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Autism and the right to education in the EU: policy mapping and scoping review of Nordic countries Denmark, Finland, and Sweden

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Introduction: The universal right to education for people with disabilities has been highlighted by the Universal Declaration on Human Rights and the Convention on the Rights of Persons with Disabilities. In this paper, we mapped policies addressing the right to education and special education needs of autistic children in Denmark, Sweden, and Finland. Methods: A policy path analysis was carried out using a scoping review as an underlying framework for data gathering. Policy mapping was performed independently by both lead authors to increase reliability. Results and discussion: The values of the Universal Declaration of Human Rights and the Convention on the Rights of Persons with Disabilities have been closely translated into the respective education systems of the countries under study, offering special education needs services and support in mainstream education with the aim of including as many children into mainstream education as possible. Even though the education systems are comparable, the approaches between the countries under study are slightly different. Denmark and Sweden have passed several policies specifically geared towards special education needs, while Finland incorporates this more in general education policy. Conclusion: All countries under study have incorporated the values of the Universal Declaration of Human Rights and the Convention on the Rights of Persons with Disabilities in their respective education systems while emphasising the need to include as many children in the mainstream system as possible.
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R E S E A R C H Open Access
Autism and the right to education in the
EU: policy mapping and scoping review
of Nordic countries Denmark, Finland,
and Sweden
Robin van Kessel
1
, Sebastian Walsh
2
, Amber N. V. Ruigrok
3
, Rosemary Holt
3
, Anneli Yliherva
4
, Eija Kärnä
5
,
Irma Moilanen
6,7
, Eva Hjörne
8
, Shruti Taneja Johansson
8
, Diana Schendel
9,10,11
, Lennart Pedersen
12
,
Meta Jørgensen
13
, Carol Brayne
2
, Simon Baron-Cohen
3
and Andres Roman-Urrestarazu
1,2,3*
Abstract
Introduction: The universal right to education for people with disabilities has been highlighted by the Universal
Declaration on Human Rights and the Convention on the Rights of Persons with Disabilities. In this paper, we
mapped policies addressing the right to education and special education needs of autistic children in Denmark,
Sweden, and Finland.
Methods: A policy path analysis was carried out using a scoping review as an underlying framework for data
gathering. Policy mapping was performed independently by both lead authors to increase reliability.
Results and discussion: The values of the Universal Declaration of Human Rights and the Convention on the
Rights of Persons with Disabilities have been closely translated into the respective education systems of the
countries under study, offering special education needs services and support in mainstream education with the aim
of including as many children into mainstream education as possible. Even though the education systems are
comparable, the approaches between the countries under study are slightly different. Denmark and Sweden have
passed several policies specifically geared towards special education needs, while Finland incorporates this more in
general education policy.
Conclusion: All countries under study have incorporated the values of the Universal Declaration of Human Rights
and the Convention on the Rights of Persons with Disabilities in their respective education systems while
emphasising the need to include as many children in the mainstream system as possible.
Introduction
Autism Spectrum Conditions (ASCs, henceforth referred
to as autism) are a set of neurodevelopmental conditions
characterised by difficulties in communication, social
interaction, and unusually narrow interests and/or re-
petitive behavioural patterns, starting in early childhood
and continuing throughout life [1,2]. The global preva-
lence of autism is estimated to be 1 percent of the
population based on a review of prevalence studies
across the world [3] with a male-to-female ratio between
3:1 and 4:1 [3,4]. Autism is associated with adverse edu-
cational and employment outcomes, and many have sig-
nificant health needs [3,5,6].
Early identification of autism and subsequent persona-
lised help if needed in early life have been shown to
benefit autistic people by improving language develop-
ment, as well as behavioural and cognitive skills [7]. A
key part of these therapies lies with the approach taken
towards the childs educational and developmental
needs. The evidence base for special educational needs
(SEN) support has been reported previously [8]. It was
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
* Correspondence: Aer56@medschl.cam.ac.uk
Robin van Kessel and Sebastian Walsh contributed equally to this work.
1
Department of International Health, School CAPHRI, Faculty of Health,
Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
2
Institute of Public Health, University of Cambridge, Cambridge, UK
Full list of author information is available at the end of the article
van Kessel et al. Molecular Autism (2019) 10:44
https://doi.org/10.1186/s13229-019-0290-4
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
identified that support in the areas of cognition and
learning, social, emotional and mental health, and com-
munication and interaction can lead to significant bene-
fits for the development of children with SEN, while also
acknowledging that the SEN for autistic children may
differ significantly per person.
Grindal and colleagues [9] describe four overarching
educational approaches that schools can adopt: a) exclu-
sion, which indicates an environment where children are
denied access to education in any way; b) segregation,
which happens when children with SEN are being edu-
cated in a separated environment; c) integration, which
describes the environment where children with SEN are
included in mainstream education, yet have to com-
pletely adapt to its standardised requirements; and d) in-
clusion (also known as inclusive education), which
entails going beyond simply integrating children with
SEN into mainstream education, to a process of systemic
educational reform with a vision of providing equitable
learning experiences for all children. They find that in-
clusive education conveys clear and consistent evidence
[of] substantial short- and long-term benefits for children
with and without disabilities[9]. When looking at chil-
dren with disabilities specifically, they reported improved
social and cognitive development, along with better inte-
gration into post-secondary education or employment.
The evidence base for the importance of equal and in-
clusive education for autistic children has steadily been
reflected in the production of global, and more specific-
ally European-wide, educational policies supporting the
rights of autistic children in education. The crucial pol-
icy that protects and promotes the rights of autistic chil-
dren was produced by the United Nations in the
Universal Declaration of Human Rights (UDHR) [10],
which states that everyone has a fundamental human
right to an education directed to the full development
of the human personality. After its ratification, it be-
came the foundation of human rights policy, strategies,
and actions in decades to come. It was followed up by
the Convention on the Rights of Persons with Disabil-
ities (CRPD) [11] which declares that persons with dis-
abilities can access an inclusive, quality, and free primary
and secondary education on an equal basis with others
in the communities in which they live.
Even though the rights of people with disabilities had
already been declared in the UDHR, the CRPD produced
clear guidelines and rules that adopters had to adhere to.
Consequently, it had a significant impact on both inter-
national strategies and national policies that sought to
address the conditions for people with disabilities.
Whilst the CRPD has been signed by all Member States
of the European Union (EU), the competence needed to
implement the values covering the educational rights of
autistic people lies exclusively with the individual EU
Member States. This is the result of the ratification of the
Treaty on the Functioning of the European Union [12],
which delegated the competence to regulate the education
system (thus also the inclusion of children with SEN in
that system) completely to the EU Member States.
Here, we will map the autism and SEN policies aimed
at children under the age of 18 in the Nordic countries,
namely: Denmark (5.7 million people), Sweden (10.1
million people), and Finland (5.5 million people) [13].
We aim to investigate how these Nordic EU countries
approached the implementation of an education policy
that promotes the rights of an autistic child to a fair and
inclusive education. We will examine this by mapping
SEN and disability policies in the context of key policy
documents such as the UDHR and CRPD. Furthermore,
this paper aims to specifically investigate how and to
what extent the concept of inclusive education is imple-
mented in national legislation. Inclusive education can
have significant benefits for autistic children [8,9] and
the need for inclusive education to be introduced and
developed in the national education systems has been en-
dorsed at the international level as well in the Salamanca
Statement [14] and more specifically in the CRPD [11]. Fi-
nally, an overview of the educational structure of the three
countries under study is included in Additional file 1.
This work is part of a larger project of the European
Consortium for Autism Researchers in Education (EDU-
CAUS) with an overarching aim of a systematic com-
parison of policy across all EU countries against the
vision of an education system which supports autistic
children to fulfil their potential. Like the previous work
by EDUCAUS [15] (van Kessel R, Roman-Urrestarazu A,
Ruigrok A, Holt R, Commers M, Hoekstra RA, et al.
Autism and Family Involvement in the Right to Education
in the EU:Policy Mapping and Scoping Review of Nordic
Countries Denmark, Finland, and Sweden. Forthcoming),
this was done by investigating how the values set out in
UN documents like the UDHR and CRPD were translated
into national education policy over time. We chose to
focus on the abovementioned countries because of their
shared geographical and cultural characteristics, as well as
similar policy values, which should make for an equal
comparison between the countries. Furthermore, these
three countries account for 4.2% of the total EU popula-
tion (512.6 million people) [13] influenced by autism and
SEN policies.
Methods
Previous work by Roleska and Roman-Urrestarazu and
van Kessel and Roman-Urrestarazu established the the-
oretical framework and validated the methodology that
we used in this policy mapping exercise [15] (van Kessel
R, Roman-Urrestarazu A, Ruigrok A, Holt R, Commers
M, Hoekstra RA, et al. Autism and Family Involvement
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in the Right to Education in the EU:Policy Mapping and
Scoping Review of Nordic Countries Denmark, Finland,
and Sweden. Forthcoming). The scoping review method-
ology allows for swift mapping of the key concepts
underpinning a wide research area. This methodology is
especially suitable for investigating complex matters that
have not been comprehensively reviewed [16,17]. Add-
itionally, this scoping review and mapping project was
performed through the means of a policy path depend-
ence analysis [18]. This methodology is particularly use-
ful for investigating the development of policy based on
preceding legislation (such as the UDHR and CRPD)
combined with conditional factors [18]. It also amalgam-
ates competing ideas and values, which allows for the
examination of interactions among different countries as
well as how they follow supranational guidance (e.g.
United Nations or EU guidance).
Because there is no single, representative data source
in the EU with regards to autism and SEN policy, we
adopted a qualitative modular approach to legislative
and policy work across the different educational policy
layers of analysis (Danish, Swedish, and Finnish specific).
This approach divided the searches into two categories:
(1) legislation and policy, and (2) scientific literature.
Both categories were independently searched in duplica-
tion by two of the main authors. By independently exe-
cuting the search strategy and comparing results
afterwards, replicability could be warranted, thus in-
creasing the reliability of the work [19]. After the
searches were completed, the results were compared and
synthesised into a single dataset, from which further
analysis was derived. We used the PRISMA framework
to report our findings [20].
Theoretical framework for data analysis and path
dependency
An analysis of policy path interdependency was carried
out drawing on past and current international, EU, and
national policies in the field of SEN and autism from
1948 up to date as part of the EDUCAUS project. Path
dependence approaches allow the identification of pol-
icymaking patterns and establish influences and interre-
lations among policies in linear layers of temporality
[21]. It also enables policy process-tracing, which (1)
aims to explain what factors are present in critical policy
junctures, (2) aims to create a reference framework and
depict how decision processes come to conclusions, and
(3) aims to describe how behaviour that takes place in
different stakeholders as a response to external factors
(e.g. a change in the policy environment) affects different
institutional arrangements [22,23]. In this case, the
UDHR is taken as the starting point, a milestone docu-
ment that influenced the creation and the content of EU
and national policies. We used a timeline to show
connection and overlap between policies to enable fur-
ther analysis. This enabled the interpretation of policy
creation as historical sequences and patterns and
allowed for the identification of path dependence [21].
Current disability, inclusion, and autism policies are a
result of previous events that were tracked with the use
of this framework. All policies were analysed by identify-
ing their input in the field of education, advantages and
disadvantages, and their relation to other policies.
Eligibility criteria
In order to remain consistent with the work previously
done by EDUCAUS (van Kessel R, Roman-Urrestarazu
A, Ruigrok A, Holt R, Commers M, Hoekstra RA, et al.
Autism and Family Involvement in the Right to Education
in the EU:Policy Mapping and Scoping Review of Nordic
Countries Denmark, Finland, and Sweden. Forthcoming),
the eligibility criteria displayed in Table 1were used dur-
ing the data collection of this study.
Data collection and search strategy
The first step in this policy mapping was to review and
extract relevant policies and legislation that address the
right to education of autistic people directly from ori-
ginal governmental sources. Several databases were used
in the collection of data. The national Danish policy
website (https://www.retsinformation.dk), Swedish policy
repositories (https://beta.lagrummet.se/ and https://
www.government.se/), and the Finnish policy repository
(FinLex; https://www.finlex.fi/en/) were used for the re-
trieval of Danish, Swedish, and Finnish policy documents
respectively. Additionally, the EU database for national
policy (N-Lex; http://eur-lex.europa.eu/n-lex/) was also
used to search for the national governmental documents.
No limit was put on language and no time limit was
used during the searches, as the goal was to create a
timeline of policy development, implementation, and
interaction. As a result, these search criteria allowed our
search strategy to find relevant constitutions that date
prior to 1948 as well. In order to adequately gauge the
impact that the UDHR and subsequent policy have had
on national policy, it was important to include these na-
tional constitutions as reference points.
Table 1 A summary of the eligibility criteria
Inclusion criteria Exclusion criteria
-Scope related to the right to education,
the national education systems, disability
laws, inclusion, and special education
needs;
-Policies by non-
governmental organisations.
-Aimed at those under 18 years of age;
-Documents drafted by a governmental
institution;
-Publication date after 1948.
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The second step was to develop a multi-layered search
strategy for electronic databases (PubMed and Google
Scholar). A selection of key terms was created to use as
the foundation of the search terms: autism; disability;
SEN; education; law; policy; right to education; special
needs; special education; inclusive education. Next, the
academic databases PubMed and Google Scholar were
searched using the following combinations of search
terms: autism & disability;autism & SEN;autism &
education;autism & law;autism & policy;SEN &
disability;SEN & law;SEN & policy;disability &
law;disability & policy. The final search query is
shown in Table 2, along with its constituent terms.
The national policy depositories were searched using the
separate key terms, as combining the search terms yielded
little results. The third step consisted of merging policy
and academic publications according to the eligibility
criteria.
The fourth step was to acquire further information
through searching reference lists of key articles (e.g. sci-
entific articles, policy documents, governmental docu-
ments) and grey literature. Policy documents and
governmental strategies in the countries under study
were compared to the already mapped EU disability and
educational policy. In case documents were not present,
general disability policies and legislation were analysed.
The data collection was built on the appraisal of three
searches: one for every country under study. The final
step was to merge the three searches into one single data
repository for the purpose of this scoping review and to
compare it to the already mapped policy of the United
Nations and the EU for further analysis.
Data analysis
Inter-rater reliability
Since the data collection of this paper is performed in
duplication by the two main authors, it is crucial to de-
termine inter-rater reliability. This was done by deter-
mining Cohens Kappa for each country under study
separately. The analysis was performed using R [24], par-
ticularly using the psychpackage [25].
Determination of path dependency
After the search strategy was completed, the gathered
data was compared to the data that was already gathered
on UN and EU policy in the previous work of EDU-
CAUS (van Kessel R, Roman-Urrestarazu A, Ruigrok A,
Holt R, Commers M, Hoekstra RA, et al. Autism and
Family Involvement in the Right to Education in the EU:
Policy Mapping and Scoping Review of Nordic Countries
Denmark, Finland, and Sweden. Forthcoming). As a re-
sult, the extent to which the values of international pol-
icies are integrated into the national policies could be
established. An overview of international policies and
their respective values is provided in Additional file 2.
Results
We identified 1888 sources (437 for Denmark, 1032 for
Sweden, 419 for Finland) through database searching
and 6 through other sources. No duplicates were identi-
fied; therefore, 1894 sources were analysed against the
eligibility criteria. After reviewing abstracts, 77 sources
were considered eligible for full-text screening. Examples
of excluded items included a legislative piece on how
education for adults with SEN is regulated, a regulation
on addressing deaf-blind and visually impaired children
specifically, and legislation that only applied to children
with SEN outside the educational institution. Even
though these items matched the search criteria, they fall
outside the scope of this report. The full-text screening
concluded in the further exclusion of 29 articles, with a
difference in scope, lack of relevance, and unavailability
of the full text being the most common factors. The
remaining 48 articles (43 policy documents and 5 scien-
tific sources) were included in this review. Also, the Da-
nish policy repository only included policy post-1985.
Therefore, we used a non-scientific database (Google) to
search for documents that reported on Danish education
policy pre-1985. In doing so, we identified 1 report by the
Danish Ministry of Education that is considered grey lit-
erature, which is represented in the 6 sources mentioned
above. A PRISMA flowchart illustrates the entire process
in Figs. 1and 2. Additionally, since the search was inde-
pendently conducted by the two main authors, Cohens
Kappa was used to ensure inter-reliability [26] in the data-
base searches. This was done by appraising the searches
and outcomes of each country under study separ-
ately (Additional file 3). The results of this analysis are
shown in Table 3. In order to account for the lower out-
comes for Sweden and Finland, country experts were in-
volved to ensure the completeness and correctness of the
policy analysis.
Denmark
Denmark has adopted numerous policies that have
shaped their education system to incorporate and
Table 2 The build-up of the final search query for academic
databases
Search query
Term 1 ((((((((((autism & law) OR autism & policy) OR autism & SEN)
OR autism & education) OR autism & disability) OR SEN &
policy) OR SEN & law) OR disability & law) OR disability &
policy))
Term 2 ((Denmark OR Sweden OR Finland))
Final
Query
((((((((((autism & law) OR autism & policy) OR autism & SEN)
OR autism & education) OR autism & disability) OR SEN &
policy) OR SEN & law) OR disability & law) OR disability &
policy)) AND ((Denmark OR Sweden OR Finland))
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include children with SEN. A full summary with descrip-
tions of policies is included in Additional file 4.
The development of the Danish education system for
SEN can be divided into two parts, based on the policies
included. On the one hand, documents up until 1979
had a general theme of establishing a definition for SEN
and clarifying that children with SEN should be identi-
fied as early as possible in order to be able to address
their conditions as adequately as possible. More specific-
ally, the constitution [27] specified access to education
for children with SEN and Folkenskolens Specialunder-
visning[28] recognised that children with SEN have
particular needs that need to be addressed. Subse-
quently, the Executive Order on Primary Schools Special
Education for Students with General Learning Disabil-
ities [29] set out a number of options for the educational
environment for these children ranging from having all
teaching take place within a mainstream classroom but
with additional support (i.e. an inclusive approach); to
being educated partly within mainstream classrooms and
partly within the special needs classroom (i.e. an integra-
tive approach); and finally, to being solely educated sep-
arately from their peers, which could take place either
within mainstream or special schools (i.e. a segregate ap-
proach). The accompanying circular on public school
special education and other special educational assist-
ance [30] further developed these options by prescribing
class sizes for SEN education and enabling the extension
of mandatory education when necessary.
On the other hand, documents from 1980 onward
generally had the theme of shaping the education system
to better include the children with SEN, so that they are
not isolated in special education, away from their typical
peers. The first step towards this was making sure that
the progress of children with SEN was able to be mea-
sured without being compared to their typical peers. In
the Statement of opinion assessments, etc. for students
receiving special education and other special education
assistance in primary and lower secondary schools, it is
explained that, for children with SEN, a separate declar-
ation can be made available that is indicative of them
achieving their progress in a certain topic [31]. Next, all
existing legislation on SEN education was unified into a
single document: The Special Education and Other Spe-
cial Assistance in Folkeskolen [32]. It re-humanisedthe
children with SEN, as it specifically emphasised that the
Fig. 1 An overview of the data collection process using a PRISMA flowchart
van Kessel et al. Molecular Autism (2019) 10:44 Page 5 of 15
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needs of a child should be focused on, rather than the
diagnosis, and that children with SEN should no longer
be viewed in categories. It also stressed the role of the
pedagogical-psychological service (PPR) in deciding if a
student needs special education or other special
assistance. The two last policies in this theme both
aimed at fostering a more inclusive environment, mov-
ing away from segregation as much as possible. The
measures set out in the Guidance on primary school
special education and other special educational assist-
ance [33] encapsulate the essence of truly inclusive edu-
cation of children with SEN. It is not just simply
legislating for the presence of children with SEN into
mainstream education, but also a change across the
whole culture and organisation of the school that em-
braces the whole worth of the child for the benefit of
that child, their peers, and the school. Finally, the Folk-
eskole Law amending the Law on the elementary school,
the Act on Private Independent Schools etc. Act and the
folk high schools, continuation schools, home schools and
trade schools (boarding schools) recognised the increase
of children in special education [34]. Its aim was to reduce
the number of children admitted to special education and
the provisions set out to achieve that were (1) redefining
Fig. 2 A chronological overview of Danish, Swedish, and Finnish policies with regard to SEN and autism
Table 3 An analysis of inter-reliability of the policy database
searches using Cohens Kappa
Denmark Sweden Finland
Investigator 1 Eligible 33 25 13
Not eligible 404 1007 406
Investigator 2 Eligible 38 27 20
Not eligible 399 1005 399
Total included 25 12 6
Total excluded 412 1020 413
Cohens Kappa 0.81 0.51 0.39
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when a child would be considered a child with SEN; and
(2) giving the municipality and schoolsdirectoramore
decisive role in judging when a child is to be placed in spe-
cial education.
One notable detail about access to free education is
that it has been a legal right of all children in Denmark
as far back as 1814 and compulsory since 1855 [35]. In
1814, education access covered only 7 years of education
(from age 67 years to 14 years); however, the coverage
has been extended through the course of the 20th Cen-
tury to apply to children from age 56 years to the age
of 16 years [36]. This right was later re-affirmed in the
Danish Constitution of 1953 [27].
It is mentioned above that the Special Education and
Other Special Assistance in Folkeskolen unified previous
legislation on SEN education. These prior documents
were the first available legal documents to recognise the
specific requirements of children with specific condi-
tions. It started with a report on special education from
a commission under the Danish Ministry of Education
concerning students with intellectual disabilities and stu-
dents with reading, speech, visual, or hearing problems
[28]. This report was followed up with specific circulars
[3746] concerning the education of students not able
to attend the regular school due to behavioural and psy-
chological conditions (1972), dyslexia (1974), deaf and
hearing-impaired, blindness and disability involving vi-
sion, physical handicap, language, and speech problems
(all in 1979).
Grants for SEN are available in Denmark for additional
teaching hours and materials to support the pupils, prac-
tical assistance to aid assimilation into school life more
broadly, and for counselling support for parents and
teachers [47]. Referral to regional authorities is generally
done by the school, although this process can be triggered
by the parents or healthcare staff. Where necessary, assist-
ance in determining the individual needs of the child are
available from a national knowledge and advisory service.
Provision is also laid out for children whose needs would
be best served in a school outside of their locality, with a
funding arrangement between the municipality where they
are resident and that of the school.
Given the responsibilities of the primary school
teachers to address SEN in class, the education for
teachers was examined as well. The Order on the educa-
tion for professional bachelor as a teacher in primary
school gives a complete overview on the competences
that a primary school teacher should be proficient in
[48]. From these competencies, three focus on or involve
the education of children with SEN, which are respect-
ively called student learning and development,general
teaching competence, and special education. Whereas
the first two tracks involve the general ability of a
teacher to recognise and act upon the behaviour,
capabilities, and environment of a child, the special edu-
cation track sets out specific details for teachers to learn
in order to best address SEN in their classroom environ-
ment (e.g. reasoned planning and executing an adapted
teaching strategy).
Despite progress, and although the Danish Parliament
argued for the 2012 inclusion-law[34] in light of the
Salamanca Statement [14], the inclusion lawwas also
motivated by economic considerations. While the
changes in SEN policy in Denmark over the years have
been for the most part motivated by new insight into the
needs of SEN students, this weakened in the wake of the
2008 financial crisis and the coinciding public sector re-
form in Denmark that shifted all of the economic costs
of SEN services solely to the local municipality. The Ex-
ecutive Orders and Guidance documents in 20122014
accompanying the Folkeskole law [4951] that dropped
the crucial provision that a decision on a students need
for special education service and assistance should never
be based on economic resources, placed the over-all
decision-making power with the school principal (on be-
half of the municipal authorities) and reduced the role
of the PPR, parents, and teacher in the decision process
must also be viewed in an economic light apart from
educational and didactic considerations.
The 2012 inclusion lawsparked a strong, and on-
going, public debate on its effects, in response to which
the government appointed an expert panel to character-
ise the student population affected by the transition to
inclusion, identify key problems and make recommenda-
tions for practical implementation of inclusion. In the
expert report published in 2016 [52], the panels overall
impression was that inclusion had inaugurated positive
trends in studentsoverall welfare but substantial chal-
lenges remained to be met. The report further detailed 8
major challenge areas and many associated recommen-
dations around strengthening inclusive learning environ-
ments; focusing on studentsneeds in learning and well-
being and engaging students; better prioritization of ef-
forts and resources at all levels; strengthening proactive
rather than reactive measures; improving access to pro-
fessional knowledge and help such as PPR; strengthening
competencies of teaching staff in working with children
with special needs; and strengthening parental involve-
ment and responsibility.
Although these recent events illustrate the potential
for SEN policy setbacks in real time, in the larger pic-
ture, Denmark has made significant steps in moving
from a segregated approach to educating children with
SEN towards a more inclusive approach. Free education
for all children has always been implemented in the Da-
nish system; a clear definition of SEN was established
early on, as well as the right that these children should
receive an education like other children; and school
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systems and teacher education were changed incremen-
tally over time to better support children with SEN.
Sweden
Sweden has adopted several elaborate policies in order
to form its education system to its current state. An
overview of all included policies with their descriptions
has been added in Additional file 5.
Compulsory education in Sweden was already imple-
mented before the implementation of the UDHR in
1948. The universal Elementary school was introduced
as far back as 1842 and 6 years of schooling was made
compulsory for all children in 1882 [53]. This implied
that pupils from all social strata entered the school, in-
cluding children with special education needs and/or de-
velopmental disabilities, although they were offered only
minimum courses (i.e. a very short period of schooling).
The first step in developing the Swedish education sys-
tem after the ratification of the UDHR by the UN was to
clearly establish the rights of children with SEN. This
was done firstly by the 1962 Curriculum for Compulsory
Education [54,55], which tasked schools to actively con-
tribute to the development of their children into inde-
pendent, individual, and harmonious adults as much as
possible. Additionally, it stressed the need for children
with SEN to attend special classes and established eight
of these for children with disabilities to attend. The Spe-
cial School Act [56] subsequently specified developmental
delay as a condition that required SEN services to be dis-
tributed to. The Swedish Constitution [57]solidifiedthe
right to free and accessible education for all children cov-
ered by compulsory education and put the institutions in
charge of taking care of the children during their stay.
The first mention of an integrative or inclusive school
system came right before the implementation of the
Swedish Constitution in the School Regulation Act [58],
which also addressed the roles of the teachers and spe-
cialised equipment in attending to the SEN of children.
This was later elaborated by the 1985 Education Act
[59], which also laid down the foundation for the current
education system. The Act itself covers a lot of different
aspects of the education system, most notably (1) right
and access to education; (2) the option of special educa-
tion only for children unable to attend mainstream edu-
cation due to the severity of their condition; (3)
provisions specifically for developmentally delayed chil-
dren; and (4) the notion that children with autism spe-
cifically are included in the scope of legislation that
focuses on children with intellectual/learning conditions.
Additionally, the Education Act regulated funding for
primary, secondary, and special education. It states that
the municipalities are the principles of the public
schools in their respective areas. This also implies that
the financing of these institutions is regulated through
governmental pathways. With regard to the provision of
SEN support, it also explains that there is funding avail-
able for municipalities to use, as well as that the munici-
palities have the right to be reimbursed by the state for
their expenditures on SEN support. The Primary School
Regulation [60], which closely followed the 1985 Educa-
tion Act, further elaborated on SEN, SEN services, and
special education. It laid out that additional support
needs to be provided for children that have difficulties at
school and should ideally be given in the regular envir-
onment that the child would belong in, though it also
acknowledged several groups that special classes can be
arranged for.
Afterwards, in the 1994 Elementary School Curricu-
lum, the necessity to meet the rights and needs of chil-
dren in school is stressed again. What this document
expands on, though, is the role of the teachers, specify-
ing that they should consider the needs, requirements,
experiences, and thoughts of a child while teaching
them. Finally, a new Education Act was implemented in
2010 [61]. Compared to the previous Act (which it still
built upon), the way autism was handled changed
slightly, i.e. it was no longer being treated identically to
intellectual disabilities in all cases, but only when an in-
tellectual disability is actually present. According to the
Act, everyone should be included in mainstream schooling
and placement in special teaching groups should be used
only as a provision of last resort. Moreover, the Act pre-
scribes that the student health should become a central activ-
ity with a strengthened mandate to prevent the emergence of
problems and promote student health and welfare.
The environment for children with autism and their
families received some developments over the years as
well, starting with the Law regulating Support and Ser-
vice to Persons with Certain Functional Disabilities [62].
Its contents are focused on improving the environment
in which the children with autism live, which, by exten-
sion, can have positive effects on their educational per-
formance. It creates opportunities for parents/guardians
to relax by providing services that temporarily take care
of their child with autism. Alternatively, it also puts
measures in place that enables a child with autism to be
placed elsewhere if it cannot live at home due to its con-
dition. The Act on Discrimination against Children and
the Discrimination Act [63,64] predominantly addressed
stigma and discrimination on the basis of disability.
Their scope includes education, making it so that chil-
dren with disabilities have as equal an opportunity as
possible when attending mainstream education. The
only difference between the two Acts is that the Dis-
crimination Act expanded the scope of the Act on Dis-
crimination against Children.
Since teachers are predominantly responsible for ad-
dressing the SEN of their children in the classroom, their
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education was investigated as well. The Higher Educa-
tion Ordinance sets out the requirements for teacher
training at all levels [65]. In terms of addressing SEN,
the curriculum recognizes two different types of special
educators: Special Education Needs Coordinators (SEN-
COs) and special education teachers. Göransson, Lindq-
vist, and Nilhom explain that the education of both
types of special educators is the same in many aspects
[66]. According to them, both education paths should
lead to a skillset that is needed to work for and with
children with SEN, as well as knowledge to develop and
lead educational work with the goal to address the needs
of all children. They further elaborate that the difference
between the two types is that special education teachers
are schooled to work in compulsory schools while SEN-
COs are schooled to work in preschools as well as com-
pulsory schools with the childs whole education
environment. In terms of teacher education, this is
reflected by the fact that special education teachers re-
ceive more individual-centred learning goals (e.g. know-
ledge of assessment and grading as well as language and
conceptual development), while the education for SEN-
COs focuses on schoolsorganisation and learning envir-
onment. They finally note that both groups are trained
to be able to work in schools for children with intellec-
tual disability. Later on, when implementing the Best in
classa new teacher educationproposal [67], main-
stream teacher training was changed. Whereas previ-
ously teacher training applied to all of mainstream
education, it is now subdivided into four categories: pre-
primary education, primary education, subject education,
and vocational education, each specialising on that spe-
cific part of the educational trajectory.
Ultimately, SEN services have existed in the Swedish
education system since before the adoption of the
UDHR. They also recognised and classified autism as a
condition on par with developmental disorders as early
as 1985 and later differentiated it from intellectual dis-
abilities in 2010. Additionally, the Swedish system is
structured in its approach towards SEN. According to
the mapped legislation, SEN should first be addressed in
mainstream classrooms to the best of the teacherabil-
ities. Only when it is no longer feasible to keep a child
with SEN in a mainstream classroom, can a transferral
to special education be considered. Also, since the muni-
cipalities are in charge of their respective primary and
secondary schools, the financing of SEN support in these
schools is state-governed.
Finland
Finland has adopted various policies since the UDHR
was implemented by the UN. A synopsis of the policies
included in Additional file 6.
When the UDHR was implemented, Finland already
had some resemblance of an education system in place
[68]. The first elementary schools were established in
1866, though home and church were responsible for
basic education (e.g. reading and writing) before a child
would be accepted in an elementary school, which was
completely free. Compulsory education was introduced
shortly after the First World War, in 1921. After the
Second World War, education of children started with
elementary school for everybody. Upon completion,
there was a choice between two educational trajectories:
upper comprehensive schooling, which led to studying
in university; or senior primary schooling, which led to
studying in vocational schools.
The first notice of allowing children with SEN to fol-
low education came in the Regulation on Special Care
for the Mentally Handicapped [69], which allowed for
children that were unable to attend mainstream educa-
tion to receive training separately until the end of their
compulsory school age. Though in order for this to
apply, they would need to be assessed by trained profes-
sionals in order to gauge their possibilities and capabil-
ities. A more inclusive approach to the education of
children with SEN came with the ratification of the Basic
Education Act [70]. This Act addressed many different
aspects of education and the incorporation of children
with SEN in the education system. It sets out goals for
teaching, clarifies what SEN services are and that, when
possible, they should be provided in a mainstream class-
room, sets out conditions under which a child may be par-
tially or completely moved to special education, and
explains what the personal plans for the organisation of
teaching should include, along with whom should be in-
cluded while drafting. Subsequently, the renewed Finnish
Constitution [71] re-emphasised several basic human rights
for children with SEN, such as that all children should be
treated equally and their right to free basic education.
Over time, special education continued to grow in size,
to the point that the Special Education Strategy [72] was
drafted in order to create a proposal for a long-term
strategy that would improve pre-primary and basic spe-
cial education. In this strategy, it was proposed that the
primary form of support would need to shift to an earl-
ier support and prevention-based approach. The aim of
this approach was to reinforce learning and growth and
to prevent the magnification and/or escalation of prob-
lems relating to learning, development, or social inter-
action. Additionally, the Strategy urged for the content
of special education to improve in a way that decisions
on whether a child needs special education would be-
come binding, including resources required, group size
of the class, the adaptation of the syllabus, and the cap-
acities of the child. However, it also recognises that it
would be necessary to change the process of coming to a
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decision on SEN slightly, in a way that it should include
pedagogic experts as well.
The final document that addressed the provision of
services to children with SEN among others is the Stu-
dent Care Act [73], which can be divided into three
themes: its aims, allocating responsibilities, and the stu-
dent health plan. The aims all refer back to the rights of
the children set out in the previously covered docu-
ments. In terms of responsibilities, the municipalities in
which the educational institution is located are allocated
responsibility for the children, the involvement of psy-
chologists or social workers, and, albeit optionally, pro-
vide support in organising additional services for
educational institutions. Lastly, it introduced a student
health plan, which includes details such as the amount
of healthcare the child requires, the initiatives to protect
the child from bullying, harassment, and a cooperation
of different stakeholders that contribute to the childs
well-being. Even though it does not specifically target
potential SEN of children, it can be useful to keep track
of the additional health needs that many of the condi-
tions that cause the SEN to require. As such, it has the
potential to indirectly benefit the education of children
with SEN.
With teachers being predominantly responsible for ad-
dressing the SEN of their children, it is crucial to investi-
gate their training as well. The Government Decree on
University Degrees [74] sets out the courses in which
teachers in Finland are trained. During teacher
training, aspiring teachers follow courses on each
potential step of the education system: early and pre-
primary education, basic education, special education,
etc. As such, every teacher has at least a basic under-
standing of what SEN are and how to approach them
in a classroom.
In short, the SEN policy in Finland is incorporated
in general education policy. There are few policies
aimed towards SEN or disability specifically, yet these
topics are broadly covered in the overarching policies
that regulate education (e.g. the Basic Education Act).
Nevertheless, some form of equity is achieved through
the referenced articles from the Constitution and the
way SEN services are set up in the Acts. This is
because legislation dictates that every child should be
given the resources and services they need in order to
develop themselves to their fullest. It is not specified
how SEN services are financed in educational institu-
tions. However, since educational institutions are
funded by the state, it is implied that the provision of
SEN services falls under this funding as well. Overall,
as the Finnish basic education system is based on the
philosophy of inclusion and all children are supported
individually so that they can successfully complete
their basic education.
Discussion
This study aimed to map autism, SEN, and education
policies that cover the right and access to education for
autistic children, as well as the assistance provided dur-
ing their education in Denmark, Sweden, and Finland.
Additionally, it investigated how inclusion was integrated
into respective national education policy using a policy
path dependence analysis. This data was compared to
the reference framework of UN and EU policy that was
already available prior to this study (van Kessel R,
Roman-Urrestarazu A, Ruigrok A, Holt R, Commers M,
Hoekstra RA, et al. Autism and Family Involvement in
the Right to Education in the EU:Policy Mapping and
Scoping Review of Nordic Countries Denmark, Finland,
and Sweden. Forthcoming). As a result, we mapped all
relevant SEN policies that affect the education of autistic
children as well as their universal right to education in
an attempt to create a comprehensive report once the
EU mapping exercise is complete with the aim of unveil-
ing both bad and good practices when it comes to SEN
education.
As already established in previous work (van Kessel R,
Roman-Urrestarazu A, Ruigrok A, Holt R, Commers M,
Hoekstra RA, et al. Autism and Family Involvement in
the Right to Education in the EU:Policy Mapping and
Scoping Review of Nordic Countries Denmark, Finland,
and Sweden. Forthcoming), the UDHR marked a critical
juncture for policy, both internationally and in the EU.
When comparing the legislation adopted in the different
policy layers to the Danish, Swedish, and Finnish policy
environment, this also holds true for these countries.
Notably, in the case of Denmark and Sweden, all chil-
dren were already legally entitled to education prior to
the ratification of the UDHR. Also, the approach to-
wards the education of people with disabilities in
Denmark and Sweden involved the ratification of policy
that specifically addressed this topic on top of the cover-
age in basic education policy, while Finland has inte-
grated its approach fully in basic education policy. Even
though the approaches may differ slightly, the results are
comparable.
All three countries have made significant efforts to
adapt their education system to offer a place for all chil-
dren (regardless of physical, mental, or social state), as
well as to offer SEN services and support in mainstream
education. That is up until the point it stops being in
the childs best interest, according to a group of experts
that will assess each case individually, to attend main-
stream education. In doing so, the UDHRs values on the
right to education are comprehensively considered in
the three Nordic countries. Additionally, the values of
UN and EU policy are reflected back in the national pol-
icy of these countries. Even though the international
documents are not referenced in national policy, the
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measures that are taken are comparable in that similar
outcomes are achieved: an improved education system
that is appropriate and accessible for children with and
without disability.
One of the aims of this study was to investigate to
what extent the education system of the countries under
study incorporated inclusive education. While the term
itself is never mentioned in any of the legislative docu-
ments, the ideology is being adopted in all three coun-
tries. All three education systems aim to include as
many children in their mainstream education as pos-
sible, with additional services, support, or equipment of-
fered where required. This is reinforced by the notion
that all educational institutions receive funding from
their respective municipality, and by extension from
their respective state, to accommodate as many children
in their educational institution as possible, taking the
health and educational needs of the child into account.
Only if the child is burdened by their condition to such
an extent that it is no longer feasible to attend main-
stream education, will they be transferred to a special
educational arrangement (e.g. special school setting, spe-
cial teaching group). As such, it is safe to say that, while
significant steps have already been made towards an in-
clusive environment, there is still a certain amount of
segregation present in the Nordic education systems.
Nevertheless, this is not necessarily a fault. While it is
important for children with SEN to be included as much
as possible in mainstream education for mutual benefit
[9], it is also crucial that the education of typical chil-
dren does not suffer from inclusion practices. As such,
exclusion practices should be removed as soon as pos-
sible, but measures of segregation may still have a place
in the current education system.
It is interesting to note that all three countries under
study approach inclusive education from the perspective
of the child with SEN. Even though the benefits for typ-
ical children to be in contact with children with SEN is
well documented [9], it is notable how, for example,
guidelines on the guidance of neurotypical children are
left out of inclusive education policy, while they do play
a crucial factor in inclusive education. Additionally, all
three countries emphasise the role of the teacher in ad-
dressing SEN in the classroom. Therefore, we investi-
gated the teacher training curricula as well and found
that all three countries under study include courses on
SEN and how to address them in a classroom. Unfortu-
nately, the exact contents of the respective courses could
not be reviewed at the time of writing this paper. As
such, we can assert that teachers in Denmark, Sweden,
and Finland all have at least a basic understanding of
SEN and how to address them in a classroom.
It has to be noted that there are some contrasts be-
tween the three countries. As previously mentioned,
Finland incorporates its SEN strategy more in general
education policy, while Denmark and Sweden also
passed several policies specifically geared towards SEN
and disability policy. As a result, the environment in
Finland has become less regulated and there are fewer
guidelines to help schools formulate their SEN strategies.
While this is not an inherently negative situation, it
poses the risk that schools fill in the inevitable gaps in
legislation locally without national guidance, which may
result in a heterogeneous environment for children with
SEN to study and develop. Also, while Danish and Swed-
ish education policies strongly imply that their focal
point is children, Finnish policy explicitly states so. Con-
sequently, potential room for (mis)interpretation is re-
moved in the application of these policies: children are
the focal point and all measures taken by schools or
other educational institutions should support them and
their development. Additionally, even though all coun-
tries under study aim to address SEN for children with
disabilities, Finland and Denmark operate without a
clear definition of disability. Their policies generally
refer to disabilities as conditions that inhibit education
and structurally state that teachers should take mea-
sures to address the corresponding needs, without going
into detail as to what kind of needs should be met in
what way. Furthermore, while Denmark and Finland
predominantly put the educational institutions in charge
of the decision-making processes that pertain to the
child with SEN, Sweden includes family members in the
process as well. The inclusion of family in the decision-
making process is a factor that has already been
reviewed in the previous work of EDUCAUS (van Kessel
R, Roman-Urrestarazu A, Ruigrok A, Holt R, Commers
M, Hoekstra RA, et al. Autism and Family Involvement
in the Right to Education in the EU:Policy Mapping and
Scoping Review of Nordic Countries Denmark, Finland,
and Sweden. Forthcoming). One particular detail that
should be noted in the Swedish system when considering
how autism is addressed in education, is its disconnec-
tion from intellectual disabilities in recent times unless
the child with autism actually has an intellectual disabil-
ity. As a result, children with autism no longer run the
risk of being sent to a special school based on their con-
dition and have better access to education. Moreover,
Finland has taken additional steps to support children
with SEN. Instead of starting the process while the child
attends primary school, it implemented measures that
target pre-primary education and special education. In
doing so, it aimed to create an educational environment
in which learning and developmental conditions could
be better addressed. Finally, in recent years, Danish pol-
icy has reconsidered the scope of SEN in an attempt to
facilitate more children in mainstream classrooms. Now,
children that require less than 9 teaching hours of
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additional support are not considered to be children
with SEN and are to be assisted primarily by the teacher
in charge. According to the 2012 inclusion law[34], the
child must be given additional education, support or
personal assistance if needed to solve practical issues at-
tending school, aiding their fundamental right to max-
imum development. Nevertheless, these measures put
more responsibilities on the classroom teachers. The Da-
nish governments expert panel report in 2016 highlighted
the strengthening of teacherscompetencies in working
with children with special needs and access to relevant
professional support as one of the key challenge areas in
the implementation of inclusion.
This scoping review has some limitations that should
be accounted for. Firstly, the results of this study cannot
be generalized across countries, only within the three
countries explored. Secondly, it is challenging to deter-
mine how the approaches to SEN are put into practice.
Therefore, the results of this paper remain strictly theor-
etical. Thirdly, during the execution of the search strat-
egy, the N-Lex database was unavailable for Denmark
and Finland. A large advantage of using the N-Lex is
that it will automatically translate an index term from
English to the respective language of the country under
investigation. However, since this service was unavail-
able, we relied on manual translations of index terms.
Whilst all synonyms of the translated index term were
included, it does not rule out the possibility that some
meaning was lost in translation and that that might have
affected the outcomes of this paper. To account for this
limitation, Danish, Swedish, and Finnish experts were
asked to assist in searching and interpreting the legisla-
tion for their respective countries. Fourthly, the Danish
policy repository only included limited entries pre-1985.
As a result, we had to rely on synopses of legislations
that predate 1985 or had to acknowledge that the policy
path dependence for Denmark would be incomplete. As
it stands, there was only one completely unavailable pol-
icy document, namely the 1975 law on primary and
lower secondary schools. Fifthly, only governmental doc-
uments were included in this research. Consequently,
potential actions by NGOs were disregarded by this
paper, unless their work was adopted in national legisla-
tion (e.g. the Charter for Persons with Autism, drafted
by Autism-Europe and adopted by the European Parlia-
ment). Finally, the scope of this study was limited to aut-
istic children. In other words, autistic adults that are
part of the education system were not covered by the
contents of this paper, even though they may experience
similar challenges in their educational endeavours.
Lastly, there are some opportunities for further work
as well. For instance, it would be beneficial to investigate
how inclusion policies are translated into practice in the
countries under study. At the time of writing this report,
no such investigation has been done, even though it
could provide significant improvements either in policy
recommendations and/or in the education environment.
Also, teacher training should be investigated beyond
these Nordic countries. With inclusion becoming more
prevalent in the EU, it is crucial that teachers have the
knowledge, skills, and competences to adequately ad-
dress SEN in their classrooms.
Conclusion
This study provided insight into the SEN policy environ-
ment of Denmark, Sweden, and Finland. The values of
the UDHR and CRPD were integrated into all education
systems under study through national legislation. Main-
stream schools offer SEN services and support until par-
ticipation in mainstream education ceases to be in the
childs best interest due to the severity of their SEN.
Also, the provision of SEN services is done exclusively
through schools. There are no other institutions in-
volved in providing these services. Inclusive education,
while not mentioned specifically in national legislation,
is a guiding factor in the education systems of the coun-
tries under study.
Supplementary information
Supplementary information accompanies this paper at https://doi.org/10.
1186/s13229-019-0290-4.
Additional file 1. Key characteristics of the Nordic education systems.
This table gives a brief overview of the core components of the Nordic
education systems.
Additional file 2. An overview of the specific policies and their values
of the United Nations and European Union. This overview provides a list
of the core values of the policies that involved human rights, autism, and
special education that were implemented by the United Nations and the
European Union.
Additional file 3. The source code used to calculate the inter-rater reli-
ability. This source code shows the number of articles deemed eligible
and non-eligible by both authors, how many they agreed on, and in-
cludes all details on how Cohens Kappa was calculated for all three
countries to determine inter-rater reliability.
Additional file 4. A chronological overview and description of the
Danish policies on education and SEN. A point by point overview of the
implications of each respective policy that was analysed for Denmark.
Additional file 5. A chronological overview and description of the
Swedish policies on education and SEN. A point by point overview of the
implications of each respective policy that was analysed for Sweden.
Additional file 6. A chronological overview and description of the
Finnish policies on education and SEN. A point by point overview of the
implications of each respective policy that was analysed for Finland.
Abbreviations
ASCs: Autism spectrum conditions; CRPD: Convention on the Rights of
Persons with Disabilities; EDUCAUS: European Consortium for Autism
Researchers in Education; EU: European Union; NGOs: Non-governmental
organisations; PPR: Pedagogical-psychological service; SEN: Special education
needs; SENCOs: Special Education Needs Coordinators; UDHR: Universal
Declaration of Human Rights
van Kessel et al. Molecular Autism (2019) 10:44 Page 12 of 15
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Acknowledgements
Firstly, we would like to thank Dr. Roman-Urrestarazu for the guidance and
learning experience during the writing process of this paper. Secondly, we
would like to thank Dr. Ruigrok and Dr. Holt for their extensive input and
feedback on the structure of the paper and on the correct use of language
surrounding autism. Thirdly, the insights of the Nordic experts on the Finnish
(Dr. Yliherva, Dr. Kärnä, and Dr. Moilanen), Swedish (Dr. Hjörne and Dr. Shruti
Johansson), and Danish (Dr. Schendel, Mr. Pedersen, and Ms. Jørgensen) edu-
cation environments was crucial in correctly interpreting and analysing the
respective legislation. Finally, we would like to thank Dr. Brayne and Dr.
Baron-Cohen for the opportunity to take part in this project and for the infal-
lible infrastructure the Institute of Public Health and the Autism Research
Centre, respectively.
Authorscontributions
All authors contributed equally in their respective ways. RvK, SW, and ARU
were in charge of writing and editing the manuscript. AR and RH reviewed
the document and accounted for correct language use with regards to
autism. All other authors reviewed the manuscript in its different stages and
provided their input respectively, mainly taking care of the correct
interpretation of the original language used in the legislation, as well as
accounting for documents that were missed during the initial search by the
lead authors. All authors read and approved the final manuscript.
Funding
The project leading to this application has received funding from the
Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant
agreement no. 777394. The JU receives support from the European Unions
Horizon 2020 research and innovation programme and EFPIA and AUTISM
SPEAKS, Autistica, SFARI. Dr. Andres Roman-Urrestarazus work received fund-
ing from the Gillings Fellowship in Global Public Health and Autism Research,
Grant Award YOG054. Dr. Rosemary Holt and Dr. Amber Ruigrok received
funding from the Innovative Medicines Initiative EU-AIMS (grant agreement
no. 115300: FP7/20072013). Simon Baron-Cohen was supported by the Aut-
ism Research Trust, Autistica, and the MRC during the period of this work.
Dr Andres Roman-Urrestarazus work received funding from the Gillings Fel-
lowship in Global Public Health and Autism Research, Grant Award YOG054.
SBC, AR, and RH received funding from Innovative Medicines Initiative 2 Joint
Undertaking (JU) under grant agreement no. 777394. The JU receives support
from the European Unions Horizon 2020 research and innovation
programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. They also re-
ceive funding from the Autism Research Trust, Autistica, the MRC, the Well-
come Trust and the NIHR Cambridge Biomedical Research Centre. The
research was supported by the National Institute for Health Research (NIHR)
Collaboration for Leadership in Applied Health Research and Care East of
England at Cambridgeshire and Peterborough NHS Foundation Trust. The
views expressed are those of the author(s) and not necessarily those of the
NHS, NIHR, or Department of Health and Social Care.
Availability of data and materials
While all data are publicly available, a list of used documents along with
their source has been included.
Ethics approval and consent to participate
Due to all data being publicly available and already in force in the respective
Member States, the outcomes of this study have no ethical implications.
Also, since the study was completely based off of public data, there was no
situation in which it was necessary to request consent.
Competing interests
There are no competing interests between the collaborating authors in this
study.
Author details
1
Department of International Health, School CAPHRI, Faculty of Health,
Medicine and Life Sciences, Maastricht University, Maastricht, the
Netherlands.
2
Institute of Public Health, University of Cambridge, Cambridge,
UK.
3
Autism Research Centre, Department of Psychiatry, University of
Cambridge, Cambridge, UK.
4
Child Language Research Center, Logopedics,
Faculty of Humanities, University of Oulu, Oulu, Finland.
5
Philosophical
Faculty, School of Educational Sciences and Psychology, University of Eastern
Finland, Joensuu, Finland.
6
PEDEGO, University of Oulu, Oulu, Finland.
7
Child
Psychiatric Clinic, University Hospital of Oulu, Oulu, Finland.
8
Department of
Education and Special Education, University of Gothenburg, Gothenburg,
Sweden.
9
iPSYCH, The Lundbeck Foundation Initiative for Integrative
Psychiatric Research, Aarhus, Denmark.
10
National Centre for Register-Based
Research, Aarhus University, Aarhus, Denmark.
11
Department of Public Health,
Aarhus University, Aarhus, Denmark.
12
Center for Autisme, Herlev, Denmark.
13
Special Area Autism, Central Region, Aarhus, Denmark.
Received: 29 January 2019 Accepted: 23 September 2019
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... Dedication toward inclusive education was previously found to not only be aimed at improving the education system for children with SEN, but they can also be a result of economic considerations (van Kessel, Walsh, et al., 2019). According to other policy mapping articles, autism-specific policy is often barely present and the emphasis lies on general SEN policy (Roleska et al., 2018;van Kessel, Dijkstra, et al., 2020;van Kessel, Hrzic, et al., 2020;van Kessel, Steinhoff, et al., 2020;van Kessel, Walsh, et al., 2019). ...
... Dedication toward inclusive education was previously found to not only be aimed at improving the education system for children with SEN, but they can also be a result of economic considerations (van Kessel, Walsh, et al., 2019). According to other policy mapping articles, autism-specific policy is often barely present and the emphasis lies on general SEN policy (Roleska et al., 2018;van Kessel, Dijkstra, et al., 2020;van Kessel, Hrzic, et al., 2020;van Kessel, Steinhoff, et al., 2020;van Kessel, Walsh, et al., 2019). As such, this paper analyses the development of the education environment on a policy level in order to explore how (special) education policy itself was affected by the austerity measures. ...
... This methodology enables us to see policy creation as historical sequences and patterns and identify path dependence (Mahoney, 2000). The use of this methodology is validated by previous work of EDUCAUS that mapped education policy pertaining to autism (Roleska et al., 2018;van Kessel, Dijkstra, et al., 2020;van Kessel, Hrzic, et al., 2020; van Kessel, Steinhoff, et al., 2020;van Kessel, Walsh, et al., 2019), as well as other fields where it was used to investigate policy developments across different policy layers (Bunt et al., 2020;Neicun et al., 2019). Data were gathered through the use of a scoping review, which allows for rapid mapping of the key concepts that underpin a wide research area and is particularly suitable for exploring complex matters that have not yet been comprehensively reviewed (Arksey & O'Malley, 2005;Levac et al., 2010). ...
Article
Full-text available
en This study explores how autism and education policy are affected by austerity measures in Ireland, Portugal, Italy, and Greece by using a path dependence analysis. The implementation of mixed mainstream classrooms and improvements to infrastructure coincided with the ratification of inclusive education policy. Austerity measures appeared temporally associated with furthering of integration and inclusion policy for all countries under study, potentially due to the economic incentives of an integrated system. This trend is especially visible in Ireland, Portugal, and Greece, whereas lesser so in Italy. Even though the initial focus of this analysis was autism, the findings are applicable to the general area of special education needs due to the non-specific nature of national policies. 摘要 zh 本文通过路径依赖分析,探究了爱尔兰、葡萄牙、意大利和希腊的紧缩措施如何影响自闭症和教育政策。混合主流课堂的实行、基础设施的提升,与包容性教育政策的批准同时发生。紧缩措施似乎在时间上与各国融合政策及包容政策的延长相关,这可能归因于融合系统的经济激励。该趋势在爱尔兰、葡萄牙和希腊尤为明显,意大利的趋势较小。尽管本研究的最初重点是自闭症,但鉴于国家政策的一般性,研究发现也适用于特殊教育需求领域。 Resumen es Este estudio explora cómo el autismo y la política educativa se ven afectados por las medidas de austeridad en Irlanda, Portugal, Italia y Grecia mediante el uso de un análisis de dependencia de la trayectoria. La implementación de aulas convencionales mixtas y las mejoras a la infraestructura coincidieron con la ratificación de la política de educación inclusiva. Las medidas de austeridad aparecieron temporalmente asociadas con la promoción de la política de integración e inclusión para todos los países en estudio, posiblemente debido a los incentivos económicos de un sistema integrado. Esta tendencia es especialmente visible en Irlanda, Portugal y Grecia, mientras que es menor en Italia. Aunque el enfoque inicial de este análisis fue el autismo, los hallazgos son aplicables al área general de necesidades de educación especial debido a la naturaleza no específica de las políticas nacionales.
... Recently, autism, SEN, and education policies in 20 EU Member States-covering 76,87% of the EU population (Eurostat, 2018)-have been mapped by the European Consortium for Autism Researchers in Education (EDUCAUS) using a path dependency framework. The aim of EDUCAUS was to systematically compare policy across all EU Member States against the vision of an education system that supports children with autism to fulfill their potential (Roleska et al., 2018;van Kessel, Dijkstra et al., 2020;van Kessel, Hrzic et al., 2020;van Kessel, Steinhoff et al., 2020;van Kessel, Walsh et al., 2019). Each policy analysis focused on a specific theme, including parental involvement ( , teacher education ( van Kessel, Steinhoff et al., 2020;van Kessel, Walsh et al., 2019), and teacher responsibilities ( van Kessel, Steinhoff et al., 2020). ...
... The aim of EDUCAUS was to systematically compare policy across all EU Member States against the vision of an education system that supports children with autism to fulfill their potential (Roleska et al., 2018;van Kessel, Dijkstra et al., 2020;van Kessel, Hrzic et al., 2020;van Kessel, Steinhoff et al., 2020;van Kessel, Walsh et al., 2019). Each policy analysis focused on a specific theme, including parental involvement ( , teacher education ( van Kessel, Steinhoff et al., 2020;van Kessel, Walsh et al., 2019), and teacher responsibilities ( van Kessel, Steinhoff et al., 2020). Each review found IE to be present in national policies of most Member States, though many of the investigated countries also retain segregation-based frameworks. ...
... This study synthesizes the findings of the policy analyses by EDUCAUS, which comprises descriptive data on individual policies of the 20 investigated EU Member States (Roleska et al., 2018; van Kessel, Dijkstra et al., 2020; van Kessel, Hrzic et al., 2020; ; van Kessel, Steinhoff et al., 2020; van Kessel, Walsh et al., 2019). Information in each case was collected by means of a scoping review (Arksey & O'Malley, 2005;Levac, Colquhoun, & O'Brien, 2010) of the respective national policy repository and analyzed through a path-dependence analysis (Mahoney, 2000). ...
Article
Full-text available
Children with special education needs (SEN), such as children with autism, benefit from being included in education along with typical peers. However, development and implementation of inclusive education (IE) is considered difficult. This paper identifies conditions that facilitate IE development for children with autism in the European Union and benchmarks to track IE policy development. Education policy data from 30 legislative regions in the European Union were analyzed through a qualitative comparative analysis using eight conditions: a definition of SEN, the right to education for children with SEN, support for teaching staff, support services for children with SEN, individualized learning outcomes, parental involvement, and mixed mainstream classes. The right to education for children with SEN is implemented in all regions under study. Seven of the examined conditions were associated with IE: an established definition of SEN, support for teaching staff, support services for children with SEN, individualized learning outcomes, parental involvement, IE policies, and mixed mainstream classrooms. Mixed classrooms and support services for children with SEN were identified as necessary for IE. IE policies and support for teaching staff were present in all scenarios that facilitated IE. While the analysis was initially focused on autism, the policies consisted predominantly of general SEN policies, allowing the results to be interpreted in a wider context, beyond autism. Ultimately, mixed mainstream classrooms and support services for children with special needs were found essential for consistent IE development. Support for teaching staff and IE policies facilitate IE and should be further explored and implemented.
... The policy mapping framework in this article is based on previously validated work. [19][20][21] Data were gathered through a scoping review and analyzed through a policy path dependence analysis. [22][23][24] Due to the absence of a comprehensive EU data source on autism and SEN policy, a modular approach was adopted to analyze the education policy environments under study. ...
... Consistent with previous work, [19][20][21] inclusion criteria consisted of (i) a scope relating to the right to education, national education system, disability laws, inclusion or SEN; (ii) aimed at children under 18 years; (iii) drafted by a governmental institution; and (iv) published after 1948. Constitutions were always included and no language limitations were set. ...
... Like previous work, [19][20][21] the data collection consisted of five steps in which governmental websites formed the primary source for data collection: (i) review and extract policies relevant to the education of children with SEN; (ii) develop a multi-layered search strategy for scientific databases (Google Scholar/PubMed); (iii) merge policy and academic publications conform the eligibility criteria; (iv) acquire further information through searching reference lists; and (v) merge all documents into one data repository for the purpose of this scoping review and path dependence analysis. Table 1 shows the policy repositories that were used per country. ...
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Background: Special education provides an array of support that can advantageously meet special education needs (SEN) of children with autism. This report maps autism and SEN policies, and tension of international legislation in Malta, Cyprus, Luxembourg and Slovenia. Methods: A policy path analysis was performed using a scoping review as fundamental methodological framework. Results: Education for children with SEN developed from limited education towards segregation, and further to integration, and inclusion in mainstream education. International policy has greatly influenced the education systems under study. The rights to education and to have SEN addressed have been adopted in all countries. Inclusion is seen to be gradually incorporated by Malta, Cyprus and Luxembourg—closely following values of international documents through concise SEN policies. Slovenia’s education system remains segregated, indicating potential tension. Conclusions: It appears that mainstream schools offer SEN services until no longer feasible for the child in the majority of investigated countries. Inclusion has become a guiding principle for most education systems under study. Finally, small states either commit to the implementation of inclusion or delay it and attempt to improve the education system for children with SEN in different ways.
... Gathered data was analyzed using the UN and EU policy data that was mapped in previous EDUCAUS papers (Roleska et al., 2018;van Kessel et al., 2019a). Supplementary File 1 shows an overview of the policy data of the respective policies. ...
... While this benefits the autism community by granting them access to the services discussed in the policies, it also points toward a lack of specificity being incorporated in national policy. This is a stark contrast to other EU countries, such as France, Northern Ireland, Spain, and Flanders (Belgium), where specific autism-related policies are implemented to guide how autism should be addressed in those specific countries (Roleska et al., 2018;van Kessel et al., 2019a). Alternatively, the Germanspeaking community in Belgium and Luxembourg implemented institutions that are specifically geared toward assisting autistic children (van Kessel et al., 2019a). ...
... This is a stark contrast to other EU countries, such as France, Northern Ireland, Spain, and Flanders (Belgium), where specific autism-related policies are implemented to guide how autism should be addressed in those specific countries (Roleska et al., 2018;van Kessel et al., 2019a). Alternatively, the Germanspeaking community in Belgium and Luxembourg implemented institutions that are specifically geared toward assisting autistic children (van Kessel et al., 2019a). As such, even though the Baltic States are progressing on par with other EU countries in terms of the development of their education system, specifically addressing autism in national policy is an aspect in which there is still room for improvement. ...
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The Soviet occupation of the Baltic States followed by joining the United Nations (UN) and European Union make these countries an interesting point of comparison in the development of autism and education policy. This study investigates how policies changed following the transition and how the right and access to education are facilitated for autistic children by performing a path dependence analysis. All Baltic States created new education policies following the transition out of the Soviet era, with their accession to the UN and their appetite to follow internationally available guidance. The right to education for all children in was adopted in all education systems. Education facilities for children with disabilities were implemented in all countries. Afterward, all countries started toward the development of more inclusive systems. Nevertheless, the majority of policies did not specify for autism, yet covered special education needs in general. A development in Latvia should be noted, where various special education needs are outlined in national policy, along with provisions and professional assistance required to address them in mainstream or special classrooms. Ultimately, education policy flourished after the transition. Their development caught up to other European Union countries and they are currently working on implementing inclusive education.
... The policy mapping framework in this article is based on previously validated work. [19][20][21] Data were gathered through a scoping review and analyzed through a policy path dependence analysis. [22][23][24] Due to the absence of a comprehensive EU data source on autism and SEN policy, a modular approach was adopted to analyze the education policy environments under study. ...
... Consistent with previous work, [19][20][21] inclusion criteria consisted of (i) a scope relating to the right to education, national education system, disability laws, inclusion or SEN; (ii) aimed at children under 18 years; (iii) drafted by a governmental institution; and (iv) published after 1948. Constitutions were always included and no language limitations were set. ...
... Like previous work, [19][20][21] the data collection consisted of five steps in which governmental websites formed the primary source for data collection: (i) review and extract policies relevant to the education of children with SEN; (ii) develop a multi-layered search strategy for scientific databases (Google Scholar/PubMed); (iii) merge policy and academic publications conform the eligibility criteria; (iv) acquire further information through searching reference lists; and (v) merge all documents into one data repository for the purpose of this scoping review and path dependence analysis. Table 1 shows the policy repositories that were used per country. ...
Article
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Background: Special education provides an array of support that can advantageously meet special education needs (SEN) of children with autism. This report maps autism and SEN policies, and tension of international legislation in Malta, Cyprus, Luxembourg and Slovenia. Methods: A policy path analysis was performed using a scoping review as fundamental methodological framework. Results: Education for children with SEN developed from limited education towards segregation, and further to integration, and inclusion in mainstream education. International policy has greatly influenced the education systems under study. The rights to education and to have SEN addressed have been adopted in all countries. Inclusion is seen to be gradually incorporated by Malta, Cyprus and Luxembourg-closely following values of international documents through concise SEN policies. Slovenia's education system remains segregated, indicating potential tension. Conclusions: It appears that mainstream schools offer SEN services until no longer feasible for the child in the majority of investigated countries. Inclusion has become a guiding principle for most education systems under study. Finally, small states either commit to the implementation of inclusion or delay it and attempt to improve the education system for children with SEN in different ways.
... Recently, autism, SEN, and education policies in 20 EU Member States-covering 76,87% of the EU population [11]-have been mapped by the European Consortium for Autism Researchers in Education (EDUCAUS) using a path dependency framework. The aim of EDUCAUS was to systematically compare policy across all EU Member States against the vision of an education system which supports autistic children to ful l their potential [12][13][14][15][16][17] [in press]. Each policy analysis focused on a speci c theme, including parental involvement [13], teacher education [14,16], and teacher responsibilities [16]. ...
... The aim of EDUCAUS was to systematically compare policy across all EU Member States against the vision of an education system which supports autistic children to ful l their potential [12][13][14][15][16][17] [in press]. Each policy analysis focused on a speci c theme, including parental involvement [13], teacher education [14,16], and teacher responsibilities [16]. Each review found IE to be present in national policies of most Member States, though many of the investigated countries also retain segregation-based frameworks. ...
... This study synthesizes the ndings of the policy analyses by EDUCAUS, which comprises descriptive data on individual policies of the 20 investigated EU Member States [12][13][14][15][16][17]. Information in each case was collected by means of a scoping review [28,29] of the respective national policy repository and analyzed through a path dependence analysis [30]. ...
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Background: Children with special education needs (SEN), such as autistic children, benefit from being included in education along with typical peers. However, development and implementation of inclusive education (IE) is considered difficult. This paper identifies conditions that facilitate IE development for autistic children in the European Union and benchmarks to track IE policy development. Methods: Education policy data from thirty legislative regions in the European Union were analyzed through a qualitative comparative analysis using eight conditions: a definition of SEN, the right to education for children with SEN, support for teaching staff, support services for children with SEN, individualized learning outcomes, parental involvement, and mixed mainstream classes. Results: The right to education for children with SEN is implemented in all regions under study. Seven of the examined conditions were associated with an environment of IE in the European Union from an autism perspective: an established definition of SEN, support for teaching staff, general availability of support services for children with SEN, individualized learning outcomes, parental involvement, IE policies, and mixed mainstream classrooms. Mixed classrooms and support services for children with SEN were identified as necessary for IE. IE policies and support for teaching staff were present in all scenarios that facilitated IE. Even though the analysis was initially focused on autism, the policies consisted predominantly of general SEN policies. As such, the results can be interpreted in a wider context, beyond autism. Conclusion: Mixed mainstream classrooms and support services for children with special needs were found essential for consistent IE development. Support for teaching staff and IE policies facilitate IE and should be further explored and implemented.
... Instead, inclusion means to establish a rich, accessible learning environment that is adapted to all pupils' prerequisites (8). Scandinavian countries have in recent years taken political decisions towards implementing inclusion of youth with NDDs in education (9), seeking to operationalize the United Nations convention on the rights of persons with disabilities and the Salamanca Statement and Framework for Action on Special Needs Education, a document signed by 92 nations, aiming to lead the progress towards inclusive education. 1,2 The concept of inclusion is viewed somewhat differently depending on history, social factors and culture (10). ...
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'Inclusion' aims to achieve adaptation of the environment to the diverse prerequisites and needs of individuals, instead of demanding of individuals to cope with the challenges of a given context themselves exclusively. All Scandinavian countries have made formal decisions to enhance inclusive practice for children and adolescents with disabilities in educational settings, seeking to implement international conventions. We investigated current inclusive practice for students with neurodevelopmental disorders (NDDs) in Swedish primary, secondary and high-schools using the 61-item INCLUSIO scale among N=4778 school staff with educational responsibilities in 68 public and private schools across 11 municipalities. Overall, school staff reported not to be well prepared to teach students with NDDs and that their school's implementation of concrete inclusive practice was limited. Findings indicate a gap between inclusive educational ambitions and current practice for students with NDDs. Enriched teacher education and supervision for NDDs, a shift in pedagogical views of NDDs and better collaboration between community services, as well as systematic evidence-based implementation plans driven by policy makers and educational authorities may help improve inclusive practice.
... When a teacher has pedagogical competence, it will have a huge effect in the interaction of learning. Students become more caring, served, valued, listened to, strengthened by giving positive words, guided, experienced learning can develop their potential [24], [25]. Violence will not arise if the application of pedagogical competencies is carried out into learning interactions [26]. ...
Conference Paper
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This research aims to reveal the professionalism of primary school teachers in selection of models and media in the process of learning to teach at classroom. Teachers profession will never be replaced by anyone, especially at the elementary school level because it has a noble duty, which is to prepare the next generation to build nation. Therefore, researchers are interested in conducting research on the professionalism that teachers have in terms of the selection of models and media used. Model and media variables are chosen because they are one indicator of learning success. The type of research used is mixed research by presenting charts accompanied by reasons from respondents. The respondents in this study is teachers at the elementary school level of 23 respondents. The result of this study is an overview of the models and media that teachers use in the learning process of teaching. Hopefully through this research can be a professional teaching reference material, especially for elementary school teachers in learning management that appeals to students.
... Like previous work by Authors' Consortium (Roleska et al., 2018; van Kessel, Roman-Urrestarazu, et al., 2019;Walsh, et al., 2019), the data collection consisted of five steps. This five-step process is depicted in Fig. 1. ...
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Background This report maps autism and special education needs (SEN) policies, alongside teacher responsibilities in the education of children with SEN in Austria, Hungary, Czech Republic, and Slovakia. Methods and Procedure A policy path analysis using a scoping review as an underlying methodological framework was performed. Outcomes and Results The end of communism and accession to the European Union were critical for the countries under study. They passed crucial policies after international policies and adopted a three-stream approach towards providing education: (1) special schools; (2) special classes in mainstream schools; or (3) mainstream classes. Special schools remain for children that cannot participate in mainstream schools. Teachers are given high levels of responsibility. Conclusion and Implications Changes in international guidance greatly impacted Austria, Hungary, Slovakia and the Czech Republic. The education systems aim for inclusion, though segregation remains for children that cannot thrive in mainstream schools. Teachers are pivotal in the education of children with SEN, more so than with typical children.
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The low employment rates of persons with Autism Spectrum Conditions in the European Union (EU) are partly due to discrimination. Member States have taken different approaches to increase the employment rate in the recent decades, including quota and anti‐discrimination legislation, however, the implications for people with autism are unknown. The purpose of this scoping review was to provide a comprehensive overview of the history of these employment policies, from seven EU Member States (Germany, France, the Netherlands, the United Kingdom [prior to exit], Slovakia, Poland, and Romania), exploring the interdependence on international and EU policies, using a path dependency analysis. The results indicate that internationally a shift in focus has taken place in the direction of anti‐discrimination law, though employment quotas remained in place in six out of the seven Member States as a means to address employment of people with disability in combination with the new anti‐discrimination laws. Lay summary Discrimination is partially responsible for the low employment of people with autism. Several approaches have been taken in recent years, such as anti‐discrimination laws and setting a mandatory number of people with disabilities that need to be employed. This study finds that, internationally and in the European Union, the focus was initially on the use of quotas and gradually moved to anti‐discrimination, with both being used simultaneously.
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Introduction Autistic people may have different educational needs that need to be met to allow them to develop their full potential. Education and disability policies remain within the competence of EU Member States, with current educational standards and provisions for autistic people implemented locally. This scoping review aims to map EU and national special education policies with the goal of scoping the level of fulfilment of the right to education of autistic people. Methods Four EU countries (United Kingdom, France, Poland and Spain) were included in this scoping review study. Governmental policies in the field of education, special education needs and disability law were included. Path dependency framework was used for data analysis; a net of inter-dependencies between international, EU and national policies was created. Results and discussion Each country created policies where the right to free education without discrimination is provided. Poland does not have an autism specific strategy, whereas the United Kingdom, France and Spain have policies specifically designed for autistic individuals. Within the United Kingdom, all countries created different autism plans, nevertheless all aim to reach the same goal—inclusive education for autistic children that leads to the development of their full potential. Conclusion Policy-making across Europe in the field of education has been changing through the years in favour of autistic people. Today their rights are noticed and considered, but there is still room for improvement. Results showed that approaches and policies vastly differ between countries, more Member States should be analysed in a similar manner to gain a broader and clearer view with a special focus on disability rights in Central and Eastern Europe.
Article
Objective: To derive the first systematically calculated estimate of the relative proportion of boys and girls with autism spectrum disorder (ASD) through a meta-analysis of prevalence studies conducted since the introduction of the DSM-IV and the International Classification of Diseases, Tenth Revision. Method: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The Medline, Embase, and PsycINFO databases were searched, and study quality was rated using a risk-of-bias tool. Random-effects meta-analysis was used. The pooled outcome measurement was the male-to-female odds ratio (MFOR), namely the odds of being male in the group with ASD compared with the non-ASD group. In effect, this is the ASD male-to-female ratio, controlling for the male-to-female ratio among participants without ASD. Results: Fifty-four studies were analyzed, with 13,784,284 participants, of whom 53,712 had ASD (43,972 boys and 9,740 girls). The overall pooled MFOR was 4.20 (95% CI 3.84-4.60), but there was very substantial between-study variability (I2 = 90.9%). High-quality studies had a lower MFOR (3.32; 95% CI 2.88-3.84). Studies that screened the general population to identify participants regardless of whether they already had an ASD diagnosis showed a lower MFOR (3.25; 95% CI 2.93-3.62) than studies that only ascertained participants with a pre-existing ASD diagnosis (MFOR 4.56; 95% CI 4.10-5.07). Conclusion: Of children meeting criteria for ASD, the true male-to-female ratio is not 4:1, as is often assumed; rather, it is closer to 3:1. There appears to be a diagnostic gender bias, meaning that girls who meet criteria for ASD are at disproportionate risk of not receiving a clinical diagnosis.
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Ruth Berins Collier and David Collier are political scientists who use comparative historical research to discover and evaluate patterns and sources of political change. Their work is an overall analysis of Chile, Brazil, Uruguay, Colombia, Argentina, Peru, Venezuela, and Mexico, plus case studies of four distinct pairs in that group: Chile/Brazil, Uruguay/Colombia, Argentina/Peru, and Venezuela/Mexico. In addition, the Colliers meticulously describe and discuss their methods for the study including the limitations of their approach. The authors specifically focus on why and how organized labor movements in the first half of the twentieth century were incorporated into the political process in the eight Latin American countries they study. They analyze the role played by political parties, central government control, worker mobilization, and conflict between radical vs. centrist political philosophies and activities.