J Autism Dev Disord (2014) 44:572583 DOI 10.

1007/s10803-013-1908-6

ORIGINAL PAPER

Evaluating the Effectiveness of an Intervention Program to Inuence Attitudes of Students Towards Peers with Disabilities
Anke de Boer Sip Jan Pijl Alexander Minnaert Wendy Post

Published online: 28 August 2013 Springer Science+Business Media New York 2013

Abstract In this study we examine the effectiveness of an intervention program to inuence attitudes of elementary school students towards peers with intellectual, physical and severe physical and intellectual disabilities. A quasiexperimental longitudinal study was designed with an experimental group and a control group, both comprising two rural schools. An intervention program was developed for kindergarten (nexperimental = 22, ncontrol = 31) and elementary school students without disabilities (nexperimental = 91, ncontrol = 127) (age range 412 years old). This intervention consisted of a 3 weeks education project comprising six lessons about disabilities. The Acceptance Scale for Kindergarten-revised and the Attitude Survey to Inclusive Education were used to measure attitudes at three moments: prior to the start of the intervention, after the intervention and 1 year later. The outcomes of the multilevel analysis showed positive, immediate effects on attitudes of kindergarten students, but limited effects on elementary school students attitudes. Keywords Attitudes Peers Severe physical and intellectual disabilities Inclusive education Intervention

Introduction Traditionally, children with severe physical and intellectual disabilities have been educated in settings which are physically and socially segregated from their typically developing peers. Over the past decades this approach has changed as education policy began advocating the inclusion of children with disabilities in regular education settings (Downing and Packham-Hardin 2007). Inclusion policies like the Salamanca Statement (UNESCO 1994) and the UN Convention on the Rights of Persons with a Disability (United Nations 2006) underline the importance of education for all and aim at students with disabilities being educated alongside their typically developing peers. Following international developments in inclusion policies, inclusive education is also an on-going trend in the Netherlands. Recent education policies such as the Together-To-School-Again (1994) and the Centers of Expertise Act (2003) have focused particularly on including children with auditory, speech and language, physical and intellectual disabilities as well as children with challenging behavior in mainstream schooling. Including children with severe physical and intellectual disabilities in mainstream settings is often seen as unrealistic in the Netherlands. However, some initiatives have been set up to include such children in regular schools as well, since it is believed all students, with or without disability, benet from inclusive education. With respect to students without disabilities, Downing and Packham-Hardin (2007) state that there is little evidence indicating that students without disabilities do not benet from inclusive education. For example, positive academic and social outcomes are found in students without disabilities. Regarding academic results, Cole et al. (2004) showed that students without disabilities in an inclusive setting made signicant greater progress in

A. de Boer (&) S. J. Pijl A. Minnaert W. Post Department of Special Education and Youth Care, University of Groningen, Grote Rozenstraat 38, 9712 TJ Groningen, The Netherlands e-mail: anke.de.boer@rug.nl S. J. Pijl Norwegian University of Science and Technology, Trondheim, Norway

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reading and mathematics. Regarding social outcomes, more awareness and understanding of people with disabilities has been reported as a benet for students without disabilities (Copeland et al. 2002). Conversely, children with disabilities also benet from contacts with typically developing students in integrated settings. It has been reported that they benet in their communication skills (Fisher and Meyer 2002), academic outcomes (Hunt et al. 2003) and in terms of social skills/interaction (Cole and Meyer 1991). Despite growing awareness and increased interaction, peer acceptance is often lacking. Children with different types of disabilities often experience difculty in being accepted by typically developing peers (Koster et al. 2010; Smoot 2004). It has been found that the attitudes of typically developing students play a role in accepting children with disabilities (De Boer et al. 2012b; Vignes et al. 2009). Swaim and Morgan (2001) examined students attitudes towards peers with autism and found less positive attitudes towards this target group, compared to developing peers. In the study of De Boer et al. (2012c), attitudes of students were measured towards three disability types, namely: attention decit hyperactivity disorder (ADHD), autism spectrum syndrome (ASS) and intellectual disability. Their study showed that students hold least positive attitudes towards children with ADHD. More positive attitudes were found towards children with ASS than towards children with intellectual disabilities. With respect to children with severe physical and intellectual disabilities, Schepis et al. (2003) concluded that they often require support to participate with typically developing peers. Negative attitudes by peers without a disability towards children with severe physical and intellectual disabilities is also reported by others (e.g., Gannon and McGilloway 2009; Laws and Kelly 2005; Yude et al. 1998). The relationship between attitudes of peers and the acceptance of students with disabilities suggests the importance of promoting more positive attitudes among typically developing students. This ultimately may lead to a better social inclusion of children with disabilities in general education. When promoting more positive attitudes, it is important to consider variables which relate to attitudes, like students age, gender and the disability type. Previous research has shown that students attitudes are more positive when they are older (Nowicki 2006; Vignes et al. 2009). Moreover, it has been stated that girls hold more positive attitudes towards peers with disability than boys (Laws and Kelly 2005; Siperstein et al. 2007). Regarding the disability type, Nowicki (2006) found that students were least positive towards students with an intellectual disability, compared with students with a physical disability. A comparison of students attitudes according to

the disability types central in the current study has not been made so far. Focusing on attitudes in the eld of inclusive education seems to be relevant as attitudes predict ones future behavior (Azjen 2005). Within attitude change theories, like the theory of planned behavior (TPB) or the contact theory (CT) (Allport 1954) background factors play an important role in explaining attitudes and future behavior. It has been stated that direct experience with, and information about the attitude object moderate the attitude ol and Petty behavior relation (Azjen 2005). Moreover, Brin (2005) argued that people have a need to know to form attitudes what refers to the desire to possess knowledge about and understanding of the social world (p. 575). Lee and Rodda (1994) suggested that a combination of knowledge and experience would be most effective in changing attitudes in which basic knowledge should be acquired rst. In the case of the inclusion of children with severe physical and intellectual disabilities in mainstream schooling, such knowledge could focus on understanding the needs of such children in order to reduce misunderstandings and feelings of pity. Providing knowledge has recently been the focus of interventions in which the aim is to inuence attitudes among elementary school students towards children with disabilities (Favazza and Odom 1997; Holtz 2007; Ison and Altwasser 2006; Rillotta and et al. 2010; Krahe Nettelbeck 2007; Swaim and Morgan 2001). Such programs focus on different disabilities (i.e., physical and intellectual, or psychiatric issues), duration and ages (i.e., kindergarten or elementary school students). Research has been conducted in order to establish the effects of these intervention programs. This presents a confusing picture. For example, some studies showed that the intervention had a positive effect on the attitudes of and Altwasser regular elementary school students (Krahe 2006; Rillotta and Nettelbeck 2007), while others revealed that the intervention did not inuence attitudes among students of the same age and school setting (Bell and Morgan 2000; Godeau et al. 2010). When compared to elementary school students, limited information is available on kindergarten students attitudes towards children with disabilities (De Boer et al. 2012a) and interventions to inuence these attitudes. Apart from an intervention developed by Favazza and Odom (1997), which established positive effects on the attitudes of these students, there are no other studies, as far as we know, which have focused on this age group. Despite the knowledge acquired over the last decade on students attitudes towards children with disabilities and attitude changes through interventions, certain questions remain unanswered. First, very little attention has been given in interventions to children with severe physical and

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intellectual disabilities. Second, results of the studies conducted show mixed outcomes on the attitudes of elementary school students and limited knowledge on the effects of the interventions on kindergarten students attitudes. Third, the question whether such interventions result in long-term effects is often neglected or cannot be guaranteed (Godeau et al. 2010; Hunt and Hunt 2004). This Dutch study has been set up in an attempt to ll these gaps in knowledge by answering the following research question: What are the short- and long-term effects of an intervention that provides knowledge about disability on the attitudes of typically developing students towards peers with physical and intellectual disabilities?

group comprising two schools. All participating schools contained single grades 18 or a combination of grades (e.g., grade 5 and 6, due to the small number of students). In our study, grade 2 and 3 belonged to the kindergarten classes (n = 4, age range 56 years) and grade 48 to the elementary classes (n = 13 classes, 711). Thus, the total sample of this study comprised 4 schools, two in the experimental condition and two in the control group which comprised a total number of 4 kindergarten classes and 13 elementary classes. Prior to the study parents of all participating students received a letter about the study in which they were asked if their child could participate in the program. All parents gave their consent. Intervention

Method Design and Procedure In order to answer the research question we designed a quasi-experimental longitudinal study with three repeated measures done in an experimental and a control group. The study was conducted between November 2009 and May 2011 in a rural district in the north of the Netherlands. The three time measurements were 2 weeks before the start of the intervention (Time 1), 1 week after (Time 2) and a follow-up 1 year later (Time 3). Two regular elementary schools comprising the experimental group were selected for the study because they were about to set up a community school (September 2011). In the Netherlands, a community school often comprises different educational facilities for children from 0 to 12 years, like pre and after school care, daycare centers (04 years) and elementary schools. Besides these facilities, the community school participating in the study had an education center for children with severe physical and intellectual disabilities (from 12 to 18 years). The current study was designed to prepare students of the experimental group for future contact with children with severe physical and intellectual disabilities attending the education center. In order to select schools to participate as the control group, we drew up three selection criteria: 1. 2. 3. Regular elementary school (students 412 years old); Located in the same rural district as the experimental schools; No students with disabilities in the class. The intervention was based on the Special Friends program (Favazza and Odom 1997). This 6 weeks intervention program focuses on kindergarten students and aims to teach students that everyone is unique, regardless of disability. It also aims to increase all three attitude components (Triandis 1971), namely: knowledge, feelings and behavioral intentions. The goal of the original intervention is to create more awareness of typically developing students about peers with disabilities via structured storytelling, cooperative learning groups and parental involvement (for more information see Favazza et al. 1999). The intervention developed for the current study included one component of the Special Friends program: structured storytelling. The research teams intervention program consisted of two lessons per week over 3 weeks based on the target group of the education center: children with physical and intellectual disabilities. Due to the different ages of the participating students (512 years), we developed six lessons for each two grades (grades 1 and 2, 3 and 4, 5 and 6, 7 and 8)1.2 The structure and content of the lessons were the same for all grades, but were geared to the age of the students. Because the materials used by teachers in grades 1 and 2 and 3 and 4 often differ from those used in grades 58, we chose storybooks in the lessons for kindergarten students and movies or reallife stories for the older grades. Each storybook included a character with a disability, like a spider with ve legs (see example Table 1). The stories and movies used for grades 58 included a peer with a disability, like the daily life of a girl whose sister has a severe physical and intellectual
1

Ten schools in the same rural district were invited to participate in the control group. Three schools were willing to participate in the study (response rate 33 %). One of the schools, however, had a student with Downs syndrome so was not admitted to participate. This resulted in a control

It is very common two grades are combined into one class due to the small number of students in rural districts of the Netherlands. 2 Because the schools preferred a school-wide intervention, we implemented the intervention in all grades, including rst grade. However, due to the young age of these students we did not assessed their attitudes.

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disability. The storybooks, movies and real life stories were selected using the checklist for selection of books developed for the Special Friends program (see Favazza et al. 1999), comprising ten selection criteria, such as a book should not encourage pity. One of three types of disability (physical, intellectual or severe physical and intellectual disability) was discussed twice weekly. Thus six 45-minute lessons were designed resulting in an intervention over a period of 3 weeks. The rst lesson was particularly aimed at explaining the specic type of disability. For example, a story about a character/ child with a physical disability was either read (book) or shown (video) by the teacher, followed by a group discussion. For the second lesson, an activity was designed showing the impact of a physical disability in daily life (i.e., a sport activity in which the students use a wheelchair). Table 1 presents an example of a lesson for kindergarten students. In addition, teachers received a detailed lesson plan to follow for each lesson and background information about the three disability types. Parents of the children in the experimental group had also received an information package including: background information on the program, a timetable and details about the three types of disability. Table 2 presents a summary of the intervention. Fidelity of the Intervention In order to achieve the commitment and encouragement of the teachers to implement the intervention, we organized a meeting with them. The rst draft of the intervention was presented at this meeting so that teachers could give feedback on its design. One of the outcomes of the meeting was that teachers indicated that two lessons per week was the maximum they could incorporate into their curriculum. They also suggested structuring the lessons in such a way that only a minimum of preparation was needed. The teachers feedback was used in the nal design of the intervention. After its

implementation, teachers were asked to complete an evaluation form. In one of the questions teachers were asked to indicate if they implemented all aspects of the intervention. All teachers indicated that the all the lessons were given and that they implemented the lessons according to our design. Moreover, they indicated to be satised about the design of the lessons, length and materials selected. Participants Two hundred and seventy-one students participated in the study (Nkindergarten students = 53, Nelementary school students = 218). Because we used different measures for kindergarten and elementary school students, we will present both samples separately. Because the administration of the kindergarten questionnaire is time consuming (app. 20 min per group of 3 students) and disturbing the daily curriculum, we randomly selected half the kindergarten students per class to participate in the study. This resulted in ftythree kindergarten students, who attended grade 2 or 3 and were 5 or 6 years old. Two hundred and eighteen elementary school students in grades 48 participated in the study (age range 712 years, M = 9.9, SD = 1.2). Student demographics are presented in Table 3.
Table 2 Summary of the intervention Content of the intervention Six lessons per grade (1/2, 3/4, 5/6, 7/8) focusing on 2 9 physical disability 2 9 intellectual disability 2 9 severe physical and intellectual disability Background information about the disabilities for teachers Description of each lesson Teaching aids/materials Information letter for parents

Table 1 Example of lesson goals and materials for kindergarten students (grade 1/2) Grade 1/2week 1, lesson 1: physical disability Description of the situation The students did not receive any information about people with disabilities and the extent to which this affects peoples daily lives. The existing knowledge comes from experiences in students0 own lives, like family members Aim of the lesson At the end of the lesson students know what a physical disability is At the end of the lesson students can explain what kind of activities/plays a peer in a wheelchair can and cannot do Teaching aids/material Storybook Slompie: een spin met vijf poten [Slompie, a spider with ve legs] Presentation of the storybook, available at: www.kleutergroep.nl/Boeken/Powerpoints/Slompie.pps Materials like: puzzles, pencils, games, building bricks etc. Drawings of games/activities

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Measures Attitudes of Kindergarten Children Towards Peers with Disabilities The Acceptance Scale for Kindergarten-revised (ASK-R), developed by Favazza and Odom 1996) was used to assess attitudes of kindergarten students (age 5 and 6). The ASKR consist of questions reecting two attitude components (Triandis 1971): the affective component (feelings) and the behavioral component (behavioral intentions). The scale was administered to groups of three students by reading instructions and questions verbatim from a standardized protocol (designed by Favazza and Odom 1996). Administering the questionnaire took about 20 min per group. The questionnaire was printed on colored sheets showing three faces per question. Students were asked to record their responses by marking an X on either the happy face (for YES), the sad face (for NO), or the half happy face (for MAYBE). Each response category yielded a score, namely: 0 = no, 1 = maybe, 2 = yes. The original ASKR consists of 18 items resulting in a score range of 036 (a = 0.79). An example of an item was: I would like to be friends with a child who cannot see. Because we used the Dutch version of the ASK-R for the rst time for this, we analyzed whether the scale had appropriate reliability. Reliability analysis revealed that four negatively formulated statements (after recoding) showed low correlations with other statements in the scale. During the administration of the questionnaire it was already noticed that students had difculty answering those items. This, together with the low correlations, made us
Table 3 Student demographics Kindergarten students (N = 53) Experimental group (n = 22) n Gender Boys Girls Grade 2 3 4 5 6 7 8 12 10 16 15 15* 20 16 24 16 26* 19 27 24 31 14 8 15 16 35 56 57 70 Control group (n = 31) n Elementary school students (N = 218) Experimental group (n = 91) n Control group (n = 127) n

decide to exclude these statements from the main analysis, resulting in a nal scale of 14 statements (aT1 = 0.79, aT2 = 0.82, aT3 = 0.87). Scale scores ranged from 0 to 28, with a higher score reecting a more positive attitude. The total score of each student was included in the analysis as dependent variable. Attitudes of Elementary School Students Towards Children with Disabilities The attitudes of elementary school students were assessed using the Attitude Survey Towards Inclusive Education (ASIE) (age 812). The ASIE was constructed and evaluated in a study by De Boer et al. (2012c) and has been used in previous Dutch educational research (see De Boer et al. 2011). The ASIE is based on the CATCH questionnaire and designed specically for students between 8 and 12 years old (see Rosenbaum et al. 1986). The ASIE consist of items reecting two attitude components: the affective component (feelings) and the behavioral component (behavioral intentions). The item quality of the ASIE questionnaire was analyzed using the Mokken model (Mokken 1971), which is based on item response theory (IRT). The outcomes of the analyses resulted in a satisfactory scalability coefcient of H = 0.50. The reported reliability coefcient of the scale was q = 0.92 (for more details we refer to De Boer et al. 2012c). The ASIE consisted of two parts: a vignette and attitude statements. The rst part presented a vignette about a hypothetical child with a disability. It is likely that students aged 812 years interpret the term disability in many different ways, which made us decide to design vignettes. Due to the aim of this study we designed three different vignettes focusing on a child with a physical, intellectual and severe physical and intellectual disability (see Appendix section). The study of De Boer et al. (2012c) showed that elementary age students are gender sensitive to the child presented in the vignette, so gender-specic vignettes were developed for boys and girls. The vignettes were developed by the rst author and veried by a research assistant with a degree in special education. All students randomly received a questionnaire including one of the vignettes. This means that each class was randomly divided in three (taking boys and girls into account), so each vignette was covered equally per class. To overcome as much as possible that students would receive a questionnaire with a different vignette at each measurement, we coded each questionnaire prior to the assessment (i.e., school, class, student, vignette number). This coding was used at each measurement. The second part of the questionnaire consisted of fourteen attitude statements about the inclusion of the child presented in the vignette, like I would stick up for John if

* The data of these students was excluded at time measurement 1 and 2

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he were teased. It took about 20 min to complete the questionnaire. Students of Grade 4 (age 78) were initially included in the study. However, during the rst measurement it turned out that the statements were too difcult to read for students of this age. We decided to read the statements aloud. As a consequence, the assessment procedure differed signicantly for this grade compared to the assessment procedure for grades 58. For example, by reading the statements aloud it was impossible to take the genderspecic vignettes into account. Hence, the reliability of students answers in grade 4 can be questioned. This made us decide to exclude the data of students in this grade for time measurements 1 and 2. As a consequence, the sample of elementary school students was reduced by 41 students, resulting in a total sample of 177 elementary school students (nexperimental group = 76, ncontrol group = 101). Students were asked to indicate their level of agreement with the statements via a 5-point Likert scale (1 = totally disagree to 5 = totally agree), with a higher score reecting a more positive attitude. The reliability coefcients for the current study were, resp. aT1 = 0.76, aT2 = 0.79, aT3 = 0.80. The mean score of each student was included in the analysis as dependent variable. Independent Variables The independent variables for the current study were as follows: age, gender, type of vignette, condition and measurement. Analysis We performed multilevel analyses with the attitude scores serving as dependent variables. Because we were dealing with hierarchically nested data in which measurements were nested within students within classes, a general linear model could not be used (Snijders and Bosker 1999). Consequently, multilevel modeling was preferred. The analyses was executed in the program MLwiN 2.23 (Rasbash et al. 2005), which is designed specically for analyzing hierarchical data. We began the analyses by executing a three-level empty model (a model without any independent variables), with classes as the highest level, students as the second level and repeated measures as the lowest level. Since it appeared that there was no signicant variability between classes within schools, a multilevel with two levels was considered: students at the highest level and repeated measures as the lowest level. We then included each time measurement as a dummy variable in the model and considered random slopes. This approach results in more information about the variance structure per time measurement (Snijders and

Bosker 1999). In the end, we tested whether there were differences in attitude scores between the control and the experimental group at each point in time. Additionally, we added possible covariates (such as age and gender) separately in the model, and explored which interactions were present. The variables which were relevant or showed a signicant relationship with the dependent variable (i.e., students attitude scores) were included in the nal model. In the results section we present the empty model and the nal model (a model including time and condition and other covariates). In all models a p value of 0.05 was considered statistically signicant. We examined the differences in deviance between the models to establish whether there was an improvement in the nal model. The signicance of an increase in deviance was tested by a Chi square test, with the number of degrees of freedom equal to the number of extra model parameters in the largest model.

Results The Effects of the Intervention on Kindergarten Students Attitudes Descriptive statistics showed that kindergarten students had a mean attitude score of 7.80 (SD = 5.68) at time 1. Using the rule of thumb of De Boer et al. (2012a), the outcomes indicated that forty per cent of students held negative attitudes (score \7), while the remaining sixty per cent held neutral ones (a score between 7 and 21) (Table 4). After applying the empty model, we included gender as an independent variable to establish whether there were differences between boys and girls attitudes. No differences in attitude were found between boys and girls, so no further attention was paid to this variable. We started by testing whether there was a difference in attitude scores between both conditions. The analysis showed there was no main effect of condition (see nal model in Table 5), indicating that there was no signicant difference in attitude scores between the two conditions at the rst measurement. The outcomes of the analysis revealed a signicant interaction effect between condition and Time 2. This outcome indicates that students attitudes in the experimental condition were signicantly more positive immediately after the intervention was carried out. No signicant interaction effect was found between condition and Time 3, indicating that the effect of the intervention did not last in the experimental group. In addition, the results showed a signicant overall effect of Time 3. This means that students attitudes were signicantly more positive at Time 3 (i.e., 1 year after the intervention) compared to Times 1 and 2. A comparison of deviance

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578 Table 4 Attitudes of kindergarten students by condition and time Time 1 Mean Experimental (n = 22) Control (n = 31)
a a

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Time 2 SD 6.2 5.2 Mean 14.0 10.2 SD 5.8 6.7

Time 3 Mean 12.3 12.9 SD 6.1 7.2

A comparison between the deviance of the empty model and the nal model revealed a signicant improvement of the nal model, v2 (12) = 24.51, p \ 0.05.

6.8 8.5

Discussion In this study we explored the possibilities of promoting more positive attitudes of kindergarten and elementary school students towards children with physical, intellectual and severe physical and intellectual disabilities through an intervention based on acquired knowledge. By means of a longitudinal design we examined the possible short- and long-term effects in an experimental group consisting of two schools. Based on the ndings, we conclude that the attitudes of kindergarten students hold signicantly more positive attitudes immediately after the intervention compared to kindergarten students in the control group. No long-term effect of the intervention could be established. Moreover, students attitudes in both conditions were signicantly more positive at the last measurement. We did not nd any effect of the intervention on elementary school students. An overall effect of the type of vignette was found, indicating that elementary school students hold more negative attitudes towards children with intellectual and severe physical and intellectual disabilities than towards children with physical disabilities. Besides this, a decrease in attitudes was found at the last measurement, indicating that students became more negative over time. We also found that elementary school boys hold signicantly more negative attitudes than girls. Attitudes of Kindergarten Students An eye-catching outcome of this study concerns the low attitude scores observed in kindergarten students at Time 1. The kindergarten students in both conditions had mainly negative attitudes. These attitude scores are quite lower than the scores of American and Greek kindergarten students reported by Nikolaraizi et al. (2005), who reported neutral to positive attitudes of kindergarten students. The negative attitudes of Dutch students might be linked to the fact that the implementation of inclusive education policies has only recently begun. Although there is an on-going trend towards inclusive education in the Netherlands, it is not obvious that students with disabilities are included in regular schools. The students in our sample did not have any experience of being in direct contact with a peer with a disability, which might explain such negative attitudes. Also, it has been reported that experience with inclusive education may result in more positive attitudes (Kalyva and Agaliotis 2009; Nowicki 2006; Siperstein et al. 2007). With respect to the development towards more inclusive

There was no signicant difference between the two conditions at Time 1

between the empty model and the nal model revealed a signicant improvement of the nal model, v2 (9) = 24.51, p \ 0.05. The Effects of the Intervention on Elementary School Students Descriptive statistics showed that elementary school students had a mean attitude score of 3.57 (SD = 0.61) at Time 1. Using the rule of thumb of De Boer et al. (2012a), two per cent of the students indicated held a negative attitude (score \2.5). A small majority of students showed a score of [3.5, indicating a positive attitude (53 %). The descriptive statistics for both conditions and measurement are presented in Table 6. Conducting the multilevel analysis showed that there was an effect of condition (see nal model, Table 7), indicating a signicant difference in attitude scores between the experimental group and the control group at Time 1. Expanding the model showed that there was no interaction effect between condition and Time 2. There was no improvement in attitudes in the experimental group after the intervention took place. Additionally, the results showed a signicant overall negative effect of age, indicating that students became more negative the older they become. In order to establish whether age, gender and the type of vignette had an effect on students attitudes, we included these variables in the model. No effect of age was found and therefore excluded from further analysis. The outcomes revealed an overall signicant difference between boys and girls, indicating that boys hold signicant more negative attitudes than girls. No two- and three-way interaction effects were found between gender, condition and measurement. Moreover, no two- and three way interaction effects were found between condition, measurement and vignette. We did nd a signicant overall effect of vignette, showing that students hold the most negative attitudes towards children with intellectual disabilities and severe physical and intellectual disabilities, compared to children with a physical disability. No differences were found between the intellectual and the severe physical and intellectual disabilities. Again, no interaction effects were found.

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J Autism Dev Disord (2014) 44:572583 Table 5 Model estimates for the variable effects on kindergarten students attitudes for different models Model Empty model Coefcient (S.E.)a Final model Coefcient (S.E.) t value

579

Fixed part Intercept Conditionb Experimental Measurementc Time 2 Time 3 Condition * Time 2d Condition * Time 3 Random part Variance Between students Within measurements Time 1 Time 2 Time 3 Covariance Time 1 * Time 2 Time 1 * Time 3 Time 2 * Time 3 Deviance
a b c d

10.726 (0.626)

8.499 (1.031) -1.744 (1.591) 1.651 (1.445) 4.376 (1.445) 5.444 (2.174) 1.211 (2.199) -1.096 1.142 3.028** 2.504* 0.550

7.583 (4.416) 35.816 (5.239) 38.005 (7.748) 42.928 (8.752) 30.960 (6.191) 16.981 (6.436) 6.140 (5.058) 8.424 (5.550) 960.999 936.489

* Signicant at p \ 0.05. ** Signicant at p \ 0.01 S.E. = Standard Error Control = reference Time 1 = reference Condition * Time 1 = reference

Table 6 Attitudes of elementary school students by condition and time Time 1a Mean Experimental (n = 76) Control (n = 101)
a

Time 2 SD 0.60 0.49 Mean 3.43 3.59 SD 0.62 0.54

Time 3 Mean 3.45 3.56 SD 0.55 0.64

3.60 3.63

This study showed that the intervention had short term effects on kindergarten students attitudes. However, the third time measurement revealed that the attitude change did not last. On the one hand, this could mean that kindergarten attitudes can indeed be inuenced by a knowledge-based intervention program. On the other hand, the results suggest that an improvement of the intervention is needed to strengthen its effectiveness in the long-term. Although our intervention was based on the Special Friends program (Favazza et al. 1999), we only included a knowledge component. Including the other components of the program (structured play and home reading) might lead to stronger long-term effects. This study showed that students attitudes in both conditions were signicantly improved at Time 3 (1 year after the intervention), indicating that kindergarten students become more positive when they become older. A possible explanation of the improvement might be the effect of maturation. This effect refers to processes changing over time, like growing older, wiser, tired or bored. As stated by Goodman (1989), students become more knowledgeable as they become older. Moreover, the increase in attitudes in both conditions can also be attributed to the assessment of the questionnaire. Since talking about disabilities is not common for kindergarten students, the assessment of the questionnaire can be seen as an intervention in itself. It might be that students were stimulated to think and talk about disabilities for the rst time in their lives. This may suggest that such talk is a rst step in helping to shape the attitudes of such young students. There are, however, some limitations which should be considered when interpreting the outcomes. The small sample size of the kindergarten group is clearly a limitation of the study. In addition, it should be noted that the instrument used for kindergarten students, the ASK-R, does not particularly focus on the disabilities represented in the intervention. It is therefore unclear if students attitudes towards children with physical, intellectual and severe physical and intellectual disabilities became more positive. In any future research it is advisable to match the items of the instrument with the disabilities represented in the intervention.

There was no signicant difference between the two conditions at Time 1

Attitudes of Elementary School Students With respect to elementary school students, the ndings of this study show that providing knowledge had a limited inuence on their attitude. This is in line with other studies which also reported non-signicant outcomes (Bell and Morgan 2000; Godeau et al. 2010; Swaim and Morgan 2001). A possible explanation for these results might be the stigma associated with disability, which affects older

education in the Netherlands, this suggests that that the attitudes of Dutch kindergarten students may become more positive in future, as they gain experience of interacting with peers with disabilities. Thus, monitoring the attitude development and level of acceptance of Dutch kindergarten students who experience inclusive education is recommended.

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580 Table 7 Model estimates for the variable effects on attitudes of elementary school students for different models
Model Empty model Coefcient (S.E.)a Final model Coefcient (S.E.) t value

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Fixed part Intercept Genderb Boys Vignettec Intellectual Severe physical/ intellectual Conditiond Experimental Measuremente Time 2 Time 3 Condition * Time 2f Condition * Time 3 Random part Variance Between students Within measurements Time 1 Time 2 Time 3 Covariance Time 1 * Time 2 Time 1 * Time 3 Time 2 * Time 3 Deviance 786.981 0.130 (0.029) 0.179 (0.026) 0.106 (0.029) 735.578 0.160 (0.024) 0.173 (0.015) 0.305 (0.032) 0.337 (0.037) 0.285 (0.031) -0.054 (0.051) -0.179 (0.073) -0.120 (0.078) 0.039 (0.108) 1.059 -2.452* -1.538 0.361 -0.182 (0.086) 2.116* -0.250 (0.079) -0.240 (0.082) -3.164** -2.927** -0.209 (0.064) -3.265** 3.547 (0.033) 3.975 (0.090)

* Signicant at p \ 0.05. ** Signicant at p \ 0.01. *** Signicant at p \ 0.001

a b c d e f

In line with other studies, our ndings underline that boys hold more negative attitudes than girls. The outcomes of this study indicate that boys and girls do not change differently, as no interaction effects were found. To ensure stronger intervention effectiveness in boys and girls, De Boer et al. (2012b) suggest taking the differences between boys and girls attitudes into account. Based on the outcomes of this study it can be concluded that elementary school students hold the most negative attitudes towards children with intellectual and severe physical and intellectual disabilities than towards students with a physical disability. This is a disappointing result, as there is already an on-going trend to include the latter group of children in regular schools. It is likely that certain behaviors typical for children with severe physical and intellectual disabilities (e.g., use of a wheelchair, difculties in talking, uncontrolled movements) (Vlaskamp et al. 2005) may frighten students. This underlines the importance of explaining the behavior of such children in order to remove students irrational fear. With respect to both kindergarten students and elementary school students, it should be mentioned that it was their attitudes rather than any knowledge acquired that was measured in this study. Although we focused on knowledge about disabilities in the intervention, the cognitive component (i.e., beliefs and knowledge) was not measured by both instruments used. It may be that students gained knowledge about disability through the intervention, which can then be seen as a starting point for attitude change over time. It is highly recommended to include a measurement or structured interview in future research to examine the cognitive component, like students knowledge about disabilities and what students learned from the intervention. Another limitation of this study is the signicant difference between both conditions at Time 1, so that the outcomes need to be interpreted with some caution. Implications of the Study The results of this study clearly point out the potential of the intervention to inuence attitudes positively, particularly at the kindergarten stage. As Innes and Diamond (1999) reported, early childhood years might be a particular fruitful time to teach students about diversity in relation to disability. However, improvements of the intervention seem necessary in order to strengthen long-term effects. One such improvement might be to include parents in the intervention, as it has been argued that they are important in developing young childrens attitudes (Bricker 1995). The signicant link between the attitudes of parents and children towards students with disabilities (De Boer et al. 2011; Innes and Diamond 1999) suggests that parental involvement may lead to greater effectiveness of

S.E. = Standard Error Girls = reference Physical = reference Control = reference Time 1 = reference Condition * Time 1 = reference

students more (Bell and Morgan 2000). For example, as a consequence of the intervention students might have realized what it means to have a disability in daily life and how this would affect them when coming into contact with a disabled person. Corresponding with other studies, the outcomes of this study raise the question whether short term intervention, such as ours, can achieve the intended objectives among elementary school students.

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interventions to improve these attitudes. For example, parents can be included in the intervention by reading storybooks at home about disability. Another improvement could be to have the intervention over a longer period or repeat it at different time intervals (Bell and Morgan 2000). By comparing an intervention at different time spans, Rillotta and Nettelbeck (2007) established a stronger positive change in attitude in students who followed an eight-session intervention rather than a three-session one or no intervention at all. Finally, the intervention might be improved by including activities that bring children in direct contact with peers with disabilities. As stated by Zajonc (2001), repeated exposure to something (in this case disability) is sufcient to change attitudes. Including shared activities in the intervention like sports or art, might lead to stronger effects (Rillotta and Nettelbeck 2007). This study made a rst attempt to inuence attitudes towards children with disabilities among kindergarten and elementary school students in a Dutch education setting. More specically, we attempted to prepare typically developing students for their future contact with children with severe physical and intellectual disabilities. The intervention evaluated in this study demonstrated the potential of preparing students for such future contact. However, a st important, but challenging, step is to improve the intervention in order to establish greater effectiveness and more long-term. The current study focused on a specic disability type of which is not very common yet to be included in general schools. Other low-incidence disability types (e.g., students with autism spectrum disorders, ASD) (Carter et al. 2010) seem to be an important target group to focus on in future interventions. This is of particular interest as students with ASD are more and more included in our Dutch general education system in the last years (MinOCW 2010). As the social inclusion of students with ASD is not obvious (see Koster et al. 2009) these students need attention in future research as well.

computer because he is a slow writer. Sometimes it is also difcult to understand what John says. Janet: a girl showing aspects of a cognitive disability Janet is a girl your own age and has just moved to where you live. She attends the same school as you, has just started to read and write but has difculty with math. While Janet can run and play like other children, she sometimes forgets the rules of certain games. She needs extra time to learn her work and can be forgetful in class. Sometimes it is difcult to understand what Janet says. She does enjoy playing music. For part of the day, Janet receives extra learning assistance outside the classroom. Jack: a boy with severe physical and intellectual disabilities Jack is a boy your own age and has just moved to where you live. He attends the same school as you, and while his hearing and sight are good, he has difculty with learning and talking. Jack has his own teacher who helps him with learning. He uses a wheelchair which he drives himself, and can also walk short distances. Jack has difculty playing as he is easily distracted. Because he cannot talk, he often makes noises or smiles when he likes something. Jack enjoys music and can play with a music box for a long time.

References
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Appendix: The vignettes used in the Attitude Survey towards Inclusive Education (ASIE) John: a boy showing aspects of a physical disability John is a boy your own age and has just moved to where you live. He attends the same school as you but has difculty walking. He walks with leg braces, uses crutches, and sometimes needs a wheelchair for daytrips with his family. John is not always able to attend school as he often needs to visit a doctor who helps him with his walking. John is a good learner and has a sense of humor. At school he uses a

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