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1 Research Article Korean J Child Stud 2017;38(4): pissn: eissn: X A Case Study on Child-Centered Play Therapy for a Child with ADHD and ODD: Focusing on the Change of Play Theme at Stage Se Young Kim Department of Social Welfare, Shinkyoung University, Hwaseong, Korea ADHD : Objective: This study was aimed to enhance of the effects of child-centered play therapy and the process of therapeutic change in a child with ADHD and ODD by examining the process of play therapy and the change of play themes at stages. Methods: The participant was a first-grade boy in primary school who was diagnosed with ADHD and ODD. The researcher directly conducted 62 sessions of child-centered play therapy once per week for 1 year and 5 months. Results: First, the child s aggressive and rebellious behavior decreased, and self-control and social situations adjusted accordingly through the child-centered play therapy. Second, looking at the changes of play theme at stage, the play themes of controlling and safety and exploration and mastery were mainly performed in the intimacy formation stage. The play theme of power and aggression increased significantly in the aggressive stage, and the play themes of family and nurturing and power and aggression increased in the degenerative stage. Finally, power and aggression decreased and family and nurturing and controlling and safety increased in the end stage Conclusion: The effectiveness of child-centered play therapy was confirmed for a child with ADHD and ODD. By analyzing the play themes at stages of play therapy, certain patterns of change were identified. Keywords: ADHD (Attention Deficit Hyperactivity Disorder), ODD (Oppositional Defiant Disorder), child-centered play therapy, play theme,, (Attention Deficit Hyperactivity Disorder [ADHD]; American Psychiatric Association [APA], 2013) (Health Insurance Policy Research Institute, 2015). ADHD Corresponding Author: Se Young Kim, Department of Social Welfare, Shingyeong University, Namyangjungang-ro, Namyang-eup, Hwaseong-si, Gyeonggi-do, Korea childwelfare30@hanmail.net The Korean Association of Child Studies This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 Se Young Kim %, ADHD (Lim, Kim, & Shin, 2015). ADHD,.. (Faraone, Biederman, & Mick, 2006; Koh & Jeong, 2013; Yang, Cheong, & Hong, 2006), ADHD., 67% (Koo, Choi, & Kwon, 2012; S. H. Lee, 2009). (Majewicz-Hefley & Carlson, 2007; Weyandt, 2001).,, (S. Lee, 2014) (Choi, 2012; H. S. Kim, 2013; Koh & Jeong, 2013). ADHD, (J. W. Kang et al., 2012; J. Y. Kim et al., 2005). ADHD (J. W. Kang et al., 2012). ADHD,,. ADHD 60% (J. W. Kang et al., 2012; K. Kim & Yun, 2015; J.-R. Lee & Kang, 2012; Young & Amarasinghe, 2010) ADHD. ADHD (Barkley, 1990; H. S. Kim, 2013). ADHD, (H. S. Kim, 2013; J. Y. Kim et al., 2005). ADHD. (Landreth, 2012). (E. K. Lee, 2016)., (S. Kim, 2016). (Landreth, 2012). Brassett-Harknett Butler (2007),,, ADHD. ADHD. Bratton, Ray, Rhine Jones (2005), Lin Bratton (2015) ADHD, (S. Kim, 2016). J.-S. Lee, Lee Mun (2006),. Chae (2005), Kenny Winick (2000) (S. Kim, 2016). ADHD,. H. S. Kim (2013) 3 ADHD. (usual care) ADHD (J.-S. Lee et al., 2006). (single-case design) (S. Lee,

3 105 Child-Centered Play Therapy for a Child With ADHD and ODD 2014; Ray, 2008; Ray, 2010; Urquiza, 2010), ADHD.. (S. Lee, 2014). VanFleet, Sywulak Sniscak (2011). (Ray, 2010), (Drewes, Bratton, & Schaefer, 2011), (Benedict & Hastings, 2002; Woo, 2005). (Benedict, 2003; Benedict & Hastings, 2002; K. Kim & Yun, 2015), (VanFleet et al., 2011).,. S. Lee (2014),, (Baggerly & Bratoon, 2010; Phillips, 2010).. (Y. Lee, 2016; Woo, 2005), (Y. Kim, 2012), (M. H. Kang & Woo, 2011), (Kwon & Lee, 2015), (K. Kim & Lim, 2014).,,.,. ADHD, Benedict (1998). ADHD. ADHD. ADHD,.. 1 ADHD? 2 ADHD? 연구대상 기본정보 7 1 1,,,., 1. ADHD,., 3, 3.,,,

4 Se Young Kim 106. ADHD. 6 ADHD 1,. 심리평가, (Landreth, 1993). 연구도구아동중심놀이치료 KEDI-WISC (Korean Educational Development Institute-Wechsler Intelligence Scale for Children), SCT (Sentence Completion Test), Rorschach, HTP (House-Tree-Person test), KFD (Kinetic Family Drawing test), BGT (Bender-Gestalt Test),. (Full Scale Intelligence Quotient [FSIQ] = 104, Verbal IQ [VIQ] = 98, Performance IQ [PIQ] = 110; ),,,,,. ADHD. 사례개념화, ADHD.,,,., ADHD Rogers Axline (1969)., , 20..,.,.,.,.,,. 놀이주제분류체계 Benedict (1998) (Benedict Play Therapy Analysis System [BPTAS]).,,,, 5, Table 1.,,,,, (Benedict et al., 1998).

5 107 Child-Centered Play Therapy for a Child With ADHD and ODD Table 1 Play Themes by BPTAS Play theme Power and aggression Family and nurturing Control and safety Exploration and mastery Sexualized play Detail themes Good guy vs bad guy, aggression, death by aggression, death by natural cause, devouring, power, seeking Constancy, separation, nurturing, positive self-nurturing, failed nurturance, failed nurturance with abuse, failed nurturance and neglect, shopping and store Burning, burning and drowning, broken, fixing, bridge building, instability, cleaning, messing, sorting, safety and containment, rescue, escape Exploration, mastery Sexualized activities, sexualized behavior, sexual curiosity 연구절차,,.,,,,..,,.,.,.,,,,,, (Bratton, Landreth, & Homeyer, 1993).. Nordling Guerney (1999),,,,., 1 (BPTAS). (triangulation; Mathison, 1988) 2. 놀이치료단계별진행과정 1 5, 6 27, 28-57, (Nordling & Guerney, 1999).. 자료분석 친밀감형성단계 (1 5 회기 ) 2. 1, (rapport). 1 2.,.?.

6 Se Young Kim ,.,,,,,,..,...,.. 공격단계 (6-27회기),, ,,,,.,... 5, ,.,,.,..,,. 퇴행단계 (28-57회기), , ADHD,.,? ,,,,.,..,.., 2.,.,.,

7 109 Child-Centered Play Therapy for a Child With ADHD and ODD,. ' ',.,.. 종료단계 (58-62회기) ,,, 2.,,.,.,,.. 62,.,....,. 놀이주제변화 Figure 1 Table (50.0%), 7 (25.0%), 4 (14.3%), 3 (10.7%). 38 (40.0%), 34 (35.8%), 13 (13.7%), 10 (10.5%), 40 (34.5%), 38 (32.8%), 29 (25.0%), 9 (7.7%). 6 (30.0%), 5 (25.0%), 4 (20.0%)..., ,, 2,,,, 1. (%) Exploration & Mastery 25% Family & Nurturing 14.3% Power & Aggression 10.7% Control & Safety 50% Exploration & Mastery 13.7% Family & Nurturing 10.5% Power & Aggression 35.8% Power & Aggression 32.8% Control & Safety 40% Exploration & Mastery 7.7% Family & Nurturing 25% Control & Safety 34.5% Figure 1. Changes of play themes at stage. Exploration & Mastery 25% Family & Nurturing 30% Power & Aggression 20% Control & Safety 25% Ⅰ.Warm-up Ⅱ.Aggressive Ⅲ.Regressive.Mastery (Stage)

8 Se Young Kim 110 Table 2 Frequency of Play Themes at Stage Themes Warm-up (1-5ss) Aggressive (6-27ss) Stage Regressive Mastery (28-57ss) (58-62ss) Total Power and aggression Good guy vs bad guy Aggression Death by aggression 2 2 Death by natural cause 2 2 Devouring 0 Power Seeking Total (percentage) 3(10.7) 34(35.8) 38(32.8) 4(20.0) 79 Family and nurturing Constancy Separation 0 Nurturing Positive self-nurturing Failed nurturance 0 Failed nurturance with abuse 0 Failed nurturance and neglect 0 Shopping and store Total (percentage) 4(14.3) 10(10.5) 29(25.0) 6(30.0) 49 Control and safety Burning 0 Burning and drowning Broken Fixing, 1 1 Bridge building Instability Cleaning 1 1 Messing Sorting Safety and containment Rescue Escape Total (percentage) 14(50.0) 38(40.0) 40(34.5) 5(25.0) 97 Exploration and mastery Exploration Mastery Total (percentage) 7(25.0) 13(13.7) 9(7.7) 5(25.0) 34 Sexualized play Sexualized activities 0 Sexualized behavior 0 Sexual curiosity 0 Total (percentage) 0 Total (percentage) 28(100) 95(100) 116(100)20(100) 259 Note. ss = session. Unit of measurement is the number of times. 5, , 1., , 6, 5, 4, 3, 3, 2 1.! 11, 10, 8, 3, 2. 11, 2. 5, 3, 1 1., , 9, 8, 5, 2, 1. 14, 13, 6, , 10, 4, 3, 7, 2., , 1. 3, 1. 4, 1. 2,

9 111 Child-Centered Play Therapy for a Child With ADHD and ODD 1., ADHD..,,.,.,. ADHD, ADHD. 1 ADHD 1 62,..,.,,..,.. ADHD K. Kim Yun (2015),. (Landreth, 1993).,.,. ADHD, 1,, 2 (Landreth, 2012; E. K. Lee, 2016; Ray, 2010). (D. Kim, An, & Koo, 2016) ADHD. T. I. Kim (2003),.. (Landreth, 1993). ADHD.., (Koh & Jeong, 2013) (S. Kim, 2016), ADHD.,, 1

10 Se Young Kim 112 (Green, Crenshaw, & Langtiw, 2009)., (. ) (J. S. Lee, 2012).,. (Green et al., 2009)., (J. S. Lee, 2012). (Benedict & Hastings, 2002). (Benedict & Hastings, 2002).,, (Benedict & Hastings, 2002). (Benedict & Hastings, 2002).,, (J. S. Lee, 2012). (Benedict & Hastings, 2002).,, (Green et al., 2009).., (J. S. Lee, 2012), (Green et al., 2009).,,, (Green et al., 2009).,..,.. PTSD (Post-Traumatic Stress Disorder) (Y. Lee, 2016), (Kwon & Lee, 2015),. (Benedict et al., 1998)., (Jung, 2008), (Nordling & Guerney, 1999). (VanFleet et al., 2011).,.,.

11 113 Child-Centered Play Therapy for a Child With ADHD and ODD.. ADHD,,.,,.., ADHD,. ADHD K. Kim Yun (2015), (Jung, 2008; VanFleet et al., 2011). 1, ADHD. Yoo (1997), ADHD. (Choi, 2012). ADHD., ADHD. Notes This article was presented at the 2016 Annual Fall Conference of the Korean Association of Child Studies. Conflict of Interest No potential conflict of interest relevant to this article was reported. In English References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: APA Publishing. Axline, V. (1969). Play therapy. New York: Ballantine. Baggerly, J., & Bratoon, S. (2010). Building a firm foundation in play therapy research: Response to Phillips (2010). International Journal of Play Therapy, 19(1), Barkley, R. A. (1990). Attention-deficit hyper-activity disorder: A handbook for diagnosis and treatment. New York: Guilford Press. Benedict, H. E. (2003). Object relations/thematic play therapy. In C. E. Schaefer (Ed.), Foundations of play therapy (pp ). New York: Wiley. Benedict, H. E., & Hastings, L. (2002). Object relations play therapy. In J. Magnavita (Ed.), Comprehensive handbook of psychotherapy: Psychodynamic/object relations (Vol. 1, pp ). New York: Wiley. Benedict, H. E., Htnan, L., Wooley, L., Shelton, L., Narcavage, C., McGee, W.,... Holmberg, J. (1998). Development of a method for studying the thematic content of young children in play therapy. Unpublished manuscript, Baylor University, Waco, TX. Brassett-Harknett, A., & Butler, N. (2007). Attention-deficit/ hyperactivity disorder: An overview of the etiology and a review of the literature relating to the correlates and lifecourse outcomes for men and women. Clinical Psychology Review, 27(2), doi: /j.cpr Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Professional Psychology: Research and Practice, 36(4), doi: / Bratton, S., Landreth, G., & Homeyer, L. (1993). An intensive three

12 Se Young Kim 114 day play therapy supervision/training model. International Journal of Play Therapy, 2(2), doi: /h Drewes, A. A., Bratton, S. C., & Schaefer, C. E. (Eds.). (2011). Integrative play therapy. Hoboken, NJ: John Wiley & Sons. Faraone, S. V., Biederman, J., & Mick, E. (2006). The age dependent decline of attention deficit/hyperactivity disorder: A metaanalysis of follow-up studies. Psychological Medicine, 36(2), doi: /s x Green, E. J., Crenshaw, D. A., & Langtiw, C. L. (2009). Play theme-based research with children. The Family Journal: Counseling and Therapy for Couples and Families, 17(4), doi: / Kenny, M. C., & Winick, C. B. (2000). An integrative approach to play therapy with an autistic girl. International Journal of Play Therapy, 9(1), 11. doi: /h Landreth, G. L. (1993). Child-centered play therapy. Elementary School Guidance & Counseling, 28(1), Retrieved from Landreth, G. L. (2012). Play therapy: The art of the relationship (3rd ed.). New York: Routledge. Lin, Y,-W., & Bratton, S. C. (2015). A meta-analytic review of childcentered play therapy approaches. Journal of Counseling & Development, 93(1), doi: /j x Majewicz-Hefley, A., & Carson, J. S. (2007). A meta-analysis of combined treatments for children diagnosed with ADHD. Journal of Attention Disorder, 10(3), doi: / Mathison, S. (1988). Why triangulate? Educational Research, 17(2), Nordling, W. J., & Guerney, L. F. (1999). Typical stages in the child-centered play therapy process. The Journal for the Professional Counselor, 14(1), Phillips, R. D. (2010). How firm is our foundation? Current playtherapy research. International Journal of Play Therapy, 19(1), doi: /a Ray, D. C. (2008). Evidence-based play therapy. In C. E. Schaefer & H. G. Kaduson (Eds.). Contemporary play therapy: Theory, research, and practice. New York: Guilford Press. Ray, D. C. (2010). Advanced play therapy: Essential conditions, knowledge, and skills for child practice. New York: Routledge. Urquiza, A. J. (2010). The future of play therapy: Elevating credibility through play therapy research. International Journal of Play Therapy, 19(1), doi: /a VanFleet, R., Sywulak, A. E., & Sniscak, C. C. (2011). Childcentered play therapy. New York: Guilford. Weyandt, L. L. (2001). Attention deficit hyperactivity disorder: An ADHD primer. Boston: Allyn & Bacon. Young, S., & Amarasinghe, M. J. (2010). Practitioner review: Non-pharmacological treatments for ADHD: A lifespan In Korean approach. Journal of Child Psychology and Psychiatry, 51(2), doi: /j x Chae, E. Y. (2005). A case study on the effect of play therapy for ODD child. Korean Journal of Play Therapy, 8(1), Choi, J.-A. (2012). Literature review of play therapy intervention for children with ADHD. Family and Environment Research, 50(5), Health Insurance Policy Research Institute. (2015, May 11). Attention Deficit Hyperactivity Disorder (ADHD), In 2013, 66% of the 58,121 patients with health insurance patients were teenagers. Health Insurance Policy Research Institute Press Releases. Retrieved from boards/b0039/13958 Jung, H. J. (2008). Play therapy. Seoul: Gyoyangin. Kang, J. W., Park, E. J., Kim, S. C., Shin, Y.-J., Shin, Y.-M., Jung, J.,... Yook, K.-H. (2012). Pharmacotherapy of comorbid disruptive behavioral disorders in children and adolescents with ADHD. Journal of the Korean Academy of Child and Adolescent Psychiatry, 23(Suppl.), S55-S65. Retrieved from Kang, M. H., & Woo, J. Y. (2011) The effect of play therapy on the change in play theme of reactive attachment disorder (RAD) and the declination in autistic spectrum. The Journal of Special Education: Theory and Practice, 12(2), Kim, D., An, Y., & Koo, S. Y. (2016). A meta-analysis of singlesubject studies on non-pharmacological interventions for school-aged ADHD children. Journal of Emotional & Behavioral Disorders, 32(1), Retrieved from Kim, H. S. (2013). The effects of combined parents training play therapy on ADHD-ODD of aggression and family relationships: A case study. Korean Journal of Christian Counseling, 24(3), Retrieved from dbpia.co.kr/article/node Kim, J. Y., Yoo, H. K., Goh, J. K., Jeon, J., Hong, J. P., Kim, S. Y., & Kim, C. Y. (2005). Comorbidity of outpatient clinic patients with attention deficit hyperactivity disorder using K-SADS-PL. The Korean Journal of Psychopathology, 14(1, 2), Kim, K., & Lim, M. (2014). A case study of PTSD children s client-centered play therapy. Korean Journal of Play Therapy, 17(3), Kim, K., & Yun, H. (2015). An analysis of play themes shown in the child-centered play therapy process of a child with ADHD. Korean Journal of Play Therapy, 18(1), doi: /kapt Kim, S. (2016). A case analysis study on play therapy based on

13 115 Child-Centered Play Therapy for a Child With ADHD and ODD eclectic approach. Early Childhood Education Research & Review, 20(3), Kim, T. I. (2003). A case study on the effects of play therapy on an emotionally disturbed child (Master s thesis). Retrieved from Kim, Y. (2012). Play themes in sibling group play therapy with child witnesses of domestic violence. Korean Journal of Play Therapy, 15(3), Koh, E., & Jeong, S. (2013). A review of single-subject design research for non-pharmacological intervention for children with ADHD. Asian Journal of Education, 14(2), Retrieved from Koo, H. J., Choi, S. M., & Kwon, J. H. (2012). Youth psychotherapy outcome research: Methodological review and meta-analysis ( ). The Korean Journal of Clinical Psychology, 31(1), Retrieved from Kwon, Y.-J., & Lee, K.-Y. (2015). Play therapy case study of a girl representing a habitual masturbation behaviors: Emphasizing on play themes during play therapy. The Journal of Child Education, 24(2) doi: /kjce Lee, E. K. (2016). A case study of child-centered play therapy for a child in foster care suffering from attachment trauma. Korean Journal of Play Therapy, 19(2), Lee, J. S. (2012). A case study on the effects of long-term play therapy a 7-year-old girl with an anxiety disorder. Korean Journal of Play Therapy, 15(1), Lee, J.-S., Lee, Y., & Mun, B.-G. (2006). A study of play patterns in play therapy sessions. Korean Journal of Child Psychotherapy, 1(1), Retrieved from newnonmun.com/article=13467 Lee, J.-R., & Kang, K.-S. (2012). Review on the characteristics, changed definition of ADHD and the impact of ADHD on students life. Korean Journal of Child Psychotherapy, 7(1), Retrieved from com/article=38699 Lee, S. (2014). Evidence-based treatments for children and adolescents and evidence-based play therapy. Korean Journal of Play Therapy, 17(3), Lee, S. H. (2009). Overview of psychological therapy in Korea children with ADHD ( ). Child Studies, 18, Retrieved from Lee, Y. (2016). An analysis of posttraumatic play characteristics of an abused child in play therapy. Korean Journal of Play Therapy, 19(4), doi: /kapt Lim, J. H., Kim, E. J., & Shin, J. H. (2015). A case study of theraplay-based art therapy on attachment and behavioral problems in a child with ADHD. Journal of Special Education & Rehabilitation Science, 54(2), Retrieved from Woo, J. (2005). A significant feature of play therapy themes in PTSD children. Journal of Emotional & Behavioral Disorders, 21(3), Retrieved from dbpia.co.kr/article/node Yang, S.-J., Cheong, S., & Hong, S. D. (2006). Prevalence and correlates of attention deficit hyperactivity disorder: Schoolbased mental health services in Seoul. Journal of the Korean Neuropsychiatric Association, 45(1), Retrieved from Yoo, M. S. (1997). Play therapy: Theory and practice. Seoul: Sangjosa. Se Young Kim ORCID Received April 30, 2017 Revision received July 9, 2017 Accepted August 7, 2017

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