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Journal of the Korean Home Economics Association 2012;50(5):125-138 http://dx.doi.org/10.6115/khea.2012.50.5.125 Literature Review of Play Therapy Intervention for Children with ADHD Department of Counseling Psychology, Dong Shin University Assistant Professor : Jin-Ah Choi Abstract The purpose of this study was to analyze the research literature on play therapy intervention for children with ADHD. Thirty-nine studies, conducted from 1995 to 2010, were analyzed. The results of the literature review are as follows: The most commonly studied subjects were elementary school children in grades 1-3. The most common subject selection method was to select ADHD tendency children. The most typical intervention setting used was a counseling center. The most frequent intervention was 11-15 sessions of group counseling. Pre-post experimentalcontrol research designs were the most commonly used. In the analyzed studies, play therapy-game play therapy, CBPT, CCPT, sand play therapy, and theraplay- was used for ADHD children. The studies found that game play therapy and cognitive-behavior play therapy are effective for improving ADHD children s attention, impulsiveness, and self-control. The major game play therapy activities used were dart games, Simon says games, fishing games, dominoes, Jenga, Beat the Clock, the board game Stop, and Ice, break., ice, break. Based on these findings, this article presents implications and discussion for play therapy intervention for ADHD children. (ADHD), (play therapy), (game play therapy), (cognitive-behavioral play therapy) Corresponding Author : Jin-Ah Choi, Department of Counseling Psychology, Dong Shin University, 252 Daeho-dong, Naju-si, Jeollanam-do, 520-714, Korea Tel: +82-61-330-3534 Fax: +82-61-330-3538 E-mail: mochoi2020@hanmail.net. - 125 -

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Table 1. General characteristics of research subject I: Master s & doctoral thesisa No Research subject Age (school grade) Subject criteria Intervention method Session Setting 1 Kim(2002) 7 years old ADHD tendency Individual 20 Counseling center 2 D-Y. Kim(2003) Elementary 3rd grade (mean) ADHD tendency Group 10 Counseling center 3 H-R. Kim(2003) Elementary 2nd grade ADHD tendency Group 16 Elementary school 4 Lee(2003) A: infant A: 20 ADHD tendency Individual B: elementary 1st grade B: 22 Counseling center 5 Park(2004) 8 years old Diagnosed ADHD Individual 12 Counseling center 6 Kim(2004) Infant ADHD tendency Group 15 Kindergarden 7 Lee(2004) Elementary 2nd grade ADHD tendency Group 12 Elementary school 8 Kang(2005) Elementary 3rd grade ADHD tendency Group 16 Elementary school 9 Kim(2005) Elementary 3rd grade ADHD tendency Group 14 Elementary school 10 Choi(2005) Elementary 1-2nd grade Diagnosed ADHD Group 12 Social welfare center 11 Song(2005) Elementary 3-4th grade ADHD tendency Group 12 Counseling center 12 Oh(2005) Elementary Diagnosed ADHD Individual (3case) 15 Counseling center 13 Yun(2005) Infant ADHD tendency Group 10 Kindergarden 14 Moon(2005) Elementary 2nd grade ADHD tendency Group 8 Elementary school 15 Han(2006) Elementary 4th grade Diagnosed ADHD Individual 32 Counseling center 16 Jung(2006) Elementary 2-3rd grade Diagnosed ADHD Group 12 Social welfare center 17 Lee(2006) 5-8 years old & parent ADHD tendency Group 8 Counseling center 18 Hong(2006) Elementary 1st grade Diagnosed ADHD Individual 34 Counseling center 19 Kim(2006) Elementary 4th grade ADHD tendency Group 10. 20 Yoon(2007) Elementary 2-3rd grade Diagnosed ADHD Group 10 Counseling center 21 H-S. Kim(2008) Elementary 2-3rd grade ADHD tendency Group 12 Social welfare center 22 Yang(2008) Elementary 1-3rd grade Diagnosed ADHD Group 10 Hospital 23 Ha(2008) Elementary 3rd grade ADHD tendency Group 12 Elementary school 24 M-Y. Kim(2008) Elementary 4th grade Diagnosed ADHD Group 15. 25 M-H. Kim(2008) 3-6 years old ADHD tendency Individual 10 Counseling center 26 So(2009) 4 years old ADHD tendency Group 16 Kindergarden 27 Lee(2009) 8-11 years old ADHD tendency Group 12. 28 Lee(2010) Elementary 5th grade ADHD tendency Group 18. 29 Nam(2010) Elementary 2nd grade ADHD tendency Group 15. 30 Sin(2010) Elementary 4-5th grade ADHD tendency Group 10. 31 Kim(2010) 6-10 years old ADHD tendency Group 12 Elementary school Table 2. General characteristics of research subject II: Journal articles No Research subject Age (school grade) Subject criteria Intervention method Session Setting 1 Song & Jung(1998) 6 years old ADHD tendency Individual 50 Social welfare center 2 Nam, Moon, & Bang(2000) Elementary 3rd grade ADHD tendency Group 11 Elementary school 3 Kim(2006) 4 years old ADHD tendency Individual 40. 4 Lee & Yoon(2007a) Infant, child & sibling, parent ADHD tendency Group 8. 5 Lee & Yoon(2007b) Infant, child & sibling, parent ADHD tendency Group 8. 6 Park(2008) Elementary 3rd grade ADHD tendency Individual 28. 7 Yun & Kil(2009) Elementary 4th grade ADHD tendency Group 11 Elementary school 8 Kim & You(2010) Elementary 5th grade ADHD tendency Group 12. - 129 -

Table 3. Summary of general characteristics Age (school grade) Subject criteria Intervention method Session Setting Type Master s & doctoral thesis Journal articles N (%) N (%) Infant 4 ( 12.9) 2 (25) Infant, elementary 2 ( 6.5) 2 (25) Elementary 1-3rd grade 16 ( 51.6) 2 (25) Elementary 4-6th grade 5 ( 16.1) 2 (25) Elementary 1-6th grade 4 ( 12.9) Total 31 (100) 8 (100) Diagnosed ADHD 10 ( 32.3) ADHD tendency 21 ( 67.7) 8 (100) Total 31 (100) 8 (100) Individual counseling 7 ( 23) 3 (37.5) Group counseling 24 ( 77) 5 (62.5) Total 31 (100) 8 (100) 8-10 session 9 ( 29) 2 (25) 11-15 session 13 ( 42) 3 (37.5) 16-20 session 6 ( 19) 20 over session 3 ( 10) 3 (37.5) Total 31 (100) 8 (100) Kinder garden 3 ( 12) Elementary school 7 ( 28) 2 (67) Social welfare center 3 ( 12) 1 (33) Counseling center/hospital 12 ( 48) Total 25 (100) 3 (100) - 130 -

Table 4 Intervention approach by research subject I: Master s & doctoral thesis No Research subject Research Dependent Independent variable design variable Intervention approach 1 Kim(2002) Game play therapy A Game play therapy 2 D-Y. Kim(2003) CBPT +parent education H, M CBPT 3 H-R. Kim(2003) Group game play therapy A, At Game play therapy 4 Lee(2003) Integrative play therapy A, H, I, Anxiety Integrative play therapy 5 Park(2004) Game play therapy A, Se Game play therapy 6 Kim(2004) Game play therapy A, H, I, S Game play therapy 7 Lee(2004) Attention play program A, H, I, Sa Play activity 8 Kang(2005) CBPT A, I, Sc CBPT 9 Kim(2005) Group play therapy Pr, Tp CBPT 10 Choi(2005) Group game play therapy A, H, I Game play therapy 11 Song(2005) Group game play therapy A, H, I, behavior Game play therapy 12 Oh(2005) Play therapy A, H, I CCPT 13 Yun(2005) Group play therapy program H, aggression CCPT 14 Moon(2005) Play activities program A, H, I, Tp Play activity 15 Han(2006) Sand play therapy Dev, spiritual cap. Sand play therapy 16 Jung(2006) Play based self control training A, H, I, S CBPT 17 Lee(2006) Experimental family play therapy A, H, I, Ff Family play therapy 18 Hong(2007) Game play activity A, H, I Play activity 19 Kim(2006) Play centered cognitive behavior program A, S, Se CBPT 20 Yoon(2007) Group game play program I, S, Ef Game play therapy 21 H-S. Kim(2008) Emotion based group play program A, H, I, Ec Emotion based group play program 22 Yang(2008) CBPT + parent education A, I, Tp, self-perception CBPT 23 Ha(2008) Attention play program A, H, I, Sa Play activity 24 M-Y. Kim(2008) Attention training A, I Game play therapy 25 M-H. Kim(2008) Theraplay H Theraplay 26 So(2009) Sand play therapy H, Tp Sand play therapy 27 Lee(2009) CBPT A, I CBPT 28 Lee(2010) Play activity H, I Game play therapy 29 Nam(2010) Game play program A Game play therapy 30 Sin(2010) Group sand play therapy Empathy, Pr Sand play therapy 31 Kim(2010) Play therapy S, Sa, play behavior CCPT Note. pre-post pre-post-follow up pre-post experimental-control pre-post-follow up experimental-control prepost qualitative analysis pre-post experimental-control qualitative analysis base-medi-main base-medi-main experimental-control base-medi qualitative analysis base-medi-main pre-post experimental-control AB ABAB qualitative analysis Note. A = attention; H = hyperactivity; I = impulsiveness; S = self-control; Se = self-esteem; Sc = self-concept; Sa = school adaptation; At = adaptation; Ma = maladaptation; M = mother s variable; Pr = peer relationship; Tp = task performance; Ef = executive function; Ec = emotional control; Ff=family function. - 131 -

Table 5. Intervention approach by research subject II: Journal articles No Research subject Research design Independent variable Dependent variable Intervention approach 1 Song & Jung(1998) Play therapy (with a sibling) S, At, expressiveness CCPT 2 Nam, Moon, & Bang (2000) Play therapy A, H CCPT 3 Kim(2006) Sand play therapy A, H, Sc Sand play therapy 4 Lee & Yoon(2007) Family play therapy A, H, I, Ff Family play therapy 5 Lee & Yoon(2007) Family play therapy A, H, I Family play therapy 6 Park(2008) Play therapy I, aggression Integrated play therapy 7 Yun & Kil(2009) Group game play therapy Ef Game play therapy 8 Kim & You(2010) Psycho-motoric play therapy A, I, social skill Psycho-motoric play therapy Note. pre-post pre-post-follow up pre-post experimental-control pre-post-follow up experimental-control prepost qualitative analysis qualitative analysis Note. A = attention; H = hyperactivity; I = impulsiveness; S = self-control; Sc = self-concept; At = adaptation; Ef = executive function; Ff = family function. Table 6. Results of the intervention approach Research model Intervention approach Master s & doctoral thesis Journal articles Type N (%) N (%) Pre-post 4 ( 13) 1 (12.5) Pre-post-follow up 2 ( 6.5) 2 (25 ) Pre-post experimental-control 7 (22.6) 1 (12.5) Pre-post-follow up experimental-control 2 ( 6.5) 1 (12.5) Pre-post qualitative analysis 5 (16) 1 (12.5) Pre-post experimental-control qualitative analysis 4 (13) Base-medi-main 2 ( 6.5) Base-medi-main experimental-control 1 ( 3.2) Base-medi qualitative analysis 1 ( 3.2) Base-medi-main pre-post experimental-control 1 ( 3.2) AB 1 ( 3.2) ABAB 1 ( 3.2) Qualitative analysis 2 (25 ) Total 31 (100) 8 (100) Game play therapy 10 (32.2) 1 (12.5) CBPT(cognitive-behavior play therapy) 7 (22.5) CCPT(child-centered play therapy) 3 ( 9.7) 2 (25) Sand play therapy 3 ( 9.7) 1 (12.5) Integrative play therapy 1 ( 3.2) 1 (12.5) Family play therapy 1 ( 3.2) 2 (25) Theraplay 1 ( 3.2) Psycho-motoric play therapy 1 (12.5) Emotion based group play program 1 ( 3.2) Play activity 4 (13) Total 31 (100) 8 (100) - 132 -

Table 7. Type of game play therapy used in the studies Attention Impulsiveness Type of game play Dart game Simon says game Fishing game Domino Jenga (block game) Beat the clock Stop board game Ice, break., ice, break Beat the clock Research subject Kim(2002), H-R. Kim(2003), Park(2004), Kim(2008), Nam(2010) Kim(2002), H-R. Kim(2003), Kim 2004), Nam(2010) Kim(2002), H-R. Kim(2003), Kim(2008), Nam(2010) Kim(2002), H-R. Kim(2003), Park(2004), Nam(2010) Kim(2004), Nam(2010) Kim(2008), Nam(2010) Kim(2004), Choi(2005), Lee(2010) Kim(2004), Choi(2005) Choi(2005), Lee(2010) Table 8. CBPT skills regularly used in the studies Attention, impulsiveness. CBPT skills Self-instruction Relaxation Modeling Behavior-list Response cost Reinforcement Problem solving skill Research subject D-Y. Kim(2003), Kang(2005), Jung(2006). Kim(2006), Kang(2008) D-Y. Kim(2003) D-Y. Kim(2003), Jung(2006) D-Y. Kim(2003), Kang(2005) Jung(2006) D-Y. Kim(2003) D-Y. Kim(2003) - 133 -

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