Tourette’s Disorder, Attention Deficit Hyperactivity Disorder, Play Therapy, Parental Involvement, Case Study, Psychoanalysis

This case study explored long-term play therapy’s efficacy for a young child with comorbid Tic Disorder (TD) and ADHD. It evaluated whether psychoanalytic play therapy with parental involvement improved the child’s ADHD/TD core symptoms, emotional regulation, and narrative coherence. A 5-year-old boy with TD and ADHD participated in the study, completing 227 play therapy sessions rooted in psychoanalytic and analytical psychology, emphasizing symbolic expression and unconscious processes over 3 years and 5 months. Concurrently, his caregivers had 97 interviews, supported therapeutic progress, and tackled family dynamics. Symptoms were assessed via the SNAP-IV scale, with qualitative observations tracking emotional regulation, narrative coherence, and symbolic play. Significant improvements occurred: SNAP-IV scores for inattention decreased from 15 to 8, hyperactivity/impulsivity from 14 to 8, and overall ADHD symptoms from 29 to 16. Qualitative findings included enhanced emotional regulation, narrative coherence, and fragmented experience integration via symbolic play, along with the child’s better rule adherence and verbal expression. Findings suggest long-term psychoanalytic play therapy, with active parental involvement, may be an effective treatment modality for children with comorbid TD and ADHD. This approach addresses core symptoms and supports emotional narrative development. Clinically, this study highlights nonpharmacological interventions’ potential for children with complex neurodevelopmental disorders.

Attention Deficit Hyperactivity Disorder (ADHD) is the most frequently diagnosed neurobehavioral disorder among children and adolescents, with prevalence estimates ranging from 5% to 12% in developed nations [1]. Importantly, research indicates a significant overlap between Tic Disorder (TD) and ADHD. Approximately 50% of individuals with TD also have ADHD, and over 43% of children with ADHD exhibit tic symptoms (Hansen et al., 2018). The co-occurrence of Tic Disorder (TD) and ADHD is a prevalent phenomenon that significantly impacts the quality of life of affected individuals, leading to challenges in academic, social, and emotional functioning [2-6]. Despite the well-documented co-occurrence of ADHD and TD, systematic research on its effects and interventions remains limited, particularly in the areas of long-term non-pharmacological interventions for young children [7]. Coffey also highlighted that despite the well-documented co-occurrence of ADHD and tic