Journal of Early Intervention, 1996

Vol. 20, No. 3, 189-203

Copyright 1996 by the Council for Exceptional Children

Assessing the Comfort Zone of

Child Care Teachers in Serving
Young Children With Disabilities

VIRGINIA BUYSSE, PATRICIA WESLEY, LYNETTE KEYES, &

DONALD B. BAILEY, JR.
University of North Carolina at Chapel Hill

This study employed 2 methods to assess the attitudes of 52 general early childhood teachers serving
young children with disabilities in inclusive early childhood settings. The first consisted of a structured
interview using an index of functional child characteristics to assess professional comfort in serving an
individual child. The second consisted of a rating scale to assess global attitudes toward the benefits
and drawbacks of inclusion. Findings indicated significant differences in teachers' comfort levels as a
function of severity of the child's disability across all domains. Predicted comfort scores were lowest
when the child was reported to have severe to profound disabilities in the areas of leg functioning,
muscle tone, and appropriate behavior.

Inclusive programming for young children
with disabilities and their families is still con-
sidered by many to be an innovative prac-
tice. Previous research suggests that, among
the many factors that determine successful
implementation of innovation in the schools,
teacher attitudes play a central role (Stein &
Wang, 1988). Although a number of studies
have documented that parents of preschool-
ers with and without disabilities, particularly
parents of children who participated in an
inclusive setting (Diamond & LeFurgy, 1994),
typically hold positive views about inclusive
programming (Bailey & Winton, 1987; 1989;
Guralnick, 1994; Reichartet al., 1989; Turn-
bull & Blacher-Dixon, 1980; Turnbull, Win-
ton, Blacher, & Salkind, 1983; Winton, 1986),
very little is known about the attitudes of gen-
eral early childhood personnel toward the in-
clusion of young children with disabilities in
general child care and preschool programs.
Volk and Stalhman (1994) speculated that at-
titudes toward inclusion among general early
childhood personnel could range from con-
cern about self-competence in meeting indi-
vidual needs to feelings of sympathy and sad-
ness for a child or resentment about having to
assume additional responsibilities and learn
new skills.
The majority of studies examining adult at-
titudes toward individuals with disabilities can
be divided into two groups. Initial studies
involved measures of attitudes toward disabil-
ities or disability subgroups using broad cat-
egories (e.g., mentally retarded, deaf, physi-
cally disabled; Antonek & Livneh, 1988). This
approach has been criticized because of dif-
ferences in how categorical labels are used
and interpreted and because of the variability
that exists among individuals with the same
disability label (Home, 1985; Ward & Cen-
ter, 1987).

Buysse, Wesley, Keyes, & Bailey 189

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 With the shift away from segregated edu-
cational programming for children with dis-
abilities, a second group of studies has as-
sessed the views of teachers, parents, and
administrators toward inclusive philosophy,
policies, and practices. Early studies of atti-
tudes toward inclusion of school-age chil-
dren with disabilities suggested that teachers
who received intensive inservice training or
who reported successful experiences in teach-
ing students with disabilities had more posi-
tive views toward inclusion and that teacher
attitudes generally became less positive as
grade level increased (Larivee & Cook, 1979,
1981, cited in Antonak & Livneh, 1988). In a
recent study conducted with Israeli elemen-
tary school teachers, Schechtman, Reiter, and
Schanin (1993) reported that teachers who
viewed efforts to integrate the child with dis-
abilities into the classroom as a personal and
professional challenge were more likely to
have favorable attitudes toward inclusion,
whereas the amount of external school sup-
port teachers received had little bearing on
how they perceived inclusion.
Additional research has demonstrated that
values and attitudes represent a potential bar-
rier to inclusive programming in early child-
hood settings (Rose & Smith, 1992). Parents,
teachers, and administrators in early child-
hood programs have expressed concerns
about the adequacy of resources, preparation
of children and teachers for inclusion, and
potential conflicts with respect to different
program philosophies and goals for general
and special education (Peck, Hayden, Wand-
schneider, Peterson, & Richarz, 1989). Al-
though both teachers and parents have iden-
tified numerous benefits of early childhood
inclusion, their responses to survey items re-
garding problems with inclusion have varied,
leading researchers to conclude that desir-
able outcomes are likely to be associated with
program quality and individual experiences
with inclusion (Bailey & Winton, 1987; Peck,
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Carlson, & Helmstetter, 1992; Winton, 1993).
These findings also could reflect an increased
awareness of the advantages of inclusion, to-
gether with a recognition of the difficulties
involved in trying to implement inclusive prac-
tices effectively (Schechtman et al., 1993).
Other researchers have argued that a more
functional assessment approach is needed to
account for the influence of contextual fac-
tors and child characteristics on teacher atti-
tudes, which would lead to clearer implica-
tions for individualized programming (Home,
1985; Ward & Center, 1987). As Wilczenski
(1992) noted,
Educators' attitudes toward inclusive educa-
tion might be expected to vary based on
functional issues, that is, the physical,
academic, social, or behavioral accommo-
dations that students with disabilities require
in order to function in a regular class,
regardless of their labeled handicap, (p. 306)
The emphasis on teacher accommodations
in attitude assessment may be viewed as an
extension of our understanding of how dif-
ferent caregiver patterns have emerged for
parents of children with various types of dis-
abilities, sometimes referred to as caretaking
burden (Erickson & Upshur, 1989). Only a
few studies have applied the notion of care-
taking burden to educational contexts in
which teachers without specialized training
have primary responsibility for instructing stu-
dents with disabilities. Ward and Center
(1987) asked teachers and administrators to
rate on a 5-point Likert scale their willingness
to include children with characteristics such
as short attention span, moderate intellectual
ability, mild mobility difficulties, and the need
for medical monitoring. A factor analysis re-
vealed five factors in which child character-
istics clustered according to the demands chil-
dren made in terms of teacher time, skills,
and needs for assistance, and not on the basis
of traditional disability categories (e.g., phys-
JEI, 1996, 20:3
 ical, intellectual, sensory). A related study
found that both prospective and experienced
teachers reported more positive attitudes to-
ward students who could learn and did not
inhibit learning in their peers (Wilczenski,
1992). Results of this study further indicated
that teachers were willing to make physical
accommodations for students with disabili-
ties but responded less favorably to making
academic and behavioral accommodations.
With respect to young children with dis-
abilities, several studies have investigated the
relationship between child characteristics and
attitudes toward inclusion among parents
(Green & Stoneman, 1989; Guralnick, 1994),
and at least one study has examined this is-
sue among general early childhood staff (Eiser-
man, Shisler, & Healey, 1995). Guralnick
(1994) found that mothers' perceptions of the
benefits and drawbacks of early childhood
inclusion were not associated with severity of
disability and other child characteristics, but
mothers of children with significant behav-
ioral problems identified more drawbacks than
did other mothers. Green and Stoneman
(1989) derived a comfort score by presenting
parents of typically developing children with
a list of 13 disabling conditions (e.g., child
who is deaf, child in a wheelchair, child with
severe mental retardation) and asking parents
to rate how they would feel about the child
with disabilities being included in their child's
preschool class. The study found that pre-
schoolers with behavioral problems and se-
vere disabilities elicited the most concerns
among parents. Similarly, Eiserman and his
colleagues reported that general early child-
hood educators' and administrators' attitudes
were least favorable toward serving preschool-
ers with significant involvement (Eiserman et
al., 1995).
A review of the literature on teacher atti-
tudes leads us to several conclusions about
research on this topic in early childhood set-
tings. First, although there are few studies as-
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sessing attitudes among general early child-
hood personnel serving preschoolers with
disabilities, research on teacher attitudes to-
ward school-age children with disabilities sug-
gests that teacher attitudes may be critical in
determining the success of inclusive place-
ments and that attitudes may be more vari-
able than other factors such as administrative
and curricular strategies (Chow & Winzer,
1992). Second, in addition to assessing glo-
bal attitudes toward disabilities and inclusion
as well as identifying external supports or in-
trinsic factors associated with teachers' atti-
tudes, there is a need to develop and evalu-
ate assessment approaches that assume an
acceptance continuum (Home, 1985). Such
an approach could be used to identify a teach-
er's comfort in serving a particular child on
the basis of child characteristics and the types
of accommodations perceived as necessary
for a successful placement.
The purpose of this study was to examine
the attitudes of general early childhood teach-
ers toward the inclusion of preschoolers with
disabilities in general early education set-
tings. The study addressed the following ques-
tions: (a) How comfortable are general early
childhood teachers in serving individual chil-
dren with disabilities? (b) What are teachers'
views regarding the benefits and drawbacks
of early childhood inclusion in general? and
(c) How do factors such as the severity of the
child's disability, years of professional expe-
rience, and the number of consultation ses-
sions with an early childhood special educa-
tor contribute to teachers' attitudes toward
inclusion and their comfort in serving indi-
vidual children?
METHOD
Participants
The participants were 52 general early child-
hood teachers from community child care pro-
grams and 18 early childhood special edu-
191
cators who served as consultants in these
settings. The teachers worked in child care
programs in North Carolina that historically
had enrolled only typically developing chil-
dren, but had begun to serve a few children
with disabilities at the time of this study. The
child care programs were public, for-profit
and not-for-profit centers that met state min-
imum standards for A or AA licensing. All of
the centers operated 5 days a week for at
least 8 hours a day. The child care teachers
were all women who ranged in age from 24
to 56 years, with a mean age of 38 years (SD
= 9.3). More than half had worked in the
child care field more than 10 years and 84%
reported having professional experience with
children with special needs. Six percent of
the child care teachers held master's degrees,
32% bachelor's degrees, 28% associate de-
grees, and 34% had high school diplomas.
Of the total sample, 39% were African Amer-
ican and 6 1 % were Caucasian.
The early childhood special educators who
interviewed child care teachers for this study
worked for community mental health pro-
grams. They provided services to children and
families who were eligible for special ser-
vices under the Infant-Toddler or Preschool
Programs of the Individuals with Disabilities
Education Act (IDEA, 1991). The early child-
hood special educators were all women and
had either bachelor's or master's degrees in
early childhood special education. Thirty-six
percent of the early childhood special edu-
cators indicated they had met with the child
care teacher six or fewer times before the
interview; 64% reported they had met with
her more than six times and that their rela-
tionships were well established.
Instrumentation
ABILITIES Index. The ABILITIES Index (Sime-
onsson & Bailey, 1988) was used to describe
children's functional abilities and assess teach-
ers' comfort levels across nine domains: au-
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dition, behavior, intellectual functioning,
limbs, intentional communication, tonicity,
integrity of physical health, eyes, and struc-
tural status. Each domain is rated on an or-
dinal scale from 1 to 6 (1 = normal func-
tioning, 6 = profound disability). Previous
research has demonstrated the reliability of
the index among raters who differed consid-
erably with respect to discipline and relation-
ship to the child (Bailey, Simeonsson, Buysse,
& Smith, 1993). Weighted kappa coefficients
for multiple raters were reported to range from
.24 to .90 with a mean of .60. The index was
also found to be an acceptable and useful
method of describing infants and preschool-
ers with disabilities among parents, teachers,
and therapists who used it (Buysse, Smith,
Bailey, & Simeonsson, 1993) and in devel-
oping consensus ratings among professionals
with different backgrounds (Bailey, Buysse,
Simeonsson, & Smith, 1995).
Benefits and Drawbacks of Early Child-
hood Inclusion. A variation of the scale de-
veloped by Bailey and Winton (1987) was
used to assess global attitudes toward inclu-
sion. Modifications to the scale consisted of
changes in terminology (i.e., from handi-
capped children to children with special
needs, from mainstreaming to early child-
hood inclusion) and the addition of a brief
definition of inclusion in the directions. The
scale consists of 28 statements divided into
two sections: possible benefits and possible
drawbacks. Respondents are asked to rate
each of the 28 statements on a 5-point Likert
scale in which 1 equals definitely not a ben-
efit (or drawback) and 5 equals definitely a
benefit (or drawback). The 28 items form four
subscales related to Children With Special
Needs, Typically Developing Children, Fam-
ilies of Children With Special Needs, and Fam-
ilies of Typically Developing Children. Con-
sistent with previous research (Bailey &
Winton, 1987; Guralnick, 1994), we found
high internal consistency within the four sub-
JEI, 1996, 20:3
scales based on Cronbach's alpha, which
ranged from .72 to .88 (M = .82). At the end
of each section, respondents were asked to
write the number of the item that represents
the greatest benefit or drawback to early child-
hood inclusion.
Procedure
We recruited the early childhood special ed-
ucators at a statewide meeting for early in-
terventionists who served as consultants in
child care centers by describing the study and
asking for volunteers. Additionally, we con-
ducted two training sessions regarding study
procedures for early childhood special edu-
cators who agreed to participate and we were
available by telephone to answer follow-up
questions. We then distributed to the early
childhood special educators packets that con-
tained a letter to the child care teacher de-
scribing the study, a consent form and a de-
mographic form for the child care teacher, a
script for the interview, the ABILITIES Index
and comment form, and the Benefits and
Drawbacks rating scale. Early childhood spe-
cial educators returned completed packets by
mail to the researchers in pre-addressed,
stamped envelopes.
Early childhood special educators were
asked to recruit 1-3 general early childhood
teachers from child care classrooms that en-
rolled young children with disabilities who
were on the early childhood special educa-
tor's caseload. In all instances, early child-
hood special educators explained the study
to the teacher beforehand, made an appoint-
ment to meet with her in the child care center
to complete the packet, and followed a
scripted interview guide. The teacher com-
pleted the ABILITIES Index twice. First, she
selected a child with disabilities in her class-
room and, in conjunction with the early child-
hood special educator, charted a profile of
that child's abilities. This was accomplished
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by marking X's in the appropriate boxes to
indicate the child's level of functioning on
the 1-6 scale (i.e., normal, suspected, mild,
moderate, severe, profound) across the nine
domains (e.g., audition, behavior, intellec-
tual functioning). If more than one child with
disabilities was enrolled, a method was pro-
vided for randomly selecting only one child.
A second profile was created on the same
ABILITIES Index to indicate the point on the
1-6 scale at which the teacher's comfort
ended for each domain, as described below.
The second profile was completed indepen-
dently by the teacher, in response to scripted
questions asked by the early childhood spe-
cial educator. Beginning with Level 2 (i.e.,
suspected disability) under the first domain
on the index (i.e., audition), the early child-
hood special educator asked the teacher if
she was comfortable serving a child with a
hearing loss at this level (i.e., suspected dis-
ability). If the answer was "yes," no marking
was made, and the early childhood special
educator proceeded to Level 3 (i.e., mild dis-
ability). The early childhood special educator
then continued by asking if the teacher was
comfortable serving a child with a hearing
loss at this level (i.e., mild disability), and so
forth until the answer was "No." At that point,
the teacher was instructed to mark an O at
the level where she no longer felt comfort-
able, and her comfort zone was established
for the first domain. This process was re-
peated for each of the remaining domains on
the index. Our intent in having the teacher
first complete a profile on a child currently
enrolled in her classroom was to provide an
opportunity for her to consider actual do-
mains of functioning in a child with whom
she was familiar before making judgments
about a hypothetical case. This approach al-
lowed us to determine, in an indirect fashion,
instances in which there was a discrepancy
between a child's ability level in a particular
area and the teacher's comfort in serving that
193
child. Figure 1 shows an example of the com-
pleted profiles based on an interview with
one child care teacher. The early childhood
special educator also recorded unprompted
comments made by the teacher during the
interview on a form that was provided for this
purpose. The comment form was organized
according to domains on the ABILITIES In-
dex. After the interview, the teacher com-
pleted the Benefits and Drawbacks rating scale
and returned it to the early childhood special
educator in a sealed envelope.
After all of the interviews and forms were
completed, the first two authors attended a
statewide meeting of early childhood special
educators who participated in the study to
obtain feedback about the method used to
assess child care teachers' comfort in serving
young children with disabilities. We re-
corded early childhood special educators'
Figure 1.
One teacher's comfort zone based on the A
194
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comments as we presented them with three
questions used to guide this discussion: (a)
How acceptable is the ABILITIES Index as a
method of assessing professional comfort in
serving children with disabilities? (b) Did child
care teachers understand the nature of the
task? and (c) How could the information about
comfort level be used in planning or evalu-
ating services for children and families?
RESULTS
Descriptive Analyses
ABILITIES Index ratings. As noted earlier, chil-
dren with disabilities enrolled in child care
settings were rated on the ABILITIES Index
from 1 (normal functioning) to 6 (profound
disability). Mean ratings and standard devia-
tions based on these ratings are displayed in
Table 1. The highest mean ratings (indicating
Index
/£/, 1996, 20:3
TABLE 1. within a domain (indicating a lower level of
Mean Ratings on the ABILITIES Index for functioning).
Children Enrolled in Child Care Settings Comfort scores. Table 2 displays the range
(N = 52) of teachers' comfort ratings, their median com-
fort ratings, and mean comfort discrepancy
Subdomain M SD
scores across the eight domains of interest.
Left Ear 1.44 1.01 Comfort discrepancy scores were derived for
Right Ear 1.45 1.06
an individual teacher by calculating the dif-
Social Skills 2.82 1.40
ference between the teacher's comfort rating
Appropriate Behavior 2.39 1.34
Intellectual Functioning 3.06 1.36 (i.e., the point at which the teacher indicated
Left Hand 2.08 1.47 she was no longer comfortable) and the child's
Left Arm 2.04 1.46 actual level of functioning across domains on
Left Leg 2.50 1.76 the ABILITIES Index. The difference between
Right Hand 2.14 1.41 the two ratings could range from - 5 to + 5 .
Right Arm 2.04 1.41 Therefore, a child care teacher was consid-
Right Leg 2.48 1.75 ered uncomfortable in a particular area of
Receptive Communication 2.14 1.32
child functioning if the discrepancy score was
Expressive Communication 3.00 1.62
a negative value. There were no negative
Hypertonicity 2.22 1.67
Hypotonicity 2.02 1.44 mean discrepancy scores, suggesting that, in
Health 2.14 1.37 general, teachers were comfortable in serv-
Left Eye 1.50 1.18 ing children with disabilities enrolled in their
Right Eye 1.48 1.20 programs. Mean discrepancy scores were low-
Structural Status 2.02 1.35 est in the area of intellectual functioning. Ta-
Note. Mean ratings were based on a scale of 1 ble 2 also displays the number of times a
(indicating normal functioning) to 6 (indicating child's actual rating on the ABILITIES Index
profound disability).
fell outside a teacher's comfort zone in serv-
ing that child.
lower levels of functioning) were obtained in
the areas of intellectual functioning, expres- Ratings on the benefits and drawbacks
sive language, and social skills. To reduce scale. Table 3 displays the mean ratings and
the number of variables and to create mean- standard deviations across four subdomains
ingful predictors, some of the 19 subdomains related to benefits and drawbacks of early
on the ABILITIES were combined or elimi- childhood inclusion. Results indicated that,
nated to produce eight domains of interest: overall, child care teachers perceived poten-
appropriate behavior, social skills, expressive tial benefits of inclusion for both children with
communication, receptive communication, disabilities and their families as well as typi-
intellectual functioning, hand and arm func- cally developing children and their families.
tioning, leg functioning, and tonicity. Do- With respect to children with special needs
mains that were eliminated consisted of vi- and their families, the highest rated items in-
sion, hearing, health, and structural status, cluded the effects of inclusion on preparing
which had mean ratings in the normal range children for the real world (M = 4.69, SD =
and low variability. Subdomains were col- .62), helping children to become more inde-
lapsed within several areas of functioning (e.g., pendent (M = 4.71, SD = .58), and promot-
left and right hand, hypertonicity and hypo- ing learning (M = 4.63, SD = .64). The high-
tonicity) by selecting the higher of two ratings est rated item for typically developing children

Buysse, Wesley, Keyes, & Bailey 195

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TABLE 2.
Teachers' Comfort Ratings by Domain

Discrepancy Frequency of Child's

Range of Median Scores Rating Falling Outside
Comfort Comfort M Teacher 's Comfort Zone
Domain Ratings Ratings (SD) (Total N = 52)
Appropriate Behavior 2-6 4.0 1.80 5
(1.61)
Social Skills 2-6 4.5 1.72 6
(1.95)
Expressive 1-6 5.0 1.68 4
Communication (1.80)
Receptive Communication 2-6 5.0 2.44 2
(1.75)
Intellectual Functioning 2-6 5.0 1.58 3
(1.69)
Hand and Arm 2-6 5.0 2.42 16
Functioning (1.94)
Leg Functioning 2-6 5.0 2.10 12
(2.28)
Tonicity 2-6 5.0 1.88 6
(2.07)
Note. Discrepancy scores were derived by calculating the difference between the teacher's comfort ratings and the
child's actual level of functioning across domains.

and their families addressed opportunities for
nondisabled children to learn about individ-
ual differences in their peers (M = 4.59, SD
= .64).
In general, ratings regarding possible draw-
backs were more variable than ratings of ben-
efits. Overall mean ratings of possible draw-
backs for children with special needs and their
families approached 3.0, whereas mean ratings
for typically developing children and their fam-
ilies were somewhat lower, indicating fewer per-
ceived drawbacks for nondisabled children and
families. For children with disabilities and their
families, the items rated as the greatest draw-
backs were exposure to teachers with little or
no specialized training (M = 3.41, SD = 1.27),
fewer opportunities to receive special help and
individualized instruction (M = 3.19, SD =
1.31), and the possibility that families might ob-
serve their children being rejected or teased (M
- 3.18, SD = 1.35). Mean ratings on individ-
ual items pertaining to drawbacks of inclusion
for typically developing children and families
were uniformly low.
Respondents were also asked to list the
number of the items representing the greatest
benefit and greatest drawback of inclusion.
Of the benefits that teachers rated, the one
selected most frequently as the greatest ben-
efit of inclusion was the ability of children
with special needs to learn more (31%). The
item selected most frequently as the greatest
drawback was the likelihood that teachers
would lack specialized training in serving chil-
dren with special needs (34%).
Multivariate Analysis
To examine factors that might be related to
teachers' comfort in serving young children
with disabilities, we created a model in which
comfort scores across domains on the ABIL-
ITIES Index varied as a function of the follow-

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TABLE 3.
Mean Ratings on the Benefits and
Drawbacks Scale
Subscale M SD
Benefits for
Children With Special Needs 4.54
Families of Children With Special
Needs 4.47
Typically Developing Children 4.44
Families of Typically Developing
Children 4.36
Drawbacks for
Children With Special Needs 2.80
Families of Children With Special
Needs 2.87
Typically Developing Children 2.37
Families of Typically Developing
Children 2.31
Note. Within each subscale, items were rated from 1
{definitely not a benefit or drawback) to 5 {definitely a
benefit or drawback).
ing variables: three levels of severity of the
child's disability based on ABILITIES Index
ratings (i.e., normal to suspected, mild to mod-
erate, moderate to profound); the eight do-
mains of interest from the ABILITIES Index;
the interaction between severity of the child's
disability and domain; overall mean ratings
regarding drawbacks of inclusion for chil-
dren with and without disabilities; teachers'
race, education, years of experience; and the
number of consultation sessions (i.e., more
than six sessions, six or fewer sessions). We
fit a hierarchical linear model treating all pre-
dictors as fixed (Bryk & Raudenbush, 1987;
McLean, Sanders, & Stroup, 1991). This ap-
proach was selected over MANOVA because
it allows severity to vary across domains of
the ABILITIES Index for each teacher. Only
statistically significant predictors were re-
tained in the final model. The results indi-
cated a significant main effect for severity, F
(2, 307) = 353.45, p < .0001, and an inter-
action effect for severity by domain, F (14,
307) = 3.24, p < .0001. Other significant
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predictors of teachers' comfort levels in-
cluded teachers' education, F (2,307) = 3.45,
p < .03, number of consultative sessions, F
(1, 307) = 3.63, p < .05, and ratings on
drawbacks of inclusion for children with spe-
cial needs, F (1, 307) = 10.33, p < .001.
.56 Follow-up tests to explain the interaction
effects revealed significant differences in com-
.71
fort scores as a function of the severity of the
.62
child's disability across all domains. With re-
.79
spect to each domain, the predicted comfort
levels decreased as the severity of the child's
1.09 disability increased. The significant interac-
tion can be explained by differences in the
.87 magnitude of the decrease for different do-
1.00 mains. Except for the appropriate-behavior do-
main, however, the predicted comfort scores
1.03 for individual domains were similar to the mean
across all domains. Adjusted mean comfort
scores averaged across all domains were 3.51
(SE = .17) for children with ABILITIES ratings
in the normal to suspected range of function-
ing, 2.02 (SE = .17) for children with ratings
in the mild to moderate range, and .45 (SE =
.17) for children with ratings in the severe to
profound range. The adjusted mean comfort
scores for the appropriate-behavior domain
were 2.81 (SE = .21), 1.72 (SE = .22), and
0.44 (SE = .25) for normal, mild, and severe
levels, respectively. Predicted comfort scores
were lowest when the child was reported to
have severe to profound disabilities in the ar-
eas of leg functioning (M = .08, SE = .23),
tonicity (M = .16, SE = .29), and appropriate
behavior (M = .44, SE = .25).
Additional follow-up tests revealed a rela-
tionship between teachers' general attitudes
toward inclusion and their comfort in serving
an individual child. Teachers who identified
more drawbacks of inclusion for children with
disabilities generally had the lowest comfort
scores. On average, comfort scores de-
creased by .43 of a point for every 1-point
increase in the overall drawbacks score for
children with special needs. In addition, the
197
comfort scores of teachers with college de-
grees were, on average, .49 less than those
with a high school education, whereas com-
fort scores for teachers with associate degrees
were, on average, .39 higher than teachers
with high school degrees. Finally, teachers
who participated in more than six sessions
with a consultant had lower comfort scores
than teachers who participated in six or fewer
sessions.
Comments Child Care Professionals Made
During Interviews
Comments child care teachers made during
the structured interview were typed as they
appeared on the teacher comment forms un-
der ABILITIES Index domains (e.g., audition,
intellectual functioning, social skills). Next,
we identified domain-specific comments and
concerns that three or more child care teach-
ers mentioned. Table 4 summarizes the
teacher comments and concerns by domain.
Finally, one researcher independently read
all of the comments, including those men-
tioned fewer than three times, and developed
six categories of general concerns about early
childhood inclusion that appeared to cut
across domains of child functioning. A sec-
ond researcher independently read each com-
TABLE 4.
Domain-Specific Comments and Concerns about
Domain
Audition
Behavior and Social Skills
Intellectual Functioning
Limbs
Intentional Communication
Tonicity
Physical Health
Vision
Structural Status
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ment and verified the concern categories.
These included the following: (a) develop-
ment, health and safety of the child with dis-
abilities; (b) development, health, and safety
of the other children; (c) need for additional
training, technical assistance, and support;
(d) modifications in the classroom environ-
ment, structure, or curriculum, (e) use of spe-
cial devices and adaptive equipment, and (f)
liability issues.
Comments Early Childhood Special
Educators Made During a
Statewide Meeting
To analyze the comments of early childhood
special educators who participated in the
study, w e compared and combined re-
sponses that emerged from our written notes.
The following responses were representative
of early childhood special educators who at-
tended the state meeting.
How acceptable is the ABILITIES Index as a
method of assessing professional comfort in
serving children with disabilities? Early child-
hood special educators generally agreed that
the ABILITIES Index was an acceptable way
of gathering information about teachers' com-
fort in serving young children with disabili-
ties. One early childhood special educator
Inclusion
Comments and Concerns Made by Three or More Teachers
Need to learn sign language
Effects on other children's safety and learning
Need additional training
Need better teacher-child ratios to offer individualized instruction
Need additional consultation and assistance
Uneasy about wheelchairs
Need additional training
Comfortable because of previous experiences
Might hurt the child with special needs
Potential for spreading infection in group care settings
Need training and support
(None)
/£/, 1996, 20:3
commented, "It was like stepping stones for
me to build rapport with the teacher." Others
mentioned that they liked the specificity of
the information they received regarding teach-
ers' concerns. For example, it was possible
using this approach to determine if a child
care teacher was experiencing discomfort
about working with the child at the level of
left and right arms, hands, or limbs, as op-
posed to simply addressing the child's overall
physical abilities. None of the teachers inter-
viewed reacted negatively to participating in
the interview or completing the two ABILI-
TIES Index profiles, but some were reported
to be somewhat inhibited by the task, ini-
tially.
Did child care teachers understand the na-
ture of the task? There was consensus that
child care teachers generally were able to
understand the nature of the task. One early
childhood special educator noted that, for
some domains (e.g., tonicity) and levels of
severity, teachers appeared less confident in
making a judgment. "They (teachers) would
say, 'Give me an example.'" This suggests
that some teachers may need additional in-
formation or experience to make informed
ratings of both child functioning and profes-
sional comfort.
How could the information about comfort
level be used in planning or evaluation ? Early
childhood special educators suggested three
possible uses for information derived from
comfort zone ratings. One early childhood
special educator suggested that this approach
could be used as a self-evaluation tool for
child care teachers to examine their own at-
titudes and feelings regarding children with
disabilities. Others recommended using com-
fort zone ratings on a pre- and posttest basis
to evaluate training and technical assistance
to support early childhood inclusion. A third
option involved using this approach to assist
in planning or supporting appropriate inclu-
sive placements. As one participant noted,
Buysse, Wesley, Keyes, & Bailey
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"If the teacher isn't comfortable, don't place
the child there; if she's already serving the
child, provide support."
DISCUSSION
In this study, we used two approaches to ex-
amine the attitudes of general early child-
hood teachers currently serving young chil-
dren with disabilities in inclusive child care
settings. By focusing on the views of child
care teachers, the findings extend our knowl-
edge about adult attitudes toward the inclu-
sion of young children with disabilities in com-
munity-based programs and are useful in
evaluating an individualized approach based
on child characteristics as a method of gath-
ering this information.
Results regarding perceived benefits and
drawbacks of early childhood inclusion
among general early childhood teachers
closely corresponded to findings from two
earlier studies involving parents of preschool-
ers with and without disabilities in a university-
based program (Bailey & Winton, 1987) and
those with children enrolled in community-
based programs (Guralnick, 1994). Overall,
teachers perceived potential benefits of in-
clusion both for children with disabilities and
their families as well as for typically devel-
oping children and their families. In this study
and the two previous studies (Bailey & Win-
ton, 1987; Guralnick, 1994), teachers and
parents viewed preparation for the real world
as one of the principal benefits of inclusion
for children with special needs. Teachers iden-
tified additional benefits of inclusion for chil-
dren with disabilities with respect to promot-
ing learning and helping them to become
more independent, two outcomes likely to be
particularly relevant among general early
childhood educators. Similar to previous re-
search, teachers identified the opportunity to
learn about individual differences in their
peers as an important benefit of inclusion for
199
typically developing children. Unfortunately,
very little research has been conducted on
this topic (Guralnick, 1994). Despite a grow-
ing awareness of the importance of peer ac-
ceptance for children with disabilities, it is
not well understood how typically develop-
ing children view peers with disabilities, the
nature and quality of their relationships with
these children, and how child characteristics,
programmatic features, and family beliefs in-
fluence peer acceptance.
In contrast to previous research with par-
ents (Bailey & Winton, 1987; Guralnick 1994),
child care teachers expressed fewer overall
concerns about the effects of inclusion for
children with and without disabilities and their
families. The items teachers rated as the great-
est drawbacks of inclusion for children with
special needs, however, were similar to those
identified as the greatest concerns among par-
ents in earlier studies. Notably, teachers ex-
pressed concerns about the lack of special-
ized training among early childhood personnel
and fewer opportunities for children with dis-
abilities to receive special services and indi-
vidualized instruction in inclusive settings.
This is a reassuring finding, because teachers
who acknowledge these needs are likely to
be receptive to receiving additional training,
consultation, and technical assistance to sup-
port inclusive placements for young children
with disabilities and their families.
In addition to completing the benefits and
drawbacks scale to assess general attitudes to-
ward inclusion, child care teachers partici-
pated in a structured interview using the ABIL-
ITIES Index to assess professional comfort in
serving an individual child. Overall, findings
indicated that teachers were comfortable in
serving the children with disabilities enrolled
in their classrooms. In examining both the
child's profile and the teacher's comfort rat-
ings, however, we were able to determine the
frequency with which the child's functional
abilities fell outside the teacher's comfort zone.
200
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There were 16 occurrences of this phenome-
non for children with disabilities in the areas
of hand and arm functioning and 12 occur-
rences for children with difficulties with leg
functioning. These findings suggest that an in-
dividualized approach to attitude assessment,
based on child characteristics, may be most
effective when this method is used as a diag-
nostic tool with implications for targeting con-
sultation and technical assistance efforts. For
example, early interventionists who serve as
consultants in general early childhood pro-
grams could use information based on com-
fort zone ratings to identify collaborative class-
room goals with teachers, such as using
appropriate positioning techniques or modify-
ing the classroom environment to accommo-
date wheelchairs and walkers. This approach
also could be used as a self-assessment tool to
indicate the professional comfort of therapists
and specialists in providing technical assis-
tance to general early childhood teachers
across the nine domains on the ABILITIES In-
dex.
The study also examined a variety of factors
thought to be related to teachers' comfort in
serving young children with disabilities. In gen-
eral, across all domains on the ABILITIES In-
dex, teachers' comfort levels decreased as the
severity of the child's disability increased.
Moreover, we obtained an interaction effect
for severity by domain. Follow-up analyses re-
vealed that comfort levels were lowest when
the child was reported to have severe to pro-
found disabilities in the areas of leg function-
ing, tonicity, and appropriate behavior. The
finding that teachers' views varied as a func-
tion of the severity of the child's disability are
consistent with findings reported by Eiserman
et al. (1995) and those for parents reported by
Green and Stoneman (1989). These findings
stand in contrast to those of Guralnick (1994),
who found that the severity of the child's dis-
ability generally did not alter the perceptions
of mothers' views regarding the benefits and
JEh 1996, 20:3
drawbacks of inclusion. Although previous re-
search suggests that preschoolers with behav-
ioral problems and severe disabilities elicit the
most concern among parents, this study is
among the first to document teachers' discom-
fort in serving young children with significant
problems in the area of limb functioning.
Additional factors found to predict teach-
ers' comfort in serving young children with
disabilities included teachers' education, the
number of consultation sessions with an early
childhood special educator, and ratings on
drawbacks of inclusion for children with spe-
cial needs. The finding that teachers with col-
lege degrees were less comfortable serving
children with special needs than those with a
high school education or an associate degree
is difficult to interpret. One possible expla-
nation concerns differences in educational
programs that prepare professionals at vari-
ous levels in North Carolina. At the time the
study was conducted, community college fac-
ulty from across the state were engaged in
efforts to prepare associate level teachers to
work with young children with and without
disabilities in inclusive settings. No compa-
rable efforts existed to prepare bachelor's level
teachers to work in inclusive settings. It is
unclear why teachers with high school diplo-
mas had higher comfort scores than teachers
with college degrees.
The finding that teachers who received less
consultation were more comfortable in serv-
ing children with disabilities appears coun-
terintuitive and is likely a spurious finding.
Although we attempted to account for the
length of the consultation relationship by di-
viding the sample into teachers who met with
the consultant six times or less and those who
met on more than six occasions, in reality,
the majority of the teachers and consultants
probably were in the initial stages of the con-
sultation process. Future research should ex-
amine how various consultation approaches
(Buysse, Schulte, Pierce, & Terry, 1995; File
Buysse, Wesley, Keyes, & Bailey
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& Kontos, 1992; Wesley, 1994), along with
the frequency, intensity, and perceived use-
fulness of consultation sessions, affect teach-
ers' attitudes toward inclusion and comfort in
serving individual children and families.
This study also found an association be-
tween teachers' general attitudes toward in-
clusion based on the benefits and drawbacks
scale and their comfort in serving an individ-
ual child with disabilities. In general, teach-
ers who expressed more concerns about po-
tential drawbacks of inclusion for children
with special needs had the lowest comfort
scores. Future studies should investigate
whether efforts aimed at increasing teachers'
comfort levels for individual children can af-
fect their attitudes about inclusion in general.
The study was subject to several limita-
tions. First, because inclusive placements for
young children with disabilities did not re-
flect the predominant service delivery model
at the time this study was conducted, we were
unable to obtain a random sample of child
care teachers. Instead, they were recruited
through early childhood special educators
who were receiving training and support to
function as consultants in child care class-
rooms in which at least one child with dis-
abilities was enrolled. In addition, the pro-
cess for selecting child care teachers who were
recruited for the study was not specified or
controlled. The generalizabiIity of study find-
ings may be limited, therefore, to child care
teachers with similar characteristics who re-
ceive comparable levels of consultation and
support services. Second, this study assessed
the attitudes of child care teachers but did
not thoroughly examine the factors that un-
derlie teachers' attitudes and comfort in serv-
ing young children with disabilities and their
families. Future studies should address this
shortcoming by investigating both external fac-
tors such as professional experience, consul-
tation, and training, and internal factors such
as personal and professional philosophy and
201
perceived competence in working with young
children with disabilities and their families
that might influence teachers' views.
Finally, the method presented in this study,
which graphically depicted teachers' comfort
in serving an individual child with disabili-
ties, should be evaluated in future studies.
Several possible research directions emerged
from the responses of the early childhood spe-
cial educators who used this approach and
described the method as an easy and accept-
able way of gathering information from child
care teachers. Teachers' comments and con-
cerns about inclusion and their decreased
comfort in serving young children with se-
vere disabilities should not be viewed as dis-
couraging findings. Giangreco, Dennis, Clon-
inger, Edelman, and Schattman (1993)
reported that, despite teachers' initial hesi-
tance about serving children with severe dis-
abilities in general education classrooms,
many later described transformations that oc-
curred as a result of direct experiences and
their willingness to be involved with these
children in a meaningful way.
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203