The Educational Placement of Children with ASD In Middle Childhood: The Contribution of Child Attachment and Maternal Insightfulness

Background: Decisions regarding the educational placement of children with ASDs are based on a number of factors, including children's' cognitive functioning, adaptive behavior, social abilities and presence of behavior problems. Children with higher levels of functioning in all domains tend to be placed in the general educational system (within "mainstreaming" and "inclusion" systems), whereas children who function at lower levels tend to be placed in special education schools. Previous work has emphasized the role of children's IQ as well as the age of entry into intervention programs as predictors of their educational placement (Harris & Handleman, 2000), but we are not aware of any study that examined the contribution of the quality of children's early relationships to their placement.

Objectives: The present study is the first to examine in a sample of children with ASD the role of children's attachment as well as maternal insightfulness (which involves maternal insight into the motives that underlie the child's behavior, a complex view of the child, an acceptance of the child’s challenging behavior, and an openness to new information about the child) at the preschool age, as predictors of children’s educational placement in middle childhood.

Methods: 41 boys diagnosed with Autism Disorder (AD) or Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) and their mothers participated in the study. Children's diagnosis and level of functioning was confirmed using the ADOS-G, the ADI-R, the Vinland and a standardized intellectual or developmental test.

Preschool age (ages 2.7 – 5.8 years): children's attachment to their mothers was assessed using the Strange Situation Procedure (Ainsworth et al., 1978), and mother's insightfulness was assessed using the Insightfulness Assessment (Koren-Karie & Oppenheim, 2001).

Middle-school age (ages 8.6 -11 years): children's educational placement was ranked as follows: 1 - special education school; 2 – special education class in a general school; and 3 – regular classroom in a general school.

Results: Children’s early security of attachment as well as maternal insightfulness predicted higher educational placement ranking over and above the contribution of IQ, which made an independent contribution to children’s future placement.

Conclusions: Although the quality of children's early relationships is not a contributing factor to the onset of ASDs, it appears to be associated with children’s later educational placement, with more optimal early relationships associated with an educational placement closer to that of typically developing children. An important caveat is that it is possible that child factors which were not assessed in this study may have contributed to their future placement. This caveat notwithstanding, the findings suggest that both maternal insightfulness and child attachment should be included as a focus of early interventions.