This study is a part of a larger research project PAL (www.ju.se/ccd/pal) that focuses upon issues of functionality, including support and services society provides marginalized individuals/groups across the life span in the nation-state of Sweden. Project PAL focuses primarily upon two groups – children and adults with an ADHD diagnosis and those who are deaf or hard-of-hearing. Despite their differences (for instance, a symptom-based diagnosis and a physical impairment), both groups have seen substantial changes since the turn of the century. In Sweden and internationally, a dramatic increase has occurred in the number children who have received an ADHD diagnosis (Atladottir et al.), and a concomitant rise of ADHD medication (Socialstyrelsen, 2017). In parallel, almost all deaf toddlers receive CI, Cochlear Implants – an advanced hearing aid that is surgically implanted in the inner ear – in Sweden (SOU, 2011:30). Despite these developments, little systematic knowledge exists regarding the school situation for these two groups in the Swedish school system (for exceptions where pupil case studies have been conducted, see Holmström & Bagga-Gupta, 2017). No knowledge exists regarding where these pupils are in the Swedish school landscape. What is known is that deaf/hard-of-hearing pupils (in comparison with hearing pupils) in Sweden continue to struggle as far as school achievement is concerned and that their results are lower in the special schools (SPM, 2008). Furthermore, recent studies that have focused the situation of pupils diagnosed with ADHD in “ADHD special education classes” (for instance, Malmqvist, 2018, Malmqvist & Nilholm, 2016) raise concerns regarding their schooling and the special support that they are offered. It should be noted that Sweden, unlike many other countries, endorses a system where special support should be provided based on the assessment of educational needs rather than any medical diagnoses (Nilholm et al. 2013). Knowledge regarding the school placement patterns and the provision of support currently made available is important for decision-making in the Swedish school system.

The overall aim of the study presented in this paper is to provide a birds-eye view of the placement patterns of pupils who are diagnosed with ADHD and those who are deaf/hard-of-hearing – both those with and without CI’s in the Swedish compulsory school system. In addition to providing a comparative picture of the two groups, the study will also dwell upon the nature of provision that schools report they make available to these two groups.

The theoretical framework

A one-school-for-all point of departure frames all educational policy in Sweden and school placement of different categories – ethnicity, gender, class, functionality – is broadly an issue of hegemony and varies across time and space (Bagga-Gupta 2014). This study takes inspiration from sociocultural theoretical perspectives where a social framing on learning and participation is upheld (Bagga-Gupta, 2017). Decisions about the school placement and support for pupils with an ADHD diagnosis or those who are deaf/heard-of-hearing are made at different levels in the educational system. Such decisions are closely related to school ideologies, locally and nationally (Göransson, Malmqvist & Nilholm, 2013). Lewis and Norwich’s (2005) conceptual framework regarding decision-making in schools postulates two main positions when the needs of ‘categorised students’ is in focus:

- the “Unique differences” position foregrounds the unique pedagogic needs of individual learners, relegating the common pedagogic needs of all learners in the background, and

- the “General differences” position wherein the needs specific to a certain category of pupils – like deaf or ADHD pupils – are seen as being primary; here the unique needs of individual learners are seen as being less important for decision-making in school contexts.

This total population study is based upon a web-based survey sent to all – 5198 – compulsory schools in Sweden. The study is conducted within the PAL project and has received ethical clearance from the Regional Ethical Board in 2016. A team of expert scholars related to the two groups focused upon in project PAL were involved in streamlining the extensive battery of questions in the survey. The survey was subsequently piloted in three schools in one region in Sweden. It was also scrutinized by organizations and experts at Statistics Sweden (2018) who administered the survey. The questionnaire had a common first section that covered background issues followed by a section that exclusively focused on the school situation for deaf/hard-of-hearing pupils. The last section focused entirely on the school situation for pupils with an ADHD diagnosis. 18 main questions focused upon each group. Most of them were identical for both groups. The questions were organised into four themes: Conditions for communication, Special needs provision, Placement, and Academic outcomes. Barring a few Likert scale questions, replying to most questions necessitated that the staff used school documentation related to specific pupils. The aim of using the latter type of questions was to collect data regarding the pupils’ factual school situation; not to elicit individual respondents’ beliefs about them. Such questions, where respondents are ‘data-collectors’, are time-consuming and it is a well-known that an extensive use of these is clearly related to lower response rates in survey-based studies (Baruch and Holtom, 2008). The school population consisted of municipality schools, municipality schools for students with intellectual impairments, independent schools, independent schools for students with intellectual impairments, Sami schools and special schools. This means that this study constitutes a total population study of all elementary and secondary aged pupils in school grades 1-9 (aged 7-15) who have an ADHD diagnosis or are deaf/hard-of-hearing. A 42 percent response rate was achieved (2170 schools). An extensive analysis of this response rate was conducted in collaboration with Statistics Sweden (2018) with the aim of examining differences between the schools that participated and those that did not. Nine key variables, including type of schools and socio-economic status in the schools’ catchment areas (based on an aggregation of variables) were tested, and only minor differences were found. A salient conclusion is that the schools in the study data set appear to be representative for all Swedish schools.

This study of the provision of support for two groups of pupils in Sweden highlights some tensions related to issues of categorization and problems associated with large-scale surveys. In addition to presenting a birds-eye view of the overarching support that is provided nationally at the compulsory school level, the differences and similarities between the provision provided to two groups of pupils is discussed. Thus, only some overall findings and a birds-eye view from this extensive total-population school survey are presented in this study. 2304 deaf/hard-of-hearing pupils (1069 girls, 1235 boys) were identified. Of these 252 pupils are reported to have received CI’s (136 girls, 116 boys). In comparison, more than five times more pupils with an ADHD diagnosis were reported ie. 12,529 pupils (3175 girls, 9354 boys). While the number of deaf/hard-of-hearing pupils remained steady across the nine years of school, there was a significant increase of pupils reported to have an ADHD diagnosis during the latter school years. 46 percent (988) of the schools in the dataset report to have pupils who are deaf/heard-of-hearing, whereas 85 percent (1832 schools) report having pupils with an ADHD diagnosis. 903 schools had students with both groups of pupils. Almost 11 percent of the schools (227) reported that they did not have either group. In addition to the overarching patterns at the national level, the paper will present patterns related to where pupils are reported to receiving support – inside the main classroom, in separate groups or in individual one-on-one teaching situations. A related issue is how much time the pupils are outside their regular classroom. The results show that pupils with ADHD had substantially more lesson time outside the regular classroom than pupils who are deaf/hard-of-hearing. A gendered and ethnic profile of the responses will also be discussed.

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