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Bridges and barriers for children with NDC in mainstream school

2.3 Neurodevelopmental conditions

2.3.3 Bridges and barriers for children with NDC in mainstream school

Educational inclusion should not be treated naively or ideologically, as its implementation comes with multiple challenges. While inclusion philosophy aims at educating all children in mainstream schools (Ainscow et al., 2006), the current trend is to achieve that more children can attend mainstream schools (Florian, 2014b; Norwich et al., 2021), including those with a wide range of diverse needs, such as an NDC. There is a tendency to focus more on

procedural skills and behavioral outcomes in non-inclusion settings for students with ASD than on academic skills (Kurth & Mastergeorge, 2010), which is similar to educating students with ADHD in special settings (DuPaul & Weyandt, 2006). Previous studies show that when teaching students with ADHD in small groups, designed only for meeting that particular group, the teaching often consists of reducing disruptive activity and control of behavior (Hjörne, 2011). Preliminary goals seem to be to foster adaptive social behavior or what is considered appropriate in a school setting rather than pedagogical content knowledge and academic performance (Hjörne, 2011; Kos, Richdale, & Hay, 2006). This is also recognized by parents, and when expressing benefits with inclusion, the general education classroom provides students with NDC the opportunity to engage more in academic tasks (Roberts &

Simpson, 2016) and to have a better chance at a normal life (Waddington & Reed, 2006).

Recent literature, however, demonstrates several obstacles and fewer opportunities for equity

and learning for students in mainstream settings (Stark et al., 2021; Zweers, Tick, Bijstra, &

Van De Schoot, 2020). In fact, when children with NDC are enrolled in a mainstream school, parents are concerned with significant cases where it does not work well and where student exclusion or underachievement is the outcome (Andersson, 2020; Roberts & Simpson, 2016).

Therefore, while inclusion is a paramount goal in education, without systematic

implementation of interventions and sufficient support, the educational inclusion will not fulfill its ambition and philosophy (Pellicano et al., 2018). The inclusive education philosophy guides schools towards a system where all children grow and develop side by side, no matter what prerequisites exist, This philosophy promotes taking care of and

celebrating diversity. The paradox is when schools celebrate diverse learners and at the same time are being measured in terms of achievement among students and rankings of standards both internationally and nationally (Hornby, 2015).

Children with moderate and severe disabilities have impairments that need to be addressed from several perspectives. In this case, there is a huge need for a full continuum of services and support. Support from teachers is one of the key strategies for accommodating students with NDC in the mainstream classroom. There is a great body of literature supporting and highlighting the importance of teachers’ knowledge, attitudes and awareness in providing excellent education to students with NDC (Roberts & Simpson, 2016; Parsons, Guldberg, MacLeod, Jones, Prunty, & Balfe, 2011). Unfortunately, there are fewer attempts to build up this knowledge. Principals and school management express enough service and knowledge among their staff (Bartonek et al., 2018) and themselves (Roberts & Simpson, 2016). This picture is not shared among general education teachers (Bartonek et al., 2018; Humphrey &

Symes, 2013).

A serious problem for educationally included students is that despite attempts of students with NDC achieving educational goals, there are still challenges of academic achievement and participation that are not met in a satisfactory manner (Ashburner, Ziviani, & Roger, 2008). Moreover, as a consequence of the shortage in knowledge among teachers and school staff, students with ASD are more at risk of being excluded from school (Roberts & Simpson, 2016). Parents express that there is a lack of academic accommodations and pedagogical support from teachers in mainstream settings (Tamm et al., 2019; Andersson, 2020). This is in line with the investigation performed by the Swedish School Inspectorate (2012). They found a limited amount of sufficient support for students with NDC, and the support was seldom evaluated or adapted to the individual’s needs. With inappropriate support and inclusion, it is not questionable that many parents search for and prefer specialized

placements for their children (Barnard, Prior, & Potter, 2000; Kurth & Mastergeorge, 2010;

Linton, 2015). The public school system is required to provide educational services for students with ASD and ADHD, but are often unequipped for this mission. Growing numbers of students with ASD now attend mainstream schools and increasing numbers of teacher assistants or paraprofessionals are being employed to support them (Symes & Humphrey, 2011). A risk factor with this support is that students receive less attention from the class teacher and are being further isolated from their peers. Furthermore, there are issues with the

competence of and the relationship with the class teachers. Many teacher assistants and paraprofessionals have no formal training of ASD or other students’ needs (Lindqvist, Östergren, & Holme, 2020; Symes & Humphrey, 2011).

Inclusion of students with ASD to increase participation, presence and achievement is not trivial and requires extensive knowledge and sensitivity by all staff that meet and teach the student. Symes and Humphrey (2011) examined factors in inclusive settings that facilitated or hindered teaching assistants in effectively supporting students with ASD. Prerequisites for success were access to expertise and teacher awareness of ASD. The expertise would preferably be in-house to provide opportunities for this expertise to be shared. Teacher assistants found it particularly challenging to support a child if the given teacher did not help to create an inclusive atmosphere. Lack of teacher awareness of ASD was difficult in many ways, ranging from teachers not understanding or addressing the needs of the learner to not being able to adjust the work or tasks. Lack of teacher awareness and ability to include students with ASD may lead to social exclusion or students being completely assigned to their teacher assistants and with activities that are significantly different from that of their classmates (Schwab, Sharma, & Loreman, 2018). Other important components for inclusive education and cooperation found by Symes and Humphrey (2011) were positive attitudes towards students with special educational needs, school leadership support for inclusion, collaboration and respect. To conclude, teacher assistants/paraprofessionals can facilitate inclusion under optimal circumstances and hinder inclusion under less advantageous conditions. A shared vision for the change in school must include several professions, otherwise those shared values and principles will not come alive (Booth & Ainscow, 2002).

The whole-school inclusive culture requires all staff to have an understanding of the expectation of inclusion within their school (Symes & Humphrey, 2011).

Social skills difficulties and communication limitations are major concerns for students with ASD in school (Falkmer, 2013; Hebron & Humphrey, 2014; Linton, 2015). Students with more advanced language skills can still have difficulties with abstraction, imagination and pragmatic language. The limited ability to have a back-and-forth conversation or only paying attention to certain areas of interest are particularly challenging in mainstream settings (Pierangelo & Giuliani, 2008). There are several activities during the school day that consist of interaction with peers and social gatherings. Social skills that children can typically learn by watching others or through imitation may need to be explicitly taught to students with ASD and ADHD. All these social challenges affect school functioning to a high degree.

Studies have shown that students with autism have an increased risk of low participation and exclusion in school (Ashburner et al., 2010). The limitation of participation could lead to more barriers and social exclusion (Linton, 2015). Students with autism experience the social arena and social interactions as particularly stressful (Roberts & Simpson, 2016). Bullying and teasing are major concerns for students with autism (Barnard, Prior, & Potter, 2000;

Humphrey & Symes; Williams, Gleeson, & Jones, 2018) and ADHD (Holmberg & Bölte 2008), elevating the risk for psychiatric issues such as anxiety and depression (Hebron &

Humphrey, 2014). Social skills training is often neglected by schools (Barnard et al., 2000) and autism awareness is low (Pellicano, Dinsmore, & Charman, 2014).

Problematic absenteeism is a problem of inclusion failure. An increasing number of students with ASD drop out of school (Parson & Lewis, 2010), which is also seen in the Swedish context (School Inspectorate, 2012). This is similar in ADHD, where adolescents with ADHD are eight times more likely than adolescents without ADHD to drop out of high school (Kent et al., 2011). Students who have good mental health, high self-esteem and positive academic experiences are less absent during the academic year (Kent et al., 2011).

Adolescence can be a particularly difficult developmental period for students with NDC (Jacobson, Williford, & Pianta, 2011). Students with NDC often exhibit a specific deficit in the academic setting, and since school is more complex and demanding over the years and grades, there is an urgent need for interventions for adolescents with NDC in school settings.

Executive functioning skills play an important role in students’ cognitive functioning in school. Students with weaker executive functioning skills have more behavioral problems and less regulatory control, which affects academic achievement (Jacobson et al., 2011).

Transitions from elementary school to middle/high school are particularly challenging since the change is both physical from one school building to another as well as psychosocial, e.g., increases in number of teachers, class size, expectations and decreases in perceived teacher support (Hughes et al., 2010). The expectancy of more independence is an issue, and in a mainstream setting, there might even be more expectations of students’ autonomy and working skills and motivation. Traditional instructional strategies such as complex verbal instructions and demonstrations may be distracters rather than focus of attention for students with NDC. Integrating multiple items of information or managing to know where and how to begin with a task is another challenging situation in mainstream schools (Hume, Plavnick, &

Odom, 2012). Executive function impairments have been addressed by school-based interventions, e.g., the Challenging Horizons Program (Evans, Langberg, Schultz, Vaughn, Altaye, Marshall, & Zoromski, 2016) for adolescents and Individual Work Systems (Hume et al., 2012) for younger students. However, medical treatment is still the most common

treatment, even though no evidence for better academic achievement is found (Young &

Amarasinghe, 2010). Another approach to meet complex needs among students are special settings with additional support and resources.

Further challenges in mainstream settings are sensory hyper- and hypo-processing of information. Students might be very sensitive to sounds, textiles, tastes or smells (Leader, Tuohy, Chen, Mannion, & Gilroy, 2020), or with food selectivity. In the school area, there are many locations that can cause stressful situations, such as the cantina, school yard or gymnasium. As a large number of students with autism experience difficulties in sensory processing (Volkmar, Paul, Klin, & Cohen, 2005), the classroom and other facilities in school can therefore be problematic. The overload of stimuli in several contexts and the inability to filter background noise or hypersensitivity to certain sounds will make the mainstream environment hard and tiring. There are barriers in the psychosocial, the

pedagogical/didactical and the physical environment that need consideration and preparation for students with NDC in inclusive settings (Tufvesson & Tufvesson, 2009).

2.4 INTERVENTIONS—EVIDENCE-BASED PRACTICE FOR SUPPORT IN THE