Research Article Korean J Child Stud 2017;38(4):103-115 https://doi.org/10.5723/kjcs.2017.38.4.103 pissn: 1226-1688 eissn: 2234-408X 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, 400-5 Namyangjungang-ro, Namyang-eup, Hwaseong-si, Gyeonggi-do, Korea E-mail: 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 (http:// 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.
Se Young Kim 104 6.5%, 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,
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.,,,
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 -. 2.. Rogers Axline (1969)., 1 62 1 5. 40, 20..,.,.,.,.,,. 놀이주제분류체계 Benedict (1998) (Benedict Play Therapy Analysis System [BPTAS]).,,,, 5, Table 1.,,,,, (Benedict et al., 1998).
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, 58 62 (Nordling & Guerney, 1999).. 자료분석 친밀감형성단계 (1 5 회기 ) 2. 1, (rapport). 1 2.,.?.
Se Young Kim 108 3 5 1,.,,,,,,..,...,.. 공격단계 (6-27회기),,. 6 27.,,,,.,... 5,. 22 27,.,,.,..,,. 퇴행단계 (28-57회기),. 28 32, 33 36 ADHD,.,?. 37 57,,,,.,..,.., 2.,.,.,
109 Child-Centered Play Therapy for a Child With ADHD and ODD,. ' ',.,.. 종료단계 (58-62회기). 58 59. 60,,, 2.,,.,.,,.. 62,.,....,. 놀이주제변화 Figure 1 Table 2. 14 (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%)..., 1 5 3.,, 2,,,, 1. (%) 100 90 80 70 60 50 40 30 20 10 0 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)
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 2 8 13 23 Aggression 11 6 2 19 Death by aggression 2 2 Death by natural cause 2 2 Devouring 0 Power 1 10 14 1 26 Seeking 3 3 1 7 Total (percentage) 3(10.7) 34(35.8) 38(32.8) 4(20.0) 79 Family and nurturing Constancy 2 5 4 11 Separation 0 Nurturing 2 3 12 5 22 Positive self-nurturing 1 3 4 Failed nurturance 0 Failed nurturance with abuse 0 Failed nurturance and neglect 0 Shopping and store 1 10 1 12 Total (percentage) 4(14.3) 10(10.5) 29(25.0) 6(30.0) 49 Control and safety Burning 0 Burning and drowning 2 2 1 5 Broken 2 6 8 16 Fixing, 1 1 Bridge building 2 9 14 3 28 Instability 1 3 2 6 Cleaning 1 1 Messing 1 5 5 11 Sorting 1 3 4 Safety and containment 3 5 9 1 18 Rescue 1 4 5 Escape 1 1 2 Total (percentage) 14(50.0) 38(40.0) 40(34.5) 5(25.0) 97 Exploration and mastery Exploration 5 2 2 1 8 Mastery 2 11 7 4 25 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, 2. 2. 2, 1., 6 27 9, 6, 5, 4, 3, 3, 2 1.! 11, 10, 8, 3, 2. 11, 2. 5, 3, 1 1., 28 57 14, 9, 8, 5, 2, 1. 14, 13, 6, 3 2. 12, 10, 4, 3, 7, 2., 58 62 5, 1. 3, 1. 4, 1. 2,
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
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).,.,.
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