research paper on students with disabilities

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here .

Loading metrics

Open Access

Peer-reviewed

Research Article

Participation of children with disabilities in school: A realist systematic review of psychosocial and environmental factors

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Occupational Therapy and Arts Therapies Subject Area, School of Health Sciences, Queen Margaret University, Edinburgh, Scotland, United Kingdom

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing

Roles Data curation, Formal analysis, Investigation, Project administration, Writing – original draft, Writing – review & editing

Roles Conceptualization, Formal analysis, Investigation, Writing – original draft, Writing – review & editing

Affiliation Department of Occupational Therapy & PhD Program in Rehabilitation Sciences, Boston University, Boston, United States of America

Affiliation School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia

Affiliation Occupational Therapy, Faculty of Public Health and Health Care, University of Ruse, Ruse, Bulgaria

Affiliation Department of Physical Therapy, Occupational Therapy Division, Faculty of Health Sciences, University of Granada, Granada, Spain

Affiliation Saitama Prefectural University, Graduate School of Health, Medicine and Welfare, Saitama, Japan

Affiliation Amsterdam University of Applied Sciences, Faculty of Health, School of Occupational Therapy, Amsterdam, the Netherlands

Roles Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing

Affiliation Child Life and Health, SMC Research Centre, Edinburgh University, Edinburgh, Scotland, United Kingdom

• Donald Maciver, 
• Marion Rutherford, 
• Stella Arakelyan, 
• Jessica M. Kramer, 
• Janet Richmond, 
• Liliya Todorova, 
• Dulce Romero-Ayuso, 
• Hiromi Nakamura-Thomas, 
• Marjon ten Velden, 

• Published: January 29, 2019
• https://doi.org/10.1371/journal.pone.0210511
• Reader Comments

In order to make informed decisions about how best to support children and young people with disabilities, effective strategies that facilitate active and meaningful participation in school are required. Clinical factors, diagnosis or impairments somewhat helpful in determining what should be provided in interventions. However, clinical factors alone will not offer a clear view of how to support participation. It is helpful then to look at wider psychosocial and environmental factors. The aim of this review was to synthesise evidence of psychosocial and environmental factors associated with school participation of 4–12 year old children with disabilities to inform the development of participation-fostering interventions.

A systematic search and synthesis using realist methods was conducted of published research. Papers had to include consideration of psychosocial and/or environment factors for school participation of children with disabilities. The review was completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Papers were identified via Boolean search of the electronic databases MEDLINE, CINAHL, PhycINFO and ERIC (January 2006-October 2018). Appraisal focussed on contributions in terms of whether the articles are appropriate for the review (relevance) and research quality (rigour). Data were analyzed using content and thematic analysis methods using a realist framework. A narrative synthesis of results was reported.

Results and implications

We identified 1828 papers in the initial search. Seventy two papers were included in the final synthesis. Synthesis of findings led to three overarching mechanisms representing psychosocial factors for children (1) identity (2) competence and (3) experience of mind and body. Environmental aspects (context) compromised five interrelated areas: (1) structures and organization, (2) peers, (3) adults, (4) space and (5) objects. Our synthesis provides insights on how professionals may organize efforts to improve children’s participation. Consideration of these findings will help to proactively deal with suboptimal participation outcomes. Development of theoretically determined assessments and interventions for management of school participation are now required.

Citation: Maciver D, Rutherford M, Arakelyan S, Kramer JM, Richmond J, Todorova L, et al. (2019) Participation of children with disabilities in school: A realist systematic review of psychosocial and environmental factors. PLoS ONE 14(1): e0210511. https://doi.org/10.1371/journal.pone.0210511

Editor: Tzipi Horowitz-Kraus, Cincinnati Children’s Hospital, UNITED STATES

Received: September 3, 2018; Accepted: December 23, 2018; Published: January 29, 2019

Copyright: © 2019 Maciver et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: Funding for this work was received from the Salvesen Mindroom Centre for Learning Difficulties.

Competing interests: The authors have declared that no competing interests exist.

Introduction

According to the World Health Organization’s World Report on Disability, an estimated 95 million children (5.1%) aged 0–14 years have some form of disability [ 1 ]. Common issues include Autism Spectrum Conditions, Developmental Delay, Behavioral Disorders and Learning Difficulties [ 1 ]. In many countries, these children have rights to be included in mainstream school [ 2 – 5 ]. For professionals who work with children this shift towards social and educational inclusion has meant that practices have had to evolve in tandem. Rehabilitation professionals now deliver a wide range of approaches to support early intervention and prevention for children with diverse needs. This includes school-based approaches alongside teachers and families to enable children’s full and active participation in school [ 6 ].

Participation or “involvement in life situations” [ 1 ] is a key outcome. Participation may take place anywhere. In this paper, we focus on the context of school. Participation in school includes unstructured activities (e.g friendships, play), organized activities (e.g. sports, clubs, arts), classroom based activities (e.g. group work, study) and engagement in social roles [ 7 ]. Children with disabilities are at significant risk for limited participation in school [ 8 ]. Such restrictions have significant lifetime consequences for achievement, quality of life and wellbeing [ 9 – 12 ]. There are several issues. Attendance for children with disabilities is reduced compared to peers [ 13 ]. Students with disabilities participate less in structured and unstructured activities, and experience reduced interaction and playground participation [ 14 ]. Children with disabilities additionally show less engagement in the wider school world, including clubs and organizations [ 13 , 15 ].

Whilst there is an urgent need to develop interventions that promote participation in school, there is limited understanding of processes that may enable it [ 16 ]. Research to date has recognized the importance of psychosocial factors, though conclusions have been hampered by heterogeneous populations and variability in design and outcome measures [ 17 ]. There is little in the way of specific school based research to guide practices. Moreover, a requirement remains for comprehensive theories/models, as research has primarily considered individual psychosocial factors in isolation. A trend is departure from “medical” and “social” models. Both positions have been challenged as limiting [ 18 ]. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) [ 1 ] has been foundational to discussion with its definition of participation as “involvement in a life situation” and its assertion that the environment is a key determinant of participation (an integration of the “medical” and “social” models). However, the ICF has also provoked confusion and inconsistency in the field [ 16 , 19 , 20 ]. Everything people do is “involvement in a life situation” and participation is classified together with “activities” giving rise to conflicting interpretations [ 19 , 21 ]. Driven by the ICF, there has also been a tendency to focus on a portfolio of actions done in everyday life [ 19 ]. Such indicators of “doing” say little about psychosocial drivers of participation such as motivation, social connection, preferences, choice and meaningfulness [ 19 , 22 , 23 ]. This paucity of theory leads to a situation whereby enhancement of participation outcomes is often an aspiration, but reliable, environmental or psychosocial interventions are not available.

To date only Imms et al. 2016 has conducted research which integrates various factors in a useful new direction [ 24 ]. Their narrative systematic review, although it did not focus on school specifically, concluded that the participation phenomenon is essentially dichotomous—requiring children to “attend” (be present) and also to be “involved” (engage, experience and so forth) [ 24 ]. A further insight has been to differentiate between participation and other influencing or “participation related constructs” which include preferences, sense of self and activity competence [ 24 ]. This work highlights the importance of careful definition, as well as identification of some import psychosocial factors. However, this work did not consider environment factors in detail, and was based on an analysis of randomized controlled trials (RCT) and intervention type studies only. Such restrictive inclusion criteria will have contributed to limiting the data that could have been available. RCTs rarely focus on context, detail on mechanisms of action or conceptual underpinnings [ 25 ]. Analysis of RCTs is less useful for answering conceptual or theory based questions [ 26 ]. Therefore, the present review employed a realist review approach to identify a broad range of environmental and psychosocial factors associated with participation, and to uncover the association between context, mechanisms and participation outcomes in school-aged children with disabilities to guide the development and implementation of interventions and assessments.

Materials and methods

The United Kingdom Medical Research Council’s (MRC) guidance on development of complex interventions argues that new interventions must be underpinned by a conceptual framework and a theoretical understanding of the key processes underpinning an intervention [ 27 ]. This study uses realist review to address the requirement for theory and conceptual framework development outlined by the MRC. The process drew on systematic review and realist review methods. For systematic searching of the literature, we followed the PRISMA guidelines [ 28 ], as far as was relevant for a realist review. Realist methods were completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines [ 26 ].

We selected realist review as it meets requirements for dealing with complexity of both topic and research methods [ 25 , 29 , 30 ]. Realist review is an interpretive, theory-driven narrative summary which applies realist philosophy of exploring context, mechanisms and outcomes [ 25 ]. Developed in response to the weaknesses of traditional systematic review, realist review focusses on refining and developing theory. Realist reviews are organized around Context-Mechanism-Outcome (CMO) configuration [ 25 ]. Review aims to identify what works for whom, in what circumstances, in what respects and how, by identifying processes (mechanisms) that lead to outcomes in context [ 25 , 29 , 30 ]. The identification of open, embedded, interactive systems is central to the process of analysis. These assumptions constitute a realist philosophical ‘lens’ [ 25 ]. The steps of realist review are: (1) identifying the review question; (2) formulating the initial theory; (3) searching for primary studies; (4) selecting the studies and appraise their quality; (5) extracting, analyzing and synthesizing data. The details are described below [ 25 ].

Identifying the question

The review question was: “What are the mechanisms and contexts which determine successful participation in 4–12 year old children with disabilities in school?” In developing the question, we drew from a range of perspectives. As the findings were indented for use internationally, the research team included professionals from several countries (Japan, the United Kingdom, Spain, Australia, Bulgaria, the Netherlands, and the United States of America). We ensured that team members represented a range of voices from those with an interest in participation in schools, representing expertise in psychology, rehabilitation, medicine, community pediatrics, neurodisability, community health sciences, education, occupational therapy, disability theory, and global health. The research team included professors, post-doctoral fellows and a range of senior academics and expert clinicians. A wider advisory group included rehabilitation, social care and educational practitioners and managers who provided regular input. Initial questions and review direction were discussed over email between the research team and advisory group. This included a discussion on realist informed approaches including an explanation of Context, Mechanism and Outcomes and the basics of realist theory. The research and advisory groups felt that the focus and question set was an authentic question which reflected curiosity about how schools were working and interest in understanding how to improve children’s participation.

Formulating the initial theory

In line with a realist review approach, our initial thinking was informed by factors identified in the literature as possible key drivers of participation outcomes in school. Key literature was identified and synthesized through a scoping search [ 1 , 10 , 16 , 17 , 19 – 21 , 23 , 24 , 31 – 37 ]. This initial scoping helped to identify theoretical areas, concepts and perspectives (a summary of the initial literature review is presented in Appendix A in S1 File ). Amongst the main ideas considered were Bronfenbrenner’s ecological systems model [ 31 ], the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) [ 1 ] and practice models to support participation [ 34 ]. Using the above scoping review, discussion and analysis amongst the research team and advisory group led to the development of initial mechanisms, contexts and outcomes, and the target population. Initial mechanisms focused on personal psychosocial factors which may drive participation outcomes: (1) children’s choices, initiative, interests and skills and (2) patterning and performance of participation, including routines (e.g. going to school, eating lunch, playing with friends) and roles. Initial thinking also considered psychosocial factors related to common issues experienced by children with disabilities including pain, anxiety, stress, or fatigue. In considering the context, we drew on ecological systems theory, focusing on the “microsystem” as the system closest to the person and the one in which they have direct contact [ 31 ]. In this case, the characteristics of classrooms and schools, denoting circumstances within school that may be considered as enablers or barriers. This approach meant that issues pertaining to context outside the school (for example, the role of parents, home life, or government policies) were not considered.

Participation in school was the outcome of interest. The most common definition of participation originates in the World Health Organization’s International Classification of Functioning Disability and Health referring to a person’s “involvement in life situations” [ 1 ]. As noted, other authors have criticized this definition [ 17 , 38 ]. The definition used in the review builds on the ICF definition, but also implies that participation must be meaningful, with personal or social significance. Our definition reflects recent ideas [ 24 ] that participation has two essential components: attendance and involvement. The definition is presented in Table 1 .

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0210511.t001

The target population was defined as children who have a physical, developmental, behavioral, or emotional condition and who also require health and education services of a type or amount beyond that required by children generally [ 39 ]. Middle child hood (4–12 years) was selected as the target group. During middle childhood (defined as ages 4 to 12), a child’s mastery of developmental challenges is strongly influenced by school experiences, hence exploring participation in this context is important. Children are moving from nursery/kindergarten provision to increasingly formal education settings, but have not yet entered the adolescent phase where a number of other unique challenges appear.

Systematic searching process

Searches were conducted for English Language papers in MEDLINE, CINAHL, PhycINFO and ERIC databases covering the period January 2006 and November 2018. This span was chosen in order to capture a contemporary conceptualization of participation. Searching was completed by DM and SA. The search strategy utilized text word searching in the title or abstract along with database Subject Headings. Terms included disability “special needs”, “additional needs”, “disabled persons”, “motor disorders”, “developmental disabilities”, “intellectual disability”, “communication disorders”; age “child”, “children,” “pediatric”, “girl”, “boy”, “schoolchild”, “participation”, “inclusion,” “involvement”, “engagement”, “life situations,” “environment”, “surroundings”,”setting”, “context”, “school”, “education“, “class”, and “teacher”. Strategies were developed with support from an information professional (Appendix B in S1 File illustrates the strategy used in MEDLINE). In addition, a hand search compiled by DM and SA checked reference lists from relevant articles, including all those included in the review.

Selection and appraisal of studies

Members of the research team screened a portion of the titles and abstracts (DM, SA, MR). The potentially relevant records identified by individual members of the research team were then discussed with the other authors to confirm eligibility. This was followed by screening the full text of potentially relevant studies to determine eligibility for inclusion.

Overall, if papers contained evidence relevant to school participation (or related proxy outcome, e.g. school attendance), for children with a disability/special educational need, with discussion of environmental and/or psychosocial factors, the document was retained for further review. In keeping with realist methods, selection criteria regarding study design were not predominant [ 25 , 29 , 30 ]. Methodologically, papers could include any type of peer-reviewed paper including intervention studies, observational research, qualitative research and literature reviews. Literature reviews may be included in realist review if they provide relevant theoretical insights [ 25 , 29 , 30 ]. We did reject all purely descriptive accounts (e.g. opinion pieces or editorials) and grey literature as there was ample peer-reviewed material. We also excluded psychometrics focused papers, due to their general interest in identifying what participation was, rather than its influencing factors. Children with disabilities were identified via medical diagnosis or other support needs (e.g. identified as requiring “special” education). Papers focusing solely on community or leisure participation were rejected, although papers which discussed school participation amongst other settings were included. We aimed to identify studies of relevance to middle childhood which we defined as 4–12 years. Studies close to this age range were passed onto the next stage for further assessment if the findings were viewed by the team as potentially relevant and generalizable to middle childhood. In some cases the assessment of age was not necessary, as the participants were teachers, parents or health professionals, and in the case of some reviews. Initial screening criteria are in Table 2 .

https://doi.org/10.1371/journal.pone.0210511.t002

In accordance RAMESES guidelines [ 26 ], final selection of papers focused on contributions in terms of whether articles were appropriate for the research question (relevance) and quality of evidence (rigour) [ 25 , 29 , 30 ]. This was an iterative process, and disagreements were dealt with via discussion (DM, SA and MR). Review of relevance was used to ensure a systematic process and to reduce selection bias. A system of questions was used to identify whether an article was relevant by examining content, insights provided by the study and focus (see Table 3 ). Assessment of rigour was used to judge quality, credibility and trustworthiness of evidence [ 25 ]. Each reviewer appraised each paper by asking key questions on research quality [ 40 ]. Papers could be excluded on the basis of relevance or rigour. Each paper was scored 0 (failed to meet criteria) or 1 (met criteria). Studies scoring 0 on either criteria were excluded.

https://doi.org/10.1371/journal.pone.0210511.t003

Data extraction, analysis and synthesis

Data were extracted using predefined forms by DM, SA and MR, regularly checking each other’s work. Data were extracted on: country and author; sample characteristics: sample size; participants’ age and gender; diagnostic category (if available); key findings; relevance and rigor mechanisms, contexts, and outcomes.

Analysis were done by DM, SA and MR following a staged process based on careful review, coding and frequent return to primary studies as necessary. Broad aspects of context and mechanism were identified and coded first. The key analytic process in realist review involves iterative testing and refinement of theoretically based explanations for why outcomes happen, using research papers as data sources [ 25 , 29 , 30 ]. In our case we were focused on participation in the school, and we attempted to find and synthesize evidence to demonstrate that particular mechanisms were important in generating school participation outcomes and to identify which aspects of context mattered. Data were synthesized using qualitative methods (content and thematic analysis) [ 41 ], using realist concepts as a framework [ 25 , 26 ]. Context and mechanisms were operationalized using codes and sub-codes as in typical qualitative analysis [ 41 ]. In the early stages very many individual codes were created and grouped. For example all aspects relating to the child’s motivations were grouped into a broad “motivations” category and all aspects of the physical environment were grouped into a “physical environment” category. Specific aspects were then identified and coded with sub-codes, e.g. social aspects, physical access, or assistive devices. As analysis progressed, more refined codes were created and sorted and grouped to identify mutually exclusive categories of mechanisms and contexts which were coherent and could be designated a single unifying label.

As the analysis progressed, evidence of which mechanisms and context were important was carefully mapped against the emerging taxonomy. Tables were derived, including categories and sub-components, including each article relating to the sub-component. Regular meetings were held and interpretations shared across the research team and advisory group, including re-examination the original articles. Further refinement of the findings continued until agreement was reached. Following final assessment, two members of the research team reviewed once again the articles, and checked the findings. We also attempted to identify disconfirming data or data that might challenge or refute ideas. During this process there was a point at which no new categories of mechanisms or context emerged i.e. saturation was attained. Final labels were then assigned to each area and the narrative summary was written.

The electronic literature search and hand search identified 1828 papers, 1168 of which were removed at the title and abstract stage. Next, 172 papers were reviewed in full. On review, 100 papers were excluded, leading to 72 papers in the final synthesis ( Fig 1 ) (full details of all papers are provided in Appendices C and D in S1 File ). Type of disability was consistent with issues commonly seen in schools (including Autism Spectrum Disorders, Cerebral Palsy, Learning Disability, Learning Difficulty, Developmental Delay, and Physical Disabilities) (Appendices C and D in S1 File ). Forty-six percent (n = 33) of the research was quantitative in design (including trials, cross sectional studies, observational studies and quasi-experimental studies), with the remainder consisting of mixed-methods (n = 4, 5%), qualitative (n = 17, 24%) and review papers (n = 18, 25%). Sample size ranged from 6 to 47 participants in qualitative research, and 14 to 3,752 participants in quantitative (excluding two very large national studies ranging from 18,119 to 64,076 (weighted) participants) (Appendix C in S1 File ). Studies from Europe (n = 28), the USA and Canada (n = 22) accounted for 70% of papers with the remainder coming from Australia (n = 11), Brazil (n = 1), Chile (n = 1), Israel (n = 4), Japan (n = 1), New Zealand (n = 1), Taiwan (n = 1), India (n = 1) and Thailand (n = 1) (Appendices C and D in S1 File ).

https://doi.org/10.1371/journal.pone.0210511.g001

The initial analysis identified 72 contexts and 79 mechanisms. These were the psychosocial child and environment factors driving participation outcomes in schools. Further analysis revealed three synthesized mechanisms, and five synthesized contexts. Based on the evidence, we constructed a conceptual framework that depicts mechanisms and contexts influencing school participation for children with disabilities ( Fig 2 ). Details on specific categories of mechanisms and context are provided below.

Context and mechanisms hypothesized to be vital intervening factors in predicting children’s participation. Context provides opportunities and constraints. Mechanisms drive participation outcomes. Participation as an outcome has two components: attendance and involvement [ 24 ]. As children participate, they experience feelings, sensations and perceptions which may be adaptive or maladaptive (e.g. enjoyment, boredom, amusement). There is a cyclical relationship between participation, context and mechanisms.

https://doi.org/10.1371/journal.pone.0210511.g002

Synthesis of findings led to three overarching mechanisms representing psychosocial issues and the child’s experiences (supporting studies are presented in Table 4 and Appendix E in S1 File ).

• (1). Identity —these mechanisms were associated with “being”, or the thoughts and feelings the child had about themselves (e.g. believing in themselves, having confidence, understanding their roles or feeling a like a member of the school community) as well as perceptions of activities and tasks in school (e.g. interests, preferences or perceived enjoyment).
• (2). Competence —these mechanisms were associated with “doing” or what the child did in school (e.g. following rules, showing interest, being confident, or following a routine).
• (3). Experience of mind and body (symptoms) –these mechanisms were associated with issues commonly experienced by children with disabilities in schools: pain, anxiety, mood and fatigue/tiredness.

https://doi.org/10.1371/journal.pone.0210511.t004

Analysis indicated that these mechanisms related to the child “being”, and how children perceived and made sense of their participation within school. Firstly, the information extracted from studies overwhelmingly and specifically demonstrated the relevance of mechanisms related to motivations, preferences, and interests. The key mechanisms were children’s own interests and preferences including selection of certain activities based on interests/preferences and perceptions around potential enjoyment (or not) of activities which motivated choices [ 14 , 24 , 42 – 46 , 46 – 52 ]. Participation was also strongly influenced by children’s self-perceptions, including self-esteem, self-efficacy, confidence, and perceived competence—all of which influenced children’s activity in-the-moment and over time, influencing current and future participation[ 24 , 46 , 48 – 58 ]. Perceptions around meaningfulness were also identified as an influencer of participation, including perceptions around activities that were valued or especially significant to children, as well as perceptions of personal satisfaction and pleasure associated with activities[ 14 , 21 , 24 , 45 , 50 , 51 , 59 , 60 ].

Children’s internalization and understanding of routines and habits emerged as conditions influencing participation in school. Studies highlighted children’s internalization of habit/routine, familiarity with habit/routine and automaticity of habit/routine were mechanisms for participation [ 44 , 53 , 62 – 64 ]. Knowing the steps involved in activities or routines led to reduced demands on the child to understand, process, or plan, and when internalized as patterns of actions, facilitated participation by providing a set of rules to navigate the school context. Routines of the school day were noted to shape children’s daily participation, with references to the fact that children’s participation in school was supported by structured activities and programs [ 44 , 64 ], and that regularized activities in the classroom supported participation for children with disabilities [ 44 ]. Children themselves perceived that rules, norms and routines are important in structuring their participation [ 62 ]. Parents also indicated that routines influence participation [ 44 , 53 ].

Children’s knowledge, understanding and subjective experience of roles influenced their participation. In the school, possible roles included being a pupil, friend or member of a club. Disabled children tended to occupy less “desirable” roles within the school. Roles considered desirable by children, especially those including being good at something (e.g. best in class) or “best friend” roles were seldom held by children with disabilities [ 61 ]. Children with disabilities also engaged in less “doing roles” (such as athlete, leader, helper and tutor) and more were likely to be classified into negative roles including “challenged learner”, victim or bully [ 61 ]. Mechanisms influencing participation were internalization of roles (either positive or negative roles), leading to positive or negative self-perceptions, and understanding/knowledge of role requirements [ 56 , 61 ]. Related mechanisms included self-perceptions relating to inclusion, focusing on children’s subjective experiences of social inclusion, sense of membership and sense “school” identity [ 57 ].

Competence.

Competence mechanisms reflected “doing” or behavioral aspects and how children engaged in participation. Well-supported mechanisms enabling participation were children taking initiative, being proactive and acting on interests [ 14 , 24 , 44 , 52 , 53 , 65 – 68 ] Research also demonstrated that seeking independence and autonomy, showing responsibility and commitment, displaying persistence and perseverance were drivers of participation [ 45 , 47 , 51 – 53 , 57 , 68 – 72 ].

Other competence mechanisms related to following routines and having daily habits [ 55 , 62 ] as well as consistency of behavior, including being predictable, being systematic and preparedness for routines [ 55 , 62 ]. Also identified as important conditions for participation were children meeting teachers’ expectations and following the school’s rules [ 61 ]. Finally, patterns of behaviors that followed from particular roles were identified as shaping quality and quantity of participation, including patterns of behaviors associated with friendship roles and patterns of behaviors associated with school-based roles (for example sports team member) [ 57 , 61 , 70 , 71 , 73 ].

Studies exploring relationships between skills and participation were common. In total, 27 papers provided data. However, researchers are now concluding that deficits or improvements in skills, although related to participation, are not related in a direct or linear fashion. The evidence challenges the idea that an increase in skill equates to an increase in participation. Psychological characteristics, personality and preferences are also important [ 14 ]. The evidence did indicate, however, that skills were important for the completion of certain types of activities in certain situations. For example, social skills are often required to access play situations [ 57 ]. The mechanisms related to skills identified as important for participation were organisation and planning (e.g. sequencing, concentration and memory) [ 35 , 46 , 49 , 51 , 52 , 55 , 56 , 63 , 70 , 72 , 74 ]; communication/social skills [ 14 , 15 , 42 , 49 , 51 – 53 , 67 , 72 , 74 ] and motor skills [ 8 , 14 , 49 , 51 , 52 , 55 , 58 , 70 – 72 , 74 – 80 ].

Experience of mind and body.

The literature provided good support for the influence of symptoms associated with disability on participation. These were pain, fatigue, anxiety and mood. Twenty-two papers provided data. Identified mechanisms were concerned with experiences related to symptoms. These were: pain (especially cognitions and catastrophizing) [ 8 , 14 , 52 , 71 , 75 , 79 , 81 – 83 ]; fatigue, including lowered energy, tiredness, and sleep disturbance[ 14 , 46 , 58 , 71 , 80 , 84 – 86 ]; anxiety and its consequences including fear, frustration, and anger [ 46 , 51 , 53 , 58 , 60 , 71 , 80 , 87 – 89 ], and low mood, sadness or depression [ 13 , 52 , 71 , 80 , 81 , 84 , 89 ].

Fundamental underpinnings were closely related across the different symptoms, drawing on social learning and cognitive-behavioural theory, suggesting that illness behaviours or responses generate negative behavioural patterns which may be maintained and strengthened over time [ 8 , 13 , 71 , 75 , 81 , 83 ]. These mechanisms lead to reduced participation through disengagement from activity and a cyclical pattern of attempts to control symptoms through increasing withdrawal from activities.

The next step was to explore how and which contexts facilitated or provided opportunities for participation versus contexts which restricted/constrained participation. This twofold role of context was evident throughout. Context comprised five interrelated areas: (1) structures and organization of the school, (2) peers, (3) adults, (4) physical spaces and (5) objects. Sub-components of each area were identified by the reviewers, focusing on opportunities (supports) or constraints (barriers) to school participation (supporting studies are presented in Table 5 and Appendix F in S1 File ).

https://doi.org/10.1371/journal.pone.0210511.t005

Structure and organization.

Structure and organization was a well-supported aspect focusing on the ways things were done in the school. Facilitative aspects were described as being tailored to the child, responsive to needs, individualized, and child led [ 10 , 15 , 17 , 21 , 24 , 42 – 44 , 49 , 52 , 54 , 57 , 58 , 62 – 65 , 67 – 70 , 80 , 90 – 94 , 96 ]. Facilitative structures/organization were also described as adaptable and flexible [ 10 , 14 , 36 , 44 , 52 , 64 , 65 , 68 , 69 , 80 , 96 , 97 , 98 ], predictable [ 44 ] and well-planned [ 10 , 68 , 69 , 93 , 96 , 98 ]. The most common constraint to participation identified was lack of individualization [ 15 , 20 , 42 , 44 , 49 , 53 , 57 , 58 , 65 , 66 , 69 , 71 , 72 , 80 , 91 , 97 , 98 ]. Other identified constraints included rigid routines [ 10 , 14 , 67 , 80 , 84 , 92 , 93 , 97 , 98 ] or routines which were unpredictable or disordered [ 70 , 72 ].

There was abundant evidence that adults (referring to teachers and other staff within school) were key in creating opportunities for participation and were also influential in shaping the quality, frequency and range of children’s roles [ 16 , 21 , 42 , 43 , 52 , 57 , 61 , 64 , 66 , 96 , 97 , 99 ]. Adult’s positive and sympathetic attitudes were facilitative of participation [ 14 , 93 , 96 , 99 , 100 ] as were individuals who were competent and knowledgeable [ 44 , 62 , 49 , 68 , 96 , 99 ]. Good collaboration between adults was also facilitative [ 14 , 68 , 93 , 96 , 99 ]. Attitudes were identified as restrictive, as well as adults who were unsympathetic [ 10 , 44 , 47 , 53 , 58 , 71 , 72 , 80 , 93 , 99 , 100 ] or lacking in knowledge [ 14 , 35 , 49 , 101 ]and institutional collaboration [ 35 , 69 , 99 ]. Adults were also noted to play a part in shaping negative roles (e.g. by ‘pigeonholing’ children with disabilities as less able and therefore offering them fewer participation opportunities, or by being reluctant to allow students to learn or play independently) [ 61 ].

The evidence indicated that facilitative peers (referring to other children within the school) provided practical and emotional support enabling participation [ 10 , 15 , 16 , 21 , 43 , 44 , 46 , 49 , 57 , 58 , 60 , 64 , 68 ]. Facilitative peers also provided opportunities for friendship [ 43 , 49 , 61 , 71 , 73 ]. Positive attitudes were also identified as important in creating opportunities for participation [ 24 , 36 , 46 , 69 , 93 , 100 ]. Studies also identified non-supportive actions and behaviours, including bullying [ 15 , 43 – 45 , 57 , 61 , 71 , 73 , 80 , 92 , 99 ], negative attitudes [ 10 , 46 , 53 , 58 , 78 , 80 , 92 , 93 , 100 ], and friendship avoidance [ 15 , 49 , 60 , 66 , 71 , 87 ].

Supportive spaces were described as being accessible and usable [ 10 , 14 , 21 , 24 , 36 , 44 , 45 , 59 , 60 , 65 , 67 , 68 , 69 , 71 , 78 , 97 , 99 ] with suitable design/layout and suitable sensory qualities [ 53 , 60 , 62 , 68 , 86 , 96 , 99 ]. Constraints to participation focused on restricted access to areas where activities happen [ 10 , 14 , 35 , 47 , 49 , 52 , 53 , 60 , 65 , 71 , 78 , 92 , 97 , 99 , 103 ]. Other issues included unsuitable sensory qualities, spaces which were unfamiliar, and spaces which were crowded or difficult to navigate [ 35 , 52 , 53 , 60 , 65 , 97 , 99 ].

Research on objects focused on the availability of objects needed to participate in specific activities, for example, wheelchairs and assistive devices [ 10 , 14 , 21 , 24 , 35 , 36 , 52 , 59 , 60 , 62 , 63 , 65 , 91 , 99 ]. Usability and acceptability to the child were noted as important [ 14 , 44 , 50 , 52 , 53 , 60 , 71 , 72 , 99 ]. Research on constraints associated with objects was fairly limited. Objects being unavailable [ 10 , 60 , 65 , 72 , 99 ], difficult to use [ 35 , 53 , 50 , 99 ] or isolating/stigmatizing [ 45 , 50 ] were identified as constraints to participation.

This realist review has developed a conceptual framework for children’s school participation, and identified the processes (mechanisms) and contexts influencing participation outcomes. The synthesis is of key issues that decision-makers and interventionists may consider to help children to participate in school.

The findings support the hypothesis that identified mechanisms and contexts are important factors associated with participation outcomes. Specifically, the findings show mechanisms in three clusters focusing on identity, competence and the child’s experience of mind and body. The context (environment) is conceptualized in terms of adults, peers, the schools’ structures and routines and spaces/objects. Unlike most models designed for dealing with specific impairments or diagnoses, this model is useful with any child with any health related need or disability experiencing problems with their participation. This is a middle range theory. The term ‘middle range’ theory refers to the level of abstraction at which useful theory for realist work is written: detailed enough and ‘close enough to the data’ that testable hypotheses can be derived from it, but abstracted enough to apply to other situations as well [ 26 ]. Middle range is useful because it offers an analytical approach to linking findings from different situations [ 26 ]. The outcomes of a realist review are ideally framed as middle range theory—that is, theory that can usefully be applied across a range of situations, or in a number of domains [ 26 ]. Findings are (by design) age limited (4–12 years old), but are independent of gender, disability category or ethnicity, supporting application across a range of clinical and educational settings. Ideas reflect a contemporary conceptualization of participation drawn from 72 research papers. The model imagines mechanisms and contexts in dynamic and transactional relationships. This is a “generative causality” model. Explanation is not a matter of a singular mechanism or a combination of mechanisms asserting influence on an outcome. School participation emerges out of a cooperation of factors.

No single factor fully explains variance in participation [ 56 ]. Previous research provides indications of which features of the child significantly affect the participation of students with disabilities, including focus on psychosocial factors for participation, such as preferences [ 102 ]. Our findings support the significant importance of children’s preferences, interests and motivations for participation. Our review also adds to the literature by providing detail on habits and routines which are novel elements not commonly considered. Based on our findings, we recommend that issues associated with habits and routines are closely considered in future. We have found that deficits in routine and habits are important contributors. Habit and routines are performed repeatedly and are relatively automatic. They specify what the child will do and in what order, and, thus, constitute key mechanisms for participation. Habits and routines must be understood and internalized and there are additionally ties to environment. As noted by Engman and Cranford (2016), the quality of habitual action is not equally easy for all—in some environments “non-normative embodiment” (i.e. disability) is less likely to make habitual behaviour achievable than in others [ 104 ]. The structure of the environment enables or restricts consistent, structured and planned schedules and routines. Adults facilitate breaks, social routines, setting of rules and expectations, while objects (timetables and other prompts) provide specific routines (e.g. for gathering information, or which classes to go to).

Our model focusses on participation as a key outcome which is influenced by environmental factors. In line with the ICF [ 1 ], and in the wider literature, the environment is noted to have a significant influence on participation [ 8 , 75 , 78 , 92 , 100 ]. We advance thinking by identifying specific environment factors and offering potential for comprehensive assessment and intervention. This is important, as the potential selection of environmental factors is vast. The issue is to identify specific matters facilitating or obstructing participation in school. The identification of issues must be completed in tandem with a contemporary model of participation itself. Small aspects of the school microsystem can go unnoticed if attention is not drawn to them. A focus on the school environment explicitly defined will support guidelines for working to support participation. The current study findings indicate contextual influence of the school is not just a sum of the people, objects and spaces, but also “how” things are done, or expected to be done within the school (the structures and organization of the school) and the important part adults play in providing opportunities for participation and social roles. Our findings highlight the importance of a nuanced understanding of the environment and not just consideration of physical aspects. Identification of physical aspects of the school, whist important, should always be considered alongside the social environment.

Implications for practitioners

International practice is moving towards the adoption of system/ecological views, but the field still operates predominantly from a unidirectional perspective where “something” is provided to “fix” the person with a disability [ 18 ], rather than operating from more contemporary view of participation as a phenomenon that can be mobilized at different levels. The findings of this review show that individual and environmental interventions should be developed promote participation outcomes in schools. Identified mechanisms offer a potential basis for developing psychosocial child-focused interventions. Mechanisms (e.g. preferences, perceptions of self, perceptions of roles, internalization of routines) are appropriate targets for intervention. These ideas are congruent with recent studies emphasizing that individually tailored coaching and mentoring may help to improve children’s participation [ 17 ]. As noted, however, change will not be effective if it is only targeted at the child. Contextual elements interact with mechanisms to make participation more or less likely and must also be a focus for intervention.

With a focus on school, teachers’ knowledge is of key importance [ 105 ]. Efforts are required to assist teachers’ regarding knowledge and confidence in enhancing participation. Teachers work with increasingly diverse groups of learners and are responsible for attempting to achieve positive outcomes [ 106 ]. Concerns have been expressed that education remains less effective for learners with disabilities [ 2 ]. Concerns are understandable particularly when schools and teachers tend to be rated on achievement, rather than participation [ 107 ]. Existing supports, strategies and approaches for children with disabilities, along with theoretical underpinnings, are frequently superficial and lacking in detail [ 108 ]. Practical aspects of how to “do” inclusion or participation are therefore difficult to see and implement. Previously developed supports and interventional resources have also tended to focus on specific issues or diagnoses (e.g. Autism, Dyslexia, Learning Disability)–leading to “a programme for every problem” [ 109 ]. This has two consequences. Firstly, educationalists follow a medical or disease orientated model, with the consequential issues around disempowerment and depersonalization of people with disabilities [ 18 ]. Secondly, those with responsibility for supporting children with disabilities may feel overwhelmed by the range of options [ 105 ]. The complexity and number of programs makes selecting the right option for the right child at the right time difficult.

Implications for research

Future research could explicitly link intervention components to mechanisms as described in this review. Following methods which use formal means for developing theoretically determined interventions [ 110 ], ‘theory-based’ rather than ‘theory-inspired’ interventions, may be developed. Such research is closely aligned to the UK MRC framework for development of complex interventions [ 27 ]. Identified mechanisms offer a basis for understanding how and why therapeutic or educational interventions for children may or may not be effective at improving school participation. Identification of strategies for the detection and cultivation of facilitative contextual elements would also follow from the above methods.

Further research activities include selection of appropriate items for school participation measurement. Parent-report methods have been commonly used in medical and psychological research to collect participation information [ 86 ]. However, researchers should also consider other data collection methodologies, particularly report by teachers [ 19 ].

Limitations

While we have attempted to make our search as sensitive as possible (and erred on the side of sensitivity as opposed to specificity), participation continues to be a diverse area spanning several disciplines with limited consensus on terminology. It is difficult to design a perfect strategy. Given the methodological assumptions of realism, other reviewers could come to different conclusions. However, themes and concepts driving the model were apparent across different types of difficulties/disabilities, across studies that used different research methods, and across a range of international contexts. Consistency in identified features provides evidence to support conclusions.

Conclusions

This was the first realist review to explore mechanisms and contexts for school participation of children with disabilities. This paper presents a conceptual framework including child psychosocial factors, such as understanding of routines, sense of self, and perceptions of role, and as well as characteristics of the school environment. We encourage researchers, practitioners, and policymakers to consider these contexts and mechanisms when addressing school participation among children with disabilities. Consideration of interventions, designed specifically to enhance participation by targeting mechanisms, contexts and the processes identified in this review, is now key.

Supporting information

S1 file. appendices..

https://doi.org/10.1371/journal.pone.0210511.s001

S2 File. PRISMA standards.

https://doi.org/10.1371/journal.pone.0210511.s002

S3 File. RAMESES standards.

https://doi.org/10.1371/journal.pone.0210511.s003

Acknowledgments

The study was initiated by a partnership between the Salvesen Mindroom Centre in the University of Edinburgh and the CIRCLE Collaboration (Child Inclusion: Research into Curriculum, Learning and Education) research team at Queen Margaret University, Edinburgh. We would like to acknowledge Miriam Crowe, Deborah McCartney and Cathleen Hunter for support and critical comment on the manuscript. Funding for this work was received from the Salvesen Mindroom Centre for Learning Difficulties.

• 1. World Health Organization. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY. Switzerland: World Health Organization; 2007.
• View Article
• Google Scholar
• 5. United Nations International Children’s Emergency Fund. Children with disabilities. New York: United Nations; 2013.
• PubMed/NCBI
• 18. Oliver M. Understanding disability: From theory to practice. NY: St. Martin’s Press; 1996.
• 22. Hemmingsson H, Egilson S, Hoffman O, Kielhofner G. A user’s manual for the School Setting Interview (SSI)(version 3.0). Chicago: MOHO Clearinghouse, Department of Occupational Therapy, University of Illinois at Chicago; 2005.
• 25. Pawson R. Evidence-based policy: a realist perspective. London: Sage; 2006.
• 29. Pawson R, Tilley N, Tilley N. Realistic evaluation. London: Sage; 1997.
• 30. Pawson R. The science of evaluation: a realist manifesto. London: Sage; 2013.
• 31. Bronfenbrenner U. The ecology of human development. Cambridge, MA: Harvard University Press; 1979.
• 33. Bronfenbrenner U, Morris P. The ecology of developmental processes. In: Damon W, Lerner RM, editors. Handbook of child psychology: Theoretical models of human development. Hoboken, NJ, US: John Wiley & Sons; 1998 p 993–1028.
• 34. Kielhofner G. A model of human occupation: Theory and application. Baltimore: Lippincott Williams & Wilkins; 2002.
• 37. Solli HM, Da Silva AB. The holistic claims of the biopsychosocial conception of who’s international classification of functioning, disability, and health (ICF): A conceptual analysis on the basis of a pluralistic-holistic ontology and multidimensional view of the human being. 2012;37; 277.
• 41. Grbich C. Qualitative data analysis: An introduction. London: Sage; 2012.

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• PubMed/Medline
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Access and participation of students with disabilities: the challenge for higher education.

1. Introduction

2. conceptualisation, 3. results, state of play, access, and participation of students with disabilities in higher education, 4.1. search strategy, 4.2. selection criteria, 4.3. literature selection, 4.4. data extraction and analysis, 6. discussion, 7. conclusions, limitations and future studies, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

• Ainscow, M.; Slee, R.; Best, M. Editorial: The Salamanca statement: 25 years on. Int. J. Incl. Educ. 2019 , 23 , 671–676. [ Google Scholar ] [ CrossRef ]
• European Agency for Special Needs and Inclusive Education. Evidence of the Link between Inclusive Education and Social Inclusion: A Review of the Literature ; European Agency for Special Needs and Inclusive Education: Odense, Denmark, 2018. [ Google Scholar ]
• UN. Empowering Children with Disabilities for the Enjoyment of Their Human Rights, Including through Inclusive Education ; UN: New York, NY, USA, 2019. [ Google Scholar ]
• Ramberg, J.; Watkins, A. Exploring inclusive education across Europe: Some insights from the European agency statistics on inclusive education. Fire Forum Int. Res. Educ. 2020 , 6 , 85–101. [ Google Scholar ] [ CrossRef ]
• Lacono, T.; Keefe, M.; Kenny, A.; Mckinstry, C. A document review of exclusio-Tnary practices in the context of australian school education policy. J. Policy Pract. Intellect. Disabil. 2019 , 16 , 264–272. [ Google Scholar ] [ CrossRef ]
• World Health Organization. The World Health Report 2001: Mental Health: New Understanding, New hope ; World Health Organization: Geneva, Switzerland, 2001. [ Google Scholar ]
• Darrow, A. Barriers to effective inclusion and strategies to overcome them. Gen. Music Today 2009 , 22 , 29–31. [ Google Scholar ] [ CrossRef ]
• Nieto, C.; Moriña, A. Barriers and Facilitators for the Educational Inclusion of Persons with Intellectual Disabilities. Siglo Cero 2021 , 52 , 29–49. [ Google Scholar ] [ CrossRef ]
• Pivik, J.; McComas, J.; Laflamme, M. Barriers and facilitators to inclusive education as reported by students with physical disabilities and their parents. Except. Child. 2002 , 61 , 97–107. [ Google Scholar ] [ CrossRef ]
• Márquez, C.; Sandoval, M.; Sánchez, S.; Simón, C.; Moriña, A.; Morgado, B.; Moreno-Medina, I.; García, J.A.; Díaz-Gandasegui, V.; Elizalde San Miguel, B. Evaluación de la inclusión en educación superior mediante indicadores. REICE. Rev. Iberoam. Sobre Calid. Efic. Y Cambio En Educ. 2021 , 19 , 33–51. [ Google Scholar ] [ CrossRef ]
• Pérez Castro, J. Between barriers and enablers: The experiences of university students with disabilities. Sinéctica 2019 , 53 , 1–22. [ Google Scholar ] [ CrossRef ]
• Yssel, N.; Pak, N.; Beilke, J. A Door Must Be Opened: Perceptions of Students with Disabilities in Higher Education. Int. J. Disabil. Dev. Educ. 2016 , 63 , 384–394. [ Google Scholar ] [ CrossRef ]
• Alcain, E.; Medina, M. Hacia una educación universitaria inclusiva: Realidad y retos. Rev. Digit. Investig. Docencia Univ. 2017 , 11 . [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Mullins, L.; Preyde, M. The lived experience of students with an invisible disability at a Canadian university. Disabil. Soc. 2013 , 28 , 147–160. [ Google Scholar ] [ CrossRef ]
• Moriña, A.; Cotán Fernández, A. Educación Inclusiva y Enseñanza Superior desde la Mirada de Estudiantes con Diversidad Funcional. Rev. Digit. Investig. Docencia Univ. 2017 , 11 , 20–37. [ Google Scholar ] [ CrossRef ]
• Thomas, L. Developing inclusive learning to improve the engagement, belonging, retention, and success of students from diverse groups. In Widening Higher Education Participation. A Global Perspective ; Shah, E.M., Bennett, A., Southgate, E., Eds.; Elsevier: Oxford, UK, 2016; pp. 135–159. [ Google Scholar ]
• Hewett, R.; Douglas, G.; McLinden, M.; Keil, S. Developing an inclusive learning environment for students with visual impairment in higher education: Progressive mutual accommodation and learner experiences in the United Kingdom. Eur. J. Spec. Needs Educ. 2017 , 32 , 89–109. [ Google Scholar ] [ CrossRef ]
• Sharma, U.; Loreman, T.; Simi, J. Stakeholder perspectives on barriers and facilitators of inclusive education in the solomon islands. J. Res. Spec. Educ. Needs 2017 , 17 , 143–151. [ Google Scholar ] [ CrossRef ]
• Alesech, J.; Nayar, S. Teacher strategies for promoting acceptance and belonging in the classroom: A New zealand study. Int. J. Incl. Educ. 2019 , 25 , 1140–1156. [ Google Scholar ] [ CrossRef ]
• Fernández Batanero, J.M. TIC y Discapacidad: Investigación e Innovación Educativa ; Octaedro: Barcelona, Spain, 2020. [ Google Scholar ]
• Boynton, l.; Mahon, J. Secondary teachers’ experiences with students with disabi-lities: Examining the global landscape. Int. J. Incl. Educ. 2018 , 22 , 306–322. [ Google Scholar ] [ CrossRef ]
• Aguirre, A.; Carballo, R.; López-Gavira, R. Improving the academic experience of students with disabilities in higher education: Faculty members of Social Sciences and Law speak out. Innov. Eur. J. Soc. Sci. Res. 2021 , 34 , 305–320. [ Google Scholar ] [ CrossRef ]
• Bunbury, S. Disability in higher education do reasonable adjustments contribute to an inclusive curriculum? Int. J. Incl. Educ. 2020 , 24 , 964–979. [ Google Scholar ] [ CrossRef ]
• Moriña, A.; Perera, V.H.; Melero, N. Difficulties and reasonable adjustments carried out by Spanish faculty members to include students with disabilities. Br. J. Spec. Educ. 2020 , 47 , 6–23. [ Google Scholar ] [ CrossRef ]
• Moswela, E.; Mukhopadhyay, S. Asking for too much? The voices of students with disabilities in Botswana. Disabil. Soc. 2011 , 26 , 307–319. [ Google Scholar ] [ CrossRef ]
• Xiao, Y.; Watson, M. Guidance on Conducting a Systematic Literature Review. J. Plan. Educ. Res. 2019 , 39 , 93–112. [ Google Scholar ] [ CrossRef ]
• Manterola, C.; Astudillo, P.; Arias, E.; Claros, N. Revisiones sistemáticas de la literatura. Qué se debe saber acerca de ellas. Cirugía Española 2013 , 91 , 149–155. [ Google Scholar ] [ CrossRef ]
• Moher, D.; Shamseer, L.; Clarke, M.; Ghersi, D.; Liberati, A.; Petticrew, M.; Shekelle, P.; Stewart, L. Preferred Reporting Items for Systematic review and Meta-analysis Protocols (PRISMA-P) 2015 statement. Syst. Rev. 2015 , 4 , 1–9. [ Google Scholar ] [ CrossRef ]
• Knoke, D.; Yang, S. Social Network Analysis ; Sage: Thousand Oaks, CA, USA, 2008. [ Google Scholar ]
• Moriña Díez, A.; Molina Romo, V. La universidad a análisis: Las voces del alumnado con discapacidad. Rev. Enseñanza Univ. 2011 , 37 , 23–35. [ Google Scholar ]
• Nava-Caballero, E.M. The Access and the integration of the students with disability of Leon’s University. Rev. Complut. Educ. 2011 , 23 , 293–316. [ Google Scholar ] [ CrossRef ]
• Ryan, J. Access and participation in higher education of students with disabilities: Access to what? Aust. Educ. Res. 2011 , 38 , 73–93. [ Google Scholar ] [ CrossRef ]
• Ocampo González, A. Inclusion of students with disabilities into the university. Challenges and opportunities. Rev. Latinoam. Educ. Inclusiva 2012 , 6 , 227–239. [ Google Scholar ]
• Opini, B. Barriers to Participation of Women Students with Disabilities in University Education in Kenya. J. Postsecond. Educ. Disabil. 2012 , 25 , 65–79. [ Google Scholar ]
• McEwan, R.C.; Downie, R. College Success of Students with Psychiatric Disabilities: Barriers of Access and Distraction. J. Postsecond. Educ. Disabil. 2013 , 26 , 233–248. [ Google Scholar ]
• Zubilllaga del Río, A.; Alba Pastor, C.; Sánchez Hípola, M.P. Technology as a tool to respond to diversity in the university: Analysis of disability as a differentiating factor in the access and use of ICT among college students. Rev. Fuentes 2013 , 13 , 193–216. [ Google Scholar ]
• Kendall, L. Higher education and disability: Exploring student experiences. Cogent Educ. 2016 , 3 , 1256142. [ Google Scholar ] [ CrossRef ]
• Palma, O.; Soto, X.; Barría, C.; Lucero, X.; Mella, D.; Santana, Y.; Seguel, E. An qualitative study of the adaptation process and inclusion of a group of students with disabilities from higher education at University of Magallanes. Magallania 2016 , 44 , 1–10. [ Google Scholar ]
• Heiman, T.; Fichten, C.S.; Olenik-Shemesh, D.; Keshet, N.S.; Jorgensen, M. Access and perceived ICT usability among students with disabilities attending higher education institutions. Educ. Inf. Technol. 2017 , 22 , 2727–2740. [ Google Scholar ] [ CrossRef ]
• Alsalem, G.M.; Abu Doush, I. Access Education: What is needed to have accessible higher education for students with disabilities in Jordan? Int. J. Spec. Educ. 2018 , 33 , 541–561. [ Google Scholar ]
• Majoko, T.; Dunn, M.W. Participation in higher education: Voices of students with disabilities. Cogent Educ. 2018 , 5 , 1542761. [ Google Scholar ] [ CrossRef ]
• Rodríguez Molina, G.A.; Valenzuela Zambrano, B. Access and continuity of students with disability in Chilean universities. Sinéctica 2019 , 53 , 1–10. [ Google Scholar ] [ CrossRef ]
• Ansay, N.N.; Moreira, L.C. Policies for access to higher education for students with disabilities in Chile and Brazil. Rev. Ibero-Am. Estud. Educ. Araraquara 2020 , 15 , 539–559. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• Yusof, Y.; Chan, C.C.; Hillaluddin, A.H.; Ramli, F.Z.A.; Saad, Z.M. Improving inclusion of students with disabilities in Malaysian higher education. Disabil. Soc. 2019 , 35 , 1145–1170. [ Google Scholar ] [ CrossRef ]
• Braun, A.M.B.; Naami, A. Access to Higher education in Ghana: Examining experiences through the lens of students with mobility disabilities. Int. J. Disabil. Dev. Educ. 2019 , 68 , 95–115. [ Google Scholar ] [ CrossRef ]
• Dreyer, L.M. Specific learning disabilities: Challenges for meaningful access and participation at higher education institutions. J. Educ. 2021 , 85 , 75–92. [ Google Scholar ] [ CrossRef ]
• Newman, L.A.; Madaus, J.W.; Lalor, A.R.; Javitz, H.S. Effect of accessing supports on higher education persistence of students with disabilities. J. Divers. High. Educ. 2021 , 14 , 353–363. [ Google Scholar ] [ CrossRef ]
• Shpigelman, C.N.; Mor, S.; Sachs, D.; Schreuer, N. Supporting the development of students with disabilities in higher education: Access, stigma, identity, and power. Stud. High. Educ. 2021 , 14 , 1–16. [ Google Scholar ] [ CrossRef ]
• Valle-Flórez, R.E.; de Caso Fuentes, A.M.; Baelo, R.; García-Martín, S. Faculty of education professors’ perception about the inclusion of university students with disabilities. Int. J. Environ. Res. Public Health 2021 , 18 , 11667. [ Google Scholar ] [ CrossRef ]
• Paz-Maldonado, E. Educational inclusion of students in situation of disability in higher education: A systematic review. Rev. Interuniv. 2020 , 31 , 123–146. [ Google Scholar ] [ CrossRef ]
• Corrales, A.; Soto, V.; Villafañe, G. Learning barriers for students with disabilities in a chilean university. Student demands—Institutional challenges. Actual. Investig. Educ. 2016 , 16 , 67–96. [ Google Scholar ]
• Nimante, D.; Baranova, S.; Stramkale, L. The university administrative staff perception of inclusion in higher education. Acta Pedagog. Vilnesia 2021 , 46 , 90–104. [ Google Scholar ] [ CrossRef ]
• Fernández Batanero, J.M.; Montenegro Rueda, M.; Fernández Cerero, J.; Tadeu, P. Formación del Profesorado y TIC para el Alumnado Con Discapacidad: Una Revisión Sistemática. Rev. Bras. Educ. Espec. 2020 , 26 , 711–732. [ Google Scholar ] [ CrossRef ]
• Joshi, G.S.; Bouck, E.C. Examining Postsecondary Education Predictors and Participation for Students with Learning Disabilities. J. Learn. Disabil. 2015 , 50 , 3–13. [ Google Scholar ] [ CrossRef ]
• Björnsdóttir, K. Belonging to higher education: Inclusive education for students with intellectual disabilities. Eur. J. Spec. Needs Educ. 2017 , 32 , 125–136. [ Google Scholar ] [ CrossRef ]
• Martins, M.H.; Borges, M.L.; Gonçalves, T. Attitudes towards inclusion in higher education in a Portuguese university. Int. J. Incl. Educ. 2018 , 22 , 527–542. [ Google Scholar ] [ CrossRef ]
• Herrero, P.R.; Gasset, D.I.; Garcia, A.C. Inclusive education at a Spanish university: The voice of students with intellectual disability. Disabil. Soc. 2020 , 36 , 376–398. [ Google Scholar ] [ CrossRef ]
• Espinosa, C.X.; Gómez, V.; Cañedo, C.M. Access and retention in higher education of students with disabilities in Ecuador. Form. Univ. 2012 , 5 , 27–38. [ Google Scholar ] [ CrossRef ] [ Green Version ]

Click here to enlarge figure

Share and Cite

Fernández-Batanero, J.M.; Montenegro-Rueda, M.; Fernández-Cerero, J. Access and Participation of Students with Disabilities: The Challenge for Higher Education. Int. J. Environ. Res. Public Health 2022 , 19 , 11918. https://doi.org/10.3390/ijerph191911918

Fernández-Batanero JM, Montenegro-Rueda M, Fernández-Cerero J. Access and Participation of Students with Disabilities: The Challenge for Higher Education. International Journal of Environmental Research and Public Health . 2022; 19(19):11918. https://doi.org/10.3390/ijerph191911918

Fernández-Batanero, José María, Marta Montenegro-Rueda, and José Fernández-Cerero. 2022. "Access and Participation of Students with Disabilities: The Challenge for Higher Education" International Journal of Environmental Research and Public Health 19, no. 19: 11918. https://doi.org/10.3390/ijerph191911918

Article Metrics

Article access statistics, further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

Advertisement

College Students with Disabilities: Factors Influencing Growth in Academic Ability and Confidence

• Published: 19 May 2020
• Volume 62 , pages 309–331, ( 2021 )

Cite this article

• Mikyong Minsun Kim   ORCID: orcid.org/0000-0001-9795-7674 1 &
• Elisabeth Louise Kutscher 2  

3553 Accesses

22 Citations

2 Altmetric

Explore all metrics

Using large-scale longitudinal data, this study sought to examine factors influencing two important student development outcomes in students with disabilities attending 4-year colleges and universities. Informed by Astin’s Input-Environment-Outcome model and the interactional model of disability, this study investigated the effect of student characteristics (i.e., disability type, gender, mother’s education level) and environmental factors (i.e., faculty encouragement and engagement in political discussion) on the development of academic ability and intellectual confidence in students’ senior year of college. The comparison between two outcome models for students with learning disabilities and those with physical or sensory disabilities provided important educational implications. Results from the multiple regression analyses revealed that both student characteristics and environmental factors significantly affect student development, accounting for students’ academic ability and intellectual confidence upon entering college. Institutional policy implications and educational interventions for college students with disabilities were also discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

Students with Disabilities in Higher Education: A Review of the Literature and an Agenda for Future Research

College environment, student involvement, and intellectual development: evidence in china.

Factors that Promote High School Graduation: a Review of the Literature

Explore related subjects.

• Artificial Intelligence

Adams, K. S., & Proctor, B. E. (2010). Adaptation to college for students with and without disabilities: Group differences and predictors. Journal of Postsecondary Education and Disability, 22 (3), 166–184.

Google Scholar  

Americans With Disabilities Act [ADA] of 1990, Public Law No. 101–336, 104 Stat. 328, (1990).

Anctil, T. M., Ishikawa, M. E., & Scott, A. T. (2008). Academic identity development through self-determination successful college students with learning disabilities. Career Development for Exceptional Individuals, 31 (3), 164–174.

Astin, A. W. (1991). Assessment for excellence: The philosophy and practice of assessment and evaluation in higher education . New York: American Council on Education/Macmillan.

Astin, A. W. (1996). Involvement in learning revisited: Lessons we have learned. Journal of College Student Development, 37 (2), 123–134.

Avellone, L., & Scott, S. (2017). National databases with information on college students with disabilities. NCCSD Research Brief, 1(1). Huntersville, NC: National Center for College Students with Disabilities, Association on Higher Education and Disability. http://www.NCCSDonline.org .

Baker, K. Q., Boland, K., & Nowik, C. M. (2012). A campus survey of faculty and student perceptions of persons with disabilities. Journal of Postsecondary Education and Disability, 25 (4), 309–329. Retrieved from https://ssrn.com/abstract=1647134

Bandura, A. (2012). On the functional properties of perceived self-efficacy revisited. Journal of Management, 38 (1), 9–44.

Berry, H. G., Ward, M., & Caplan, L. (2012). Self-determination and access to postsecondary education in transitioning youths receiving Supplemental Security Income benefits. Career Development for Exceptional Individuals, 35 , 68–75.

Bong, M. (2012). Self-efficacy. In J. Hattie & E. Anderman (Eds.) International guide to student achievement. Retrieved from https://ebookcentral.proquest.com

Chen, X. (2005). First generation students in postsecondary education: A look at their college transcripts (NCES 2005–171). U.S. Department of Education, National Center for Education Statistics. Washington, DC: U.S. Government Printing Office.

Choi, N. (2005). Self-efficacy and self-concept as predictors of college students’ academic performance. Psychology in the Schools, 42 (2), 197–205.

Cole, E. V., & Cawthon, S. W. (2015). Self-disclosure decisions of university students with learning disabilities. Journal of Postsecondary Education and Disability, 28 (2), 163–179.

DaDeppo, L. M. (2009). Integration factors related to the academic success and intent to persist of college students with learning disabilities. Learning Disabilities Research & Practice, 24 (3), 122–131.

Dallas, B. K., & Sprong, M. E. (2015). Assessing faculty attitudes toward Universal Design instructional techniques. Journal of Applied Rehabilitation Counseling, 46 (4), 18–28.

Evans, N. J., Broido, E. M., Brown, K. R., & Wilke, A. K. (2017). Disability in higher education: A social justice approach . San Francisco, CA: Jossey-Bass.

Fichten, C. S., Nguyen, M. N., Amsel, R., Jorgensen, S., Budd, J., Jorgensen, M., et al. (2014). How well does the theory of planned behavior predict graduation among college and university students with disabilities? Social Psychology of Education, 17 (4), 657–685.

Fleming, A. R., Oertle, K. M., & Plotner, A. J. (2017). Student voices: Recommendations for improving postsecondary experiences of students with disabilities. Journal of Postsecondary Education and Disability, 30 (4), 309–326.

Gelbar, N. W., Madaus, J. W., Lombardi, A., Faggella-Luby, M. N., & Dukes, L. (2015). College students with physical disabilities: Common on campus, uncommon in the literature. Physical Disabilities: Education and Related Services, 34 (2), 14–31.

Ginsberg, S. M., & Schulte, K. (2008). Instructional accommodations: Impact of conventional vs. social constructivist view of disability. Journal of the Scholarship of Teaching and Learning, 8 (2), 84–91. Retrieved from https://files.eric.ed.gov/fulltext/EJ854849.pdf

Hall, C. W., & Webster, R. E. (2008). Metacognitive and affective factors of college students with and without learning disabilities. Journal of Postsecondary Education and Disability, 21 (1), 32–41.

Harvey, M. W. (2002). Comparison of postsecondary transitional outcomes between students with and without disabilities by secondary vocational education participation: Findings from the National Education Longitudinal Study. Career Development for Exceptional Individuals, 25 (2), 99–122.

Hedrick, B., Dizen, M., Collins, K., Evans, J., & Grayson, T. (2010). Perceptions of college students with and without disabilities and effects of STEM and non-STEM enrollment on student engagement and institutional involvement. Journal of Postsecondary Education and Disability, 23 (2), 129–136.

Hen, M., & Goroshit, M. (2014). Academic procrastination, emotional intelligence, academic self-efficacy, and GPA: A comparison between students with and without learning disabilities. Journal of Learning Disabilities, 47 (2), 116–124.

Hendrickson, J. M., Therrien, W. J., Weeden, D. D., Pascarella, E., & Hosp, J. L. (2015). Engagement among students with intellectual disabilities and first year students: A comparison. Journal of Student Affairs Research and Practice, 52 (2), 204–219.

Higher Education Research Institute [HERI]. (2019). CIRP Freshman Survey. Retrieved from https://heri.ucla.edu/cirp-freshman-survey/

Hong, B. S. (2015). Qualitative analysis of the barriers college students with disabilities experience in higher education. Journal of College Student Development, 56 (3), 209–226.

Hurtado, S., & DeAngelo, L. (2012). Linking diversity and civic-minded practices with student outcomes.  Liberal Education ,  98 (2), 14–23. Retrieved from https://www.heri.ucla.edu/PDFs/Linking-Diversity-and-Civic-Minded-Practices-with-Student-Outcomes.pdf

Jenson, R. J., Petri, A. N., Day, A. D., Truman, K. Z., & Duffy, K. (2011). Perceptions of self-efficacy among STEM students with disabilities. Journal of Postsecondary Education and Disability, 24 (4), 269–283.

Jorgensen, S., Fichten, C. S., Havel, A., Lamb, D., James, C., & Barile, M. (2005). Academic performance of college students with and without disabilities: An archival study. Canadian Journal of Counselling, 39 (2), 101–117.

Kim, M. M. (2002). Cultivating intellectual development: Comparing women-only colleges and coeducational colleges for educational effectiveness. Research in Higher Education, 43 (4), 447–481.

Kim, M. M., & Williams, B. C. (2012). Lived employment experiences of college students and graduates with physical disabilities in the United States. Disability & Society, 27 (6), 837–852.

Kim, W. H., & Lee, J. (2016). The effect of accommodation on academic performance of college students with disabilities. Rehabilitation Counseling Bulletin, 60 (1), 40–50.

Kimball, E., Friedensen, R., & Silva, E. (2017). Engaging disability: Trajectories of involvement for college students with disabilities. In E. Kim & K. C. Aquino (Eds.), Disability as diversity in higher education: Policies and practices to enhance student success . New York: Routledge.

Kimball, E. W., Wells, R. S., Ostiguy, B. J., Manly, C. A., & Lauterbach, A. A. (2016). Students with disabilities in higher education: A review of the literature and an agenda for future research. In M. B. Paulsen (Ed.), Higher education: Handbook of theory and research . Switzerland: Springer.

Kuh, G. D. (2007). What student engagement data tell us about college readiness. Peer Review, 9 (1), 4–8.

Leake, D. (2015). Problematic data on how many students in postsecondary education have a disability. Journal of Postsecondary Education and Disability, 28 (1), 73–87.

Lent, R. W., Brown, S. D., & Gore, P. A., Jr. (1997). Discriminant and predictive validity of academic self-concept, academic self-efficacy, and mathematics-specific self-efficacy. Journal of Counseling Psychology, 44 (3), 307.

Lombardi, A. R., & Lalor, A. R. (2017). Faculty and administrator knowledge and attitudes regarding diversity. In E. Kim & K. C. Aquino (Eds.), Disability as diversity in higher education: Policies and practices to enhance student success . New York: Routledge.

Lombardi, A., Murray, C., & Dallas, B. (2013). University faculty attitudes toward disability and inclusive instruction: Comparing two institutions. Journal of Postsecondary Education and Disability, 26 (3), 221–232.

Lombardi, A. R., Murray, C., & Gerdes, H. (2012). Academic performance of first-generation college students with disabilities. Journal of College Student Development, 53 (6), 811–826.

Madaus, J. W., Lalor, A. R., Gelbar, N., & Kowitt, J. (2014). The journal of postsecondary education and disability: From past to present. Journal of Postsecondary Education and Disability, 27 (4), 347–356.

Mamiseishvili, K., & Koch, L. C. (2011). First-to-second-year persistence of students with disabilities in postsecondary institutions in the United States. Rehabilitation Counseling Bulletin, 54 (2), 93–105.

Marsh, H. W., & Seaton, M. (2012). Academic self-concept. In J. Hattie & E. Anderman (Eds) International guide to student achievement. Retrieved from https://ebookcentral.proquest.com

Martz, E. (2003). Invisibility of disability and work experience as predictors of employment among community college students with disabilities. Journal of Vocational Rehabilitation, 18 (3), 153–161.

Mayhew, M. J., Rockenbach, A. N., Bowman, N. A., Seifert, T. A., Wolniak, G. C., & Pascarella, E. T. (2016). How college affects students: 21st century evidence that higher education works (Vol. 3). San Francisco, CA: Jossey-Bass.

Murray, C., Flannery, B. K., & Wren, C. (2008). University staff members' attitudes and knowledge about learning disabilities and disability support services. Journal of Postsecondary Education and Disability, 21 (2), 73–90.

Murray, C., Lombardi, A., & Kosty, D. (2014). Profiling adjustment among postsecondary students with disabilities: A person-centered approach. Journal of Diversity in Higher Education, 7 (1), 31.

National Center for Education Statistics. (2018). Children 3 to 21 years old served under Individuals with Disabilities Education Act (IDEA), Part B, by age group and sex, race/ethnicity, and type of disability: 2017–18 (Table 204.50). Retrieved from https://nces.ed.gov/programs/digest/d18/tables/dt18_204.50.asp

Newman, L. A., & Madaus, J. W. (2015). Reported accommodations and supports provided to secondary and postsecondary students with disabilities: National perspective. Career Development and Transition for Exceptional Individuals, 38 (3), 173–181.

O’Neil Green, D., Willis, H., Green, M. D., & Beckman, S. (2017). Access Ryerson: Promoting disability as diversity. In E. Kim & K. C. Aquino (Eds.), Disability as diversity in higher education: Policies and practices to enhance student success . New York: Routledge.

Oliver, M. (2013). The social model of disability: Thirty years on. Disability and Society, 28 (7), 1024–1026.

Pascarella, E. T., & Terenzini, P. T. (2005). How college affects students: A third decade of research (Vol. 2). Indianapolis, IN: Jossey-Bass.

Peña, E. V. (2014). Marginalization of published scholarship on students with disabilities in higher education journals. Journal of College Student Development, 55 (1), 30–40. https://doi.org/10.1353/csd.2014.0006 .

Article   Google Scholar  

Prince, A. M., Hodge, J., Bridges, W. C., & Katsiyannis, A. (2018). Predictors of postschool education/training and employment outcomes for youth with disabilities. Career Development and Transition for Exceptional Individuals, 41 (2), 77–87.

Quinlan, M. M., Bates, B. R., & Angell, M. E. (2012). ‘What can I do to help?’: Postsecondary students with learning disabilities' perceptions of instructors' classroom accommodations. Journal of Research in Special Educational Needs, 12 (4), 224–233.

Raines, J. B., & Rossow, L. F. (1994). The Americans with Disabilities Act: Resolving the separate-but-equal problem in colleges and universities.  West's Education Law Quarterly ,  3 (2), 308–18. Retrieved from https://eric.ed.gov/?id=EJ483372

Raue, K., & Lewis, L. (2011). Students with disabilities at degree-granting postsecondary institutions. (No. NCES 2011–018). Washington, DC: U.S. Department of Education, National Center for Education Statistics. Retrieved from https://nces.ed.gov/pubs2011/2011018.pdf

Rojewski, J. W., Lee, I. H., & Gregg, N. (2013). Causal effects of inclusion on postsecondary education outcomes of individuals with high-incidence disabilities. Journal of Disability Policy Studies, 25 (4), 210–219.

Ryan, S., & Runswick-Cole, K. (2008). Repositioning mothers: Mothers, disabled children and disability studies. Disability & Society, 23 (3), 199–210.

Rehabilitation Act of 1973, Pubic Law No. 93–112, 87 Stat. 394, (1973).

Scott, S. (2019). Access and participation in higher education: Perspectives of college students with disabilities. NCCSD Research Brief, 2(2). Huntersville, NC: National Center for College Students with Disabilities, Association on Higher Education and Disability. https://www.NCCSDclearinghouse.org

Shakespeare, T. (2014). Disability rights and wrongs revisited (2nd ed.). New York: Routledge.

Shallish, L. (2017). A different diversity? Challenging the exclusion of disability studies from higher education research and practice. In E. Kim & K. C. Aquino (Eds.), Disability as diversity in higher education: Policies and practices to enhance student success . New York: Routledge.

Sniatecki, J. L., Perry, H. B., & Snell, L. H. (2015). Faculty attitudes and knowledge regarding college students with disabilities. Journal of Postsecondary Education and Disability, 28 (3), 259–275.

Stevens, C. M., Schneider, E., & Bederman-Miller, P. (2018). Identifying faculty perceptions of awareness and preparedness relating to ADA compliance at a small, private college in NE PA. American Journal of Business Education, 11 (2), 27–40.

Thomas, S. B. (2000). College students and disability law. The Journal of Special Education, 33 (4), 248–258.

Thompson-Ebanks, V. (2014). Personal factors that influence the voluntary withdrawal of undergraduates with disabilities. Journal of Postsecondary Education and Disability, 27 (2), 195–207.

Troiano, P. F. (2003). College students and learning disability: Elements of self-style. Journal of College Student Development, 44 (3), 404–419.

U.S. Department of Education (2015).  Digest of Education Statistics, 2015.  National Center for Education Statistics (NCES 2016–014). Retrieved from https://nces.ed.gov/fastfacts/display.asp?id=60

Vaccaro, A., & Kimball, E. (2017). “It’s a very deep, layered topic”: Student affairs professionals on the marginality and intersectionality of disability. In E. Kim & K. C. Aquino (Eds.), Disability as diversity in higher education: Policies and practices to enhance student success . New York: Routledge.

Vuong, M., Brown-Welty, S., & Tracz, S. (2010). The effects of self-efficacy on academic success of first-generation college sophomore students. Journal of College Student Development, 51 (1), 50–64.

Weis, R., Sykes, L., & Unadkat, D. (2012). Qualitative differences in learning disabilities across postsecondary institutions. Journal of Learning Disabilities, 45 (6), 491–502.

Wessel, R. D., Jones, D., Blanch, C. L., & Markle, L. (2015). Pre-enrollment considerations of undergraduate wheelchair users and their post-enrollment transitions. Journal of Postsecondary Education and Disability, 28 (1), 57–72.

Wessel, R. D., Jones, J. A., Markle, L., & Westfall, C. (2009). Retention and graduation of students with disabilities: Facilitating student success. Journal of Postsecondary Education and Disability, 21 (3), 116–125.

Download references

Acknowledgement

Authors extend their appreciation for anonymous reviewers’ helpful comments.

Author information

Authors and affiliations.

Higher Education Administration Program, Department of Educational Leadership, Graduate School of Education and Human Development, The George Washington University, 2134 G. St. NW #111, Washington, DC, 20052, USA

Mikyong Minsun Kim

Department of Special Education and Disability Studies, The George Washington University, Washington, DC, USA

Elisabeth Louise Kutscher

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Mikyong Minsun Kim .

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Kim, M.M., Kutscher, E.L. College Students with Disabilities: Factors Influencing Growth in Academic Ability and Confidence. Res High Educ 62 , 309–331 (2021). https://doi.org/10.1007/s11162-020-09595-8

Download citation

Received : 17 July 2019

Published : 19 May 2020

Issue Date : May 2021

DOI : https://doi.org/10.1007/s11162-020-09595-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• College students with disabilities
• Learning, physical, or sensory disability
• Academic ability
• Intellectual self-confidence
• Demographic and institutional factors and policies
• Longitudinal data analysis
• Find a journal
• Publish with us
• Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

Participation of children with disabilities in school: A realist systematic review of psychosocial and environmental factors

Donald maciver.

1 Occupational Therapy and Arts Therapies Subject Area, School of Health Sciences, Queen Margaret University, Edinburgh, Scotland, United Kingdom

Marion Rutherford

Stella arakelyan, jessica m. kramer.

2 Department of Occupational Therapy & PhD Program in Rehabilitation Sciences, Boston University, Boston, United States of America

Janet Richmond

3 School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia

Liliya Todorova

4 Occupational Therapy, Faculty of Public Health and Health Care, University of Ruse, Ruse, Bulgaria

Dulce Romero-Ayuso

5 Department of Physical Therapy, Occupational Therapy Division, Faculty of Health Sciences, University of Granada, Granada, Spain

Hiromi Nakamura-Thomas

6 Saitama Prefectural University, Graduate School of Health, Medicine and Welfare, Saitama, Japan

Marjon ten Velden

7 Amsterdam University of Applied Sciences, Faculty of Health, School of Occupational Therapy, Amsterdam, the Netherlands

Ian Finlayson

Anne o’hare.

8 Child Life and Health, SMC Research Centre, Edinburgh University, Edinburgh, Scotland, United Kingdom

Kirsty Forsyth

Associated data.

All relevant data are within the paper and its Supporting Information files.

In order to make informed decisions about how best to support children and young people with disabilities, effective strategies that facilitate active and meaningful participation in school are required. Clinical factors, diagnosis or impairments somewhat helpful in determining what should be provided in interventions. However, clinical factors alone will not offer a clear view of how to support participation. It is helpful then to look at wider psychosocial and environmental factors. The aim of this review was to synthesise evidence of psychosocial and environmental factors associated with school participation of 4–12 year old children with disabilities to inform the development of participation-fostering interventions.

A systematic search and synthesis using realist methods was conducted of published research. Papers had to include consideration of psychosocial and/or environment factors for school participation of children with disabilities. The review was completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Papers were identified via Boolean search of the electronic databases MEDLINE, CINAHL, PhycINFO and ERIC (January 2006-October 2018). Appraisal focussed on contributions in terms of whether the articles are appropriate for the review (relevance) and research quality (rigour). Data were analyzed using content and thematic analysis methods using a realist framework. A narrative synthesis of results was reported.

Results and implications

We identified 1828 papers in the initial search. Seventy two papers were included in the final synthesis. Synthesis of findings led to three overarching mechanisms representing psychosocial factors for children (1) identity (2) competence and (3) experience of mind and body. Environmental aspects (context) compromised five interrelated areas: (1) structures and organization, (2) peers, (3) adults, (4) space and (5) objects. Our synthesis provides insights on how professionals may organize efforts to improve children’s participation. Consideration of these findings will help to proactively deal with suboptimal participation outcomes. Development of theoretically determined assessments and interventions for management of school participation are now required.

Introduction

According to the World Health Organization’s World Report on Disability, an estimated 95 million children (5.1%) aged 0–14 years have some form of disability [ 1 ]. Common issues include Autism Spectrum Conditions, Developmental Delay, Behavioral Disorders and Learning Difficulties [ 1 ]. In many countries, these children have rights to be included in mainstream school [ 2 – 5 ]. For professionals who work with children this shift towards social and educational inclusion has meant that practices have had to evolve in tandem. Rehabilitation professionals now deliver a wide range of approaches to support early intervention and prevention for children with diverse needs. This includes school-based approaches alongside teachers and families to enable children’s full and active participation in school [ 6 ].

Participation or “involvement in life situations” [ 1 ] is a key outcome. Participation may take place anywhere. In this paper, we focus on the context of school. Participation in school includes unstructured activities (e.g friendships, play), organized activities (e.g. sports, clubs, arts), classroom based activities (e.g. group work, study) and engagement in social roles [ 7 ]. Children with disabilities are at significant risk for limited participation in school [ 8 ]. Such restrictions have significant lifetime consequences for achievement, quality of life and wellbeing [ 9 – 12 ]. There are several issues. Attendance for children with disabilities is reduced compared to peers [ 13 ]. Students with disabilities participate less in structured and unstructured activities, and experience reduced interaction and playground participation [ 14 ]. Children with disabilities additionally show less engagement in the wider school world, including clubs and organizations [ 13 , 15 ].

Whilst there is an urgent need to develop interventions that promote participation in school, there is limited understanding of processes that may enable it [ 16 ]. Research to date has recognized the importance of psychosocial factors, though conclusions have been hampered by heterogeneous populations and variability in design and outcome measures [ 17 ]. There is little in the way of specific school based research to guide practices. Moreover, a requirement remains for comprehensive theories/models, as research has primarily considered individual psychosocial factors in isolation. A trend is departure from “medical” and “social” models. Both positions have been challenged as limiting [ 18 ]. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) [ 1 ] has been foundational to discussion with its definition of participation as “involvement in a life situation” and its assertion that the environment is a key determinant of participation (an integration of the “medical” and “social” models). However, the ICF has also provoked confusion and inconsistency in the field [ 16 , 19 , 20 ]. Everything people do is “involvement in a life situation” and participation is classified together with “activities” giving rise to conflicting interpretations [ 19 , 21 ]. Driven by the ICF, there has also been a tendency to focus on a portfolio of actions done in everyday life [ 19 ]. Such indicators of “doing” say little about psychosocial drivers of participation such as motivation, social connection, preferences, choice and meaningfulness [ 19 , 22 , 23 ]. This paucity of theory leads to a situation whereby enhancement of participation outcomes is often an aspiration, but reliable, environmental or psychosocial interventions are not available.

To date only Imms et al. 2016 has conducted research which integrates various factors in a useful new direction [ 24 ]. Their narrative systematic review, although it did not focus on school specifically, concluded that the participation phenomenon is essentially dichotomous—requiring children to “attend” (be present) and also to be “involved” (engage, experience and so forth) [ 24 ]. A further insight has been to differentiate between participation and other influencing or “participation related constructs” which include preferences, sense of self and activity competence [ 24 ]. This work highlights the importance of careful definition, as well as identification of some import psychosocial factors. However, this work did not consider environment factors in detail, and was based on an analysis of randomized controlled trials (RCT) and intervention type studies only. Such restrictive inclusion criteria will have contributed to limiting the data that could have been available. RCTs rarely focus on context, detail on mechanisms of action or conceptual underpinnings [ 25 ]. Analysis of RCTs is less useful for answering conceptual or theory based questions [ 26 ]. Therefore, the present review employed a realist review approach to identify a broad range of environmental and psychosocial factors associated with participation, and to uncover the association between context, mechanisms and participation outcomes in school-aged children with disabilities to guide the development and implementation of interventions and assessments.

Materials and methods

The United Kingdom Medical Research Council’s (MRC) guidance on development of complex interventions argues that new interventions must be underpinned by a conceptual framework and a theoretical understanding of the key processes underpinning an intervention [ 27 ]. This study uses realist review to address the requirement for theory and conceptual framework development outlined by the MRC. The process drew on systematic review and realist review methods. For systematic searching of the literature, we followed the PRISMA guidelines [ 28 ], as far as was relevant for a realist review. Realist methods were completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines [ 26 ].

We selected realist review as it meets requirements for dealing with complexity of both topic and research methods [ 25 , 29 , 30 ]. Realist review is an interpretive, theory-driven narrative summary which applies realist philosophy of exploring context, mechanisms and outcomes [ 25 ]. Developed in response to the weaknesses of traditional systematic review, realist review focusses on refining and developing theory. Realist reviews are organized around Context-Mechanism-Outcome (CMO) configuration [ 25 ]. Review aims to identify what works for whom, in what circumstances, in what respects and how, by identifying processes (mechanisms) that lead to outcomes in context [ 25 , 29 , 30 ]. The identification of open, embedded, interactive systems is central to the process of analysis. These assumptions constitute a realist philosophical ‘lens’ [ 25 ]. The steps of realist review are: (1) identifying the review question; (2) formulating the initial theory; (3) searching for primary studies; (4) selecting the studies and appraise their quality; (5) extracting, analyzing and synthesizing data. The details are described below [ 25 ].

Identifying the question

The review question was: “What are the mechanisms and contexts which determine successful participation in 4–12 year old children with disabilities in school?” In developing the question, we drew from a range of perspectives. As the findings were indented for use internationally, the research team included professionals from several countries (Japan, the United Kingdom, Spain, Australia, Bulgaria, the Netherlands, and the United States of America). We ensured that team members represented a range of voices from those with an interest in participation in schools, representing expertise in psychology, rehabilitation, medicine, community pediatrics, neurodisability, community health sciences, education, occupational therapy, disability theory, and global health. The research team included professors, post-doctoral fellows and a range of senior academics and expert clinicians. A wider advisory group included rehabilitation, social care and educational practitioners and managers who provided regular input. Initial questions and review direction were discussed over email between the research team and advisory group. This included a discussion on realist informed approaches including an explanation of Context, Mechanism and Outcomes and the basics of realist theory. The research and advisory groups felt that the focus and question set was an authentic question which reflected curiosity about how schools were working and interest in understanding how to improve children’s participation.

Formulating the initial theory

In line with a realist review approach, our initial thinking was informed by factors identified in the literature as possible key drivers of participation outcomes in school. Key literature was identified and synthesized through a scoping search [ 1 , 10 , 16 , 17 , 19 – 21 , 23 , 24 , 31 – 37 ]. This initial scoping helped to identify theoretical areas, concepts and perspectives (a summary of the initial literature review is presented in Appendix A in S1 File ). Amongst the main ideas considered were Bronfenbrenner’s ecological systems model [ 31 ], the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) [ 1 ] and practice models to support participation [ 34 ]. Using the above scoping review, discussion and analysis amongst the research team and advisory group led to the development of initial mechanisms, contexts and outcomes, and the target population. Initial mechanisms focused on personal psychosocial factors which may drive participation outcomes: (1) children’s choices, initiative, interests and skills and (2) patterning and performance of participation, including routines (e.g. going to school, eating lunch, playing with friends) and roles. Initial thinking also considered psychosocial factors related to common issues experienced by children with disabilities including pain, anxiety, stress, or fatigue. In considering the context, we drew on ecological systems theory, focusing on the “microsystem” as the system closest to the person and the one in which they have direct contact [ 31 ]. In this case, the characteristics of classrooms and schools, denoting circumstances within school that may be considered as enablers or barriers. This approach meant that issues pertaining to context outside the school (for example, the role of parents, home life, or government policies) were not considered.

Participation in school was the outcome of interest. The most common definition of participation originates in the World Health Organization’s International Classification of Functioning Disability and Health referring to a person’s “involvement in life situations” [ 1 ]. As noted, other authors have criticized this definition [ 17 , 38 ]. The definition used in the review builds on the ICF definition, but also implies that participation must be meaningful, with personal or social significance. Our definition reflects recent ideas [ 24 ] that participation has two essential components: attendance and involvement. The definition is presented in Table 1 .

The target population was defined as children who have a physical, developmental, behavioral, or emotional condition and who also require health and education services of a type or amount beyond that required by children generally [ 39 ]. Middle child hood (4–12 years) was selected as the target group. During middle childhood (defined as ages 4 to 12), a child’s mastery of developmental challenges is strongly influenced by school experiences, hence exploring participation in this context is important. Children are moving from nursery/kindergarten provision to increasingly formal education settings, but have not yet entered the adolescent phase where a number of other unique challenges appear.

Systematic searching process

Searches were conducted for English Language papers in MEDLINE, CINAHL, PhycINFO and ERIC databases covering the period January 2006 and November 2018. This span was chosen in order to capture a contemporary conceptualization of participation. Searching was completed by DM and SA. The search strategy utilized text word searching in the title or abstract along with database Subject Headings. Terms included disability “special needs”, “additional needs”, “disabled persons”, “motor disorders”, “developmental disabilities”, “intellectual disability”, “communication disorders”; age “child”, “children,” “pediatric”, “girl”, “boy”, “schoolchild”, “participation”, “inclusion,” “involvement”, “engagement”, “life situations,” “environment”, “surroundings”,”setting”, “context”, “school”, “education“, “class”, and “teacher”. Strategies were developed with support from an information professional (Appendix B in S1 File illustrates the strategy used in MEDLINE). In addition, a hand search compiled by DM and SA checked reference lists from relevant articles, including all those included in the review.

Selection and appraisal of studies

Members of the research team screened a portion of the titles and abstracts (DM, SA, MR). The potentially relevant records identified by individual members of the research team were then discussed with the other authors to confirm eligibility. This was followed by screening the full text of potentially relevant studies to determine eligibility for inclusion.

Overall, if papers contained evidence relevant to school participation (or related proxy outcome, e.g. school attendance), for children with a disability/special educational need, with discussion of environmental and/or psychosocial factors, the document was retained for further review. In keeping with realist methods, selection criteria regarding study design were not predominant [ 25 , 29 , 30 ]. Methodologically, papers could include any type of peer-reviewed paper including intervention studies, observational research, qualitative research and literature reviews. Literature reviews may be included in realist review if they provide relevant theoretical insights [ 25 , 29 , 30 ]. We did reject all purely descriptive accounts (e.g. opinion pieces or editorials) and grey literature as there was ample peer-reviewed material. We also excluded psychometrics focused papers, due to their general interest in identifying what participation was, rather than its influencing factors. Children with disabilities were identified via medical diagnosis or other support needs (e.g. identified as requiring “special” education). Papers focusing solely on community or leisure participation were rejected, although papers which discussed school participation amongst other settings were included. We aimed to identify studies of relevance to middle childhood which we defined as 4–12 years. Studies close to this age range were passed onto the next stage for further assessment if the findings were viewed by the team as potentially relevant and generalizable to middle childhood. In some cases the assessment of age was not necessary, as the participants were teachers, parents or health professionals, and in the case of some reviews. Initial screening criteria are in Table 2 .

In accordance RAMESES guidelines [ 26 ], final selection of papers focused on contributions in terms of whether articles were appropriate for the research question (relevance) and quality of evidence (rigour) [ 25 , 29 , 30 ]. This was an iterative process, and disagreements were dealt with via discussion (DM, SA and MR). Review of relevance was used to ensure a systematic process and to reduce selection bias. A system of questions was used to identify whether an article was relevant by examining content, insights provided by the study and focus (see Table 3 ). Assessment of rigour was used to judge quality, credibility and trustworthiness of evidence [ 25 ]. Each reviewer appraised each paper by asking key questions on research quality [ 40 ]. Papers could be excluded on the basis of relevance or rigour. Each paper was scored 0 (failed to meet criteria) or 1 (met criteria). Studies scoring 0 on either criteria were excluded.

Data extraction, analysis and synthesis

Data were extracted using predefined forms by DM, SA and MR, regularly checking each other’s work. Data were extracted on: country and author; sample characteristics: sample size; participants’ age and gender; diagnostic category (if available); key findings; relevance and rigor mechanisms, contexts, and outcomes.

Analysis were done by DM, SA and MR following a staged process based on careful review, coding and frequent return to primary studies as necessary. Broad aspects of context and mechanism were identified and coded first. The key analytic process in realist review involves iterative testing and refinement of theoretically based explanations for why outcomes happen, using research papers as data sources [ 25 , 29 , 30 ]. In our case we were focused on participation in the school, and we attempted to find and synthesize evidence to demonstrate that particular mechanisms were important in generating school participation outcomes and to identify which aspects of context mattered. Data were synthesized using qualitative methods (content and thematic analysis) [ 41 ], using realist concepts as a framework [ 25 , 26 ]. Context and mechanisms were operationalized using codes and sub-codes as in typical qualitative analysis [ 41 ]. In the early stages very many individual codes were created and grouped. For example all aspects relating to the child’s motivations were grouped into a broad “motivations” category and all aspects of the physical environment were grouped into a “physical environment” category. Specific aspects were then identified and coded with sub-codes, e.g. social aspects, physical access, or assistive devices. As analysis progressed, more refined codes were created and sorted and grouped to identify mutually exclusive categories of mechanisms and contexts which were coherent and could be designated a single unifying label.

As the analysis progressed, evidence of which mechanisms and context were important was carefully mapped against the emerging taxonomy. Tables were derived, including categories and sub-components, including each article relating to the sub-component. Regular meetings were held and interpretations shared across the research team and advisory group, including re-examination the original articles. Further refinement of the findings continued until agreement was reached. Following final assessment, two members of the research team reviewed once again the articles, and checked the findings. We also attempted to identify disconfirming data or data that might challenge or refute ideas. During this process there was a point at which no new categories of mechanisms or context emerged i.e. saturation was attained. Final labels were then assigned to each area and the narrative summary was written.

The electronic literature search and hand search identified 1828 papers, 1168 of which were removed at the title and abstract stage. Next, 172 papers were reviewed in full. On review, 100 papers were excluded, leading to 72 papers in the final synthesis ( Fig 1 ) (full details of all papers are provided in Appendices C and D in S1 File ). Type of disability was consistent with issues commonly seen in schools (including Autism Spectrum Disorders, Cerebral Palsy, Learning Disability, Learning Difficulty, Developmental Delay, and Physical Disabilities) (Appendices C and D in S1 File ). Forty-six percent (n = 33) of the research was quantitative in design (including trials, cross sectional studies, observational studies and quasi-experimental studies), with the remainder consisting of mixed-methods (n = 4, 5%), qualitative (n = 17, 24%) and review papers (n = 18, 25%). Sample size ranged from 6 to 47 participants in qualitative research, and 14 to 3,752 participants in quantitative (excluding two very large national studies ranging from 18,119 to 64,076 (weighted) participants) (Appendix C in S1 File ). Studies from Europe (n = 28), the USA and Canada (n = 22) accounted for 70% of papers with the remainder coming from Australia (n = 11), Brazil (n = 1), Chile (n = 1), Israel (n = 4), Japan (n = 1), New Zealand (n = 1), Taiwan (n = 1), India (n = 1) and Thailand (n = 1) (Appendices C and D in S1 File ).

The initial analysis identified 72 contexts and 79 mechanisms. These were the psychosocial child and environment factors driving participation outcomes in schools. Further analysis revealed three synthesized mechanisms, and five synthesized contexts. Based on the evidence, we constructed a conceptual framework that depicts mechanisms and contexts influencing school participation for children with disabilities ( Fig 2 ). Details on specific categories of mechanisms and context are provided below.

Context and mechanisms hypothesized to be vital intervening factors in predicting children’s participation. Context provides opportunities and constraints. Mechanisms drive participation outcomes. Participation as an outcome has two components: attendance and involvement [ 24 ]. As children participate, they experience feelings, sensations and perceptions which may be adaptive or maladaptive (e.g. enjoyment, boredom, amusement). There is a cyclical relationship between participation, context and mechanisms.

Synthesis of findings led to three overarching mechanisms representing psychosocial issues and the child’s experiences (supporting studies are presented in Table 4 and Appendix E in S1 File ).

• (1) Identity —these mechanisms were associated with “being”, or the thoughts and feelings the child had about themselves (e.g. believing in themselves, having confidence, understanding their roles or feeling a like a member of the school community) as well as perceptions of activities and tasks in school (e.g. interests, preferences or perceived enjoyment).
• (2) Competence —these mechanisms were associated with “doing” or what the child did in school (e.g. following rules, showing interest, being confident, or following a routine).
• (3) Experience of mind and body (symptoms) –these mechanisms were associated with issues commonly experienced by children with disabilities in schools: pain, anxiety, mood and fatigue/tiredness.

Analysis indicated that these mechanisms related to the child “being”, and how children perceived and made sense of their participation within school. Firstly, the information extracted from studies overwhelmingly and specifically demonstrated the relevance of mechanisms related to motivations, preferences, and interests. The key mechanisms were children’s own interests and preferences including selection of certain activities based on interests/preferences and perceptions around potential enjoyment (or not) of activities which motivated choices [ 14 , 24 , 42 – 46 , 46 – 52 ]. Participation was also strongly influenced by children’s self-perceptions, including self-esteem, self-efficacy, confidence, and perceived competence—all of which influenced children’s activity in-the-moment and over time, influencing current and future participation[ 24 , 46 , 48 – 58 ]. Perceptions around meaningfulness were also identified as an influencer of participation, including perceptions around activities that were valued or especially significant to children, as well as perceptions of personal satisfaction and pleasure associated with activities[ 14 , 21 , 24 , 45 , 50 , 51 , 59 , 60 ].

Children’s internalization and understanding of routines and habits emerged as conditions influencing participation in school. Studies highlighted children’s internalization of habit/routine, familiarity with habit/routine and automaticity of habit/routine were mechanisms for participation [ 44 , 53 , 62 – 64 ]. Knowing the steps involved in activities or routines led to reduced demands on the child to understand, process, or plan, and when internalized as patterns of actions, facilitated participation by providing a set of rules to navigate the school context. Routines of the school day were noted to shape children’s daily participation, with references to the fact that children’s participation in school was supported by structured activities and programs [ 44 , 64 ], and that regularized activities in the classroom supported participation for children with disabilities [ 44 ]. Children themselves perceived that rules, norms and routines are important in structuring their participation [ 62 ]. Parents also indicated that routines influence participation [ 44 , 53 ].

Children’s knowledge, understanding and subjective experience of roles influenced their participation. In the school, possible roles included being a pupil, friend or member of a club. Disabled children tended to occupy less “desirable” roles within the school. Roles considered desirable by children, especially those including being good at something (e.g. best in class) or “best friend” roles were seldom held by children with disabilities [ 61 ]. Children with disabilities also engaged in less “doing roles” (such as athlete, leader, helper and tutor) and more were likely to be classified into negative roles including “challenged learner”, victim or bully [ 61 ]. Mechanisms influencing participation were internalization of roles (either positive or negative roles), leading to positive or negative self-perceptions, and understanding/knowledge of role requirements [ 56 , 61 ]. Related mechanisms included self-perceptions relating to inclusion, focusing on children’s subjective experiences of social inclusion, sense of membership and sense “school” identity [ 57 ].

Competence mechanisms reflected “doing” or behavioral aspects and how children engaged in participation. Well-supported mechanisms enabling participation were children taking initiative, being proactive and acting on interests [ 14 , 24 , 44 , 52 , 53 , 65 – 68 ] Research also demonstrated that seeking independence and autonomy, showing responsibility and commitment, displaying persistence and perseverance were drivers of participation [ 45 , 47 , 51 – 53 , 57 , 68 – 72 ].

Other competence mechanisms related to following routines and having daily habits [ 55 , 62 ] as well as consistency of behavior, including being predictable, being systematic and preparedness for routines [ 55 , 62 ]. Also identified as important conditions for participation were children meeting teachers’ expectations and following the school’s rules [ 61 ]. Finally, patterns of behaviors that followed from particular roles were identified as shaping quality and quantity of participation, including patterns of behaviors associated with friendship roles and patterns of behaviors associated with school-based roles (for example sports team member) [ 57 , 61 , 70 , 71 , 73 ].

Studies exploring relationships between skills and participation were common. In total, 27 papers provided data. However, researchers are now concluding that deficits or improvements in skills, although related to participation, are not related in a direct or linear fashion. The evidence challenges the idea that an increase in skill equates to an increase in participation. Psychological characteristics, personality and preferences are also important [ 14 ]. The evidence did indicate, however, that skills were important for the completion of certain types of activities in certain situations. For example, social skills are often required to access play situations [ 57 ]. The mechanisms related to skills identified as important for participation were organisation and planning (e.g. sequencing, concentration and memory) [ 35 , 46 , 49 , 51 , 52 , 55 , 56 , 63 , 70 , 72 , 74 ]; communication/social skills [ 14 , 15 , 42 , 49 , 51 – 53 , 67 , 72 , 74 ] and motor skills [ 8 , 14 , 49 , 51 , 52 , 55 , 58 , 70 – 72 , 74 – 80 ].

Experience of mind and body

The literature provided good support for the influence of symptoms associated with disability on participation. These were pain, fatigue, anxiety and mood. Twenty-two papers provided data. Identified mechanisms were concerned with experiences related to symptoms. These were: pain (especially cognitions and catastrophizing) [ 8 , 14 , 52 , 71 , 75 , 79 , 81 – 83 ]; fatigue, including lowered energy, tiredness, and sleep disturbance[ 14 , 46 , 58 , 71 , 80 , 84 – 86 ]; anxiety and its consequences including fear, frustration, and anger [ 46 , 51 , 53 , 58 , 60 , 71 , 80 , 87 – 89 ], and low mood, sadness or depression [ 13 , 52 , 71 , 80 , 81 , 84 , 89 ].

Fundamental underpinnings were closely related across the different symptoms, drawing on social learning and cognitive-behavioural theory, suggesting that illness behaviours or responses generate negative behavioural patterns which may be maintained and strengthened over time [ 8 , 13 , 71 , 75 , 81 , 83 ]. These mechanisms lead to reduced participation through disengagement from activity and a cyclical pattern of attempts to control symptoms through increasing withdrawal from activities.

The next step was to explore how and which contexts facilitated or provided opportunities for participation versus contexts which restricted/constrained participation. This twofold role of context was evident throughout. Context comprised five interrelated areas: (1) structures and organization of the school, (2) peers, (3) adults, (4) physical spaces and (5) objects. Sub-components of each area were identified by the reviewers, focusing on opportunities (supports) or constraints (barriers) to school participation (supporting studies are presented in Table 5 and Appendix F in S1 File ).

Structure and organization

Structure and organization was a well-supported aspect focusing on the ways things were done in the school. Facilitative aspects were described as being tailored to the child, responsive to needs, individualized, and child led [ 10 , 15 , 17 , 21 , 24 , 42 – 44 , 49 , 52 , 54 , 57 , 58 , 62 – 65 , 67 – 70 , 80 , 90 – 94 , 96 ]. Facilitative structures/organization were also described as adaptable and flexible [ 10 , 14 , 36 , 44 , 52 , 64 , 65 , 68 , 69 , 80 , 96 , 97 , 98 ], predictable [ 44 ] and well-planned [ 10 , 68 , 69 , 93 , 96 , 98 ]. The most common constraint to participation identified was lack of individualization [ 15 , 20 , 42 , 44 , 49 , 53 , 57 , 58 , 65 , 66 , 69 , 71 , 72 , 80 , 91 , 97 , 98 ]. Other identified constraints included rigid routines [ 10 , 14 , 67 , 80 , 84 , 92 , 93 , 97 , 98 ] or routines which were unpredictable or disordered [ 70 , 72 ].

There was abundant evidence that adults (referring to teachers and other staff within school) were key in creating opportunities for participation and were also influential in shaping the quality, frequency and range of children’s roles [ 16 , 21 , 42 , 43 , 52 , 57 , 61 , 64 , 66 , 96 , 97 , 99 ]. Adult’s positive and sympathetic attitudes were facilitative of participation [ 14 , 93 , 96 , 99 , 100 ] as were individuals who were competent and knowledgeable [ 44 , 62 , 49 , 68 , 96 , 99 ]. Good collaboration between adults was also facilitative [ 14 , 68 , 93 , 96 , 99 ]. Attitudes were identified as restrictive, as well as adults who were unsympathetic [ 10 , 44 , 47 , 53 , 58 , 71 , 72 , 80 , 93 , 99 , 100 ] or lacking in knowledge [ 14 , 35 , 49 , 101 ]and institutional collaboration [ 35 , 69 , 99 ]. Adults were also noted to play a part in shaping negative roles (e.g. by ‘pigeonholing’ children with disabilities as less able and therefore offering them fewer participation opportunities, or by being reluctant to allow students to learn or play independently) [ 61 ].

The evidence indicated that facilitative peers (referring to other children within the school) provided practical and emotional support enabling participation [ 10 , 15 , 16 , 21 , 43 , 44 , 46 , 49 , 57 , 58 , 60 , 64 , 68 ]. Facilitative peers also provided opportunities for friendship [ 43 , 49 , 61 , 71 , 73 ]. Positive attitudes were also identified as important in creating opportunities for participation [ 24 , 36 , 46 , 69 , 93 , 100 ]. Studies also identified non-supportive actions and behaviours, including bullying [ 15 , 43 – 45 , 57 , 61 , 71 , 73 , 80 , 92 , 99 ], negative attitudes [ 10 , 46 , 53 , 58 , 78 , 80 , 92 , 93 , 100 ], and friendship avoidance [ 15 , 49 , 60 , 66 , 71 , 87 ].

Supportive spaces were described as being accessible and usable [ 10 , 14 , 21 , 24 , 36 , 44 , 45 , 59 , 60 , 65 , 67 , 68 , 69 , 71 , 78 , 97 , 99 ] with suitable design/layout and suitable sensory qualities [ 53 , 60 , 62 , 68 , 86 , 96 , 99 ]. Constraints to participation focused on restricted access to areas where activities happen [ 10 , 14 , 35 , 47 , 49 , 52 , 53 , 60 , 65 , 71 , 78 , 92 , 97 , 99 , 103 ]. Other issues included unsuitable sensory qualities, spaces which were unfamiliar, and spaces which were crowded or difficult to navigate [ 35 , 52 , 53 , 60 , 65 , 97 , 99 ].

Research on objects focused on the availability of objects needed to participate in specific activities, for example, wheelchairs and assistive devices [ 10 , 14 , 21 , 24 , 35 , 36 , 52 , 59 , 60 , 62 , 63 , 65 , 91 , 99 ]. Usability and acceptability to the child were noted as important [ 14 , 44 , 50 , 52 , 53 , 60 , 71 , 72 , 99 ]. Research on constraints associated with objects was fairly limited. Objects being unavailable [ 10 , 60 , 65 , 72 , 99 ], difficult to use [ 35 , 53 , 50 , 99 ] or isolating/stigmatizing [ 45 , 50 ] were identified as constraints to participation.

This realist review has developed a conceptual framework for children’s school participation, and identified the processes (mechanisms) and contexts influencing participation outcomes. The synthesis is of key issues that decision-makers and interventionists may consider to help children to participate in school.

The findings support the hypothesis that identified mechanisms and contexts are important factors associated with participation outcomes. Specifically, the findings show mechanisms in three clusters focusing on identity, competence and the child’s experience of mind and body. The context (environment) is conceptualized in terms of adults, peers, the schools’ structures and routines and spaces/objects. Unlike most models designed for dealing with specific impairments or diagnoses, this model is useful with any child with any health related need or disability experiencing problems with their participation. This is a middle range theory. The term ‘middle range’ theory refers to the level of abstraction at which useful theory for realist work is written: detailed enough and ‘close enough to the data’ that testable hypotheses can be derived from it, but abstracted enough to apply to other situations as well [ 26 ]. Middle range is useful because it offers an analytical approach to linking findings from different situations [ 26 ]. The outcomes of a realist review are ideally framed as middle range theory—that is, theory that can usefully be applied across a range of situations, or in a number of domains [ 26 ]. Findings are (by design) age limited (4–12 years old), but are independent of gender, disability category or ethnicity, supporting application across a range of clinical and educational settings. Ideas reflect a contemporary conceptualization of participation drawn from 72 research papers. The model imagines mechanisms and contexts in dynamic and transactional relationships. This is a “generative causality” model. Explanation is not a matter of a singular mechanism or a combination of mechanisms asserting influence on an outcome. School participation emerges out of a cooperation of factors.

No single factor fully explains variance in participation [ 56 ]. Previous research provides indications of which features of the child significantly affect the participation of students with disabilities, including focus on psychosocial factors for participation, such as preferences [ 102 ]. Our findings support the significant importance of children’s preferences, interests and motivations for participation. Our review also adds to the literature by providing detail on habits and routines which are novel elements not commonly considered. Based on our findings, we recommend that issues associated with habits and routines are closely considered in future. We have found that deficits in routine and habits are important contributors. Habit and routines are performed repeatedly and are relatively automatic. They specify what the child will do and in what order, and, thus, constitute key mechanisms for participation. Habits and routines must be understood and internalized and there are additionally ties to environment. As noted by Engman and Cranford (2016), the quality of habitual action is not equally easy for all—in some environments “non-normative embodiment” (i.e. disability) is less likely to make habitual behaviour achievable than in others [ 104 ]. The structure of the environment enables or restricts consistent, structured and planned schedules and routines. Adults facilitate breaks, social routines, setting of rules and expectations, while objects (timetables and other prompts) provide specific routines (e.g. for gathering information, or which classes to go to).

Our model focusses on participation as a key outcome which is influenced by environmental factors. In line with the ICF [ 1 ], and in the wider literature, the environment is noted to have a significant influence on participation [ 8 , 75 , 78 , 92 , 100 ]. We advance thinking by identifying specific environment factors and offering potential for comprehensive assessment and intervention. This is important, as the potential selection of environmental factors is vast. The issue is to identify specific matters facilitating or obstructing participation in school. The identification of issues must be completed in tandem with a contemporary model of participation itself. Small aspects of the school microsystem can go unnoticed if attention is not drawn to them. A focus on the school environment explicitly defined will support guidelines for working to support participation. The current study findings indicate contextual influence of the school is not just a sum of the people, objects and spaces, but also “how” things are done, or expected to be done within the school (the structures and organization of the school) and the important part adults play in providing opportunities for participation and social roles. Our findings highlight the importance of a nuanced understanding of the environment and not just consideration of physical aspects. Identification of physical aspects of the school, whist important, should always be considered alongside the social environment.

Implications for practitioners

International practice is moving towards the adoption of system/ecological views, but the field still operates predominantly from a unidirectional perspective where “something” is provided to “fix” the person with a disability [ 18 ], rather than operating from more contemporary view of participation as a phenomenon that can be mobilized at different levels. The findings of this review show that individual and environmental interventions should be developed promote participation outcomes in schools. Identified mechanisms offer a potential basis for developing psychosocial child-focused interventions. Mechanisms (e.g. preferences, perceptions of self, perceptions of roles, internalization of routines) are appropriate targets for intervention. These ideas are congruent with recent studies emphasizing that individually tailored coaching and mentoring may help to improve children’s participation [ 17 ]. As noted, however, change will not be effective if it is only targeted at the child. Contextual elements interact with mechanisms to make participation more or less likely and must also be a focus for intervention.

With a focus on school, teachers’ knowledge is of key importance [ 105 ]. Efforts are required to assist teachers’ regarding knowledge and confidence in enhancing participation. Teachers work with increasingly diverse groups of learners and are responsible for attempting to achieve positive outcomes [ 106 ]. Concerns have been expressed that education remains less effective for learners with disabilities [ 2 ]. Concerns are understandable particularly when schools and teachers tend to be rated on achievement, rather than participation [ 107 ]. Existing supports, strategies and approaches for children with disabilities, along with theoretical underpinnings, are frequently superficial and lacking in detail [ 108 ]. Practical aspects of how to “do” inclusion or participation are therefore difficult to see and implement. Previously developed supports and interventional resources have also tended to focus on specific issues or diagnoses (e.g. Autism, Dyslexia, Learning Disability)–leading to “a programme for every problem” [ 109 ]. This has two consequences. Firstly, educationalists follow a medical or disease orientated model, with the consequential issues around disempowerment and depersonalization of people with disabilities [ 18 ]. Secondly, those with responsibility for supporting children with disabilities may feel overwhelmed by the range of options [ 105 ]. The complexity and number of programs makes selecting the right option for the right child at the right time difficult.

Implications for research

Future research could explicitly link intervention components to mechanisms as described in this review. Following methods which use formal means for developing theoretically determined interventions [ 110 ], ‘theory-based’ rather than ‘theory-inspired’ interventions, may be developed. Such research is closely aligned to the UK MRC framework for development of complex interventions [ 27 ]. Identified mechanisms offer a basis for understanding how and why therapeutic or educational interventions for children may or may not be effective at improving school participation. Identification of strategies for the detection and cultivation of facilitative contextual elements would also follow from the above methods.

Further research activities include selection of appropriate items for school participation measurement. Parent-report methods have been commonly used in medical and psychological research to collect participation information [ 86 ]. However, researchers should also consider other data collection methodologies, particularly report by teachers [ 19 ].

Limitations

While we have attempted to make our search as sensitive as possible (and erred on the side of sensitivity as opposed to specificity), participation continues to be a diverse area spanning several disciplines with limited consensus on terminology. It is difficult to design a perfect strategy. Given the methodological assumptions of realism, other reviewers could come to different conclusions. However, themes and concepts driving the model were apparent across different types of difficulties/disabilities, across studies that used different research methods, and across a range of international contexts. Consistency in identified features provides evidence to support conclusions.

Conclusions

This was the first realist review to explore mechanisms and contexts for school participation of children with disabilities. This paper presents a conceptual framework including child psychosocial factors, such as understanding of routines, sense of self, and perceptions of role, and as well as characteristics of the school environment. We encourage researchers, practitioners, and policymakers to consider these contexts and mechanisms when addressing school participation among children with disabilities. Consideration of interventions, designed specifically to enhance participation by targeting mechanisms, contexts and the processes identified in this review, is now key.

Supporting information

Acknowledgments.

The study was initiated by a partnership between the Salvesen Mindroom Centre in the University of Edinburgh and the CIRCLE Collaboration (Child Inclusion: Research into Curriculum, Learning and Education) research team at Queen Margaret University, Edinburgh. We would like to acknowledge Miriam Crowe, Deborah McCartney and Cathleen Hunter for support and critical comment on the manuscript. Funding for this work was received from the Salvesen Mindroom Centre for Learning Difficulties.

Funding Statement

Funding for this work was received from the Salvesen Mindroom Centre for Learning Difficulties.

Data Availability

• Watch Live: Law & Crime Network
• WATCH LIVE: Young Thug YSL racketeering trial
• 9 Shocking Times Defendants Testified at Trial
• 10 Most Memorable Law&Crime Network Trials
• Watch Live: Brevard County Bond Court
• Where to Watch
• TV Schedule
• Bodycam Videos
• Justice Rules
• Buried with Love
• Prime Crime
• Cops Reloaded
• Law&Crime Productions

Florida teacher used foam mat to ‘swaddle’ student with disabilities, dragged her into bathroom as punishment: Police

Inset: Beatriz Rapisarda (Brevard County Sheriff). Background: Sunrise Elementary School (WFTV).

An elementary school teacher in Florida faces child abuse and false imprisonment charges after she was accused of dragging and straddling a student with disabilities and locking her in a bathroom.

Beatriz Rapisarda, 41, was arrested in connection with incidents that happened this week at Sunrise Elementary School in Palm Bay, officials said. Palm Bay is more than 70 miles southeast of Orlando.

Police responded to the school on Thursday on a call of allegations of physical abuse between a teacher and student, according to a  probable cause affidavit .

Once there, witnesses told law enforcement that there was an incident in a classroom for the intellectually disabled between the teacher and a student, who was described as low-functioning and only slightly verbal, the document said.

The alleged abuse started after the teacher wanted the student to go from one area to another, but the student said no, the affidavit said.

The teacher then pushed the student “at least twice,” using two open palms to the student’s chest area, the document said.

When the student protested by throwing herself to the ground, the teacher allegedly grabbed the student by her wrist and “pulled her straight up” before the student threw herself to the ground again, the document said.

The teacher then got on top of the student and “straddled” her as the student lay on her back and pinned the student’s arms to the ground, the affidavit said witnesses told the officer.

When the student got up, the teacher stepped in front of the student, grabbed her under the arms, and dragged her toward the bathroom, the document said.

The witnesses told the officer Rapisarda uses the bathroom as a “form of punishment,” where she often puts the student and closes the door with only her foot lodged in it, so it’s not completely shut, the affidavit said.

In the alleged incident, as the teacher pulled the student across the classroom about 30 feet and as the student kicked and screamed, the student’s foot became stuck on a shelf. The teacher grabbed the student’s ankle and wrist and pulled her away from the shelf with her knee in the student’s back while pinning the student’s right arm down, the document said.

The teacher had “all her weight” on the student, one witness told the police, according to the affidavit.

When the student tried to crawl away, the teacher then dragged the student to the bathroom on her back by both wrists and held the bathroom door nearly completely shut as the student banged on the door for up to 10 minutes, the document said.

“The witnesses stated that this action was so shocking that one left the classroom and notified their supervisor,” the affidavit said.

The document noted a witness telling police about a previous incident with the teacher on Tuesday, in which she “wrapped” the student in a foam mat in a “swaddle” or “burrito style” and had the student stand in place while the teacher wrapped her arms around the mat enfolding the student for between five and seven minutes. The witnesses also said the teacher has a bathroom schedule for the special-needs kids and has denied them the use of the bathroom if they didn’t use it at their allotted time, the document said.

The four witnesses told the officer the teacher’s behavior was “unacceptable” and “aggressive” and called her “very controlling,” the document said. The parents told the officer they wanted to pursue the matter criminally, the affidavit said.

Brevard Public Schools released a statement , saying it was cooperating with the investigation and has placed Rapisarda on administrative leave.

Rapisarda is being held at the Brevard County Jail on $10,000 bond. She’s scheduled to be arraigned on Sept. 19, online court records show.

Have a tip we should know? [email protected]

Filed Under:

Follow law&crime:.

Teen shot girlfriend’s father during argument about ‘inappropriate’ social media posts, deputies say

Mother who jumped off overpass formally charged with killing her 3-year-old twins who were found in car’s backseat

‘Desecrated and discarded like refuse’: Man sentenced for beating, strangling his girlfriend to death days after he was released from jail and on a no-contact order for previous assaults against her

Self-described ‘board certified’ plastic surgeon performed unlicensed cosmetic procedure and treated woman for ‘infections,’ DA alleges

‘She kept delivering the packages for Amazon’: Mom with baby in stroller allegedly ‘dragged’ by SUV driver who set carriage upright and walked away

Man said he ‘had to stab’ estranged girlfriend in front of toddler, leaving child alone with body