Educational inclusion for students with neurodevelopmental conditions

Abstract: Introduction: Inclusive education is the response to the human rights movement that requested equal rights to general education for all students, independent of their prerequisites and/or disabilities. Inclusion is different from integration, which concentrates on the capacities of an individual to adapt to a given mainstream. Inclusion demands that we change the existing educational environment in order to respond to the diverse needs of all learners. Inclusive education focuses on multiple aspects, such as participation, belonging and academic achievement. Teachers’ attitudes, as well as their experience of working with children having neurodevelopmental conditions (NDC), is well described in the literature as crucial for creating and believing in inclusive values. The prerequisites for general teachers (e.g., professional development, supervision and resources) in mainstream school settings are poor. As the number of children on the autism spectrum and with attention deficit hyperactivity disorder in inclusive settings is increasing, the need for evidence-based strategies to facilitate inclusion has become urgent. Autism spectrum disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are neurodevelopmental conditions associated with deficits that can make life in school harder, e.g., executive dysfunctions or social impairments. Little is known about the practical dimensions of inclusive education from different angles. Furthermore, there is a lack of views and perspectives from the students themselves, whose environment we are aiming to improve. Theoretical frameworks used for the design and interpretation of studies in this thesis are the bio-ecological model by Bronfenbrenner, the bio-psychological framework from the World Health Organization (WHO), the International Classification of Functioning, Disability and Health, the ICF Core Sets and the Human Environment Interaction model (HEI). Objectives: This research examines inclusive practice for students with neurodevelopmental conditions. The overall aim of this thesis is to explore educational inclusion for students with NDC, focusing on how it works in practice and what key elements are essential for the development of more powerful inclusive agendas. For this purpose, four studies were conducted: a systematic literature review (study I), an intervention study for teachers’ learning (study II), an exploratory study of social validity from social skills training (study III) and a multi-perspective study of lived experiences of educational inclusion (study IV). Methods: Study II-IV consisted of a mixed methods design, with qualitative and quantitative methods, including participants with ADHD and ASD (adolescents), their caregivers and professionals (teachers and school management). Participants were recruited from mainstream high and secondary schools. Two of the studies are multi-responder studies. In study III, the responders are students, teachers and school management and in study IV, students, parents and teachers. The triangulation increases the validity through the convergence of information from different participants. Data collection tools are the literature search (study I), questionnaires (study II) and semi-structured interviews and structured surveys conducted through interviews based on the instrument INCLUSIO (study IV). The sample size in study II is n = 26, in study III, n = 20 (students n = 13, teachers n = 5 and school management n = 2) and in study IV, n = 56 (students n = 19, caregivers n = 17 and teachers n = 17). Quantitative data in study II and IV was handled and analyzed with the SPSS (Version 27) and analyzed by descriptive and inference statistics. The interviews in study III were audio-recorded and transcribed verbatim with meaningful concepts extracted from the transcriptions and linked to social validity categories from the work by Wolf (1978) and analyzed through thematic analysis. Results: The results based on the completed data collection show supporting and hindering areas in the school environment. Accommodations in the learning environment is a promising but understudied approach. Effective accommodations for enhancing learning for students on the autism spectrum found in study I are didactical accommodations for completing tasks and assignments, prompting procedures for on-task behavior, social interventions for better functioning and social inclusion and video-modeling for understanding and preparing for different situations in school. Professional development for teachers’ learning towards improved self-efficacy and inclusive skills are effective, despite the lack of long-term perspectives. Training teachers in implementing evidence-based methods in practice can be done by lesson study cycles. Teachers’ knowledge of concrete accommodations rose from the initial phase where assumptions about an improved learning environment can be made. Social skills group training is feasible in naturalistic settings, such as the school environment. There were generalizations of teachers’ as well as students’ skills. Moreover, the whole school’s social environment was developed and improved. Results from study IV demonstrate large discrepancy in some of the areas significant for inclusion in school, e.g., direct instructions and individual support, available resources, the social environment and the responsibility for achievement. Parents and students express lack of sufficient support in the explicit classroom situation, e.g., with tasks and assignments. The teachers evaluated the learning environment as more inclusive than students and parents in most of the examined areas. Similar views and agreements were in the lack of competence among staff. For educational inclusion, most valuable was individual support, followed by functional response to behavioral characteristics and a structured learning environment. Conclusions: As more students on the autism spectrum and other developmental conditions are attending inclusive environments, exploring and evaluating practice from multiple perspectives can ascertain what is working well and what is not. Furthermore, this research indicates how to improve inclusive education and contributes with evidence of how to enhance participation for students with NDC, e.g., by professional development for teachers and social skills group training for students. Our findings show that the students themselves are still regarded as the owners of the problem and the learning environment is not accommodating enough, where especially the psychosocial domain is neglected. In order to adjust the learning environment sufficiently to provide inclusive education, there is a need for further and more extensive competence regarding learners’ characteristics and conditions associated with NDC. In order to provide an equal learning environment for all students, there is a need for inclusive special didactics. This study contributes to stakeholders and educators as well as to the society as a whole in order to further strengthen the inclusive agenda.