Treatment, Management

Inclusion

In a growing number of schools across the United States, it is now possible to walk into elementary, middle and secondary classrooms and observe students with Down syndrome and other cognitive and physical disabilities learning with their nondisabled peers. This practice of welcoming, valuing, empowering and supporting diverse academic and social learning among students of all abilities is called Inclusive education.

Inclusive education is more than mainstreaming. Mainstreaming implies that a student from a separate special education class visits the regular classroom for specific, usually non-academic, subjects. Inclusion is an educational process by which all students, including those with disabilities, are educated together for the majority of the school day. With sufficient support, students participate in age-appropriate, general education programs in their neighborhood schools.

Inclusion is a philosophy of education based on the belief in every person’s inherent right to fully participate in society. Inclusion implies acceptance of differences. It makes room for the person who would otherwise be excluded from the educational experiences that are fundamental to every student’s development.

When inclusion is effectively implemented, research has demonstrated academic and social benefits for all students: both those who have special needs as well as typical students. Friendships develop, nondisabled students are more appreciative of differences and students with disabilities are more motivated. True acceptance of diversity ultimately develops within the school environment and is then carried into the home, workplace and community.

Benefits of Inclusion

A number of studies over the years have reported the various benefits of inclusive education. In 1996, the National Down Syndrome Society published a research report on the inclusion of children with Down syndrome in general education classes1. After analyzing and comparing extensive parent and teacher questionnaires, this study found that with proper support and adequate communication between parents, teachers and professionals, inclusion is a favorable educational placement for children with Down syndrome. The study also found that the learning characteristics of students with special needs were more similar to their nondisabled peers than they were different. Moreover, teachers reported positive experiences with students with Down syndrome. They described their students as eager to learn, especially when encouraged, and reported personal satisfaction in terms of their professional achievements.

Literature documenting successful inclusion practices is significant and growing. An analysis by Baker, Wang and Walberg in 1994 concluded that “special-needs students educated in regular classes do better academically and socially than comparable students in non-inclusive settings2.” Research by Hollowood et al., (1995) found inclusion was not detrimental to students without disabilities3. In fact, a national study of inclusive education conducted in 1995 by the National Center on Educational Restructuring and Inclusion (NCERI) reported academic, behavioral and social benefits for students with and without disabilities4. The study also concluded that students within each of IDEA’s 13 categories of disability, at all levels of severity, have been effectively integrated into general education classrooms. NCERI also reported positive outcomes and high levels of professional fulfillment for teachers. A number of other studies confirming the educational and social benefits of inclusion for students with and without disabilities can be found in the reference list at the end of this publication5,6,7.

In May 2000, the Indiana Inclusion Study8 investigated the academic benefits of inclusive education for students without disabilities. This study concluded that students without disabilities who were educated in inclusive settings made significantly greater progress in math than their peers. Although their progress in reading was not significantly greater than their peers, there was a “consistent pattern” in their scores that favored educating students without disabilities in inclusive settings.

This and other research has highlighted improved academic skills, social skills, communication skills and peer relationships as four of the most important benefits of inclusion. Nondisabled students can serve as positive speech and behavior role models for those with disabilities and students with disabilities offer their nondisabled peers acceptance, tolerance, patience and friendship. As allies and friends, peers can offer support both in and out of the classroom. These findings show that everyone involved in inclusive schooling can benefit from the experience.

The introduction to the Individuals with Disabilities Education Act acknowledges that education in inclusive settings works when the mandates of the law are followed. It states:

Almost 30 years of research and experience has demonstrated that the education of children with disabilities can be made more effective by:

• having high expectations for such children and ensuring their access to the general education curriculum in the regular classroom, to the maximum extent possible, in order to--
• meet developmental goals and, to the maximum extent possible, the challenging expectations that have been established for all children; and be prepared to lead productive and independent adult lives, to the maximum extent possible;
• strengthening the role and responsibility of parents and ensuring that families of such children have meaningful opportunities to participate in the education of their children at school and at home;
• coordinating this title with other local, educational service agency, State, and Federal school improvement efforts, including improvement efforts under the Elementary and Secondary Education Act of 1965, in order to ensure that such children benefit from such efforts and that special education can become a service for such children rather than a place where such children are sent;
• providing appropriate special education and related services, and aids and supports in the regular classroom, to such children, whenever appropriate;
• supporting high-quality, intensive preservice preparation and professional development for all personnel who work with children with disabilities in order to ensure that such personnel have the skills and knowledge necessary to improve the academic achievement and functional performance of children with disabilities, including the use of scientifically based instructional practices, to the maximum extent possible;
• providing incentives for whole-school approaches, scientifically based early reading programs, positive behavioral interventions and supports, and early intervening services to reduce the need to label children as disabled in order to address the learning and behavioral needs of such children;
• focusing resources on teaching and learning while reducing paperwork and requirements that do not assist in improving educational results; and
• supporting the development and use of technology, including assistive technology devices and assistive technology services, to maximize accessibility for children with disabilities.

Inclusive education has also been shown to have a positive impact on employment outcomes. A 1988 study by Affleck et al., spanning fifteen years, found that students with disabilities educated in inclusive settings had an employment rate of 73 percent while those in segregated programs had an employment rate of 53 percent9. Ferguson and Asch (1989) found that the more time students with disabilities spent in regular classes, the more they achieved as adults in employment and continuing education10. More recently, in its 1997 annual report to Congress, the U.S. Department of Education noted: “across a number of analyses of post-school results, the message was the same: those who spent more time in regular education experienced better results after high school11.” As nearly all employment settings are themselves inclusive, involving people with and without disabilities, it is easy to imagine why inclusive education has a positive impact on employment outcomes.

Speech and language therapy

Feeding:

Speech is a secondary function that uses the same anatomic structures used for feeding and respiration. Low muscle tone (hypotonia) affects feeding and will also affect speech. In feeding, children gain practice with strengthening and coordinating the muscles that will be used for speech. If your child has difficulty feeding, it is important to seek guidance from a feeding specialist (a speech-language pathologist or occupational therapist who has advanced training). Feeding therapy can to help strengthen the oral muscles. This can also have a positive effect on speech.

Other skills:

Other important pre-speech and pre-language skills are the ability to imitate and echo sounds; turn-taking skills (learned through games such as peek-a-boo); visual skills (looking at the speaker and looking at objects); auditory skills (listening to music and speech for lengthening periods of time, listening to speech sounds); tactile skills (learning about touch, exploring objects in the mouth); oral motor skills (using the tongue, moving lips); and cognitive skills (understanding object permanence, cause and effect relationships).  The family can stimulate these pre-speech and language skills at home. Contact Child Find in your area, and ask for speech-language pathology services for your child. The SLP can help you learn the skills that you need to help your child move along the journey to learning language and using speech.

When should speech-language pathology services begin? What is early language intervention?

 

Speech-language pathology services can begin in infancy. Treatment may involve sound stimulation, language stimulation accompanying play, feeding, oral motor exercises and/or other techniques. It should always include the family as a partner in treatment because the family is the primary teacher of speech and language. Early language intervention (ELI) is the designation given for services provided to infants and toddlers from birth through the end of age two. Speech-pathology services should be part of a comprehensive overall treatment plan for infants and toddlers. It may involve sessions at home or in a center, and may be part of a team approach involving physical, occupational and other therapists working together with the family.

 

A government-sponsored early intervention program is available in all communities in the U.S. Speech-language and other therapy services are often provided at these programs for eligible children under age three, based on disability and an evaluation. Most children with Down syndrome qualify for speech-language services. After age three, there may be continuing services sponsored through the school system with an IEP  or through community agencies, private practitioners, university clinics, medical centers and other sources.