Abstract:
In light of the current trend in the United States of America for the inclusion of ALL handicapped students into the regular classroom this paper is to defend the need for school districts to provide a full continuum of services, including center-based programs, for their special education students. Two case studies are presented. Both of these students were unsuccessful in special education classrooms in regular elementary schools. They were placed in a low-ratio center-based program. At this time inclusion would not meet their individual needs. According to Tom E.C. Smith (1994) "students with mental retardation would have and will most likely reach their potential if their placements and programming was or is based on their individual needs...individual studen't needs precede concern for any philosophy".
The inclusion of individuals with severe disabilities is a hot issue in special education. Arguments for inclusion focus on placing ALL students, regardless of ability, in regular education classes where their needs would be met by a support staff and the general education teacher. Arguments against inclusion focus on the possible negative effects on both the special education and regular education students. Specifically, these arguments include 1) the lack of empirical support for inclusion, 2) the possible detrimental effects on general education students, and 3) the inability of general educators to individualize instruction to meet the needs of the severely disabled special education students (Wilson, 1999).
Literature Review
Lloyd Dunn
As the trend toward the inclusion of special needs children into regular education classrooms continues it is important to review Lloyd Dunn's (1968) article and its impact on special education. Dunn challenged the use of the special day class (SDC) model for children labeled educably mentally retarded (EMR). He hypothesized that EMR students would succeed at least Keller as well in regular programs. Dunn did NOT extend his argument to apply to children with severe and profound disabilities nor did he realize the number of features of SDCs that would be sacrificed, i.e., low pupil-teacher ratios, teachers with specialized training, programs with vocational and social goals, greater expenditures per student, and greater individualization of instruction (MacMillan, Semmel, and Gerber, 1994).
REI and TASH
The Regular Education Initiative (REI) proposed a restructuring of special and general education. The primary goal of the REI is to change the place of instruction from special to regular classrooms. Advocates of the REI suggest that current special education is separate and discriminatory by segregating and labeling children. They propose a new general education which will be appropriate for ALL children. According to Lipsky & Gartner (1987) and Stainback & Stainback (1988) TOTAL integration of general and special education can work to the ultimate benefit of children. The Association of Persons with Severe Handicaps (TASH) has had a profound impact on special education policy-making in Michigan and New Mexico as advocates for inclusion viewing the continuum as having "outlived its usefulness and should be eliminated" (Fuchs & Fuchs, 1995). So as the REI supported cooperation between general and special education the full inclusionists, such as TASH, would like to eliminate special education, a change unsubstantiated by research.
J.M. Kauffman
Kauffman (1995), however, states that the PRIMARY objective should be more effective education and the SECONDARY objective should be the least restrictive or most normalized setting. Given the research today effective education in regular classrooms for ALL handicapped students is indefensible.
IDEA
In the United States the Individuals with Disabilities Education Act (IDEA) legally entitles students with disabilities to be educated with non-disabled children to the "maximum extent possible". The law stipulates that such students will be provided supplementary aids and services as needed. It leaves room, however, for school districts to interpret what constitutes the "maximum extent possible".
The 1997 Reauthorization of the IDEA calls for providing the greatest possible access to the general education curriculum as a means for improving educational outcomes for students with disabilities. Nancy Safer (1999) stresses, though, that one size does not fit all.
The law stipulates that the school district must make available a full continuum of alternative placements, including general education classroom placement on a full- or part-time basis, resource rooms, special education classes, and special schools. The assumption here is that any single placement is not appropriate for meeting the diverse needs of all students with disabilities. The heart of IDEA, then, is the Individualized Education Program (IEP). Placement with no decision making and with consideration only for chronological age violates very important procedural rights and protections provided by IDEA.
Position Statements
Several position statements appear in The Illusion of Full Inclusion (Kauffman & Hallahan, 1995). Organizations which believe that providing a full continuum of services to meet the needs of disabled students as provided by the IDEA include: American Council for the Blind; American Federation of Teachers; Children and Adults with Attention Deficit Disorders; Consumer Action Network of, by, and for Deaf and Hard of Hearing Americans; Council for Exceptional Children; Council for Learning Disabilities; Division for Learning Disabilities, Council for Exceptional Children; Learning Disabilities Association of America; National Education Association; and the National Joint Commission on Learning Disabilities. According to these groups the full inclusion of all disabled students in regular classrooms is in violation of the IDEA. In December, 1993, more than 40 national organizations met in Washington D.C. "for the single purpose to preserve the continuum in IDEA" as it represents choice and opportunity for the disabled community (Fuchs & Fuchs, 1995).
Case Studies
To defend the need for a full continuum of special education services and, in particular, the need for low-ratio center-based classroom programs, two case studies are presented. Both children are in a center-based program and are in a low-ratio classroom. At the time of this writing there are two students with two full-time adults. Both students came to this program from classrooms for the Autistic Impaired where there were five students with two staff. Their needs could not be met in such a classroom.
Tommy
Tommy, 12, has been diagnosed as Autistic Impaired and Trainable Mentally Impaired. He entered this program with severe obsessive, aggressive, and destructive behaviors. These behaviors included running away, hitting and pinching others, turning over the teacher's desk, file cabinets, and table, dumping and throwing toys, stuffing items under and behind classroom furniture, etc. His behavior is extremely unpredictable. For example, he jumped out of the window of his mother's car while she was driving causing her to lose control and hit a tree. Tommy does not follow verbal directions well (Figure l) and seems to have no concept of danger.
Restraints are used to calm him and to control escalating behaviors (Figure 2). In October, 1998, after pulling the electrical outlets from the walls at home and breaking the shower door his mother admitted him to a psychiatric hospital for evaluation. He was there for two weeks and his medications were changed from clonidine, depakene, and cogentin to risperdal, wellbutrin, serzone, and depakene. Upon his return to school he was sedated and the inappropriate behaviors ceased. A secretin infusion was administered in April, 1999. The behaviors reappeared and escalated. This lasted approximately ten days. The positive effect of the secretin infusion was a temporary increase in the use of speech and language (Figure 3). Tommy was also more visually aware of his environment and there was improved eye contact as well as some initial improvement in pretend play (Figure 4). Subsequent secretin infusions were not administered based upon the advice of his physician.
Although improvements were documented after the secretin treatment it was still apparent that the medications were responsible for controlling his behavior. Without these Tommy would be less able to learn and function in society. Even with these medications his behavior is unpredictable and often inappropriate in the community. He does, and always will, require one- on-one supervision for his own safety.
Alisha
Alisha, 10, is diagnosed Autistic Impaired and Severely Mentally Impaired. She came to this program from an Autistic Impaired classroom with five students and two staff. She was unsuccessful in this setting using a variety of behavioral plans. She is non-verbal, does not dress herself, and is not toilet trained. She does not wash her hands (Figure 5) or brush her teeth independently. She prefers to feed herself with her fingers often playing with her food (Figure 6), but will use a spoon with prompting. When Alisha came to our program she had severe tantrums (Figure 7), ingested mucous from her nose, and spit at others. The severe spitting behavior was a health risk to those around her. She smeared saliva on furniture, toys, and materials, and she flung it at others. Alisha had stereotypical behaviors of rocking, hand gazing, and flicking a string. She was extremely anxious in crowds.
In September, 1999, Alisha had a psychiatric evaluation and was put on prozac. Her behaviors escalated. She was taken off the prozac and put on risperdal. The negative behaviors all but disappeared. There are no more tantrums and no need for restraints. Spitting at others (Figure 8) has decreased significantly although she still smears saliva at times on a table top or the floor. Buspar was added to the risperdal and she demonstrates much less anxiety at the shopping mall and in restaurants. She is able to participate in community outings and seems more content and less fearful. She comes when called, puts toys away, and walks appropriately beside an adult. It would be remiss not to say, however, that when she has missed her usual dosage of medication the old behaviors return.
In spite of significant improvements in the behaviors of both Tommy and Alisha they will always need pharmacotherapy for the severe behavior problems associated with their intellectual and developmental disabilities. Tommy will need supervision at all times and Alisha will need total care. It would be grossly negligent to insist on regular classroom placement for these two children and others like them. It would be a disservice to them and the regular education classroom teacher and students. Such a placement would be unjustifiable.
Conclusion
In conclusion, with the United States IDEA and the two case studies presented above we must ensure that all special education students and their families have the choice of a full continuum of classroom placements and services. Choices for students with severe mental retardation and autism must include a variety of classroom placements which would best meet their needs. For children like Tommy and Alisha a classroom with a low pupil-teacher ratio in a center-based program is necessary.
With Tommy and Alisha diagnosed as Autistic Impaired let us hear what Bernard Rimland of the Autism Research Institute in San Diego says. He is the father of an autistic child. "Much as my wife and I would like to have our autistic son Mark be able to cope successfully in a normal school, it is very clear to us that he could not have done so. He has come along much farther than we ever dared hope, and we are quite confident it is because he was always in special classes, taught by experienced, skilled, caring teachers, exhibiting monumental patience, who had gone to great lengths to train themselves in methods that would help Mark and children like him achieve their full potential...If your child functions far below the normal child intellectually, academically, and socially, does it make sense to insist that he or she be "included" in a regular classroom? Certainly not, in my view, and in the view of many, if not the vast majority, of parents of autistic children...Full inclusion means abolishing the special education provisions that are vitally important to autistic children" (Kauffman & Hallahan, 1995).
Special education consultant Laurence Lieberman (1992) spoke out in a letter to the editor of Education Week. In it he states that "some educators would place the issue of full inclusion solely in the realm of morality. Anything separate is evil. There may be a higher immorality than separateness: lack of progress, lack of achievement, lack of skills, and splintered learning of meaningless academic trivia...Full inclusion is not the right thing to do. It is one right thing to do, sometimes...Any organization...that endorses full inclusion is taking an extremist position that has no place in an educational system and a society that prides itself on its choices and multiple ways to achieve a desired quality of life".
Lieberman (1996) also states that "by definition, the regular classroom is where the academic curriculum rules. Consequently, full inclusion into regular classrooms for students with severe mental disabilities imposes both academic and school failure on them...some children with disabilities should not be in regular classrooms. Placing them there handicaps them even more. To have children with disabilities failing in the regular classroom is unacceptable...As long as there are people with disabilities there will be a need for special services that goes beyond anything a regular classroom teacher can ordinarily provide...the continuum of services must be preserved".
References
Dunn, L.M. (1968). Special education for the mentally retarded-Is much of it justifiable? Exceptional Children, 35, 5-22.
Fuchs, D. & Fuchs, L.S. (1995). Counterpoints: Special Education-Ineffective? Immoral? Exceptional Children, 61, 303-306.
Fuchs, D. & Fuchs, L.S. (1995). Inclusive Schools Movement and the Radicalization of Special Education Reform. In J.M. Kaufman & D.P.Hallahan (Eds.), The illusion of full inclusion: A comprehensive critique of a current special education bandwagon (pp. 223-225, 232). Austin, TX:Pro-Ed.
Kauffman, J.M. & Hallahan, D.P. (1995). The illusion of full inclusion: A comprehensive critique of a current special education bandwagon. Austin,TX:Pro-Ed.
Lieberman, L.M. (1992). In a letter to the editor, Education Week, December 16, 1992.
Lieberman, L.M. (1995). Preserving special education for those who need it. In Stainback, W. & Stainback, S. (Eds.), Controversial issues confronting special education: divergent perspectives (pp. 16-27). Boston:Allyn and Bacon.
Lipsky, D.K. & Gartner, A. (1987). Capable of achievement and worthy of respect: Education for handicapped students as if they were full-fledged human beings. Exceptional Children, 54, 69-74.
MacMillan, Donald L., Semmel, Melvyn I., & Gerber, Michael M. (1995). The social context: Then and now. In J.M. Kauffman & D.P. Hallahan (Eds.), The illusion of full inclusion: A comprehensive critique of a current special education bandwagon (pp. 19-38). Austin, TX:Pro- Ed.
Rimland, Bernard (1993). Inclusive education: Right for some. Autism Research Review International, 7, 1, 3.
Safer, N. (1999). Universal design: Ensuring access to the general education curriculum. Research connections in special education, 5, 1-8.
Smith, Tom E.C. (1994). Inclusion as a philosophy which leads to loss of vision: A response to Rainforth's philosophy versus student need? Education and training in mental retardation and developmental disabilities, 29, 253-255.
Stainback, S. & Stainback, W. (1988). Letter to the editor. Journal of Learning Disabilities, 21, 452-453.
Wilson, Barbara A. (1999). Inclusion: Empirical guidelines and unanswered questions. Education and training in mental retardation and developmental disabilities, 34, 119-133.
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