Education for individuals with Down syndrome - An overview

doi:10.3104/9781903806319


Evidence of outcomes

Benefits of education

Rynders and his colleagues in Minnesota have been working to improve the educational outcomes for children with Down syndrome for more than 30 years. In a 1990 paper, they challenged the view that children with Down syndrome were largely considered 'trainable' rather than 'educable', publishing data illustrating the educational achievements of young people in their research studies. In 1997, they published a further paper combining data on 171 children with Down syndrome from several longitudinal and cross-sectional studies. They emphasise that their data illustrates that the majority of children have gained some competence in literacy and numeracy skills, justifying an academic curriculum, and that most students are making steady progress throughout their teenage years.[6,8]

There have also been a number of papers reporting on the progress of a cohort of young people with Down syndrome in Australia from their progress in an early intervention programme through to adult life, indicating that those accessing an academic curriculum in inclusive settings have achieved greater progress in academic skills such as reading and number.[9,18]

Inclusion research

Inclusion research to 1997

  • The few available studies show gains in academic skills from accessing the curriculum with support in mainstream classrooms.
  • No evidence of specific benefits of education in special schools in the UK.
  • These studies do not consider research on self-esteem, social relationships or happiness.

While there has been a steady increase in the number of children with Down syndrome in inclusive placements, there has only been limited planned research evaluation of the outcomes to date. In a recent review,[16] Cunningham and colleagues documented the trends in inclusion and evidence of outcomes. They identified only 4 outcome studies at that time that met their criteria for rigorous research: 3 in the United Kingdom[19-21] and one from the United States of America.[22]

Recent review paper

Cunningham and colleagues conclude from their review[16] that the available evidence is sparse but it does indicate that academic attainments are higher for children with Down syndrome in mainstream placements and that levels of self-sufficiency are similar to those attained in special schools. In their review, they point out that there is actually no evidence of specific benefits of education in special schools in the United Kingdom, despite specialist teachers, smaller classes and additional resources.

However, this review also points out that at that time, there was no research on the effects of school placement on self-esteem, social relationships and happiness. It is possible that life in a mainstream school could adversely affect self-esteem and that reciprocal, mutually supportive social relationships between pupils would be more difficult for the pupil with Down syndrome in a mainstream setting. There is now some evidence on these issues from the Hampshire studies, conducted by the authors and their colleagues, which are summarised below.[23,25-27,31]

Since the Cunningham review[16] was published there have been three other United Kingdom studies,[24,28,29] which evaluate aspects of inclusion in comparison with special school placement. Their findings are discussed below.

The Hampshire studies of inclusion

The Hampshire studies provide the most extensive database currently available on inclusion for children with Down syndrome and on outcomes from special education. The studies span a 14 year period and are the result of continuous research collaboration between the Psychology Department of the University of Portsmouth and Down Syndrome Education International during that time.

Two main studies

In 1986 information was collected on all aspects of the development and educational progress of 90 teenagers with Down syndrome (11 to 18 year olds). At this time all the teenagers were being educated in special schools, with 95 (94%) in schools for children with severe learning difficulties (SLD) and 5 (6%) in schools for children with moderate learning difficulties (MLD).[30] In 1999, 46 families in Hampshire with teenage children with Down syndrome (11 to 20 years) took part in a similar study. Twenty eight (61%) of the teenagers were being educated in special schools (24 in Severe Learning Difficulties and 4 in Moderate Learning Difficulties) and 18 (39%) in local mainstream secondary schools (and fully included in mainstream for all or most of their education).

The data from these two studies allows three questions to be addressed:-

  1. Are teenagers in special schools progressing faster in 1999 than in 1986, given the availability of more knowledge of the children's specific special educational needs and positive changes in social attitudes to disability in that time?
  2. Are teenagers in mainstream schools in 1999 progressing faster than the teenagers in 1986?
  3. Are the teenagers included in mainstream schools in 1999 showing any benefits or disadvantages of inclusion when compared to their peers in special schools in 1999?

In this module it is only appropriate to provide a summary of the main findings of this research. The reader wishing to review more detailed information is referred to articles discussing the research in more depth.[27,31] Some of the information collected on specific skills and abilities is included in other modules as appropriate (e.g. reading and numeracy achievements).

The studies in 1986 and 1999 measured developmental progress relevant to education under several headings:

Hampshire studies: Measures

  • Daily living skills
  • Communication skills
  • Academic skills
  • Social skills
  • Behaviour
  • Daily living skills - personal care skills such as independence in dressing, bathing, toileting and at mealtimes.
  • Communication skills - understanding and using spoken and/or signed language.
  • Academic skills - reading, writing, arithmetic, money and general knowledge.
  • Social skills - social independence outside the home (crossing roads, using buses etc), social contacts (social activities outside school time) and leisure interests.
  • Behaviour - difficult or unusual behaviours.

In 1999, the same areas of development were assessed using the same measures as in 1986, but in addition, two other standardised measures of development and behaviour in all these areas were included to allow comparison with studies elsewhere in the world (The Vineland Scale of Adaptive Behaviour and The Connors Parent Rating Scales). The main findings will be discussed in relation to each area of development.

Hampshire studies: Group comparisons

  1. 1986 and 1999 teenagers in special schools.
  2. 1999 teenagers in mainstream schools and 1986 teenagers (who were all in special schools).
  3. 1999 teenagers in special school and 1999 teenagers in mainstream schools.

In the main, the comparison groups (1986 - special, 1999 - mainstream, 1999 - special) do not differ significantly from one another on any of the variables that are known to influence children's progress. The age distributions, the comparative numbers of boys and girls, the position of the children in their families (i.e. only, first, middle, eldest) and the social class distribution of the comparison groups are all the same, except for one feature of the 1999 teenagers. The mainstreamed group are significantly younger as a group (mean age 14 years 8 months) than the special school comparison group (mean age 16 years 4 months), as a greater proportion of the younger teenagers have been included in mainstream for all of their education than the older ones. This means that the study is less likely to find mainstream advantages as all the skills being measured improve with age according to the 1986 results.

Since measures of all the children's development at school entry are not available, the researchers cannot be absolutely certain that the children placed in mainstream were not more able at the start of their school careers than those placed in special schools. However, educational placement policy varied in Hampshire at the time these children started school. The LEA was divided into four divisions each covering a geographical area of the County. In the South East Division inclusion began in earnest in 1988, due to parent lobbying and support for the schools from the second author, Gillian Bird, a specialist psychologist funded by the Down Syndrome Educational Trust to develop inclusion with the schools. The children with Down syndrome were placed in their local mainstream school at 5 years purely on the basis of their parent's preference for a mainstream placement and not on the basis of ability.

In the other three divisions, inclusion was started much later and still remains more limited. These policy and practice differences mean that equally able children with Down syndrome in most of the County were being placed in special schools while in the South East Division they were being placed in their local mainstream school with the support of a full time Learning Support Assistant (LSA). The research team have information on the children starting in mainstream schools at 5 years that indicates that they covered the range of ability that is representative of the majority of children with Down syndrome.

The findings discussed below tend to support the researchers' assumptions that the two groups of teenagers did not vary in potential ability at the start of their school career as, on all the measures that are less likely to be influenced by school experience, there are no differences in the range of achievements of the two groups as teenagers. However, to be as careful as possible to establish fair comparison groups, when comparing mainstream and special school effects for the 1999 group, the 5 least able teenagers (18%) have been removed from the special school group. This is based on the assumption that the least able children were not being placed in mainstream schools ten to twelve years ago in any part of the county.

Hampshire studies: Group differences

  • The teenagers in mainstream schools (1999) were on average younger than the teenagers in special schools (1999 and 1986).
  • There were no other significant differences between the groups which might affect outcomes - other than school placement.

In summary, before considering the findings, there are no differences between the 1986 and 1999 groups that may effect the conclusions other than time of birth and school experience. There is one difference between the 1999 mainstream and special school groups that is significant. The mainstream teenagers are younger (more being under 15 years of age) but this would have the effect of making mainstream advantages less likely in the findings.

The data from the 1999 questionnaires were coded blind - the researchers did not know which school group the child was in when coding the results.

The findings

Personal practical independence

Hampshire studies: Findings

  • No differences in daily living skills in any of the groups.
  • Spoken language skills are significantly better for the mainstream school group.
  • Academic skills for the special school group are better in 1999 than they were in 1986.
  • Academic skills are significantly better for the mainstream group than the special school group in 1999.
  • Social skills show no differences overall, although the mainstream under 15's show more advanced social skills than the special school under 15's.
  • Fewer over 15's in the mainstream 1999 group than in the special 1999 group, but data suggests a benefit for the over 15's in the special school group for developing mutually supportive friendships.
  • Better social behaviour for the 1999 mainstream group than for the 1999 special school group on one of the behaviour measures, but no difference between groups on the other two measures.
  • All of the teenagers progress with age on daily living skills, behaviour and social measures.
  • Only the teenagers in the mainstream school group show an improvement in language and academic skills with increasing age (11-18 years).

In this area of development most of the teenagers in 1986 were well on their way to complete independence as they progressed through their teenage years. The studies found no significant differences between the groups in daily living skills in 1986 or 1999, and that in both the special and mainstream groups daily living skills were improving with age. Special schools, especially schools for pupils with severe learning difficulties, would have daily living skills on their curriculum. However, these findings suggest that these skills are not influenced by school placement and are predominantly learned at home.

Communication skills

The communication skills of the teenagers have improved significantly in 1999 when compared to the communication skills of the teenagers in 1986, but only for those 1999 teenagers who have been in mainstream education. On the Vineland communication measures this difference between teenagers in mainstream or special education can be clearly seen. Significantly, there is no difference in the understanding of spoken language between the two groups, but there is a considerable difference in expressive (spoken) language skills. The expressive language skills of the teenagers in mainstream are on average 2 years and 6 months ahead of those of their peers in special education in 1999. This gain, based on norms for typically developing children, is dramatic as past studies have shown progress on language measures to be about 5 months per year for teenagers with Down syndrome.[32,33]

Academic progress

The academic skills of the 1999 teenagers, in reading, writing and arithmetic, have improved significantly compared to the achievements of the teenagers in 1986. However, again, the mainstreamed teenagers are way ahead. The 1999 special school teenagers are significantly ahead of the 1986 teenagers on writing and arithmetic measures only. The 1999 mainstreamed teenagers are significantly ahead of the 1999 (and 1986) special school teenagers on reading, writing, arithmetic, and general knowledge but not on money skills. On the Vineland reading and writing measure, the 1999 mainstreamed teenagers are 3 years and 4 months ahead of the 1999 special school teenagers (mean scores being 9 years 1 month compared to 5 years 9 months).

Social skills and leisure activities

All the 1999 teenagers have higher scores on social independence and social contacts, when compared with the achievements of the 1986 group. There are no overall school placement effects on social development for the 1999 groups except on one Vineland scale which indicates a possible benefit of being in special school. On the Interpersonal Relationships scale, which assesses personal interactive and friendship skills, the 1999 special school teenagers score significantly higher. One interpretation of this might be that the teenagers with Down syndrome in special schools have a peer group in school that allows real reciprocal, mutually supportive relationships to flourish with peers of similar interests and abilities, but those in mainstream schools do not. Most of the teenagers with Down syndrome are included on an individual basis in their local school but the other teenagers with similar levels of intellectual or learning disability are still in special schools at the present time. While the mainstreamed teenagers with Down syndrome may have a range of friendships with their typically developing peers, these may be different in nature. These friendships may be caring and helping relationships rather than close special friendships which allow a mutual sharing of experiences and emotional support.

However, this finding needs to be interpreted with caution as the younger group of mainstreamed teenagers (those under 15 years) score higher on this Interpersonal Relationships scale than their special school peers in the same age range (also under 15 years). This group may be benefiting from more experience in inclusion in the schools, as they progress through school.

Since all the other areas of the teenagers' development are either the same or significantly improved by being in mainstream school, the implication of the interpersonal relationships finding is that all teenagers with learning disabilities should be included in mainstream education to ensure optimum educational environments for both academic and social development.

Social behaviour

Overall, there is little evidence of any differences in behaviour between the comparison groups. Scores tend to be lower (less difficult behaviours) for the 1999 mainstreamed teenagers but the difference is only statistically significant on one of the behaviour scales used - the Vineland behaviour measure.

Progress with age

For the 1999 teenagers, their achievements on the daily living, behaviour and social measures are improving with age as they did in the 1986 study. For the 1999 mainstreamed teenagers, their communication and academic skills are improving significantly with age but there is no significant improvement with age for the 1999 teenagers in special schools on these skills.

Gender differences

The only areas in which there are any differences between boys and girls in the 1999 groups are on the Vineland measures of communication, reading and writing skills. As a group the mainstreamed boys are significantly more delayed than the girls in developing expressive language and in reading progress. This may be due to a tendency for boys with Down syndrome to have greater speech-motor difficulties.[34]

In summary

Summary

  • Teenagers in the 1999 special school group have better writing, arithmetic, social independence and social contacts out of school compared with teenagers in 1986.
  • Teenagers in the 1999 mainstream group are ahead of teenagers in the 1986 group on spoken language, reading, writing, arithmetic, behaviour, as well as social independence and social contacts out of school.
  • Teenagers in the 1999 mainstream group are significantly ahead of teenagers in the 1999 special school group on spoken language, reading, writing and arithmetic.
  • Currently (in the UK) there is a lack of opportunity to develop close and special, reciprocal friendships in mainstream schools with friends of the same age with similar levels of cognitive development.

If we return to the questions which this study set out to answer;

  1. Are teenagers in special schools progressing faster in 1999 than in 1986, given the availability of more knowledge on the children's specific special educational needs and positive changes in social attitudes to disability in that time? The teenagers in special schools are only showing significant gains in some academic skills (writing and arithmetic). Both groups of 1999 teenagers have gained a small amount in social independence and social contacts in the community.
  2. Are teenagers in mainstream schools in 1999 progressing faster than the teenagers in 1986? The teenagers in mainstream schools in 1999 are significantly ahead of the teenagers in 1986 on spoken language, reading, writing, arithmetic, one measure of behaviour, social contacts out of school and social independence.
  3. Are the teenagers included in mainstream schools in 1999 showing any benefits or disadvantages of inclusion when compared to their peers in special schools in 1999? The teenagers in mainstream schools have much better spoken language development (2 years 6 months ahead on average) than their peers in special schools and they have much better reading and writing skills (3 years 4 months ahead on average). They are also ahead on arithmetic and general knowledge and tend to show fewer behaviour difficulties. The only possible disadvantage may be the lack of opportunity to develop close and special, reciprocal friendships, which are based on mutual understanding and support. This may be because at present other teenagers, with similar levels of language and learning difficulties are still in the segregated special schools.

Why are there no advantages in special education?

Hampshire studies - possible explanations for language and academic gains?

The differences between the groups may be explained by a combination of:

  • The very wide range of ability and skills of pupils in small special school classrooms, making the teacher's task very difficult
  • Age appropriate peer groups and competent role models in mainstream classrooms
  • Individually tailored curriculum in mainstream classrooms, with a high level of individual support from an assistant
  • Higher expectations for pupils' academic achievements in mainstream classrooms
  • A normal language environment in mainstream schools
  • Taking part in reading and writing activities every day in mainstream classes, with support for learning, particularly for recording work

Perhaps the most important finding to explain is the lack of any educational advantage for those in special schools despite smaller classes and specialist teachers. The teenagers in the special schools might be expected to be ahead on daily living skills and practical independence, especially as special schools tend to focus the curriculum on these areas and the special school teenagers in the study are significantly older.

The researchers were also surprised to find that the special schools were not achieving better outcomes than in 1986, except in writing and arithmetic. These gains suggest that a more academic curriculum is now in place. However, the special schoolteacher is trying to teach reading and number to 8 to 10 children of very varying ability levels, especially in a school for pupils with Severe Learning Difficulties. It would be very difficult for the child with Down syndrome to receive the same quality or quantity of instruction in this setting as in the mainstream classroom, however dedicated the teacher.

In the mainstream classroom, the child with Down syndrome is learning to read or count in an age appropriate peer group and is therefore surrounded by competent role models. Most of the class can progress at a similar pace in the classroom and be taught successfully as a group and the child with Down syndrome has an individually tailored curriculum to work on at the same time, with the help of a Learning Support Assistant. Research from Devon, discussed in the next section, also suggests that the teaching staff have higher expectations for the child's academic achievement in the mainstream schools.

The spoken language gains shown by the mainstreamed teenagers are probably due to two factors; being in a normal language environment and taking part in reading and writing activities on every school day. In the mainstream school, all the teenagers' peers talk normally, exposing them to normal language models all the time and including them in conversations. Children with Down syndrome in mainstream classrooms will be recording their work, even if they are not yet independent writers, as they have a Learning Support Assistant to help them. This enables them to practise grammatically correct sentences, even though they may not yet be producing such sentences independently in their daily conversations. Reading, writing and spelling activities will teach new vocabulary and new grammar and will improve the sound production skills needed for clear speech. All these are areas of significant difficulty for most children and young people with Down syndrome.

It is unlikely that any special school environment can provide such an effective learning environment for developing speech, language, literacy and numeracy skills as the mainstream school classroom, for the reasons described. However dedicated the teaching staff and however hard they work, they cannot develop an optimal learning environment without a non-disabled peer group. Since there are no disadvantages for the development of daily living skills, social independence and appropriate behaviour and only one possible disadvantage - the availability of special friends - the implications of these data are that all children with Down syndrome and those with special educational needs similar to those with Down syndrome, should be fully included in mainstream schools.

Similar findings from other studies

Other studies report similar findings

  • Pupils aged 7 to 14 years in mainstream schools are more advanced in language, literacy and memory development than pupils in special schools.
  • A reluctance for special school teachers to acknowledge and tailor teaching towards specific cognitive profiles and learning styles associated with Down syndrome.

In a separate study, Laws, Byrne and Buckley[24] compared the language and memory development of 22 of the children with Down syndrome in mainstream school placements in Hampshire with 22 children with Down syndrome in special schools in a neighbouring county. This county had very few children with Down syndrome in mainstream school placements (only 5 out of 85 in the age range studied). The children's ages ranged from 7 years 3 months to 14 years 8 months and the two groups were matched for age. The children in the mainstream placements achieved significantly higher scores for vocabulary, grammar and digit span measures but not for non-verbal measures. The mainstreamed children with Down syndrome in the younger group (under 10 years 4 months) were on average, two and a half years ahead on vocabulary knowledge and for the older group, 11 months ahead on vocabulary and 9 months on grammar comprehension. On a reading measure all but 2 of the mainstream group were classified as readers and all but 3 of the special school pupils were classified as non-readers. Even when vocabulary knowledge and age were statistically controlled for, grammar comprehension and digit spans were significantly better for the mainstream pupils. This study reports similar language and literacy gains in mainstream placement as the within Hampshire study.

To other recent United Kingdom studies[28,29] evaluate aspects of inclusion in comparison with special school and their findings may explain the lack of benefits found for special education.

Findings in Devon, United Kingdom

In the first study, Beadman[28] reports on the outcomes for 24 children with Down syndrome in primary education in South Devon, an area of a county in the United Kingdom. Thirteen of the children are in mainstream schools and 11 are in special schools. The children in the mainstream schools are supported by a Learning Support Assistant, usually full-time at the start of their school career.

Beadman reports that in special schools ''there was less emphasis on teaching reading than in mainstream schools and less material available for the teaching of reading. Staff were resistant to new ideas generated by research and had closed minds, feeling that the general approach of the special school fulfilled the learning needs of all pupils attending. Many expressed the view that labelling or diagnosing a child was inappropriate. Classrooms were generally poorly equipped with reading materials and schemes, and all children offered a very limited choice of reading scheme - usually the Oxford Reading Tree.

Oxford Reading Tree is a series of reading books that are widely used in UK schools

One school was introducing paired reading for staff and parents to use with the children, and although books were being changed regularly, most of the children were unable to access the print successfully, instead sitting passively whilst the book was read to them by an adult. Some teachers did not have access to, or knowledge of, the first 100 or 200 key words for reading and spelling.

Letterland is a set of materials used to teach phonics in some UK schools

There was little evidence of any structured systematic phonics teaching beyond the initial sounds of Letterland. For many of the children this level of reading achievement would, perhaps, be unrealistic. On the other hand, other students, including the children with Down syndrome were being denied the opportunity to develop these important reading skills. There was little evidence of individual books being made for the children, or accessing language through print.''[28, pp 20-21] The report also states that ''Teaching staff (in special schools) interviewed in the study expressed strong views that children with Down syndrome were part of the special school population, and differentiation occurred in the same way for all children. There was no evidence of the children with Down syndrome having their education plans differentiated, taking into account the learning styles advocated by recent research. Indeed, there was quite strong resistance voiced by staff to these research findings.''

Beadman's findings confirm the experience of the Portsmouth research team. It has been very difficult to persuade special school staff to come to training days on cognitive development, speech and language, or literacy teaching for children with Down syndrome, yet teachers from mainstream schools are eager to attend and to plan to meet the children's special learning needs effectively in the mainstream classroom.

Findings in Oxford, United Kingdom

In the second study, Dew-Hughes[35] compared the social development and independent learning skills of 12 children with severe learning difficulties being educated in either a mainstream or a severe learning difficulty school, some of whom had Down syndrome. Dew-Hughes reports that on the mainstream site the children with severe learning difficulties were able to:

  1. Work co-operatively and autonomously for up to 300 percent longer than their peers in special school
  2. Form groups and pairs spontaneously, distinguishing appropriately between companions for work and recreation
  3. Change to a self-determined activity, within an agreed academic range, after completing a given task

They had a classroom day over two hours longer than their peers in special schools, whose timetables were constrained by difficulties of movement and physical care.

A comparable group in special school were:

  1. Seen as being less mature than their peers and more dependant on adult help
  2. Given little responsibility for their own belongings and equipment, or opportunities to make choices, take risks or determine activities

They had a complex, individualised curriculum with frequent changes of activity and groups often determined by the least able in the class.[29, p 16] In the discussion of this study the authors indicate that there is a tendency to still 'mother' children in the special school and that there are higher expectations for age-appropriate behaviour and social maturity in the mainstream school.

Other Hampshire studies on social inclusion

Some other small-scale studies have been conducted in Hampshire schools, looking at aspects of social acceptance and social interactions within inclusive school settings. These studies do not provide comparative information on special schools but they do provide comparisons with the children with Down syndrome with typically developing peers in the same schools.

Social acceptance

Social development and social inclusion studies

Four studies found:

  • Opportunities for social development were more limited in special schools than mainstream schools.
  • Pupils in mainstream primary schools were averagely popular and chosen as friends, but not as best friends.
  • The acceptance of the behaviour of pupils with Down syndrome by mainstream peers may not have been helping these pupils to improve their behaviour.
  • The length of time spent interacting socially at mainstream secondary schools was the same for pupils with and without Down syndrome, although for pupils with Down syndrome interaction was more likely to be with an adult. Conversations were less often initiated by the pupils with Down syndrome.
  • No difference in self concept between teenagers in mainstream and special schools.

Laws and colleagues[23] investigated the popularity of 8 to 11 year olds with Down syndrome in mainstream settings. Sixteen children with Down syndrome, all in different schools, were compared with 122 peers in the same classes. They report that the majority of children with Down syndrome were averagely popular and chosen as friends as often as other children in school. However, they were less likely to be nominated as a 'best friend' or as someone to invite home. These findings may be highlighting the early indications of the need for 'reciprocal' friendship opportunities suggested in the teenage findings already discussed. Interestingly, the behaviour of the children with Down syndrome did not affect their popularity although it did for their typically developing peers. Non-disabled peers who behaved badly were less likely to be popular, suggesting that the children are making special allowances for the behaviour of children with Down syndrome. While this may seem a positive outcome, it could be argued that this unconditional peer acceptance does not encourage children with Down syndrome to improve their behaviour. The popularity of the children with Down syndrome was not influenced by either their expressive or receptive language skills, again illustrating the acceptance of the other children.

Social interaction

Quail[26] carried out a small observational study of the social interactions of 7 teenagers with Down syndrome in mainstream secondary schools in comparison with peers in the same classes. She reported that there were no differences in overall time spent in interacting with others nor the average length of an interaction. However, when considering the interactions of the teenagers with Down syndrome, more were initiated by the other person than was the case for the typically developing peers and more interactions were with adults rather than peers. Topics of conversation were more likely to be work related than socially related for the teenagers with Down syndrome. These teenagers are being supported in fully inclusive classes by a Learning Support Assistant, which explains the amount of adult initiated and work related interactions. The positive findings are that the pupils with Down syndrome are in conversations as often and for as long as their peers. The negative findings are that too many of these conversations are with an adult and initiated by the other partner. The value of this type of study is that the findings can be discussed in school and efforts made to be sensitive to these issues. For example, perhaps seating arrangements would influence adult versus peer conversations, as often the Learning Support Assistant is seated beside the student with Down syndrome to support their learning in lessons, reducing casual interactions with peers. If students with Down syndrome are less confident in initiating conversations, then this might be addressed directly with the pupil by providing some support and practice for conversations and by alerting the other pupils to the need to support the pupil.

Self-esteem

It has been suggested that the self-esteem and happiness of students with Down syndrome might be adversely affected by being in mainstream education, where they may be surrounded by more able children all the time. The only study available on this issue at present is one by Gould.[25]

Gould investigated the self-concept of 24 teenagers aged 12 to 18 years, 11 in mainstream education and 13 in special education. She found no difference in their levels of self-concept and concludes that ''the crucial factor is that individuals feel happy and secure in their school placement, and receive positive attitudes towards their efforts and abilities in school''. She also found no relationship between ability measures and levels of self-concept among these teenagers.