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J Autism Dev Disord (2014) 44:572–583
DOI 10.1007/s10803-013-1908-6
ORIGINAL PAPER
Evaluating the Effectiveness of an Intervention Program
to Influence Attitudes of Students Towards Peers with Disabilities
Anke de Boer • Sip Jan Pijl • Alexander Minnaert •
Wendy Post
Published online: 28 August 2013
Ó 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
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
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
J Autism Dev Disord (2014) 44:572–583
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
573
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, Briñol 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; Krahé 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 (Krahé 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
123
574
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
123
J Autism Dev Disord (2014) 44:572–583
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.
J Autism Dev Disord (2014) 44:572–583 575

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.
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.

Fidelity of the Intervention

Table 2 Summary of the intervention

In order to achieve the commitment and encouragement of Content of the intervention

the teachers to implement the intervention, we organized a Six lessons per grade (1/2, 3/4, 5/6, 7/8) focusing on
meeting with them. The first draft of the intervention was 2 9 physical disability
presented at this meeting so that teachers could give feed- 2 9 intellectual disability
back on its design. One of the outcomes of the meeting was 2 9 severe physical and intellectual disability
that teachers indicated that two lessons per week was the
Background information about the disabilities for teachers
maximum they could incorporate into their curriculum. They
Description of each lesson
also suggested structuring the lessons in such a way that only
Teaching aids/materials
a minimum of preparation was needed. The teachers’ feed-
Information letter for parents
back was used in the final design of the intervention. After its

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

123
576 J Autism Dev Disord (2014) 44:572–583

Measures decide to exclude these statements from the main analysis,

resulting in a final scale of 14 statements (aT1 = 0.79,
Attitudes of Kindergarten Children Towards Peers aT2 = 0.82, aT3 = 0.87). Scale scores ranged from 0 to 28,
with Disabilities with a higher score reflecting a more positive attitude. The
total score of each student was included in the analysis as
The Acceptance Scale for Kindergarten-revised (ASK-R), dependent variable.
developed by Favazza and Odom 1996) was used to assess
attitudes of kindergarten students (age 5 and 6). The ASK- Attitudes of Elementary School Students Towards Children
R consist of questions reflecting two attitude components with Disabilities
(Triandis 1971): the affective component (feelings) and the
behavioral component (behavioral intentions). The scale The attitudes of elementary school students were assessed
was administered to groups of three students by reading using the Attitude Survey Towards Inclusive Education
instructions and questions verbatim from a standardized (ASIE) (age 8–12). The ASIE was constructed and evalu-
protocol (designed by Favazza and Odom 1996). Admin- ated in a study by De Boer et al. (2012c) and has been used
istering the questionnaire took about 20 min per group. in previous Dutch educational research (see De Boer et al.
The questionnaire was printed on colored sheets show- 2011). The ASIE is based on the CATCH questionnaire
ing three faces per question. Students were asked to record and designed specifically for students between 8 and
their responses by marking an ‘X’ on either the happy face 12 years old (see Rosenbaum et al. 1986). The ASIE
(for YES), the sad face (for NO), or the ‘half happy face’ consist of items reflecting two attitude components: the
(for MAYBE). Each response category yielded a score, affective component (feelings) and the behavioral compo-
namely: 0 = no, 1 = maybe, 2 = yes. The original ASK- nent (behavioral intentions). The item quality of the ASIE
R consists of 18 items resulting in a score range of 0–36 questionnaire was analyzed using the Mokken model
(a = 0.79). An example of an item was: ‘I would like to be (Mokken 1971), which is based on item response theory
friends with a child who cannot see’. (IRT). The outcomes of the analyses resulted in a satis-
Because we used the Dutch version of the ASK-R for factory scalability coefficient of H = 0.50. The reported
the first time for this, we analyzed whether the scale had reliability coefficient of the scale was q = 0.92 (for more
appropriate reliability. Reliability analysis revealed that details we refer to De Boer et al. 2012c).
four negatively formulated statements (after recoding) The ASIE consisted of two parts: a vignette and attitude
showed low correlations with other statements in the scale. statements. The first part presented a vignette about a
During the administration of the questionnaire it was hypothetical child with a disability. It is likely that students
already noticed that students had difficulty answering those aged 8–12 years interpret the term ‘disability’ in many
items. This, together with the low correlations, made us different ways, which made us decide to design vignettes.
Due to the aim of this study we designed three different
Table 3 Student demographics vignettes focusing on a child with a physical, intellectual
Kindergarten students Elementary school students and severe physical and intellectual disability (see
(N = 53) (N = 218) ‘‘Appendix’’ section). The study of De Boer et al. (2012c)
showed that elementary age students are gender sensitive to
Experimental Control Experimental Control
group group group group the child presented in the vignette, so gender-specific
(n = 22) (n = 31) (n = 91) (n = 127) vignettes were developed for boys and girls. The vignettes
n n n n were developed by the first author and verified by a
Gender
research assistant with a degree in special education. All
Boys 14 15 35 57
students randomly received a questionnaire including one
of the vignettes. This means that each class was randomly
Girls 8 16 56 70
divided in three (taking boys and girls into account), so
Grade
each vignette was covered equally per class. To overcome
2 12 16 – –
as much as possible that students would receive a ques-
3 10 15 – –
tionnaire with a different vignette at each measurement, we
4 – – 15* 26*
coded each questionnaire prior to the assessment (i.e.,
5 – – 20 19
school, class, student, vignette number). This coding was
6 – – 16 27
used at each measurement.
7 – – 24 24
The second part of the questionnaire consisted of four-
8 – – 16 31
teen attitude statements about the inclusion of the child
* The data of these students was excluded at time measurement 1 and 2 presented in the vignette, like ‘I would stick up for John if

123
J Autism Dev Disord (2014) 44:572–583
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
577
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
123
578
Table 4 Attitudes of kindergarten students by condition and time
Time 1 a
Time 2 Time 3
Mean SD Mean SD Mean
Experimental (n = 22) 6.8 6.2 14.0 5.8 12.3
Control (n = 31) 8.5 5.2 10.2 6.7 12.9
a
There was no significant difference between the two conditions at
Time 1
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.
123
J Autism Dev Disord (2014) 44:572–583
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.
SD
6.1
7.2 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
J Autism Dev Disord (2014) 44:572–583 579

Table 5 Model estimates for the variable effects on kindergarten This study showed that the intervention had short term
students’ attitudes for different models effects on kindergarten students’ attitudes. However, the
Model Empty model Final model t value third time measurement revealed that the attitude change
Coefficient Coefficient did not last. On the one hand, this could mean that kin-
(S.E.)a (S.E.) dergarten attitudes can indeed be influenced by a knowl-
Fixed part edge-based intervention program. On the other hand, the
Intercept 10.726 (0.626) 8.499 (1.031) results suggest that an improvement of the intervention is
Conditionb needed to strengthen its effectiveness in the long-term.
Experimental -1.744 (1.591) -1.096 Although our intervention was based on the Special Friends
Measurementc
program (Favazza et al. 1999), we only included a
Time 2 1.651 (1.445) 1.142
knowledge component. Including the other components of
the program (structured play and home reading) might lead
Time 3 4.376 (1.445) 3.028**
to stronger long-term effects.
Condition * 5.444 (2.174) 2.504*
Time 2d This study showed that students’ attitudes in both con-
Condition * 1.211 (2.199) 0.550 ditions were significantly improved at Time 3 (1 year after
Time 3 the intervention), indicating that kindergarten students
Random part become more positive when they become older. A possible
Variance explanation of the improvement might be the effect of
Between students 7.583 (4.416) maturation. This effect refers to processes changing over
Within 35.816 (5.239) time, like growing older, wiser, tired or bored. As stated by
measurements Goodman (1989), students become more knowledgeable as
Time 1 38.005 (7.748) they become older. Moreover, the increase in attitudes in
Time 2 42.928 (8.752) both conditions can also be attributed to the assessment of
Time 3 30.960 (6.191) the questionnaire. Since talking about disabilities is not
Covariance common for kindergarten students, the assessment of the
Time 1 * Time 2 16.981 (6.436) questionnaire can be seen as an intervention in itself. It
Time 1 * Time 3 6.140 (5.058) might be that students were stimulated to think and talk
Time 2 * Time 3 8.424 (5.550) about disabilities for the first time in their lives. This may
Deviance 960.999 936.489 suggest that such talk is a first step in helping to shape the
attitudes of such young students.
* Significant at p \ 0.05. ** Significant at p \ 0.01
a There are, however, some limitations which should be
S.E. = Standard Error
b
considered when interpreting the outcomes. The small
Control = reference
c
sample size of the kindergarten group is clearly a limitation
Time 1 = reference
d
of the study. In addition, it should be noted that the
Condition * Time 1 = reference
instrument used for kindergarten students, the ASK-R, does
not particularly focus on the disabilities represented in the
Table 6 Attitudes of elementary school students by condition and intervention. It is therefore unclear if students’ attitudes
time
towards children with physical, intellectual and severe
Time 1a Time 2 Time 3 physical and intellectual disabilities became more positive.
Mean SD Mean SD Mean SD In any future research it is advisable to match the items of
the instrument with the disabilities represented in the
Experimental (n = 76) 3.60 0.60 3.43 0.62 3.45 0.55 intervention.
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 Attitudes of Elementary School Students

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.
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

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Table 7 Model estimates for the variable effects on attitudes of In line with other studies, our findings underline that
elementary school students for different models boys hold more negative attitudes than girls. The outcomes
Model Empty model Final model t value of this study indicate that boys and girls do not change
Coefficient Coefficient differently, as no interaction effects were found. To ensure
(S.E.)a (S.E.)
stronger intervention effectiveness in boys and girls, De
Fixed part Boer et al. (2012b) suggest taking the differences between
Intercept 3.547 (0.033) 3.975 (0.090) boys’ and girls’ attitudes into account.
Genderb Based on the outcomes of this study it can be concluded
Boys -0.209 (0.064) -3.265** that elementary school students hold the most negative
Vignettec attitudes towards children with intellectual and severe
Intellectual -0.250 (0.079) -3.164** physical and intellectual disabilities than towards students
Severe physical/ -0.240 (0.082) -2.927** with a physical disability. This is a disappointing result, as
intellectual there is already an on-going trend to include the latter
Conditiond group of children in regular schools. It is likely that certain
Experimental -0.182 (0.086) 2.116* behaviors typical for children with severe physical and
Measuremente intellectual disabilities (e.g., use of a wheelchair, difficul-
Time 2 -0.054 (0.051) 1.059 ties in talking, uncontrolled movements) (Vlaskamp et al.
Time 3 -0.179 (0.073) -2.452* 2005) may ‘frighten’ students. This underlines the impor-
Condition * -0.120 (0.078) -1.538 tance of explaining the behavior of such children in order
Time 2f
to remove students’ irrational fear.
Condition * 0.039 (0.108) 0.361
Time 3
With respect to both kindergarten students and ele-
Random part
mentary school students, it should be mentioned that it was
Variance
their attitudes rather than any knowledge acquired that was
Between students 0.160 (0.024) measured in this study. Although we focused on knowledge
Within 0.173 (0.015) about disabilities in the intervention, the cognitive com-
measurements ponent (i.e., beliefs and knowledge) was not measured by
Time 1 0.305 (0.032) both instruments used. It may be that students gained
Time 2 0.337 (0.037) knowledge about disability through the intervention, which
Time 3 0.285 (0.031) can then be seen as a starting point for attitude change over
Covariance time. It is highly recommended to include a measurement
Time 1 * Time 2 0.130 (0.029) or structured interview in future research to examine the
Time 1 * Time 3 0.179 (0.026) cognitive component, like students’ knowledge about dis-
Time 2 * Time 3 0.106 (0.029) abilities and what students learned from the intervention.
Deviance 786.981 735.578 Another limitation of this study is the significant difference
* Significant at p \ 0.05. ** Significant at p \ 0.01. *** Significant at between both conditions at Time 1, so that the outcomes
p \ 0.001 need to be interpreted with some caution.
a
S.E. = Standard Error
b
Girls = reference Implications of the Study
c
Physical = reference
d
Control = reference The results of this study clearly point out the potential of
e
Time 1 = reference the intervention to influence attitudes positively, particu-
f
Condition * Time 1 = reference 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
students more (Bell and Morgan 2000). For example, as a seem necessary in order to strengthen long-term effects.
consequence of the intervention students might have real- One such improvement might be to include parents in the
ized what it means to have a disability in daily life and how intervention, as it has been argued that they are important
this would affect them when coming into contact with a in developing young children’s attitudes (Bricker 1995).
disabled person. Corresponding with other studies, the The significant link between the attitudes of parents and
outcomes of this study raise the question whether short children towards students with disabilities (De Boer et al.
term intervention, such as ours, can achieve the intended 2011; Innes and Diamond 1999) suggests that parental
objectives among elementary school students. involvement may lead to greater effectiveness of

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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
581
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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