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  1. Herbert H.G. Wettig & Ulrike Franke Evaluation of the Effectiveness of Theraplayon Receptive Language Disorder2 Studies evaluating the Effectiveness of Theraplayon toddlers and preschool childrenwith dual diagnoses of both receptive language disorder, and oppositional defiant behaviour, or shy interaction behaviouror autistic-like-like lack of social mutuality in interaction.January 2004

  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. 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 comprehensionor receptive language disorder do not exist. 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) 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. 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* total N= 95 children* with oppositional defiant behaviour N= 82 children* with shy interaction behaviour N= 42 children* with an autistic-like lack of social mutuality 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 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) The Effectiveness of Theraplay on receptive language disorders

  9. 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 - boys4;08 years - girls Social Status74% 68 legitimate children24% 22 illegitimate children 2% 2 foster children (3 no answer) Gender, Age and Statusof toddlers and preschool children with dual diagnosesof receptive language disorder and oppositional defiant behaviour The Effectiveness of Theraplay on receptive language disorders

  10. 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 involved12% 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 mothers12% 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 tongue15% 14 bilingual upbringing 77% 73 are in Kindergarten Status of the Mother and Upbringing of the Childof toddlers and preschool children with dual diagnosesof receptive language disorder and oppositional defiant behaviour The Effectiveness of Theraplay on receptive language disorders

  11. Degree of Markedness of the Symptomsof Social Interaction Disorderas well as Receptive Language disorder of children with oppositional defiant behaviour A Comparison of clinically conspicuous toddlers and preschool childrenwith clinically not symptomatic children 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) 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 disorderAssessment Method: CASCAP-D (Doepfner et al., 1999) 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 disorderAssessment Method: CASCAP-D (Doepfner et al., 1999) 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 MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999) The Effectiveness of Theraplay on receptive language disorders

  16. Reductionof Social Interaction Disordersas well as Receptive Language Disorderof children with oppositional defiant behaviourafter Treatment with TheraplayA Comparisonof clinically conspicuous toddlers and preschool childrenwith the ‘norm‘ of clinically not symptomatic children The Effectiveness of Theraplay on receptive language disorders

  17. Reduction of Oppositional Defiant Behaviourof children with dual diagnoses of receptive language disorder and oppositional defiant behaviour Assessment Method: CASCAP-D (Doepfner et al., 1999) The Effectiveness of Theraplay on receptive language disorders

  18. Reduction of Unwillingness to Cooperateof children with dual diagnoses of receptive language disorder and oppositional defiant behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999) 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) 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) The Effectiveness of Theraplay on receptive language disorders

  21. Clinical and statistical Significanceof Reduction of Symptomsafter Treatment with TheraplayG=Mean after CASCAP-D, =Change, s=Standard deviation4-point scale: 1=not noticeable; Symptom: 2=slight...,3=marked, 4= strong 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 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 andoppositional defiant behaviour with Theraplay A Comparisonof clinically conspicuous toddlers and preschool childrenwith of ‘norm‘ of clinically not symptomatic children The Effectiveness of Theraplay on receptive language disorders

  24. Lasting Effects of the Reduced Oppositional Defiant Behaviourof children with dual diagnoses of receptive language disorder and oppositional defiant behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)Means 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 behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)Means 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 The Effectiveness of Theraplay on receptive language disorders

  27. Lasting Effectsof the Reduced Receptive Language Disorderof children with dual diagnoses of receptive language disorder and oppositional defiant behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)Means 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. ZollingerMeans 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 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 insecuritythe 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. The Effectiveness of Theraplay on receptive language disorders

  31. 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) Gender, Age and Status of toddlers and preschool childrenwith dual diagnoses of shy interaction and receptive language disorder The Effectiveness of Theraplay on receptive language disorders

  32. 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 tongue11% 2 bilingual upbringing 75% 15 are in Kindergarten MCS: N=82 children 67% 54 married mothers10% 8 unmarried mothers living together with a partner 5% 4 separated 19% 15 single mothers (1 no a.) in upbringing 75% 61 both parents involved25% 20 single parent (1 no answer) 80% 63 born in Germany 89% 72 German mother tongue19% 15 bilingual upbringing 75% 60 are in Kindergarten Status of Mother and Upbringingof toddlers and preschool childrenwith dual diagnoses of shy interaction and receptive language disorder The Effectiveness of Theraplay on receptive language disorders

  33. Degree of Markedness of the Symptoms of Social Interaction Disorderas well as Receptive Language disorderof children with shy interaction behaviour A Comparison of clinically conspicuous toddlers and preschool childrenwith clinically not symptomatic children The Effectiveness of Theraplay on receptive language disorders

  34. Degree of Shynessof toddlers and preschool children with dual diagnoses of shy interaction and receptive language disorder of shy children with Average Degree of MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999) 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 MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999) 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 MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999) 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 MarkednessAssessment Method: CASCAP-D (Doepfner et al., 1999) The Effectiveness of Theraplay on receptive language disorders

  38. Reductionof Social Interaction Disordersas well as Receptive Language Disorderof children with shy interaction behaviourafter Treatment with TheraplayA Comparisonof clinically conspicuous toddlers and preschool childrenwith the ‘norm‘ of clinically not symptomatic children The Effectiveness of Theraplay on receptive language disorders

  39. Reduction of Shynessof children with dual diagnoses of receptive language disorder and oppositional defiant behaviour Assessment Method: CASCAP-D (Doepfner et al., 1999) Means The Effectiveness of Theraplay on receptive language disorders

  40. Reduction of Unwillingness to Cooperateof children with dual diagnoses of receptive language disorder and oppositional defiant behaviour Assessment Method: CASCAP-D (Doepfner et al., 1999) Means 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 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 The Effectiveness of Theraplay on receptive language disorders

  43. Clinical and Statistical Significanceof Reduction of Symptomsafter Treatment with TheraplayG=Mean after CASCAP-D, =Change, s=Standard deviation4-point scale: 1=not noticeable; Symptom: 2=slight...,3=marked, 4= strong The Effectiveness of Theraplay on receptive language disorders

  44. Duration of Therapyof children with dual diagnoses of receptive language disorder and oppositional defiant behaviour (Number of therapeutic 30-minute sessions)Means 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 andshy interaction behaviour with Theraplay A Comparisonof clinically conspicuous toddlers and preschool childrenwith of ‘norm‘ of clinically not symptomatic children 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 The Effectiveness of Theraplay on receptive language disorders

  47. Lasting Effects of Reduced Unwillingness to Cooperateof children with dual diagnoses of receptive language disorder and shy interaction behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)Means The Effectiveness of Theraplay on receptive language disorders

  48. The Lasting Effects of Reduced Inattentivenessof children with dual diagnoses of receptive language disorder and shy interaction behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)Means 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 behaviourAssessment Method: CASCAP-D (Doepfner et al., 1999)Means 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 The Effectiveness of Theraplay on receptive language disorders

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