1. Herbert H.G. Wettig & Ulrike Franke Evaluation of the Effectiveness of Theraplay on Attention-Deficit-Hyperactivity Disorder (ADHD) 2 studies evaluating the Effectiveness of Theraplay on toddlers and preschool children with dual diagnoses of attention-deficit-hyperactivity disorder and developmental language disorder in coincidence 2004

2. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 2 Overview Symptoms of hyper kinetic disorders –Attention-deficit (ADD) –Restlessness and/or Impulsiveness (HD) Research on the Effectiveness of Theraplay in HD –2 total samples of a controlled longitudinal- and a multi-center study –Selected samples of inattentive hyperactive and/or impulsive children Results of Evaluating the Effectiveness of Theraplay –Symptoms’ degree of markedness of inattentiveness and hyperactivity –Reduction of the symptoms and the lasting effect of the reduced symptoms of inattentive and hyperactive children on inattentive toddlers and preschool children suffering ADHD on impulsive ADHD-toddlers and preschool children suffering ADHD on hyperactive, physically restlessness toddlers and preschool children suffering ADHD –Duration of therapy in average number of necessary sessions

3. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 3 Symptoms of Inattentiveness in the Therapeutic Interaction Reference: Doepfner et al, 1999 German version of Clinical Assessment Scale for Child and Adolescent Psychopathology The researcher/therapist observes, –that the child is often distracted during testing, e.g. by irrelevant stimuli (sounds, objects, etc.), –e.g. that the child looks out of the window or to someone else, –e.g. that the child always needs to be brought back to the situation, –e.g. that the child always interrupts his or her exercises. The primary caretaker describes, –e.g. that the child is easily interrupted, –e.g. that the child is often imprecise, –e.g. that the child often loses things, –e.g. that the child easily forgets things that were said, –e.g. that the child is easily distracted when playing, –e.g. that the child is unable to concentrate.

4. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 4 Symptoms of Increased Impulsiveness (Lack of Impulse Control) based on CASCAP-D (Döpfner et al., 1999) German version of Clinical Assessment Scale for Child and Adolescent Psychopathology Lack of control of cognitions and actions. Inadequate reactions in social context –They often answer without thinking first. –They often interrupt other in conversation. Impatience –Unable to wait until it’s their turn. –They often interrupt games or conversations. Often excessive language - Inadequate reactions to social restrictions. DD: lack of restraint, dominant, increased physical activity, inattentive, irritated reactions, driven, etc.

5. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 5 Symptoms of Hyper Kinetic Disorders in physically restless children based on CASCAP-D (Döpfner et al., 1999) German version of Clinical Assessment Scale for Child and Adolescent Psychopathology Continuous, excessive physical activity. Motoric restlessness until aimless activity. (Movement of fingers, hands, arms, legs, constantly moving on chair, getting up, walking or running around). Unnecessary disturbance and restlessness while playing. Uninfluenced by requests or restrictions. The symptoms in context are shown in various disorders (e.g. hyper kinetic disorders, affective disorders, Anorexia nervosa, reactive attachment disorders, lack of restraint, Autisms, mentally challenged). DD: dominant, oppositional defiant, impulsive, driven restless, etc.

6. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 6 Different Distribution of hyper kinetic disorders (HD) in boys and girls based on Remschmidt (Hrsg.) (2000). children- and adolescent psychiatry, p. 144, or based on Knölker, Mattejat, Schulte-Markwort (2000). children- and adolescent psychiatry Prevalence of hyper kinetic disorders –School Age Children 3% - 4% –During childhood 3% -10% Boys’ hyper kinetic disorders rate is higher than girls. –Boys’ rate (to suffer from hyper kinetic disorders) is 3 x higher than girls. –Boys’ rate (to suffer from hyper kinetic disorders) in clinical samples is 6 – 9 x higher than girls.

7. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 7 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.

8. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 8 Selected Samples of inattentive children with different social interaction disorder* = 100% CLS N= 50 (about 83%) children* with attention deficit disorder (ADD) N= 25 (about 42%) children* with hyper kinetic impulsiveness N= 19 (about 32%) children* with hyper kinetic activity disorder (HD) N= 30 clinically not symptomatic toddlers and preschool children of the same age and gender (matched) MCS N=183 (rd. 73%) children* with attention deficit disorder (ADD) N=106 (rd. 42%) children* with hyper kinetic impulsiveness N= 80 (rd. 32%) children* with hyper kinetic activity disorder (HD)

9. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 9 Socio-demographic Structure (1) CLS- and MCS-Samples of toddlers and preschool children with attention deficit hyper activity disorder First contact with primary caretaker/diagnostic of children N=50 or N=183 inattentive children with social interaction disorder = 100% CLS: Mother’s Family Status 90% married mothers no unmarried living together 8% separated mothers 2% single mothers Child’s Family Status 90% legitimate children 10% illegitimate, physical child no adopted/foster children Child’s Upbringing 85% both parents involved 15% single parent involved MCS: Mother’s Family Status 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 76% both parents involved 24% single parent involved

10. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 10 Socio-demographic Structure (2) CLS- and MCS-Sample of toddlers and preschool children with attention deficit hyper activity disorder First contact with primary caretaker/diagnostic of children N=183 inattentive children with social interaction disorder = 100% CLS: Language relevant Criteria 94% Country of birth is Germany 6% other Country of birth 90% mother tongue is German 10% other mother tongue 81% one language Upbringing 19% bilingual Upbringing socially relevant Criteria 73% in kindergarten 27% not yet in kindergarten MCS: Language relevant Criteria 88% Country of birth is Germany 12% other Country of birth 93% mother tongue is German 7% other mother tongue 85% one language Upbringing 15% bilingual Upbringing socially relevant Criteria 76% in kindergarten 24% not yet in kindergarten

11. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 11 Average Age of Children toddlers and preschool children with dual diagnoses of developmental language- and attention-deficit-hyperactivity disorders* (years; months) CLS: Alter average in years; months. 4;04 N=60 children* of CLS total Sub samples of these: 4;03 N=50 inattentive children* total 4;03 N=25 impulsive children* with lack of control 4;03 N=19 hyperactive children* with excessive restlessness 4;05 N=30 clinically not symptomatic children (control group) MCS: Alter average in years; months. 4;09 N=251children* of MCS total Sub samples of these: 4;06 N=183 inattentive children* total 4;07 N=106 impulsive children* with lack of control 4;05 N= 80 hyperactive children* with excessive restlessness 4;05 N= 30 clinically not symptomatic children (control group)

12. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 12 Gender of Children toddlers and preschool children with dual diagnoses of developmental language disorder and attention-deficit-hyperactivity disorders* CLS: %boys; girls (general ratio 2.8 : 1) 69%;31% N=60 children* of CLS total Sub samples of these: 74%;26% N=50 inattentive, children* total 80%;20% N=25 impulsive children* with lack of control 79%;21% N=19 hyperactive children* with excessive restlessness 70%;30% N=30 clinically not symptomatic children (controls) MCS: %boys; girls (general ratio 2.7 : 1) 69%;31% N=183 children* of MCS total Sub samples of these: 73%;27% N=183 inattentive, children* total 77%;23% N=106 impulsive children* with lack of control 76%;24% N= 80 hyperactive children* with excessive restlessness 70%;30% N=30 clinically not symptomatic children (controls)

13. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 13 Anamnesis Presumed child’s disorder; Parents’ concerns

14. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 14 Results of Anamnesis In a large amount of children, especially those of the MCS, the parents’ anamnesis showed no evidence of developmental language disorders and behavioural disorders, e.g. shown in ADHD. In MCS children with interaction disorders through inattentiveness, impulsiveness or excessive increased restlessness mainly due to language developmental disorders, were presented. In LCS disorders of social interaction behaviour and on pervasive development disorders were often suspected, e.g. shown in autism. Possibly, behavioural disorders are often not considered worth treating. The parents were very concerned with their child’s language disorders.

15. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 15 Average Degree of Markedness of Inattentiveness (ADD) of ADHD-children Assessment methods: CASCAP-D (Döpfner et al., 1999) German version of Clinical Assessment Scale for Child and Adolescent Psychopathology

16. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 16 Average Degree of Markedness of Inattentiveness (ADD) in various kind of children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

17. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 17 Average Degree of Markedness of Inattentiveness in developmental language disorders (coincidence: ADD and SES) Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

18. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 18 Average Degree of Markedness of 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)

19. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 19 Average Degree of Markedness of impulsiveness of children (HD-Symptom) Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

20. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 20 Average Degree of Markedness of 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)

21. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 21 Average Degree of Markedness of 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)

22. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 22 Average Degree of Markedness of receptive language disorders of ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

23. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 23 Therapeutic Goal of the Treatment with Theraplay A general goal of the treatment with Theraplay is to open children with social interaction disorders to functional therapy. A special goal of the treatment with Theraplay is to make inattentive, impulsive or hyperactive children emotionally conscious of themselves and socially competent when dealing with others. Theraplay helps in regulation of child’s emotions and actions. –Inattentive children get a feel for themselves, their characteristics, abilities and skills. –Impulsive children improve their information processing. After Theraplay, therapists are better able to reach them. –Increased physically restless children experience an improved understanding for their bodies as well as feelings.

24. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 24 The Effectiveness of Theraplay (1) on inattentive toddlers and preschool children with dual diagnoses of attention-deficit-hyperactivity-syndrome and developmental language disorders.

25. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 25 Change of Oppositional Defiance of inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

26. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 26 Reduction of Uncooperative Behaviour of inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

27. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 27 Reduction of Inattentiveness of inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

28. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 28 Reduction of Impulsiveness of inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

29. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 29 Reduction of Increased Physical Restlessness of inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

30. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 30 Improvement of Receptive Language Disorder of inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

31. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 31 Clinical and Statistical Significance of reduction of symptoms based on 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 N=50 inattentive children MCS N=183 inattentive children TT-B  TT-E M  M sprob.> F TT-B  TT-E M  M sprob.> F oppositional defiant 3.1  1.3 0.80.0001 3.3  1.4 0.80.0001 uncooperative 3.1  1.6 1.10.0001 3.0  1.5 1.00.0001 inattentive 3.1  2.0 0.90.0001 3.3  2.0 0.80.0001 impulsive 2.6  1.4 0.90.0010 1.8  1.3 0.80.0001 hyperactive 1.9  1.4 0.90.0003 2.4  1.5 0.90.0001 receptive language disorder 2.6  2.0 1.10.0244 2.7  1.9 0.90.0001

32. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 32 The Lasting Effect of Therapeutic Success of Treatment with Theraplay in originally inattentive children with dual diagnoses of ADHD and developmental language disorders 2 years after discharge of Theraplay treatment A comparison with the ‚norm‘ of clinically not symptomatic children

33. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 33 The Lasting Effect of Reduced Oppositional Defiance of originally inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

34. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 34 The Lasting Effect of Reduced Uncooperative Behaviour of originally inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

35. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 35 The Lasting Effect of Reduced Inattentiveness of originally inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

36. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 36 The Lasting Effect of Reduced Impulsiveness of originally inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

37. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 37 The Lasting Effect of Reduced Physical Restlessness of inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

38. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 38 The Lasting Effect of Improved Receptive Language Disorder of originally inattentive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

39. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 39 Necessary Duration of Theraplay Therapy to achieve therapeutic goals in inattentive ADHD-children (Average number of 30-minute therapeutic sessions)

40. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 40 The Effectiveness of Theraplay (2) on impulsive toddlers and preschool children, with dual diagnoses attention-deficit-hyperactivity disorder and developmental language disorder.

41. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 41 Reduction of Oppositional Defiant Behaviour of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

42. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 42 Reduction of Uncooperative Behaviour of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

43. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 43 Reduction of Inattentiveness of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

44. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 44 Reduction of Impulsiveness of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

45. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 45 Reduction of Hyperactive & Physical Restlessness of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

46. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 46 Reduction of Playing Disorders of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

47. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 47 Covariant Reduction of Receptive Language Disorder of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

48. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 48 Clinical and Statistical Significance of 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 CLS N=18 scheue, inattentive children MCS N=86 scheue, inattentive children TT-B  TT-E M  M sprob.> F TT-B  TT-E M  M sprob.> F opposit.defiant 2.4  1.4 1.30.0002 2.8  1.4 1.20.0001 uncooperative 2.9  1.7 1.00.0001 3.0  1.5 1.10.0001 inattentive 3.2  2.1 0.70.0001 3.3  2.1 0.90.0001 impulsive 2.5  1.6 1.00.0004 2.7  1.7 1.10.0001 hyperactive 2.9  1.6 0.70.0004 3.0  1.8 0.90.0001 receptive language disorder 2.8  2.2 1.20.0033 2.7  1.9 1.00.0001

49. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 49 The Lasting Effect of Therapeutic Success of Treatment with Theraplay on toddlers and preschool children with dual diagnoses of impulsiveness and developmental language disorders 2 years after individual discharge of Theraplay treatment A comparison with ‚norm‘ of clinically not symptomatic children

50. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 50 The Lasting Effect of Reduction of Oppositional Defiant Behaviour of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

51. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 51 The Lasting Effect of Reduction of Uncooperative Behaviour of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

52. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 52 The Lasting Effect of Reduction of Inattentiveness of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

53. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 53 The Lasting Effect of Reduction of Impulsiveness of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

54. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 54 The Lasting Effect of Reduction of increased physical Restlessness of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

55. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 55 The Lasting Effect of Reduction of Playing Disorders of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

56. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 56 The Lasting Effect of Reduction of Receptive Language Disorder of impulsive ADHD-children Assessment methods: CASCAP-D German version of Clinical Assessment Scale for Child and Adolescent Psychopathology (Döpfner et al., 1999)

57. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 57 Necessary Duration of Theraplay Therapy to achieve therapeutic goals on impulsive ADHD-children (Average number of 30-minute therapeutic sessions)

58. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 58 The Effectiveness of Theraplay (3) on hyperactive, physically restless toddlers and preschool children with dual diagnoses of attention-deficit-hyperactivity disorder and developmental language disorder.

59. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 59 Reduction of Oppositional Defiant 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)

60. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 60 Reduction of Uncooperative 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)

61. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 61 Reduction of Hyperactive Physical Restlessness 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)

62. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 62 Reduction of Impulsiveness 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)

63. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 63 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)

64. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 64 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)

65. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 65 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)

66. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 66 Reduction of Receptive Language 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)

67. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 67 Clinically and Statistical Significance of 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 CLS N=19 hyperactive, increased restless children MCS N=80 hyperactive, increased restless children TT-B  TT-E M  M sprob.> F TT-B  TT-E M  M sprob.> F oppositional defiant 2.6  1.3 1.20.0001 2.9  1.4 1.10.0001 uncooperative 2.8  1.5 1.10.0001 3.0  1.5 1.10.0001 hyperactive 3.0  1.6 1.00.0001 3.1  1.8 1.00.0001 impulsive 3.0  1.6 0.90.0001 3.2  1.8 0.90.0001 inattentive 3.2  1.6 0.70.0001 3.4  2.2 0.90.0001 play disordered 2.2  1.6 0.9< 0.05 2.3  1.4 1.20.0001 clowning behaviour 1.7  1.2 0.9< 0.04 2.3  1.4 1.10.0001 receptive language disorder 2.8  2.2 1.20.0033 2.7  1.9 1.00.0001

68. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 68 Results of Research D The Effectiveness of Theraplay in inattentive, impulsive or hyperactive, restless ADHD-children In both studies the change of symptoms were very similar. Both studies show corresponding results. Both studies concur that attentiveness, impulsiveness and hyperactivity in toddlers and preschool children have shown clinically as well as statistically significant improvement based on Theraplay treatment. Based on Theraplay, children show significantly less impulsive and increased physical restlessness. Children are significantly more attentive as well as cooperative. Moreover other relevant symptoms show significant improvement. Covariant improvement can also be shown in receptive language disorder. The reached therapeutic success is steady. No noticed relapse. Two years after treatment with Theraplay improvement remains in general on reached therapeutic level.

69. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 69 The Lasting Effect of Reduction of Oppositional Defiant 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)

70. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 70 The Lasting Effect of Reduction of Uncooperative 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)

71. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 71 The Lasting Effect of Reduction of Hyperactive, Physical Restlessness 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)

72. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 72 The Lasting Effect of Reduction of Impulsiveness 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)

73. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 73 The Lasting Effect of 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)

74. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 74 The Lasting Effect of 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)

75. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 75 The Lasting Effect of 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)

76. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 76 The Lasting Effect of Reduction of Receptive Language Disorder 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)

77. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 77 Necessary Duration of Theraplay Therapy to attain therapeutic goals in hyperactive, physically restless ADHD-children (Number of 30-minute therapeutic sessions)

78. Copyright 2004 Theraplay Institut The Effectiveness of Theraplay on Attention Deficit Hyperactivity Disorders 78 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: Franke.Theraplay@t-online.de Questions about the evaluation research: Herbert H.G. Wettig Clinical Psychologist Phone: +49-(0)7152-27062 Fax: +49-(0)7152-22602 e-Mail: Herbert.Wettig@t-online.de ® 1996 Theraplay is legally protected by 39518465 and 39518466Franke.Theraplay@t-online.deHerbert.Wettig@t-online.de