Is Inclusivity an Indicator of Quality of Care for Children With Autism in Special Education?

OBJECTIVE: To determine whether the proportion of time spent in an inclusive educational setting, a process indicator of the quality of schooling for children with autism, improves key outcomes.METHODS: Patients were 484 children and youth educated in special education with a primary diagnosis of autism in the National Longitudinal Transition Study-2. These individuals were ages 20 to 23 in 2007. We used propensity-score inverse probability of treatment weights to eliminate the effect of multiple confounders. A causal interpretation of the effect of inclusivity on key educational and functional outcomes still depends on a critical assumption, that inclusivity is not confounded by remaining, omitted confounders.RESULTS: Compared with children with autism who were not educated in an inclusive setting (n = 215), children with autism who spent 75% to 100% of their time in a general education classroom (n = 82) were no more likely to attend college (P = .40), not drop out of high school (P = .24), or have an improved functional cognitive score (P = .99) after controlling for key confounders.CONCLUSIONS: We find no systematic indication that the level of inclusivity improves key future outcomes. Research on educational and functional outcomes for children with autism can benefit from data on large samples of children educated in real-world settings, such as the National Longitudinal Transition Study-2, but more nuanced indicators should be developed to measure the quality of special education for children with autism.

目的：确定在融合教育环境中所花费时间的比例（自闭症儿童学校教育质量的一个过程指标）是否能改善关键结果。 方法：研究对象为国家纵向转衔研究 - 2中484名接受特殊教育且主要诊断为自闭症的儿童和青少年。这些人在2007年年龄为20至23岁。我们使用倾向得分治疗权重的逆概率来消除多个混杂因素的影响。对融合教育对关键教育和功能结果影响的因果解释仍然取决于一个关键假设，即融合教育不受剩余的、被遗漏的混杂因素的干扰。 结果：与未在融合环境中接受教育的自闭症儿童（n = 215）相比，在普通教育教室中度过75% - 100%时间的自闭症儿童（n = 82）在控制关键混杂因素后，上大学的可能性没有增加（P = 0.40），高中辍学的可能性没有降低（P = 0.24），功能认知分数也没有提高（P = 0.99）。 结论：我们没有发现系统的迹象表明融合程度能改善关键的未来结果。对自闭症儿童教育和功能结果的研究可以受益于在现实环境中接受教育的大量儿童的数据，比如国家纵向转衔研究 - 2，但应该开发更细致的指标来衡量自闭症儿童特殊教育的质量。