The name of the article is, Is Inclusivity of Quality of Care for Children with Autism in

Special Education. The purpose of this study was to determine whether the proportion of time
spent in an inclusive educational setting is a process indicator for the quality of schooling for
children with autism spectrum improves key outcomes. (Foster & Pearson, para 1)
The article is about 484 participants with a primary diagnosis of Autism spectrum
ranging in age from 20-23 to see if participants who were not educated in an inclusive setting,
spending 75-100 percent time in a general education classroom were more likely to attend
college, not drop out of high school or have an improved cognitive function, and key future
outcomes after controlling for key confounds. The diagnosis of autism spectrum includes
individuals with autistic disorder, Asperger Syndrome, and pervasive developmental disorder not
otherwise specified who have experienced varying degrees of severity. In special education they
use process measures to measure and ensure treatment quality. By law, children in special
education must have an Individualized Education Plan that sets goals for each child and a
treatment plan to attain those goals. A requirement under the Individuals with Disabilities Act is
that children be educated in the least restrictive or inclusive setting which is defined as educating
a child in a general education classroom with a focus on bringing the services to the child.
(Foster& Pearson, para 2, 3, 6)
The National Longitudinal Transition Study-2 is a ten year of youth with disabilities who
were receiving special education services in public or state-supported special schools. It uses a
nationally representative sample of youth in special education that were between the ages of 13
and 16 on December 1, 2000. A total of 434 of these individuals had a primary diagnosis of
autism based on parent report and were included in these analyses. The study collected data
biannually in 5 waves from 2001-2009. The current study uses wave 2 data. Wave 2 data was

collected in 2003 for characteristics of the school program and home environment. Wave 4 data
was collected in 2007 for outcome measures. This study used data collected using two
instruments which are a parent telephone interview and a school program questionnaire. The
National Longitudinal Transitions Study-2 assessed academic performance by collecting data
using a direct assessment of a students abilities by a trained on-site professional, other than the
students teacher. (Foster& Pearson, para 9, 10)
The covariate represents potential confounders which are variables that influence
outcomes, exposure and inclusivity. The parent interview provided data on explanatory variables
including the severity of the youths disability, the level of family support for education, and
demographic information. There were four measures of functioning that were also included and
they were, the number of domains affected by the disability, a functional cognitive scale, a social
skills scale, and whether the youth was able to be evaluated using the direct assessment.
(Foster& Pearson, para 10)
The number of domains affected ranged from zero to seven, it included vision, hearing,
expressive, communication, receptive language, bidirectional communication, use of arms,
hands, and feet and general health. The functional cognitive scale measured a combination of
parent-reported cognitive, sensory, and motor skills used to perform daily activities for an
example like counting change. Parents rated their child on a scale from 1 to 4. On the scale a one
was not at all well and a four was very well for each skill. The rating from each skill was added
to create the functional cognitive scale. The scale ranged from 4 to 16. A four was not at all well
for any of the skills and a 16 were very well for all the skills. The social skills were measured by
using items from the Social Skills Rating System that were answered by the parent. The items
that were selected from the Social Skills Rating System from the assertion and self-control

subscales for inclusion in the National Longitudinal Transition Study-2 because these were
assumed to be most relevant to school success. The social skills scale ranged from 0 to 18, and
measured the youths ability to interact with family and friends. To measure the family support
for education at school as well as the frequency with which the parent attended school meetings,
school or class events or volunteered at the school a scale was used that ranged from 0 to 12. A
scale that ranged from 1 to 9 was used to measure family support for education in the home as
well as the frequency in which the parent helped the youth with homework and talked with the
youth about his or her school experience. The parents were asked to rate of the students
persistence and how often the youth kept working at something until it was finished, even if it
takes a long time. The responses were categorized by never, sometimes and very often. (Foster&
Pearson, para 10, 11, 12, 13, 14)
The primary exposure of interest in the analysis was the time the youth spent in a general
education classroom. The school program questionnaire collected data on the courses that each
student took during the 2003 school year and whether each course was take in a general
education or special education classroom. The number of course taken in a general education
classroom was divided by the total number of courses taken to calculate the proportion. The
proportion of time spent in an inclusive setting was then categorized as a 0,1 to 74 percent to a
100 percent of courses taken in a general education classroom. (Foster& Pearson, para 15)
There were three outcomes that were assessed in this analysis by using the wave 4 data
and they were not dropping out of high school, any college attendance, and the cognitive
functional scale at wave 4. The youth were expected to graduate from high school by wave 4.
The youth were coded as not dropping out if the parent reported that they graduated and received
a certificate or General Education Development certificate, or they were still in high school at the

time of the wave 4 data collection. Any college attendance was based on the parents report of
whether or not the youth attended any type of post-secondary in the previous two years including
post-secondary classes to earn a high school degree, a 2 year or 4 year college or a postsecondary
vocational school. The functional cognitive scale at wave 4 was calculated the same way as the
scale used for wave 2. (Foster& Pearson, para 16)
Propensity Score Methodology is the probability of treatment assignment conditional on
observed baseline characteristics. The propensity score allows one to design and analyze an
observational (nonrandomized) study so that it mimics some of the particular characteristics of a
randomized controlled trial. In particular, the propensity score is a balancing score: conditional
on the propensity score, the distribution of observed baseline covariates will be similar between
treated and untreated subjects. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144483/)
In an observational study is the link between an exposure and an outcome that represents
an association and then moving from that particular association to drawing casual inference
depends on a key assumption. Under the assumption that the outcomes for individuals at a level
of inclusivity represents a counterfactual for what other, comparable children would experience
had they had that same level of inclusivity, rather than what they actually experienced. (Foster &
Pearson, para 17)
Ignorability assumes away unobserved differences over and above any covariates used to
adjust comparisons of individuals at different levels of exposure. Ignorability essentially assumes
that the exposure, inclusivity in this study, is randomly assigned among subgroups of participants
sharing the same set of observed characteristics. It is impossible to fully test this assumption
empirically, but at least a necessary condition for plausibility is that one select the correct

covariates and omits incorrect ones. Correct means potential confounders variable that influence
both inclusivity and the outcomes of interest. Analyses grounded in ignorability generally
involve comparisons of outcomes across levels of exposure adjusted for the covariates selected.
An analyst might regress the outcome on exposure and the covariate selected. Casual inference
in this case, even if ignorability is correct, is the mechanics of regression or other methods work
correctly, which means that the adjustment mechanism fully balances the distribution of the
covariates across levels of exposure. In a regression context, achieving balance involves
specifying the functional form of the regression model correctly. (Foster & Pearson, para 17, 18)
An alternative methodology for adjusting comparisons across levels of exposure for
covariates involves propensity score. They predict probability of exposure and represent a
convenient summary of the covariates. The propensity score can be used to calculate adjusted
between-groups in a variety of ways such as matching. The propensity score-based methods
assume ignorability but do have advantages over regression, like producing estimates of the
effect of the exposure with a clear interpretation and checking covariates balance. The propensity
scores can be used in analyses that take various forms. Inverse probability of treatment weights
was used; this methodology was easily generalized beyond two levels of exposure. The weights
are calculated as one over the probability of exposure actually received. These weights can be
incorporated in the analyses like survey weights that represent pseudopopulatons where the
covariates and exposure are no longer related. Inclusivity is an ordered category. To generate
predicted levels of inclusivity a multinomial logit model was used. (Foster & Pearson, para 19)
In the descriptive statistics table it reported that the covariate, the level of inclusivity
experienced, and outcomes of interest. It resulted that the vast majority of the youth with autism
were male. Roughly 6 in 10 participated in direct assessments as part of the study. For the

average child that had autism the disorder was identified early which was age two. The table
provides information on the exposure which was that 45% spent no time in the regular
classroom, 17% spent three quarters or more of their school day in a regular classroom setting.
This variation reflects the childs characteristics as well as the supply side factors such as the
range of special education services offered in the school. (Foster & Pearson, para 22)
In the multinomial logit the results had 2 coefficient estimates for each covariate. These
represent the log-odds of a choice relative to the reference category of 0% inclusivity. The
covariates do not predict inclusivity. The covariates with significant coefficients could reflect the
chance findings given the large number of coefficient estimates. There is no confounding
relationship between the exposure and the covariates to be removed. (Foster & Pearson, para 23)
In an outcome analyses it presented the unadjusted and adjusted levels of the 3 outcomes
of the inclusivity variable. The effect of dropping out of high school and those spending no time
in inclusive setting are least likely to continue in high school. The gap between those youth and
those spending all their time in an inclusive setting was 17 percent. Adjusting for the covariates
narrows the gap 8 percent. (Foster & Pearson, para 25) In the second outcome which was college
attendance, the gap between the highest and lowest categories is 57 percent. Adjusting for the
covariates closes the gap to 14 percent. ((Foster & Pearson, para 26) In the third outcome, the
score on the functional cognitive scale, the between-group difference is largely unchanged by
adjusting for the covariates. For all the three outcomes measured, adjusting for confounders
removes the effect of inclusive setting and the children who spent 75-100 percent of their time in
a general education classroom were no more likely to attend college, drop out of high school, or
have an improved functional cognitive score after controlling for key confounders. (Foster &

Pearson, para 27) In the analysis it suggests that inclusivity does not improve educational or
functional outcomes for children with autism. (Foster & Pearson, para 28)
Any biases would be in the direction of overstating effects such as that better functioning
youth were, all else equal, still more likely to be in inclusive settings. The apparent effect of
inclusivity on high school completion is an overestimate. There is no real way to test the
possibility. It is possible that unobserved differences biased the estimated effects of inclusivity
toward zero. The best one can do is qualitatively judge the plausibility of ignorability included
covariables and what one knows about the processes determining explorer of inclusivity. (Foster
& Pearson, para 28)
The strengths of this study are that the list of covariates included in the analyses is more
extensive than that used in previous research, even though adding covariates did not change the
relationship between inclusivity and the outcomes very much. Another strength of this study was
that even though the ignorability assumption is valid it remains true that the effect of measured
of a amorphous treatment, although the measure of inclusivity is crude, it is one of the main
measures of the quality of special education. The last strength of this study is that this study
illustrates the challenges of understanding the effect of real-world services and treatments
especially those involved in a rather small heterogeneous group. Data in this study was from
previous research that had much strength. (Foster& Pearson, para 29, 32, 33)
The weaknesses of this study are that the measures used in this study cannot predict
features of special education involvement like inclusivity. The placement in special education is
randomly assigned, and the youth find their way into placement based on school and district
characteristics such as funding which is unrelated to their own needs and goals. Schools,

districts, and states differ in their funding and eligibility requirements for special education. If
funding did have influence on childrens outcomes directly and fostered inclusivity. Another
weakness of this study is that the data lacks key measures specific to the characteristics and
education of children with autism. A limitation of this study is a fuller understanding of
inclusivity and other potential measures of educational quality for both better data and measures.
(Foster &Pearson, para 30, 32, 33)
The progress in understanding the quality of education for children with autism may very
well depend on development of datasets for children with autism that are enriched by measures
developed for that population and includes careful description of their learning environment, and
sufficient size to illumine variation in the experiences of these children within and between
communities. Community-level variations in school policies and strategies may represent natural
experiments that provide instrumental variables or regression discontinuities that offer the
potential for valid casual inference in the absence of ignorability. (Foster & Pearson, para 33)
In conclusion, this paper gives an overall summary of the article Is Inclusivity an
Indicator of Quality of Care With Autism in Special Education, the objection of the study, the
methodology used, the results gained from the study, the strengths, weaknesses, and limitations
the study had.