School placement
Mainstream
Special
Unit
Diagnosis
Autism
59 % (46)
35 % (27)
6 % (5)
Asperger’s
61 % (11)
28 % (5)
11 % (2)
Mean autism severity (standard deviations)
Total ABC
(31–155)
50.9 (2.5)
64.0 (4.6)
54.0 (1.8)
Sensory subscale
(0–27)
7.9 (0.5)
9.4 (0.9)
8.1 (0.3)
Relating subscale
(4–38)
15.1 (0.7)
19.3 (1.2)
16.6 (0.1)
Body and object use subscale
(0–38)
8.9 (0.6)
11.2 (1.2)
9.6 (0.2)
Language subscale
(0–31)
8.5 (0.6)
10.3 (1.1)
8.0 (1.1)
Social and self help skills subscale
(6–25)
10.4 (0.5)
14.0 (0.8)
11.6 (0.1)
At this point, it should be noted that the situation in the UK may be somewhat in advance of that in the USA, where figures imply that just over a quarter of children with ASD are in mainstream education (Individuals with Disabilities Education Act 2004). As will be noted below, there are historical reasons for this difference, which, in themselves, have implications for approaches taken to educating children with ASD in the mainstream, and which may need to be considered when assessing the evidence laid out in this chapter .
In the above-mentioned study by Waddington and Reed (in press), a number of education authorities in the UK were surveyed (combined population = 919,000), and the school placements of the children with ASD in these areas were extracted from the authorities’ records. Although it must be acknowledged that the practice across the four individual authorities varied, further inspection of these data (see Table 22.1) shows that the majority of pupils with ASD in these authorities combined were placed in a mainstream school, or in a unit attached to a mainstream school. This study also assessed the severity of ASD symptoms (using the Autism Behavior Checklist (ABC)), and it was noted that the children with ASD who were placed in special schools tended to have more severe autistic symptoms and traits than their peers with ASD in mainstream schools (especially on the “relating” and “social and self-help skills” subscales of the ABC). A similar finding of differential placement based on the child’s functioning was noted by Eaves and Ho (1997; see also Buysse et al. 1994), who assessed the likelihood of a child with ASD being placed in a mainstream school, a unit attached to a mainstream school, or a special school, and found that this varied with their level of intellectual functioning as measured by the Wechsler Intelligence Scale for Children—Revised (Fig. 22.1).
The comparison between the numbers of children with ASD placed in mainstream schools reported initially by Barnard et al. (2000), and subsequently by Waddington and Reed (in press), chimes with the suggestion that there was around a 15 % increase in the placement of such children in mainstream schools between 2004 and 2009 (Frederickson et al. 2010). In fact, it is important to note in the context of discussing “inclusive” educational practice, individuals with ASD are the only SEN group that is increasingly represented in mainstream schools; the presence of all other SEN-related diagnoses are decreasing in mainstream schools, at least in the UK (Office of National Statistics 2004, 2009). These changes are possibly a product of diagnostic substitution (Matson and Shoemaker 2009; Shattuck 2006), the closure of special schools (Department for Education and Skills 2006), or of the selection policies of schools that tend to make it harder for children with SEN to be accepted in those schools (see West and Hind 2006) .
Thus, it can be assumed that at least 60 % of children with ASD are being educated in mainstream schools. Given that this could translate into between 0.5 and 1 % of the child population, this is a sizable issue. The consequences of educating pupils with ASD in mainstream education, the problems of this approach, and how can these problems be overcome is undoubtedly a topic of importance beyond the context of ASD. In fact, the mainstream education of pupils with ASD is an issue that has already merited special consideration, even within the overarching context of SEN mainstreaming (see Norwich and Lewis 2005; Warnock 2005). The stark statistic is that pupils with ASD who are educated in a mainstream school are 20 times more likely to be excluded from that school than their typically developing peers (Department of Education and Skills 2006). Moreover, 20 % of pupils with ASD will be excluded or suspended from their school at least once (Barnard et al. 2000), compared to only 8 % of children with another SEN diagnosis (Department for Education 2011). There are also higher levels of behavioral problems in children with ASD in a mainstream setting compared to their typically developing peers (Ashburner et al. 2010), and these pupils exhibit higher levels of emotional problems (Macintosh and Dissanayake 2006) .
It might be important also to note that there are numerous reasons why pupils with ASD are being educated in mainstream schools. Most children with ASD in mainstream settings will be recognized as such, and will have been deliberately placed in a mainstream setting, either to promote an inclusive education agenda, or because there are no special schools available. However, it may well be that there is a subset of individuals with ASD in mainstream schools who have not been diagnosed (Humphrey 2008), and who have developed strategies to cope with the problems that this form of education presents for them (Batten et al. 2006). This group presents, what Connor (2000) has termed, an “invisible problem,” and this group may receive no help, even though it may be necessary (see Lord 2011). Moreover, an undisclosed diagnosis can lead to increased negative reactions on the part of the included child’s peers (Ochs et al. 2001). The size of this issue can actually be estimated. Baron-Cohen et al. (2009), comparing the SEN register to a screening procedure conducted across a sample of the schools (both mainstream and special) included on that register, suggested that there may be as many as 40 % undiagnosed cases of ASD in children in schools, although it is not clear whether this proportion was similar in mainstream and special school. Similarly, Kim et al. (2011) suggested that a remarkably high number of children in mainstream school may display signs of ASD in diagnostic tests, but those children either do not require or do not receive any help. In this South Korean study, there were prevalence rates of over 3.5 % in male pupils and 1.5 % in female students. This latter statistic corroborates an increasingly accepted view that ASD is underestimated in females (see also Attwood 2007; Gould and Ashton-Smith 2011). As this “invisible” group receives no support, they may be particularly vulnerable to the range of issues that can beset pupils with ASD in mainstream (and indeed any) schools. These problematic issues include social isolation (Bauminger and Kasari 2000; Humphrey and Symes 2010), and even the onset of comorbid psychiatric problems like depression (Barnhill and Myles 2001; Ghaziuddin et al. 2002). In the development of mainstream education for pupils with ASD, it is of paramount importance to suggest ways these problems can be overcome in both the visible and invisible ASD populations. It is these well-recognized problems that form the basis for interventions and programs aimed at enhancing the mainstream education of children with ASD .
The Pendulum of Segregated Education and Its Relation to ASD
The inclusion of children with SEN in mainstream educational settings has been a controversial concept in education for nearly two centuries . It remains so today because it relates not only to educational values, but also to social values and to a person’s sense of individual worth. Any discussion about the education of children with ASD in mainstream should, therefore, be placed in the wider context of the discussions regarding appropriate education for children with SEN. This will serve to highlight the key concerns regarding mainstream education for children with SEN and offer an important perspective to the current discussion as, for most of this period, children with ASD were covered by the broader terms applied to children with SEN (see Frith 1989). Moreover, even a brief overview of the development of the study of ASD reveals that determining the appropriate education of children with ASD has been intimately connected to the conception of ASD (see Kanner and Eisenberg 1955; Lovaas 1987; Yarmolenko 1926) .
The history of education for children with SEN across different countries and the development of the concept of ASD are outlined in Table 22.2. Inspection of this timeline reveals that in many countries (other than the UK), for much of the period covered, the debate about SEN policy was not primarily about education, but rather it was about sterilization. For example, in the 1930s, between 60,000 and 70,000 children with SEN were sterilized in the USA (Fennell 1996), where the concept of educating children with SEN only became enshrined in law in 1975. Similarly, in 1933, Germany introduced laws about compulsory sterilization for people with learning disabilities, as were also in existence in Norway, Denmark, Sweden, and Switzerland (see Roy et al. 2006 for discussion). This approach to individuals with SEN was rejected in the UK in 1934 after a brief consideration by the Brock Committee .
Table 22.2
Schematic of timeline of major events in the inclusive education debate in the UK and elsewhere
Date | UK | USA and Elsewhere |
|---|---|---|
1860s | First special schools for physical problems | |
1870 | Education Act (1970) Expands right to education to working classes | |
1900–1950 | Mental Deficiency Act (1913) Introduces concept of “feeble-minded” but educable | 60,000–70,000 individuals with learning disabilities sterilized |
Brock Committee (1930) Rejects sterilization for those with learning difficulties | Law for the Prevention of Progeny with Hereditary Diseases (Germany, 1933) | |
1950–1979 | Warnock Report (1978) Calls for inclusive education for all | 20 % of individuals with SEN receive an education |
Rehabilitation Act (1973) Introduces notion of right to education for persons with disabilities | ||
Rolf v. Weinberger (1974) Reveals around 100–15,000 people with SEN sterilized | ||
Education of all Handicapped Children Act (1975) | ||
1980 | Education Act (1981) Introduces SEN statements and right to help with mainstream education | |
1990s | Individuals with Disabilities Education ACT (1990) | |
U.N. Salamanca Statement (1994) | ||
2000s | Education Act (2001) Mainstream placements should be the norm | No Child Left Behind Act (2001) |
Warnock Report (2005) Concludes inclusive education is not working |
Schools based on special needs (for visually impaired and physically disabled pupils) began to appear in the UK from about 1865 (Gillard 2011). After the extension of educational provision to the working classes in the late nineteenth century (Education Act 1870), increasing numbers of “working class” children were excluded from school due to their learning and behavior problems; a “class” imbalance problem that still persists today with nearly 90 % of all children subject to school exclusions coming from manual/semiskilled or unemployed parental backgrounds (Daniels et al. 2003) .
The exclusion of slow learning and emotionally disturbed children from general educational settings created a difficulty, as many of these children were actually legally entitled to an education by the 1870 Education Act. The solution was an expansion of the special school sector from a prime focus on physically disabled and sensory-impaired children to those with what now would be termed a learning disability. The acceptance that some children excluded from mainstream schools should receive education also led to a dichotomy in the way in which individuals with special needs were treated. Children with severe learning difficulties—then called “educationally subnormal”—were not considered capable of benefiting from education and did not attend schools, but rather were provided with training centers. In contrast, individuals with SEN who were thought to benefit from education—then often termed “feeble-minded”—were provided with places in schools that catered for their special needs. Simmons (1978) documents how the UK Mental Deficiency Act of 1913 cemented the increasing use of the term “feeble-minded,” and led to further increases in the use of special schools in the UK.
Although the passage of such education acts in the UK may have been considered enlightened for the time (especially contrasting the situation in the UK with that in the rest of the world), the proliferation of special schools also produced problematic issues for SEN policy that have endured over the last century. Stigma, equality of provision, and educational effectiveness were main concerns then and are still now. The first of these concerns was the perceived stigma that is often attached to being educated in a special school; such labels follow the individuals through their lives, reduce their opportunities, feed other people’s prejudices, and limit their choices (Gray 2002). Indeed, the discriminatory and stigmatizing status of special schools is still keenly felt in this century, as seen in the following description of special education:
Special schools have become the 21st Century gulags, where the collective fears of children who are seen as different is assuaged and their segregation from other children is reconstructed as ‘special education’ in a ‘safe’ environment. These children are in a very real sense ‘the disappeared’—Joe Whittaker. (2001, p. 15) .
An issue that is closely related to the potential stigmatizing aspects of placing children in segregated schools is whether different school provisions can ever, in practice, be equal or produce the possibility of equivalent outcomes. This is the aspect of the debate that underlies and prompts much of the “rights agenda” regarding inclusive education. This question was famously highlighted in the context of racial segregated education by the Brown versus Board of Education (1954) case that decided that the “separate but equal” doctrine, adopted in Plessy versus Ferguson (1896), had no place in the field of public education:
Segregation of white and colored children in public schools has a detrimental effect upon the colored children…A sense of inferiority affects the motivation of a child to learn. Segregation with the sanction of law, therefore, has a tendency to [retard] the educational and mental development of negro children…We conclude that, in the field of public education, the doctrine of “separate but equal” has no place. Separate educational facilities are inherently unequal.
Similar debate has also been held over gender segregation, but this time over the issue of whether single-sex schools are beneficial. A review by Spielhofer et al. (2004) examined the claims that gender-segregated education reduces sexually stereotyped subject choices and is academically advantageous for girls. However, they found little evidence to demonstrate that this was the case and concluded that the research literature failed to provide convincing evidence that single-sex education has an impact on pupil performance.
It should be noted that in both cases of race- and gender-segregated education, the outcome of the debate was ultimately decided on the basis of whether the provision negatively or positively impacted the children. That is, it was argued on the basis of the educational effectiveness of the approach, and it is this latter issue that drove much of the move away from special education from the 1960s onwards .
From the establishment of special schools at the end of the nineteenth century to the 1960s, the positive impact of segregated schools on the progress of children with SEN was probably minimal. Certainly, in the context of ASD, Rutter et al. (1967) noted that special schools were little more than “holding bays” and did not improve the prognosis of individuals with ASD who were educated in those settings. In fact, the early reports on the prognosis for individuals with ASD were unremittingly bleak (see Howlin 1997; Levy and Perry 2011). For example, Rutter and Lockyer (1967; see also Lockyer and Rutter 1969; Rutter et al. 1967) found that over 50 % of these individuals were institutionalized 10 years after their diagnosis. Findings such as these prompted the drive to “normalization” in education with a hope of improving the prospects of these children (Nirje 1969), and, ultimately, to the view that “mainstreaming” children with SEN would facilitate their access to and participation in society. In the UK, this position was first crystallized in the 1970 Education Act, which removed the legal distinction between those who were educable (previously, the “feeble-minded”) and those who were not educable (previously, the “educationally subnormal”), effectively entitling all children to education for the first time; this “integration” movement became one of the “central contemporary issues in special education” (Department of Education and Science 1978, p. 99).
For many, this Warnock report (Department of Education and Science 1978) which introduced the term “special educational needs” was the strongest articulation of the inclusive education movement, and has been described as a “major reformulation” of ideas about education and of the kind of provision to be made for pupils with SEN (see Wedell 2008). The Warnock report began the wholesale movement of pupils with SEN (including ASD) into mainstream schools, and had a major impact on legislation. The Education Act (1981) embedded these fundamental changes into the education system, and this drive towards mainstreaming all children with SEN was continued in the Education Act 2001, which legislated that: “The starting point is always that children who have statements will receive mainstream education” (Department of Education and Science 2001), and which might be considered the “high water mark” for the inclusion program in the UK .
The UK lead was later followed throughout the world; in particular, the UNESCO Salamanca Statement (1994) called for inclusion to be the norm because it combats discriminatory attitudes (Peck et al. 1992), creates welcoming communities (Bogdan and Taylor 1989; Murray-Seegert 1989), provides education for all, and improves efficiency and cost effectiveness of the entire education system (Affleck et al. 1988; Piuma 1989).
However, despite the initially positive reactions to the inclusion agenda, problems soon began to emerge with this as a wholesale educational policy. Many began to argue that trying to force all students into the inclusion mold was just as coercive and discriminatory as trying to force all students into the mold of a special education class or a residential institution (Kauffman 1989; Mesibov 1990). Others suggested that this movement was little more than an exploitation of the child with SEN to fulfill a political abstract ideal and was pursued without regard for what is best for the child (see Lindsay 2003; Norwich 2005 for a discussion). For example, Bricker (1995) argued that the needs of the individual child should not be lost in a movement to advocate one type of placement over all others. While the proponents of inclusion argued that inclusive education is of value in itself, others noted that there are other important values with which a commitment to inclusion in mainstream schools may be in conflict such as a commitment to the best education for the individual (see Lindsay 2003; Norwich 2005). Moreover, it was not long before the fact that children with SEN are a very heterogeneous population came to be recognized as a barrier to a wholesale application of a mainstreaming policy (Cole et al. 1991; Mills et al. 1998). This was particularly true of those with ASD (see Lord and McGee 2001). Still others suggested that this “inclusive movement” might primarily be based on financial considerations, and on the assumption that placement of all children within mainstream settings would be cheaper (Kauffman 1989; Schopler 1990).
A lack of clarity in the definition of SEN and the absence of clear and consistent criteria regarding which children should have a statement led to further practical problems. Such problems include parents being unclear when they are entitled to provide extra help for their child, the respective roles of schools and local authorities not being defined, leaving room for conflict over who is responsible, and local education authorities having an open-ended commitment to an ill-defined group at a time when resources were limited (see Vevers 1992). Although the impact of such financial considerations cannot be underestimated, it was the educational effectiveness of the mainstreaming approach for children with SEN that ultimately led to serious questioning about this form of educational policy.
Advocates of inclusion had argued for the academic, prognostic, and social benefits that they expected the children to experience (Rutter et al. 1967; Stobart 1986; Warnock 2005). However, research noted that mainstreamed children with ASD and SEN in general often had very low social status and acceptance in the school community (Nabuzoka and Smith 1993), suggesting that, in practice, such children were physically present in the school but socially and emotionally excluded. The lack of substantial and consistent evidence for either the social or educational gains anticipated by the proponents of inclusion (Davis et al. 2004a) propelled many to say the research on the benefits of including a child with ASD in a mainstream school placement was inconclusive at best (Humphrey and Parkinson 2006) and more often was contraindicative (see sections below).
The growing weight of such evidence finally prompted the report by Warnock (2005) addressing the impact of educational policy for children with SEN; the report concluded that it was not working. The central debate contained in this report concerned whether mainstreamed children with SEN participate more if they are taught in mainstream schools than if they are taught in special schools. It concluded that they do not, and especially noted that the group with ASD was at particular risk from social exclusion.
In the light of these considerations, inclusion as a policy has been reassessed, so that it does not mean that all children should be educated in the same school, but rather they should be included within a common educational project: a view echoing that endorsed by the Tomlinson Committee (1996), where a mainstream placement was not thought of as a sufficient condition of inclusion. This report defined inclusion as a system, which is not necessarily an integrated setting.
The significance of the Tomlinson (1996) and Warnock (2005) reports was to illustrate that the concept of inclusion is primarily concerned with participation, and the prime objective of the rights argument can be achieved over a wide range of provisions that may go well beyond simple placement in mainstream schools. This shift challenged the initial, simple view of placing pupils with SEN into mainstream schools that were developed in accordance with the “normalization” agenda (Nirje 1969). This view still holds some sway; for example, Bailey (1998) suggested that inclusion focuses on three key aspects: (1) physically being in the same place, (2) doing the same educational activities as others, and (3) being socially accepted and feeling a sense of belonging. However, it is not regarded as central to the discussion. Booth (1996) criticized concepts of inclusion which describe such an ideal state or aim in an influential paper and instead suggested that inclusion be viewed as comprising: “two linked processes: …increasing the participation of students in the cultures and curricula of mainstream schools and communities…[and] reducing exclusion of students from mainstream cultures and communities” (p. 96). Thus the notion of inclusion shifted to a focus on schools responding to all pupils as individuals and restructuring the educational activities and provision to support those children (Sebba and Sachdev 1997).
It is this latter concept that is currently considered as inclusive. For example, Booth and Ainscow (2000) and Humphrey (2008) described inclusion as a “process” involving many things including the placement of pupils with SEN in mainstream schools, participation of all pupils in the curriculum and social life of mainstream schools, participation of all pupils in learning which leads to the highest possible level of achievement, and the participation of young people in the full range of social experiences and opportunities once they have left school. How this hierarchy of mainstream inclusion is achieved is, of course, of paramount importance. Norwich and Lewis (2005) note that any attempt at inclusion must not only involve recognition of the commonalities between the pupils attending that school, but also recognize group- and individual-specific needs, and provide support so that all pupils in the school can access the curriculum on offer.
The Impact of Mainstream Education on the Child with ASD
The preceding sections have highlighted some of the arguments regarding the education of children with ASD and SEN in mainstream school settings . As noted throughout the above discussion, the emerging themes regarding the aims of mainstream educational placements for children with ASD are not solely about “rights,” but involve judgments regarding how effective that education is for the child with ASD (which may also, of course, be considered by some as an imperative in itself). From this debate, the key areas that have emerged in terms of the aims of inclusive education include the academic progress of the children, the social development of the children, and the impact of the school placement on the child’s self-concept. However, the importance that should be attached to each of these issues in judging the success of a mainstream school placement for a child with ASD is not clear. Without the foundation of a definition of successful inclusion, neither evidence regarding effectiveness of mainstream education nor the practices that might best facilitate that practice can be developed.
In order to investigate these issues, Frederickson et al. (2004) sought to obtain staff views on what successful inclusion meant to them. It was hoped to investigate similarities and differences between the views of the staff groups centrally involved in implementing inclusion and to determine what skills they considered important in achieving successful inclusion. Any differences between different staff groups, such as mainstream and special school staff, in the rated importance of particular skills for successful inclusion, might reflect differences between the groups in their understanding of successful inclusion. The participants from different groups (mainstream school teachers, special school teachers, and educational psychologists) were presented with a hypothetical situation, in which six pupils, who used to attend a special school, were placed in a fictitious mainstream school. The participants were asked what information they would need in order to convince them that there has been a successful inclusion.
The results are shown in Table 22.3, which demonstrates two findings of importance. Firstly, the key areas regarded as representing successful inclusion in a mainstream school were academic progress, social progress, the child’s views, happiness and discipline, and compliance with school rules (see also Eldar et al. 2010). Secondly, the results also indicated differences between the groups of professionals, in that, while all agreed that academic and social progress were of paramount importance, mainstream teachers placed more emphasis on discipline, and special school teachers placed more weight on the child’s happiness.
Table 22.3
Percentage of responses suggesting important themes for judging the success of school inclusion reported by Frederickson et al. (2004)
AOP | Att | CVH | PSH | DCB | LAP | SP | SSS | MM | |
|---|---|---|---|---|---|---|---|---|---|
Special | 1 | 8 | 19 | 4 | 9 | 25 | 21 | 9 | 4 |
Primary | 6 | 4 | 5 | 5 | 19 | 20 | 28 | 7 | 7 |
Secondary | 4 | 6 | 13 | 3 | 14 | 21 | 22 | 12 | 5 |
Professional Support | 5 | 4 | 16 | 4 | 4 | 18 | 25 | 17 | 7 |
These findings corroborate the key issues that emerged from the above discussion of mainstream education for children with ASD and also allow focus on assessing the degree to which these aspects are achieved by children with ASD in mainstream setting. The following sections present an admittedly selective review concerning how mainstream education impacts these four areas for children with ASD, not with the aim of producing definitive evidence on this topic (there is none), but to highlight the problems encountered by children with ASD placed in mainstream schools, and also where support needs to be given in helping the child with ASD in a mainstream setting.
Academic Progress
A key issue in the argument for education in mainstream schools was that special schools did not produce the level of academic gains that should be expected in children with ASD (e.g., Lockyer and Rutter 1969). The contemporary situation with regard to this issue presents a mixed picture of results from rather few studies, almost all of which have significant flaws. In the broad area of intellectual disabilities , which is often comorbid with ASD (La Malfa et al. 2004), there have been a number of reviews of the impact of mainstream education on academic and intellectual development. Two of these reviews have been relatively wide ranging and have produced similar conclusions to one another (Freeman and Alkin 2000; Ruijs and Peetsma 2009); both suggest that mainstream placements offer some small advantages to children with mild intellectual disabilities compared to special educational placements, while both acknowledge that there are a number of studies that report no difference between these placements. In contrast, a review of children with behavioral problems often associated with ASD (Smith and Matson 2010) suggested that greater academic gains were made by children who displayed behavior problems in special schools (Schneider and Leroux 1994). The difference between the conclusions of this review and the reviews for learning difficulties may well be connected by the interference with academic progress produced by problem behaviors, especially in mainstream schools where discipline and compliance are seen as key to success (Frederickson et al. 2004). Given the association of ASD with behavior problems (see Smith and Matson 2010; Wacker et al. 2009), this may suggest an inherent problem for mainstream education.
Although relatively few in number, there are some studies that have observed the effects of inclusion in mainstream schools for children with ASD, but as for the broad intellectual disabilities literature , these studies have reported mixed results. One of the few studies to report an advantage for mainstream schools in terms of academic/intellectual gains was conducted by Kurth and Mastergeorge (2010) on children aged between 12 and 14 years old who had continuously been in the same setting for some time. In this study, pupils who were in a mainstream setting for significant amounts of their school day (> 80 %) obtained higher scores on standardized tests of reasoning (including both abstract and inferential skills) than students who spent less than 50 % of their school day in general education. However, the authors also noted that both sets of students did demonstrate gains in academic skills on these standardized measures.
In contrast, Harris et al. (1990) assessed increases in the ratio between developmental level and rate of language use in segregated versus integrated school provision. The results of this study found no differences between the developmental level and the rate of language use between students with ASD in the two settings, suggesting no difference in mainstream and special school in terms of the academic/educational advances for the children in those placements.
Similarly, Waddington and Reed (in press) assessed the records of 108 children with ASD (aged between 5 and 16 years) who were placed exclusively in either special or mainstream school. Particular focus was given to the pupil’s achievement based on their national curriculum results, rather than on standardized tests, which may have a greater level of ecological validity. There were no differences in the autism severity or diagnoses between the pupils exclusively educated in mainstream schools and those educated in special schools (Fig. 22.2). Inspection of these data displayed in Fig. 22.2 reveals that the overall level of performance of the pupils was around the UK P-level 8 (a scale with 8 levels that is used for children working below that expected of children in the first year of primary school—usually 5–6 years old), which is much lower than would be expected for a cohort of this age. Further inspection shows that there was a slight advantage for pupils in the special placements over the mainstream schools in terms of national curriculum results. However, these differences were not great in magnitude and suggest no great impact on the academic achievement of the children.
Fig. 22.2
Relationship between school placement and educational outcome (UK P-levels) as reported by Waddington and Reed (in press)
Of course, there are many differences in the instructional methods that are adopted by mainstream and special education teachers (see Frederickson et al. 2010; Fuchs et al. 1992; Kauffman et al. 1985) that may account for the differences in the academic outcomes noted for each provision. For example, class sizes in special schools are typically smaller than those in mainstream classrooms (Office of Special Education Programs 1994; Reed et al. 2011). Smaller teacher-to-student ratios may lead to more individualized teaching that may foster children’s performance (Hocutt 1996). Moreover, the curriculum in special schools tends to focus more on functional and daily living skills, and they work at a slower pace (Gersten and Woodward 1999). Any one of these differences may be responsible for the differences, or lack of difference between the outcomes from the schools. However, the methodology employed in a study reported by Panerai et al. (2009) partially addresses this issue. In this report, the progress of children with ASD, as measured on a test of developmental level, was compared across mainstream and special schools that were employing the same teaching technique (Treatment and Education of Autistic and related Communication handicapped Children; TEACCH). The academic/intellectual outcomes were virtually identical in these two groups and were higher than those noted in a mainstream class lacking this structured teaching approach.
The pattern of results reported above suggests that it is not necessarily the core ASD symptoms (see also Eaves and Ho 1997) nor the intellectual functioning of the children (cf. Freeman and Alkin 2000; Ruijs and Peetsma 2009) that impact their academic development in mainstream school. However, one factor that may determine academic success in mainstream schools could be the level of disruptive behavior emitted by the children with ASD (see also Kauffman et al. 1985; Kupersmidt and DeRosier 2004). In most studies that examined impact of mainstream versus special schools, the children have been included in the school for some time, suggesting that these are the pupils who are not emitting externalizing behaviors (as children with ASD who do emit externalizing behaviors are often excluded from such settings). One of the more negative results was reported by Ashburner et al. (2010), who found that teachers rated 54 % of the children with ASD included in their mainstream classrooms as underachieving, relative to their ability. This was not based on objective measures but rather by teacher perception; these children were also noted to emit high levels of disruptive behavior and to experience difficulty with the noise and class transitions of a mainstream school. This latter finding is in line with the perceptions of teachers regarding factors promoting successful mainstream inclusion (Frederickson et al. 2004).
In summary, there is no great reason to suppose that mainstream education will necessarily produce greater academic gains than placement in special schools. These mixed results and difficulties in controlling these studies tightly complicate the interpretation of this set of results. However, it might be suggested that those with lower intellectual functioning probably fare slightly better in special schools (Waddington and Reed in press), but those with higher intellectual functioning may well progress better in mainstream schools (Ruijs and Peetsma 2009). However, there are issues for those with ASD who do have higher intellectual functioning that may mitigate the positive impact of mainstream schools on their academic progress. These issues include the interaction between any perceptual sensitivities and the noisy environment of the school (Ashburner et al. 2010), the teaching style adopted in mainstream classes (Panerai et al. 2009), their levels of disruptive behavior (Kupersmidt and DeRosier 2004), and the teacher perceptions (Ashburner et al. 2010). Thus, in terms of academic progress, the safest conclusion is that this will be a product of the interaction between the individual and the school, and not simply a function of school placement.
Social Progress
The major reason put forward by proponents of inclusive education for placing children with SEN in mainstream schools is the assumed impact of a mainstream placement on their social skills (see Connor 2000; Harris and Handleman 1997). Indeed, in terms of the general population of children with SEN, there may be some evidence to support this position. McGregor and Vogelsberg (1998) performed a review of the literature on SEN inclusion in mainstream and concluded that mainstream education is correlated with better social interaction and communication skills. Baker et al. (1994), in another review, noted small-to-medium-sized positive effects on social indices. In a single study, Buckley et al. (2006) noted strong gains for children with Down syndrome when they were included in mainstream schools. However, as Kurth and Mastergeorge (2010) have noted, a great deal of this work has been conducted on children with SEN whose primary deficits are not in the social area, as they are in ASD. It is well established that participation in social activities is particularly restricted in children and adults with ASD, and this may make generalization from the results obtained in the SEN literature to children with ASD difficult (Hilton et al. 2008; Knight et al. 2009; Orsmond et al. 2004).
The situation with regard to the effects of mainstream placements on the social progress of children with ASD is variable, with a preponderance of the evidence suggesting that problems can emerge in this domain from unmanaged inclusive programs. On the positive side, Strain (1983) focused on children with ASD in preschool and primary school and found that those children in mainstream schools exhibited more pro-social behaviors than their special school peers. Similarly, Buysse and Bailey (1993) documented greater improvements in social skills (defined as social behavior and play skills) for children with ASD in inclusive settings compared to segregated school settings. However, it is also important to be somewhat wary of accepting such data on face value as indicative of greater social progress. Boutot and Bryant (2005) suggested that ten pupils with ASD placed in a mainstream school were as “accepted,” “visible,” and “associated with peer groups” as those without disabilities in those settings. Unfortunately, inspection of these data show that, while there were indeed no statistical differences between the groups on all measures, the children with ASD performed worse than their peers; for example, while 70 % of the children with ASD were associated with a social network, 83 % of their typically developing peers were associated; the relatively small sample makes interpretation of the statistical significance difficult in practical terms.
In contrast to these positive results concerning social progress, several other studies have shown no such pattern of gains for children with ASD educated in mainstream placements (e.g., Durbach and Pence 1991; Harris et al. 1990; Reed et al. 2011). For example, Reed et al. (2011) assessed 54 children with ASD attending mainstream school and 86 children with ASD attending a special school. The children in the two groups were matched in terms of their age, gender, and the severity of autism symptoms. They were assessed at the start of the school year and then again at the end of the school year using the Vineland Adaptive Behavior scale, which includes measures of social and communication behaviors. The study found that both groups made similar improvements (Fig. 22.3).
Fig. 22.3
Improvement in standardized scores of the Vineland Adaptive Behavior Scales over 9 months in school placements as reported by Reed et al. (2011)
Of potentially critical importance among these findings are a series of studies that have highlighted the social exclusion often suffered by children with ASD in mainstream school settings, often making their putative inclusive education a burden, rather than a benefit, for them (see Mesibov 1990). For example, Koster et al. (2010) found that children with SEN (including those with ASD) reported having fewer friendships with children in mainstream placements than typically developing peers (see also Cairns and Cairns 1994). A key question with respect to these data, however, is how many friends does it take to represent social progress? Perhaps more worryingly, Humphrey and Symes (2010; see also Ashburner et al. 2008) found that children with ASD reported more social rejection and lower acceptance in a mainstream school than both other SEN-included children (dyslexia) and a matched typically developing group (see also Koster et al. 2010). In fact, several authors have suggested that social isolation and loneliness are more characteristic of the child with ASD in the mainstream school than enhanced social interaction (e.g., Bauminger and Kasari 2000; Knight et al. 2009; Ochs et al. 2001), and, at the extreme, levels of bullying are particularly high for these pupils (Attwood 2007). Similar findings to these are often reported from the perspective of the child with ASD in many qualitative reports (e.g., Browning et al. 2009; Humphrey and Lewis 2008).
The level of social isolation and social exclusion experienced by children with ASD in mainstream schools can lead to mental health problems (Barnhill and Myles 2001), especially around the time of transition to secondary education (Ghaziuddin and Greden 1998) when social comparison becomes more of an issue (Bellini 2006; Humphrey and Lewis 2008). This is more of an issue with higher functioning children with ASD or those with Asperger’s disorder (Ghaziuddin and Greden 1998). However, as these are the very sorts of children with ASD who are likely to be included (see Buysse et al. 1994; Eaves and Ho 1997; Waddington and Reed in press), this aspect of education in a mainstream setting remains a serious problem.
The theoretical basis of expecting inclusion to promote social skills was based on the notion that children would model from their typically developing peers, and thus, acquire appropriate social behavior (see Boutot and Bryant 2005). In unmanaged mainstream placements, these suggestions runs into three problems that may explain the relative lack of success in this aspect of inclusive education: (1) It has long been established that children with ASD have deficits in their ability to model and imitate without special training (Rogers and Pennington 1991), (2) it has similarly long been established that imitation learning is better when the model of the behavior is perceived as similar to the observer (DiSalvo and Oswald 2002), familiar to the subject (Birch 1980), or socially agreeable rather than dominating (Marinho 1940). This suggests that unsupervised modeling may work better from other children with similar SEN problems than from typically developing peers. This view is consistent with findings reported by Osborne and Reed (2011) that children with ASD perform better in mainstream when there are more children with SEN in the school, and (3) if modeling were to occur, then there is little evidence that peers will spontaneously model strong pro-social behaviors (Attwood 2007; Humphrey and Symes 2010).
Thus, the evidence in relation to the effects and experiences of a child with ASD in the mainstream setting with regard to social progress is mixed, but with the strong suggestion that social progress will not spontaneously occur by mere placement in a mainstream setting. However, having presented this rather negative conclusion, it should be noted that many of these data are taken from psychometric assessments of social interactions and functioning, and not from actual classroom observation. This important gap in the literature will need to be filled prior to stronger conclusion being drawn in this area
Child Views and Happiness
The issue of whether a mainstream placement improves the child’s psychological state including their self-concept is a rather fraught and complex area. Indeed, once included in a mainstream school, the views of the parents, teachers, and of the children themselves are often self-contradictory with respect to the impact of that placement on the child’s psychological state. Moreover, there are many issues related to the measurement of this particular aspect of a child’s development that are not easily resolved (see Koster et al. 2010).
As discussed above, there is still a widespread view that education in special provision is stigmatizing (see Gray 2002; Whittaker 2001). This negative perception extends not only to the future prospects of the child, but also to the view that such a placement has on the child’s self-perception (Schneider and Leroux 1994). This was one of the key issues in deciding the judgment in Brown versus Board of Education (1954). In fact, when asked a simple question, a majority of parents of children with ASD want a mainstream placement for their child, not least as they believe that it will help their child develop a stronger self-concept (see Barnard et al. 2000; Resch et al. 2010). Indeed, child-related stress reported by parents decreased after their toddlers had been placed in mainstream education (Baker-Ericzn et al. 2005).
However, this rather broad characterization of parental views about the positive aspects of inclusion obscures a wide range of opinion with respect to the impacts of the placement on their child (cf. Leyser and Kirk 2004; Resch et al. 2010; Russell et al. 2012). For example, Leyser and Kirk (2004) noted that while parents expressed support for inclusion of their children with SEN in mainstream schools, this support was much more pronounced if their child had milder special needs, and most parents expressed worries about the deleterious impacts on the child’s psychological state and self-concept caused by the potentially negative social reactions of their peers (see also above).
There have been surprisingly few studies of the impact of school inclusion on child depression and anxiety using typical psychometric tools, and most of the evidence stems from qualitative studies that have addressed the issue of pupil’s views of mainstream placement (e.g., Bauminger and Kasari 2000; Browning et al. 2009; Humphrey and Lewis 2008; Ochs et al. 2001). These studies have noted that children with ASD often hold self-contradictory views about their mainstream education, premised on mutually exclusive values. In many cases, these views pivot around the potential dichotomy between wanting to be included in mainstream as they feel that this is somehow important (Straub 1995) and is a “privilege” for them (Humphrey and Lewis 2008), and the negative effects their treatment in that placement has on their own feelings (Bauminger and Kasari 2000; Ochs et al. 2001). Their views that a mainstream placement is to be valued are often premised on very negative perceptions regarding their own special needs (see Humphrey and Lewis 2008) that already stigmatize the children in addition to any special school placement. Such views will not be overcome by simple inclusion (see Nota et al. 2006, for a review). Additionally, many children with ASD included in mainstream schools express great concerns over the negative social reactions of their peers (Humphrey and Lewis 2008), and bullying (Browning et al. 2009) which strongly diminished their self-concept (see Bauminger and Kasari 2000). These negative impacts can lead to the later development of comorbid psychiatric problems (see Barnhill and Myles 2001; Ghaziuddin and Greden 1998). Thus, if “de-stigmatizing” is the goal of inclusive education for children with ASD, then there may be a heavy price to pay later in terms of depression and a reduced self-concept.
It has to be acknowledged that other than these qualitative studies, there is almost no evidence regarding how mainstream school impacts this aspect of children’s development, and there are two major issues that need to be borne in mind when assessing these data. In terms of the qualitative data, these obviously are drawn from rather higher-functioning individuals with ASD (see Browning et al. 2009). In itself, this may tend to bias the samples surveyed, and even may highlight concerns over social interaction-induced problems to a greater extent than they are present for other included children who are not functioning at such a high level (although, as noted above, it is the higher functioning children who do tend to be included; Eaves and Ho 1997; Waddington and Reed in press). Moreover, there are concerns over the status of data that can be obtained through such self-report measures, which, in fairness, are the only way to estimate the child’s views. As noted by several researchers (e.g., Cunningham and Glenn 2004; Koster et al. 2010), SEN pupils might have a positively distorted self-perception, overestimating their social status in the school. Although this may well be true, and such unrealistic evaluation may well cause problems in terms of the support that is offered or perceived as needed (Browning et al. 2009), it is less of an issue in terms of assessing the children’s self-perception. If the included children are happy with the few friends that they may have, then that is all that is needed for an increase in their self-concept (and most people have an unrealistic estimation of their own ability, which stops depression setting in; see Alloy and Abramson 1979). Given all of these considerations, it may be safest to conclude that the impact of mainstream education is not dependent on just the mere fact of placement in this setting, as initially hoped for by many educators (Nirje 1969) and many parents (e.g., Resch et al. 2010), but it is largely dependent on the impact of the placement on a range of other aspects of the child’s functioning and on their experience in that setting.
Behavior and Compliance
It is widely acknowledged that a key area that makes children with ASD challenging for their parents is the high level of externalizing behaviors that such children can display (see Eisenhower et al. 2005; Lecavalier et al. 2006; see Osborne and Reed 2009, for a review). Whether or not externalizing behaviors are considered as a core problem for ASD depends on which diagnostic classification system is followed (cf. DSM-IV-TR; ICD-10). Irrespective of this question, it is clear that parents report the externalizing problems to be more problematic than other facets of ASD by school age (Osborne and Reed 2009). Similarly, the presence of such behavioral problems rather than the child’s views and happiness are thought to be key in defining a successful inclusion placement by mainstream educators (Eldar et al. 2010; Frederickson et al. 2004). Moreover, the statistics on school exclusion for children with ASD cited above (see Department for Education and Skills 2006) suggest that the aspect of behavior is the main instigator of school suspensions, and critically, of permanent school exclusions, which are associated with subsequent higher levels of criminal behavior and homelessness (Pirrie et al. 2011).
The literature devoted to this topic has suggested that the behavior problems experienced by children with ASD in a mainstream school are greater than those of their peers (Ashburner et al. 2010; Gadow et al. 2005; Macintosh and Dissanayake 2006; Reed et al. 2011). In these studies, both parent and teacher ratings of problem behaviors tend to be higher for children with ASD than for matched typically developing peers. Ashburner et al. (2010) compared teacher ratings of the problem behaviors emitted by pupils with an ASD diagnosis (broadly defined), who had an average IQ with those behaviors emitted by age- and gender-matched typically developing children educated in the same mainstream classrooms. The children with ASD were rated as having greater levels of behavioral and emotional problems than their typically developing peers. The study reported by Macintosh and Dissanayake (2006) compared parent- and teacher-rated behaviors of pupils with high-functioning autism and Asperger’s disorder to those emitted by typically developing children matched for chronological and mental age. The groups with autism and Asperger’s disorder did not display any differences from one another in terms of their problem behaviors based on either teacher or parent reports. However, both groups were rated as having social-skill deficits and greater numbers of problem behavior relative to typically developing children (Fig. 22.4).
Fig. 22.4
Mean parents’ and teachers’ ratings of social skills and behavior problems using the social skills rating system in three groups of children at mainstream school calculated from the data as presented by Macintosh and Dissanayake (2006)
Both of these studies (Ashburner et al. 2010; Macintosh and Dissanayake 2006) have suggested that behavioral problems are greater in children with ASD than in matched controls. Of course, there are several unresolved issues with respect to the impact of mainstream schools on problem behaviors of children with ASD, such as whether these behaviors are more pronounced in children with lower- or higher-functioning ASD. There are few studies with data bearing on this issue. Gadow et al. (2005) noted that pupils with higher-functioning ASD had more severe psychiatric symptoms, including oppositional defiant disorder, than lower-functioning pupils in mainstream settings. Osborne and Reed (2011) replicated these results comparing children with Asperger’s disorder to children with ASD who were being educated in mainstream schools.
A second issue in regard to the impact of mainstream schools on behavioral problems of children with ASD is whether these children would have the same level of behavioral disorders in a special school setting. The evidence on this issue is very sparse with only one controlled study being conducted that has directly compared matched children with ASD in mainstream and special schools. In this study, also described above, Reed et al. (2011) measured the change in teacher-rated behavior problems in groups of matched children with higher-functioning ASD who attended either mainstream or special schools over the course of a year. The children made improvements in their behavior problems in both types of placements; however, those children in specialist provisions made greater improvements in area of conduct problems. Of course, there are many reasons why mainstream and special schools would differ from one another, and which explain these findings (see the section above), but the comparison of results reported for children undergoing the same curriculum (the Preschool Inventory of Repertoires for Kindergarten, PIRK®) in special or mainstream schools, reported by Waddington and Reed (2009; Studies 1 and 2), shows greater gains in terms of conduct disorders and hyperactivity, as measured by the teacher-rated Strengths and Difficulties Questionnaire, in the special schools compared to the mainstream schools. It should be noted that the group attending the special schools had more severe autism symptoms, and higher levels of behavior problems, at intake than the children in the mainstream group, although the latter difference had disappeared at the end of the year’s exposure to the PIRK® curriculum .
Related posts:
Psychological Theories of Childhood Autism
Economics of Autism Spectrum Disorders: An Overview of Treatment and Research Funding
Designing Curriculum Programs for Children with Autism
Recovery and Prevention
Family Adaptation to a Diagnosis of Autism Spectrum Disorder
Reinforcement Arrangements for Learners with Autism Spectrum Disorder
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