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Effects of regular versus special school placement on students with Down syndrome: A systematic review of studies

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PDF can be found at: http://www.downsyndroom.nl/download/archief/onderwijs/algemeen/reviewinclusive Abstract Background Since the 1980s, more and more children with Down syndrome are in regular education. Parents and schools expect social and cognitive advantages. Method This systematic review of studies on the effects of school placement of students with Down syndrome, with special reference to self-help skills, language, academics and social functioning, is based on the following criteria. Firstly, studies were published in the period 1970-2010. Secondly, any study with a direct comparison between placements in developmental or social outcomes was included. However, studies with a very small sample size (n<3) were excluded. Thirdly, non-comparative studies were included if in the study the acceptance of regularly placed children with Down syndrome by their own classmates was evaluated. Single case studies were excluded. Finally, studies were published in English, Dutch, German, French, Italian, Portuguese, Spanish, Norwegian, Swedish, Danish or Greek. To detect studies, comprehensive sources such as Picarta, Google, Medline, ERIC and Science Direct were used. In addition, a request for relevant research reports was sent out to all member organisations of the European Down Syndrome Organisation (EDSA). Results The literature search yielded 133 potentially relevant studies, of which 53 met the inclusion criteria. In 26 studies, regularly and specially placed children with Down syndrome were compared and in another 27 studies, the acceptance of regularly placed children with Down syndrome by their classmates was evaluated. In nine of the 26 comparative studies, no attempt was made to disentangle the effect of selective placement from the effect of differences in stimulation between settings. However, in fifteen studies researchers did statistically correct for the effect of important other child and/or family variables that could have an impact on development. Furthermore, four studies can be considered to be natural experiments in which school placement was not determined by child characteristics but by geographical area and/or generation. Results show that regular classroom placement yields a better development of language and academic skills, even after the effect of selective placement has been taken into account. As regards self-help skills, under the same condition, there seem to be no differences between both types of school. Social functioning shows a mixed image. For social network, behaviour, and self-competence, no differences at all or small positive differences for regularly placed children were found. However, most studies also highlight that mere placement in a regular setting without any support is not enough. Interactions between children with and without Down syndrome need to be modelled and fostered. Furthermore, although regularly placed children are generally fairly well accepted by their peers, they are less often seen as ‘best’ friend. Apparently, in special education, there exist more opportunities for being ‘best’ friends. Conclusion Children with Down syndrome learn more academic and language skills in regular education, not only because of selective placement. They are well accepted by their peers. However, peer interactions need to be modelled and fostered. Furthermore, opportunities for the development of intimate ‘best’ friendships have to be organized explicitly.
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In: New Developments in Down Syndrome Research ISBN 978-1-62081-893-0
Editors: Alard van den Bosch and Elise Dubois ©2012 Nova Science Publishers, Inc.
Chapter II
Effects of Regular Versus Special
School Placement on Students
with Down Syndrome:
A Systematic Review of Studies
Gert de Graaf
1,2,
, Geert van Hove
1
and Meindert Haveman
3
1
Department of Orthopedagogics, Ghent University, Belgium
2
Dutch Down Syndrome Foundation, Meppel, The Netherlands
3
Department of Rehabilitation Sciences, University of Dortmund, Germany
Abstract
Background Since the 1980s, more and more children with Down syndrome are in
regular education. Parents and schools expect social and cognitive advantages.
Method This systematic review of studies on the effects of school placement of
students with Down syndrome, with special reference to self-help skills, language,
academics and social functioning, is based on the following criteria. Firstly, studies were
published in the period 1970-2010. Secondly, any study with a direct comparison
between placements in developmental or social outcomes was included. However, studies
with a very small sample size (n<3) were excluded. Thirdly, non-comparative studies
were included if in the study the acceptance of regularly placed children with Down
syndrome by their own classmates was evaluated. Single case studies were excluded.
Finally, studies were published in English, Dutch, German, French, Italian, Portuguese,
Spanish, Norwegian, Swedish, Danish or Greek. To detect studies, comprehensive
sources such as Picarta, Google, Medline, ERIC and Science Direct were used. In
addition, a request for relevant research reports was sent out to all member organisations
of the European Down Syndrome Organisation (EDSA).
Results The literature search yielded 133 potentially relevant studies, of which 53
met the inclusion criteria. In 26 studies, regularly and specially placed children with
Corresponding author: Email: Graaf.Bosch@ziggo.nl or gertdegraaf@downsyndroom.nl
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Gert de Graaf, Geert van Hove and Meindert Haveman
46
Down syndrome were compared and in another 27 studies, the acceptance of regularly
placed children with Down syndrome by their classmates was evaluated. In nine of the 26
comparative studies, no attempt was made to disentangle the effect of selective placement
from the effect of differences in stimulation between settings. However, in fifteen studies
researchers did statistically correct for the effect of important other child and/or family
variables that could have an impact on development. Furthermore, four studies can be
considered to be natural experiments in which school placement was not determined by
child characteristics but by geographical area and/or generation. Results show that regular
classroom placement yields a better development of language and academic skills, even
after the effect of selective placement has been taken into account. As regards self-help
skills, under the same condition, there seem to be no differences between both types of
school. Social functioning shows a mixed image. For social network, behaviour, and self-
competence, no differences at all or small positive differences for regularly placed
children were found. However, most studies also highlight that mere placement in a
regular setting without any support is not enough. Interactions between children with and
without Down syndrome need to be modelled and fostered. Furthermore, although
regularly placed children are generally fairly well accepted by their peers, they are less
often seen as ‘best’ friend. Apparently, in special education, there exist more
opportunities for being ‘best’ friends.
Conclusion Children with Down syndrome learn more academic and language skills
in regular education, not only because of selective placement. They are well accepted by
their peers. However, peer interactions need to be modelled and fostered. Furthermore,
opportunities for the development of intimate ‘best’ friendships have to be organized
explicitly.
Keywords: Down syndrome, education, disability, inclusion, inclusive education
Introduction
In many developed countries the right to public school education for children with Down
syndrome was not established until the 1970s. With the exception of Italy, a country adopting
a full inclusive educational system as early as 1977, in practical terms this newly acquired
right to education almost inevitably meant special school placement. In the 1970s, and in
most countries even in the early 1980s, very few students with Down syndrome entered
regular education.
However, since the mid 1980s in many countries, including the UK (Cuckle, 1997),
Australia (Bochner and Pieterse, 1996) and the Netherlands (de Graaf, 2007a; Scheepstra,
1998), more and more children with Down syndrome are entering regular schools. For
children with Down syndrome, the parent’s choice for more inclusion has been and still is the
driving force for changes in educational placements. Dutch studies show that parents with
children with Down syndrome choose regular schools for social, educational and ethical
reasons (de Graaf, 1998; Pijl and Scheepstra, 1998; Poulisse, 2002).
The consequences of the social principle of inclusive education, the expectation that in
the long term regular school placement of children with disabilities will lead to a more open
and tolerant society, are rather difficult to research in any direct way. However, one could
argue that a more tolerant society derives from positive experiences in childhood, such as
children with disabilities being accepted by peers. The extent to which this is really
Effects of Regular Versus Special School Placement ...
47
happening in the schools can be researched. Consequently, an important research topic is the
question whether regular school placement really leads to the social and cognitive advantages
these parents (and those regular schools which agree to take the child) are expecting and
hoping for. Does regular placement of students with Down syndrome really lead to better
self-help skills, language development, academics and social functioning?
Earlier Reviews on the Effect of Placement
for Children with Disabilities
Studies into the effects of special versus regular placement for children with disabilities
date back into the 1930s (Carlberg and Kavale, 1980). Three meta-analyses (Baker, Wang,
and Walberg, 1994/95; Carlberg and Kavale, 1980; Wang and Baker, 1985/86) conclude that
placement in a regular class leads to small to moderate positive effects on cognitive and social
development of students with intellectual disabilities (ID). However, in a recent review,
Lindsay (2007) states that there is not enough methodologically sound research to prove the
superiority of inclusive education for students with disabilities. However, Lindsay’s review is
rather limited in scope, only reviewing articles in eight relevant journals published in the
period 2001-2005. In contrast, Ruijs and Peetsma (2009) reviewed a larger body of research
and conclude that inclusive education leads to neutral to positive effects on cognitive and
socio-emotional development.
The academic achievement of students with special educational needs in inclusive classes
is comparable or even better to that of their counterparts in non-inclusive classes. However,
most studies in these reviews focus on students with mild disabilities, including many studies
on students with specific learning difficulties.
Only one review by Freeman and Alkin (2000) specifically aims at research on students
with ID, ranging from mild to severe ID. These reviewers state that many of these studies
suffer from methodological shortcomings. Nevertheless, they conclude that the research
seems to support the notion that students with ID develop more academic and social
competence in regular schools than in special education, also if comparing students of similar
intelligence. However, we cannot assume that the results of these reviews will automatically
apply to students with Down syndrome as well. We will have to focus on Down syndrome
specific research.
Earlier Down Syndrome Specific Reviews
In contrast to our review of international research, earlier reviews on the effect of regular
versus school placement on students with Down syndrome were narrower in scope, and in
particular covered only studies published in English.
Cunningham, Glenn, Lorenz, Cuckle, and Shepperdson (1998) identified only four
outcome studies at that time, three in the UK (Casey, Jones, Kugler, and Watkins, 1988;
Philps, 1992; Sloper, Cunningham, Turner, and Knussen, 1990) and one in the USA (Fewell
and Oelwein, 1990). These four studies are included in our review. Buckley and Bird (2000)
Gert de Graaf, Geert van Hove and Meindert Haveman
48
identified another five comparative studies from the UK (Beadman, 1997; Dew-Hughes and
Blandford, 1998; Gould, 1998; Laws, Byrne, and Buckley, 2000; and the study later
published as Buckley, Bird, Sacks, and Archer, 2006). In addition they reviewed two non-
comparative studies on social acceptance and interactions of students with Down syndrome in
mainstream schools (Laws, Taylor, Bennie, and Buckley, 1996; Quail, 2000).
All of these studies are included in our review as well, with the exception of Dew-Hughes
and Blandford (1998), as in presenting their results no distinction was made between students
with and without Down syndrome and, moreover, out of 12 participants only two had Down
syndrome.
Both Cunningham et al. (1998) and Buckley and Bird (2000) conclude that regular
classroom placement appears to support academic skill development in children with Down
syndrome.
Method
Criteria for Inclusion and Exclusion of Studies
Our review covers the period 1970-2010. Studies were published in English, Dutch,
German, French, Italian, Portuguese, Spanish, Norwegian, Swedish, Danish or Greek.
We included in our review any study in which a comparison was made between regularly and
specially placed children with Down syndrome in their development or functioning.
Subsequently, the material could be divided in results regarding self-help skills, language,
academics and/or social functioning. However, we excluded studies in which only one
regularly placed child was compared with only one specially placed other child, as this
approach will yield rather idiosyncratic results. Furthermore, most comparative studies
contain a regularly placed group and a specially placed control group. However, sometimes a
comparison is made with a reference group outside the specific study. In that case, this study
was only included if adequate and precise information on this reference group was presented.
We not only included studies on the effect of school placement, but also studies on the
effect of regular versus special preschool placement, as in different countries the moment
children enter the school system can vary. For instance in the Netherlands children enter the
school system at age 4, while in many other countries children between 4 and 6 are still in
preschool.
To avoid publication bias we included not only studies published in scientific journals,
but also studies published as book, conference paper, PhD or master’s thesis. We searched for
articles published since 1970, because worldwide only since the 1970s, and in many countries
even later, children with Down syndrome were granted the right to public school education.
As a result, before the 1970s only few entered the educational system at all, and regular
school placement must have been extremely rare.
Finally, we included not only studies targeted solely on pupils with Down syndrome, but
also studies in which children with Down syndrome formed a substantial subgroup of a mixed
research population. However, the latter were only included if the researchers presented their
results separately for pupils with and without Down syndrome, or if they had checked that
Effects of Regular Versus Special School Placement ...
49
their results were not different for pupils with and without Down syndrome, or if a vast
majority of the children in the study had Down syndrome.
In addition, studies without a direct comparison between placements were included if in
the study the acceptance of regularly placed children with Down syndrome by their
classmates was evaluated.
Any study measuring this acceptance (through interviews or questionnaires with children,
parents or teachers, sociometric methods or direct observation) was included, with the
exception of: 1) single case studies; 2) studies targeted at investigating ways of social support
in the regular school, but not actually evaluating the extent of acceptance by peers in any
systematic way; 3) studies measuring attitudes of children in mainstream schools towards
children with Down syndrome in general, however without them having any actual classroom
contact with children with Down syndrome.
Literature Search
To reach a complete overview of studies on this issue over the period 1970-2010, a
literature search was conducted in Picarta, Google, Medline, ERIC and Science Direct, using
different combinations of relevant entries (Down syndrome, trisomy-21, integration,
inclusion, inclusive, education, disability, school; and also equivalents in Dutch, German and
French). If in a publication authors referred to other studies on this topic, we tried to obtain
these as well.
To get an even broader view, beyond these language boundaries, a request for relevant
research reports was sent out on the mailing list of the member organisations of the European
Down Syndrome Organisation (EDSA).
In this way, it was possible to reach Board members of more than 40 syndrome specific
European organisations in more than 25 countries. However, this yielded response only from
Germany, France, Poland, Belgium and Malta. The organisations from these first three
countries reported that to their knowledge no relevant Down syndrome specific studies on
regular school placement had been conducted in their country. The organisation from
Belgium referred to one study; however, this article already had been found through the
literature search and, moreover, didn’t meet the inclusion criteria. From Malta one study was
derived, also not meeting the inclusion criteria.
Through the Down syndrome Organisation, we were brought into contact with
researchers with experience in educational research on children with Down syndrome from
Norway (Anne-Stine Dolva) and Italy (Renzo Vianello). Dolva (email to the first author 9-8-
2011) reported that, apart from her own dissertation, to her knowledge no relevant Down
syndrome specific educational studies had been conducted in Norway, Sweden and Denmark.
Vianello (email to the first author 14-7-2011) sent two articles from Italy, one on attitudes of
teachers, parents and peers towards students with Down syndrome and another one on the
development of students with Down syndrome.
Vianello stated that in the Italian system all children with Down syndrome go to regular
schools, making it impossible to conduct studies on the effects of regular placement with a
specially placed control group.
Subsequently, in addition to the request to the European Down syndrome Organisation,
another literature search was conducted in Google with combinations of the afore mentioned
Gert de Graaf, Geert van Hove and Meindert Haveman
50
entries, but now in Italian, Portuguese, Spanish, Norwegian, Swedish, Danish and Greek. This
yielded educational studies on children with Down syndrome from Latin America, Italy and
Greece. However, most did not meet our inclusion criteria.
Results
The literature search yielded 133 potentially relevant educational studies on students with
Down syndrome from 23 different countries. 70 of these studies had been conducted in the
period 2000-2010, 39 in the 1990s, 22 in the 1980s and only 2 in the 1970s, confirming the
fact that in the 1970s, integration in regular education of children with Down syndrome must
have been extremely rare.
This total of 133 potentially relevant studies contained 31 comparative studies from 8
different countries and 102 non-comparative studies from 23 different countries. Applying the
exclusion criteria, the total number of included studies was reduced to 53 from 12 different
countries, with 26 comparative studies from 6 different countries (Argentina, Australia,
Ireland, the Netherlands, UK, USA) and 27 non-comparative studies from 11 different
countries (Australia, Colombia, Guatemala, Ireland, Italy, the Netherlands, New Zealand,
Norway, South Africa, UK, USA). Consequently, bearing in mind that four decades of
international research in 11 different languages were reviewed, the picture that emerges is the
relative scarcity of studies on the topic.
In table 1, in order of year of publication, all comparative studies included are presented.
In table 2 the non-comparative studies included are presented. If the same study was reported
in different publications, for instance as a thesis and as articles, the publication with most
details is referred to in the first column in the tables 1 and 2.
Table 3 presents studies excluded, explaining the reasons why. Out of the pool of
potentially relevant comparative studies, one study (Diniz, 2008) (Table 3, No. 63) was
excluded because only two children were compared; one study (Dew-Hughes and Blandford,
1998) (Table 3, No. 103) because no clear distinction was made between students with and
without Down syndrome; and three studies (Gheradini, 2000; Schramm, 1974; Vianello and
Lanfranchi, 2009) (Table 2, No. 39 and 53; Table 3, No. 61) because a comparison was made
with a reference group outside the study without precise information on this reference group.
However, two of these studies (Gheradini, 2000; Schramm, 1974) (Table 2, No. 39 and 53)
could be included as a non-comparative study containing information on acceptance by
classmates.
Out of the pool of potentially relevant non-comparative studies a majority of 53 were
excluded because the study contained no information on social acceptance. Also excluded
were 20 single case studies, 6 studies on attitudes of school children to children with Down
syndrome in general (instead of own classmates with Down syndrome) and 5 mixed
population studies in which no clear distinction was made between students with and without
Down syndrome.
As can be seen in table 3, a few studies were excluded for more than one reason.
Table 1. Included comparative studies on the effect of (pre)school placement on students with Down syndrome
Study
Country
N
Longitudinal/
Cross-sectional
Age in yrs
Effect* of regular placement
Also
reported
in:
Self-
help
Language
Academics
Social
1. Matthews (2009)
Ireland
65
C
12-19
-
-
-
0 Having a
close friend;
AR Having a
group of
friends;
AR (s)
Having a
friend
without a
disability;
AR (s)
Speaking to
many people
during social
activities;
AR (s)
Number of
social
activities in
clubs
2. Turner et al.
(2008)
UK
71
L
6-14 at t1; 11-19
at t2; 18-26 at t3
-
-
AR (s)
-
3. Vervat (2008)
NL
43
C
8-13
AR
(s)
AR (s)
-
0 Self-esteem
4. Dijkxhoorn et al.
(2007)
NL
504
C
4-18
AR
(s)
-
-
-
Table 1. (Continued)
Study
Country
N
Longitudinal/
Cross-sectional
Age in yrs
Data sources
Effect* of regular placement
Also
reported
in:
Self-help
Language
Academics
Social
5. de Graaf
(2007a;b)
NL
121
C
5-13
Parent
questionnaire
AR (s)
AR (s)
AR (s)
AR (s)
Friendships at
home;
AR (s) Having
a friend without
a disability;
AS (s) Having
a friend with a
disability;
AS (s) Equal
friendships at
school
6. Buckley,
Bird, Sacks,
et al. (2006)
UK
46 (now)
+ 90
(older
cohort)
C
11-20
Parent
questionnaire;
Vineland;
Conners rating
scale
0
AR (s)
AR (s)
0 Socialisation
Vineland;
AR (s)
Behavioural
problems +
social mature
behaviour;
AS (s)
Interpersonal
relationships
Buckley
et al.
(2002a;b)
7. McMahon
(2003)
Ireland
38
C
6-16
Parent
questionnaire
(adaptation of
Vineland)
-
0
-
0 Socialisation
and behavioural
problems
Study
Country
N
Longitudinal/
Cross-sectional
Age in yrs
Data sources
Effect* of regular placement
Also
reported
in:
Self-help
Language
Academics
Social
8. Cuckle and
Wilson (2002)
UK
14
C
12-18
Interviews with
students,
classmates, parents
and teachers
-
-
-
AS Friends at
school
9. Freeman
and Kasari
(2002)
USA
27
C
5-11
Direct observation
-
-
-
AS (s)
Quality of
interaction
during play
date with
chosen friend
10. Bochner et
al. (2001)
Australia
30
C
18-36
Normative tests on
reading and
language
-
AR (s)
AR (s)
Reading
-
11. Laws et al.
(2000)
UK
44
C
7-14
Normative tests on
reading, language
and memory.
-
AR (s)
AR (s)
Reading
-
12. Begley
(1999)
UK
64
C
8-16
PSPCSA (child)
-
-
-
0 Self-esteem
13. Gould
(1998)
UK
24
C
11-18
PSPCSA (child)
-
-
-
0 Self-esteem
14. Beadman
(1997)
UK
22
C
4-12
IQ-test; ratings of
behaviour by
teachers
-
AR
-
0 Behavioural
problems
15. Bronson et
al. (1997)
USA
115
(38 DS)
C
5
IQ; systematic
observation
-
-
AR (s)
Task-
oriented
behaviour
AR(s) Using
adequate
social
strategies
16. Bochner
and Pieterse
(1996)
Australia
87
C
13-20
Parent questionnaire
0
-
AR
AR
Independent
behaviour
Table 1. (Continued)
Study
Country
N
Longitudinal/
Cross-
sectional
Age in yrs
Data sources
Effect* of regular placement
Also
reported
in:
Self-
help
Language
Academics
Social
17. Yadarola
(1996)
Argentina
54 (C) ;
and 10
(L)
C (54);
and L (10)
5-10 (C); 5-10
(L) at t1,
9-14 at t4
Teacher and parent
questionnaires and
interviews; classroom and
recess observations
-
AR
AR
AR Number
of
interactions;
Positive
interactions;
Child’s
satisfaction
with school
and with
school tasks
Yadarola
(1998)
18. Laws et
al. (1995)
UK
14
L
4-10 at t1; 8-
14 at t2
Normative tests on reading,
language and non-verbal IQ
-
AR (s)
AR (s)
-
19. Hauser-
Cran and
Bronson
(1993)
USA
148
(49 DS)
C
3
IQ; systematic observation
-
-
AR (s)
Task-
oriented
behaviour
AR (s) Using
adequate
social
strategies
20. Philps
(1992)
UK
30
C
5-11
Normative tests on language
and IQ, teacher
questionnaire
-
0
AR (s)
AR (s)
Number of
interactions at
playtime;
AS (s)
Number of
language
initiations to
peers
21. Fewell
and Oelwein
(1990)
USA
135
(58 DS)
L
3-10 (6 mths
between t1
and t2)
Criterium-referenced test
0
AS (s)
-
0 Social
development
22. Sloper,
Cunningham,
et al. (1990)
UK
181
C
6-14
Teacher and parent
questionnaire
AR
(s)
-
AR (s)
-
Study
Country
N
Longitudinal/
Cross-
sectional
Age in yrs
Data sources
Effect* of regular placement
Also
reported
in:
Self-help
Language
Academics
Social
23. Sloper,
Turner, et al.
(1990)
UK
181
C
6-14
Teacher and parent
questionnaire
-
-
-
0 Social
contacts after
school
24. Casey et al.
(1988)
UK
36
L
4-10
Normative tests on
language, math, MA
-
AR (s)
AR (s)
-
25. Lorenz et
al. (1985)
UK
115
C
5-7
IQ; MA; teacher
questionnaire on
reading;
AR (s)
26. Sinson and
Wetherick
(1981)
UK
7
L
2-5
Direct observation of
interactions with peers
AS Eye
contact and
social
interactions
*:
0= no difference; AR= Advantage for Regular students; AS= Advantage for Special students; (s)= statistically significant difference (p<0.05).
Table 2. Included descriptive studies on the social acceptance of regularly placed students with Down syndrome
Study
Country
N
Longitudinal/
Cross-sectional
Age in yrs
Data sources
Also reported in:
27. Dolva (2009)
Norway
6
L
10
Participant observation and interviews with staff and
child with Down syndrome
Dolva et al.
(2010)
28. Guralnick et al.
(2009)
USA
81 (27 DS)
C
4-7
Parent questionnaires on social network; normative tests
on language and IQ; parent rating scales for behaviour;
Vineland
29. Klompas (2008)
South Africa
3
C
8-12
Interviews with parents and teachers
30. Castro (2007)
Colombia
60
C
3-16
Questionnaires for school staff, parents, counsellors and
persons with Down syndrome
31. Wilson (2007)
UK
35 (18 DS)
C
5-16
interviews with staff; rating of self-esteem (competence
and social acceptance) with the PSPCSA (child)
32. de Graaf (2006)
NL
15
L
4-13
Interviews with parents, regular teachers and counsellors
from special education; narrative observations; parent
and staff questionnaires.
33. Hamilton (2005)
Australia
30 (10 DS)
L
4-5
Observations of interactions
Table 2. (Continued)
Study
Country
N
Longitudinal/
Cross-sectional
Age in yrs
Data sources
Also reported in:
34. Solorzano Arriaga
(2005)
Guatemala
5
C
5-12
Observations of interactions, interviews with
teachers and parents
35. Commodari and
Pirrone (2004)
Italy
119
C
11-15
Sociometric ratings by classmates
36. Shevlin et al. (2003)
Ireland
3
C
13-15
Interviews with parents (looking in retrospective at
integration in primary school)
37. Rietveld (2002)
New Zealand
4 (2 DS)
L
4-5
Observations of interactions; interviews with staff
and parents.
Rietveld (2008)
38. de Graaf (2001)
NL
12
C
5-13
Interviews with parents and teachers; narrative
observations.
de Graaf (2002)
39. Gheradini (2000)
Italy
385
C
6-15
Questionnaires for teachers and head teachers
40. Quail (2000)
UK
7
C
11-18
Observations of interactions
41. de Graaf (1998)
NL
18 (16 DS)
C
5-16
Interviews with parents
42. Kliewer (1998a;b)
USA
10
L
2-10
Participant observation and interviews with staff
43. Scheepstra (1998)
NL
23
C
6-8
Observations of interactions; ratings of social
acceptance by teachers; sociometric rating by
classmates.
Scheepstra et al.
(1999); Pijl and
Scheepstra
(1996;1998)
44. Laws et al. (1996)
UK
16
C
8-11
Sociometric ratings by classmates
45. Wolpert (1996)
USA
250
C
4-20
Parent and teacher questionnaire
46. Petley (1993)
UK
10
C
6-8
Interviews with parents and headmasters
47. Rietveld (1989)
New Zealand
6
L
6-7 at t1;
9-11 at t2
Observations of interactions
48. Rietveld (1986)
New Zealand
8
C
6-7
Observations of interactions; teacher questionnaire.
49.Hudson and Clunies-
Ross (1984)
Australia
15 (11 DS)
C
5-8
Sociometric ratings by classmates; ratings by parents
and teachers; observations of interactions
50. Pieterse and Center
(1984)
Australia
8
C
7-9
Sociometric ratings by classmates; teacher ratings.
51. Knox (1983)
Australia
6
L
3-7
Observations of interactions
52. Rogers-Warren et al.
(1980).
USA
4
C
5-6
Observations of interactions
53. Schramm (1974)
USA
2
C
8-10
Interviews with parents and teachers
Effects of Regular versus Special School Placement ...
57
Table 3. Studies excluded from the review
Study
Country
Reason* for exclusion
54. Odluyurt and Batu (2010)
Turkey
C
55. Tanti Burlò (2010)
Malta
C
56. Wendelborg and Tøssebro (2010)
Norway
F
57. Beltrame et al. (2009)
Brazil
E
58. Doherty and Egan (2009)
Ireland
C
59. Gannon and McGilloway (2009)
Ireland
D
60. Hooton and Westaway (2009)
UK
C
61. Vianello and Lanfranchi (2009)
Italy
B
62. Silva (2009)
Brazil
C;E
63. Diniz (2008)
Brazil
A
64. Keenan (2008)
Ireland
C
65. Koulousia (2008)
Greek
C
66. Morrison (2008)
South Africa
E
67. Muniz (2008)
Brazil
C
68. Neto and Silva (2008)
Brazil
C
69. Sirlopu et al. (2008)
Chile
D
70. Gannon and McGilloway (2007)
Ireland
D
71. Sioutis (2007)
Greek
C
72. Alvarez and Ramirez (2006)
Colombia
C
73. Casale-Giannola andWilson Kamens (2006)
USA
E
74. Johnson (2006)
UK
C
75. Engelbrecht et al. (2005)
South Africa
C
76. van Hove et al. (2005)
Belgium
F
77. Kenny et al. (2005)
Ireland
C
78. Rynders (2005)
USA
C
79. Solórzano Arriaga (2005)
Guatemala
C
80. Butler and Hodge (2004)
USA
E
81. Down’s Syndrome Association (2004)
UK
C
82. Felice (2004)
Argentina
C
83. Fox et al. (2004)
UK
C
84. Campbell et al. (2003)
Australia
C
85. Eloff and Kriel (2003)
South Africa
C
86. McCormick et al. (2003)
USA
C;E
87. Clarke (2002)
Ireland
D
88. Kostelnik et al. (2002)
USA
E
89. Mori (2002)
Argentina
C
90. Newmark (2002)
South Africa
C
91. Engelbrecht et al. (2001)
South Africa
C
92. Gaad (2001)
United Arabic Emirates
C
93. Vianello and Moalli (2001)
Italy
D
94. Wang et al. (2001)
USA
C
95. Wolpert (2001a;b)
USA
C
96. Egan-McGann (2000)
Ireland
C
97. Gash et al. (2000)
France, Ireland, Portugal,
Spain
D
98. Muthukrishna et al. (2000)
South Africa
C
99. Freeman et al. (1999)
USA
C
Gert de Graaf, Geert van Hove and Meindert Haveman
58
Table 3. (Continued)
Study
Country
Reason* for exclusion
100. Kasari et al. (1999)
USA
C
101. Martins (1999)
Brazil
C
102. Velez et al. (1999)
Colombia
C
103. Dew-Hughes and Blandford (1998)
UK
F
104. Giangreco et al. (1998)
USA
E
105. Cuckle (1997)
UK
C
106. Engelbrecht et al. (1997)
South Africa
C
107. Rao (1997)
Hong Kong
C
108. Sader (1997)
South Africa
C
109. Wybranski (1997)
USA
C
110. Cheney and Demchak (1996)
USA
E
111. Lorenz (1996)
UK
C
112. Muthukrishna (1996)
South Africa
C
113. Scheepstra et al. (1996)
NL
C
114. Cormany (1994)
USA
C;F
115. Passaro (1994)
USA
C;E
116. Fox and Hanline (1993)
USA
C
117. Barringer (1992)
USA
E
118. Elias (1991)
USA
E
119. West and Cummins (1990)
USA
C
120. Center (1989)
Australia
F
121. Allen (1987)
UK
E
122. Fredericks et al. (1987)
USA
C
123. Bookbinder (1986)
UK
E
124. Budgell (1986)
UK
C
125. Elias et al. (1986)
USA
E
126. Fredericks (1986)
USA
E
127. Humphreys (1984)
USA
C
128. Centre for Studies on Integration in
Education (1983)
UK
C;E
129. Elias et al. (1983)
USA
E
130. Bruni (1982)
USA
E
131. Cooke (1982)
USA
C;E
132. Hayes et al. (1981)
Australia
C;F
133. Gorelick and Brown (1974)
USA
C
*:
A= Comparative study with only two children; B= Study in which a comparison is made with a
reference group outside the study, without presenting adequate and precise information on this
reference group; C= Non-comparative study, however without information on the extent of social
acceptance of the students with Down syndrome by their peers; D= Study exploring peer attitudes
to children with Down syndrome in general, not to real classmates with Down syndrome;
E= Non-comparative single case study; F= Study in which only a minority has Down syndrome
and in presenting the results no distinction is made between students with and without Down
syndrome.
Effects of Regular Versus Special School Placement ...
59
Selective Placement or Differential Stimulation?
To understand differences in development between specially and regularly placed
students with Down syndrome, two processes should be disentangled: selective placement
versus differential stimulation. Do children with Down syndrome acquire more academics in
regular education because the children with more potential have a higher chance to be in
regular education? Or, do they learn more academics because regular education is more
stimulating?
For practical and ethical reasons, it is impossible to conduct at random trials of
placements. So, researchers usually use one of two different approaches, or a combination of
both, to differentiate between the effects of selective placement versus differential
stimulation. The first approach is looking at the effect of placement on a dependent variable
(for instance academics) while statistically correcting for the possible effects of other relevant
child and/or family variables (for instance mental age of the child or parental educational
level). The second approach is looking at natural experiments in which school placement was
not determined by child characteristics but by geographical area and/or generation.
Self-Help Skills
Seven studies (Table 1, No. 3-6, 16, 21, 22) could be found in which a comparison
between placements was made with regard to self-help skills of children with Down
syndrome. In four of these studies, notably an English study from Sloper, Cunningham, et al.
(1990) (No. 22) and three Dutch studies of respectively Vervat (2008), Dijkxhoorn,
Oudheusden, and Berckelaer-Onnes (2007) and de Graaf (2007b) (No. 3, 4, and 5), a
difference was found, i.e. the regularly placed students were more advanced. However, this
could very well be the result of selective placement.
In research conducted by Sloper, Cunningham, et al. (No. 22), the difference between
regularly and specially placed students in self-help skills disappeared after controlling for
differences in mental age. Furthermore, in both a study of Buckley, Bird, Sacks, et al. (2006)
(also reported in Buckley, Bird, Sacks and Archer, 2002a;b) (No. 6) and Fewell and Oelwein
(No. 21), no significant differences in self-help skills were found.
It is important to note that the study of Buckley, Bird, Sacks, et al. (2006) can be
considered to be a natural experiment, in which according to Buckley and colleagues school
placement was not determined by child characteristics but by differences in educational
policy in different geographical areas. Finally, in a research of Bochner and Pieterse (1996)
(No. 16) no differences were found in daily living skills between a relatively recent cohort of
Australian teenagers with Down syndrome, of which more than half had been in regular
education for most of their school career, and older more segregated cohorts.
There is no evidence that regular placement of children with Down syndrome leads to a
better development of self-help skills, but neither there is any evidence for an advantage of
special school placement in this regard. It might very well be the case that parents of children
with Down syndrome have more influence on the development of their child’s self-help skills
than school placement.
Gert de Graaf, Geert van Hove and Meindert Haveman
60
Language
In twelve studies (Table 1, No. 3, 5-7, 10, 11, 14, 17, 18, 20, 21, 24), researchers
evaluated language development. In only one of these, notably Fewell and Oelwein (1990)
(No. 21), a difference was found in favour of special placement. However, Fewell and
Oelwein themselves don’t attribute the higher gains in expressive language of children with
Down syndrome in special preschool and school settings to the placement itself, but to the
fact that in the special preschool settings an effective program for early intervention was
carried out in a more intensive way. In this program strong emphasis was put on stimulating
speech and language skills, among others by using whole sight word reading for language
enrichment. Apparently, it is not where the children are educated, but more what is educated
in a particular setting and with what intensity. However, an even more important issue in the
context of this review is a methodological characteristic of this study. The more segregated
children were younger than the more integrated and the researchers did not statistically
control for age. Whereas development in Down syndrome is not necessarily linear, this might
flaw the comparison between settings.
In a study by Philps (1992) (No. 20), no differences in formal language measures
(Reynells Developmental Language scales) were found between regularly and specially
placed children with Down syndrome. In another study, by McMahon (2003) (No. 7), results
indicated that school placement had no statistically significant effect on the development of
communicative adaptive skills in children with Down syndrome. However, the advantage in
communication skills of the regularly placed children nearly reached statistical significance
(p=0.052), despite the fact that the specially placed children on average were two years older.
Yet, according to McMahon, this result of no difference remained the same when age and
gender differences were taken into consideration. However, for the huge differences in
calendar age of the specially and regularly placed children, correction was made in a rather
rough way, only by dividing the group in children under and above twelve years of age.
Moreover, in this specific comparison between specially and regularly placed children,
McMahon only looked at actual school placement, without taking the child’s school history
into account. Consequently, students who might have been in mainstream education for
almost their entire school career, and only lately had been transferred to a special school,
were considered to be specially placed students. Interestingly, McMahon made two other
comparisons. Both children who had previously attended mainstream preschool and children
who had previously attended mainstream school displayed significantly higher
communication results (p<0.01) than did children who had never attended another school (ten
out of eleven of the students in this latter group had started their school career in special
education).
In all the other nine studies (Table 1, No. 3, 5, 6 , 10, 11, 14, 17, 18, 24), differences were
found in favour of regular classroom placement. In five of these (No. 3, 5, 10, 14, 17) no
attempt was made to disentangle the effect (on language skills) of selective placement from
the effect of differences in stimulation. However, three other studies, of Buckley, Bird, Sacks,
et al. (2006) (No. 6), Laws et al. (2000) (No. 11) and Casey et al. (1988) (No. 24), can be
considered to be natural experiments. School placement was not determined by child
characteristics but by differences in educational policy in different geographical areas. This
implies that we may attribute the differences in language development in these three studies
to differential stimulation between settings. Moreover, in the Casey et al. study (No. 24),
Effects of Regular Versus Special School Placement ...
61
regularly placed children showed higher gains in receptive language, also after controlling for
age, mental age and initial scores on language and academics. In the research of Laws et al.
(2000) (No. 11), regularly placed students had higher scores on diverse measures for language
skills, also after controlling for differences in receptive vocabulary (which normally correlates
with mental age). And, in the study of Buckley, Bird, Sacks, et al. (2006) (No. 6), regularly
placed students had much higher scores on speech and language skills than specially placed
students, but no differences were found in daily living skills nor in the overall socialisation
score on the Vineland Adaptive Behaviour Scales. Finally, in a small longitudinal study of
Laws, Buckley, Bird, MacDonald, and Broadley (1995) (No. 18) on 14 students with Down
syndrome, at age 4-10 years no differences between settings in language, memory and non-
verbal cognitive development were found. At age 8-14 however, 6 out of 7 regularly placed
children and 1 out of 7 specially placed children had some reading abilities (on the BAS).
‘Readers’ were more advanced on measures for language development at age 8-14. There
were no differences in non-verbal abilities.
On basis of the available recent studies we may conclude that regular classroom
placement has considerable advantages for the language development of children with Down
syndrome. Especially in the study of Buckley, Bird, Sacks, et al. (2006) (No. 6), a large effect
was found. The regularly placed teenagers in this particular study had on average scores of 2
years and 6 months higher on speech and language skills on the Vineland (and moreover, in a
parent questionnaire on average their speech was rated as more articulate).
Academics
Fourteen studies (Table 1, No. 2, 5, 6, 10, 11, 15-20, 22, 24, 25) related to academic
skills. In each of these, regularly placed students with Down syndrome had better academic
skills than their specially placed counterparts. This also applies after correcting for
differences in non-academic cognitive functioning, as demonstrated in the studies of Turner,
Alborz, and Gayle (2008) (No. 2), de Graaf (2007b) (No. 5), Buckley, Bird, Sacks, et al.
(2006) (No. 6), Bronson, Hauser-Cran, and Warfield (1997) (No. 15), Hauser-Cran and
Bronson (1993) (No. 19), Philps (1992) (no. 20), Sloper, Cunningham, et al. (1990) (no. 22),
Casey et al. (1988) (No.24) and Lorenz, Sloper, and Cunningham (1985) (No. 25). In
addition, three studies of Buckley, Bird, Sacks, et al. (2006) (No. 6), Laws et al. (2000) (No.
11) and Casey et al. (1988) (No. 24) can be considered to be natural experiments in which
school placement was not determined by child characteristics but by geographical area. In one
more study, of Laws et al. (1995) (No. 18), no differences between settings in language,
memory and non-verbal cognitive development were found early in the school career of the
children with Down syndrome at age 4-10 years. At age 8-14 however, 6 out of 7 regularly
placed children and 1 out of 7 specially placed children had some reading abilities (on the
BAS). Finally, making a comparison with older almost totally segregated generations of
students with Down syndrome, both the study of Buckley, Bird, Sacks, et al. (2006) (No. 6)
and Bochner and Pieterse (1996) (No. 16) show a considerable advantage in academic skills
in the more recent cohorts of teenagers with Down syndrome, of which many had been in
regular education for most of their school career. The Buckley, Bird, Sacks, et al. (2006)
study demonstrates that this generational difference is totally explained by the higher level of
Gert de Graaf, Geert van Hove and Meindert Haveman
62
academic skills of the students with Down syndrome in regular educational settings in the
more recent cohort.
We may conclude that the differences in academic skills in favour of regularly placed
children with Down syndrome cannot be the result merely of selective placement in regular
schools of the more able children. It also is a direct result of more stimulation of academic
development in regular settings. Turner et al. (2008) (No. 2) and Sloper, Cunningham, et al.
(1990) (No. 22) found a modest beneficial effect on academic skills of mainstream
attendance. In the studies of de Graaf (2007b) (No. 5), Buckley, Bird, Sacks, et al. (2006)
(No. 6), Laws et al. (2000) (No. 11), Yadarola (1996) (No. 17) and Laws et al. (1995) (No.
18), even considerable advantages of regular placement on the development of academic
skills were demonstrated. Moreover, the beneficial effects of regular classroom placement
have been proven for diverse aspects of school learning, notably task-oriented behaviour
(Bronson et al., 1997 (Table 1, No. 15); Hauser-Cran and Bronson, 1993 (No. 19); Yadarola,
1996 (No. 17)), reading (Bochner, Outhred, and Pieterse, 2001 (No. 10); Buckley, Bird,
Sacks, et al., 2006 (No. 6); de Graaf, 2007b (No. 5); Laws et al., 2000 (No. 11); Laws et al.,
1995 (No.18); Lorenz et al., 1985 (No. 25); Philps, 1992 (No. 20); Sloper, Cunningham, et
al., 1990 (No. 22); Turner et al., 2008 (No. 2); Yadarola, 1996 (No. 17)), writing (Buckley,
Bird, Sacks, et al., 2006 (No. 6); de Graaf, 2007b (No. 5); Philps, 1992 (No. 20); Sloper,
Cunningham, et al., 1990 (No. 22); Turner et al., 2008 (No.2); Yadarola, 1996 (No.17)) and
math (Buckley, Bird, Sacks, et al., 2006 (No. 6); Casey et al, 1988 (No. 24); de Graaf, 2007b
(No. 5); Sloper, Cunningham, et al., 1990 (No. 22); Turner et al., 2008 (No. 2); Yadarola,
1996 (No. 17)).
Social Aspects
As regards social aspects, in eighteen studies (Table 1, No. 1, 3, 5-9, 12-17, 19-21, 23,
26), a comparison was made between regular and special placement. The results show a
mixed image.
In ten studies (Table 1, No. 1, 3, 6, 7, 12, 13, 14, 17, 21, 23), no significant differences
between settings were found in social aspects, notably regarding social skills (McMahon,
2003) (No. 7), gains in social skills (Fewell and Oelwein, 1990) (No. 21), social network
(Sloper, Turner, Knussen, and Cunningham, 1990) (No. 23), self-esteem (Begley, 1999 (No.
12); Gould, 1998 (No. 13); Vervat, 2008 (No. 3)), behavioural problems (Beadman, 1997
(No. 14); Buckley, Bird, Sacks, et al., 2006 (No. 6); McMahon, 2003 (No. 7)) and having a
close friend (Matthews, 2009) (No. 1). Additionally, in a study by Yadarola (1996) (No. 17),
teachers in special and regular primary education rated their students with Down syndrome
more or less similarly on social behaviour, peer interactions and acceptance, with the
exception that, in comparison with peers in special schools, peers in regular schools were
more highly rated on being protective towards their classmate with Down syndrome and on
helping the child with school work, a finding by Yadarola interpreted as a sign of a supportive
peer group in regular schools. In the study of Buckley, Bird, Sacks, et al. (2006) (No. 6),
specially placed students had significantly more behavioural problems on the Vineland
Adaptive Behaviour Scales, but not on the Conners Rating Scales. Furthermore, it is
important to note that most mainstreamed students with Down syndrome in the research of
Sloper, Turner, et al. (1990) (No. 23) were not in their neighbourhood school. This might
Effects of Regular Versus Special School Placement ...
63
explain why in this particular study regular placement didn’t lead to more opportunities for
playing with other children at home. As regards self-esteem, Glenn and Cunningham (2001)
state that for persons with Down syndrome the validity of the measure used, the Pictorial
Scale of Perceived Competence and Social Acceptance for Young Children, is doubtful. Too
many of them rate themselves positively by choosing the most positive answer instead of
really considering their own situation.
Eight studies (Table 1, No. 1, 5, 6, 15, 16, 17, 19, 20) demonstrated advantages of regular
classroom placement. As regards social mature behaviour, Bochner and Pieterse (1996) (No.
16), using parent questionnaires, reported more social mature behaviour in their recent cohort
of Australian teenagers with Down syndrome, of which more than half had been in regular
education for most of their school career, than in older more segregated cohorts. Buckley,
Bird, Sacks, et al. (2006) (No. 6) reported a similar difference between generations. In
addition, according to the parent questionnaire conducted on the more recent cohort in the
study of Buckley and colleagues, the regularly placed teenagers with Down syndrome had
more social mature behaviour than their specially placed counterparts (and less behavioural
problems according to the Vineland). As has been stated, in this particular study placement
was not determined by child characteristics but by differences in educational policy in
different geographical areas. Furthermore, Bronson et al. (1997) (No. 15) and Hauser-Cran
and Bronson (1993) (No. 19) demonstrated in a study of respectively 115 and 148
preschoolers with developmental disabilities (one third Down syndrome) that social mature
behaviour (using more adequate social strategies), and task-oriented behaviour as well, was
higher in more integrated settings, also after controlling for cognitive ability of the child and
demographic and socio-economic characteristics of the family. Philps (1992) (No. 20)
reported that the children with Down syndrome in mainstream took part in more interactions
at playtime than those in schools for children with Moderate Learning Difficulties (MLD).
Based on observations, Yadarola (1996) (No. 17) reported that during recess in the special
schools the social climate tended to be either one of poor control of aggression, with not
enough surveillance by staff, resulting in aggressive behaviour in some children and fear in
others, or one of overprotection, resulting in children mostly interacting with staff instead of
peers. In the regular schools, social climate was more balanced, promoting positive
interaction with peers. Although some of the children with Down syndrome in regular schools
encountered overprotection by teachers and peers (actually more often than in special
schools), this didn’t result in an overall overprotective climate during recess. As regards
social network, on the basis of parent questionnaires, de Graaf (2007a) (No. 5) reported that
regularly placed students with Down syndrome had more opportunities for playing with other
children (not siblings) at home than their specially placed counterparts, also after correcting
for differences in non-academic skills. Furthermore, students in regular education more often
had a friend without a disability, a result not only found by de Graaf (2007a) but by Matthews
(2009) (No. 1) as well. In addition, in Matthew’s study regularly placed children more often
participated in social activities in clubs and they were more frequently rated as speaking to
many people during social activities.
In six studies (Table 1, No. 5, 6, 8, 9, 20, 26) a disadvantage of regular placement was
reported. Four of these studies (No. 5, 6, 8, 17) made use of questionnaires and/or interviews
with students, parents and/or teachers. We firstly discuss the findings from these studies. In
comparison with specially placed teenagers, regularly placed teenagers with Down syndrome
had less opportunities for friendships with other peers with a developmental disability and as
Gert de Graaf, Geert van Hove and Meindert Haveman
64
a result for the development of equal close friendships at school (Buckley, Bird, Sacks, et al.,
2006 (No. 6); Cuckle and Wilson, 2002 (No. 8)). De Graaf (2007a) (No. 5) confirmed this
finding for children with Down syndrome in primary education. However, it is important to
note that, although specially placed students with Down syndrome had more opportunities for
developing equal close friendships at school, these friendships seldom continued into the
home situation (Cuckle and Wilson, 2002; de Graaf, 2007a), partly as a consequence of
limited transport skills of the children and teenagers involved. Barriers to participation in
leisure activities, according to a study of Matthews (2009) (No. 1) were not having a friend to
go with, followed by not knowing how to do activities, not having a place nearby and not
having a way to get there. Indeed, many parents of teenagers with Down syndrome (Bochner
and Pieterse, 1996 (No. 16); Buckley, Bird, Sacks, et al., 2006 (No. 6); Cuckle and Wilson,
2002 (No. 8)) worry about the relative social isolation of their child. Consequently, Cuckle
and Wilson conclude that parents of children with Down syndrome should continue helping
organize the social life of their child, long after the child has reached an age at which for
children without Down syndrome there no longer is a need to do such.
Three other studies (Table 1, No. 9, 20, 26) made use of direct observation of
interactions. Sinson and Wetherick (1981) (No. 26) videotaped the interactions of seven
children with Down syndrome in a special preschool setting and of three of these children in a
regular playgroup. In the regular playgroup situation, the children without a disability, on first
encounter, attempted to make eye-contact with the children with Down syndrome. During this
encounter, the children without a disability became increasingly uneasy, having no success in
sustaining mutual gaze. Observations of the three children with Down syndrome in their
regular playgroups over a period of two years indicated that the other children eventually
gave up and the children with Down syndrome became isolates. In the special setting,
however, the children with Down syndrome interacted with each other in much the same way
as the children without a disability in the regular playgroup. There was ample evidence of
mutual gaze as a precursor of verbal and play interactions. Sinson and Wetherick, clearly
conceptualising from the deficit model of disability, suggest that children with Down
syndrome have a deficit, demonstrated by untypical mutual gaze behaviour, directly leading
to their isolation from typical peers. However, in another related article, Sinson and
Wetherick (1986) state that interactions of the children with Down syndrome with their
mothers, and with their siblings as well, were not affected. They conclude that the prevailing
method of simply introducing a child with Down syndrome into an unknown preschool peer
group unlikely will lead to successful social integration. On the other hand, according to
Sinson and Wetherick (1986), prolonged contacts with peers in a family play situation with
mothers present, from an early age, probably support social integration. The value of the
study by Sinson and Wetherick is in demonstrating that social inclusion is not reached by
mere placement without any support. However, Sinson and Wetherick fail to consider the
possibility that not only mothers in a family play situation, but educators in preschool settings
as well, have an opportunity to model and foster social interactions between children with and
without disabilities.
Freeman and Kasari (2002) (No. 9) studied the interactions of dyads of children in play-
date situations. Participants were 54 children, 27 with Down syndrome and 27 who were their
chosen friend (the parents were asked to bring a friend of the child with Down syndrome to
the play-date). In comparison with children with Down syndrome from regular education
classes, children with Down syndrome from special education classes were rated as more
Effects of Regular Versus Special School Placement ...
65
cohesive and coordinated in their quality of play and they spent more time in simple social
play and less time in solitary, parallel or parallel aware play. The children from general and
special education were not different on demographic and developmental characteristics. This
suggests that during these organised play-dates the interactions of the children with Down
syndrome with their chosen friend more often displayed the characteristics of a close
friendship (instead of just being playmates) if the child with Down syndrome was from a
special school.
As regards another qualitative aspect of interaction, Philps (1992) (No. 20) conclude that,
although children with Down syndrome in mainstream took part in more interactions at
playtime than those in MLD, when initiations of language were examined it was clear that all
the children initiated more language when they were in the company of younger or less able
peers. This kind of setting occurred more often in MLD schools than in mainstream, except
where children played with younger children at playtime in mainstream settings. In order to
stimulate more language initiations, Philps suggest that children with Down syndrome in
regular education should deliberately be put in the role of leader on occasions, instead of
being in a situation with more able peers all the time.
Non-Comparative Studies on Social Aspects
In addition to these comparative studies, in 27 other non-comparative studies (Table 2),
the acceptance of regularly placed children with Down syndrome by their classmates was
evaluated.
Sixteen of these studies (Table 2, No. 29, 30-32, 35, 36, 38, 39, 41, 43-45, 46, 49, 50, 53)
evaluated acceptance by exploring the perceptions of classmates, parents, teachers and/or
head teachers. Regularly placed children with Down syndrome are generally fairly well
accepted by their peers, according to sociometric evaluations (Commodari and Pirrone, 2004
(Table 2, No. 35); Hudson and Clunies-Ross, 1984 (No. 49); Laws et al., 1996 (No. 44);
Pieterse and Center, 1984 (No. 50); Scheepstra, 1998 (No. 43)) and questionnaires and/or
interviews with parents, teachers and/or head teachers (Castro, 2007 (Table 2, No. 30);
Gheradini, 2000 (No. 39); de Graaf, 1998 (No. 41), 2001 (No. 38), 2006 (No. 32); Hudson
and Clunies-Ross, 1984 (No. 49); Klompas, 2008 (No. 29); Petley, 1993 (No. 46); Pieterse
and Center, 1984 (No. 50); Scheepstra, 1998 (No. 43); Schramm, 1974 (No. 53); Shevlin,
Walsh, Kenny, McNeela, and Molloy, 2003 (No. 36); Wilson, 2007 (No. 31); Wolpert, 1996
(No. 45)). In addition, the study of Wilson (2007) (No. 31) shows that children with Down
syndrome in regular education positively evaluate their acceptance by peers, rating
themselves higher than children with general developmental delay (not Down syndrome), and
even higher than children without a disability.
However, whereas the children in four of the sociometric studies had a generally high
level of peer acceptance, in the research of Scheepstra (No. 35), though only one child had a
‘rejected’ sociometric status, 12 out of 23 children (6-8 years of age) had a ‘neglectedstatus.
Children with a ‘neglected’ status are not actively disliked or avoided, but they are less often
chosen as preferred playmate. Furthermore, while in the study of Laws et al. (1996) (No. 44),
considering all six sociometric questions, most children with Down syndrome (8-11 years of
age) had an average social status, they were definitively less often seen as ‘best’ friend by
classmates. It is important to realize that sociometric results are dependent upon the exact
Gert de Graaf, Geert van Hove and Meindert Haveman
66
content of the questions posed to children. From the sociometric study of Commodari and
Pirrone (No. 35) in Italian middle school, it appears that children with Down syndrome
frequently would be invited to birthday parties by classmates, however were more likely to be
excluded from activities involving a certain degree of ability, like doing schoolwork together
or joining a sport team. Commodari and Pirrone conclude that in middle school students
without disabilities accept classmates with Down syndrome, but in practice during many
school and leisure related activities prefer to socialise with peers without disabilities.
In addition, parents interviewed by de Graaf (1998) (No. 41) reported that in regular
school their child’s contacts with classmates gradually changed from interactions based on
equality in preschool to interactions that resemble a relationship with an older sibling towards
the end of primary school. Both headmasters and parents in the study of Petley (1993) (No.
46) recognized the risk of relationships in which the child is mollycoddled’ by classmates
and not treated with equal respect. According to Wilson (2007) (No. 31), school staff
interviewed sometimes overestimated the degree of acceptance of children with Down
syndrome by their peers, not recognizing the difference between supportive relationships and
equal status relationships. Parents and teacher in the study of Klompas (2008) (No. 29)
reported that the three children with Down syndrome (8-12 years of age) in this study,
although well accepted, lacked reciprocal friendships. Therefore, parents of, particularly
older, regularly placed students with Down syndrome should be advised to organize contacts
also with peers with a disability, supplementary to the relations their child has with children
without a disability. However, one could make a strong case to do just as well in the case of
specially placed students, because the parents report that their special friendships with
classmates are often confined to only the school hours (de Graaf, 2007a; Cuckle and Wilson,
2002) (Table 1 No. 5 and 8). Moreover, from the study of de Graaf (2007a) it is clear that
specially placed children also have a larger chance of not having any friendship at all with
children without a disability.
In another study (Guralnick, Connor, and Johnson, 2009) (Table 2, No. 28), acceptance
by preschool peers was approached in a more indirect way, not through directly informing
about peer acceptance in preschool, but asking mothers about the home-based social network
of their child. In comparison with two control groups, a calendar age matched group and a
mental age matched group, children with Down syndrome had a significantly smaller network
size (mother-identified regular playmates, maximum of 5 children) and a less high frequency
with which playmates played in mother’s home in the previous 3 months. In addition, a
smaller percentage of identified playmates were currently in the school program of the child
with Down syndrome. Only around one third of the children with Down syndrome knew any
of their playmates as a result of being classmates, whereas this was the case for nearly two
thirds and over three quarters of the MA-match and CA-match groups, respectively.
Guralnick et al. suggest that a major contributor to these peer social network limitations may
well be underlying peer-related social competence difficulties in children with Down
syndrome.
In twelve studies (Table 2, No. 27, 33, 34, 37, 38, 42, 43, 47, 48, 49, 51, 52), researchers
explored acceptance by peers making (also) use of direct observation of interactions. An early
study is by Rogers-Warren, Ruggles, Peterson, and Cooper (1980) (No. 52). In a
mainstreamed preschool setting with 60 percent children with a disability, four 5-6 years old
children with Down syndrome and four typically developing contrast children were observed.
The children with Down syndrome and the contrast children preferred the same play areas in
Effects of Regular Versus Special School Placement ...
67
the classroom and in the playground. The children with Down syndrome had a higher
frequency of solitary play, the contrast children a higher frequency of parallel play. The
children with Down syndrome tended to play more often with other children with a disability.
The contrast children more often chose to play with peers without a disability. However,
interaction between children with Down syndrome and children without a disability occurred
in all activities.
Eleven studies (Table 2, No. 27, 33, 34, 37, 38, 42, 43, 47, 48, 49, 51) focussed on
individual inclusion with only one child with Down syndrome being included in a regular
preschool or school. As we have seen in the previous section, Sinson and Wetherick (1981)
(Table 1, No. 26) suggest that children with Down syndrome over time almost inevitably will
become more and more isolated in regular preschool and school settings. In a recent study by
Hamilton (2005) (Table 2, No. 33) a more or less similar result was found. Compared with
typically developing preschool children, children with Down syndrome in inclusive preschool
displayed infrequent interactions with peers. While typically developing children increased
their peer interactions during activities expected to promote peer interaction (for instance
during playtime), the interactive engagement of the children with Down syndrome was
unrelated to the characteristics of class activities. Longitudinally, over a period of two years,
in contrast to the typically developing children, children with Down syndrome did not
increase their rates of peer interaction. Informal observations revealed that teachers in this
study didn’t use effective strategies to enhance peer interaction in children with Down
syndrome. Hamilton concludes that their implicit strategy of only prompting children to be in
physical proximity to other children, without actually encouraging interactive engagement,
should be supplemented by explicit teaching strategies, like designing activities that require
group interaction among children and adults, prompting and reinforcing peer interaction,
modelling interactive behaviour, and interpreting for the typically developing children the
meaning of the social behaviour of the children with disabilities.
Some other studies contradict the suggestion of Sinson and Wetherick that children with
Down syndrome over time almost inevitably will become more and more isolated in regular
preschool and school settings. Knox (1983) (Table 2, No. 51) observed six children with
Down syndrome (3-7 years of age, two in preschool and four in school). During the 9 week
observation period, the children with Down syndrome increased both their use of language to
initiate interactions with peers as well as their responding to verbal directions by peers.
Hudson and Clunies-Ross (1984) (No. 49) found no differences in the rates of positive and
negative peer interactions of 11 regularly placed school children with Down syndrome (6-8
years of age) in comparison with 11 randomly selected contrast children from their
classrooms. However, the children with Down syndrome initiated fewer interactions with
peers than the typically developing contrast children.
This last result, less initiations to peers, was found in three other studies as well (Quail,
2000 (Table 2, No. 40); Rietveld, 1986 (No. 48); Scheepstra, 1998 (No. 43)). Quail (2000)
(No. 40) carried out a study of the social interactions of 7 teenagers with Down syndrome in
mainstream secondary schools in comparison to peers from the same classrooms. There were
no differences in overall time spent in interaction. However, the other person more often
initiated the interactions of the teenagers with Down syndrome and they had more
interactions with adults than with peers. Topics in the conversations of the teenagers with
Down syndrome were likely to be work related rather than socially related. In this specific
study, these patterns of interactions might partly be the result of the fact that the teenagers
Gert de Graaf, Geert van Hove and Meindert Haveman
68
were being supported by a Learning Support Assistant for most of the day. However,
comparing 23 children with Down syndrome (6-8 years of age), in the Dutch situation with
only a limited amount of support a week (8 hours), with 23 low achieving contrast children
from the same classrooms, Scheepstra (1998) (No. 43) (also reported in Scheepstra, Nakken,
and Pijl, 1999; and in Pijl and Scheepstra, 1996) observed fewer interactions with peers, more
interactions with the teacher, fewer initiations to peers, and more work related and less
socially related interactions by the children with Down syndrome. Finally, Rietveld (1986)
(No. 48) compared eight children with Down syndrome (6-7 years of age) with eight low
achieving contrast children from their classrooms. There were no differences in the rates of
social play. However, the children with Down syndrome initiated fewer interactions to peers.
Interestingly, Rietveld (1989) (No. 47) carried out a follow-up study of six of these children
with Down syndrome, now 9-11 years of age. In comparison with the first study, she
observed in the children with Down syndrome more initiations to peers and from peers and
less interactions with the teacher. Also, a higher percentage of time was spent in social play
and the interactions were more complex and varied with more advanced language.
Remarkably, the difference between the children with Down syndrome and the contrast
children in the rate of initiating to peers had disappeared.
Four studies (Dolva, 2009 (Table 2, No. 27); Kliewer, 1998a;b (No. 42); Rietveld, 2002
(No. 37); Solorzano Arriaga, 2005 (No. 34)) made use of a more qualitative interpretative
methodology. By in depth exploration of small samples, this kind of research can cast light
upon the complexities of the inclusion process and the role of the cultural and educational
context. Dolva (2009) (No. 27) studied six students with Down syndrome in inclusive
schools, in the classroom and in the playground, collecting data through field observations
and interviewing the child and the staff. The children with Down syndrome were well
accepted by peers. Dolva observed examples of equal interactions in which all children
participating understood the activity and could interact on a rather equal basis. However more
often she observed unequal interactions, with limited understanding of the activity by the
child with Down syndrome and/or involving tasks that at first were too difficult. In these
situations peers spontaneously divided tasks in a complementary way, or they adjusted tasks
or own behaviour or created other tasks in order to include the pupil with Down syndrome
without losing the original meaning of the activity. Class staff members were found to
experience interaction between students with Down syndrome and peers challenging, but still
possible because of peers’ acceptance. Staff applied different strategies to facilitate peer
interaction, for example: organising academic activities and group work; purposefully
selecting tasks and pairing children to work together; educating peers to behave supportively;
providing individual support to help the child to understand activities and scaffolding
participation. Solorzano Arriga (2005) (No. 34) studied the social development of five girls
with Down syndrome in two Guatemalan (non-special) private schools. She concludes that
social integration in the schools should be supported by making curricular adaptations and
that families can play an important role in preparing their child with Down syndrome for
school integration by systematically stimulating the child’s development form an early age
onwards. Kliewer (1998a;b) (No. 42) explored the (pre)school literacy experience of 10
students with Down syndrome. Two broad definitions of literacy were uncovered. The first
regarded reading as confirming to a hierarchy of sub-skills. In these classrooms students with
Down syndrome were separated from citizenship in the classrooms’ literate communities. The
second regarded reading as the construction of shared meaning in specific contexts. In these
Effects of Regular Versus Special School Placement ...
69
classrooms, students with Down syndrome were valued as symbolic beings and engaged
literacy as a communication tool. As a result, during the school day, there were more
opportunities for participation and for demonstrating friendship. According to Kliewer, the
first definition of literacy seems to be more in line with a deficit model of disability,
interpreting difference as deficit, the second with the social model. Both Kliewer (No. 42) and
Rietveld (2002) (No. 37) (also reported in Rietveld, 2008) highlight the consequences of the
way staff conceptualises disability. Rietveld carried out an in depth study of the experiences
of four boys, two with Down syndrome and two typically developing, during their transition
from preschool to school. The children were observed using continuous narrative recordings
during all aspects of the curriculum in preschool and in school. Teachers, parents and peers
were interviewed. Inclusion or exclusion turned out not to be within-child characteristics, but
largely dependent on the context, both for the children with and without Down syndrome,
demonstrated by the huge changes in the extent of inclusion between the preschool and school
setting for two of the boys. In one of the schools, staff modelled that it was acceptable to
exclude when ‘deviant’ children did not fit the existing implicit or explicit classroom rules.
Also, teacher and teacher-aide positively reinforced children when they assigned the child
with Down syndrome an inferior status role, for instance the role of ‘the object of a
caregiver’. By contrast, in another school the teacher openly interpreted the likely intent of
any unconventional behaviour in a positive and valuing manner. Furthermore, she included
activities that highlighted the competencies and interests of her student with Down syndrome
in a way that made the overall class culture more inclusive for many more children. The
teacher and teacher-aide recognised and interrupted demeaning inclusion, e.g. excessive
hugging, picking up. The staff scaffolded children to re-frame any problems they interpreted
within a deficit framework to one that focussed on context. Successful outcomes of inclusion
were associated with schools embracing at all levels a social model of disability, that focuses
on the context and sees disability as a part of, not distinct from that context.
Conclusion
In the period 1970-2010, the context of regular placement of pupils with Down syndrome
has changed from integration, to mainstreaming, to inclusive education. As a result, the way
children with Down syndrome are supported in regular schools may have shifted over time.
Furthermore, the organisation and curriculum of special schools for children with Down
syndrome may have changed. In addition, also differences between countries in these regards
may and probably will exist. The evidence found in this 40-year period of research is limited
to twelve different countries, or regarding only comparative studies to only six countries. As
regard the beneficial effect of regular schooling on, particularly, academic and language
development of children with Down syndrome, despite these cultural, organisational and
educational differences between these countries, the findings of the studies in this review
converge to a considerable extent. This suggests that, even with these differences, there are
sufficient similarities in the organisation and curriculum of special schools for children with
Down syndrome and in the support of regularly placed pupils with Down syndrome over time
and between different countries - at least between the countries from which the studies are
derived - to make a review of research a sensible enterprise. For instance, starting in the mid
Gert de Graaf, Geert van Hove and Meindert Haveman
70
1980s and in many different countries, regular schooling for pupils with Down syndrome
means education in a regular classroom with individual support to some extent. Furthermore,
one could argue that special schools for children with Down syndrome, worldwide, will tend
to focus more on practical and social skill acquisition, and as a result probably be liable to de-
emphasise academic skill acquisition.
From our review it can be concluded that regular placement of students with Down
syndrome, i.e. education in a regular classroom with individual support to some extent, yields
a better development of language and academic skills, even after the effect of selective
placement has been taken into account. In some of the studies a modest beneficial effect could
be proven, in other studies even considerable advantages of regular placement on the
development of language and academic skills were demonstrated. As regards self-help skills,
under the same condition, there seem to be no differences.
As regards social functioning, the results show a mixed image. For some social aspects
(social network, behaviour, self-competence) no differences at all or small positive
differences for regularly placed children were found. However, studies also highlight that for
many children with Down syndrome, mere placement in a regular setting without any support
might not be enough. Social interactions between children with and without Down syndrome
oftentimes need to be modelled and fostered. In addition, to get around the tendency of many
children with Down syndrome in regular settings to respond to initiations of others rather than
initiate to peers themselves, it is also advised to put children with Down syndrome sometimes
in a leading position. Two qualitative studies suggest that in schools embracing a social
model of disability, rather than a deficit model, the necessary social support to facilitate both
more interactions, as well as more reciprocity and equal status in these interactions, seems to
be more likely available. Furthermore, although regularly placed children are generally fairly
well accepted by their peers, they are less often seen as ‘best’ friend. In addition, regularly
placed teenagers with Down syndrome have fewer opportunities for friendships with other
peers with a developmental disability and, as a result, for the development of equal close
friendships at school. Therefore, parents of, particularly older, regularly placed students with
Down syndrome should be advised to organize contacts also with peers with a disability,
supplementary to the relations their child has with children without a disability. However, one
could make a strong case to do just as well in the case of specially placed students, because
the parents report that their special friendships with classmates are often confined to only the
school hours.
It is important to mention the fact that in research on the effect of school placement, IQ
and/or mental age usually are conceptualised as independent variables, i.e. control variables
in determining the effect of placement on development, and not as dependent variables.
However, it is conceivable that intelligence, aside of being a factor in determining placement,
itself also might be directly influenced by school experience. In that case, cross-sectional
studies in which IQ and/or mental age are used as control variables might underestimate the
positive effect of regular placement on academic and language development. In a study by
Rao (1997) on 6 preschoolers with Down syndrome, all attending a centre-based educational
intervention program for three mornings a week, 3 of these children also attended regular
preschools, two days a week. The researchers compared the children in the Program Only
group with those in the Program Plus Preschool group. At the start of the study, both the
mother’s educational level and the child’s IQ, chronological age and mental age were similar
in both groups. A year later, the IQ of all 3 children in the Program Only group had decreased
Effects of Regular Versus Special School Placement ...
71
(on average minus 6 points, range from minus 3 to minus 10). The change in IQ scores for
children in the Program Plus Preschool group was less dramatic (on average plus 1 point,
range from minus 1 to plus 2). This study does not demonstrate the superiority of regular
preschool placement in comparison to special preschool placement, because the 3 children not
in regular preschool actually stayed at home on the days they didn’t visit the special
educational centre. However, acknowledging that the sample size was very small, the study
does suggest that the development of IQ might be influenced by preschool experience. In
earlier decades, debate was fierce on the question whether children with Down syndrome
institutionalised at an early age had lower IQ’s than home-reared children as a result of
institutionalisation or as a result of being ‘constitutionally inferior in intelligence’ (Carr,
1988). Carr (1988), in her review of four decades of studies on IQ of children with Down
syndrome, concludes that the evidence offers very little support for the constitutional
inferiority hypothesis. The alternative hypothesis, that the difference between home- and
institution-reared children is due to environmental influence, according to Carr, not only
accounts more simply for the facts, but is also in accord with the effects on these children of
environmental enrichment. This debate might be relevant to the present discourse on the
effects of school placement. Firstly, we encounter the same issue of disentangling the effect
of selective placement from the effect of differences in stimulation between settings.
Secondly, the former debate shows that IQ should be considered as a dependent variable, a
variable that is influenced by experience and thus possibly by school experience as well. In
this regard, Vianello and Moalli (2001) (Table 3, No. 93) and Gheradini (2000) (Table 2, No.
39) make the interesting suggestion that school aged children with Down syndrome in the
Italian educational system, as a result of inclusion, might have a higher mean IQ than usually
found in international research (according to Vianello and Moalli with an average IQ of 45
for Italian subjects and less than 40 for others); however, in both articles this hypothesis is not
supported by a thorough analysis of different international studies. Nevertheless, although
methodologically very complex, the suggestion of comparing the cognitive development of
children with Down syndrome in different countries, contrasting inclusive educational
systems with more segregated systems, could be an avenue for future research. Alternatively,
in countries where some children with Down syndrome go to regular schools and others to
special schools, another avenue could be following-up representative groups of children with
Down syndrome throughout their school career, not only repeatedly measuring their skills,
but also their mental age at different chronological ages.
Apart from studying the potential effect of an inclusive school system on mean total IQ in
children with Down syndrome, Vianello and Lanfranchi (2001) (Table 3, No. 61) suggest that
it might be interesting to look at their profile of development. Vianello and Lanfranchi
present two Italian studies, one on mental age and academic development in school-aged
children with Down syndrome, and one on intellectual level and scores on daily activities and
socialization in adolescents with Down syndrome. Both studies show that in many cases the
age-equivalent of specific skills (academics, especially reading; daily living skills; social
skills) is higher than the age-equivalent of mental development. According to Vianello and
Lanfranchi, this ‘surplus’ is not usually found in international research and might be the result
of inclusive education. However, this hypothesis is not supported by a thorough analysis of
different international studies. Vianello and Lanfranchi only refer to research of Zigler and
colleagues over a period of 40 years, stating that persons with a intellectual disability
oftentimes demonstrate a ‘deficit’ in skills in respect to their mental age, as a result of having
Gert de Graaf, Geert van Hove and Meindert Haveman
72
less motivation to work and having less self-esteem. However, firstly, this research was not
Down syndrome specific, secondly the personality and motivational characteristics of the
persons in Zigler’s research might have been influenced by institutionalisation. Vianello and
Lanfranchi conclude that, in their article they have formulated more questions than generated
answers. The affirmation that ‘surplus’ in academic and social performance seems to be
greater where academic inclusion of persons with a disability is more widespread, is still a
hypothesis to confirm. However, the study of Buckley, Bird, Sacks, et al. (2006) (Table 1,
No. 6) is in agreement with the hypothesis that education can influence the developmental
profile. In a paper accompanying their study, titled ‘Evidence that we can change the profile
from a study of inclusive education’, Buckley, Bird, and Sacks (2006) conclude that the
Down syndrome specific profile a profile of communication weaknesses relative to social
and daily living skills can be changed. It is not an inevitable outcome of having Down
syndrome, as this profile is seen in teenagers in special education settings, but not in
teenagers in inclusive education.
As regards the beneficial effect of regular classroom placement on language develop-
ment, different mechanisms might play a role. Firstly, the regular classroom seems to be a
richer language environment, with more challenging language being used by teaching staff, as
a small explorative UK study of Dew-Hughes and Blandford (1998) (Table 3, No. 103)
suggests. Based on observations, these researchers reported that classroom language was less
sophisticated in the special schools. Language was simple and direct, allowing for compre-
hension by the less fluent members of the class. In mainstream schools, language was more
challenging. Secondly, peers in a regular classroom will most certainly be behavioural
examples using more complex language than those in a special classroom. Yadarola (1996)
(Table 1, No. 17) reported that the children with Down syndrome in Argentinean special
education were surrounded by peers who mostly used signs and/or very short-spoken
utterances for communication, whereas peers in regular school used more complex language.
As a result, children with Down syndrome in regular schools were invited and encouraged to
understand and use more complex language themselves, whereas in special schools the
children with Down syndrome adapted to the special-school-specific communication culture
of signing and using simple phrases. Finally, more emphasis on academic skills in regular
classrooms, especially on reading activities, might foster understanding and use of more
complex language.
Only a very limited amount of research has been done on the reasons why regular school
placement, i.e. education in a regular classroom with individual support to some extent, leads
to better academic skills in children with Down syndrome. Lorenz et al. (1985) (Table 1, No.
25) start with denying the contention that most children with Down syndrome in special
schools are not taught to read, as in their birth cohort of children with Down syndrome, 38
percent of teachers from the schools for children with Severe Learning Difficulties reported to
teach reading to the children with Down syndrome and another 33 percent reported to teach
prereading skills. However, Lorenz et al. state that their data suggest that when children with
Down syndrome at a three- to five-year-level are matched for mental age, those in regular
schools score highest on a checklist of reading skills and those in schools for children with
Severe Learning Difficulties score lowest. Lorenz et al. suggest that an explanation might be
that in the special school curriculum there is a greater emphasis on the development of
prerequisites, including fine motor and language skills, before reading is taught, resulting in
an unnecessary postponement from prereading to reading activities. The point at which
Effects of Regular Versus Special School Placement ...
73
teachers move pupils from prereading to reading activities may be important in the
acquisition of reading skills. Furthermore, according to Lorenz et al., studies on teachers’
aims suggest that teachers in special schools generally place much less emphasis on reading
skills compared to teachers in regular primary schools. These findings are corroborated by
both the cross-sectional and longitudinal research of Yadarola (1996) (Table 1, No. 17). In
this study, teachers from special schools placed less emphasis on academic skill development.
The transfer from teaching prerequisites to teaching reading, writing and math, was
postponed. Most children with Down syndrome at age 9 and 10 in the Argentinean special
schools had not yet been exposed to any instruction at all in reading, writing or math.
Teachers in special schools strongly believed that before starting instruction in academics,
certain prerequisite skills should have been developed. In sharp contrast, in regular schools,
the onset of teaching these skills to children with Down syndrome usually was around the age
of 5 or 6. In addition, two small explorative UK studies, of Beadman (1997) (Table 1, No. 14)
and Dew-Hughes and Blandford (1998) (Table 3, No. 103), report that in special schools most
teacher time was devoted to the least able children in the classroom. Effective teaching time
was greatly reduced as a result of time spent on transport, physical care regimes, therapies
and slower-moving members of the group. The teaching staff in special schools had lower
expectations for academic achievement of their students with Down syndrome than teaching
staff in mainstream schools. In special schools, classrooms were generally poorly equipped
with reading materials and schemes. Furthermore, in regular school students with Down
syndrome received more individual instruction time (in the UK half to fulltime personal
assistance is quite common for mainstreamed children with Down syndrome). Also in the
study of Philps (1992) it turned out that there was a significantly greater time spent in one to
one work in mainstream than in the MLD schools studied. The Dutch research of de Graaf
(2007b) confirms that in the Netherlands as well, although regular schools receive less money
for extra assistance time for a student with Down syndrome than in the UK (in the
Netherlands on average 4 to 8 hours extra teacher’s time a week), students with Down
syndrome still receive more individual instruction time in regular schools than in special
schools. In addition, it was demonstrated that in regular schools children with Down
syndrome on average spent one and a half to twice as much time on academic learning than in
special schools.
Regular placement of students with Down syndrome has a beneficial effect on language
and academic skills. However, it is important to note that merely regular placement is not
enough. In the different studies regular placement means placement in a regular classroom
with individual support to some extent, though varying between countries and regions and
between individual students. Cunningham et al. (1998) and Cuckle (1997) demonstrate that in
the nineties in the UK huge local differences existed in the extent to which students with
Down syndrome started their school career in regular schools and in the extent to which they
stayed in regular education to at least the end of primary education. These differences must be
the result of varying local educational policies, probably with as a result differences in
support of mainstreamed children with Down syndrome. So, an important question is what
amount and kind of support is needed in order to make regular placement feasible for
individual children with Down syndrome. In the Netherlands, according to de Graaf (2007a),
approximately 56 percent of all children with Down syndrome from the years of birth 1993-
2000 started their school career in regular education. Of children with Down syndrome who
started their school career at a regular school slightly more than 40 percent continued in
Gert de Graaf, Geert van Hove and Meindert Haveman
74
regular education for the entire elementary school period. This implies that transferring
mainstreamed children with Down syndrome to special school during the elementary years is
quite common. Again, this points at the question what amount and kind of support is needed
to make regular placement feasible for individual children with Down syndrome. Only a very
limited amount of research has been done on the question why the regular school career of
some children with Down syndrome comes to an early end while others continue in regular
education for the entire elementary school period. From the few (Dutch) systematic studies
(de Graaf, 2006, 2007a; Poulisse, 2002; Scheepstra, 1998) it can be concluded that not only
child characteristics but also school characteristics determine whether a child with Down
syndrome will succeed or not in regular education. Some schools succeed in providing
inclusive education for very challenging children. De Graaf (2006) investigated twenty cases
of ‘problematic integration situations’. These included 13 children with Down syndrome
whose regular school placement was in danger at that moment, 4 children who were only
recently placed in a special school after one or more years of regular education and 3 children
who had just started anew at another regular school after being sent away from their first
regular school. In each case, parents, teaching staff from the regular school, and counsellors
from special education (who advise the regular schools) were interviewed about their
perceptions of why a ‘problematic integration situation’ had emerged. In relation to school
characteristics, according to parents and counsellors from special education, differences in
staff attitude and school vision on inclusion, and according to parents, counsellors and regular
teachers alike, the way teachers, assistants, counsellors and parents manage to work together
determine whether a child will succeed or not at a certain regular school. However, this
important issue deserves a more elaborate analysis which is beyond the scope of this review.
It is important to note that research on the effects of inclusive education on children
without disabilities shows that regular classroom placement of students with disabilities has
no negative impact on the development of classmates (Cole, Waldron, and Majd, 2004; Hunt
and Goetz, 1997; Hollowood, Salisbury, Rainforth, and Palombaro, 1994; Manset and
Semmel, 1997; McDonnell, Thorson, McQuivey, and Kiefer-O'Donnell, 1997; McIntosh,
Vaughn, Schumm, Haager, and Lee, 1993; Saint-Laurent et al., 1998; Salend and Garrick
Duhaney, 1999; Sharpe, York, and Knight, 1994; Staub, 2005; Staub and Peck, 1994/95;
Waldron and Cole, 2000). According to some studies, it even brings them positive social
advantages like more pro-social behaviour (Allodi, 2002; Hunt and Goetz, 1997; York,
Vandercook, Macdonald, Heise-Neff, and Caughey, 1992), better moral development (Dumke
and Mergenschröer, 1990; Staub, 2005; Staub and Peck, 1994/95; York et al., 1992) and a
more accepting and less stereotyping attitude toward persons with disabilities (Fisher, 1999;
Lehrer, 1983; Salend and Garrick Duhaney, 1999; Scheepstra, 1998; Staub, 2005; Staub and
Peck, 1994/95; York et al., 1992) and towards persons from other minorities (Fisher, 1999;
Kishi and Meyer, 1994; Staub, 2005; Staub and Peck, 1994/95).
In the light of the proven advantages of regular placement for the development of
language and academics, more opportunities for inclusion of children with Down syndrome in
regular classrooms should be created. Besides this, inside the special schools children with
Down syndrome should receive more attention in regard to the teaching of academic skills.
We acknowledge that children with Down syndrome are not a homogenous group. Turner and
Alborz (2003) rightly argue that a small percentage of children with Down syndrome are
unable to achieve any significant level of literacy or numeracy and that the needs of these
children should not be overlooked by placing too much emphasis on academics. However,
Effects of Regular Versus Special School Placement ...
75
presently, for the vast majority of children with Down syndrome in special schools often too
much of their learning potential in this area remains unused. Furthermore, social interactions
with other children, at school and outside school hours, for many children with Down
syndrome need to be organized and supported deliberately. This is independent of the school
type the child is going to. Finally, embracing a social model of disability, rather than a deficit
model, seems to be facilitative for social inclusion.
Acknowledgment
The authors wish to express their thanks to Emma de Moel, who corrected the English.
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