Limitations

There are some limitations in the studies which limit the generalizability. First, the systematic review only included accommodations for autistic students, where the overall NDC focus lacks perspectives of ADHD. However, interventions for students with ADHD were searched for in literature and studied in parallel for overall understanding of educational inclusion of the target group. The rest of the studies represent ASD and ADHD equally. Second, the sample size is small in study II, III and IV. The intervention for teachers did not include a control group, but nevertheless there were three participating schools for broader statistical analyses and sufficient measures of evidence. Moreover, the study did not measure students’

outcome or students’ expressed improvements in the learning environment. The aim was not to measure student outcome, but nonetheless doing so could have provided further interesting evidence. There is a small gender bias as well as representing group bias where there is not even representation of personnel categories. The investigations of social validity in study III could be combined with a long-term follow-up for more sustainability in the measurement for more reliable results. With regard to gender and age differences among students, no analyses were done and there were no considerations of confounding factors, such as comorbidity, symptom severity, culture, school conditions, sources at school or socioecological

background. Thus, the results should be interpreted with caution, but nonetheless the results have covered relevant aspects of educational inclusion and the outcome is valuable for stakeholders in practice as well as on the policy level of society.

7 CONCLUSIONS OF THE EMPIRICAL STUDIES

The characteristics of educational inclusion investigated through a series of studies can be summarized as follows: (1), the specific needs and conditions associated with NDC have to be addressed when preparing the learning environment for inclusion, and a structured

learning environment is the first important step, but is nevertheless not complete or sufficient;

(2), the psychosocial environment and students’ well-being, prerequisites for learning, are a neglected area of research and not adjusted enough for students with NDC— social skills group training or individual social skills training can develop and improve the social

environment in schools; (3), the surrounding environment needs awareness and adjustments to give a safe context for the right training prerequisites, and general teachers need and ask for more competence in meeting and teaching students with NDC in mainstream classrooms;

(4), innovative approaches and interventions can be implemented more frequently in inclusive settings for enhanced educational inclusion.

The quest for more knowledgeable staff for educational inclusion is in line with Petersson-Bloom (2020) and Petersson-Petersson-Bloom and Bölte (2022), where the specific and sometimes complex needs cannot be met without broad competence. Collaboration with special needs teachers and coordinators is one way of addressing the diversity in the classroom, but nevertheless, inclusion excellence requires both more extensive and more evenly spread competence. The lack of understanding and recognition of needs in diagnosed students has been largely documented in other studies (Bölte et al., 2021a; Falkmer, 2013; Stark et al., 2022), and the situation has led to the urgency of having new learning objectives in teacher education curricula (UD, 2020). When preparing and adjusting the learning context, just targeting the overall learning environment for high-quality teaching and equity is not enough due to the lack of taking into account the individual differences or needs that exist between students with NDC. The ecological model by Bronfenbrenner (1978, 2005) and the bio-psychological model by WHO (2001) can assist stakeholders in appraising and documenting health-related functioning in school settings. In addition, new developed instruments can provide tools for assessing the learning environment, e.g., INCLUSIO (Leifler et al., 2022).

Interventions aiming to improve the psychosocial environment are necessary for the students’

development, learning and mental health. However, implementing interventions is complex and can be costly and might require further funding for schools, also highlighted by Hume et al., (2021) and Kucharczyk et al., (2015), where they emphasize the necessity of

implementing evidence-based methods for students with NDC and how that calls for rigorousness and competence in the school setting. There is a need for balance between the art of interventions where interventions and accommodations that are preferable and in majority should focus on the learning environment and not impairments or modification of individual traits. Hence, social skills training should likewise implement interventions targeting the surrounding environment, e.g., enhanced autism awareness among peers and all school staff.

In agreement with, e.g., Hornby (2015) and Ravet (2011), the inclusive philosophy can be combined with evidence-based methods and strategies originally placed within traditions from special education. Our results demonstrate evidence and favoring of interventions targeting NDC for teachers and students, aiming to improve inclusion. This implies

educational inclusion is better met when addressing the quality of the learning environment from two standpoints, general improvements as well as additional improvements explicitly implemented for students with NDC. The focused interventions have to be designed and evaluated advantageously together with the child or youth and further in collaboration with different professionals. Parents are significant information providers when understanding and preparing for support. Hence, our results emphasize the importance of further exploration of psychosocial factors in the environment, in several school years, not forgetting higher grades.

The advantage of the studies included in the thesis is the multi-perspective, where

implementing interventions is evaluated from several standpoints. Furthermore, identification and assessment of educational inclusion domains from the perception of students, caregivers and teachers provide valuable comparisons for future research orientations. This perspective is in line with Florian (2014a), questioning how measurements should be made for capturing inclusion reality. Legal acts and declarations of human rights state that children with ASD and ADHD should attend mainstream school and be provided the necessary support in the learning context (UN, 2006, 2015; UNESCO, 1994, 2005). The findings here confirm the discrepancy that still exists between legislations for inclusion and how it is implemented in school settings in practice. The needs of the students can be diverse and the complex task of designing interventions and adequate methods are preferably conducted in collaboration with staff. Nevertheless, regular teachers should be better equipped with understanding as well as tools in order to deal with student diversity in the classroom. The tools are knowledge of concrete accommodations for participation and accessibility.

In Swedish school settings, we have included students with NDC in mainstream classrooms since 2011 and we have to make it work better. Students with NDC without comorbidity have few alternatives and sometimes no option but to attend mainstream schools, and in many cases, they will not receive appropriate and sufficient support. The process and teamwork for improved educational inclusion starts with the knowledge of the dynamics and dilemmas, continues with preparing and providing the right circumstances (including awareness of the costs), and for the best of the students, ends with actions and concrete improvements in the learning contexts. Excellence can be achieved, in line with the philosophies from Plato, by acting. To conclude, excellent educational inclusion is better achieved through skills that take place in practice.

8 POINTS OF PERSPECTIVE