Original article 29
Factors Affecting the School Placement of Children with Spina Bifida C. M. A. Wasson l , C. M. Banniste?, G. (Stellman) Ward'3
Summary Integr'ating ehildren \\ ith disabilities into mainstream sehools has been an aeti\'e poliey in Britain sinee the 198 I ~=dueation Aet. 26 ehildren "'ith spina bifida, 13 of" hom "'ere edu caled in mainstream schools. and 13 in special schools "ere assessed tn c1arif)' the relati\'e impOliance of the foIlO\\'ing factors I) IQ, 2) \Iobilit)', 3) I land function, I) ßladder and bo"el function, and ,l) Beha\iour. A marked difference "as found bet"een those attend Ing mainstream ancl special schools. 11 13 of the former attained scores "'ithin the normal range as compared to onl)' 2, 1:1 of the latter. 'either mobilit~· nor hand function alone "'ere found to influence school placement and a marked correlation "'as found bet"'een the t,,·o. \\'hilst those educated in special schools had more marked problems, alJ children functioned poorl)' compared \\'ith the norms for able-bodied peers. ",either bladder nor bO"'el incontinence hindered attendance at mainstream school, but faecal soiling was considered the more serious problem. The frequency of beha\'ioural problems sho\\'ed a similar distribution amongst the t\\'o groups. Comments from parents highlighted their rese[\'alions about both special and mainstream schooling \\'hich indicates the polic)' for integration needs considerably more commitment from GO\'ernment and Education Authorilies in order to succeed.
Key words Spina bifida - Schooling function
IQ - Mobilit)' - Hand
Introduction The policy of educating children with spina bifida and other handicaps in schools for children with special needs, or integrating them into mainstream schools has been under discussion in Great Britain for some time. As early as 195-1, lhe Government supported integration. ,,:\10 handicapped child should be sent to a Special School who can satisfactorily be educated in an ordinary school. ,. The .\ linislry of Ed ucation (195-1)
!{l'CCl\cd July IR H)U2 Eur.J Pediatr Surg 2, Suppll (1992) 2U-31 © Ilippokrates \erlag Stuttgalt \Iasson Editeur Paris
The Education Act of 1981 that came into force in Britain in 1983 placed a general duty on Local Educalion Authorities to integrate children with disabilities into mainstream schools, prO\'iding thal: I. The child was capable of receiving an appropriale educalion; 2. The education of existing pu pils would nol be ad\'ersely arfected by lhe inclusion of children with special needs and 3. Efficient use was made of exi ting resources. GO\'ernment policy, hO\\'e\'er, appeared lo be rather half-healted in its commitment to integration: the 1988 Education Heform Act, by instituting a . ational Curriculum, encouraged "opting out" of local gO\'ernment contral br direct appJication for GO\'ernment funding "and adoption of a polier of attracting pu pils according to the schools" academic performance seems lo have incompatible aims wilh the 1981 Act, despile Minislerial assurances lo continuing commitment to integration. In Great Britain, integrating chiJdren with special needs into mainstream schools was increasing, but prO\'ision \'aried greatly acrass the country; a child with special needs in Comwall far example was about four times as likely to attend normal school as a similar child in Manchester. However, the latest evidence published by the Centre for Studies on Integration in Education in May 1992 suggests a slight increase in segregation at Primary Schoollevel (5 to 11 years) between 1988 and 1991, when the Standard Attainment Tests of the National Curriculum were intraduced. The 1989 ChiJdren Act, which came into force in 1991, emphasised even more strangl)' than the 1981 Education Act the rights of the child, and the need to include parents in active partnership in deciding how best to cater for its needs. It clearly stated that needs should not be considered in terms of resources available; on the contrary, there is a statutor'y obligation to allocate resources to upport the identified needs of the child. It seems that Govemment polier on integration and ho\\' this is interpreted at locallevel can lherefore be at odds.
~'aterials
and methods
This stud)' looked at 26 children \\'ith pina bifida li\ ing in the Greater \Ianchester Area and tried to a sess "hich "ere Ihe most important factors influencing school placement. Comments "ere also gathered on ho" schools ha\e tried to cater for the special needs of these children; parents' \'ie\\s "ere sought on the efficienc)' of ho" this "'as done.
Downloaded by: Universite Laval. Copyrighted material.
1\ ledieal Sehool, L'ni\'ersity of :\Ianehester, ,\Ianehester .\\ 13 9PL, 2, 30 epartments of ",eurosurgery and Clinieal Ps)'eholog)', Booth I lall Children's Hospital, Charlestown Hd., Blaekley, ,\Ianehester :\19 2AA, U.K.
Eur J Pediatr Sltrg 2, Suppl J (1992) The 26 children with spina bifida in thi study were registered under one of u (018). The ages of the children at time of study were ..j yrs 8 mths to 18 )TS 8 mths. 18 chiJdren were of Prima!)' School age (under 1I years at the beginning of the school year) and 8 were of Secondary School age. The children were a sessed according to se\-eral faclors and the results analysed to see which were influential in affecting school placements. The following parameters \\'ere assessed: Physical Factors I ..\ tobility 2. Continence :3..\Ianual c1exterity I. Seizure
Other Factors I. IQ 2. Beha\iour :3. Schooling
Information \\ as obtained b}" I. Extraclion from thc medicalnotes 2. InterYie\\ \\'ith child ancl parent :3. Psychologieal assessment using the \\'echsler Scales some of \\ hieh \\'ere carried out a number of years pre\·iousl.\ I. .\n adapted \Ianual Dexterity Scale of The Test of \Iotor Impair ment (Stott et al 1U/3) 5. An adapted Parents' .\ssessment Schedule of the Hutter Scales (196,) to measure beha\'iour Children \\ ere classified aceording to each parameter a" foll
Factors Affecting the School Placement of Children with Spina Bifida C. M. A. Wasson l , C. M. Banniste?, G. (Stellman) Ward'3
Summary Integr'ating ehildren \\ ith disabilities into mainstream sehools has been an aeti\'e poliey in Britain sinee the 198 I ~=dueation Aet. 26 ehildren "'ith spina bifida, 13 of" hom "'ere edu caled in mainstream schools. and 13 in special schools "ere assessed tn c1arif)' the relati\'e impOliance of the foIlO\\'ing factors I) IQ, 2) \Iobilit)', 3) I land function, I) ßladder and bo"el function, and ,l) Beha\iour. A marked difference "as found bet"een those attend Ing mainstream ancl special schools. 11 13 of the former attained scores "'ithin the normal range as compared to onl)' 2, 1:1 of the latter. 'either mobilit~· nor hand function alone "'ere found to influence school placement and a marked correlation "'as found bet"'een the t,,·o. \\'hilst those educated in special schools had more marked problems, alJ children functioned poorl)' compared \\'ith the norms for able-bodied peers. ",either bladder nor bO"'el incontinence hindered attendance at mainstream school, but faecal soiling was considered the more serious problem. The frequency of beha\'ioural problems sho\\'ed a similar distribution amongst the t\\'o groups. Comments from parents highlighted their rese[\'alions about both special and mainstream schooling \\'hich indicates the polic)' for integration needs considerably more commitment from GO\'ernment and Education Authorilies in order to succeed.
Key words Spina bifida - Schooling function
IQ - Mobilit)' - Hand
Introduction The policy of educating children with spina bifida and other handicaps in schools for children with special needs, or integrating them into mainstream schools has been under discussion in Great Britain for some time. As early as 195-1, lhe Government supported integration. ,,:\10 handicapped child should be sent to a Special School who can satisfactorily be educated in an ordinary school. ,. The .\ linislry of Ed ucation (195-1)
!{l'CCl\cd July IR H)U2 Eur.J Pediatr Surg 2, Suppll (1992) 2U-31 © Ilippokrates \erlag Stuttgalt \Iasson Editeur Paris
The Education Act of 1981 that came into force in Britain in 1983 placed a general duty on Local Educalion Authorities to integrate children with disabilities into mainstream schools, prO\'iding thal: I. The child was capable of receiving an appropriale educalion; 2. The education of existing pu pils would nol be ad\'ersely arfected by lhe inclusion of children with special needs and 3. Efficient use was made of exi ting resources. GO\'ernment policy, hO\\'e\'er, appeared lo be rather half-healted in its commitment to integration: the 1988 Education Heform Act, by instituting a . ational Curriculum, encouraged "opting out" of local gO\'ernment contral br direct appJication for GO\'ernment funding "and adoption of a polier of attracting pu pils according to the schools" academic performance seems lo have incompatible aims wilh the 1981 Act, despile Minislerial assurances lo continuing commitment to integration. In Great Britain, integrating chiJdren with special needs into mainstream schools was increasing, but prO\'ision \'aried greatly acrass the country; a child with special needs in Comwall far example was about four times as likely to attend normal school as a similar child in Manchester. However, the latest evidence published by the Centre for Studies on Integration in Education in May 1992 suggests a slight increase in segregation at Primary Schoollevel (5 to 11 years) between 1988 and 1991, when the Standard Attainment Tests of the National Curriculum were intraduced. The 1989 ChiJdren Act, which came into force in 1991, emphasised even more strangl)' than the 1981 Education Act the rights of the child, and the need to include parents in active partnership in deciding how best to cater for its needs. It clearly stated that needs should not be considered in terms of resources available; on the contrary, there is a statutor'y obligation to allocate resources to upport the identified needs of the child. It seems that Govemment polier on integration and ho\\' this is interpreted at locallevel can lherefore be at odds.
~'aterials
and methods
This stud)' looked at 26 children \\'ith pina bifida li\ ing in the Greater \Ianchester Area and tried to a sess "hich "ere Ihe most important factors influencing school placement. Comments "ere also gathered on ho" schools ha\e tried to cater for the special needs of these children; parents' \'ie\\s "ere sought on the efficienc)' of ho" this "'as done.
Downloaded by: Universite Laval. Copyrighted material.
1\ ledieal Sehool, L'ni\'ersity of :\Ianehester, ,\Ianehester .\\ 13 9PL, 2, 30 epartments of ",eurosurgery and Clinieal Ps)'eholog)', Booth I lall Children's Hospital, Charlestown Hd., Blaekley, ,\Ianehester :\19 2AA, U.K.
Eur J Pediatr Sltrg 2, Suppl J (1992) The 26 children with spina bifida in thi study were registered under one of u (018). The ages of the children at time of study were ..j yrs 8 mths to 18 )TS 8 mths. 18 chiJdren were of Prima!)' School age (under 1I years at the beginning of the school year) and 8 were of Secondary School age. The children were a sessed according to se\-eral faclors and the results analysed to see which were influential in affecting school placements. The following parameters \\'ere assessed: Physical Factors I ..\ tobility 2. Continence :3..\Ianual c1exterity I. Seizure
Other Factors I. IQ 2. Beha\iour :3. Schooling
Information \\ as obtained b}" I. Extraclion from thc medicalnotes 2. InterYie\\ \\'ith child ancl parent :3. Psychologieal assessment using the \\'echsler Scales some of \\ hieh \\'ere carried out a number of years pre\·iousl.\ I. .\n adapted \Ianual Dexterity Scale of The Test of \Iotor Impair ment (Stott et al 1U/3) 5. An adapted Parents' .\ssessment Schedule of the Hutter Scales (196,) to measure beha\'iour Children \\ ere classified aceording to each parameter a" foll
