ORIGINAL PAPER

Evaluating the Effectiveness of an Intervention Programto Influence Attitudes of Students Towards Peers with Disabilities

Anke de Boer • Sip Jan Pijl • Alexander Minnaert •

Wendy Post

Published online: 28 August 2013

� Springer Science+Business Media New York 2013

Abstract In this study we examine the effectiveness of an

intervention program to influence attitudes of elementary

school students towards peers with intellectual, physical

and severe physical and intellectual disabilities. A quasi-

experimental longitudinal study was designed with an

experimental group and a control group, both comprising

two rural schools. An intervention program was developed

for kindergarten (nexperimental = 22, ncontrol = 31) and ele-

mentary school students without disabilities (nexperimental =

91, ncontrol = 127) (age range 4–12 years old). This inter-

vention consisted of a 3 weeks education project com-

prising six lessons about disabilities. The Acceptance Scale

for Kindergarten-revised and the Attitude Survey to

Inclusive Education were used to measure attitudes at three

moments: prior to the start of the intervention, after the

intervention and 1 year later. The outcomes of the multi-

level analysis showed positive, immediate effects on atti-

tudes of kindergarten students, but limited effects on

elementary school students’ attitudes.

Keywords Attitudes � Peers � Severe physical and

intellectual disabilities � Inclusive education �Intervention

Introduction

Traditionally, children with severe physical and intellectual

disabilities have been educated in settings which are

physically and socially segregated from their typically

developing peers. Over the past decades this approach has

changed as education policy began advocating the inclu-

sion of children with disabilities in regular education set-

tings (Downing and Packham-Hardin 2007). Inclusion

policies like the Salamanca Statement (UNESCO 1994)

and the UN Convention on the Rights of Persons with a

Disability (United Nations 2006) underline the importance

of ‘education for all’ and aim at students with disabilities

being educated alongside their typically developing peers.

Following international developments in inclusion pol-

icies, inclusive education is also an on-going trend in the

Netherlands. Recent education policies such as the Toge-

ther-To-School-Again (1994) and the Centers of Expertise

Act (2003) have focused particularly on including children

with auditory, speech and language, physical and intellec-

tual disabilities as well as children with challenging

behavior in mainstream schooling. Including children with

severe physical and intellectual disabilities in mainstream

settings is often seen as unrealistic in the Netherlands.

However, some initiatives have been set up to include such

children in regular schools as well, since it is believed all

students, with or without disability, benefit from inclusive

education. With respect to students without disabilities,

Downing and Packham-Hardin (2007) state that there is

little evidence indicating that students without disabilities

do not benefit from inclusive education. For example,

positive academic and social outcomes are found in stu-

dents without disabilities. Regarding academic results,

Cole et al. (2004) showed that students without disabilities

in an inclusive setting made significant greater progress in

A. de Boer (&) � S. J. Pijl � A. Minnaert � W. Post

Department of Special Education and Youth Care, University of

Groningen, Grote Rozenstraat 38, 9712 TJ Groningen,

The Netherlands

e-mail: anke.de.boer@rug.nl

S. J. Pijl

Norwegian University of Science and Technology, Trondheim,

Norway

123

J Autism Dev Disord (2014) 44:572–583

DOI 10.1007/s10803-013-1908-6

reading and mathematics. Regarding social outcomes,

more awareness and understanding of people with dis-

abilities has been reported as a benefit for students without

disabilities (Copeland et al. 2002). Conversely, children

with disabilities also benefit from contacts with typically

developing students in integrated settings. It has been

reported that they benefit in their communication skills

(Fisher and Meyer 2002), academic outcomes (Hunt et al.

2003) and in terms of social skills/interaction (Cole and

Meyer 1991).

Despite growing awareness and increased interaction,

peer acceptance is often lacking. Children with different

types of disabilities often experience difficulty in being

accepted by typically developing peers (Koster et al.

2010; Smoot 2004). It has been found that the attitudes of

typically developing students play a role in accepting

children with disabilities (De Boer et al. 2012b; Vignes

et al. 2009).

Swaim and Morgan (2001) examined students’ attitudes

towards peers with autism and found less positive attitudes

towards this target group, compared to developing peers. In

the study of De Boer et al. (2012c), attitudes of students

were measured towards three disability types, namely:

attention deficit hyperactivity disorder (ADHD), autism

spectrum syndrome (ASS) and intellectual disability. Their

study showed that students hold least positive attitudes

towards children with ADHD. More positive attitudes were

found towards children with ASS than towards children

with intellectual disabilities. With respect to children with

severe physical and intellectual disabilities, Schepis et al.

(2003) concluded that they often require support to par-

ticipate with typically developing peers. Negative attitudes

by peers without a disability towards children with severe

physical and intellectual disabilities is also reported by

others (e.g., Gannon and McGilloway 2009; Laws and

Kelly 2005; Yude et al. 1998). The relationship between

attitudes of peers and the acceptance of students with dis-

abilities suggests the importance of promoting more posi-

tive attitudes among typically developing students. This

ultimately may lead to a better social inclusion of children

with disabilities in general education.

When promoting more positive attitudes, it is important

to consider variables which relate to attitudes, like stu-

dents’ age, gender and the disability type. Previous

research has shown that students’ attitudes are more posi-

tive when they are older (Nowicki 2006; Vignes et al.

2009). Moreover, it has been stated that girls hold more

positive attitudes towards peers with disability than boys

(Laws and Kelly 2005; Siperstein et al. 2007). Regarding

the disability type, Nowicki (2006) found that students

were least positive towards students with an intellectual

disability, compared with students with a physical dis-

ability. A comparison of students’ attitudes according to

the disability types central in the current study has not been

made so far.

Focusing on attitudes in the field of inclusive education

seems to be relevant as attitudes predict one’s future

behavior (Azjen 2005). Within attitude change theories,

like the theory of planned behavior (TPB) or the contact

theory (CT) (Allport 1954) background factors play an

important role in explaining attitudes and future behavior.

It has been stated that direct experience with, and infor-

mation about the attitude object moderate the attitude-

behavior relation (Azjen 2005). Moreover, Brinol and Petty

(2005) argued that people have ‘a need to know’ to form

attitudes what refers to ‘‘the desire to possess knowledge

about and understanding of the social world’’ (p. 575). Lee

and Rodda (1994) suggested that a combination of

knowledge and experience would be most effective in

changing attitudes in which basic knowledge should be

acquired first. In the case of the inclusion of children with

severe physical and intellectual disabilities in mainstream

schooling, such knowledge could focus on understanding

the needs of such children in order to reduce misunder-

standings and feelings of pity.

Providing knowledge has recently been the focus of

interventions in which the aim is to influence attitudes

among elementary school students towards children with

disabilities (Favazza and Odom 1997; Holtz 2007; Ison

et al. 2010; Krahe and Altwasser 2006; Rillotta and

Nettelbeck 2007; Swaim and Morgan 2001). Such pro-

grams focus on different disabilities (i.e., physical and

intellectual, or psychiatric issues), duration and ages (i.e.,

kindergarten or elementary school students).

Research has been conducted in order to establish the

effects of these intervention programs. This presents a

confusing picture. For example, some studies showed that

the intervention had a positive effect on the attitudes of

regular elementary school students (Krahe and Altwasser

2006; Rillotta and Nettelbeck 2007), while others revealed

that the intervention did not influence attitudes among

students of the same age and school setting (Bell and

Morgan 2000; Godeau et al. 2010). When compared to

elementary school students, limited information is avail-

able on kindergarten students’ attitudes towards children

with disabilities (De Boer et al. 2012a) and interventions to

influence these attitudes. Apart from an intervention

developed by Favazza and Odom (1997), which established

positive effects on the attitudes of these students, there are

no other studies, as far as we know, which have focused on

this age group.

Despite the knowledge acquired over the last decade on

students’ attitudes towards children with disabilities and

attitude changes through interventions, certain questions

remain unanswered. First, very little attention has been

given in interventions to children with severe physical and

J Autism Dev Disord (2014) 44:572–583 573

123

intellectual disabilities. Second, results of the studies con-

ducted show mixed outcomes on the attitudes of elemen-

tary school students and limited knowledge on the effects

of the interventions on kindergarten students’ attitudes.

Third, the question whether such interventions result in

long-term effects is often neglected or cannot be guaran-

teed (Godeau et al. 2010; Hunt and Hunt 2004). This Dutch

study has been set up in an attempt to fill these gaps in

knowledge by answering the following research question:

What are the short- and long-term effects of an inter-

vention that provides knowledge about disability on

the attitudes of typically developing students towards

peers with physical and intellectual disabilities?

Method

Design and Procedure

In order to answer the research question we designed a

quasi-experimental longitudinal study with three repeated

measures done in an experimental and a control group. The

study was conducted between November 2009 and May

2011 in a rural district in the north of the Netherlands. The

three time measurements were 2 weeks before the start of

the intervention (Time 1), 1 week after (Time 2) and a

follow-up 1 year later (Time 3).

Two regular elementary schools comprising the experi-

mental group were selected for the study because they were

about to set up a community school (September 2011). In the

Netherlands, a community school often comprises different

educational facilities for children from 0 to 12 years, like pre

and after school care, daycare centers (0–4 years) and ele-

mentary schools. Besides these facilities, the community

school participating in the study had an education center for

children with severe physical and intellectual disabilities

(from 12 to 18 years). The current study was designed to

prepare students of the experimental group for future contact

with children with severe physical and intellectual disabil-

ities attending the education center.

In order to select schools to participate as the control

group, we drew up three selection criteria:

1. Regular elementary school (students 4–12 years old);

2. Located in the same rural district as the experimental

schools;

3. No students with disabilities in the class.

Ten schools in the same rural district were invited to

participate in the control group. Three schools were willing

to participate in the study (response rate 33 %). One of the

schools, however, had a student with Down’s syndrome so

was not admitted to participate. This resulted in a control

group comprising two schools. All participating schools

contained single grades 1–8 or a combination of grades

(e.g., grade 5 and 6, due to the small number of students).

In our study, grade 2 and 3 belonged to the kindergarten

classes (n = 4, age range 5–6 years) and grade 4–8 to the

elementary classes (n = 13 classes, 7–11). Thus, the total

sample of this study comprised 4 schools, two in the

experimental condition and two in the control group which

comprised a total number of 4 kindergarten classes and 13

elementary classes.

Prior to the study parents of all participating students

received a letter about the study in which they were asked

if their child could participate in the program. All parents

gave their consent.

Intervention

The intervention was based on the ‘Special Friends’ pro-

gram (Favazza and Odom 1997). This 6 weeks intervention

program focuses on kindergarten students and aims to

teach students that everyone is unique, regardless of dis-

ability. It also aims to increase all three attitude compo-

nents (Triandis 1971), namely: knowledge, feelings and

behavioral intentions. The goal of the original intervention

is to create more awareness of typically developing stu-

dents about peers with disabilities via structured storytell-

ing, cooperative learning groups and parental involvement

(for more information see Favazza et al. 1999).

The intervention developed for the current study inclu-

ded one component of the Special Friends program:

structured storytelling. The research team’s intervention

program consisted of two lessons per week over 3 weeks

based on the target group of the education center: children

with physical and intellectual disabilities.

Due to the different ages of the participating students

(5–12 years), we developed six lessons for each two grades

(grades 1 and 2, 3 and 4, 5 and 6, 7 and 8)1.2 The structure

and content of the lessons were the same for all grades, but

were geared to the age of the students. Because the mate-

rials used by teachers in grades 1 and 2 and 3 and 4 often

differ from those used in grades 5–8, we chose storybooks

in the lessons for kindergarten students and movies or real-

life stories for the older grades. Each storybook included a

character with a disability, like a spider with five legs (see

example Table 1). The stories and movies used for grades

5–8 included a peer with a disability, like the daily life of a

girl whose sister has a severe physical and intellectual

1 It is very common two grades are combined into one class due to

the small number of students in rural districts of the Netherlands.2 Because the schools preferred a school-wide intervention, we

implemented the intervention in all grades, including first grade.

However, due to the young age of these students we did not assessed

their attitudes.

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disability. The storybooks, movies and real life stories were

selected using the ‘checklist for selection of books’

developed for the Special Friends program (see Favazza

et al. 1999), comprising ten selection criteria, such as ‘a

book should not encourage pity’.

One of three types of disability (physical, intellectual or

severe physical and intellectual disability) was discussed

twice weekly. Thus six 45-minute lessons were designed

resulting in an intervention over a period of 3 weeks. The

first lesson was particularly aimed at explaining the specific

type of disability. For example, a story about a character/

child with a physical disability was either read (book) or

shown (video) by the teacher, followed by a group discus-

sion. For the second lesson, an activity was designed

showing the impact of a physical disability in daily life (i.e.,

a sport activity in which the students use a wheelchair).

Table 1 presents an example of a lesson for kindergarten

students. In addition, teachers received a detailed lesson plan

to follow for each lesson and background information about

the three disability types. Parents of the children in the

experimental group had also received an information

package including: background information on the program,

a timetable and details about the three types of disability.

Table 2 presents a summary of the intervention.

Fidelity of the Intervention

In order to achieve the commitment and encouragement of

the teachers to implement the intervention, we organized a

meeting with them. The first draft of the intervention was

presented at this meeting so that teachers could give feed-

back on its design. One of the outcomes of the meeting was

that teachers indicated that two lessons per week was the

maximum they could incorporate into their curriculum. They

also suggested structuring the lessons in such a way that only

a minimum of preparation was needed. The teachers’ feed-

back was used in the final design of the intervention. After its

implementation, teachers were asked to complete an evalu-

ation form. In one of the questions teachers were asked to

indicate if they implemented all aspects of the intervention.

All teachers indicated that the all the lessons were given and

that they implemented the lessons according to our design.

Moreover, they indicated to be satisfied about the design of

the lessons, length and materials selected.

Participants

Two hundred and seventy-one students participated in the

study (Nkindergarten students = 53, Nelementary school students =

218). Because we used different measures for kindergarten

and elementary school students, we will present both

samples separately. Because the administration of the

kindergarten questionnaire is time consuming (app. 20 min

per group of 3 students) and disturbing the daily curricu-

lum, we randomly selected half the kindergarten students

per class to participate in the study. This resulted in fifty-

three kindergarten students, who attended grade 2 or 3 and

were 5 or 6 years old. Two hundred and eighteen ele-

mentary school students in grades 4–8 participated in the

study (age range 7–12 years, M = 9.9, SD = 1.2). Student

demographics are presented in Table 3.

Table 1 Example of lesson goals and materials for kindergarten students (grade 1/2)

Grade 1/2—week 1, lesson 1: physical disability

Description of the situation

The students did not receive any information about people with disabilities and the extent to which this affects people’s daily lives. The

existing knowledge comes from experiences in students0 own lives, like family members

Aim of the lesson

At the end of the lesson students know what a physical disability is

At the end of the lesson students can explain what kind of activities/plays a peer in a wheelchair can and cannot do

Teaching aids/material

Storybook ‘Slompie: een spin met vijf poten’ [Slompie, a spider with five legs]

Presentation of the storybook, available at: www.kleutergroep.nl/Boeken/Powerpoints/Slompie.pps

Materials like: puzzles, pencils, games, building bricks etc.

Drawings of games/activities

Table 2 Summary of the intervention

Content of the intervention

Six lessons per grade (1/2, 3/4, 5/6, 7/8) focusing on

2 9 physical disability

2 9 intellectual disability

2 9 severe physical and intellectual disability

Background information about the disabilities for teachers

Description of each lesson

Teaching aids/materials

Information letter for parents

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Measures

Attitudes of Kindergarten Children Towards Peers

with Disabilities

The Acceptance Scale for Kindergarten-revised (ASK-R),

developed by Favazza and Odom 1996) was used to assess

attitudes of kindergarten students (age 5 and 6). The ASK-

R consist of questions reflecting two attitude components

(Triandis 1971): the affective component (feelings) and the

behavioral component (behavioral intentions). The scale

was administered to groups of three students by reading

instructions and questions verbatim from a standardized

protocol (designed by Favazza and Odom 1996). Admin-

istering the questionnaire took about 20 min per group.

The questionnaire was printed on colored sheets show-

ing three faces per question. Students were asked to record

their responses by marking an ‘X’ on either the happy face

(for YES), the sad face (for NO), or the ‘half happy face’

(for MAYBE). Each response category yielded a score,

namely: 0 = no, 1 = maybe, 2 = yes. The original ASK-

R consists of 18 items resulting in a score range of 0–36

(a = 0.79). An example of an item was: ‘I would like to be

friends with a child who cannot see’.

Because we used the Dutch version of the ASK-R for

the first time for this, we analyzed whether the scale had

appropriate reliability. Reliability analysis revealed that

four negatively formulated statements (after recoding)

showed low correlations with other statements in the scale.

During the administration of the questionnaire it was

already noticed that students had difficulty answering those

items. This, together with the low correlations, made us

decide to exclude these statements from the main analysis,

resulting in a final scale of 14 statements (aT1 = 0.79,

aT2 = 0.82, aT3 = 0.87). Scale scores ranged from 0 to 28,

with a higher score reflecting a more positive attitude. The

total score of each student was included in the analysis as

dependent variable.

Attitudes of Elementary School Students Towards Children

with Disabilities

The attitudes of elementary school students were assessed

using the Attitude Survey Towards Inclusive Education

(ASIE) (age 8–12). The ASIE was constructed and evalu-

ated in a study by De Boer et al. (2012c) and has been used

in previous Dutch educational research (see De Boer et al.

2011). The ASIE is based on the CATCH questionnaire

and designed specifically for students between 8 and

12 years old (see Rosenbaum et al. 1986). The ASIE

consist of items reflecting two attitude components: the

affective component (feelings) and the behavioral compo-

nent (behavioral intentions). The item quality of the ASIE

questionnaire was analyzed using the Mokken model

(Mokken 1971), which is based on item response theory

(IRT). The outcomes of the analyses resulted in a satis-

factory scalability coefficient of H = 0.50. The reported

reliability coefficient of the scale was q = 0.92 (for more

details we refer to De Boer et al. 2012c).

The ASIE consisted of two parts: a vignette and attitude

statements. The first part presented a vignette about a

hypothetical child with a disability. It is likely that students

aged 8–12 years interpret the term ‘disability’ in many

different ways, which made us decide to design vignettes.

Due to the aim of this study we designed three different

vignettes focusing on a child with a physical, intellectual

and severe physical and intellectual disability (see

‘‘Appendix’’ section). The study of De Boer et al. (2012c)

showed that elementary age students are gender sensitive to

the child presented in the vignette, so gender-specific

vignettes were developed for boys and girls. The vignettes

were developed by the first author and verified by a

research assistant with a degree in special education. All

students randomly received a questionnaire including one

of the vignettes. This means that each class was randomly

divided in three (taking boys and girls into account), so

each vignette was covered equally per class. To overcome

as much as possible that students would receive a ques-

tionnaire with a different vignette at each measurement, we

coded each questionnaire prior to the assessment (i.e.,

school, class, student, vignette number). This coding was

used at each measurement.

The second part of the questionnaire consisted of four-

teen attitude statements about the inclusion of the child

presented in the vignette, like ‘I would stick up for John if

Table 3 Student demographics

Kindergarten students

(N = 53)

Elementary school students

(N = 218)

Experimental

group

(n = 22)

Control

group

(n = 31)

Experimental

group

(n = 91)

Control

group

(n = 127)

n n n n

Gender

Boys 14 15 35 57

Girls 8 16 56 70

Grade

2 12 16 – –

3 10 15 – –

4 – – 15* 26*

5 – – 20 19

6 – – 16 27

7 – – 24 24

8 – – 16 31

* The data of these students was excluded at time measurement 1 and 2

576 J Autism Dev Disord (2014) 44:572–583

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he were teased’. It took about 20 min to complete the

questionnaire.

Students of Grade 4 (age 7–8) were initially included in

the study. However, during the first measurement it turned

out that the statements were too difficult to read for stu-

dents of this age. We decided to read the statements aloud.

As a consequence, the assessment procedure differed sig-

nificantly for this grade compared to the assessment pro-

cedure for grades 5–8. For example, by reading the

statements aloud it was impossible to take the gender-

specific vignettes into account. Hence, the reliability of

students’ answers in grade 4 can be questioned. This made

us decide to exclude the data of students in this grade for

time measurements 1 and 2. As a consequence, the sample

of elementary school students was reduced by 41 students,

resulting in a total sample of 177 elementary school stu-

dents (nexperimental group = 76, ncontrol group = 101).

Students were asked to indicate their level of agreement

with the statements via a 5-point Likert scale (1 = totally

disagree to 5 = totally agree), with a higher score reflect-

ing a more positive attitude. The reliability coefficients for

the current study were, resp. aT1 = 0.76, aT2 = 0.79,

aT3 = 0.80. The mean score of each student was included

in the analysis as dependent variable.

Independent Variables

The independent variables for the current study were as

follows: age, gender, type of vignette, condition and

measurement.

Analysis

We performed multilevel analyses with the attitude scores

serving as dependent variables. Because we were dealing

with hierarchically nested data in which measurements

were nested within students within classes, a general linear

model could not be used (Snijders and Bosker 1999).

Consequently, multilevel modeling was preferred. The

analyses was executed in the program MLwiN 2.23 (Ras-

bash et al. 2005), which is designed specifically for ana-

lyzing hierarchical data.

We began the analyses by executing a three-level empty

model (a model without any independent variables), with

classes as the highest level, students as the second level and

repeated measures as the lowest level. Since it appeared

that there was no significant variability between classes

within schools, a multilevel with two levels was consid-

ered: students at the highest level and repeated measures as

the lowest level. We then included each time measurement

as a dummy variable in the model and considered random

slopes. This approach results in more information about the

variance structure per time measurement (Snijders and

Bosker 1999). In the end, we tested whether there were

differences in attitude scores between the control and the

experimental group at each point in time.

Additionally, we added possible covariates (such as age

and gender) separately in the model, and explored which

interactions were present. The variables which were rele-

vant or showed a significant relationship with the depen-

dent variable (i.e., students’ attitude scores) were included

in the final model. In the results section we present the

empty model and the final model (a model including time

and condition and other covariates). In all models a p value

of 0.05 was considered statistically significant. We exam-

ined the differences in deviance between the models to

establish whether there was an improvement in the final

model. The significance of an increase in deviance was

tested by a Chi square test, with the number of degrees of

freedom equal to the number of extra model parameters in

the largest model.

Results

The Effects of the Intervention on Kindergarten

Students’ Attitudes

Descriptive statistics showed that kindergarten students had

a mean attitude score of 7.80 (SD = 5.68) at time 1. Using

the rule of thumb of De Boer et al. (2012a), the outcomes

indicated that forty per cent of students held negative

attitudes (score \7), while the remaining sixty per cent

held neutral ones (a score between 7 and 21) (Table 4).

After applying the empty model, we included gender as

an independent variable to establish whether there were

differences between boys’ and girls’ attitudes. No differ-

ences in attitude were found between boys and girls, so no

further attention was paid to this variable.

We started by testing whether there was a difference in

attitude scores between both conditions. The analysis

showed there was no main effect of condition (see final

model in Table 5), indicating that there was no significant

difference in attitude scores between the two conditions at

the first measurement. The outcomes of the analysis

revealed a significant interaction effect between condition

and Time 2. This outcome indicates that students’ attitudes

in the experimental condition were significantly more

positive immediately after the intervention was carried out.

No significant interaction effect was found between con-

dition and Time 3, indicating that the effect of the inter-

vention did not last in the experimental group. In addition,

the results showed a significant overall effect of Time 3.

This means that students’ attitudes were significantly more

positive at Time 3 (i.e., 1 year after the intervention)

compared to Times 1 and 2. A comparison of deviance

J Autism Dev Disord (2014) 44:572–583 577

123

between the empty model and the final model revealed a

significant improvement of the final model, v2 (9) = 24.51,

p \ 0.05.

The Effects of the Intervention on Elementary School

Students

Descriptive statistics showed that elementary school stu-

dents had a mean attitude score of 3.57 (SD = 0.61) at

Time 1. Using the rule of thumb of De Boer et al. (2012a),

two per cent of the students indicated held a negative

attitude (score\2.5). A small majority of students showed

a score of [3.5, indicating a positive attitude (53 %). The

descriptive statistics for both conditions and measurement

are presented in Table 6.

Conducting the multilevel analysis showed that there

was an effect of condition (see final model, Table 7),

indicating a significant difference in attitude scores

between the experimental group and the control group at

Time 1. Expanding the model showed that there was no

interaction effect between condition and Time 2. There was

no improvement in attitudes in the experimental group after

the intervention took place. Additionally, the results

showed a significant overall negative effect of age, indi-

cating that students became more negative the older they

become.

In order to establish whether age, gender and the type of

vignette had an effect on students’ attitudes, we included

these variables in the model. No effect of age was found

and therefore excluded from further analysis. The out-

comes revealed an overall significant difference between

boys and girls, indicating that boys hold significant more

negative attitudes than girls. No two- and three-way

interaction effects were found between gender, condition

and measurement. Moreover, no two- and three way

interaction effects were found between condition, mea-

surement and vignette. We did find a significant overall

effect of vignette, showing that students hold the most

negative attitudes towards children with intellectual dis-

abilities and severe physical and intellectual disabilities,

compared to children with a physical disability. No dif-

ferences were found between the intellectual and the severe

physical and intellectual disabilities. Again, no interaction

effects were found.

A comparison between the deviance of the empty model

and the final model revealed a significant improvement of

the final model, v2 (12) = 24.51, p \ 0.05.

Discussion

In this study we explored the possibilities of promoting

more positive attitudes of kindergarten and elementary

school students towards children with physical, intellectual

and severe physical and intellectual disabilities through an

intervention based on acquired knowledge. By means of a

longitudinal design we examined the possible short- and

long-term effects in an experimental group consisting of

two schools. Based on the findings, we conclude that the

attitudes of kindergarten students hold significantly more

positive attitudes immediately after the intervention com-

pared to kindergarten students in the control group. No

long-term effect of the intervention could be established.

Moreover, students’ attitudes in both conditions were sig-

nificantly more positive at the last measurement.

We did not find any effect of the intervention on ele-

mentary school students. An overall effect of the type of

vignette was found, indicating that elementary school stu-

dents hold more negative attitudes towards children with

intellectual and severe physical and intellectual disabilities

than towards children with physical disabilities. Besides

this, a decrease in attitudes was found at the last mea-

surement, indicating that students became more negative

over time. We also found that elementary school boys hold

significantly more negative attitudes than girls.

Attitudes of Kindergarten Students

An eye-catching outcome of this study concerns the low

attitude scores observed in kindergarten students at Time 1.

The kindergarten students in both conditions had mainly

negative attitudes. These attitude scores are quite lower

than the scores of American and Greek kindergarten stu-

dents reported by Nikolaraizi et al. (2005), who reported

neutral to positive attitudes of kindergarten students. The

negative attitudes of Dutch students might be linked to the

fact that the implementation of inclusive education policies

has only recently begun. Although there is an on-going

trend towards inclusive education in the Netherlands, it is

not obvious that students with disabilities are included in

regular schools. The students in our sample did not have

any experience of being in direct contact with a peer with a

disability, which might explain such negative attitudes.

Also, it has been reported that experience with inclusive

education may result in more positive attitudes (Kalyva and

Agaliotis 2009; Nowicki 2006; Siperstein et al. 2007).

With respect to the development towards more inclusive

Table 4 Attitudes of kindergarten students by condition and time

Time 1a Time 2 Time 3

Mean SD Mean SD Mean SD

Experimental (n = 22) 6.8 6.2 14.0 5.8 12.3 6.1

Control (n = 31) 8.5 5.2 10.2 6.7 12.9 7.2

a There was no significant difference between the two conditions at

Time 1

578 J Autism Dev Disord (2014) 44:572–583

123

education in the Netherlands, this suggests that that the

attitudes of Dutch kindergarten students may become more

positive in future, as they gain experience of interacting

with peers with disabilities. Thus, monitoring the attitude

development and level of acceptance of Dutch kindergarten

students who experience inclusive education is

recommended.

This study showed that the intervention had short term

effects on kindergarten students’ attitudes. However, the

third time measurement revealed that the attitude change

did not last. On the one hand, this could mean that kin-

dergarten attitudes can indeed be influenced by a knowl-

edge-based intervention program. On the other hand, the

results suggest that an improvement of the intervention is

needed to strengthen its effectiveness in the long-term.

Although our intervention was based on the Special Friends

program (Favazza et al. 1999), we only included a

knowledge component. Including the other components of

the program (structured play and home reading) might lead

to stronger long-term effects.

This study showed that students’ attitudes in both con-

ditions were significantly improved at Time 3 (1 year after

the intervention), indicating that kindergarten students

become more positive when they become older. A possible

explanation of the improvement might be the effect of

maturation. This effect refers to processes changing over

time, like growing older, wiser, tired or bored. As stated by

Goodman (1989), students become more knowledgeable as

they become older. Moreover, the increase in attitudes in

both conditions can also be attributed to the assessment of

the questionnaire. Since talking about disabilities is not

common for kindergarten students, the assessment of the

questionnaire can be seen as an intervention in itself. It

might be that students were stimulated to think and talk

about disabilities for the first time in their lives. This may

suggest that such talk is a first step in helping to shape the

attitudes of such young students.

There are, however, some limitations which should be

considered when interpreting the outcomes. The small

sample size of the kindergarten group is clearly a limitation

of the study. In addition, it should be noted that the

instrument used for kindergarten students, the ASK-R, does

not particularly focus on the disabilities represented in the

intervention. It is therefore unclear if students’ attitudes

towards children with physical, intellectual and severe

physical and intellectual disabilities became more positive.

In any future research it is advisable to match the items of

the instrument with the disabilities represented in the

intervention.

Attitudes of Elementary School Students

With respect to elementary school students, the findings of

this study show that providing ‘knowledge’ had a limited

influence on their attitude. This is in line with other studies

which also reported non-significant outcomes (Bell and

Morgan 2000; Godeau et al. 2010; Swaim and Morgan

2001). A possible explanation for these results might be the

stigma associated with disability, which affects older

Table 5 Model estimates for the variable effects on kindergarten

students’ attitudes for different models

Model Empty model Final model t value

Coefficient

(S.E.)aCoefficient

(S.E.)

Fixed part

Intercept 10.726 (0.626) 8.499 (1.031)

Conditionb

Experimental -1.744 (1.591) -1.096

Measurementc

Time 2 1.651 (1.445) 1.142

Time 3 4.376 (1.445) 3.028**

Condition *

Time 2d5.444 (2.174) 2.504*

Condition *

Time 3

1.211 (2.199) 0.550

Random part

Variance

Between students 7.583 (4.416)

Within

measurements

35.816 (5.239)

Time 1 38.005 (7.748)

Time 2 42.928 (8.752)

Time 3 30.960 (6.191)

Covariance

Time 1 * Time 2 16.981 (6.436)

Time 1 * Time 3 6.140 (5.058)

Time 2 * Time 3 8.424 (5.550)

Deviance 960.999 936.489

* Significant at p \ 0.05. ** Significant at p \ 0.01a S.E. = Standard Errorb Control = referencec Time 1 = referenced Condition * Time 1 = reference

Table 6 Attitudes of elementary school students by condition and

time

Time 1a Time 2 Time 3

Mean SD Mean SD Mean SD

Experimental (n = 76) 3.60 0.60 3.43 0.62 3.45 0.55

Control (n = 101) 3.63 0.49 3.59 0.54 3.56 0.64

a There was no significant difference between the two conditions at

Time 1

J Autism Dev Disord (2014) 44:572–583 579

123

students more (Bell and Morgan 2000). For example, as a

consequence of the intervention students might have real-

ized what it means to have a disability in daily life and how

this would affect them when coming into contact with a

disabled person. Corresponding with other studies, the

outcomes of this study raise the question whether short

term intervention, such as ours, can achieve the intended

objectives among elementary school students.

In line with other studies, our findings underline that

boys hold more negative attitudes than girls. The outcomes

of this study indicate that boys and girls do not change

differently, as no interaction effects were found. To ensure

stronger intervention effectiveness in boys and girls, De

Boer et al. (2012b) suggest taking the differences between

boys’ and girls’ attitudes into account.

Based on the outcomes of this study it can be concluded

that elementary school students hold the most negative

attitudes towards children with intellectual and severe

physical and intellectual disabilities than towards students

with a physical disability. This is a disappointing result, as

there is already an on-going trend to include the latter

group of children in regular schools. It is likely that certain

behaviors typical for children with severe physical and

intellectual disabilities (e.g., use of a wheelchair, difficul-

ties in talking, uncontrolled movements) (Vlaskamp et al.

2005) may ‘frighten’ students. This underlines the impor-

tance of explaining the behavior of such children in order

to remove students’ irrational fear.

With respect to both kindergarten students and ele-

mentary school students, it should be mentioned that it was

their attitudes rather than any knowledge acquired that was

measured in this study. Although we focused on knowledge

about disabilities in the intervention, the cognitive com-

ponent (i.e., beliefs and knowledge) was not measured by

both instruments used. It may be that students gained

knowledge about disability through the intervention, which

can then be seen as a starting point for attitude change over

time. It is highly recommended to include a measurement

or structured interview in future research to examine the

cognitive component, like students’ knowledge about dis-

abilities and what students learned from the intervention.

Another limitation of this study is the significant difference

between both conditions at Time 1, so that the outcomes

need to be interpreted with some caution.

Implications of the Study

The results of this study clearly point out the potential of

the intervention to influence attitudes positively, particu-

larly at the kindergarten stage. As Innes and Diamond

(1999) reported, early childhood years might be a particular

fruitful time to teach students about diversity in relation to

disability. However, improvements of the intervention

seem necessary in order to strengthen long-term effects.

One such improvement might be to include parents in the

intervention, as it has been argued that they are important

in developing young children’s attitudes (Bricker 1995).

The significant link between the attitudes of parents and

children towards students with disabilities (De Boer et al.

2011; Innes and Diamond 1999) suggests that parental

involvement may lead to greater effectiveness of

Table 7 Model estimates for the variable effects on attitudes of

elementary school students for different models

Model Empty model Final model t value

Coefficient

(S.E.)aCoefficient

(S.E.)

Fixed part

Intercept 3.547 (0.033) 3.975 (0.090)

Genderb

Boys -0.209 (0.064) -3.265**

Vignettec

Intellectual -0.250 (0.079) -3.164**

Severe physical/

intellectual

-0.240 (0.082) -2.927**

Conditiond

Experimental -0.182 (0.086) 2.116*

Measuremente

Time 2 -0.054 (0.051) 1.059

Time 3 -0.179 (0.073) -2.452*

Condition *

Time 2f-0.120 (0.078) -1.538

Condition *

Time 3

0.039 (0.108) 0.361

Random part

Variance

Between students 0.160 (0.024)

Within

measurements

0.173 (0.015)

Time 1 0.305 (0.032)

Time 2 0.337 (0.037)

Time 3 0.285 (0.031)

Covariance

Time 1 * Time 2 0.130 (0.029)

Time 1 * Time 3 0.179 (0.026)

Time 2 * Time 3 0.106 (0.029)

Deviance 786.981 735.578

* Significant at p \ 0.05. ** Significant at p \ 0.01. *** Significant at

p \ 0.001a S.E. = Standard Errorb Girls = referencec Physical = referenced Control = referencee Time 1 = referencef Condition * Time 1 = reference

580 J Autism Dev Disord (2014) 44:572–583

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interventions to improve these attitudes. For example,

parents can be included in the intervention by reading

storybooks at home about disability. Another improvement

could be to have the intervention over a longer period or

repeat it at different time intervals (Bell and Morgan 2000).

By comparing an intervention at different time spans,

Rillotta and Nettelbeck (2007) established a stronger

positive change in attitude in students who followed an

eight-session intervention rather than a three-session one or

no intervention at all. Finally, the intervention might be

improved by including activities that bring children in

direct contact with peers with disabilities. As stated by

Zajonc (2001), repeated exposure to something (in this case

disability) is sufficient to change attitudes. Including shared

activities in the intervention like sports or art, might lead to

stronger effects (Rillotta and Nettelbeck 2007).

This study made a first attempt to influence attitudes

towards children with disabilities among kindergarten and

elementary school students in a Dutch education setting.

More specifically, we attempted to prepare typically

developing students for their future contact with children

with severe physical and intellectual disabilities. The

intervention evaluated in this study demonstrated the

potential of preparing students for such future contact.

However, a fist important, but challenging, step is to

improve the intervention in order to establish greater

effectiveness and more long-term.

The current study focused on a specific disability type of

which is not very common yet to be included in general

schools. Other low-incidence disability types (e.g., students

with autism spectrum disorders, ASD) (Carter et al. 2010)

seem to be an important target group to focus on in future

interventions. This is of particular interest as students with

ASD are more and more included in our Dutch general

education system in the last years (MinOCW 2010). As the

social inclusion of students with ASD is not obvious (see

Koster et al. 2009) these students need attention in future

research as well.

Appendix: The vignettes used in the Attitude Survey

towards Inclusive Education (ASIE)

John: a boy showing aspects of a physical disability

John is a boy your own age and has just moved to where

you live. He attends the same school as you but has diffi-

culty walking. He walks with leg braces, uses crutches, and

sometimes needs a wheelchair for daytrips with his family.

John is not always able to attend school as he often needs to

visit a doctor who helps him with his walking. John is a

good learner and has a sense of humor. At school he uses a

computer because he is a slow writer. Sometimes it is also

difficult to understand what John says.

Janet: a girl showing aspects of a cognitive disability

Janet is a girl your own age and has just moved to where

you live. She attends the same school as you, has just

started to read and write but has difficulty with math. While

Janet can run and play like other children, she sometimes

forgets the rules of certain games. She needs extra time to

learn her work and can be forgetful in class. Sometimes it

is difficult to understand what Janet says. She does enjoy

playing music. For part of the day, Janet receives extra

learning assistance outside the classroom.

Jack: a boy with severe physical and intellectual

disabilities

Jack is a boy your own age and has just moved to where

you live. He attends the same school as you, and while his

hearing and sight are good, he has difficulty with learning

and talking. Jack has his own teacher who helps him with

learning. He uses a wheelchair which he drives himself,

and can also walk short distances. Jack has difficulty

playing as he is easily distracted. Because he cannot talk,

he often makes noises or smiles when he likes something.

Jack enjoys music and can play with a music box for a long

time.

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