overview
DESCRIPTION
- PowerPoint PPT PresentationTRANSCRIPT
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.
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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.
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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.
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
7
The Effectiveness of Theraplayon toddlers and preschool children
with dual diagnoses ofOppositional Defiant Behaviour
and Receptive Language Disorder
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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)
28% girls (N=27) 2,5 :1 ratio boys:girls
• 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)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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)
N=19 toddlers and preschool children with oppositional defiant behaviour
(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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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)
Comparing the average degree of markedness of symptoms of the clinically conspicuous children
with the control group of clinically unobtrusive children
3,1
3,0
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=3.0; s=1.1)
N=19 toddlers and preschool children with oppositional defiant behaviour
(CLS: M=3.1; s=0.8)
Symptom's average degree of markedness1 = not noticeable markedly impaired symptom = 4
CLS therapy group MCS therapy group CLS control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
14
Inattentivenessof 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)
Comparing the average degree of markedness of symptoms of the clinically conspicuous children
with the control group of clinically unobtrusive children
2,9
3,1
1,2
1 2 3 4
N=30 clinically not symptomatic children (control group: M=1,2; sd=0.4)
N=95 toddlers and preschool children with oppositional defiant behaviour
(MCS: M=3.1; s=1.1)
N=19 toddlers and preschool children with oppositional defiant behaviour
(CLS: M=2.9; s=0.9)
Symptom's average degree of markedness1 = not noticeable strongly marked symptome = 4
CLS therapy group MCS therapy group CLS control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
15
Degree of Receptive Language Disorderof children with dual diagnoses of receptive language disorder
and oppositional defiant behaviourAverage Degree of Markedness
Assessment 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
2,9
3,0
1,0
1 2 3 4
N=30 clinically not symptomatic children (control group: M=1,0; sd=0)
N=95 toddlers and preschool children with oppositional defiant behaviour
(MCS: M=3.0, s=0.8)
N=19 toddlers and preschool children with oppositional defiant behaviour
(CLS: M=2.9; s=0.9)
Symptom's average degree of markedness1 = not noticeable strongly impaired symptom = 4
CLS therapy group MCS therapy group CLS control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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)
Average reduction of symptom after Theraplay
3,1
1,4
3,0
1,5
1,01
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 oppositional defiant behaviour (TT-B: M=3.1; s=0.8)>(TT-E: M=1.4; s=1.1) (CLS: prob.=0.0001)
N=95 toddlers and preschool children with oppositional defiant behaviour (TT-B: M=3.0; s=1.0)>(TT-E: M=1.5; s=0.6) (MCS: prob.=0.0001)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
19
Reduction of Inattentivenessof children with dual diagnoses of receptive language disorder
and oppositional defiant behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)
Average reduction of symptom after Theraplay
2,9
1,9
3,1
1,2
2,0
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 oppositional defiant behaviour (TT-B: M=2.9; s=0.9)>(TT-E: M=1.9; s=1.0) (CLS: prob.=0.0025)
N=95 toddlers and preschool children with oppositional defiant behaviour (TT-B: M=3.1; s=1.1)>(TT-E: M=2.0; s=0.8) (MCS: prob.=0.0001)
N=30 clinically not symptomatic children (control group: M=1,2; s=0.4)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
20
Reduction of Receptive Language Disorderof children with dual diagnoses of receptive language disorder
and oppositional defiant behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)
Average reduction of symptom after Theraplay
2,9
2,1
3,0
1,0
2,0
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 oppositional defiant behaviour (TT-B: M=2.9; s=0.9)>(TT-E: M=2.1; s=1.0) (CLS: prob.=0.0010)
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)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
A Comparisonof clinically conspicuous toddlers and preschool children
with of ‘norm‘ of clinically not symptomatic children
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
24
Lasting Effects of the Reduced Oppositional Defiant Behaviour of children with dual diagnoses of receptive language disorder
and oppositional defiant behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)
Means
Average reduction of symptom after Theraplay
3,2
1,41,2
1,01
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay
4 = strongly impaired3 = impaired
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)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = 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)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
26
Lasting Effects of the Reduced Inattentivenessof children with dual diagnoses of receptive language disorder
and oppositional defiant behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)
Means
Average reduction of symptoms after Theraplay
2,9
1,9
1,5
1,21
2
3
4
start of therapy end of therapy 2 years afterTheraplay
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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)
Statistical significance of change: (TT-B > TT-E: prob.=0.0025, is significant) (TT-E > 2YaTT-E: change is not yet significant)
N=30 clinically not symptomatic children (control group: M=1,2; s=0.4)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
27
Lasting Effectsof the Reduced Receptive Language Disorder
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
2,9
2,1
1,7
1,01
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
N=19 toddlers and preschool children with oppositional defiant behaviour
Statistical significance of change: (TT-B > TT-E: prob.=0.0010, change is significant) (TT-E > 2YaTT-E: change is not yet significant)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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)
2 years afterTheraplay
Solely assessed in the longitudinal study!
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)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
29
The Effectiveness of Theraplayon toddlers and preschool children
with dual diagnoses of Shy Interaction Behaviour
and Receptive Language Disorder
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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.
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
31
Gender, Age and Status of toddlers and preschool children with dual diagnoses
of shy interaction and receptive language disorder
• CLS: N=20 children• 70% boys (N=14)
30% girls (N=6) 2,3 :1 ratio boys:girls
• 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)
• MCS: N=82 children• 67% boys (N=55)
33% girls (N=27) 2,0 :1 ratio boys:girls
• 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)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
• MCS: N=82 children• 67% 54 married mothers
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
33
Degree of Markedness of the Symptoms of Social Interaction Disorder
as well as Receptive Language disorder of children with shy interaction behaviour
A Comparison of clinically conspicuous toddlers and preschool children
with clinically not symptomatic children
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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)
N=20 shy toddlers and preschool children with receptive language disorders
(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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Assessment Method: CASCAP-D (Doepfner et al., 1999)
Comparing the average degree of markedness of symptomsof clinically conspicuous children
with the control group of clinically unobtrusive children
2,0
2,3
1,1
1 2 3 4
N=30 clinically not symptomatic children (control group: M=1,1; sd=0,3)
N=82 shy toddlers and preschool children with receptive language disorders
(MZS: M=2.3; s=1.1)
N=20 shy toddlers and preschool children with receptive language disorders
CLS: M=2.0; s=1.0)
Symptom's average degree of markedness1 = not noticeable strongly impaired symptom = 4
CLS therapy group MCS therapy group control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
36
Degree of Inattentiveness of toddlers and preschool children with dual diagnoses
of shy interaction and receptive language disorder of shy Average Degree of Markedness
Assessment Method: CASCAP-D (Doepfner et al., 1999)
Comparing the average degree of markedness of symptomsof clinically conspicuous children
with the control group of clinically unobtrusive children
2,4
2,8
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=2.8; s=1.1)
N=20 shy toddlers and preschool children with receptive language disorders
(CLS: M=2.4; s=0.9)
Symptom's average degree of markedness1 = not noticeable strongly impaired symptom = 4
CLS therapy group MCS therapy group control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
37
Degree of Receptive Language Disorder of toddlers and preschool children with dual diagnoses
of shy interaction and receptive language disorder of shy Average Degree of Markedness
Assessment Method: CASCAP-D (Doepfner et al., 1999)
Comparing the average degree of markedness of symptomsof clinically conspicuous children
with the control group of clinically unobtrusive children
3,0
3,1
1,0
1 2 3 4
N=30 clinically not symptomatic children (control group: M=1,0; sd=0)
N=82 shy toddlers and preschool children with receptive language disorders
(MCS: M=3.1; s=0.8)
N=20 shy toddlers and preschool children with receptive language disorders
(CLS: M=3.0; s=0.7)
Symptom's average degree of markedness1 = not noticeable strongly impaired symptom = 4
CLS therapy group MCS therapy group control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
38
Reductionof Social Interaction Disorders
as well as Receptive Language Disorderof children with shy interaction behaviour
after Treatment with Theraplay
A Comparisonof clinically conspicuous toddlers and preschool children
with the ‘norm‘ of clinically not symptomatic children
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
39
Reduction of Shyness 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
2,5
1,1
2,9
1,2 1,21
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=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)
N=30 clinically not symptomatic children (control group: M=1,2; sd=0,4)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
40
Reduction of 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
2,0
1,3
2,3
1,31,1
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=20 shy toddlers and preschool children with receptive language disorders (TT-B: M=2.0; s=1.0) > (TT-E: M=1.3; s=0.6) (CLS: prob.=0.0051)
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)
N=30 clinically not symptomatic children (control group: M=1,1; sd=0,3)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
41
Reduction of Inattentiveness 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
2,4
1,9
2,8
1,2
1,8
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=20 shy toddlers and preschool children with receptive language disorders (TT-B: M=2.4; s=0.9) > (TT-E: M=1.9; s=0.7) (CLS: prob.=0.0099)
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)
N=30 clinically not symptomatic children (control group: M=1,2; sd=0,4)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
42
Reduction of Receptive Language Disorder 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
3,0
2,2
3,1
1,0
1,9
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=20 shy toddlers and preschool children with receptive language disorders (TT-B: M=3.0; s=0.7) > (TT-E: M=2.2; s=0.9) (CLS: prob.=0.0013)
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)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
43
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=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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
45
Lasting Effects of the Therapeutic Success2 years after treatment of children
with dual diagnoses of receptive language disorder and shy interaction behaviour
with Theraplay
A Comparisonof clinically conspicuous toddlers and preschool children
with of ‘norm‘ of clinically not symptomatic children
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Average reduction of symptoms after Theraplay
2,5
1,1 1,21,21
2
3
4
start of therapy(TT-B)
Ende derTherapie (TT-E)
2 years afterTheraplay
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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)
N=30 clinically not symptomatic children (control group: M=1,2; sd=0,4)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
47
Lasting Effects of Reduced Unwillingness to Cooperate of children with dual diagnoses of receptive language disorder
and shy interaction behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)
Means
Average reduction of symptoms after Theraplay
2,0
1,31,11,1
1
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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)
N=30 clinically not symptomatic children (control group: M=1,1; sd=0,3)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
48
The Lasting Effects of Reduced Inattentiveness of children with dual diagnoses of receptive language disorder
and shy interaction behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)
Means
Average reduction of symptoms after Theraplay
2,4
1,9
1,41,2
1
2
3
4
start of therapy(TT-B)
end of therapy (TT-E)
2 years afterTheraplay
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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)
N=30 clinically not symptomatic children (control group: M=1,2; sd=0,4)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Average reduction of symptoms after Theraplay
3,0
2,2 2,2
1,01
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
50
Improvement of Language Comprehension of children with dual diagnoses of receptive language disorder
and shy interaction behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)
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)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
51
The Effectiveness of Theraplayon toddlers and preschool children
with dual diagnoses ofan autistic-like-like lack of social mutuality in interaction
and receptive language disorder
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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.
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
53
Gender, Age and Statusof toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
• CLS: N=14 children• 86% boys (N=12)
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
• MCS: N=42 children• 71% boys (N=30)
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)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
54
Status of Mother and Upbringing of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
• 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
• MCS: N=42 children• 71% 29 married mothers
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
55
Degree of Markedness of the Symptoms of Social Interaction Disorder
as well as Receptive Language disorderof children with an autistic-like lack in social mutuality.
A Comparison of clinically conspicuous toddlers and preschool children
with clinically not symptomatic children
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
56
Autistic-like Lack of Social mutuality of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Average Degree of MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999)
Comparing the average degree of markedness of clinically conspicuous children
with the control group of clinically unobtrusive children
3,1
3,0
1,0
1 2 3 4
N=30 clinically not symptomatic children (control group: M=1,0; sd=0)
N=42 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders
(MCS: M=3.0; s=0.8)
N=14 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders
(LCS: M=3.1; s=0.8)
Symptom's average degree of markedness1 = not noticeable strongly impaired symptom = 4
CLS therapy group MCS therapy group control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
57
Uncooperative Behaviour of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Average Degree of MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999)
Comparing the average degree of markedness of clinically conspicuous children
with the control group of clinically unobtrusive children
3,5
2,9
1,1
1 2 3 4
N=30 clinically not symptomatic children (control group: M=1,1; sd=0,3)
N=42 toddlers and preschool children with both a lack ofsocial mutality, and with receptive language disorders
(MCS: M=2.9; s=1.2)
N=14 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders
(LCS: M=3.5; s=0.8)
Symptom's average degree of markedness1 = not noticeable strongly impaired symptom = 4
CLS therapy group MCS therapy group control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
58
InattentivenessInattentiveness of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Average Degree of MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999)
Comparing the average degree of markedness of clinically conspicuous children
with the control group of clinically unobtrusive children
3,1
3,0
1,2
1 2 3 4
N=30 clinically not symptomatic children (control group: M=1,2; sd=0,4)
N=42 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders
(MCS: M=3.0; s=0.8)
N=14 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders
(LCS: M=3.1; s=0.8)
Symptom's average degree of markedness1 = not noticeable strongly impaired symptom = 4
CLS therapy group MCS therapy group control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
59
Play Inabilities of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Average Degree of MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999)
Comparing the average degree of markedness of clinically conspicuous children
with the control group of clinically unobtrusive children
3,1
2,8
1,0
1 2 3 4
N=30 clinically not symptomatic children (control group: M=1,0; sd=0)
N=42 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders
(MCS: M=2.8; s=1.2)
N=14 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders
(CLS: M=3.1; s=1.1)
Symptom's average degree of markedness1 = not noticeable strongly impaired symptom = 4
CLS therapy group MCS therapy group control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
60
Receptive Language Disorderof toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Average Degree of MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999)
Comparing the average degree of markedness of clinically conspicuous children
with the control group of clinically unobtrusive children
3,8
3,5
1,0
1 2 3 4
N=30 clinically not symptomatic children (control group: M=1,0; sd=0)
N=42 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders
(MCS: M=3.5; s=0.8)
N=14 toddlers and preschool children with both a lack ofsocial mutuality, and with receptive language disorders
(CLS: M=3.8; s=0.4)
Symptom's average degree of markedness1 = not noticeable strongly impaired symptom = 4
CLS therapy group MCS therapy group control group
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
A Comparisonof clinically conspicuous toddlers and preschool children
with of ‚norm‘ of clinically not symptomatic children
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
62
Reduction of the Uncooperative Behaviour of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Assessment Method: CASCAP-D (Doepfner et al., 1999)Means
Average reduction of symptoms after Theraplay
3,5
1,8
3,0
1,1
2,0
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=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)
N=30 clinically not symptomatic children (control group: M=1,1; sd=0,3)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
63
Reduction of the Lack of Social Mutuality of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Assessment Method: CASCAP-D (Doepfner et al., 1999)Means
Average reduction of symptoms after Theraplay
3,1
2,1
3,0
1,0
2,0
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=14 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (CLS) (TT-B: M=3.1;s=0.8)>(TT-E: M=2.1;s=1.0)
N=42 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (MCS) (TT-B: M=3.0;s=0.9)>(TT-E: M=2.0;s=1.1)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
64
Reduction of Inattentiveness of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Assessment Method: CASCAP-D (Doepfner et al., 1999)Means
Average reduction of symptoms after Theraplay
3,1
2,6
3,1
1,2
2,0
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=14 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (CLS) (TT-B: M=3.1;s=0.8)>(TT-E: M=2.6;s=1.1)
N=42 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (MCS) (TT-B: M=3.1;s=1.1)>(TT-E: M=2.0;s=1.0)
N=30 clinically not symptomatic children (control group: M=1,2; sd=0,4)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
65
Reduction of the Inability to Play of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Assessment Method: CASCAP-D (Doepfner et al., 1999)Means
Average reduction of symptoms after Theraplay
3,1
1,9
2,8
1,0
1,8
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=14 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (CLS) (TT-B: M=3.1;s=1.1)>(TT-E: M=1.9;s=0.9)
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)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
66
Reduction of the Social Isolation of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Assessment Method: CASCAP-D (Doepfner et al., 1999)Means
Average reduction of symptoms after Theraplay
2,2
1,1
2,2
1,0
1,3
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=14 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (CLS) (TT-B: M=2.2;s=1.3)>(TT-E: M=1.1;s=0.4)
N=42 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (MCS) (TT-B: M=2.2;s=1.1)>(TT-E: M=1.3;s=0.6)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
67
Reduction of the Receptive Language Disorder of toddlers and preschool children with dual diagnoses
of an autistic-like lack of social mutuality and language comprehension disorder
Assessment Method: CASCAP-D (Doepfner et al., 1999)Means
Average reduction of symptoms after Theraplay
3,8
2,9
3,5
1,0
2,4
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=14 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (CLS) (TT-B: M=3.8;s=0.4)>(TT-E: M=2.9;s=0.7)
N=42 toddlers and preschool childrenwith both a lack of social mutuality, andreceptive language disorder (MCS) (TT-B: M=3.5;s=0.8)>(TT-E: M=2.4;s=0.9)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
68
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=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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
70
Lasting Effects of the Therapeutic Success2 years after treatment of children
with dual diagnoses of receptive language disorder and an autistic-like lack of social mutuality
with Theraplay
A Comparisonof clinically conspicuous toddlers and preschool children
with of ‘norm‘ of clinically not symptomatic children
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Average reduction of symptoms after Theraplay
3,5
1,8 1,8
1,11
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay(2JnTT)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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)
N=30 clinically not symptomatic children (control group: M=1,1; sd=0,3)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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
Assessment Method: CASCAP-D (Doepfner et al., 1999)Means
Average reduction of symptoms after Theraplay
3,1
2,1 2,0
1,01
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay
(2JnTT)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
73
The Lasting Effects of the Reduction of Inattentiveness
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
Average reduction of symptoms after Theraplay
3,1
2,6
2,9
1,21
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay
(2JnTT)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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.=0.0104, is p<0.02 significant) (TT-E > 2YaTT-E: prob=0.9588, not yet significant)
N=30 clinically not symptomatic children (control group: M=1,2; sd=0,4)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
74
The Lasting Effectsof the Reduction of Social Isolation
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
Average reduction of symptoms after Theraplay
2,2
1,1 1,21,01
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay
(2JnTT)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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.=0.0032, is significant) (TT-E > 2YaTT-E: change is insignificant)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
75
The Lasting Effects of the Reduction of Inability to Play
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
Average reduction of symptoms after Theraplay
3,1
1,9 1,8
1,01
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay
(2JnTT)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
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: change is insignificant)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
76
The Lasting Effects of the Reduction of the Receptive Language Disorder
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
Average reduction of symptoms after Theraplay
3,8
2,92,7
1,01
2
3
4
start of therapy(TT-B)
end of therapy(TT-E)
2 years afterTheraplay(2JnTT)
4 = strongly impaired3 = impaired
2 = slightly impaired symptom
1 = not noticeable
Solely assessed in the longitudinal study!
N=14 toddlers and preschool children withoriginally both a lack of social mutuality, andreceptive language disorder (CLS)
Statistical significanz of change: (TT-B > TT-E: prob.=0.0002, is significant) (TT-E > 2YaTT-E: change is insignificant)
N=30 clinically not symptomatic children (control group: M=1.0; sd=0)
Copyright 2004 Theraplay Institut
The Effectiveness of Theraplay on receptive language disorders
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.