Assistance to pupils with physical disabilities in regular schools: promoting inclusion or creating dependency?

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Assistance to pupils with physicaldisabilities in regular schools:promoting inclusion or creatingdependency?Snaefridur Thora Egilson a & Rannveig Traustadottir ba Occupational Therapy Program , Faculty of Health SciencesUniversity of Akureyri , Akureyri, Icelandb Centre of Disability Studies, Faculty of Social Sciences ,University of Iceland , Reykjavik, IcelandPublished online: 22 Jan 2009.

To cite this article: Snaefridur Thora Egilson & Rannveig Traustadottir (2009) Assistance to pupilswith physical disabilities in regular schools: promoting inclusion or creating dependency?, EuropeanJournal of Special Needs Education, 24:1, 21-36, DOI: 10.1080/08856250802596766

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European Journal of Special Needs EducationVol. 24, No. 1, February 2009, 21–36

ISSN 0885-6257 print/ISSN 1469-591X online© 2009 Taylor & FrancisDOI: 10.1080/08856250802596766http://www.informaworld.com

Assistance to pupils with physical disabilities in regular schools: promoting inclusion or creating dependency?

Snaefridur Thora Egilsona* and Rannveig Traustadottirb

aOccupational Therapy Program, Faculty of Health Sciences University of Akureyri, Akureyri, Iceland; bCentre of Disability Studies, Faculty of Social Sciences, University of Iceland, Reykjavik, IcelandTaylor and FrancisREJS_A_359844.sgm10.1080/08856250802596766European Journal of Special Needs Education0885-6257 (print)/1469-591X (online)Original Article2009Taylor & Francis2410000002009Associate Professor [email protected]

Drawing on the perspectives of pupils with physical disabilities, their parents andteachers, this study explored the adult support provided to pupils with physicaldisabilities in regular schools. Data were collected through observations at schoolsand qualitative interviews. In all, 49 individuals participated in this study: 14pupils with physical disabilities, 17 parents, and 18 teachers. Six themes emergedthat characterised the provision of assistance: (1) roles and responsibilities; (2)quantity and content of support (3) proximity to the pupil, (4) school priorities, (5)independence and autonomy of the child; and (6) the relationship between theteacher and the assistant. An over-reliance on adult support was found for somepupils and contexts, while this support appeared to be under-utilised orineffectively delivered in other situations. Lack of modifications of the traditionalcurriculum, teacher instructions, and educational activities increased the pupils’need for adult support in school. While it is acknowledged that teacher assistantscan make valuable contributions in promoting participation and learning amongpupils with disabilities, it is argued that the constant presence of an assistant canresult in limited use of the children’s strengths and may possibly createunnecessary or unhealthy dependencies. The findings signify that the educationsystem must align with important stakeholders – the pupils, their parents, andexternal support services – to identify alternative ways to promote participationand learning of pupils with disabilities in regular schools.

Keywords: assistants; school; inclusion; physical disabilities; support

Introduction

Despite legal and international agreements and declarations about equal rights of allpupils, access to curriculum and adaptations of the teaching environment to includechildren with special needs varies immensely, reflecting a gap between intention andimplementation (Lindsay 2003). Provision of support by teacher assistants is widelyused to promote the participation of pupils with disabilities within general educationsettings. The literature indicates that the use of teacher assistants is well established inmany countries and is often considered to be the prerequisite for inclusion (Farrell,Balshaw, and Polat 2000; Giangreco and Doyle 2007; Giangreco, Edelman, and Broer2001; Lacey 2001). Nevertheless, there is a lack of international consensus on theteacher assistants’ roles and duties, to what extent and in what circumstances theyshould be used, and what degree or type of training they should receive – as reportedin a research overview provided by Giangreco and Doyle (2007).

*Corresponding author. Email: [email protected]

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22 S.T. Egilson and R. Traustadottir

Several concerns regarding assistants’ proximity to the pupils they are assigned tosupport have been identified (Giangreco, Edelman, and Luiselli 1997; Hemmingsson,Borell, and Gustavsson 2003; Richardson 2002; Malmgren and Causton-Theoharis2006), such as separation from classmates, interference with peer interaction, depen-dence on adults, and loss of personal control. Many of these issues are of particularrelevance to children with severe physical disabilities who need practical helpwith many aspects of daily life. Lack of mobility may restrict these children’s oppor-tunities to engage in educational and social activities and in exercising choice anddecision-making. Frequently they are placed in situations that may reinforce passivityand dependency (Coster and Haltiwanger 2004; Richardson 2002; Wehmeyer andShalock 2001). Simeonsson and colleagues (2001) found that US pupils with neuro-muscular and physical problems participated less in school activities compared withthose individuals with attention, language, and learning problems. Egilson and Coster(2004) found that Icelandic pupils with physical disabilities demonstrated lowerparticipation in most school settings than pupils with cognitive and behaviouraldisabilities. Only in the classroom was the performance of the two groups comparable.Pupils with physical disabilities were provided with much more assistance on taskssuch as moving around school, using school materials, and monitoring personal careneeds than the comparison group with cognitive and behavioural disabilities.

Despite the bulk of professional literature pertaining to support provided byteacher assistants, heterogeneity in the ages and types of disabilities of pupils inmany studies may limit application of existing research. Only a handful of studieshave focused specifically on pupils with physical disabilities. In one of these studies,Richardson (2002) found that the assistants to five-year-old to eight-year-old pupilswith physical disabilities were often too willing to assist, resulting in the lack ofopportunity for the children to try out various tasks. Furthermore, the assistancefrequently disrupted the flow of play activities among the children. Hemmingsson,Borell, and Gustavsson (2003) found that the support provided to the pupils in theirstudy was primarily arranged to facilitate participation in learning activities but thepupils prioritised social participation, in the sense of being accepted and included inthe peer group. Skär and Tamm (2001) also found the relationships children andadolescents with physical disabilities had with their assistants to be complex andambivalent. The authors concluded that the rights of the pupils to influence decisionsconcerning their own life were hardly accepted, and maybe not even comprehended,by many assistants.

Giangreco and Doyle (2007) point out that perspectives of pupils with disabilitiesare notably absent from research about teacher assistant supports. The assistantsthemselves are the most common respondents, outnumbering professionals, parentsand above all pupils receiving support. Giangreco and Doyle (2007) could only iden-tify three studies that presented the perspectives of pupils with disabilities about theirdirect experience of receiving supports from teacher assistants; two Swedish studiesof pupils with physical disabilities and their own study of young adults with intellec-tual disabilities (Broer, Doyle, and Giangreco 2005; Hemmingsson, Borell, andGustavsson 2003; Skär and Tamm 2001).

Teacher assistants are a relatively recent phenomenon in Iceland, but are increas-ingly used to facilitate the education of pupils with special learning needs in regularschools. Typically they support pupils who need more help than the teacher canprovide. Training for teacher assistants has been available at selected sites for a fewyears but at present most practicing assistants have no certificate. A study by Ólason

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European Journal of Special Needs Education 23

(2005), seeking the perspectives of practicing assistants, revealed that their roles andresponsibilities varied widely by schools and communities. Due to a lack of guide-lines, the respondents often relied on their own knowledge, skills, and initiative.Commonly they were given teacher-level responsibilities, although without adequatetraining or support. According to Ólason, Icelandic school administrators increasinglyexpect assistants to function in an instructional capacity. These findings echo researchresults from other countries revealing the common lack of clear definition of teacherassistants’ work (Giangreco and Doyle 2007).

The overall aim of the present study was to examine the assistance provided toIcelandic pupils with physical disabilities in inclusive school settings, and to explorewhich factors had the most critical influences on the provision of support. The vastmajority of research on teacher assistants has been based on the perspectives of theassistants themselves and to a lesser extent on teachers. Only rarely have pupils withdisabilities and their parents been included. This study attempts to provide acomprehensive view by seeking the perspectives of pupils with physical disabilities,their parents, and their teachers. Two research questions guided the study: What arethe characteristics of the assistance provided to pupils with physical disabilities inregular schools? What are the factors that affect the assistance provided to pupilswith physical disabilities in regular schools?

Method

Design

The study was framed within an inductive perspective to capture the participants’understanding and experiences (Bogdan and Biklen 1998; Patton 2002). It wasinspired by grounded theory procedures, emphasising the constant comparativemethod most often used for multi-data sources in conjunction with multiple-sitestudies (Strauss and Corbin 1998). The qualitative design involved naturalisticobservations and semi-structured interviews that explored the experiences andperspectives of pupils, teachers, and parents regarding the assistance provided topupils with physical disabilities in general education settings. The study was carriedout by the first author as part of a larger research project examining the schoolparticipation of Icelandic pupils with physical disabilities (Egilson 2005).

Study participants

In all, 49 individuals took part in the study: 14 pupils with physical disabilities (keyparticipants), 17 parents, and 18 teachers. At least one parent and one teacher wereinterviewed for every child in the study. The sampling method was a purposefulsample to reflect the key issues and most common challenges faced by Icelandicpupils with physical disabilities and the assistance they received. Disability recordsfrom the Icelandic State Diagnostic and Counselling Centre were used to compile alist of prospective participants.

The pupils ranged in age from six to 12 years; two pupils were selected in eachgrade level from first to seventh. During the first seven years, Icelandic pupils spendmost of the time in their homeroom with one teacher. In eighth grade they entermiddle-school and no longer have as strong connection to one teacher. All participat-ing pupils had physical disabilities related to medical diagnoses such as cerebralpalsy, myelomeningocele, or neuro-muscular disorders. School size and location was

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also of concern in the selection process. Eight pupils lived in the capital area (whereapproximately 70% of the total population lives), two in other urban communities,and four in rural areas. One pupil attended a special class part-time, otherwise all theother children were in a regular class in their home school, and often the only pupilwith physical disability in their school. Two schools had more than one pupil withphysical disabilities so altogether 11 different schools were involved in the study.Children with co-occurring intellectual disabilities were excluded; however, sevenpupils had additional impairments such as mild learning disabilities and attention-deficit disorders, or used alternative communication.

A total of eight pupils had full-time assistance at the time of the study, and threehad part-time assistance. Three pupils who were without teacher assistants wereincluded for comparison and contrast. One of these pupils was in a class that hadtwo qualified teachers, one was partly in a special class but received no assistancein his regular class, and the third was without assistance at the time of the study buthad previously received full-time assistance. All of the assistants were supervisedby the general education teacher except one, who was supervised by a specialeducator. With one exception the assistants were without college education orprofessional training. Table 1 presents the demographic characteristics of the keyparticipants.

Table 1. Characteristics of pupils with physical disabilities (key participants).

Category n %

Gender

Boys 9 64

Girls 5 36

Diagnosis

Cerebral Palsy 8 57

Myeolomeningocele 2 14

Neuromuscular Disorders 3 22

Musculoskeletal Disorder 1 7

Specific Learning Needs 7 50

Alternative Communication 2 14

Primary Means of Mobility

Walks on Own 3 21.5

Crutches, Cane or Walker 3 21.5

Manual Wheelchair 1 7

Electric Wheelchair 1 7

Other (Braces, Walks with Assistance) 3 21.5

Transferred by Others 3 21.5

Amount of assistance

Full-time 8 57

Part-time 3 21.5

Other (no assistance, two teachers in class) 3 21.5

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Data generation

The parents of all of the participating pupils were contacted by telephone andinformed about the study. Once a formal consent was obtained from the parentsregarding their and their child’s participation in the study, the child’s teacher wascontacted and invited to participate. After obtaining consent from the teacher a datewas set for an interview and a school observation. In cooperation with the parents andteachers, a particular school day was chosen for a visit. The criteria was that theresearcher would be present for three to six hours in the classroom, during recess, andin at least one practical subject session, such as art, gym, music, or home economics.

Prior to the observations and interviews with the parents and the teachers, topicalguides and interview guides were developed to list the key issues that were to beexplored and discussed. The respondents were asked about the support the pupilreceived in school; how, where, and when it was provided, whether or not they werecontent with the present or prior arrangements, and the rationale for the setup. Formalinterviews were not conducted with teacher assistants but they took part in informaldiscussions during observation sessions at which time their work with pupils was alsoobserved. While most of the data focused on a particular pupil while at a certain gradelevel, longitudinal data were also obtained through follow-up parent interviews tobetter understand variations in the assistance provided to the pupils over time andacross school settings.

Observations

The children were observed during one school day. On average, four hours werespent observing each pupil in his or her classroom. The teachers and the assistantswere told that the child’s participation and the interactions within class were in focus.The teacher introduced the researcher to the class by saying she was visiting severalschools and today she wanted to know how things were done in their class. Theresearcher accompanied the pupils during one recess, and followed the teacher andthe assistant to the teacher’s lounge in another. The focus of the observation wasalways on the pupil with physical disability and the assistance she or he received. Allinteractions within the classroom were observed; the interaction between the teacherand the assistant and between the assistants and the pupils. The fieldnotes alsoincluded descriptions of the educational practices and environmental aspects thatmight affect provision of assistance.

Interviews

Following the school observations, interviews with the teachers and parents wereconducted. Interviews with teachers took place within school, and the interviews withthe parents at their homes at a time of their convenience. Each interview lasted 40–80minutes. All of the interviews were tape-recorded and transcribed verbatim for analy-sis. Although the interviews were guided by a certain structure and evolved aroundparticular topics, they were conducted in a conversational manner so that the respon-dents could tell their stories in their own way. In all, 17 parents were interviewed, 11interviews were conducted with the mother only and three with both parents present.A total of 18 teachers were interviewed. Both general and special educators wereinterviewed together if the pupils were receiving services from both individuals.

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In addition, nine pupils were interviewed after the school observations using theIcelandic edition of the School Setting Interview (Hemmingsson et al. 2005, 2006) asthe interview guide. Of the five remaining pupils, one refrained from an interview andthe others were considered to be either too young for a formal interview or they hadproblems with verbal expression. The parents of these children were asked about theirchild’s perspective on the assistance he or she received. The School Setting Interviewincludes 16 items (i.e. questions) concerning everyday school activities where pupilswith disabilities may need assistance or adjustments. Occasionally, questions wereadded to follow up on certain issues from participant observations or interviews withparents or teachers.

Besides the formal interviews, several informal discussions with the pupils, teach-ers, and assistants were conducted during fieldwork and included in the fieldnotes.The parents were contacted again approximately a year after the initial data gatheringto learn how the support provided to their child in school had evolved, thus providinga more long term overview.

Data analysis and interpretation

Interview transcripts and written fieldnotes were analysed in several ways. First, opencoding was performed to identify relevant themes and to categorise the phenomenathat related to the assistance provided to the pupils in different settings within school.The open codes were compared and contrasted to detect similarities and differencesacross cases. For reflexive analyses, the coded transcripts and analytic memos werere-read to recall the initial reactions during and after the observations and interviews.Originally, fieldnotes and interviews were analysed separately for each pupil,comparing data with data. Then recurring categories and themes from the pupils werecompared with those from the parents and the teachers separately for each group. Thedata were continuously compared with the themes for refinement and to determinethe adequacy of those themes. To strengthen credibility and confirm that the interpre-tations reflected the pupil’s actual situation, a member check was conducted byproviding summaries of the findings to parents and asking for feedback.

Findings

Recurrent patterns and themes regarding provision of assistance in this study wereidentified, classified, and verified through the different data sources into followingcategories: (1) roles and responsibilities, (2) quantity and content, (3) proximity to thepupil with physical disability, (4) school priorities, (5) independence and autonomy ofthe child, and (6) the relationship between the teacher and the assistant. All names inthe result section are pseudonyms.

Assistant roles and responsibilities

One of the most notable findings was the variation in the roles and responsibilities ofthe teacher assistants. It was generally unclear what their role should be and no formaldefinition existed as to what their duties were and under which conditions they shouldwork. Most received limited supervision from teachers or other professionals.Although many assistants worked under teacher direction and were available to all

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classroom pupils, at least two provided the primary instructions for the pupil withphysical disability. On occasion the pupil was not meant to take directions from theclass teacher and the assistant was responsible for deciding when it was appropriate.Anna’s teacher said:

I am so lucky when I am giving out assignments that Helga [the assistant] hears imme-diately when I am addressing the class but maybe not Anna [the child with physicaldisability].

Sigrun’s teacher stated: ‘You have to count on the assistant to do his job, listen to me[in class] and follow things through [with the pupil with the disability]’. In both ofthese and several other instances there were few formal meetings between the teacherand the assistant, so the latter had an immense responsibility in figuring out the appro-priate action each time, and thus, make essential decisions about the education of thepupil with the physical disability.

The relationship between the pupils’ educational needs and the roles and respon-sibilities of their assistants was not always clear. Rather, the teacher’s decisions andteaching style, traditions, or simply coincidence appeared to be the decisive factors.The interviews with the teachers revealed that often the responsibilities of the teacherassistant had not been explicitly considered, laid out or discussed.

Quantity and content of support

The assistance provided was first and foremost arranged to facilitate academic learn-ing within the classroom. The pupils typically received assistance in completingeducational assignments and during examinations. They also received support inpractical activities, such as eating, toileting, dressing, and transfers within andbetween classrooms, and in practical subjects such as art, crafts, and physical educa-tion. However, despite the obvious challenges experienced by the pupils in thesepractical matters, often there was not enough help available. Limited flexibility wasapparent; at times, either 100% assistance was offered or very little. As an example,Simon received full-time assistance during his first years at school. The set-up wasdiscontinued in sixth grade. As a result he received no assistance in challengingsituations and occasionally ran into problems with practical issues.

The pupils had no control over the amount or content of the assistance theyreceived, and most frequently the support appeared to be provided on the teachers’ orthe assistant’s own initiative. Although some pupils were satisfied, a few claimed theywould like to decide where and when assistance was provided. They even namedstrategies that would enable them to work more independently in class. Kristin in fifthgrade said:

I would like to get less support and I would like to decide who supports me … and inwhich parts of my schedule … If I were allowed to use the computer more I wouldn’tneed so much help at school. It’s not much fun having all these old ladies hanging aroundme all the time.

Snorri in fourth grade, who needed help with all personal care claimed his variousassistants acted differently, and that new assistants always needed time to adjust tohim – rather than he needed time to adjust to these different people.

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Numerous positive incidents were observed where the assistants enabled the pupilsto participate in educational activities. There is, however, a fine line between supportthat facilitates participation and support that restrains child interaction and the devel-opment of autonomy. Too much assistance can result in limited use of the children’sskills and potential, and possibly create unnecessary or unhealthy dependencies andhelplessness, as witnessed during a visit to Daniel’s class. Daniel required assistanceto go up to the board, to access books from shelves, or to distribute assignments. Hisassistant also helped him get in and out of the chair and to the bathroom during breaks.Other than that, the assistant had no specific role in class and sat passively close toDaniel most of the time. Daniel’s teacher and parents said he was able to completealmost all his educational assignments without help although he was a slow writer.Daniel’s mother was concerned that her son was getting too much support. Shebelieved it was important for him to develop independence and not have to rely onassistance all the time. Yet she was hesitant to discontinue the services as she thoughtDaniel might run into problems.

The characteristics of the pupils, such as their physical or educational capacities,did not necessarily affect the content or amount of assistance they received. As anexample, Daniel and Simon had similar functional abilities. While Daniel receivedfull-time assistance, Simon was without assistance at the time of the study. Neither didthe physical accessibility within school, use of assistive devices, nor the number ofpupils in the class appear to be decisive factors.

Proximity to the pupil with physical disability

The assistant’s proximity to the pupil with physical disability varied. Five assistantskept regular contact with the pupil they supported but did not sit next to themthroughout lessons unless necessary. Six were situated by the pupils’ side most ofthe time, even when the pupils could work independently on assignments. As aresult, a few pupils did not take directions from the teachers but rather from theassistants. In addition, they were not as active as their peers in general classroomwork. The assistant’s proximity sometimes resulted in the pupils feeling stigmatised.Maria’s mother reported:

Maria is so independent and she has been very annoyed with having an adult constantlyat her side. She wants to do everything just like the other kids. This woman [the assistant]is very conscientious and she constantly watches out that Maria does things the rightway, such as that her sitting position is good. Sometimes she [Maria] gets infuriated andthey fight just like a mother and daughter.

Many parents and teachers mentioned that they preferred ‘invisible’ assistance;someone to keep up the pupils’ pace and attention in class and ensuring they weresafe in crowded areas, such as the playground, the hallways, and the cafeteria. Thor’steacher illustrated her thoughts regarding the complexities inherent in the assistantrole:

Not everyone can stay beside a child all day and it is quite easy to become passive as anassistant. But you have to be aware of everything … People [i.e. assistants] have to knowwhat to do but at the same time let him [Thor] decide and not manipulate too much. Butyou always have to intervene when necessary. It is a fine line, to control but to let himfeel that he is in control.

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Some assistants solved the dilemma well while others helped much more thanneeded. It can be hard to go about ‘doing nothing’ and it requires insight, knowledge,and skill to recognise when and how to intervene. With unclear definition of theirroles, responsibilities, and limited supervision, the success was often up to eachassistant.

School priorities

The assistance provided was mainly in the academic aspects of the school day but mostpupils and parents prioritised social participation and acceptance in the pupil group.Frequently there was a lack of assistance during recess when the assistant had her orhis coffee break. Even though a pupil had been assigned an assistant, the support wasnot always prioritised. In the distribution of scarce school resources, the pupil some-times remained unserved or underserved when other important issues were at stake.For example, Jon had full-time assistance for all his school hours. Once, the class wasscheduled to go on a fieldtrip in a hilly area that Jon could not manage. The day beforethe trip his parents received a message from the school to keep their son at home, ashis assistant was needed for the other pupils on the trip. Lack of assistance duringfieldtrips was noted by one-half of the teachers and parents.

Some of the strategies utilised by the schools to ‘survive’ in challenging situationswere problematic for the child with disability and his or her family. To minimise whatwas seen as a burden on staff, three pupils had a number of assistants, even up to 10individuals in a given school year. Accordingly, it was difficult to coordinate andmodulate expectations and procedures; for example, regarding behaviour or the use ofassistive devices. As Robert’s teacher reported:

One person knew how to position him in the chair but another one didn’t and so on. Andseveral people didn’t know how to help him to the toilet, how to go about in thosechallenges. Even Robert was trying to instruct them what to do.

Usually parents were not consulted on the number of assistants, which sometimesstrained the collaboration between the home and school. At the time of the studySimon was without assistance. In the interview, his teacher Nina said she had insistedthat someone would help the 12-year-old boy travel to and from the school gym,‘because I had to take him to the gym and help him. And afterwards it changed, they[the school authorities] realised it couldn’t go on like this. Since then Karl [the janitor]takes him to the gym’. Later on in the interview Nina said, however:

But there is always someone sick and then they move people around to other tasks. LikeKarl who is supposed to help him [Simon] to the gym. I hardly see him these days. Wedo it [help Simon to the gym], me and the boys in class. We haven’t seen Karl for a long time.

In both of these cases the needs of the disabled children were considered inferior toother pressing priorities within the school. If the assistant was sick, the pupilscommonly missed out on sessions such as physical education or swimming as no onecould help out with the practical matters. Six parents reported being contacted andasked to pick up their child from school in such instances, especially during the firstfew years of the child’s schooling when the system appeared to be learning how toaccommodate his or her needs. This hardly occurred in the upper grades.

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Independence and autonomy of the child

A few teachers and parents reported that although the children at times objected to thepresence of the assistant, they tended to consider the assistant as their ‘possession’ andthus sometimes complained if he or she attended to their classmates. Other issuesregarding power balance and boundaries were observed. Magnus’ assistant wrotedown his assignment according to Magnus’ thorough instructions on spelling. Whenthe assignments came back with correction marks, Magnus blamed the assistant forthe errors although they were all his own. Apparently, the boy did not perceive that hewas accountable for the results, reflecting a lack of perception of control and respon-sibility for his actions. Nina described Simon’s development of independence andautonomy in school after his assistant left and he had to manage more by himself.

Something happened after he was given the key to the elevator whereby he managed toget around school on his own. He is a totally different and far more independentperson.

Nina continued to describe the positive effect on social relations that occurred whenSimon suddenly needed help with various practical matters and a group of boysstepped in to assist, and then became friends with him.

Originally, they [the boys] were just looking for something to do, I think. But now theyfind Simon fun to be with. It isn’t only Petur and Bjarni, it is Emil and many others whohave joined the group. They join him during recess and they run and turn around and Iam just scared stiff. But it is all just very enjoyable.

When left without adult assistance Simon demonstrated skills and abilities thatenabled him to be socially integrated and an active participant in the peer group. Thushe was using and developing important strategies essential for future challenges.

Relationship between the teacher and the assistant

Although a majority of the teachers who had an assistant in class claimed his or herpresence was a prerequisite for a successful integration of the pupil with physicaldisability, many found the high turnover stressful. They reported effort in constantlyhaving to relate to different people of dissimilar character and competence.Alexander’s teacher said:

The choice of the assistant is extremely important, especially for children with physicaldisabilities. You cannot hire just anyone who is available. Because this is a highlycomplicated job and you really have to choose carefully … I had a very special assistantthe first two years, an extraordinary person and I don’t want to judge those whofollowed. But all these changes are not for the good, they are not good for me and notfor the boy. It is such an interaction … Not everyone can do it and you cannot expectthem to.

Limited time for collaboration complicated matters considerably, especially whenthe teacher and assistant differed in their expectations, ideologies, and styles of inter-action with the children. A few assistants assumed an important role in the classroomin collaboration with the teacher. Occasionally they took on parts of the teachers’ role

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for the pupil with physical disability and helped his or her classmates on variousmatters.

Not all teachers like the idea of having another person in their classroom, and somefind it challenging to assume a supervisory role over another adult. On one occasionthe presence of an assistant was a burden too large to overcome. Lisa’s class was aboutto have a new teacher. The newly graduated professional claimed he did not object tohaving a child with disability in class but disapproved of the presence of another adult.School authorities then arranged to move Lisa to a different class and contacted thefamily only when matters were fully arranged. The parents and Lisa herself objectedloudly and eventually the issue was resolved with another teacher instead of movingLisa. Conversely, the assistant was sometimes the constant factor, such as when therewas high teacher turnover. Then it was the assistant who knew the child best and oftenwas able to provide valuable information on aspects regarding his or her educationalor on practical issues.

Discussion

The results of this study are consistent with recent findings in the international literature(Giangreco and Doyle 2007) and suggest that clarification of the roles and responsi-bilities of teacher assistants is timely and important, such as in defining when andwhere assistance is needed. Discussion of the findings will focus on two aspects: thecharacteristics of the assistance provided, and the factors that affected how it wasutilised. In the implication section, ways to minimise the need for adult support forpupils with physical disabilities in school will be addressed.

Characteristics of assistance provided

The pupils with physical disabilities had difficulty keeping up with their peers invarious contexts. The school playground and practical subjects, such as physicaleducation, art, and crafts, were a particular challenge as they demand a great degreeof physical performance. Overall, least assistance was provided in these settingscompared with the general classroom. This is noteworthy as the children’s barriers toparticipation in physical activity are so apparent given the limitations imposed by theirimpairments. The assistance provided appeared to be mostly focused on the academicaspects of the school day, such as the educational tasks in the main classroom.Although one of the main functions of elementary school is to contribute to the pupils’social development, measures to promote active involvement in break activities andother non-academic tasks were not a priority in this study, reflecting a disregard forthe importance of the social aspect of activity involvement outside the generalclassroom. The pupil and parent interviews revealed, however, that most respondentsprioritised social participation, meaning that the pupils were accepted in the group andnot excluded from specific activities and settings. This is consistent with the findingsof Hemmingsson, Borell, and Gustavsson (2003).

Thus, an over-reliance on adult support was found for some contexts and pupils,while this support appeared to be under-utilised or ineffectively delivered in other situ-ations, especially in practical subjects and break activities. Dependency on assistantsby the pupils was commonly reported, and on several occasions the children receivedmore assistance in the classroom than strictly needed just because an assistant wasavailable.

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Similarly to the findings of Giangreco and colleagues (2005), the parents in thisstudy expressed conflicting concerns regarding the assistance provided to their child.Because of their concerns about how their child would be accepted and instructed inschool, some parents agreed to or even requested individual support for their childalthough experiencing ambivalence about whether the assistance was really needed.

The patterns of assistance provided changed over time, for example with a differ-ent teacher or assistant or increased educational demands. Thus, the situation wasoften erratic and fluid, depending on the transaction between many aspects.

Factors affecting utilisation of assistance

Factors affecting content and amount of support were inconsistent and no direct rela-tionship was found between the pupils’ educational needs and the content or amountof assistance provided. Neither did type or severity of disability affect the utilisationof assistance. This is in contrast with the findings of other studies, which indicated thatpupils with access to teacher assistants generally had more pronounced physicalimpairments than others (Hemmingsson, Borell, and Gustavsson 2003; Schenker,Coster, and Parush 2006). In addition to the small number of pupils with disabilitiesin this study, the variability provided by the multi-source and follow-up data maypossibly account for some of these differences as the situation for many childrenvaried between years. Also, since the use of teacher assistants to support pupils withdisabilities in general education classes is not well established in Iceland, the criteriafor their utilisation may be less clear than in countries with longer traditions in thisregard.

It is reasonable to expect that use of adaptive equipment and environmentalmodifications will support the participation of pupils with physical disabilities, andminimise their need for support. Interestingly, physical accessibility within school oruse of adaptive devices did not consistently affect the content or amount of assistancethe pupil received. Neither did the number of pupils in class have a great impact, asaforementioned. The interaction between various aspects influenced the adult supportprovided each time but the attitudes and abilities of individual teachers to modify thecurriculum, instructions, or educational activities appeared to be the most importantfactors. Often these matters had not been fully considered or discussed within theschool. Thus, individual teacher’s views and teaching style, traditions within school,or simply coincidence had the most influence on the characteristics and amount ofsupport. These findings strongly indicate the lack of guidelines on the roles andresponsibilities of assistants supporting pupils with physical disabilities withinIcelandic schools.

Implications for practice

In order to avoid over-reliance on assistants in schools it is important to engage incareful decision-making about when and what type of assistance is appropriate. Therole of the assistant should be clear, and there needs to be congruence between theskills of the assistant, the pupils’ needs, and the role of other professionals working inschool. Ongoing supervision should be provided by qualified professionals to ensuresuccess. In addition, it is necessary to focus on the factors that have contributed to theexpanded use of assistants; namely, the attitudes, skills, roles, and working conditionsof educators to plan for and teach pupils with disabilities in inclusive classrooms.

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Current research suggests that the presence of an assistant may mask the pupil’seducational and developmental needs or delay attention to them (Hemmingsson,Borell, and Gustavsson 2003; Giangreco, Edelman, and Broer 2001; Giangreco andBroer 2005). Self-determination, independence, and autonomy are considered to beimportant outcomes of the education system. Yet, lack of perception of control inone’s life is commonly experienced by pupils with disabilities (Wehmeyer andSchalock 2001). Teacher assistants can make valuable contributions in promotingparticipation and learning among pupils with disabilities, as observed in this study andreported by others (Hemmingsson, Borell, and Gustavsson 2003; Farrell, Balshaw,and Polat 2000). Nevertheless, there is a fine line between support that facilitatessocial inclusion and support that inhibits interaction and autonomy. The constantpresence of an adult may increase children’s need for help and make them less sociallycompetent. Too much assistance can result in limited use of the children’s strengths,and may possibly create unnecessary or unhealthy dependencies. It may also affectand impede the development of important life skills, such as will, self-esteem, andresilience.

The findings of this study reveal that most pupils and parents prioritise assistanceto promote social inclusion, engagement, and interactions with peers, while schoolsemphasise the use of assistants to support academic learning. It is imperative thatschools listen to the views of students and parents and align with them to identifyalternative ways to promote participation and learning of pupils with disabilities inregular schools. The following aspects should be in focus.

School environment

For a more consistent and conscious practice, the contextual features and structureof different school settings must be acknowledged by school administrators andeducators. The design of the built school environment should include features thataccommodate the needs of the pupil with disability. It must be ensured that allsettings in which pupils generally circulate are available, accessible, and usable –which, in turn, may decrease the need for adult assistance. The characteristics of thepupil group – including class size, the number of other pupils with special educa-tional needs, the intensity of the other pupils’ needs, or relationships with classmates– is also of concern. The social and cultural dimensions of the school environmentare of particular importance, such as the extent to which it respects individual needsand allows for flexibility and adjustment.

Instructional tasks and methods

Often the pupils’ educational needs can be met through modifications, supplementaryor differentiated instruction, and adaptations of educational activities that may reducethe need for adult support. Flexibility and accommodations to account for the pupils’level of functioning or special learning needs are of utmost importance. It can consistof adaptations to the traditional delivery of instruction or differing instructionalmethods applied to the general education curriculum to allow the pupil with physicaldisability access to learning opportunities. To avoid stigma, however, adaptations andmodifications should only be as specialised as necessary. Efforts should be made toprovide different instructional methods within the context of typical school activitiesand across different school settings in ways that respect the pupils with physical

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disabilities. Adaptations and devices may assist pupils with physical disabilities inperforming important educational tasks, and thus lessen their need for adult support.It may include low-tech adaptations, such as pencil grips and adapted work surfaces,or high-tech devices, including adaptive computers, software, switches, and augmen-tative communication devices. Other studies have reported that adaptations arerequired in a wider manner in addition to or alternative to adult assistance if we are toincrease the opportunities of pupils with severe physical involvement to participate inthe academic and social tasks required in school (Pivik, McComas, and LaFlamme2002; Schenker, Coster, and Parush 2006). The needs of the pupil within a particularsetting must be matched with the available technology to enhance or enable activeinvolvement, interaction with others, and independence. To ensure results, thoroughcollaboration with important stakeholders within external support services is essential.

Organisational issues

Staff characteristics, the number of educators to serve the classroom, availability ofsupport services, and the training and experience of staff members should be addressedin order to decrease the need for teacher assistants within school. Acknowledgementof the extent to which government and society’s values and beliefs affect regulationsand procedures that constitute educational practices may help make visible varioushidden aspects, including formal and informal ways of communication and practices.Standards for desirable pupil behaviour and engagement in different situations mustalso be clear.

Regular schools have to find ways to promote competence and innovation inpractice and to accommodate for diversity. The educational system needs to makeprovisions for collaborative skill development for teacher assistants, and it must beassured that forum and adequate time to collaborate is provided. It is also necessaryto strengthen system structures to support staff, coordinate efforts, and fight incon-sistency to ensure that best services are available from year to year. Flexibilitywithin school enables pupils to work at different speeds, allows access to diverseopportunities, and fosters a richer learning and social environment for all. Strategiesfor achievement include emphasising inclusive practices and innovative teachingstrategies that can be shared with staff. Last, but not least, it is imperative to includethe pupils’ voice in decision-making about how, where, and when assistance isprovided in school.

Generalisability

Although the study participants were selected partly for their representativeness interms of age, grade level, school location, and disabilities, the sample size was small,the pupils were only observed during one school day, and follow-up was restricted toparent interviews. While the findings cannot be generalised, the triangulated use ofmultiple data and the variety of foci and methods strengthen the dependability of thestudy findings. Use of diverse data sources helped elucidate complex issues, andinconsistencies in findings across different kinds of data occasionally raised importantaspects.

The study was geographically confined to Iceland and the findings may not berepresentative of perspectives and practices in other countries. However, many of theissues addressed appear to be universal. Similar concerns about teacher assistants have

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be raised in other countries such as the United States, Australia, Sweden, and England(Giangreco and Doyle 2007; Hemmingsson, Borell, and Gustavsson 2003; Lacey2001; Lindsay 2007). It is imperative that we share our knowledge in order to developbest practices and adopt alternatives to traditional models for assisting pupils withdisabilities in inclusive settings.

The study raises the importance of attitudes and resources – such as knowledge,planning, and professional collaboration – in providing opportunities for pupils withphysical disabilities to participate fully and actively in all school contexts. To furtheradvance our knowledge, it would be interesting to objectively measure and comparewhether or how pupil learning and behaviour in different countries are influenced bycertain characteristics of adult support, and the effect of environmental and task modi-fications in changing the manner in which teaching assistance is provided.

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Documents

Assistance to pupils with physical disabilities in regular schools: promoting inclusion or creating dependency?