Presented at ISEC 2000

Inclusion without Support or Differentiation - A Case study of Five Children with Severe Learning Difficulties

Hala. A Hak

Participants from The Centre for Children with Special needs (The Integrated Care Society):

Professor Safia Magdi, Clinical Psychologist
Mr. Hisham A. Hamid, Clinical Psychologist
Mrs. Hala A. Hak, Educational Psychologist
Dr. Suzanne Gamal El Din, MD (Phoniatrics)
Dr. Rana Saad Eldin, MD (Phoniatrics)
Mrs. Manar Salah, Speech Therapist
Mrs. Hoda Mostafa, Speech Therapist

Abstract

The study aimed to evaluate how beneficial was the inclusion of 5 children with SLD (Down Syndrome), ages between 6 & 6 months - 7 & 8 months at the beginning of the study, in the regular school system on two levels:

1. Formal Level:

• Psychological Development
• Language Development

1. Informal Level:

• Social Inclusion
• Curriculum Inclusion

Findings:

1. Formal Level

Positive change on re-testing at the end of the school year in 60.294% of the psychological variables and in 65% of the linguistic variables. The study partially confirmed the initial hypothesis that inclusion was beneficial, despite its methodological limitations. The Wilcoxon Matched Signed-Rank Test was used in both areas (psychological & language) to assess significance of difference.

2. Informal Level

• Social Inclusion:

The children were socially accepted and included.

• Curriculum Inclusion:

Despite the positive challenge of the delivery of the national curriculum to children with SLD, problems on the academic level existed because of lack of both support in class and differentiation which hindered curriculum inclusion.

There was an overall parental satisfaction with the experience, despite earlier apprehension. Follow-up studies are needed with larger samples and better methodology.

I- INTRODUCTION

Inclusion

There is a movement towards inclusion in the international society. In 1994, the United Nations published "The Standard Rules on the Equalisation of Opportunities for Persons with Disabilities" which were "adopted by the United Nations General Assembly" in December 1993, as Resolution 48/96. In article 26 it is stated that:

"Persons with disabilities are members of society and have the right to remain within their local communities. They should receive the support they need within the ordinary structures of education, health, employment and social services." (UN, 1994; p.12). The 'ordinary' would suggest a favouring of inclusive or integrative settings versus special settings. Further, it goes on with a particular reference to education, in rule 6, where it specifies that education should be provided "in integrated settings." (UN, 1994; p. 23).

Although, as stated earlier, there is an international movement towards inclusion, many studies contend that inclusion will not be successful unless certain conditions are available to support it (Jenkinson, 1997; Hegarty, 1993 c), namely:

Ordinary schools have to have a "clear policy" that all pupils are "valued"; that "pupils with disabilities" receive an "appropriate curriculum" and that "academic organisation" must be changed to cater for their "individual needs." Further, "sufficient skilled staff" should be available. Also, there has to be "effective links with home and community." On the other hand, special schools will remain to have a role "in the medium-term future." Special schools are a " major resource in the education of pupils with disabilities. They have pioneered a great deal of provision." However, if they still wish to have a focal role, they have to adopt "new roles." Essentially, they should support "ordinary schools." Moreover, they should improve the quality of the service they provide to the students who are still enrolled in "special schools." To be able to achieve this, they have to "establish working links with ordinary schools" on three levels: "pupils, staff and resources." (Hegarty, undated, p.p. 48-50).

The Educational System in Egypt

On the national level, Egypt is one of the countries that adopt a dual-educational system. On the academic level, special schools present excerpts of the curriculum of the first 3 years of primary education for 11 school years, 2 years of which are reception and 6 years of which are primary. As the child becomes a young adult (14 years) they are introduced to prevocational training for 3 years (Ministry o Education, 1998). There is no testing in the regular form and the evaluation for progress is within-child who at the end of the school years receives a certificate that he/she has fulfilled the school requirements. However, the children do not usually join their schools at 6 years. In addition to the limited spaces, the ministry puts rules such as toilet training as well as an ability to communicate verbally. Thus, usually the child enters school at the age of 8.

According to the statistics from the Ministry of Education (MoE) with reference to the status of regular education in Egypt, the number of state-owned schools in primary education is 16152, and 6905 schools for preparatory education, in addition to 1452 schools for secondary education. With reference to special education schools, the statistics are 418 schools (1998) for various special needs (visual impairment, hearing impairment, SLD, other special needs such as poliomyelitis), as for SLD alone it is 211 schools (1998).

The children

All the children come from the Centre for Children with Special Needs (The Integrated Care Society). The centre aims to improve the quality of life of persons with special needs, support their families, ensure their human right to enjoy life and provide the suitable environment to do that. The centre offers medical, psychological, educational services, in addition to physiotherapy and speech therapy. In addition, provides parents with counselling, guidance and referral if needs be. The first child to join the regular school educational system was Ibtihag in the school year 1994-95, followed by Walaa, Mohamed, and Hamza in 1996-97. Fatma and Ali joined in 1997-98. Until then, the role of the centre was to follow-up the children through their parents and the children's end of year records. Whenever the parents met with problems, they consulted with the centre and counseling was offered. A group of professionals at the centre planned to prepare for a more rigorous study of the children included in the academic year 1998-1999.

B- METHODOLOGY

The Questions

- Will the included children benefit from inclusion on the cognitive, and language and communication levels?

- Will the included children be included socially among their peers as well as in accessing the national curriculum?

The Sample

The sample of this study consisted of Hosam, Ahmad, Norhan, Nora and Khalid.

They all have Down Syndrome, and fall within the mild category according to IQ and SQ. Selection for the children to be included is based upon progress within the pre-school years.

It is worth noting that this paper is a whole organization effort: reception, doctor, clinical psychologist, educational psychologist, teacher and teacher aid in collaboration with parents.

1st Formal Level

Tests and Tools:

PSYCOLOGICAL

Five tests were chosen to cover a range of intellectual abilities, namely attention, immediate auditory memory, comprehension of inner language, concept formation and visual memory.

(One) Goodenough-Harris Drawing Test (Samples of the drawings of children will be available in Appendix A) The child is requested either to draw a woman or a man. It is her/his choice. The test measures concept formation and the perception of the concept of man and woman. (Arabized by Farrag, El-Sayed and Magdi, 1976).

(Two) The British Picture Vocabulary Scale (BPVS) From a wide range of pictures, including objects, animals and action words, the child is offered each time 4 pictures and is requested to choose the picture the experimenter verbalizes the word for. The test measures the child's inner language and concept formation. (Dunn et al. NFER-NELSON, 1982).

(Three) The Coloured Progressive Matrices (CPM) This is a test that claims to be culturally free and is a measure of general intelligence. The child is requested to complete a missing shape in a larger design. The child is offered 6 shapes to choose the one that can fit correctly. The test is suitable in evaluating visual perception, particularly visual scanning, visual matching and formulation of visual concepts. The test provides a percentile rank as well as an estimate of mental age (MA) based on the function of visual perception in children. (J.C. Raven, J.H. Court and J. Raven, published by H.K. Lewis, 1977).

(Four) Digit Span Test This type of test is used in IQ assessment (e.g. Stanford-Binet, Wechsler, etc. It is used to assess auditory attention and short auditory memory. The children were requested to repeat a number of digits forward and backwards. (Stanford-Binet 4th edition, Arabised, El Nahda El Misrya, 1994).

(Five) Visual Immediate Memory This is a test devised by the 2 clinical psychologists participating in this study. The child is offered a card with 3 different geometric shapes. The card is shown for 7 seconds. The researcher then covers one of the shapes and asks the child to identify the shape that disappeared from large board with 21 different shapes. (S. Magdi & H. A. Hamid, 1998).

Procedure

1. The tests were applied twice, once before enrolling in schools, and the second time after the end of the school year.

Table I

From the above table, it is noted that the age range on testing was between 6 years, 6 months and 10 days and 7 years, 8 months and 16 days. On re-testing, the range was between 7 years, 2 months and 5 days and 8 years, 3 months and 29 days. The oldest was Nora and the youngest was Norhan.

2. The researcher always started with 'draw a person' test based on the premise that it is a free and attractive task which may establish rapport with the child. This was followed by the picture vocabulary test, the colored progressive matrices, visual memory and finally the digit span test.

3. Each child needed between one and a half and two hours to go through all tests. Application was done in two sessions for each child.

LANGUAGE

The Standardized Arabic Language

Test To assess language an Egyptian language test designed by Nahla A. Aziz et al., 1995, was used for that purpose. The test is designed to suit children aged 2 to 8 years language age. The test consists of 277 pictures. The pictures are offered to the child and according to performance the language age is calculated. Usually, the test needs 4 to 6 hours to take, according to the concentration of the child.

The test measures the following parametres: receptive language, expressive language, semantics, prosody and pragmatics. A separate profile of each language parametre is determined through comparing the score of the child to the corresponding score of her/his chronological age in the scaled score tables. Finally, a total profile is calculated, providing the language age of the child.

The language test is considered an accurate quantitative test that provides the language age as well as determines the area and degree of a problem. It is a diagnostic method to guide intervention (speech therapy). Further, the test is used as a follow-up tool to monitor results of intervention.

Procedure

1. The tests were applied twice, once before enrolling in schools, and the second time after the end of the school year.
2. Usually the speech therapist follows the order of the test. However, whenever she finds the child responding positively to a particular section she may follow his/her lead to encourage the child, yet the by the end of the session she should have covered the whole the test.
3. The test needed at least three hours to administer. The speech therapist is allowed to give the child the rest he/she needs during the testing sessions and then she will continue with the test.

Statistical Analysis

The sample was small, thus nonparametric statistics was used as the exact distribution of variables could not be calculated for such a sample. The Wilcoxon Matched Signed Rank Test was used to test for difference and change within group. This was used for both psychological and language assessments.

III- RESULTS & DISCUSSION

PSYCHOLOGICAL

Results

Following (Table II) are the results of the five children on the psychological evaluation (test & re-test).

Table II

Results of the five included children

From the above, we note the following:

1. Percentage of positive, negative and null changes in raw scores as well as mental ages were calculated.

2. On the positive change (P), re-testing was better than testing, while on the negative changes (N), the testing was the best. Null changes (=) was stated when both testing and re-testing were equal.

3. On raw scores, (Ps) were 73.91%, (Ns) were 8.70%, (=s) were 17.39%.

4. On mental age on BPVS, (Ps) were 100%.

5. On draw a person, (Ps) were 60% and (=s) were 40%.

6. With reference to all variables (raw scores, standard scores, and mental ages), (Ps) were 72.10%, (Ns) were 9.30% & (=s) were 18.60%.

7. On the (Ps), Khalid was the best (88.89%) followed by Ahmed & Nora (77.78%). All three had no (Ns). Hossam scored (71.43%). Norhan scored the least on both (Ps) and (Ns), it was 44.45%.

Following (Table III) is the statistical analysis on the Wilcoxon tets

Table III Results of Wilcoxon test

* near to significance (significant at less than .07)

** significant at less than .05

From the above, the following is deduced:

1. Based on Wilcoxon Matched Signed Rank Test, the difference between testing and re-testing was insignificant on the whole sample as well on the sample of the 4 included pupils (without the withdrawn child Hossam) and that is with reference to:

One- Raw score, standard score or MA in 'draw a person test'.

Two- Digit span (forward). With reference to digit span (backward) all children failed to score on testing and re-testing.

Three- Standard scores regarding colored progressive matrices.

2. A significant difference in the direction of re-testing (at less than 0.07) regarding the raw score in immediate visual memory and colored progressive matrices on the sample of the 4 included children. Hossam could not finish the test of colored progressive matrices.

3. A significant difference in the direction of re-testing in the raw score of picture vocabulary or the equivalent MA in months or years on picture vocabulary at less than 0.05 for the whole sample and less than 0.07 excluding Hossam.

Following (Table IV) presents the changes in MA and CA.

Table IV Changes in both Mental and Chronological ages

Discussion

1. The children expressed cooperation and concentration during the test sessions.

2. During sessions, parents of Ahmed and Hossam were skeptical about the value of inclusion. However, Hossam's father, who withdrew his son to a special classes, regretted that during the re-testing sessions and decided to put his son for the next school year into a regular school.

3. There was an element of randomness regarding the colored progressive matrices and few concentrated on peripheral options (shape 1 or 6). The difficulty of the test may have resulted in the low performance. Despite repetition of instructions through all items, the children found difficulty in understanding it.

4. The visual memory test was difficult, either due to the unfamiliarity with geometric shapes or the large number of visual prompts (21 shapes). Including geometric shapes in the test was meant to reduce any verbal mediation, resulting in a language memory. However, on re-testing, the difficulties disappeared and the children showed more understanding of instructions and were more cooperative and precise in answers. The results on testing were 10-40% correct answers, and in re-testing the range became 30-70% correct answers.

5. Despite difficulties in colored progressive matrices and visual memory tests, the purpose was to measure performance after inclusion and this remains valid.

6. Hossam was excluded from the visual memory test because of his poor vision, which did not enable him to scan properly and that may affect visual immediate memory.

7. Regarding the standard scores on 'Draw a person', there was improvement on re-testing scores of Khalid, Hossam, Ahmed and Nora. Norhan did better on testing. The difference according to the Wilcoxon Matched Signed Rank Test was insignificant.

8. MA on draw a person test ranged between 4-5 years, and between 4-6 years on re-test.

9. MA on colored progressive matrices test ranged between 3 years and 1 month to 3 years and 10 months, and on re-test, it ranged between 3 years and 10 months and 4 years and 7 months.

10. Regarding the colored progressive matrices, the improvement on retesting was in the case of Khalid and Ahmed. Norhan did better on testing. Hossam and Nora had equal results on both tests.

11. The child that most benefited from inclusion was Ahmed, followed by Khalid, then Nora and lastly Norhan. Hossam ranked fourth despite his segregation.

12. MA exceeded time maturation except for Norhan (she was included in Reception not P1 like the other three).

13. Comparison between test and retest with reference to raw scores and standard scores has to be handled with caution, because of the age maturation. This provides 4 options:

One. Raw scores improve, and standard scores remain the same meaning the child retained its rank amongst its peers.

Two. Raw scores improve, while standard scores deteriorate signifying improvement within-child but not commensurate with norms.

Three. Both raw and standard scores improve, signifying improvement.

Four. Both raw and standard scores deteriorate, signifying deterioration.

• LANGUAGE

Results

Following are the test results for the sample and its statistical significance:

TABLE V

RAW SCORES AND LANGUAGE AGE ON LANGUAGE ASSESSMENT SCALE AND ITS FIVE SUBSCALES

* AGES WERE CALCULATED BY MONTH

The calculation of the following table (Table VI) regarding improvement in language age was based on dividing the difference between test and retest and divided it by the initial language age.

TABLE VI - IMPROVEMENT OF LANGUAGE AGE ON THE LANGUAGE TEST

The above table reflects the following:

1. Ahmed exhibited highest overall improvement, followed by Norhan, Khalid and then Nora. Hossam showed no improvement.

2. Maximum improvement was noted in receptive and expressive language, followed by pragmatics and semantics. No real improvement was in the area of prosody.

Following, are the statistical analyses of the test results of the language testing and re-testing.

TABLE VII - RESULTS OF WILCOXON MATCHED SIGNED RANK TEST

1. Based on the Wilcoxon Matched Signed Rank Test, the difference between testing and re-testing was not significant for the whole sample as well as for the four included children (without Hossam) with reference to: One. Raw score of receptive language. Two. Both raw score and language age in semantics. Three. Both raw score and language age of prosody.

2. On the sample of the four included children, there is a significant difference in the direction of re-testing (at less than 0.07) regarding both the raw score and the language age of expressive language and both the total score and total language age.

3. On the whole sample, a significant difference in the direction of re-testing:

One. At less than 0.05, regarding both raw score and language age of expressive language and total raw score.

Two. At less than 0.07, regarding both raw score and language age of pragmatics and total language age.

The following table shows improvement of language ages and interval period between testing and re-testing.

TABLE VIII - IMPROVEMENT AND INTERVAL PERIOD

The previous table shows the following:

1. The child that has benefited most from inclusion was Ahmed, followed by Khalid and Norhan, then Nora.

2. The increase in language age equaled maturation time for Ahmed only, while was less than maturation time for Khalid, Norhan and Nora.

3. No improvement was observed with regards to Hossam.

Discussion

1. Improvement was much noted concerning expressive language probably owing to inclusion with the 'other' children. The 'other' children had better language abilities, as well as excessive data and information, which may have helped ameliorate language parametres.

2. Prosody has deteriorated. For prosody to be ameliorated, speech therapy is a must. Because of the included children's school timetable they were not provided speech therapy sessions. This is probably the reason for the setback.

3. With reference to pragmatics, once the child resorts to verbal communication as opposed to nonverbal communication, with an increase in passive and active vocabulary, a score on pragmatics is calculated. Amelioration in active vocabulary increases the score in pragmatics. Inclusion may have played a role in the gain in the area of pragmatics.

2nd. INFORMAL LEVEL

Tools

This part of the study was based on a qualitative evaluation concerned with the interpretative approach (Cohen & Manion, 1989). The data sought were not quantifiable and the techniques used were those that "reveal the actor's perspective." (Hitchcock & Hughes, 1989; p. 25). The techniques used were:

1. Observation

"Simple Observation"(Robson, 1993; p. 159) which was the passive observation of playground and classroom dynamics. The following variables were the most observed:

• Peer relations
• Class teacher relations with child with SLD

For that purpose, the researcher 'shadowed' a child with SLD for a period of time, once during the school year. It was very difficult to go into the schools because of the strict regulations of the MoE regarding visitors to schools. The presence of the children with SLD in regular schools was based on personal agreements by their parents and the directors of these schools, and not based on educational policy.

The purpose was to make a comparison between the two groups of children, those with and those without SLD, with reference to the peer relationships as well as occurrence and nature of teachers' contacts.

2. Interviews (See Appendix B for full text)

Semi-structured interviews (Robson, 1993) were designed for that purpose. The questions were open-ended. In general, probes were used to follow information that the researcher found relevant or complementing the data collected or to corroborate with other sources of information.

Procedure

The collection of data took one visit to each school where each child was included.

Observation

them during the periods of inclusion with their peers. Therefore, for periods that ranged between ten to fifteen minutes, on average, everything related to the focus areas was written down. The observation periods between twenty and forty five minutes. Access to each school was allowed only once and during very restricted hours because as said earlier there was no educational policy to support the decision of the directors of these schools to include children with SLD. Norhan was observed on March 16th, 1999 (Al Baraam School), Ahmad on May 6th, 1999 (Al Shahid Abdel Moneim Riad School), Nora on April 13th, 1999 (Cairo Primary Private School), Khalid on May 2nd, 1999 (Al Manar School), and Hossam on May 30th, 1999 (Nasr Language Schools - Special Classes).

Interviews

In each interview, the interviewee was advised of the purpose of the interview and of the confidentiality of the information. During the interviews, note-taking was used. The length of the interviews ranged from an hour to one and a half hours. These interviews were with the parents of children with SLD before and after inclusion, and with the school teachers, once during the school year. The school year started at the last week of September, 1998 and ended around the end of May, 1999.

Analysis of Data

The collected data was the perception of reality of the participants and it was the manner by which they "make sense and order their environment" (Cohen & Manion, 1989; p. 33), and from the qualitative nature of the gathered data, the analysis methods were predominantly qualitative and descriptive.

Stages of Analysis

Stage One: Isolation of general units of meaning

The researcher, in this "micro" research isolated "general units of meaning". Through "thorough familiarity" with the content of the data collected, "specific categories and meanings" were generated. (Hitchcock & Hughes, 1989; p. 35, 96 - 98). From the relevant material, patterns and themes were extracted. Recurring themes related to advantages and disadvantages of inclusion, elements of good and of bad practice, and future needs were stressed by the participants or inferred from observation.

Stage two : Validation

The resulting patterns, themes, "hypotheses, constructs or categories" needed validation. A technique of analysis suited for that stage was "triangulation" (a technique made popular by Elliott & Adelman, 1976) which "involves contrasting the perceptions of one actor in a specific situation against those of the other actors in the same situation. By doing this, an initial subjective observation or perception is fleshed out and given a degree of authenticity." Also, the "sources of data" such as "observations, interviews…" were triangulated. Thus, gradually clusters of ideas emerged.

Stage Three: Interpretation

The third stage that followed was interpretation which "involves taking a validated hypothesis and fitting it into a frame of reference that gives it meaning." (Hopkins, 1993; p. 157). The results were answers, or an attempt to answer the two research questions:

- Were the children with SLD 'segregated' or 'included' socially with their peers?

- Were the children 'segregated' or 'included' in the delivery of the National Curriculum with their peers? Stage Four: Action

The final stage shall be the action. The researcher may be in a position to offer "a plan for future action." (Hopkins, 1993; p. 158). Recommendations for improving practice will be presented in the conclusion.

Results and discussion

Results

Social Inclusion and Curriculum Inclusion

Four elements were informative with reference to the assessment of social & curriculum inclusion:

• Parents (interviews at the start & at the end of the academic year).
• Teachers (interviews during the academic year).
• The child with special needs (observation in school). ·
• The 'other' child/ peer (observation in school).

One. Parents

With reference to parental evaluation, there was a satisfaction with the experience as a whole, despite earlier apprehension. However, there were problems on the academic level because of the lack of support in class and lack of differentiation in the national curriculum. Regarding Hossam, who went to a special class, the father said his son developed in functional areas (activities of daily living) and in mathematics, but lost in the areas of reading and writing, compared to his earlier training in the centre. As said earlier, the father aimed to include his child in the next academic year and regretted pulling him out from the regular school.

Samples from parental interviews (Full text in Appendix B)

I Norhan

First Interview with the mother (25.02.1999)

"Norhan quickly accepted her new school. She now has more vocabulary. I do not know if this is learnt from the other pupils, playing with her cousins or just growth. Anyhow, she has more words in her vocabulary and makes longer sentences. Schooling did not influence her social behaviour. She is very sociable, more than is needed. Academically, she has improved, she knows bigger numbers and English words. Also her sister helps her. Norhan has benefited. She wants to do her homework, she feels a commitment to do so and she is encouraged. She writes better than her friends."

The mother complained that the director of the school was not understanding and did not want Norhan in the school.

Second Interview of the mother:

The mother did not come for a second interview. She was too occupied trying to overcome the obstacles put by the school to send her child away.

II Ahmed

First Interview with mother (27.10.98)

"He does not anymore do the bad behaviours he used to do. However, he does not know how to keep track of his things. But now he writes independently."

Second Interview with mother (at the end of the school year: 06.05.99 ):

"On the whole, his Arabic improved and his alphabet increased. His maths is still on the same level as at the centre (where he studied during his preschool years). He is integrated with his classmates and whenever he sees them on the street to school he leaves me and walks with them. He colours and paints and he does not anymore do the challenging behaviours I complained earlier from. He knows how to defend himself." The mother complained that his class teacher gave him zeroes and did not trust that he could do anything.

III Nora

First Interview with the mother (27.10.98)

The mother complained that the curriculum was heavy. However, "Nora is good and befriends the other children. They ask to sit beside her. Nora is happy to go to school. She is willing to work but she gets bored easily."

Second Interview with the mother (13.04.1999)

The curriculum remained to be difficult. Nevertheless, "Nora is disciplined and has many friends in school."

IV Khalid

First interview with mother (26.10.98):

"There is peer support. Academically, there is lot of pressure. He needs a support teacher in class. He is socially integrated and his shyness has decreased. His language improved."

Second interview with mother (02.05.99):

"He fears his class teacher. However, he never returns from school tensed or frustrated and he returns happy. Sometimes in winter we have accidents (wetting). The classroom is far from the toilet therefore I keep a change of clothes at the school".

V Hossam

First Interview with father (11.98)

His father did not like the social level of the pupils and withdrew his child to special classes in a regular school (locational integration).

Second Interview with father (after the school year: 30.05.99)

"Hossam has some stubbornness left. However, he is not anymore aggressive. He causes no damage at home and is careful with things and with his belongings. He eats and drinks independently. I am not happy here. I shall move him to special classes attached to another school. At your centre, he learnt maths and spelling, however, he did not use his brain, he only memorised by heart I wish that he learns to read and write and may be in ten years from now he may have be taught a vocation. I do not care if he gets a certificate."

On the whole, parents confirmed development in language and social skills, as well as reduction in disruptive behavior. Improvement on the academic level was confirmed by the parents of Norhan and Ahmed. Khalid's & Nora's mothers felt that their children were pressured by the National Curriculum. A need for differentiation and support was expressed.

Two. Teachers

The teachers of Nora, Khalid & Norhan accepted the children in their classes and tried to support them as much as possible. Nora's teacher contacted the centre for guidance on how to present mathematical concepts to her. The centre offered some useful strategies. Ahmed's teacher underestimated his skills and her remarks him in the interview were patronizing, labelling him an 'angel', who sleeps a lot, eats much and wets himself. It seemed she could not see her role as a teacher with him. Hossam's teacher was a special education teacher, who believed Hossam was in the right place. She believed his performance could have been better had the children in her class been properly placed, not the 'cocktail' of disabilities she had, quoting her exact words.

Samples from teachers' interviews (Full text in Appendix B)

I Norhan

"I examined her at her entry exam and wanted her to be with me. Some teachers refused the idea. Academically, she is delayed in writing, quite backward. Norhan is stubborn, needs discipline and I threaten her that I will take her to a teacher she does not like or the 'rats room'". Nevertheless, the teacher let her get away with bothering her friends (taking a rubber or water can). With reference to schoolwork, the class took no reading (her strong visual memory was not being efficiently used). As for the oral, she repeated after the teacher, however, sometimes she forgot what was said. (Poor short auditory memory). Generally, her recall was good.

II Ahmad

His teacher said that "at the beginning of the school year he had behaviour problems. We decided to act with him normally. He sometimes does his homework." But "he uses bad language. He takes other children's belongings. He does not concentrate in exams. He only participates in reading and sleeps a lot in class. Sometimes he wets himself."

III Nora

The teacher said that Nora was a polite disciplined child who did as told. "She is slow but now she copies correctly from the blackboard. Her speech can sometimes be unclear. She likes maths and English more than Arabic. She is improving. When an inspector is around, I make sure that she shows her strong points. She is kind and she loves them as much as they do love her. When she answers the questions of any teacher who comes to class, they all make it a point to me the moment I come to class. They all help her to attend to what is going on in class."

IV Khalid

Khalid was previously afraid and not wanting to mix, even in breaks, his teacher said. He gradually improved. Academically, Khalid improved. At the beginning he was slow. "He still cannot write the alphabet from memory and cannot take dictation. He needs help in maths, although his colleagues are on the same level (weak). His mother spoils him."

V Hossam

The teacher said "the classes have a bad reputation. We are considered a burden over the main school to which we are attached. We are marginalised. Hossam is spoilt, and is persistent when he wants something but not aggressive. He is friendly and affectionate. He is good on self-help. He integrated the moment he joined the school. He always expects physical harm. It can be a problem at home. I do not think it is suitable to include him in a regular school because he will be frustrated. His father overprotects him. Is it reaction formation? I suspect that. The mother is clear she wants nothing to do with the boy.

He learnt to read holistically. He knew 20 words. Now, he can read 40. He has a very strong memory but I want him to understand not memorize. With reference to writing, his fine motor coordination is poor (big letters and not on line). I teach him the letter and the phoneme. The letter name is easier than the phoneme (this is not correct educationally, a letter is a meaningless symbol)."

On the whole, none of the teachers complained of disruptive behavior except for Ahmed's teacher, who said he took the belongings of other children. However, the major problem was a lack of understanding of the children's educational needs and how to cater for them. The fact that the children had no 'legal' presence in these schools, hampered inclusion. The teachers were not trained to handle the situation. No professional support was provided and differentiation was not an educational policy.

Three. The included children and their peers

From playground and classroom observation, the children were socially included. Their peers took them for granted, supported them, and at points rejoiced in their success. In one instance, when Khalid was daydreaming in the line during the morning exercise, his peer casually prompted him to attend. When Ahmed was reading in class, the children read after him, ignoring the mistakes he made and read correctly, as if not to draw attention to his mistakes. Nora's peers took pride in her success and made it a point to tell their class teacher whenever she did well in other teachers' sessions. They shared with her their meals during break. The four of them could not be pointed out during play- time, they were all 'mates' in the proper sense of the word.

Samples of Social Inclusion (in the playground)

I Norhan - In the playground the children are playing a game. "Let's make a circle, close and open rose." Norhan is part of the circle, following instructions, having a boy & a girl to her sides. Later, the children chase one another, she participates. She is quite involved with group activity. She feels equal and the children treat her likewise.

II Ahmed - He is running at the playground to catch up with his colleagues. The group of children, including Ahmed, gathers to discuss something. He is part of the group. A boy is putting his arm around his shoulder as they talk (like buddies do).

III Nora - In the playground, Nora is seated between two girls and seems part of the group. Nora is absorbed in eating. Her friend gave her a piece of her sandwich. There is an ongoing communication and sharing of food between Nora and her friend. The break comes to an end and a friend of Nora asks her to join in lining up.

IV Khalid - In the playground, he is participating in conversation. A child is putting an arm around him. Two boys come towards him and they join arms and walk together as a group of friends. He is happy. They seem to be playing a game. He is participating. The children seem to be offering him assistance readily.

V Hossam - He goes around the playground. He walks towards the man who is selling the soft drinks. He seems to want but only stares at the man and sits beside the box where the bottles are. He watches two older children. He starts to rock, stops and looks at the box and then starts to rock. He still holds to his sandwiches and rocks (was it understimulation??). With reference to curriculum inclusion, the included children seemed to be included in the ?National Curriculum. But bearing in mind the parents and teachers' interviews, a support and differentiation policy would have helped them gain more systematically and efficiently. Norhan, being in reception, had the privilege of differentiation as the system is more lax than in primary. She worked on simpler worksheets, though from the same book as her peers. Hossam worked on an individual educational plan (IEP) basis.

Samples of Curriculum Inclusion (in the classroom)

I Norhan - The teacher starts distributing books, and she calls twice " what about mine?" The teacher is helping the children find the page they are going to work on (worksheet). She is working on a different worksheet (easier) suitable for her level. On the whole the classroom atmosphere is positive.

II Ahmed - The teacher asks him to take out his book. He does not have it with him. He is given a book and starts to read. His colleagues start reading after him. The teacher corrects his reading. However, since the text is familiar to the rest of the class, they read correctly without repeating his mistakes. [The teacher's corrections were redundant, as the peer coaching was unanimous]. Only two of the children are smiling at Ahmed's mistakes. The others seem to take him for granted.

III Nora - Nora is not participating in answering questions. She does not raise her hand. Her class teacher draws her attention and tells her, in front of the whole class, to leave her pencil. She then answers correctly the teacher's questions. When the teacher does not hear the reply, one of her colleagues says out loud 'she said so & so.'

IV Khalid - He is getting out his things from the schoolbag, but he is not participating. He is fidgeting for something. Now the teacher asks the children to get out their reading books. The teacher walks to where he is sitting and shows him the page they are going to work on. There is group reading aloud. He is participating.

V Hossam - He repeats the same line the teacher says (echolalia). The teacher starts a matching game. The other children respond. Hossam does not. He looks closely at the whole picture and looks at the separate pictures he needs to match but he does not try to attempt it.

From observation, language and social skills were obviously better than when they were at the centre, except for Hossam who seemed to regress into stereotypic behavior, probably because of the lack of stimulation and challenge. As for the curriculum, three of the children were being introduced were for the first time to the primary Egyptian national curriculum, one for the kindergarten year 2 curriculum and one for a special education curriculum.

Discussion

develop the children's social and language skills. Curriculum inclusion, though not as effective as it should be, helped presenting the children with challenge that made them more receptive and alert as have observed and confirmed by parents' interviews. On the whole, the included children enjoyed going to school. No emotional problems or any severe disruptive behavior occurred. Support and differentiation, in addition to teacher training are in need. This shall not happen, unless the presence of the children with SLD becomes part of the educational system in Egypt.

* As said earlier, full text of interviews and observation is attached as appendix B.

CONCLUSION

1. Formal

Level Positive change on re-testing at the end of the school year in 60.294% of the psychological variables and in 65% of the language variables. The study, despite its methodological limitations, partially confirmed the initial hypothesis that inclusion was beneficial. The Wilcoxon Matched Signed-Rank Test was used in both areas (psychological & language) to assess significance of difference.

2. Informal Level ·

• Social Inclusion: The children were socially accepted and included. ·
• Curriculum Inclusion: Despite the positive challenge of the delivery of the national curriculum to children with SLD, problems on the academic level existed because of lack of both support in class and differentiation which hindered curriculum inclusion.

There was an overall parental satisfaction with the experience, despite earlier apprehension. Follow-up studies are needed with larger samples and better methodology.

RECOMMENDATIONS

1. Parent-school-centre communication is crucial to the future of this experience and to ensure its continuity with lesser obstacles. On the whole, there was no communication with the schools regarding the children. The children were in these schools without any planning related to the national educational policy. Personal efforts by the parents and the centre pressurized these schools into accepting the children.

2. A balance between a national curriculum (reading, writing, etc..) and a social curriculum (training activities of daily living and survival skills) is important for those children who are included in regular schooling. Allocating time for training on the social curriculum shall further facilitate the inclusion.

3. Teachers have to be introduced to the educational and emotional needs of children with severe learning difficulties (SLD). From teachers' interviews, it is obvious that most of their difficulties with these children are a result of their lack of knowledge of the children's needs and how to meet them. The minor behavior problems that were mentioned by the school staff were not particular to children with SLD. The lack of knowledge led to the labeling of the children by some teachers which was counter-productive and may have created underestimated expectations from the children.

4. Continuity of speech therapy is a must to all included children. The fact that the centre's working hours were almost the same as those of the schools of these children led to lack of opportunity for them to be offered speech therapy sessions. Most of these parents could not afford going to private speech therapists.

5. Facilitating the physical accessibility of buildings in schools where children will be included shall be a must to avoid accidents that may humiliate the pupil with SLD (e.g. difficulty in climbing stairs, wetting oneself because a toilet is not easily accessible, etc..).

6. There is a movement towards inclusion in the international society. The United Nations' "Standard Rules on the Equalisation of Opportunities for Persons with Disabilities" stated in article 26:

"Persons with disabilities are members of society and have the right to remain within their local communities. They should receive the support they need within the ordinary structures of education, health, employment and social services." (UN, 1994; p.12). The 'ordinary' would suggest a favouring of inclusive or integrative settings versus special settings. Further, it goes on with a particular reference to education, in rule 6, where it specifies that education should be provided "in integrated settings." (UN, 1994; p. 23). This call of the international community must be our guidance in Egypt.

Acknowledgment : The team that worked on that paper wish to express their gratitude to the children with SLD and their parents for their sincere cooperation and to the Integrated Care Society for making this effort possible.

References

A. Aziz, N. et al. (1995). The Standardized Arabic Language Test . Egypt.

A. Hak, H. N. A. (1997). The Evaluation Of Inclusive Education For Pupils With Severe Learning Difficulties In A Resourced Primary School. A dissertation submitted to the University of Manchester in part fulfilment of the requirements of M. Ed. In Educational Psychology - Faculty of Education.

Cohen, L. & Manion, L (1989). Research Methods in Education. 3rd. edition. UK: Routledge.

Dunn et al. (1982). The British Picture Vocabulary Scale. NFER-NELSON Goodenough-Harris Drawing Test (1976). Arabized by Farrag, El-Sayed and Magdi.

Hegarty, S. (1993). "Reviewing the Literature On Integration", European Journal of Special Needs Education, 8(3), 194-200.

Hegarty, S. (Undated). Educating Children And Young People With Disabilities: Principles And The Review of Practice. Paris: UNESCO

Hitchcock, G. & Hughes, D. (1989). Research & The Teacher : A Qualitative Introduction to School - based Research. USA: Routledge.

Hopkins, D. (1993). A Teacher's Guide To Classroom Research. 2nd edition. UK: Open University Press.

J.C. Raven, J.H. Court and J. Raven (1977).The Coloured Progressive Matrices. H.K. Lewis

Jenkinson, J. C. (1997). Mainstream Or Special: Educating Students With Disabilities. UK: Routledge.

Ministry of Education (1998). Statistics From The Ministry of Education.

Robson, C. (1993). Real World Research ; A Resource For Social Scientists & Practitioners. UK: Blackwell Publishers Ltd.

Stanford-Binet 4th edition (1994).Arabised, El Nahda El Misrya, Egypt.

United Nations (1994). The Standard Rules on the Equalisation of Opportunities for Persons with Disabilities. USA: UN.

Appendix B

Observations of the included pupils

I Norhan

Date: 16/3/99

School: Al Baraam

Class Teacher's interview

Miss Amal, graduate of the Social Service Department, class teacher who delivers the Arabic language and Maths. There is another teacher who delivers English. She said "I examined her at her entry exam and wanted her to be w/ me. Some teachers refused the idea. She is responding and she is equal to her colleagues. The other children clarify her speech. If she is absent, the other children miss her more than any other child. When she comes into school, she shakes hands and kisses. She imitates me, and that is why the children like her. She has a special friend. Passant, the one you saw her come down class with. She only forgives Passant and no other child, because when she first came, Passant gave her crisps. N. knows her colleagues' names in full. She corrects the teacher if she pronounces the name of one of the children incorrectly. She is very precise. She dislikes some people for no reason, e.g. one of the teachers. She has her likes & dislikes.

said that they gave them abstract letters to write, then I explained we gave short words, not letters. She said that N. is very fastidious and takes a long time to write and she uses the rubber a lot. I asked the teacher if she tries to modify the behaviour. She said she does. She holds the rubber with her and only gives it to N. when she needs really to use it. However, the teacher said that she is sly and once she gets the rubber, she starts rubbing all, not just the mistake. The school system is that although the school day is 8:00 am to 1:45 pm, some children with working parents stay an extra hour and they do their homework during the time. N. usually leaves early, although for one month she used to stay the extra hour. Thus, the time is usually not enough to help her, she needs more time which the teacher can't give her, otherwise, other parents may complain. Also, the teacher says that N. is stubborn, needs discipline and threatens her that she will take her to the teacher she does not like or the "rats room". Nevertheless, the teacher lets her get away w/ bothering her friends (taking a rubber or water can). She tells the others that it is OK. I suggested that she should be disciplined.

With reference to schoolwork, the class takes no reading (her strong visual memory is not being efficiently used). As for the oral she repeats after the teacher, however, sometimes she forgets what was said. (Poor short auditory memory). Generally, her recall is good.

I asked the teacher about an event N.'s mother told me. That all the the children in the class were recognized for academic achievement, except for N. who was only invited to the party organized for this purpose. The teacher disagreed w/ the mother's version and confirmed that only 9 of the 24 children where honoured and N. was not on the list because she did not attend the term's exams. The only child who was exempted and given the acknowledgement was a child called Sarah who had leukemia and the teacher felt a moral obligation to give her a bonus of happiness. However, the teacher realizing that N. was hurt, bought her a gift and the child is starting to forgive her. The teacher said that both N. and Sarah are attached to her.

Interview w/ school doctor (Nagya)

(she approaches me). She thinks that Norhan has benefited from school, while another child in the school, also w/ DS has not. The doctor said that she is encouraging Norhan's parents. An inspector came to school and requested speech & IQ assessment. The doctor sent her papers for the assessment with a recommendation that she stays in school.

Place playground Time: during recess

9:40 - 9:50 :She comes down the stairs of the school w/ a colleague, holding hands. She lines w/ the others to buy from the canteen. Teachers are assisting the children during the buying process. She says her request but the sales woman does not understand. Her teacher clarifies that she wants the spicy crisps. She insists until she gets what she wants.

Norhan is on her own and the teacher asks 2 girls w/ her. They all hold hands. She converses w/ another girl. She is observing others. Girls spontaneously involve her in play (hide & seek). Then teachers intervene w/ a game. "Let's make a circle, close and open rose." Norhan is part of the circle, following instructions, having a boy & a girl to her sides. Later, the children chase one other, she participates. She is quite involved w/ group activity. She feels equal and the children treat her likewise.

The teacher takes a hurt child to the infirmary. Norhan waited a few seconds and then, accompanied by another child, followed the teacher.

9:55 - 10:05: Teacher came back w/ both girls, each held by one hand. Norhan started wandering eating her crisps. She walks w/ another boy who asks her for crisps and she gives him. They walk side by side. The boy turns around and she follows him. 2 boys come and ask her to join the group from class. She wanders again w/ her crisps. She independently goes to drink water. Norhan & other children follow teacher who came back w/ hurt child, but the nanny calls them back.

10:20 - 10-25: Now that I enter the class, which consists of 24 children, Norhan recognizes me. All pupils, upon teacher's request give me a strong welcome. They are now eating their sandwiches. Norhan is eyeing me and giggling at my presence. "Miss Hala", she tells her teacher.

10:45 - 10:50: She is sharing in play w/ children around the table. There are 5 children around the table. N. is playing with 2 boys. She draws her teacher's attention to look at her playing w/ one of the boys. N. stands up and picks up her bag. Her teacher says her name (the teacher's) and a name of one of the teachers and N. makes a thumbs up. When the teacher mentions a name of a certain teacher, she makes a thumbs down.

10:55 - 11:00: Child complains that N. took something from her. Teacher reprimands her. She looks ashamed. She tries to catch my eyes but I avoid her. She calls out her teacher, putting up her cup and says "I want water." Teacher tells her to wash and fill it. She goes to drink water.

11:05 - 11:20: An incident occurs w/ the teacher where N. is stubborn. She is trying to catch my eyes. The teacher insists that she goes back to her seat or else she will be punished. She goes back. A teacher comes in and tells N. Hello, and asks her to let Passant to say Hello. She refuses. I assume N. does not want too much attention given to her. She argues w/ her teacher about the rubber and the teacher tells that there will be no rubber. She goes to the basket and empties her plate thoroughly and her napkin before putting it in her school bag. She walks to teacher to take a schoolbook and the teacher tells her to go back to her seat and that she will give her book. The teacher starts distributing books, and she calls twice " what about mine?" She puts her things in her bag and calls the teacher then holds her bag while the other children are seated. She sits down and the teacher gives instructions (which page to open). She looks at the other children and flips the pages of her book. She draws stars on her book. The teacher is helping the children find the page they are going to work on (work sheet). N. is still on the wrong page. Teacher uses a rubber to correct children. She is working on a different work sheet (easier) suitable to her level. N. works on it. The teacher says she uses the rubber w/ all the children not to make N. stand out. On the whole the classroom atmosphere is positive.

II Ahmad

Date: 06/05/1999

School: Al Shahid Abdel Moneim Riad

ClassTeacher's interview

She said that "at the beginning of the school year he had behaviour problems. We decided to act with him normally. He started to salute everybody. He sometimes does his homework.

Ahmed's mother cares about him, but he does not help her. She punishes him by depriving him of food. He uses bad language. He takes other children's belongings and only returns them through me. He does not concentrate in exams. He cannot take dictation or write out of his own initiative. As for me, I really love him and he is like an angel when he is sleeping. The moment he enters the class, he eats. He only participates in reading and sleeps a lot in class. Sometimes he wets himself."

Place: Playground Time: during recess 12:15-12:25 noon

He is running at the playground to catch up with his colleagues. The group of children, including Ahmed, gathers to discuss something. He is part of the group. A boy is putting his arm around his shoulder as they talk (like buddies do). They all run as they seem to be participating in a game. Ahmed listens to his colleague who is organizing the game and joins in. They all run. A colleague talks to Ahmed. Both join in the running. He seems to be happy participating in that kind of play. They all pull each other into a circle, hug and carry one another.

Place: Classroom Time: during a session 12:30-12:40

Class has 25 children. Ahmed can see me(researcher) now. Class is arranged in rows. Ahmed is sitting alone on a front chair. The teacher explains that he usually sits among other children but today he is punished because he beat one of his classmates.

He is given a book and started to read. His colleagues start reading after him. The teacher corrects his reading. However, since the text is familiar to the rest of the class, they read correctly without repeating his mistakes. [The teacher's corrections were redundant, as the peer coaching was unanimous]. Only two of the children are smiling at Ahmed's mistakes. The others seem to take him for granted. The teacher asks him a few questions. 'What is this, …' He answers. Then she asks him to continue reading, which he does and the class continues reading after him. Whenever he finds a word difficult, the children help him.

III Nora

Date: 13.04.1999

School: Cairo Primary Private School

Class Teacher's interview:

Miss Naglaa said that Nora is a polite disciplined child who does as told. She is slow but now she copies correctly from the blackboard. Before she confused lines. She makes spelling mistakes though I think she is just being spoilt. Her speech can sometimes be unclear. With me, she is very committed. With another teacher she can misbehave either by running away from class or by behaving badly. She is still a slow reader compared to her classmates. I try to make her equal to her colleagues and ask her to read from the blackboard. She likes Maths and English more than Arabic. She is improving. I make her succeed and when an inspector is around, I make sure that she shows her strong points. She confuses few of the similar letters ? ? ? but she has memorized few of the short verses from the Holy Koran. [The teacher wanted more support on how to teach her Maths. I explained few methods and asked her to come to our centre to sit with our teachers. She did that earlier at the beginning of the school-year.

She said that Nora knows the names of all her classmates. She is kind and she loves them as much as they do love her. When she answers the questions of any teacher who comes to class, they all make it a point to tell their class teacher the moment she comes to class. They all help her to attend to what is going on in class. Class No. 25 pupils.

Observation Place: Playground Time: During recess 10:55 - 11:15

Nora cannot see me. She came down from the classroom with her colleagues. The playground is very small, therefore, most of the children sit on benches together and have their snacks while chatting. Teachers fear for them if they play, they may hurt themselves. The area will be too crowded. Nora goes towards one of the benches, talks to one of those seated who makes place for Nora. Her friend patted her and gave her a kiss on the cheek. She gave her friend her chocolate to open it for her. Her friend gives it to her and encourages her to start eating. Nora is seated between two girls and seems part of the group. Nora is absorbed in eating. Her friend gave her a piece of her sandwich. There is an ongoing communication and sharing of food between Nora and her friend. The break comes to an end and a friend of Nora asks her to join in lining up. All the children start lining up and Nora puts her bag of crisps in her pocket and joins in. She is quite disciplined. The children start to exercise by stretching their arms up. Nora participates in the group exercise in line with the whole class. They later sing and she participates. They all cheer their school. All, including Nora, walk to their classrooms.

Place: Classroom Time: During a session 11:21-11:40

Nora can see me now. The class is organized in rows. She is seated in the front row with her colleagues. The class teacher joins in, although there is already another teacher giving English [I think this was done to support Nora]. Nora gets out her notebook and pencil like all the other children upon request of the teacher. She got out the wrong notebook. She did not have the English one. The teacher decides to change the subject [probably for my sake so that Nora can share with her classmates]. The topic is the farm animals. She starts copying from the blackboard. Every now & then she attends to me. The class teacher draws her attention to copying the date. The other teacher asks her to reply to a question. Nora misinterprets the question & gives a wrong answer. The teacher asks her to sit down without correcting the answer. The teacher asks me if it is right for a 'mongol' [my commas] to be in a regular class. I quietly, not to draw Nora's attention, said yes, however, she probably needs more help than her colleagues. If she gets that kind of help she will improve. Nora is not participating in answering questions. She does not raise her hand. Her class teacher draws her attention and tells her, in front of the whole class, to leave her pencil. She then answers correctly the teacher's questions. When the teacher does not hear the reply, one of her colleagues says out loud 'she said so & so.'

IV Khalid

Manar School

Date May 2nd, 1999.

Class Teacher's interview:

Khalid was previously afraid and not wanting to mix, even in breaks. He gradually improved. Now he has friends he knows by name and plays and laughs with them. Like Mohamed (one of the children of our centre who was integrated two years earlier). He is loved by his classmates and has friends, Abdou & Haggar (a boy & a girl), but they are absent today. They sit beside each other in class.

Khalid now gets out his books, before he did not. His mother brings him up to class as he comes late in the morning after the lining up. The school is quite far for her.

Academically, Khalid improved. At the beginning he was slow. He still cannot write the alphabet from memory and cannot take dictation. He can copy words and knows the letters of the alphabet. In reading he is still behind his classmates. Now the class is in the last lesson. He is 3-4 lessons behind. It is a slight delay. I help him. He needs help in Maths, although his colleagues are on the same level (weak). He is only delayed in understanding the concept of borrowing in subtraction, otherwise he is on the same level like the rest of the class. However, he is better than before. He needs to study during summer and get private tuition. His mother used to write his homework for him and I refused, especially that he writes in class. His mother spoils him. He needs follow-up from a teacher. One uses the same teaching methods but goes slower. At the end of the day, I revise with him. He gets part of the lesson at the school (end of the day) and finishes the rest at home. At the beginning of the academic year (September & October) he did not concentrate and I would not let him write in the class notebook, only in the homework notebook (class notebook is the one shown to inspectors) and now he writes in class.

Place: Playground Time:Recess 10:55-11:05

Khalid cannot see me. The break has already started. He was standing surrounded by some of the kids. They later walked side by side. He is participating in conversation. A child is putting an arm around him. Two boys come towards him and they join arms and walk together as a group of friends. He is happy. They seem to be playing a game. He is participating. The children seem to be offering him assistance readily. They stand together by a school fence. They ran after each other. He is smiling happily. They return again to the fence. They run again and some children are holding to him. A teacher comes in and asks the children to pick up the trash some of them throw around. The break is finished. The children line up and do exercises coached by the teachers. A child helps Khalid by naturally prompting him by a touch under his arms to attend to the exercises. Khalid stands in line like everybody else. The teachers are very undisciplined, speaking about personal problems on top of the children's heads. All the children, including Khalid, salute the national flag.

Place: Classroom Time: Session 11:10-11:30

The class is 36 children. Khalid saw me as I went in. It is an English language lesson and the children are copying from the blackboard. He is getting out his things from the schoolbag, but he is not participating. He is fidgeting for something. Meanwhile, the teacher gave him a Maths writing-book (he has a slightly better control on the pencil). He is copying from the blackboard the problems and their results. Now the teacher asks the children to get out their reading books. He is sitting alone, like many other children. Teacher calls out his name, like the other children, he comes and picks up his notebook. The teacher tells the class the heading of today's lesson. The teacher walks to where he is sitting and shows him the page they are going to work on. There is group reading aloud. He is participating. The teacher calls out his name. He reads out in whispers and is quite tense. He seems confused by my (the researcher) presence. The teacher asks the group to read out loud and Khalid participates.

V Hossam

Date: 30.5.99

School: Nasr Language Schools - Special Classes (8:30-1:30)

Class Teacher's interview

His class is 8 children and one teacher(Miss Ola), who complains that she has a 'cocktail' of children with difficulties: autism, CP and Down syndrome. She has no technical support. The nannies are not efficient. The classes have a bad reputation. We are considered a burden over the main school to which we are attached. We are marginalised.

Miss Ola said "Hossam is spoilt, and is persistent when he wants something but not aggressive. He is forgiving. He is friendly and affectionate. I had to teach him to wait for his turn. He is good on self-help. He integrated the moment he joined the school. He is lovable and neat. He does not enjoy boys' toys such as cars and guns. He cares about his looks and knows he is good looking. He is sociable even with strangers. He enjoys drawing attention to himself. He never lies nor takes other people's belongings, except other children's food. He always expects physical harm. It can be a problem at home. He does not persevere. He needs firmness and he will not obey orders. I do not think it is suitable to include him in a regular school because he will be frustrated. Here he feels the top of his class. His father overprotects him. Is it reaction formation? I suspect that. The mother is clear she wants nothing to do with the boy.

He learnt to read holistically. He knew 20 words. Now, he can read 40. He does not like Arabic language. In numbers, he knew until 10 and now has reached 16. He counts on and uses beads and draws in his notebook. He learnt by heart summations but now can use cubes to do so. He has a very strong memory but I want him to understand not memorize. He recites songs. He likes to be applauded and he praises himself. He has logical replies. He narrates and follows up other people's conversation. He asks and responds to questions. With reference to writing, his fine motor coordination is poor (big letters and not on line). He knows how the word looks like and writes it. I teach him the letter and the phoneme. I make him learn similar syllables. No abstraction. The letter name is easier than the phoneme (this is not correct educationally, a letter is a meaningless symbol). He does his homework and he can stay on task 10-15 minutes. He loves drawing and music. He has artistic tendencies and does not like PE. He knows the names of actors and singers. He knows the time (morning, noon, evening). He identifies colours. He can be sloppy when he is colouring.

Place: Playground Time: Recess 10:30-10:45

He goes to the play ground with the rest of his friends. He sits alone holding to his sandwiches. He does not eat. His glasses are off. He is watching other children. He fumbles with his bag of sandwiches. On the whole, the playground is peaceful with little activity going on. A boy approached Hossam and spoke to him then left. He smacked a boy who sat behind him. His teacher called him to give him his glasses. He put them. He went towards the slide and up the ladder. He went down holding to his sandwiches. He goes around the playground. He goes towards the man who is selling the soft drinks. He seems to want but only stares at the man and sits beside the box where the bottles are. He watches two older children. He starts to rock, stops and looks at the box and then starts to rock. He still holds to his sandwiches and rocks (understimulation??). He watches a child buying a soft drink. He sits and watches others, then looks at the box and then rocks again. He is distracted by two passersby, then he starts rocking and then stops. A mother in the playground remarks about Hossam "Socrates is sitting alone, nobody impresses him." As the recess finishes and he goes towards the class, he sees me (the researcher) and his teacher asks "where is Mrs. Hala?" He points at me.

Place: Classroom Time: 10:50-11:05

He sits on the table, and the teacher asks him to sit on his chair. He is sitting around a table with another five children. He is given a matching game with his friends. He calls the name of his teacher and says 'Ahmad'. The teacher tells him this is your father's name, and your name is Hossam. He repeats the same line the teacher says. The teacher starts the matching game. The other children respond. Hossam does not. He looks closely at the whole picture and looks at the separate pictures he needs to match but he does not try to attempt it. This is the last day of school and parents start coming in to take the children.

Parental Interviews

I Norhan

First Interview with the mother (25.02.1999)

The mother complains that the director of the school is not understanding and does not want Norhan in the school. The teacher of the Arabic language accepts her so does the other children to the point that they make the same errors of speech she does to imitate her. The English language teacher is stiff with all the children, not with Norhan only. This teacher hardly smiles. Many other teachers, even those who do not teach her class accept Norhan because she is more disciplined than the other children.

Norhan quickly accepted her new school. She has an intimate friend and if her friend did not come she returns home.

She now has more vocabulary. I do not know if this is learnt from the other pupils, playing with her cousins or just growth. Anyhow, she has more words in her vocabulary and makes longer sentences. Schooling did not influence her social behaviour. She is very sociable, more than is needed. Academically, she has improved, she knows bigger numbers and English words. Also her sister helps her. Norhan has benefited. She wants to do her homework, she feels a commitment to do so and she is encouraged. She writes better than her friends. Also, her training at your centre (where the researcher works) helped her know the shapes and she did better than her colleagues. She takes individual tutoring sessions in English, Arabic and Maths. after school. The class teacher did not know how to handle her. I asked her to treat her like all the other children. She did not listen to me and she still imitated her and let the other children do the same.

Second Interview of the mother:

The mother did not come for a second interview. She was too occupied trying to overcome the obstacles put by the school to send her child away.

II Ahmed

First Interview with mother (27.10.98)

He does not anymore do the bad behaviours he used to do. However, he does not know how to keep track of his things. He loses his notebooks and pencils. He still sits under the table in class. He likes going to school, he made friends and the children now are nice with him. At the beginning of the school year, the children were reserved with him. Teachers were worried at the beginning of the year. He writes independently.

Second Interview with mother (at the end of the school year: 06.05.99 ):

They study Maths, Arabic with class teacher, in addition they have teachers for Religion, Music, Art & English. He has not been taking any speech therapy sessions since he started school.

At home, he refuses to write and he even refuses any positive reinforcement that will lead to a request to write. He does not read, but listens and he memorizes the lesson in classical Arabic. He has a very strong memory. [Usually, children w/ Down syndrome have a poor auditory memory]. On the whole, his Arabic improved and his alphabet increased. His ?Maths is still on the same level as at the centre (where he studied during his preschool years). He writes the numbers from 1 to 13.

The mother says that she has no problem w/ the school, but she changed jobs to be able to get him to school on time. He is integrated with his classmates and whenever he sees them on the street to school he leaves his mother and walks w/ them. The mother says "I'm happy. He takes permission from his teacher. His behaviour at home has greatly changed to the better, better than his siblings even. He says good-morning. He colours and paints and he does not any more do the challenging behaviours I complained earlier from." [he used to open the fridge and throw all the food on the floor whenever his mother was not around and tempt his younger brother to share with him and the mother used to come crying to us at the centre]. His behaviour is almost normal. He sets the table, cleans it up and knows where things are. He helps around the house. He goes to buy from the bakery. "I let him get in contact with these matters. However, he still needs training on how to handle currency [I explained to the mother that she has to persist on training these skills. Our role as a centre in that area existed no more]. He will only strike if someone strikes him. He knows how to defend himself. He understands matters fully. If one day he wakes up and does not feel like going to school, he gives a plausible reason (though not true) such as ' the teacher is absent, I have a stomach ache…' . "This is for sure after mixing with normal children," says his mother. He asks to be equal to his siblings.

The mother complains that his class teacher gives him zeroes and does not trust that he can do anything. As for the English language teacher, she gives him 4/10 in the oral. The mother said that she will transfer him to another teacher's class next year. He even told his present teacher that he is taking private tuition with his future class teacher. He always remembers the message his teacher asks him to relay to his mother, such as requests for payments for services at school.

All the children at the school know him and because his mother comes half an hour after school because of her working hours, the older boys who are still in the school go and fetch him. He still likes to play with water in school, wetting himself.

The head master accepts him in school. When his teacher knew a researcher was coming for observation, she said she could not have time for an interview and asked why should someone come to observe. "Ahmed is like the other kids and understands my instructions"she said. However, she spoke to the researcher for a few minutes when she went into her class.

III Nora

First Interview with the mother (27.10.98)

The mother complained that the curriculum was heavy. The English language is a problem. At school they complain of her requests to go to the toilet and escape class. Once forbidden to do so, upon her mother's suggestion, she became disciplined. She is good and befriends the other children. They ask to sit beside her. She has a problem with one girl from her class and nobody knows why. Nora is happy to go to school. She is willing to work but she gets bored easily. Her handwriting is beautiful and her teachers like her.

Second Interview with the mother (13.04.1999)

The mother did not add much except for the fact that the curriculum is difficult and that Nora is disciplined and has many friends in school. She also said that her daughter needs speech therapy sessions and she does not get that at school and has not time to come to the centre for sessions.

IV Khalid

First interview with mother (26.10.98):

There is peer support. Academically, there is lot of pressure. He needs support teacher in class. He is socially integrated and his shyness has decreased. His language improved, and he distinguishes feminine and masculine. He does role play of his teacher.

Second interview with mother (02.05.99):

He fears his class teacher. During the mid year recess, the mother took him along to work with her and he found that there was another place besides school to go to. He wanted either to go with his mother to work or to centre, where he spent his preschool years. 'I don't like Maissah [his teacher]. She really disgusts me.' He likes his English language teacher and is doing well with her. However, he never returns from school tensed or frustrated and he returns happy. "For me the school is close to where I work and we reach the school late because he is lazy in the morning?". [I suggested that she can be more firm with him]. "I do not attend the lines in the morning because I fear he might fall [He has a slight problem in his feet - I suggested that she makes sure that he attends the lines and that his friends are capable of taking care of him. Nothing happened when they lined up after recess]. Sometimes in winter we have accidents (wetting). In the morning, I make sure to take him into the toilet before I go to work. The classroom is far from the toilet therefore I keep a change of clothes at the school".

more delayed than what she says but I do not want her to feel incompetent." [I suggested to the mother that he receives private tuition during the summer vacation, since he receives no support in class].

After the classroom observation, the researcher asked the mother to continue with his speech therapy.

V Hossam

First Interview with father (11.98)

Hossam was accepted in a private primary school. The Psychological Services (Medical Insurance Department of the Ministry of Education) estimated his IQ to be 63. His father did not like the social level of the pupils and withdrew his child to special classes in a regular school (locational integration).

Second Interview with father (after the school year: 30.05.99)

Hossam has some stubbornness left. However, he is not anymore aggressive. Now he almost dresses himself completely alone. He still finds buttons difficult. He manages zippers and clips. He causes no damage at home and is careful with things and with his belongings. He knows where my clothes are. He eats and drinks independently. He gets what he wants from the fridge. He knows what harms him. He is close to his friends in school. He goes in kissing and hugging. He is no more a coward. If hit, he hits back but is not aggressive. He loves to play ball and swim in the club. I tried to teach him to play music. He learnt the musical notes with difficulty, and the teacher suggested that we wait for a while.

I am not happy here. I shall move him to special classes attached to another school. (He later advised us that he sent him to a regular school and that he regretted pulling him out from the first place). He thought that his present school had children with variable difficulties and that this did not help, especially with the presence of one teacher.

At your centre, he learnt maths and spelling, however, he did not use his brain, he only memorised by heart. Here he learnt to use his brain but at the cost of his reading skills (he could read around 30 words). He improved in maths and hand-eye coordination and instruments used in activities of daily living (ADL). He now uses the video, radio-cassette,… I wish that he learns to read and write and may be in ten years from now he may have be taught a vocation. I do not care if he get a certificate. I am still not sure shall I put him in special classes or a regular school.

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