Theraplay Conference 2005 H MIM E

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International Theraplay Conference, June 23-24, 2005 University of Chicago, Gleacher Center, Chicago, IL, USA Ulrike Franke • Herbert H. G. Wettig H-MIM The Heidelberg Marschak Interaction Method to assess the mother-child interactive behavior Quality criteria: construct validity – effect size - sensitivity – retest-reliability Research results of a controlled longitudinal study 1998-2005 in Germany Theraplay Institut Ulrike Franke und Herbert Wettig, Leonberg Germany 2005

Overview: 

Overview Introduction Objective: The assessment of the mother-child interactive behavior The Heidelberg Marschak Interaction Method (H-MIM) H-MIM: A culturally-dependent modification of the MIM Method 2 Field-studies with repeated measurement in therapy settings Sample size and sample structure Course of time of measurement and different kinds of test instruments Results An example: Toddlers and preschool children with attention disorders Hypothesis about the validity of H-MIM to assess the mother-child interactive behavior Construct validity of the H-MIM: Clinical and statistical significance of the change of mother-child interactive behavior in the process of treatment Effect size: The size of change in children’s interactive behavior after treatment Sensitivity of the H-MIM: Significance of the change of the interactive behavior Retest-reliability of the H-MIM: No statistically significant differences in scores Generalization of the results: Internal and external validity of H-MIM

Introduction: 

Introduction Objective: The assessment of mother-child interactive behavior Target group: Children who are difficult to treat in therapy due to for example ADD, ADHD, Aggressiveness, or Autism, that the usual kinds of diagnostic tests of abilities or intelligence yield little information or are nearly impossible to use, and their care givers. Diagnosis of difficult children should focus not only on the child, but also on the system, e.g. the interactive behavior with the care giver or the personal environment in which the child lives, thinks, and acts. Theraplay aims to change the interactive behavior of such children who are difficult to treat with other kinds of therapies. H-MIM was used to assess the mother-child interactive behavior at the beginning of treatment and the outcome at the end of the treatment.

The model of affect regulation of the Heidelberg Marschak Interaction Method (H-MIM)Literature: Ritterfeld & Franke, 1994, reported in Forum Logopädie, 16 (1), 2002, p. 20: 

The model of affect regulation of the Heidelberg Marschak Interaction Method (H-MIM) Literature: Ritterfeld & Franke, 1994, reported in Forum Logopädie, 16 (1), 2002, p. 20 Three important factors of interaction between the child and his of her care giver. (on basis of research results found until 1994 in German printed journals of psychology, sociology, and cultural sciences) Positive consequence: Attunement of emotions and acceptance of the care giver’s guidance gives the child a chance to learn affect regulation and interaction with parent’s support. Negative consequence: If emotional attunement is missing and the care giver tries to guide the child, the guidance does not touch the limbic system, the learning areas of the hippocampus, and the prefrontal cortex of the child. In this case affect regulation can not be achieved, because without attunement, the “emotional” neural network of the right hemisphere of the brain is not reached. 1. Attunement of the emotions between the care giver and the child 2. The child’s acceptance of guidance by the care giver relationship- orientated attachment task-orientated learning Self-esteem and self-confidence of the child 3. The child‘s affect regulation: Coping with stress

H-MIMCulturally-dependent modification of the MIM: 

H-MIM Culturally-dependent modification of the MIM H-MIM is an adaptation of the MIM to fit the typical European pattern of parent-child relationships. H-MIM was used to observe/assess the mother-child interactive behavior of clinically symptomatic toddler and preschool children, 2:6 to 6:11 years of age, with their care givers. H-MIM focuses on three important factors of social interactive behavior between children and their care givers: Attunement of the emotions in the parent-child interactive behavior, The child’s acceptance of guidance by the care giver (e.g. mother or father), Learning to regulate affects and to cope with stress, supported by the care giver. To observe the dyadic system of e.g. the mother-child interactive behavior the mother gets 5 cards with tasks to be solved together with her child. The relevant tasks are chosen out of a catalogue of different tasks 2 different tasks measuring the fitting of the emotions of the dyad, out of 18 possible ones, 2 different tasks measuring the child’s acceptance of the care givers guidance, out of 22, 1 task measuring the child’s ability to cope with stress, out of a catalogue of 4 such tasks. The kind of tasks depend on the hypothesis/diagnose of the child’s disorder.

Purposes for which the H-MIM is frequently usedin German-speaking European countries: 

Purposes for which the H-MIM is frequently used in German-speaking European countries Diagnosis of interactive behavior: How does the clinically symptomatic child act and react in reality when alone with his of her care giver (mother or father)? Diagnosis of developmental speech-language delay or impairment For example, does a child with elective mutism speak when alone with his or her care giver and not feeling observed? How is the receptive language ability of the child when with his family? Parent-child research For example, are there differences in behavior of 5-year olds at separation and reunion when with their mother or father, respectively? Parental advice Which care giver strategies most supports the social and communicative development of a symptomatic child? Youth welfare department decision-making Which parents are the best fit for an adoptive or foster child? Forensic decision-making Which parent should be responsible for custody of the child?

Method: 

Method Two field studies with repeated measurement in treatment settings 1998-2005 A Controlled Longitudinal Study (CLS) with a follow-up 2 years after termination of the treatment 2000-2004 A nation-wide Multi-Center-Study (MCS) in 9 quite different treatment facilities Objective of the studies: Evaluation of the effectiveness of Theraplay on toddler and preschool children with dual diagnoses of interactive, and speech-language disorders Function of the H-MIM: Observation and diagnosis to assess the parent-child interactive behavior in the process evaluating the effectiveness of Theraplay in the course of time

Diagnostic data sampling methods(A number of other diagnostic instruments, tests, and questionnaires were used as well): 

Diagnostic data sampling methods (A number of other diagnostic instruments, tests, and questionnaires were used as well) Data about mother and child Questionnaire collecting socio-demographic data, case history Data about the severity of the child’s symptoms Repeated measurement of the severity of the symptoms using CASCAP-D the German Version of CASCAP - Clinical Assessment Scale for Child and Adolescent Psychopathology (Doepfner et al., 1999) 4-point scale: 4 = severe symptom, 3 = clear symptom, 2 = light symptom 1 = clinically non-symptomatic) Data about the dyadic parent-child interaction Repeated assessment of the parent-child interaction solving different tasks using H-MIM the Heidelberg Marschak Interaction Method (Ritterfeld & Franke, 1994) 6-point interval scale: disagree = 1...2...3...4...5…6 = fully agree

Course of time of the Controlled Longitudinal Study (CLS): 

Course of time of the Controlled Longitudinal Study (CLS) Time points of the controlled longitudinal study (CLS) t0 = at the beginning of a 16-week waiting time (only the waiting time control group W is observed) t1 = at the beginning of the treatment with Theraplay t6 = at the termination of the treatment with Theraplay t7 = follow-up: 2 years after the end of the therapy (Time points during the process of therapy t2 – t5 are not reported here.) Normal, clinically non-symptomatic control group (N) t1 = at the beginning of a 16-week waiting time t6 = at the end of the 16-week waiting time

Course of time of the Multi-Center-Study (MCS): 

Course of time of the Multi-Center-Study (MCS) Multi-Center-Study (MCS) 2 times of measurement (pre - post) t1 = at the beginning of the treatment with Theraplay t6 = at the end of the therapy with Theraplay

Method of the Controlled Longitudinal Study (CLS): 

Method of the Controlled Longitudinal Study (CLS) Controlled Longitudinal Study (CLS) 1998 – 2003 N = 60 toddler and preschool children with dual diagnoses of developmental language, language or speech disorders, and of interactive disorders, whose treatment was terminated in 2003. The study was carried out in the Phoniatric Paed-Audiologic Center in Heidelberg 2000 – 2005 Follow-up study 2 years after individual discharge from treatment. Advantages High internal validity of the results for language disordered children because… … carried out only in one region, the catchment area of Heidelberg, Germany … carried out only in one therapeutic treatment facility, the Phoniatric Paed-Audiologic Center (PPC) in Heidelberg, Germany … carried out only with one kind of patients, toddler and preschool children with dual diagnoses of speech-language and social interactive disorders Disadvantage Generalization of the results onto other cohorts of patients is impossible. Therefore a nation-wide Multi-Center-Study (MCS) was started in 2000.

Method of the Multi-Center-Study (MCS): 

Method of the Multi-Center-Study (MCS) 2000 – 2004 Nation-wide Multi-Center-Study (MCS) Sample size N=319 clinically symptomatic toddler and preschool children whose Theraplay treatment terminated up to the end of 2004 The MCS was carried out in Germany and Austria. The MCS was carried out in 9 different therapeutic facilities: a center of early intervention, the therapeutic clinic a center of handicapped children, the kindergarten a child and adolescent psychiatry, the therapeutic clinic a council welfare department, the kindergarten in a focal area a phoniatric paed-audiologic center, the therapeutic clinic a clinic for early intervention on development language delay a practice of psychological psychotherapy for children and adolescents several practices of speech-language pathologists, etc., The MCS was carried out by 14 different Theraplay therapists.

Sample Sizeof the Controled Longitudinal Study (CLS): 

Sample Size of the Controled Longitudinal Study (CLS) N=60 Sample of clinically symptomatic toddler & preschoolers (age 2:6 – 6:11 years of age) with dual diagnoses of developmental language, language or speech disorders and different kinds of socio-emotional interactive disorders. Of these are N=50 toddler & preschoolers with attention deficit (net sample) with dual or multiple diagnoses of language and behavior disorders Out of these 50 children with dual diagnoses are selected: N=25 … with attention deficit and hyperactivity N=21 … with attention deficit and oppositional defiancy N=17 … with attention deficit and shyness N=13 … with attention deficit and an autism-like lack of social mutuality N=25 Waiting time control group (W) of clinically symptomatic preschool children (randomized sample) N=30 Normal control group (N) of normal, not clinically symptomatic toddler and preschool children** ** matched sample in age and sex.

Sample Sizeof the Multi-Center-Study (MCS): 

Sample Size of the Multi-Center-Study (MCS) N=319 total sample of clinically symptomatic children (MCS) (age 2:6 – 6:11) with dual or multiple diagnoses, respectively, with different kinds of socio-emotional interactive disorders, and different speech and language disorders. Of these are … N=291 net sample of symptomatic toddler & preschool children Of these are N=218 toddler & preschool children with attention deficit Of these 218 children with dual or multiple diagnoses are selected: N=105 with attention deficit and hyperactivity N=127 with attention deficit and oppositional defiance N=105 with attention deficit and shyness, withdrawnness N= 44 with attention deficit and an autism-like lack of social mutuality

Sample structureof the Controlled Longitudinal Study (CLS) (Mean): 

Sample structure of the Controlled Longitudinal Study (CLS) (Mean) CLS: Average age in year: month_. 4:03 N=50 toddler & preschoolers suffering from ADD, total 4:04 years, N = 37 boys 3:11 years, N = 13 girls 4:06 N=30 clinically non-symptomatic toddler and preschoolers Control group N (matched sample) CLS: Sex in %, Relation 2,9:1______ Boys; Girls 74%; 26% N=50 toddler, preschooler suffering from ADD, total 74% = 37 boys 26% = 13 girls 70%; 30% N=30 clinically non-symptomatic toddler and preschool children Control group N (matched sample) CLS: Social status and upbringing_ N=50 toddler and preschoolers suffering from ADD Social status of the mother 90% married mothers 8% unmarried living together 2% unmarried mothers Social status of the child 90% legitimate children 10% illegitimate children Upbringing of the child 85% both parents 15% one parent 71% in kindergarten

Sample structureof the Multi-Center Study (MCS) (Mean): 

Sample structure of the Multi-Center Study (MCS) (Mean) MCS: Average age in year: month_. 4:03 years, N=218 toddler & preschooler suffering from ADD 4:03 years, N = 153 boys 4:04 years, N = 65 girls 4:06 N=30 clinically non- symptomatic toddler & preschool children Control group N (matched sample) MCS: Sex in %, Relation 2,3:1 Boys; Girls 70%; 30% N=218 toddler & preschoolers with ADD 70% = 153 boys 30% = 65 girls 70%; 30% N=30 clinically non- symptomatic toddler & preschool children Control group N (matched sample) MCS: Social status and upbringing N=218 toddler and preschoolers ______suffering from ADD_____ Social status of the mother 66% married mothers 10% unmarried living together 9% been separated mothers 1% widowed mothers 13% unmarried mothers (1% n.a.) Social status of the child 77% legitimate children 17% illegitimate natural children 6% adopted/foster children Upbringing of the child 77% both parents 23% one parent 76% in kindergarten

Research resultsinvestigating the quality criteria of the Heidelberg Marschak Interaction Method(H-MIM)using studies ontoddler and preschool children with attention deficit to compare over the course of time the change of the mother-child interactive behaviorwith the change of the child’s symptoms of attention disorders: 

Research results investigating the quality criteria of the Heidelberg Marschak Interaction Method (H-MIM) using studies on toddler and preschool children with attention deficit to compare over the course of time the change of the mother-child interactive behavior with the change of the child’s symptoms of attention disorders

Hypothesisabout the construct validity of H-MIM as a diagnostic method to assess parent-child interactive disorders: 

Hypothesis about the construct validity of H-MIM as a diagnostic method to assess parent-child interactive disorders Construct validity of the H-MIM If the treatment with Theraplay® significantly and lastingly reduces the relevant symptom during the process of treatment* (repeated measurement by CASCAP-D) … then the parent-child interactive disorder will improve significantly in the same period of time* (repeated measurement by H-MIM) * Period of reducing the symptom is from the beginning to the end of Theraplay (t1 – t6) Period of lasting of the reduced symptom: 2 years after Theraplay treatment (t6 - t7).

Basis is the change of the children’s attention deficit The effectiveness of Theraplay on children with attention disorders reducing the relevant symptoms over the course of time t1 – t6in comparison with a control group N of clinically non-symptomatic children Multi-Center-Study (MCS)t1 – t6 repeated diagnoses of symptoms using CASCAP-D (Doepfner et al., 1999)scale: 4=severe symptom, 3=clear symptom, 2=light symptom, 1=non-symptomatic : 

Basis is the change of the children’s attention deficit The effectiveness of Theraplay on children with attention disorders  reducing the relevant symptoms over the course of time t1 – t6 in comparison with a control group N of clinically non-symptomatic children Multi-Center-Study (MCS) t1 – t6 repeated diagnoses of symptoms using CASCAP-D (Doepfner et al., 1999) scale: 4=severe symptom, 3=clear symptom, 2=light symptom, 1=non-symptomatic

Basis is the change of the children’s attention deficit The effectiveness of Theraplay on children with attention disorders reducing the relevant symptoms over the course of time t1 – t6in comparison with a control group N of clinically non-symptomatic children Controlled Longitudinal Study (CLS)t1 – t6 – t7 repeated diagnoses of symptoms using CASCAP-D (Doepfner et al., 1999) scale: 4=severe symptom, 3=clear symptom, 2=light symptom, 1=non-symptomatic : 

Basis is the change of the children’s attention deficit The effectiveness of Theraplay on children with attention disorders  reducing the relevant symptoms over the course of time t1 – t6 in comparison with a control group N of clinically non-symptomatic children Controlled Longitudinal Study (CLS) t1 – t6 – t7 repeated diagnoses of symptoms using CASCAP-D (Doepfner et al., 1999) scale: 4=severe symptom, 3=clear symptom, 2=light symptom, 1=non-symptomatic

1st Criterion of Suitability Construct validity of the H-MIM: 

1st Criterion of Suitability Construct validity of the H-MIM Construct validity of the H-MIM is to prove the correspondence of the statistical significance of the hypothetically predicted change of the mother-child interactive behavior over the course of time with the really observed change of the mother-child interactive behavior over the same period The change of the mother-child interactive behavior is assessed using H-MIM investigated in the Controlled Longitudinal Study (CLS) carried out over the course of time from the beginning of the waiting time (t0) until 2 years after individual termination of Theraplay therapy (t7). The change of the symptoms of the child’s disorder is evaluated using CASCAP-D investigated in the Controlled Longitudinal Study (CLS) carried out over the course of time from the beginning of the therapy (t1) until 2 years after individual termination of Theraplay therapy (t7).

Description of the 2 scales of H-MIM and CASCAP-D  to understand the following figures to validate the H-MIM : 

Description of the 2 scales of H-MIM and CASCAP-D to understand the following figures to validate the H-MIM Left scale of a graph: H-MIM ( o——o; —— ) to assess the observed improvement of mother-child interactive behavior on a 6-point interval scale: disagree = 1...2...3...4...5...6 = fully agree Mean of the fitting of emotions of the mother-child interaction Mean of the child’s acceptance to guidance by the care giver Mean of the child’s stress by separation and reunification with his mother Mean of several variables of the process (example: 10 out of 40 items) Right scale of a graph: CASCAP-D (o; – – –) Evaluates the reduction of the symptoms of the child’s attention disorder after treatment with Theraplay on a 4-point dimensional scale: 4 = severe symptoms of attention disorders of the children (mean) 3 = clear symptoms of attention disorders of the children (mean) 2 = light symptoms of attention disorders of the children (mean) 1 = clinically non-symptomatic normal children (mean of control group N)

Attunement of the emotions of mother and child in their interactive behaviorH-MIM on left scale: 6-point interval scale from very little = 1...2...3...4...5...6 = to marked: 

Attunement of the emotions of mother and child in their interactive behavior H-MIM on left scale: 6-point interval scale from very little = 1...2...3...4...5...6 = to marked

Attunement of the child’s willingness to accept  guidance from the mother in their interaction H-MIM on left scale: 6-point interval scale from does not accept = 1...2...3...4...5...6 = to fully accept: 

Attunement of the child’s willingness to accept guidance from the mother in their interaction H-MIM on left scale: 6-point interval scale from does not accept = 1...2...3...4...5...6 = to fully accept

Stress task: The child’s willingness to separate from the mother when in interaction H-MIM on left scale:6-point interval scale from unwilling = 1...2...3...4...5...6 = to willing: 

Stress task: The child’s willingness to separate from the mother when in interaction H-MIM on left scale: 6-point interval scale from unwilling = 1...2...3...4...5...6 = to willing

The child’s attention, concentration and interest in the mother-child interaction  H-MIM on left scale: 6-point interval scale from very low = 1...2...3...4...5...6 = to very high: 

The child’s attention, concentration and interest in the mother-child interaction H-MIM on left scale: 6-point interval scale from very low = 1...2...3...4...5...6 = to very high

Frequency of the child‘s contact-seeking in the mother-child interaction  H-MIM left scale: 6-point interval scale from never = 1...2...3...4...5...6 = to frequentlyH-MIM: mean of 5 items; internal consistence of the items: Cronbach‘s Alpha = .74: 

Frequency of the child‘s contact-seeking in the mother-child interaction H-MIM left scale: 6-point interval scale from never = 1...2...3...4...5...6 = to frequently H-MIM: mean of 5 items; internal consistence of the items: Cronbach‘s Alpha = .74

The developing self-confidence of the childin the mother-child interaction H-MIM on left scale: 6-point interval scale from rather shy = 1...2...3...4...5...6 = to rather self-confident: 

The developing self-confidence of the child in the mother-child interaction H-MIM on left scale: 6-point interval scale from rather shy = 1...2...3...4...5...6 = to rather self-confident

The attunement in the mother-child interactive behavior Left: 6-point interval scale from negative = 1...2...3...4...5...6 = to positive : 

The attunement in the mother-child interactive behavior Left: 6-point interval scale from negative = 1...2...3...4...5...6 = to positive

The child’s tolerance of frustration from motherin the mother-child interaction  Left scale: 6-point interval scale from not at all = 1...2...3...4...5...6 = to very well H-MIM: Mean of 3 items, internal consistence of the items: Cronbach’s Alpha = .82: 

The child’s tolerance of frustration from mother in the mother-child interaction Left scale: 6-point interval scale from not at all = 1...2...3...4...5...6 = to very well H-MIM: Mean of 3 items, internal consistence of the items: Cronbach’s Alpha = .82

Attunement of empathy in expressing affection in the mother-child interactive behavior Left scale: 6-point interval scale none = 1...2...3...4...5...6 = to frequentlyH-MIM: Mean of 5 items; internal consistence of the items: Cronbach’s Alpha = .85: 

Attunement of empathy in expressing affection in the mother-child interactive behavior Left scale: 6-point interval scale none = 1...2...3...4...5...6 = to frequently H-MIM: Mean of 5 items; internal consistence of the items: Cronbach’s Alpha = .85

The child’s ability to speak with his or her motherin the mother-child interaction Left scale: 6-point interval scale from very low = 1...2...3...4...5...6 = to very highH-MIM: mean of 4 items; internal consistence of the items: Cronbach’s Alpha = .88: 

The child’s ability to speak with his or her mother in the mother-child interaction Left scale: 6-point interval scale from very low = 1...2...3...4...5...6 = to very high H-MIM: mean of 4 items; internal consistence of the items: Cronbach’s Alpha = .88

Discussion of the research results Construct validity of the H-MIM: 

Discussion of the research results Construct validity of the H-MIM The Construct Validity of the H-MIM is confirmed. based on the sample of N=50 toddler and preschool children with dual diagnoses of attention disorder and delay in language development as well as language disorders. The high internal validity of the results of the CLS validates the H-MIM, but only for this particular population. The results have low external validity due to their limitation to one therapeutic facility (the PPC in Heidelberg), to one specific population of patients (language delay or disorder), to one Theraplay therapist (Ulrike Franke). The results can not be generalized to other populations of disordered children and adolescents. Further studies are needed to evaluate the H-MIM to generalize the results on other populations of patients.

Generalizing of the validity of the H-MIM Validity is the important point as long as the H-MIM is reliable. Generalizing asks for high external validity of the H-MIM.: 

Generalizing of the validity of the H-MIM Validity is the important point as long as the H-MIM is reliable. Generalizing asks for high external validity of the H-MIM. Controlled Longitudinal Study (CLS) High internal validity of the H-MIM due to high homogeneity of the population of patients (PPC) Low external validity of the H-MIM due to a lack of variation of the spectrum of disorders These results may not be generalized! Nationwide Multi-Center-Study (MCS) Low internal validity of the H-MIM due to great heterogeneity of the populations of patients of 9 different therapeutic facilities, treated by 14 different therapists, in two different German speaking countries Germany and Austria High external validity of the H-MIM due to a well distributed mean variation over several cohorts of patients, different therapeutic facilities, and different Theraplay therapists These results can be generalized to other populations of patients.

2nd Criterion of SuitabilityEffect size of the H-MIM Effect size (d) = capacity to recognize significant differences in mother-child interactionaround d=0.20 = low…, around d=0.50 = middle…, around d=0.80 = high effect sized<1.00 = extremely high effect size to differentiate significantlyLiterature: Bortz & Döring, Forschungsmethoden und Evaluation, 1995; Formula: d = Mt1–Mt6/st6 = population-near deviation (www,phil.uni-sb.de/jakobs/seminar/vpl/….htm : 

2nd Criterion of Suitability Effect size of the H-MIM Effect size (d) = capacity to recognize significant differences in mother-child interaction around d=0.20 = low…, around d=0.50 = middle…, around d=0.80 = high effect size d<1.00 = extremely high effect size to differentiate significantly Literature: Bortz & Döring, Forschungsmethoden und Evaluation, 1995; Formula: d = Mt1–Mt6/st6 = population-near deviation (www,phil.uni-sb.de/jakobs/seminar/vpl/….htm

2nd Criterion of SuitabilitySensitivity of the H-MIM Sensitivity = statistical significance of the capacity of H-MIM to recognize significant differences in interaction. Sensitivity (t1 – t6) = Statistically significant change after treatment with Theraplay  Lasting effect (t6 – t7) = No statistically significant (n.s.) change 2 years after therapy: 

2nd Criterion of Suitability Sensitivity of the H-MIM Sensitivity = statistical significance of the capacity of H-MIM to recognize significant differences in interaction. Sensitivity (t1 – t6) = Statistically significant change after treatment with Theraplay Lasting effect (t6 – t7) = No statistically significant (n.s.) change 2 years after therapy

Discussion of the research resultsSensitivity and effect size of the H-MIM: 

Discussion of the research results Sensitivity and effect size of the H-MIM The Sensitivity of the H-MIM is statistically significant. The child’s interactive behavior improved during the course of therapy t1 – t6 statistically significant. The Effect Size (d) of the H-MIM is very large. The change of the mother-child interactive behavior of children with attention disorders is from dmiddle =.58 to dlarge =1.21. H-MIM confirms the lasting effect of the treatment 2 years after the end of Theraplay treatment interactive behavior of children with attention disorders is stable. There was neither a relapse nor a statistically significant change in interactive behavior between child and care giver.

3rd Criterion of SuitabilityRetest-reliability of the H-MIM: 

3rd Criterion of Suitability Retest-reliability of the H-MIM Reliability is here understood as the trustworthiness of a method, to measure reliable what should be measured. Retest-Reliability is the proof of statistically relevant co-variation (rPearson > .50) of the results of a repeated measurement (t1 and t6).

Retest-reliability of the H-MIM Controlled Longitudinal Study (CLS). Total sample N=60; ADD sample N=50 Method: Retest-reliability of selected variables comparing test = t1 with retest = t6Evidence: The Correlation between test and retest has to be statistically significant: 

Retest-reliability of the H-MIM Controlled Longitudinal Study (CLS). Total sample N=60; ADD sample N=50 Method: Retest-reliability of selected variables comparing test = t1 with retest = t6 Evidence: The Correlation between test and retest has to be statistically significant

Discussion of the research resultsRetest-reliability of the H-MIM: 

Discussion of the research results Retest-reliability of the H-MIM The Reliability of the H-MIM is confirmed. The retest-reliability of the H-MIM to assess mother-child interactive behavior is proven by relatively high correlation coefficients. Pearson correlation coefficients range from r =.49 up to r =.70 and are statistically significant with prob. = .0110 up to < .0001, apart from one exception. Exception: Self-confidence of the child in mother-child interactive behavior is not statistically significant. The correlation coefficient is low (r =.18). Hypothesis: There is such a great difference between the associated symptoms of children with attention disorders, such a hyperactivity, oppositional defiance, shyness, or an autism-like lack of social mutuality that differently disordered children change their position in the group from test (t1) to retest (t6).

Theraplay InstitutUlrike Franke and Herbert Wettig KGD-71229 Leonberg, Germany Obere Burghalde 42www.theraplay-institut.orgQuestions to ask the therapist about Theraplay Ulrike FrankeSLP-S Speech-Language Pathologist and SupervisorCTT-T Certified Theraplay Therapist and Trainer (TTI)RPT-S Reg. Play Therapist and Supervisor (APT)Phone ++49-6202-54051 Fax ++49-6202-54958e-mail: Franke.Theraplay@t-online.de Questions to ask the researcher about research results Herbert H.G. Wettig DiplompsychologeClinical Psychologist, Researcher Phone ++49-7152-27061 Fax ++49-7152-22602e-mail: Herbert.Wettig@t-online.de © 1996 Theraplay is legally protected in German speaking countries by Wz. 39518465in agreement with The Theraplay Institute, Wilmette, IL, USA : 

Theraplay Institut Ulrike Franke and Herbert Wettig KG D-71229 Leonberg, Germany Obere Burghalde 42 www.theraplay-institut.org Questions to ask the therapist about Theraplay Ulrike Franke SLP-S Speech-Language Pathologist and Supervisor CTT-T Certified Theraplay Therapist and Trainer (TTI) RPT-S Reg. Play Therapist and Supervisor (APT) Phone ++49-6202-54051 Fax ++49-6202-54958 e-mail: Franke.Theraplay@t-online.de Questions to ask the researcher about research results Herbert H.G. Wettig Diplompsychologe Clinical Psychologist, Researcher Phone ++49-7152-27061 Fax ++49-7152-22602 e-mail: Herbert.Wettig@t-online.de © 1996 Theraplay is legally protected in German speaking countries by Wz. 39518465 in agreement with The Theraplay Institute, Wilmette, IL, USA