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Evaluating The Effectiveness of An Intervention Program To in Uence Attitudes of Students Towards Peers With Di..
Evaluating The Effectiveness of An Intervention Program To in Uence Attitudes of Students Towards Peers With Di..
St udent s’ At t it udes t owards Peers wit h Disabilit ies: A review of t he lit erat ure
Alexander Minnaert , Sip Pijl
Kofidou, Ch., & Mant zikos, C.(2017). Teachers’ and st udent s’ at t it udes and percept ions t owards peopl…
Const ant inos Mant zikos
Kofidou, Ch., Mant zikos, C., Chat zit heodorou, G., Kyparissos, N., & Karali, A. (2017). Teachers’ percept io…
christ y kof, Const ant inos Mant zikos
J Autism Dev Disord (2014) 44:572–583
DOI 10.1007/s10803-013-1908-6
ORIGINAL PAPER
Wendy Post
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J Autism Dev Disord (2014) 44:572–583 573
reading and mathematics. Regarding social outcomes, the disability types central in the current study has not been
more awareness and understanding of people with dis- made so far.
abilities has been reported as a benefit for students without Focusing on attitudes in the field of inclusive education
disabilities (Copeland et al. 2002). Conversely, children seems to be relevant as attitudes predict one’s future
with disabilities also benefit from contacts with typically behavior (Azjen 2005). Within attitude change theories,
developing students in integrated settings. It has been like the theory of planned behavior (TPB) or the contact
reported that they benefit in their communication skills theory (CT) (Allport 1954) background factors play an
(Fisher and Meyer 2002), academic outcomes (Hunt et al. important role in explaining attitudes and future behavior.
2003) and in terms of social skills/interaction (Cole and It has been stated that direct experience with, and infor-
Meyer 1991). mation about the attitude object moderate the attitude-
Despite growing awareness and increased interaction, behavior relation (Azjen 2005). Moreover, Briñol and Petty
peer acceptance is often lacking. Children with different (2005) argued that people have ‘a need to know’ to form
types of disabilities often experience difficulty in being attitudes what refers to ‘‘the desire to possess knowledge
accepted by typically developing peers (Koster et al. about and understanding of the social world’’ (p. 575). Lee
2010; Smoot 2004). It has been found that the attitudes of and Rodda (1994) suggested that a combination of
typically developing students play a role in accepting knowledge and experience would be most effective in
children with disabilities (De Boer et al. 2012b; Vignes changing attitudes in which basic knowledge should be
et al. 2009). acquired first. In the case of the inclusion of children with
Swaim and Morgan (2001) examined students’ attitudes severe physical and intellectual disabilities in mainstream
towards peers with autism and found less positive attitudes schooling, such knowledge could focus on understanding
towards this target group, compared to developing peers. In the needs of such children in order to reduce misunder-
the study of De Boer et al. (2012c), attitudes of students standings and feelings of pity.
were measured towards three disability types, namely: Providing knowledge has recently been the focus of
attention deficit hyperactivity disorder (ADHD), autism interventions in which the aim is to influence attitudes
spectrum syndrome (ASS) and intellectual disability. Their among elementary school students towards children with
study showed that students hold least positive attitudes disabilities (Favazza and Odom 1997; Holtz 2007; Ison
towards children with ADHD. More positive attitudes were et al. 2010; Krahé and Altwasser 2006; Rillotta and
found towards children with ASS than towards children Nettelbeck 2007; Swaim and Morgan 2001). Such pro-
with intellectual disabilities. With respect to children with grams focus on different disabilities (i.e., physical and
severe physical and intellectual disabilities, Schepis et al. intellectual, or psychiatric issues), duration and ages (i.e.,
(2003) concluded that they often require support to par- kindergarten or elementary school students).
ticipate with typically developing peers. Negative attitudes Research has been conducted in order to establish the
by peers without a disability towards children with severe effects of these intervention programs. This presents a
physical and intellectual disabilities is also reported by confusing picture. For example, some studies showed that
others (e.g., Gannon and McGilloway 2009; Laws and the intervention had a positive effect on the attitudes of
Kelly 2005; Yude et al. 1998). The relationship between regular elementary school students (Krahé and Altwasser
attitudes of peers and the acceptance of students with dis- 2006; Rillotta and Nettelbeck 2007), while others revealed
abilities suggests the importance of promoting more posi- that the intervention did not influence attitudes among
tive attitudes among typically developing students. This students of the same age and school setting (Bell and
ultimately may lead to a better social inclusion of children Morgan 2000; Godeau et al. 2010). When compared to
with disabilities in general education. elementary school students, limited information is avail-
When promoting more positive attitudes, it is important able on kindergarten students’ attitudes towards children
to consider variables which relate to attitudes, like stu- with disabilities (De Boer et al. 2012a) and interventions to
dents’ age, gender and the disability type. Previous influence these attitudes. Apart from an intervention
research has shown that students’ attitudes are more posi- developed by Favazza and Odom (1997), which established
tive when they are older (Nowicki 2006; Vignes et al. positive effects on the attitudes of these students, there are
2009). Moreover, it has been stated that girls hold more no other studies, as far as we know, which have focused on
positive attitudes towards peers with disability than boys this age group.
(Laws and Kelly 2005; Siperstein et al. 2007). Regarding Despite the knowledge acquired over the last decade on
the disability type, Nowicki (2006) found that students students’ attitudes towards children with disabilities and
were least positive towards students with an intellectual attitude changes through interventions, certain questions
disability, compared with students with a physical dis- remain unanswered. First, very little attention has been
ability. A comparison of students’ attitudes according to given in interventions to children with severe physical and
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574 J Autism Dev Disord (2014) 44:572–583
intellectual disabilities. Second, results of the studies con- group comprising two schools. All participating schools
ducted show mixed outcomes on the attitudes of elemen- contained single grades 1–8 or a combination of grades
tary school students and limited knowledge on the effects (e.g., grade 5 and 6, due to the small number of students).
of the interventions on kindergarten students’ attitudes. In our study, grade 2 and 3 belonged to the kindergarten
Third, the question whether such interventions result in classes (n = 4, age range 5–6 years) and grade 4–8 to the
long-term effects is often neglected or cannot be guaran- elementary classes (n = 13 classes, 7–11). Thus, the total
teed (Godeau et al. 2010; Hunt and Hunt 2004). This Dutch sample of this study comprised 4 schools, two in the
study has been set up in an attempt to fill these gaps in experimental condition and two in the control group which
knowledge by answering the following research question: comprised a total number of 4 kindergarten classes and 13
elementary classes.
What are the short- and long-term effects of an inter-
Prior to the study parents of all participating students
vention that provides knowledge about disability on
received a letter about the study in which they were asked
the attitudes of typically developing students towards
if their child could participate in the program. All parents
peers with physical and intellectual disabilities?
gave their consent.
Intervention
Method
The intervention was based on the ‘Special Friends’ pro-
Design and Procedure gram (Favazza and Odom 1997). This 6 weeks intervention
program focuses on kindergarten students and aims to
In order to answer the research question we designed a teach students that everyone is unique, regardless of dis-
quasi-experimental longitudinal study with three repeated ability. It also aims to increase all three attitude compo-
measures done in an experimental and a control group. The nents (Triandis 1971), namely: knowledge, feelings and
study was conducted between November 2009 and May behavioral intentions. The goal of the original intervention
2011 in a rural district in the north of the Netherlands. The is to create more awareness of typically developing stu-
three time measurements were 2 weeks before the start of dents about peers with disabilities via structured storytell-
the intervention (Time 1), 1 week after (Time 2) and a ing, cooperative learning groups and parental involvement
follow-up 1 year later (Time 3). (for more information see Favazza et al. 1999).
Two regular elementary schools comprising the experi- The intervention developed for the current study inclu-
mental group were selected for the study because they were ded one component of the Special Friends program:
about to set up a community school (September 2011). In the structured storytelling. The research team’s intervention
Netherlands, a community school often comprises different program consisted of two lessons per week over 3 weeks
educational facilities for children from 0 to 12 years, like pre based on the target group of the education center: children
and after school care, daycare centers (0–4 years) and ele- with physical and intellectual disabilities.
mentary schools. Besides these facilities, the community Due to the different ages of the participating students
school participating in the study had an education center for (5–12 years), we developed six lessons for each two grades
children with severe physical and intellectual disabilities (grades 1 and 2, 3 and 4, 5 and 6, 7 and 8)1.2 The structure
(from 12 to 18 years). The current study was designed to and content of the lessons were the same for all grades, but
prepare students of the experimental group for future contact were geared to the age of the students. Because the mate-
with children with severe physical and intellectual disabil- rials used by teachers in grades 1 and 2 and 3 and 4 often
ities attending the education center. differ from those used in grades 5–8, we chose storybooks
In order to select schools to participate as the control in the lessons for kindergarten students and movies or real-
group, we drew up three selection criteria: life stories for the older grades. Each storybook included a
character with a disability, like a spider with five legs (see
1. Regular elementary school (students 4–12 years old);
example Table 1). The stories and movies used for grades
2. Located in the same rural district as the experimental
5–8 included a peer with a disability, like the daily life of a
schools;
girl whose sister has a severe physical and intellectual
3. No students with disabilities in the class.
1
Ten schools in the same rural district were invited to It is very common two grades are combined into one class due to
participate in the control group. Three schools were willing the small number of students in rural districts of the Netherlands.
2
to participate in the study (response rate 33 %). One of the Because the schools preferred a school-wide intervention, we
implemented the intervention in all grades, including first grade.
schools, however, had a student with Down’s syndrome so However, due to the young age of these students we did not assessed
was not admitted to participate. This resulted in a control their attitudes.
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J Autism Dev Disord (2014) 44:572–583 575
disability. The storybooks, movies and real life stories were implementation, teachers were asked to complete an evalu-
selected using the ‘checklist for selection of books’ ation form. In one of the questions teachers were asked to
developed for the Special Friends program (see Favazza indicate if they implemented all aspects of the intervention.
et al. 1999), comprising ten selection criteria, such as ‘a All teachers indicated that the all the lessons were given and
book should not encourage pity’. that they implemented the lessons according to our design.
One of three types of disability (physical, intellectual or Moreover, they indicated to be satisfied about the design of
severe physical and intellectual disability) was discussed the lessons, length and materials selected.
twice weekly. Thus six 45-minute lessons were designed
resulting in an intervention over a period of 3 weeks. The Participants
first lesson was particularly aimed at explaining the specific
type of disability. For example, a story about a character/ Two hundred and seventy-one students participated in the
child with a physical disability was either read (book) or study (Nkindergarten students = 53, Nelementary school students =
shown (video) by the teacher, followed by a group discus- 218). Because we used different measures for kindergarten
sion. For the second lesson, an activity was designed and elementary school students, we will present both
showing the impact of a physical disability in daily life (i.e., samples separately. Because the administration of the
a sport activity in which the students use a wheelchair). kindergarten questionnaire is time consuming (app. 20 min
Table 1 presents an example of a lesson for kindergarten per group of 3 students) and disturbing the daily curricu-
students. In addition, teachers received a detailed lesson plan lum, we randomly selected half the kindergarten students
to follow for each lesson and background information about per class to participate in the study. This resulted in fifty-
the three disability types. Parents of the children in the three kindergarten students, who attended grade 2 or 3 and
experimental group had also received an information were 5 or 6 years old. Two hundred and eighteen ele-
package including: background information on the program, mentary school students in grades 4–8 participated in the
a timetable and details about the three types of disability. study (age range 7–12 years, M = 9.9, SD = 1.2). Student
Table 2 presents a summary of the intervention. demographics are presented in Table 3.
Table 1 Example of lesson goals and materials for kindergarten students (grade 1/2)
Grade 1/2—week 1, lesson 1: physical disability
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J Autism Dev Disord (2014) 44:572–583 577
he were teased’. It took about 20 min to complete the Bosker 1999). In the end, we tested whether there were
questionnaire. differences in attitude scores between the control and the
Students of Grade 4 (age 7–8) were initially included in experimental group at each point in time.
the study. However, during the first measurement it turned Additionally, we added possible covariates (such as age
out that the statements were too difficult to read for stu- and gender) separately in the model, and explored which
dents of this age. We decided to read the statements aloud. interactions were present. The variables which were rele-
As a consequence, the assessment procedure differed sig- vant or showed a significant relationship with the depen-
nificantly for this grade compared to the assessment pro- dent variable (i.e., students’ attitude scores) were included
cedure for grades 5–8. For example, by reading the in the final model. In the results section we present the
statements aloud it was impossible to take the gender- empty model and the final model (a model including time
specific vignettes into account. Hence, the reliability of and condition and other covariates). In all models a p value
students’ answers in grade 4 can be questioned. This made of 0.05 was considered statistically significant. We exam-
us decide to exclude the data of students in this grade for ined the differences in deviance between the models to
time measurements 1 and 2. As a consequence, the sample establish whether there was an improvement in the final
of elementary school students was reduced by 41 students, model. The significance of an increase in deviance was
resulting in a total sample of 177 elementary school stu- tested by a Chi square test, with the number of degrees of
dents (nexperimental group = 76, ncontrol group = 101). freedom equal to the number of extra model parameters in
Students were asked to indicate their level of agreement the largest model.
with the statements via a 5-point Likert scale (1 = totally
disagree to 5 = totally agree), with a higher score reflect-
ing a more positive attitude. The reliability coefficients for Results
the current study were, resp. aT1 = 0.76, aT2 = 0.79,
aT3 = 0.80. The mean score of each student was included The Effects of the Intervention on Kindergarten
in the analysis as dependent variable. Students’ Attitudes
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578 J Autism Dev Disord (2014) 44:572–583
Table 4 Attitudes of kindergarten students by condition and time A comparison between the deviance of the empty model
Time 1 a
Time 2 Time 3
and the final model revealed a significant improvement of
the final model, v2 (12) = 24.51, p \ 0.05.
Mean SD Mean SD Mean SD
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J Autism Dev Disord (2014) 44:572–583 579
Table 5 Model estimates for the variable effects on kindergarten This study showed that the intervention had short term
students’ attitudes for different models effects on kindergarten students’ attitudes. However, the
Model Empty model Final model t value third time measurement revealed that the attitude change
Coefficient Coefficient did not last. On the one hand, this could mean that kin-
(S.E.)a (S.E.) dergarten attitudes can indeed be influenced by a knowl-
Fixed part edge-based intervention program. On the other hand, the
Intercept 10.726 (0.626) 8.499 (1.031) results suggest that an improvement of the intervention is
Conditionb needed to strengthen its effectiveness in the long-term.
Experimental -1.744 (1.591) -1.096 Although our intervention was based on the Special Friends
Measurementc
program (Favazza et al. 1999), we only included a
Time 2 1.651 (1.445) 1.142
knowledge component. Including the other components of
the program (structured play and home reading) might lead
Time 3 4.376 (1.445) 3.028**
to stronger long-term effects.
Condition * 5.444 (2.174) 2.504*
Time 2d This study showed that students’ attitudes in both con-
Condition * 1.211 (2.199) 0.550 ditions were significantly improved at Time 3 (1 year after
Time 3 the intervention), indicating that kindergarten students
Random part become more positive when they become older. A possible
Variance explanation of the improvement might be the effect of
Between students 7.583 (4.416) maturation. This effect refers to processes changing over
Within 35.816 (5.239) time, like growing older, wiser, tired or bored. As stated by
measurements Goodman (1989), students become more knowledgeable as
Time 1 38.005 (7.748) they become older. Moreover, the increase in attitudes in
Time 2 42.928 (8.752) both conditions can also be attributed to the assessment of
Time 3 30.960 (6.191) the questionnaire. Since talking about disabilities is not
Covariance common for kindergarten students, the assessment of the
Time 1 * Time 2 16.981 (6.436) questionnaire can be seen as an intervention in itself. It
Time 1 * Time 3 6.140 (5.058) might be that students were stimulated to think and talk
Time 2 * Time 3 8.424 (5.550) about disabilities for the first time in their lives. This may
Deviance 960.999 936.489 suggest that such talk is a first step in helping to shape the
attitudes of such young students.
* Significant at p \ 0.05. ** Significant at p \ 0.01
a There are, however, some limitations which should be
S.E. = Standard Error
b
considered when interpreting the outcomes. The small
Control = reference
c
sample size of the kindergarten group is clearly a limitation
Time 1 = reference
d
of the study. In addition, it should be noted that the
Condition * Time 1 = reference
instrument used for kindergarten students, the ASK-R, does
not particularly focus on the disabilities represented in the
Table 6 Attitudes of elementary school students by condition and intervention. It is therefore unclear if students’ attitudes
time
towards children with physical, intellectual and severe
Time 1a Time 2 Time 3 physical and intellectual disabilities became more positive.
Mean SD Mean SD Mean SD In any future research it is advisable to match the items of
the instrument with the disabilities represented in the
Experimental (n = 76) 3.60 0.60 3.43 0.62 3.45 0.55 intervention.
Control (n = 101) 3.63 0.49 3.59 0.54 3.56 0.64
a
There was no significant difference between the two conditions at
Time 1 Attitudes of Elementary School Students
education in the Netherlands, this suggests that that the With respect to elementary school students, the findings of
attitudes of Dutch kindergarten students may become more this study show that providing ‘knowledge’ had a limited
positive in future, as they gain experience of interacting influence on their attitude. This is in line with other studies
with peers with disabilities. Thus, monitoring the attitude which also reported non-significant outcomes (Bell and
development and level of acceptance of Dutch kindergarten Morgan 2000; Godeau et al. 2010; Swaim and Morgan
students who experience inclusive education is 2001). A possible explanation for these results might be the
recommended. stigma associated with disability, which affects older
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580 J Autism Dev Disord (2014) 44:572–583
Table 7 Model estimates for the variable effects on attitudes of In line with other studies, our findings underline that
elementary school students for different models boys hold more negative attitudes than girls. The outcomes
Model Empty model Final model t value of this study indicate that boys and girls do not change
Coefficient Coefficient differently, as no interaction effects were found. To ensure
(S.E.)a (S.E.)
stronger intervention effectiveness in boys and girls, De
Fixed part Boer et al. (2012b) suggest taking the differences between
Intercept 3.547 (0.033) 3.975 (0.090) boys’ and girls’ attitudes into account.
Genderb Based on the outcomes of this study it can be concluded
Boys -0.209 (0.064) -3.265** that elementary school students hold the most negative
Vignettec attitudes towards children with intellectual and severe
Intellectual -0.250 (0.079) -3.164** physical and intellectual disabilities than towards students
Severe physical/ -0.240 (0.082) -2.927** with a physical disability. This is a disappointing result, as
intellectual there is already an on-going trend to include the latter
Conditiond group of children in regular schools. It is likely that certain
Experimental -0.182 (0.086) 2.116* behaviors typical for children with severe physical and
Measuremente intellectual disabilities (e.g., use of a wheelchair, difficul-
Time 2 -0.054 (0.051) 1.059 ties in talking, uncontrolled movements) (Vlaskamp et al.
Time 3 -0.179 (0.073) -2.452* 2005) may ‘frighten’ students. This underlines the impor-
Condition * -0.120 (0.078) -1.538 tance of explaining the behavior of such children in order
Time 2f
to remove students’ irrational fear.
Condition * 0.039 (0.108) 0.361
Time 3
With respect to both kindergarten students and ele-
Random part
mentary school students, it should be mentioned that it was
Variance
their attitudes rather than any knowledge acquired that was
Between students 0.160 (0.024) measured in this study. Although we focused on knowledge
Within 0.173 (0.015) about disabilities in the intervention, the cognitive com-
measurements ponent (i.e., beliefs and knowledge) was not measured by
Time 1 0.305 (0.032) both instruments used. It may be that students gained
Time 2 0.337 (0.037) knowledge about disability through the intervention, which
Time 3 0.285 (0.031) can then be seen as a starting point for attitude change over
Covariance time. It is highly recommended to include a measurement
Time 1 * Time 2 0.130 (0.029) or structured interview in future research to examine the
Time 1 * Time 3 0.179 (0.026) cognitive component, like students’ knowledge about dis-
Time 2 * Time 3 0.106 (0.029) abilities and what students learned from the intervention.
Deviance 786.981 735.578 Another limitation of this study is the significant difference
* Significant at p \ 0.05. ** Significant at p \ 0.01. *** Significant at between both conditions at Time 1, so that the outcomes
p \ 0.001 need to be interpreted with some caution.
a
S.E. = Standard Error
b
Girls = reference Implications of the Study
c
Physical = reference
d
Control = reference The results of this study clearly point out the potential of
e
Time 1 = reference the intervention to influence attitudes positively, particu-
f
Condition * Time 1 = reference larly at the kindergarten stage. As Innes and Diamond
(1999) reported, early childhood years might be a particular
fruitful time to teach students about diversity in relation to
disability. However, improvements of the intervention
students more (Bell and Morgan 2000). For example, as a seem necessary in order to strengthen long-term effects.
consequence of the intervention students might have real- One such improvement might be to include parents in the
ized what it means to have a disability in daily life and how intervention, as it has been argued that they are important
this would affect them when coming into contact with a in developing young children’s attitudes (Bricker 1995).
disabled person. Corresponding with other studies, the The significant link between the attitudes of parents and
outcomes of this study raise the question whether short children towards students with disabilities (De Boer et al.
term intervention, such as ours, can achieve the intended 2011; Innes and Diamond 1999) suggests that parental
objectives among elementary school students. involvement may lead to greater effectiveness of
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J Autism Dev Disord (2014) 44:572–583 581
interventions to improve these attitudes. For example, computer because he is a slow writer. Sometimes it is also
parents can be included in the intervention by reading difficult to understand what John says.
storybooks at home about disability. Another improvement
could be to have the intervention over a longer period or Janet: a girl showing aspects of a cognitive disability
repeat it at different time intervals (Bell and Morgan 2000).
By comparing an intervention at different time spans, Janet is a girl your own age and has just moved to where
Rillotta and Nettelbeck (2007) established a stronger you live. She attends the same school as you, has just
positive change in attitude in students who followed an started to read and write but has difficulty with math. While
eight-session intervention rather than a three-session one or Janet can run and play like other children, she sometimes
no intervention at all. Finally, the intervention might be forgets the rules of certain games. She needs extra time to
improved by including activities that bring children in learn her work and can be forgetful in class. Sometimes it
direct contact with peers with disabilities. As stated by is difficult to understand what Janet says. She does enjoy
Zajonc (2001), repeated exposure to something (in this case playing music. For part of the day, Janet receives extra
disability) is sufficient to change attitudes. Including shared learning assistance outside the classroom.
activities in the intervention like sports or art, might lead to
stronger effects (Rillotta and Nettelbeck 2007). Jack: a boy with severe physical and intellectual
This study made a first attempt to influence attitudes disabilities
towards children with disabilities among kindergarten and
elementary school students in a Dutch education setting. Jack is a boy your own age and has just moved to where
More specifically, we attempted to prepare typically you live. He attends the same school as you, and while his
developing students for their future contact with children hearing and sight are good, he has difficulty with learning
with severe physical and intellectual disabilities. The and talking. Jack has his own teacher who helps him with
intervention evaluated in this study demonstrated the learning. He uses a wheelchair which he drives himself,
potential of preparing students for such future contact. and can also walk short distances. Jack has difficulty
However, a fist important, but challenging, step is to playing as he is easily distracted. Because he cannot talk,
improve the intervention in order to establish greater he often makes noises or smiles when he likes something.
effectiveness and more long-term. Jack enjoys music and can play with a music box for a long
The current study focused on a specific disability type of time.
which is not very common yet to be included in general
schools. Other low-incidence disability types (e.g., students
with autism spectrum disorders, ASD) (Carter et al. 2010) References
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