4

N=30 clinically not symptomatic children (control group: M=1,2; sd=0,4)

N=82 shy toddlers and preschool children with receptive language disorders

(MCS: M=2.9; s=0.8)


(CLS: M=2.5; s=0.8)

Symptom's average degree of markedness1 = not noticeable strongly marked symptom = 4

CLS therapy group MCS therapy group control group



35

Degree of Uncooperative Behaviour of toddlers and preschool children with dual diagnoses

of shy interaction and receptive language disorder of shy Average Degree of Markedness


Comparing the average degree of markedness of symptomsof clinically conspicuous children


2,0

2,3

1,1

1 2 3 4



(MZS: M=2.3; s=1.1)


CLS: M=2.0; s=1.0)





36

Degree of Inattentiveness of toddlers and preschool children with dual diagnoses





2,4

2,8

1,2

1 2 3 4



(MCS: M=2.8; s=1.1)


(CLS: M=2.4; s=0.9)





37

Degree of Receptive Language Disorder of toddlers and preschool children with dual diagnoses





3,0

3,1

1,0

1 2 3 4



(MCS: M=3.1; s=0.8)


(CLS: M=3.0; s=0.7)





38

Reductionof Social Interaction Disorders

as well as Receptive Language Disorderof children with shy interaction behaviour

after Treatment with Theraplay


with the ‘norm‘ of clinically not symptomatic children



39

Reduction of Shyness of children with dual diagnoses of receptive language disorder


Means


2,5

1,1

2,9

1,2 1,21

2

3

4




1 = not noticeable

N=20 shy toddlers and preschool children with receptive language disorders (TT-B: M=2.5; s=0.7) > (TT-E: M=1.1; s=0.3) (CLS: prob.=0.0001)

N=82 shy toddlers and preschool children with receptive language disorders (TT-B: M=2.9; s=0.8) > (TT-E: M=1.2; s=0.5) (MCS: prob.=0.0001)




40

Reduction of Unwillingness to Cooperate of children with dual diagnoses of receptive language disorder


Means


2,0

1,3

2,3

1,31,1

1

2

3

4




1 = not noticeable


N=82 shy toddlers and preschool children with receptive language disorders (TT-B: M=2.3; s=1.1) > (TT-E: M=1.3; s=0.6) (MCS: prob.=0.0001)




41

Reduction of Inattentiveness of children with dual diagnoses of receptive language disorder


Means


2,4

1,9

2,8

1,2

1,8

1

2

3

4




1 = not noticeable


N=82 shy toddlers and preschool children with receptive language disorders (TT-B: M=2.8; s=1.1) > (TT-E: M=1.8; s=0,7) (MCS: prob.=0.0001)




42

Reduction of Receptive Language Disorder of children with dual diagnoses of receptive language disorder


Means


3,0

2,2

3,1

1,0

1,9

1

2

3

4




1 = not noticeable


N=82 shy toodlers and preschool children with receptive language disorders (TT-B: M=3.1; s=0.8) > (TT-E: M=1.9; s=0.7) (MCS: prob.=0.0001)




43

Clinical and Statistical Significanceof Reduction of Symptoms



Symptoms

CLSN=20 shy children with

receptivelanguage disorder

MCSN=82 shy children with

receptivelanguage disorder

TT-BTT-E

G Gs prob.> F

TT-BTT-E

G Gs prob.> F

receptive language disorder

3.0 2.2 0.9 0.0013 3.1 1.9 0.9 0.0001

shy 2,5 1.1 0.9 0.0001 2,9 1.2 0.8 0.0001

inattentive 2.4 1.9 0.8 0.0099 2.8 1.8 1.0 0.0001

uncooperative 2.0 1.3 0.9 0.0051 2.3 1.3 1.1 0.0001



44

Duration of Therapy of children with dual diagnoses of receptive language disorder

and oppositional defiant behaviour (Number of therapeutic 30-minute sessions)

Means

Average number of therapeutic sessions oforiginally shy children with receptive language disorder

17,0

19,5

0 5 10 15 20 25 30

Number of therapeutic sessions of N=82 shy toddlers andpreschool children with receptive language disorders

(MCS: M=19.5; s=10.7; min=5; max=55 sessions)

Number of therapeutic sessions of N=20 shy toddlers andpreschool children with receptive language disorders

(LCS: M=17.0; s=4.6; min=10; max=31 sessions)

Durchschnittliche Anzahl der Therapiesitzungen á 30 Minuten

LCS: Number of therapeutic sessions MCS: Number of therapeutic sessions



45


with dual diagnoses of receptive language disorder and shy interaction behaviour

with Theraplay





46

The Lasting Effects of Reduced Shyness of children with dual diagnoses of receptive language disorder

and shy interaction behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)

Means


2,5

1,1 1,21,21

2

3

4


Ende derTherapie (TT-E)




1 = not noticeable


N=20 shy toddlers and preschool childrenwith receptive language disorders (TT-B > TT-E: prob.=0.0001, is significant) (TT-E > 2YaTT-E: change is insignificant)




47

Lasting Effects of Reduced Unwillingness to Cooperate of children with dual diagnoses of receptive language disorder


Means


2,0

1,31,11,1

1

2

3

4






1 = not noticeable


N=20 shy toddlers and preschool childrenwith receptive language disorders (TT-B > TT-E: prob.=0.0051, is significant) (TT-E < 2YaTT-E: change is insignificant)




48

The Lasting Effects of Reduced Inattentiveness of children with dual diagnoses of receptive language disorder


Means


2,4

1,9

1,41,2

1

2

3

4


end of therapy (TT-E)




1 = not noticeable


N=20 shy toddlers and preschool childrenwith receptive language disorders (TT-B > TT-E: prob.=0.0099, is significant) (TT-E > 2YaTT-E: prob.=0.0907, is not yetsignificant)




49

The Lasting Effectsof Reduced Receptive Language Disorder

of children with dual diagnoses of receptive language disorder and shy interaction behaviour

Assessment Method: CASCAP-D (Doepfner et al., 1999) Means


3,0

2,2 2,2

1,01

2

3

4






1 = not noticeable


N=20 shy toddlers and preschool childrenwith receptive language disorders (TT-B > TT-E: prob.=0.0013, is significant) (TT-E > 2YaTT-E: no change of symptom




50

Improvement of Language Comprehension of children with dual diagnoses of receptive language disorder


Means

Improvement of language comprenhension in originally shy children with receptive language

disorder while being treated with Theraplay

13,5

16,2

22,7

27,1

12

14

16

18

20

22

24

26

28

30

start ofwaiting time

(WT-B)

start oftherapy time

(TT-B)

end oftherapy time

(TT-E)

2 years afterTheraplay(2YaTT-E)

N=20 shy toddlers and preschool childrenwith receptive language disorders (CLS)

Statistical significance of change: (WT-B > TT-B: change not yet significant) (TT-B > TT-E: prob.=0.0414, is significant) (TT-E > 2YaTT-E: change not yet significant(prob.=0.3054)



51


with dual diagnoses ofan autistic-like-like lack of social mutuality in interaction

and receptive language disorder



52

Autistic-like Lack of Social Mutualityin Social Interaction

Reference: CASCAP-D (Doepfner et al., 1999)

• The child is unable to make eye-contact, or control mimic and gesture to influence social interactions.

• A autistic-like lack of socio-emotional mutualityis shown by a deviant reaction on emotions of others.

• Hypothesis is that there is a lack of behaviour modulation in social context or an unstable integration of social, emotional and communicative behaviours.

• No relationships to peers with common interests and activities are contacted or developed.

• The characteristics are shown in all situations.



53

Gender, Age and Statusof toddlers and preschool children with dual diagnoses

of an autistic-like lack of social mutuality and language comprehension disorder


14% girls (N= 2) 6 :1 Ratio boys : girls

• 3;11 average years 3;10 years - boys4,06 years - girls

• 86% 12 legitimate children 7% 1 illegitimate K. 7% 1 adopted/foster child (1 no answer)

• 57% 8 Early Autism 7% 1 Boy is mentally incurable


29% girls (N=12) 2,5 :1 Ratio boys:girls

• 3;11 average years 4;00 years - boys3;08 years - girls

• 85% 34 legitimate children10% 4 illegitimate K. 5% 2 adopted/foster child

(2 no answer)



54

Status of Mother and Upbringing of toddlers and preschool children with dual diagnoses


• CLS: N=14 children• 100% 14 married mothers

no unmarried no separated no single mother

• 93% 13 both involved in upbringing of the

child 7% 1 single parent

• 86% 12 born in Germany

• 93% 13 German as mother tongue14% 2 bilingual upbringing

• 69% 9 are in Kindergarten


7% 3 unmarried, living together10% 4 separated 12% 5 single mother (1 no a.)

• 85% 35 both involved in upbringing of the child15% 6 single parent (1 no a.)

• 73% 29 born in Germany

• 88% 36 German as mother tongue26% 11 bilingual upbringing

• 56% 23 are in Kindergarten



55


as well as Receptive Language disorderof children with an autistic-like lack in social mutuality.





56

Autistic-like Lack of Social mutuality of toddlers and preschool children with dual diagnoses


Average Degree of MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999)

Comparing the average degree of markedness of clinically conspicuous children


3,1

3,0

1,0

1 2 3 4


N=42 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders

(MCS: M=3.0; s=0.8)


(LCS: M=3.1; s=0.8)





57

Uncooperative Behaviour of toddlers and preschool children with dual diagnoses





3,5

2,9

1,1

1 2 3 4


N=42 toddlers and preschool children with both a lack ofsocial mutality, and with receptive language disorders

(MCS: M=2.9; s=1.2)


(LCS: M=3.5; s=0.8)





58

InattentivenessInattentiveness of toddlers and preschool children with dual diagnoses





3,1

3,0

1,2

1 2 3 4



(MCS: M=3.0; s=0.8)


(LCS: M=3.1; s=0.8)





59

Play Inabilities of toddlers and preschool children with dual diagnoses





3,1

2,8

1,0

1 2 3 4



(MCS: M=2.8; s=1.2)


(CLS: M=3.1; s=1.1)





60

Receptive Language Disorderof toddlers and preschool children with dual diagnoses





3,8

3,5

1,0

1 2 3 4



(MCS: M=3.5; s=0.8)


(CLS: M=3.8; s=0.4)





61

Reductionof Social Interaction Disorder

as well as receptive language disorder in children with autistic-like lack of social mutuality

and receptive language disorder after Treatment with Theraplay


with of ‚norm‘ of clinically not symptomatic children



62

Reduction of the Uncooperative Behaviour of toddlers and preschool children with dual diagnoses




3,5

1,8

3,0

1,1

2,0

1

2

3

4




1 = not noticeable

N=14 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (CLS) (TT-B: M=3.5;s=0.8)>(TT-E: M=1.8;s=0.7)

N=42 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (MCS) (TT-B: M=3.0;s=0.8)>(TT-E: M=2.0;s=0.9)




63

Reduction of the Lack of Social Mutuality of toddlers and preschool children with dual diagnoses




3,1

2,1

3,0

1,0

2,0

1

2

3

4




1 = not noticeable






64

Reduction of Inattentiveness of toddlers and preschool children with dual diagnoses




3,1

2,6

3,1

1,2

2,0

1

2

3

4




1 = not noticeable






65

Reduction of the Inability to Play of toddlers and preschool children with dual diagnoses




3,1

1,9

2,8

1,0

1,8

1

2

3

4




1 = not noticeable


N=42 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (MCS) (TT-B: M=2.8;s1.2)>(TT-E: M=1.8;s=0.9)




66

Reduction of the Social Isolation of toddlers and preschool children with dual diagnoses




2,2

1,1

2,2

1,0

1,3

1

2

3

4




1 = not noticeable






67

Reduction of the Receptive Language Disorder of toddlers and preschool children with dual diagnoses




3,8

2,9

3,5

1,0

2,4

1

2

3

4




1 = not noticeable






68

Clinical and Statistical Significanceof Reduction of Symptoms



Symptoms

CLSN=14 children with lack of

social mutuality withinreceptive language disorder

MCSN=42 children with lack of

social mutuality withinreceptive language disorder

TT-BTT-EG G s prob.> F TT-BTT-E

G G s prob.> F

receptive language disorder 3.8 2.9 0.7 0.0002 3.5 2.4 1.1 0.0001

uncooperative 3.5 1.8 0.9 0.0001 3.0 2.0 1.3 0.0001lack soc. mutuality 3.1 2.1 0.8 0.0013 3.0 2.0 0.8 0.0001inattentive 3.1 2.6 1.0 0.0104 3.1 2.0 1.3 0.0001unable to play 3.1 1.9 0.9 0.0001 2.8 1.8 1.1 0.0001socially isolated 2.2 1.1 1.1 0.0032 2.2 1.3 1.1 0.0001



69

Duration of the Therapy of toddlers and preschool children with dual diagnosesof originally an autistic-like lack of social mutuality and

language comprehension disorder (Number of therapeutic 30-minute sessions)

Means

Average number of therapeutic sessions treating children originally suffering both an

autistic-like lack of social mutuality, and receptive language disorder.

26,6

25,2

0 5 10 15 20 25 30

N=42 toddlers and preschool children originally sufferingboth a lack of social mutuality, and receptive languagedisorder (CLS: M=25.2

sessions; Min=12; Max=60 sessions)

N=14 toddlers and preschool children originally sufferingboth a lack of social mutuality; and receptive languagedisorder (CLS: M=26.6 sessions;

Min=10; Max=43 sessions)

Average number of30-minute therapeutic sessions

CLS: Number of therapeutic sessions MCS: Number of therapeutic sessions



70


with dual diagnoses of receptive language disorder and an autistic-like lack of social mutuality

with Theraplay





71

The Lasting Effectsof the Reduction of Uncooperative Behaviour

of toddlers and preschool children with originally dual diagnosesof an autistic-like lack of social mutuality

and receptive language disorder Assessment Method: CASCAP-D (Doepfner et al., 1999)

Means


3,5

1,8 1,8

1,11

2

3

4



2 years afterTheraplay(2JnTT)



1 = not noticeable


N=14 toddlers and preschool children withoriginally both a lack of social mutuality, andreceptive language disorder (CLS)

Statistical significance of change: (TT-B > TT-E: prob.=0.0001, is significant) (TT-E > 2YaTT-E: there was no change)




72

The Lasting Effects of the Reductionof an Autistic-like Lack of Social Mutualityof toddlers and preschool children with originally dual diagnoses

of an autistic-like lack of social mutuality and receptive language disorder



3,1

2,1 2,0

1,01

2

3

4




(2JnTT)



1 = not noticeable


N=14 toddlers and preschool children withboth a lack of social mutuality, andreceptive language disorder (CLS)

Statistical significance of change: (TT-B > TT-E: prob.=0.0013, is significant) (TT-E > 2YaTT-E: change is insignificant)




73

The Lasting Effects of the Reduction of Inattentiveness



Means


3,1

2,6

2,9

1,21

2

3

4




(2JnTT)



1 = not noticeable



Statistical significance of change: (TT-B > TT-E: prob.=0.0104, is p<0.02 significant) (TT-E > 2YaTT-E: prob=0.9588, not yet significant)




74

The Lasting Effectsof the Reduction of Social Isolation



Means


2,2

1,1 1,21,01

2

3

4




(2JnTT)



1 = not noticeable







75

The Lasting Effects of the Reduction of Inability to Play



Means


3,1

1,9 1,8

1,01

2

3

4




(2JnTT)



1 = not noticeable







76

The Lasting Effects of the Reduction of the Receptive Language Disorder



Means


3,8

2,92,7

1,01

2

3

4



2 years afterTheraplay(2JnTT)



1 = not noticeable



Statistical significanz of change: (TT-B > TT-E: prob.=0.0002, is significant) (TT-E > 2YaTT-E: change is insignificant)




77

Theraplay InstitutD-71229 Leonberg Obere Burghalde 42

Questions about Theraplay: Ulrike Franke

speech-language pathologist reg. Play Therapist and Supervisor (APT)

certified Theraplay Therapist and Trainer (TTI)Phone. 06202-54051 Fax 06202-54958

eMail: [email protected]

Questions about evaluation research: Herbert H.G. Wettig

Clinical PsychologistPhone. 07152-27062 Fax 07152-22602

eMail: [email protected]

1996 Theraplay is legally protected as 39518465 and 39518466.

mailto:[email protected]

mailto:[email protected]

overview

Documents