1. Herbert H.G. Wettig & Ulrike Frofke 2004 Herbert H.G. Wettig & Ulrike Frofke Evaluation of the Effectiveness of Theraplay on toddlers and preschool children with dual diagnoses of autistic-like lack of social mutuality and receptive language disorder 2 Studies on the Effectiveness of Theraplay on toddlers and preschool children with dual diagnoses of language developmental disorder and social interaction disorder via coincidence January 2004

2. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 2 Overview Symptoms and Multi morbidity of toddlers and preschool children with autistic-like lack of social mutuality within interaction behaviour Research: Evaluation of the Effectiveness of Theraplay –Total sample of the controlled longitudinal and multi-centre study –Selected samples of toddlers and preschool children with autistic-like lack of social mutuality within interaction behaviour Results: Evaluation of the Effectiveness of Theraplay –History, parents‘ concerns over child‘s behaviour –Markedness of the symptoms of toddlers and preschool children with autistic-like lack of social mutuality within interaction behaviour –Reduction of symptoms in toddlers and preschool children with autistic-like lack of social mutuality within interaction behaviour –Duration of therapy in number of necessary sessions –Lasting effect of the reduction of symptoms of children with autistic-like lack of social mutuality within interaction behaviour

3. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 3 Autistic-like lack of social mutuality within interaction behaviour of children based on CASCAP-D (Doepfner et al., 1999) The child avoids eye-contact, is unable to mimic or make gestures in order to regulate social interaction. The lack of social (and emotional) mutuality is shown in various of impairments or deviant reactions towards others. Döpfner et al. (1999) hypothize that these children have a lack of behaviour modulation within a social context or an instable integration of social, emotional and communicative behaviour. Interestingly these children do not have general ratioships with those of the same age with suitable interests / activities. These characteristics are shown in all situations.

4. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 4 Multi morbidity of the toddlers and preschool children with autistic-like lack of social mutuality within interaction behaviour Examples Dual diagnoses of lack of social mutuality and inattentiveness. Dual diagnoses of lack of social mutuality and uncooperative behaviour. Dual diagnoses of lack of social mutuality and play disorder. Dual diagnoses of lack of social mutuality and receptive language disorder.

5. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 5 Total sample of the two research studies CLS and MCS CLS Controlled Longitudinal Study Total sample of the controlled longitudinal study N=60 clinically conspicuous toddlers and preschool children* with coincidence of language developmental- and various social interaction disorders. N=29 follow-up study of children* 2 years after individual discharge from therapy. N=30 clinically not symptomatic toddlers and preschool children in same age and gender (matched control sample). MCS Multi-Centre Study Total sample of the multi-centre study N=251 clinically conspicuous toddlers and preschool children*with dual diagnoses of language communication- and various social interaction disorders.

6. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 6 Selected Samples of toddlers and preschool children with dual diagnoses* of autistic-like lack of social mutuality and receptive language disorder CLS N= 14 (rd. 23%) toddlers and preschool children* with autistic-like lack of social mutuality and receptive language disorders Sub samples of these N= 9 (rd. 15%) toddlers and preschool children* diagnosed with „early childhood autism” (Kofner) N= 30 clinically not symptomatic toddlers and preschool children in same age and gender (matched sample) MCS N= 42 (rd. 17%) toddlers and preschool children* with autistic-like lack of social mutuality and receptive language disorders

7. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 7 Age, Gender and Status of toddlers and preschool children with autism-like lack of social mutuality and receptive language disorder CLS: N=14 children 86% boys (N=12) 14% girls (N= 2) 6 :1 general ratio b:g 3;11 average years of age 3;10 average years - boys 4,06 average years - girls 86% 12 legitimate children 7% 1 illegitimate child 7% 1 adopted/foster children (1 no answer) 64% 9 early childhood autism 7% 1 boy of these is mentally incurable MCS: N=42 children 71% boys (N=30) 29% girls (N=12) 2,5 :1 general ratio b:g 3;11 average years of age 4;00 average years - boys 3;08 average years - girls 85% 34 legitimate children 10% 4 illegitimate children 5% 2 adopted/foster children (2 no answer.)

8. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 8 Family Status of Mother and Upbringing Behaviour of the language disordered children with autism-like lack of social mutuality CLS: N=14 children 100% 14 married mothers 93% 13 both involved 7% 1 single parent involved 86% 12 Country of birth Germany 93% 13 mother tongue is German 14% 2 bilingual Upbringing 69% 9 in Kindergarten MCS: N=42 children 71% 29 married mothers 7% 3 unmarried living together 10% 4 separated mothers 12% 5 single mothers (1 k.A.) 85% 35 both involved 15% 6 single parent involved (1 k.A.) 73% 29 Country of birth is Germany 88% 36 mother tongue is German 26% 11 bilingual Upbringing 56% 23 in Kindergarten

9. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 9 Degree of Markedness of symptoms in toddlers and preschool children with dual diagnoses of autism-like lack of social mutuality and receptive language disorders A Comparison with the ‘norm‘ of clinically not symptomatic children

10. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 10 Autism-like Lack of Social Mutuality in language disordered children Average degree of markedness Assessment methods: CASCAP-D (Döpfner et al., 1999)

11. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 11 Uncooperative Behaviour of toddlers and preschool children with dual diagnoses of an autism-like lack of social mutuality and receptive language disorder Average Degree of markedness Assessment methods: CASCAP-D (Döpfner et al., 1999)

12. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 12 Inattentiveness Inattentiveness of toddlers and preschool children with dual diagnoses of an autism-like lack of social mutuality and receptive language disorder Average Degree of markedness Assessment methods: CASCAP-D (Döpfner et al., 1999)

13. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 13 Playing Disorder of toddlers and preschool children with dual diagnoses of an autism-like lack of the social mutuality and receptive language disorder Average degree of markedness Assessment methods: CASCAP-D (Döpfner et al., 1999)

14. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 14 Langauge Comprehension Disorder / Receptive Language Disorder of toddlers and preschool children with dual diagnoses of an autism-like lack of the social mutuality and receptive language disorder Average Degree of markedness Assessment methods: CASCAP-D (Döpfner et al., 1999)

15. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 15 Reduction of symptoms of toddlers and preschool children with dual diagnoses of autism-like lack of social mutuality and receptive language disorder based on treatment with Theraplay A Comparison with the ‘norm‘ of clinically not symptomatic children

16. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 16 Reduction of the autism-like lack of social mutuality of language disordered children Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

17. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 17 Reduction of Uncooperative Behaviour of language disordered children with an autistic-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

18. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 18 Reduction of Inattentiveness of the language disordered children with an autism-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

19. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 19 Reduction of Play Disorder of the language disordered children with an autism-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

20. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 20 Reduction of Social Isolation of the language disordered children with an autism-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

21. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 21 Reduction of Receptive Language Disorder of the receptive language disordered children with an autism-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

22. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 22 Clinical and Statistical Significance of the reduction of symptoms based on the 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=14 receptive language disordered children with lack of social mutuality MCS N=42 receptive language disordered children with lack of social mutuality TT-B  TT-E M  M sprob.> F TT-B  TT-E M  M sprob.> F receptive language disorder 3.8  2.9 0.70.0002 3.5  2.4 1.10.0001 uncooperative 3.5  1.8 0.90.0001 3.0  2.0 1.30.0001 playing disorder 3.1  1.9 0.90.0001 2.8  1.8 1.10.0001 lack of social mutuality 3.1  2.1 0.80.0013 3.0  2.0 0.80.0001 inattentiveness 3.1  2.6 1.00.0104 3.1  2.0 1.30.0001 socially isolated 2.2  1.1 1.10.0032 2.2  1.3 1.10.0001

23. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 23 Duration of Therapy Reduction of the symptoms of toddlers and preschool children with dual diagnoses of autism-like lack of social mutuality and receptive language disorder (Number of 30-minutes therapeutic sessions) Means

24. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 24 The Lasting Effect of Reduction of Symptoms of autism-like lack of social mutuality and receptive language disorders 2 years after treatment with Theraplay A Comparison with the ‘norm‘ of clinically not symptomatic children

25. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 25 The Lasting Effect of Reduced Autism-like Lack of Social Mutuality of the language disordered children Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

26. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 26 The Lasting Effect of Reduced Uncooperative Behaviour of language disordered toddlers and preschool children with an autism-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

27. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 27 The Lasting Effect of Reduced Inattentiveness of language disordered toddlers and preschool children with autism-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

28. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 28 The Lasting Effect of Reduced Autism-like Playing Disorder of language disordered children with autistic-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

29. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 29 The Lasting Effect of Reduced Social Isolation of language disordered children with autistic-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

30. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 30 The Lasting Effect of Reduced Receptive Language Disorder of language disordered children with autistic-like lack of social mutuality Assessment methods: CASCAP-D (Döpfner et al., 1999) Means

31. Copyright 2004 Theraplay Insitut The Effectiveness of Theraplay on autistic-like lack of social mutuality 31 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