The application of systemic practice in the The application of systemic practice in the enhancement of adaptive behavior for people with enhancement of adaptive behavior for people with

pervasive developmental disorders: A repeated pervasive developmental disorders: A repeated measures study.measures study.

Georgia GkantonaGeorgia Gkantona11 & & Nicholas ParitsisNicholas Paritsis²²

1. Psychologist, PhD in School & Developmental Psychology. E-mail: gkantona@yahoo.gr

2. Professor of Psychiatry, President of Society for Systems Therapy and Intervention. E-mail: epakmosesythepas@yahoo.com

PROGRAM FUNDED FROM THE HELLENIC MINISTRY OF HEALTH

AND THE EUROPEAN UNION

The present systemic intervention is based on the following principles of The present systemic intervention is based on the following principles of living systems development: living systems development:

1. 1. The law of experience The law of experience ((AshbyAshby, 1958). , 1958). The lack of stimulation leads to The lack of stimulation leads to functioning decrease. functioning decrease.

2. 2. The law ofThe law of over-load of information stress over-load of information stress ((MillerMiller, , 11978). 978). Each living Each living system has a certain ability to process information. If the environmental system has a certain ability to process information. If the environmental information is much more than the ability to process them, then there is information is much more than the ability to process them, then there is an overload of information stressan overload of information stress, , while if the environmental information while if the environmental information is less than the ability to process them, then there is an under-load of is less than the ability to process them, then there is an under-load of information stress. information stress.

3. 3. Development through order increase Development through order increase ((Prigogine Prigogine & & StengersStengers, 1984). , 1984). The development in living systems contains order increase. The development in living systems contains order increase.

4. 4. The law of optimal variety The law of optimal variety ((ParitsisParitsis, 1992). , 1992). The increase of the The increase of the development rate is succeeded when the variety of environmental development rate is succeeded when the variety of environmental components is high enough so as not to cause overload of components is high enough so as not to cause overload of information stress.information stress.

5. 5. The combination of variety and order in the development The combination of variety and order in the development ((Paritsis, Paritsis, 1993,1999).1993,1999). The increase of variety and at the same time The increase of variety and at the same time the increase of order contribute to speeding up the rate of the increase of order contribute to speeding up the rate of development. This happens as the increase of order reduces the development. This happens as the increase of order reduces the overload of information stress. overload of information stress.

Target of the studyTarget of the study According to the above mentioned principles it is concluded thatAccording to the above mentioned principles it is concluded that

the gradual (optimal) increase of the amount and variety of the gradual (optimal) increase of the amount and variety of stimulation in parallel with the gradual (optimal) increase of stimulation in parallel with the gradual (optimal) increase of organization and order in the environment contributes to the organization and order in the environment contributes to the maximization of functioning bettering.maximization of functioning bettering.

In this context, the hypothesis of the present study was the In this context, the hypothesis of the present study was the following one: An intervention based on the above principles that is following one: An intervention based on the above principles that is applied in individuals with profound mental retardation will result applied in individuals with profound mental retardation will result in adaptive behavior improvement in a period of 6 months. in adaptive behavior improvement in a period of 6 months.

METHODMETHODEXPERIMENTAL DESIGNEXPERIMENTAL DESIGNResearch typeResearch type:: Action researchAction research Repeated MeasuresRepeated Measures:: MeasureMeasure Α Α:: 6 6 months before participants leave the institution for months before participants leave the institution for

the boarding housethe boarding house MeasureMeasure Β Β: : 1 1 months after moving to the boarding housemonths after moving to the boarding house MeasureMeasure CC: : 6 6 months after moving to the boarding housemonths after moving to the boarding house

PARTICIPANTSPARTICIPANTSSexSex:: 9 9 men and 4 women with profound/mild mental retardation and men and 4 women with profound/mild mental retardation and

behavior problemsbehavior problemsAgeAge:: 19 – 44 19 – 44 years old years old ((meanmean= 29,6 = 29,6 yearsyears))Mean institutional careMean institutional care: 18,3 years in the Child Psychiatric : 18,3 years in the Child Psychiatric

Hospital of Athens. Hospital of Athens.

ASSESSMENT MATERIALSASSESSMENT MATERIALS

Vineland Adaptive Behavior Scales Vineland Adaptive Behavior Scales (Sparrow,(Sparrow, Balla & Cicchetti, 1984)Balla & Cicchetti, 1984)

Since adaptive behavior is a composite of various dimensions, the test measures 4 Since adaptive behavior is a composite of various dimensions, the test measures 4 domains:domains:

The Communication DomainThe Communication Domain: It evaluates the receptive, expressive, and written : It evaluates the receptive, expressive, and written communication skills. communication skills.

The Daily Living Skills Domain: The Daily Living Skills Domain: ItIt measures personal behavior as well as measures personal behavior as well as domestic and community interaction skills. domestic and community interaction skills.

The Socialization Domain : The Socialization Domain : ItIt assesses play and leisure time, interpersonal assesses play and leisure time, interpersonal relationships, and various coping skills. relationships, and various coping skills.

The Motor Skills Domain: The Motor Skills Domain: It measures both gross and fine motor skills. (not It measures both gross and fine motor skills. (not used in this study as it is only for children)used in this study as it is only for children)

Demographic questionnaireDemographic questionnaire

It has 10 items that assess: sex, age, physical condition, mental state etc.It has 10 items that assess: sex, age, physical condition, mental state etc.

PROCEDUREPROCEDURE

All assessments were conducted by the same trained psychologist who interviewed All assessments were conducted by the same trained psychologist who interviewed direct care staff. direct care staff.

RESULTSRESULTS

TableTable 11.. MediansMedians, , inter-quartile ranges andinter-quartile ranges and ZZ  - scores of Wilcoxon- scores of Wilcoxon’’s Signed Ranks Tests Signed Ranks Test

in the comparison of differences between measurement A and Bin the comparison of differences between measurement A and B

DomainDomain MeasurementMeasurement MedianMedian IInterquartile nterquartile

rangerange ΖΖ - -scorescore

Receptive Receptive CommunicationCommunication

AA 1414 11-1711-17 - 0,35- 0,35

BB 1313 7,5-17,57,5-17,5

Expressive Expressive CommunicationCommunication

AA 88 3-113-11 - 0,98- 0,98

BB 66 3-123-12

Daily Living SkillsDaily Living Skills AA 3535 21,521,5 -- 4444 -1,33-1,33

BB 2525 21-3521-35

SocializationSocialization AA 16,516,5 10 - 2610 - 26 - - 00,98,98

BB 2525 21-3521-35

Note: * P<0,05,  ** P<0,01,  *** P<0,001

TableTable 2. 2. MediansMedians, , inter-quartile ranges andinter-quartile ranges and ZZ  - scores of Wilcoxon- scores of Wilcoxon’’s Signed Ranks s Signed Ranks

TestTest in the comparison of differences between measurement B and Cin the comparison of differences between measurement B and C

DomainDomain MeasurementMeasurement MedianMedian IInternter--quartile quartile rangerange

ΖΖ - - score score

Receptive Receptive CommunicationCommunication

BB 1313 7,5 – 17,57,5 – 17,5 - 2,19*- 2,19*

CC 1717 11 – 18,511 – 18,5

Expressive Expressive communicationcommunication

BB 66 3 -123 -12 - 0,75- 0,75

CC 88 5,5 - 135,5 - 13

Daily Living Daily Living SkillsSkills

BB 2525 21-3521-35 -2,41*-2,41*

CC 3636 29 - 4329 - 43

SocializationSocialization BB 2525 21-3521-35 -2,76**-2,76**

CC 3636 29-4329-43

Note: * P<0,05,  ** P<0,01,  *** P<0,001

DISCUSSIONDISCUSSION Comparison between measurementsComparison between measurements Α Α andand Β: Β: Non significant Non significant

differencesdifferences Comparison between measurementsComparison between measurements BB andand CC: : Statistically significant Statistically significant

differences in the domains ofdifferences in the domains of: : CommunicationCommunication ( (receptivereceptive), ), Daily Daily living skillsliving skills and Socializationand Socialization

The above results may be due toThe above results may be due to: : The participants lived for a long period in an environment with small The participants lived for a long period in an environment with small

stimulationstimulation

The intervention helped the participants to activate the possibilities The intervention helped the participants to activate the possibilities they had.they had.

The systemic method applied was based on General Systems Theory The systemic method applied was based on General Systems Theory principles and it seems that it results in adaptive functioning principles and it seems that it results in adaptive functioning improvement, as was theoretically supposed improvement, as was theoretically supposed ((Paritsis,Paritsis, 1993) 1993)..

ConclusionsConclusions

The results are compatible with the principles on which the The results are compatible with the principles on which the hypothesis was based on and they reinforce themhypothesis was based on and they reinforce them

The above method needs further control and development The above method needs further control and development Η πιο πάνω μέθοδος βασισμένη σε συγκεκριμένες συστημικές Η πιο πάνω μέθοδος βασισμένη σε συγκεκριμένες συστημικές

αρχές καλεί για περαιτέρω εφαρμογή της προς τη κατεύθυνση του αρχές καλεί για περαιτέρω εφαρμογή της προς τη κατεύθυνση του ελέγχου και της ανάπτυξής της, αλλά και σε κλινικό επίπεδο προς ελέγχου και της ανάπτυξής της, αλλά και σε κλινικό επίπεδο προς την κατεύθυνση της βελτίωσης των ατόμων με νοητική υστέρησητην κατεύθυνση της βελτίωσης των ατόμων με νοητική υστέρηση

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