Characteristics of Toddlers with Autism Who Are Placed in Special Education Versus Regular Education in Israel
In Israel and most western countries, toddlers who receive an autism diagnosis are eligible for placement in either special education settings or regular education settings with an educational assistant. Remarkably little research has compared the efficacy of these educational options, which differ dramatically in their structure, content, and cost. A first important step in determining the efficacy of each option is to examine the initial characteristics of toddlers who are placed in each setting. While several studies with school age children have reported that children with lower communication skills and cognitive abilities are more often placed in special education, it is not clear if the same is true for toddlers and preschoolers. In Israel and most other western countries, the initial educational setting is selected by the parents and clinicians offer very little evidence-based advice regarding the optimal choice. To study this issue we utilized data from toddlers who were recruited to the regional autism database at the Negev Autism Center (www.negevautism.org).
To compare the characteristics of children with autism across educational settings using autism symptom severity measures, cognitive scores, and socio-demographic parameters.
105 children with autism ages 1.6 – 4.8 years old (mean: 2.7) were recruited at Soroka University Medical Center (SUMC) in Beer Sheba, Israel. Socio-demographic data was collected from the parents and all toddlers participated in ADOS assessments. Most of the toddlers also completed cognitive assessments. Comparisons were performed between toddlers in regular public daycare with assistance (n=10, average age 2.58) versus toddlers in special education daycare (n=28, average age 2.01) and between toddlers in regular kindergartens with assistance (n=23, average age 2.95) versus toddlers in special education kindergartens (n=45, average age 3.07).
Toddlers in special education kindergartens exhibited significantly higher ADOS scores in comparison to toddlers in regular education kindergartens (p = 0.03, t-test). A similar trend was also evident between special and regular day care groups (p = 0.07, t-test). There were no significant differences in cognitive scores (p > 0.19, t test). Paternal education did not differ across groups, but maternal education was significantly higher for toddlers with autism who were placed in regular kindergartens (p < 0.02). There were no significant differences across groups in parental age or socio-economic status of estimated by place of residence.
Toddlers with autism who have more severe autism symptoms tend to be placed in special education rather than regular education settings in Israel. This difference, however, was relatively small (Cohen’s d = 0.6) and no significant difference was apparent in cognitive score and most socio-economic parameters. These data suggest that placement choice is close to random and not guided by structured evidence-based clinical advice. Determining the efficacy of each educational setting for toddlers with different characteristics, using longitudinal studies is, therefore, critical for providing better clinical care.