The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) (P.L. 108-446) (http://idea.ed.gov/) guarantees a free and appropriate public education (FAPE) in the least restrictive environment (LRE) for every student with a disability. The LRE provision mandates that “to the maximum extent appropriate, children with disabilities, including children in public or private institutions or other care facilities, are educated with children who are not disabled, and special classes, separate schooling, or other removal of children with disabilities from the regular educational environment occurs only when the nature or severity of the disability of a child is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.” In general, inclusion (or inclusive education) with typical peers is often considered to be the best placement option for students with disabilities. However, a study published in Pediatrics, the official journal of the American Academy of Pediatrics, calls into question whether or not inclusive education actually leads to better outcomes in the long term for children with autism.
Researchers from the University of Alabama at Birmingham and Johns Hopkins University sought to determine whether the proportion of time spent in an inclusive educational setting, a process indicator of the quality of schooling for children with autism, improves key outcomes. The participants were 484 children and youth educated in special education with a primary diagnosis of autism in the National Longitudinal Transition Study-2 (NLTS2). The NLTS2 is a 10-year study of youth with disabilities who were receiving special education services in public or state-supported special schools. The NLTS2 uses a nationally representative sample of youth in special education who were between the ages of 13 and 16 on December 1, 2000.
The primary exposure of interest in this analysis was the proportion of time the youth spent in a general education classroom. A school program questionnaire was used to collect data on the courses that each student took during the 2003 school year and whether each course was taken in a general education or special education classroom. The proportion of time spent in an inclusive setting was categorized as 0%, 1% to 74%, or 75% to 100% of courses taken in a general education classroom.
Three outcomes were assessed in the study’s analysis: (1) not dropping out of high school, (2) any college attendance, and (3) a cognitive functional scale. Youth were coded as not dropping out if the parent reported that they graduated, received a certificate or General Educational Development certificate, or were still in high school at the time of data collection. Any college attendance was based on parent report of whether the youth attended any type of postsecondary school in the previous 2 years, including postsecondary classes to earn a high school degree, a 2-year or 4-year college, or postsecondary vocational school. The functional cognitive scale measured a combination of parent-reported cognitive, sensory, and motor skills used in performing daily activities (such as counting change). Parents rated their child on a scale of 1 (“not at all well”) to 4 (“very well”) for each of these skills. The rating for each skill was added to create the functional cognitive scale, which ranged from 4 (not at all well for any of the skills) to 16 (very well for all of the skills).
Compared with children with autism who were not educated in an inclusive setting, children with autism who spent 75% to 100% of their time in a general education classroom were no more likely to attend college, not drop out of high school, or have an improved functional cognitive score after controlling for key confounders. The researchers state that “In general, our analyses suggest that inclusivity does not improve educational or functional outcomes for children with autism.” They also note that although the link between inclusivity and outcome remains weak, “inclusive education” that is well implemented and supported might have substantial benefits. Recommendations for further research include investigation of educational and functional outcomes from data on large samples of children in real-world settings. There is also a need for developing future indicators to measure the “quality” of special education for children with autism. This includes a careful description of the learning environment and experiences within and between communities as well as key measures specific to the characteristics and education of children with autism. The authors conclude that the study illustrates the challenges of understanding the effect of real-world services and treatments and that a “A fuller understanding of inclusivity and other potential measures of educational quality may have to wait for better data and methods.”
Foster, E. M., & Pearson, E. (2012). Inclusivity an Indicator of Quality of Care for Children With Autism in Special Education? Pediatrics, 130, S179-S184. DOI: 10.1542/peds.2012-0900P
Lee A. Wilkinson, PhD is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. Dr. Wilkinson provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorder. He is also a university educator and trainer and has published widely on the topic of autism spectrum disorders both in the US and internationally. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).