Though it is a worldwide trend to include children with disabilities in regular education as much as possible, this is not obvious for children with Profound Intellectual and Multiple Disabilities (PIMD). To stimulate the inclusion of these children in regular schools, a project was launched in the Netherlands, called Together to School Classes (in Dutch: Samen Naar School Klassen). In Together to School Classes children with PIMD are integrated in regular primary schools in special integration classes. In this integration class, children with PIMD receive tailored care and education. Moreover, when it is possible, the children have so-called ‘inclusion moments’, in which children with PIMD attend the regular classroom together with typically developing peers. For instance, during play activities or music lessons.

In this study, we assess the impact of the Together to School Classes on children with PIMD. We compare children’s alertness at non-inclusion moments (in which children with PIMD attend an integration class) and to inclusion moments (in which children with PIMD attend the regular education classroom). We assess children’s alertness since alertness is one of the most important preconditions for development and learning in individuals with PIMD (Guess, Roberts, & Guy, 1999). Alertness can be described as an individual's level of interaction and engagement with the environment, which becomes manifest and observable in the individual's behaviour (Munde, Vlaskamp, Ruijssenaars, & Nakken, 2009). Observing alertness can be difficult in individuals with PIMD, as alertness levels vary greatly between and within individuals (Hogg, Reeves, Robert, & Mudford, 2001; Petry & Maes, 2006). Moreover, expressions of alertness are often subtle and difficult to interpret (Wilder & Granlund, 2003). However, there are examples of previous research in which alertness was successfully assessed in individuals with PIMD (see for instance Munde & Vlaskamp, 2014).

With this study we aim to answer the following research question: “Is there a difference in the alertness of children with PIMD during non-inclusion and inclusion moments?”

Due to the enhanced levels of contact between children with PIMD and typically developing peers, we expect that children with PIMD show more alertness during inclusion moments compared to non-inclusion moments.

Data was collected in three regular primary schools in the Netherlands. All three schools had an integration class (i.e., a “Together to School” class) in their school. Eight children with PIMD participated in the study: five boys and three girls in the age range three to nine years old. Video recordings of three non-inclusion moments and three inclusion moments were made in a timeframe of three consecutive weeks. To assess alertness the coding system of Vlaskamp, Fonteine, Tadema, & Munde (2009) was used. The Alertness Observation List distinguishes four levels of alertness namely: 1. Actively focused on the environment; 2. Inactive, withdrawn; 3. Sleeping, drowsy; 4. Agitated, discontented. Of all recorded activities the first, middle and last five minutes were coded, The level of alertness was coded each 20 seconds. In this way, changes in alertness can be noticed (Vlaskamp et al., 2009). Coding every 20 seconds, the first, middle and last five minutes of three inclusion and three non-inclusion moments sums up to 90 codes per participant. Two primary observers coded all videos, while two other observers coded each 25% of the collected videos. Cohen’s Kappa values were sufficient (0.76 and 0.85). Thereafter, the codes were assorted in two main categories: 1. alert (category 1 of the Alertness Observation List) and 2: not alert (category 2, 3 and 4 of the Alertness Observation List). For each child the percentage of time being alert (category 1) during the three inclusion moments and three non-inclusion moments were calculated.

The results indicated that children with PIMD showed higher alertness levels during non-inclusion moments compared to inclusion moments. Five children showed more alertness in non-inclusion moments. The percentage of time these children were alert during non-inclusion moments were: 84,4%, 57,8%, 100%, 89,6% and 96,5%. During inclusion moments these children were respectively 77,8%, 49,6%, 81,3%, 51,8% and 82,9% of the time alert. These percentages refer to level one of the Alertness Observation List, namely the time children are actively focused on the environment. Three children showed more alertness during inclusion moments. These children were 80,2%, 33,3% and 63,9% of the time alert during inclusion. During non-inclusion the three children were alert respectively 79,2%, 25,9% and 60,8% of the time. One explanation for the unexpected finding is the influence of the way in which the inclusive activity was shaped. For instance, at times, children with PIMD were not actively engaged in activities during inclusion moments. This led to low levels of alertness. While in non-inclusion moments the children were actively engaged or offered a favorite toy, which both resulted in high levels of alertness. This indicates that children’s alertness is influenced by the way in which activities are designed. Careful consideration of how to shape inclusive education for children with PIMD seems therefore a requirement for successful inclusion.

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