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Factors Predicting the Development of Children With Mild Disabilities in Inclusive Preschools

Sucuoğlu, Bülbin, PhD; Bakkaloğlu, Hatice, PhD; Demir, Şeyda, PhD; Atalan, Derya, PhD

doi: 10.1097/IYC.0000000000000137
Original Research/Study
ISEI Article

This study compared the developmental gains of preschool children with disabilities (CWD) and children without disabilities (CWOD) during a year they spent in preschools and examined the predictors of development in both groups (60 CWD and 57 CWOD) of children. Data on the social skills, problem behaviors, school adjustment level, student–teacher relationship, and the developmental functions of children were collected from the mothers and teachers, whereas trained assistants assessed the development of children. Analyses indicated that although all of the children made developmental gains, the psychomotor, language, and socioemotional developmental gains were greater for CWD than those for CWOD. Furthermore, social skills and school adjustment levels were found to be significant predictors of developmental gains of CWD. Implications of these findings were discussed in terms of the content of preschool curriculums, teacher preparedness related to inclusive practices, and the importance of and teaching social skills to CWD.

Division of Early Childhood Education, Faculty of Education, Hacettepe University, Ankara, Turkey (Dr Sucuoğlu); Department of Special Education, Faculty of Educational Sciences, Ankara University, Ankara, Turkey (Drs Bakkaloğlu and Demir); and Ministry of National Education, Ankara, Turkey (Dr Atalan).

Correspondence: Bülbin Sucuoğlu, PhD, Division of Early Childhood Education, Faculty of Education, Hacettepe University, 06800 Çankaya, Ankara, Turkey (

This study was a part of a larger project that was supported by the Scientific and Technological Research Council of Turkey 1001 Projects (project no. 114K649). This study was also orally presented at the International Society on Early Intervention Regional Conference at Stockholm, Sweden, on June 8–10, 2016.

The authors report no conflicts of interest.

THE EARLY YEARS are critical for children with disabilities (CWD), meaning that high-quality preschool inclusion is an important part of special education in early childhood. Inclusion is a system that may be beneficial for CWD, in that it can lead to the creation of a learning environment that promotes most aspects of child development (Guralnick, 2016). For CWD, inclusion during the preschool years is critically important at this stage, because children have yet to develop biases about others, minimizing the possibility of rejection, whereas the chance that CWD have interactions with their peers makes it easier for them to be accepted in later years. Placing CWD in general education settings may also lead teachers and parents to develop higher expectations from them (Buysse & Bailey, 1993), and interactions with typically developing peers in the early years might facilitate inclusion in later life and participation in all community activities. Furthermore, because segregation may have negative effects on CWD, such as being in socially and academically a less demanding environment and having fewer opportunities to interact with children without disabilities (CWOD) and fewer possibilities to engage in higher levels of play (Guralnick, 1990a), inclusion during the early years is a preferable practice in many countries (Brown & Guralnick, 2012 ; Gupta, Henninger, & Vinh, 2014 ; Guralnick, 2001).

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In an inclusive system, CWD are included in preschool classrooms alongside CWOD, and the teachers in these classrooms are expected to support all children's development and meet their needs through, for example, arrangement of the environment and the use of teacher and peer-mediated interventions, along with specific techniques and materials, all while cooperating closely with parents. Teachers also may become the facilitators for these children to establish and sustain friendships with their peers and support their engagement in all academic and nonacademic activities, thereby fostering a sense of belonging. Through the social interactions that might occur spontaneously or with the help of teachers in preschool classrooms, CWD can be expected to learn to use the knowledge and skills and to acquire new behaviors through observations of their peers, with the appropriate skills and behaviors who can become role models for those with disabilities.

There have been studies that indicate that CWD acquire and generalize newly learned social skills to a new environment, and they develop higher quality social interactions in inclusive preschools (Gupta et al., 2014 ; Odom et al., 2004). In addition, there have been studies showing that their scores in intellectual, early literacy, and language measures increase and they gain more developmental benefits than children in segregated learning environments (Antia & Levine, 2001 ; Holahan & Costenbader, 2000 ; Odom & Bailey, 2001 ; Odom et al., 2004 ; Paul-Brown & Caperton, 2001 ; Phillips & Meloy, 2012 ; Strain, 1983 ; Strain & Bovey, 2011). In a study comparing inclusive preschool classrooms and segregated classrooms, there were smaller adult/child ratio than inclusive programs, and children with severe disabilities showed fewer developmental gains and their interaction with peers was lower than witnessed in inclusive classrooms (Hundert, Mahoney, Mundy, & Vernon, 1998). Moreover, it has been suggested that in inclusive environments, CWD may develop larger social networks than those children who have been placed in segregated settings (Guralnick 1999 , 2001 , 2005 ; Odom, Buysse, & Soukakou, 2011 ; Odom et al., 2004). For example, although inclusion for children with autism is a controversial issue (Odom et al., 2004), Strain and Bovey (2011) argue that young children with autism in high-quality preschool classrooms demonstrate less severe behaviors related to autism than their peers in segregated environments and maintain improved behaviors when they move into general education classrooms. In addition, in studies in which when the children with severe disabilities were fully included in general classrooms, it was seen that they displayed higher levels of engagement and had larger friendship networks than their peers in segregated placements (Fryxell & Kennedy, 1995 ; Hunt, Farron-Davis, Beckstead, Curtis, & Goetz, 1994).

Children with typical development are not harmed or disadvantaged when educated in inclusive classrooms and are able to establish and sustain relationships with their peers with disabilities (Buysse & Bailey, 1993 ; Odom et al., 2004). In these environments, CWOD gain opportunity to develop an understanding of disability and differences (Diamond, 1993) and develop positive attitudes toward their peers with disabilities (Guralnick, 2001 ; Odom & Bailey, 2001). In addition, they also gain the chance to learn how to initiate interactions and how to respond to the initiations of peers with disabilities (Odom et al., 2011). Moreover, because they have the opportunity to work with and support CWD in inclusive settings, they tend to demonstrate higher levels of academic ability in inclusive settings (Fuchs, Fuchs, & Burish, 2000). Finally, in inclusive preschools, the self-esteem, confidence, and leadership skills of CWOD may increase while interacting with children who have a variety of ability levels (Katz & Chard, 2000). Although the benefits of inclusion listed previously are the desired outcomes of preschool inclusion, there may be drawbacks to placing CWD into the risk of being less accepted in their classrooms and having fewer social interactions than their peers without disabilities when there is no specific intervention to this end (Guralnick, 1990b). The expected outcomes of inclusion can be listed as the acceptance for the CWD in their classes, the development of positive social relationships and friendships, and learning to reach the full potential for all children (Division for Early Childhood [DEC] & National Association for the Education of Young Children [NAEYC], 2009). However, for these to happen, a CWD would need to have access to all of the settings, materials, and teaching that the CWOD are offered; engage in all the play and learning activities in their school settings; and to receive the necessary supports and aid allowing them to learn and develop at their own speed, and thus reach their maximum potential (Billingsley, Gallucci, Peck, Schwartz, & Staub, 1996). Accordingly, when the stage is set, when the teachers are proficient, and when there are qualified professionals to support both teachers and CWD, inclusion is considered a beneficial practice for all children (Odom et al., 2011). In other words, when inclusive practices are implemented with fidelity, both children with mild and severe disabilities and those with typical development can all gain benefits from the preschool inclusion (Odom et al., 2004 , 2011).

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Studies of the developmental gains of CWD have identified that can be considered effective in the developmental outcomes of such children. According to a study investigating the effects of inclusive and segregated settings on child development (Holahan & Costenbader, 2000), the degree of disability and the initial level of development, the number of services received, and the length of school days had significant effects on the developmental gains of children. For example, children with a higher developmental level demonstrated greater progress in the inclusive settings than those in the segregated classrooms, whereas the children with lower emotional function made similar progress in both segregated and inclusive preschools. On the contrary, the length of the school day (full day vs. half day) was not found to have a significant effect on the general knowledge and self-help skills of children, and no significant interaction was found between the length of the school day and developmental level in terms of developmental progress. In addition, no statistically significant relationship was found between the duration of services (minutes received per week) and the rate of developmental progress. As studies focusing on predictive factors related to the developmental outcomes of CWD are scarce, new studies examining the variables that predict developmental gains in inclusive preschools appear to be necessary in order to develop and implement effective inclusive programs.

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In Turkey, inclusion is accepted as the service model for CWD (Education Reform Initiative, 2011). Furthermore, it is mandatory that all the needs of young CWD are met in public and private preschools, through the provision of the necessary support services (Ministry of National Education [MoNE], 2012). The law covers young children with mild disabilities aged 3–6 years, whereas children with severe and multiple disabilities are placed in special education preschools or rehabilitation centers, where they receive special education services so as to meet their unique needs. Although recent statistics (MoNE, 2016) indicate the presence of only a small number of CWD in public preschools (only 1,399 CWD attended preschools, whereas the number of children who were enrolled for special education for preschool age CWD was 1,010), there are no reliable or current data showing the number of young CWD who are in inclusive preschools with their peers with typical development (Diken, Rakap, Diken, Tomris, & Çelik, 2016).

In Turkey, the attitudes and beliefs related to inclusive preschools are generally positive and teachers believe that young CWD should be in inclusive preschool settings (Akalın, Demir, Sucuoğlu, Bakkaloğlu, & Karasu-İşcen, 2014). Nevertheless, most of the preschool teachers are unwilling to include CWD in their classrooms because of their lack of knowledge, experience, and skills related to inclusive practices (Altun & Gülben, 2009 ; Gök & Erbaş, 2011 ; Kaya, 2005 ; Özaydın & Çolak, 2011 ; Sucuoğlu, Bakkaloğlu, Akalin, Demir, & İşcen-Karasu, 2015 ; Yavuz, 2005). A small number of studies have shown that when preschool teachers are trained in inclusive practices, their knowledge, attitudes, and relationship with children improved and the social skills and behaviors of CWD changed in a positive way (Sucuoğlu et al., 2015 ; Sucuoğlu, Bakkaloğlu, Bayraklı, & Demir, 2014).

The Turkish parents of CWD believe that being in the same environments as their peers without disabilities is beneficial for their children (Bayraklı, 2014 ; Özbaba, 2000), although they are concerned that preschool teachers who have only limited or no knowledge of the characteristics of CWD, and little experiences of the inclusion of CWD, may not be able to meet the needs of CWD. Moreover, they state their concerns related to the possibility that their children may be rejected by their peers without disabilities (Bakkaloğlu, 2013 ; Bayraklı, 2016).

There have also been several studies investigating the effects of short-term intervention programs on the various skills of CWD such as learning readiness (Birkan, 1999), readiness for inclusive settings (Odluyurt & Batu, 2010), transition (Bakkaloğlu, 2008), self-help (Aykut & Varol, 2007 ; Özen, Acar, Tavlar, & Çetin, 2013), and social skills (Balçık & Tekinarslan, 2012 ; Özaydın, İftar, & Kaner, 2008 ; Özdemir, 2008). It was found that when appropriate and evidence-based methods, such as peer-mediated interventions and activity-based teaching, were used for teaching children, their target skills improved and problem behaviors decreased (Bakkaloğlu, 2008 ; Özaydın et al., 2008). However, the number of children who participated in these studies was very few, and unfortunately, almost all studies were carried out either in university research centers or in private preschools that were collaborating with the universities.

In Turkey, although the results of the studies investigating the effects of preschool inclusion appear to be promising in regard to the children's outcomes, in practice, there are several challenges. On the one hand, although there are both segregated and inclusive education systems, the policy makers and the community seem to favor special schools that are designed especially for CWD (Uysal, 1995). In addition, many preschools and daycare centers are reluctant to enroll children with diverse abilities because of the lack of knowledge and experience in working with CWD among their teachers. Therefore, no preventive or supportive actions could be made to improve inclusive preschools and to increase the success of inclusion, not only in preschools but also in schools of all levels. On the other hand, inclusion has been largely implemented without the establishment of standards related to effective inclusion, the training of preschool teachers, and organizations of an environment for all children to learn and to develop (Diken & Sucuoğlu, 1999 ; Uysal, 1995). Consequently, we are concerned that teachers, parents, principals, and the community may begin to see that inclusion is as an unsuccessful model, not only for CWD but also for children with typical development (Sucuoğlu et al., 2015). However, in Turkey, although the physical condition of preschools is generally inadequate, the support services for both teachers and CWD are insufficient, preschool teachers have only limited experience of inclusive practices, and thus young CWD are currently being enrolled in preschool classrooms (Batu, 2010 ; Diken et al., 2016 ; Gök & Erbaş, 2011 ; Kargın, Acarlar, & Sucuoğlu, 2003).

The current study investigates to what extent preschools in Turkey support the development of CWD and CWOD and determines the factors that predict the development of the CWD and CWOD in inclusive preschools. To achieve the study objective, the development of CWD and CWOD who were enrolled in inclusive preschool classrooms was assessed at the beginning (Fall) and end (Spring) of the 2015–2016 school year. Similarly, their social skills, problem behaviors, and school adjustment, together with their relationship with their teachers, were twice assessed by the researchers. This study was guided with the following questions:

  1. Are there significant differences in the developmental composite, cognitive, language, social–emotional, and psychomotor scores gains between CWD and CWOD attending inclusive preschools?
  2. What are the predictors of the spring developmental scores of the participant CWD and CWOD in inclusive preschools?
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This study is a part of a 3-year project involving a longitudinal study that aims to determine the factors that predict the developmental gains of preschool CWD and CWOD. In this current study, the preliminary findings are presented that are related to the data (Spring scores) obtained at the end of the first year.

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Study group

Participants of the study were 117 young CWD and CWOD who attended 53 inclusive classrooms in 13 public preschools in Ankara. The CWD had an average age of 51.88 months, and CWOD had an average age of 51.64 months. All CWD had a diagnosis such as autism, motor–physical/health problems, hearing impairment, speech and language disorders, and mild intellectual disabilities. They attended the inclusive preschool classrooms on a full-time basis because there are not any part time inclusive services in Turkey. Based on their needs, all of them were provided 2–9 hr a month special education services by private special education schools or rehabilitation centers. MoNE (2012) provides 2 hr of additional support services free of charge to children with diagnosed disabilities. Parents who would like to have more hours of support must pay the additional expenses to themselves. Therefore, most of the participant children received 2 hr of extra special education services. The CWOD were matched (each teacher chose a CWOD based on same age and gender of the CWD in her classroom) with the CWD according to their age (there was not any significant difference between the mean age of the CWD and the CWOD (t = 0.272, p = .786), gender, and classrooms. Table 1 presents demographic information of the CWD and the CWOD. The development of the two groups of children was significantly different based on their Ability Index—Turkish (AI—T) version scores (t = 9.960, p = .000), the AI—T mean score of the CWOD (

= 30.02, SD = 2.88) lower than that of the CWD (

= 43.38, SD = 10.07). According to the parents and teachers, none of the CWOD was ever referred to the hospital because of developmental issues of any kind.

Table 1

Table 1

Data were collected from 122 preschool CWD and CWOD in the Fall; however, during the Spring data point, five children (one child with Down's syndrome and four children with typical development) were not assessed for the following reasons: stopped attending school as they moved to another city and long-term illness or parent decision not to send them to preschool anymore. They were, therefore, excluded from the study, resulting in the data for 117 children (60 CWD and 57 CWOD) included for analysis. There was one pair of children (one CWD plus one CWOD) in 41 classrooms, two pairs of children in eight classrooms (two CWD plus two CWOD), and in three classrooms there was only the CWD in Spring data collection point.

In this study, data were collected from the primary caregivers (i.e., mothers who consistently brought their children to school) who were mostly housewives taking care of their children and the preschool teachers. Table 2 shows the characteristics of the mothers. The age of the mothers of CWD ranged from 21 to 54 years with a mean of 32.23 (SD = 6.34). The number of education years of mothers was between 5 years and 17 years (

= 9.82 years, SD = 3.53), apart from one mother who had a graduate degree. Nine mothers (14.8%) had a job outside the home and the rest were housewives. Annual family income ranged between 600 and 6,000 Turkish liras with a mean of 2.018 Turkish liras (approximately 600 Euros). The income and the years of education of the two groups of mothers were found to be significantly different; the income level (t = 2.450, p = .016) and level of education of the mothers of the CWD were found to be lower than those of the mothers of CWOD (t = 2.84, p = .005). All participant teachers were female and had four years of college education in preschool education. The number of children included in each teacher's classroom was approximately 20 children (range: 15–25), and generally there were one or two CWD in each class. Among the teachers, 44.1% had received short-term in-service training or one preservice course in preschool inclusion. See Table 2 for teachers' and mothers' demographic information.

Table 2

Table 2

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To collect data, we used several instruments that were completed by the researchers, teachers, and parents regarding all the variables. All the instruments are briefly introduced later:

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Information forms

Teacher and parent forms that consisted of open-ended and yes or no questions were developed by the researchers and used to collect information on a variety of issues regarding demographic characteristics of children, parents, and teachers. The teacher form included questions regarding the children's age, gender, developmental level, their relationship with peers, whether the children had any disabilities, and whether they were provided any special education services in or out of preschool. The parent form covered several questions related to the parents' demographic characteristics, such as their income, level of education, age, working status, and also children's characteristics.

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Gazi Early Childhood Assessment Tool

This instrument is used to assess the development of young children aged between 0 and 72 months and helps determine whether young children have developmental delays (Temel, Ersoy, Avcı, & Turla, 2005). It consists of four subtests assessing psychomotor (73 items), cognitive (60 items), language (60 items), and socioemotional (56 items) development. To assess a child's development, the child is observed during play in appropriate settings with the appropriate toys and by interviews with the parent or the caretaker; thus, the information about the children can be collected for a variety of behaviors and skills. Validity and reliability studies have found that the scores of the Gazi Early Childhood Assessment Tool (GECAT) have medium- and high-level correlations (between .81 and .98) with the Denver Developmental Screening Test scores. Spearman–Brown r values varied between .47 and .94 (.82 and .94 for the total score, .57 and .88 for psychomotor, .47 and .84 for cognitive, .47 and .84 for language subtest, and finally .47 and .81 for socioemotional). The instrument has a manual and users are required to have a certificate indicating that they are able to use the instrument correctly. In the current study, three PhD students in the department of special education were trained to use the GECAT until the interrater reliability reached 90%. They assessed the development of all the children individually both by observing children in a play situation that they had established in preschools and by interviewing mothers in the same setting. Each assessment session took at least 1 or 2 hr for each child.

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Preschool and Kindergarten Behavior Scales

The Preschool and Kindergarten Behavior Scales (PKBS) is a norm-referenced and standardized rating scale developed to assess social skills and identify behavior problems in preschool children aged 3–6 years (Merrell, 1996). It contains two separate scales: The Social Skills Scale, which includes subscales for social cooperation, social interaction, and social independence, and The Problem Behavior Scale, which identifies both externalizing and internalizing behavior problems displayed in the early years (Merrell, 1996). A 4-point Likert scale (0 = never, 3 = frequently) is used by teachers, parents, or caregivers to rate the child's social skills and behaviors exhibited both at home and at school. Higher scores on the Social Skills Scales indicate greater social skills and higher scores on the Problem Behavior Scales imply more problems. Studies that have investigated the psychometric properties of the Turkish Form of the PKBS (PKBS-T) showed that it has good reliability and validity values (Fazlıoğlu, Okyay, & Ilgaz, 2011 ; Poyraz-Tüy, 1999). Cronbach's α values were between 0.85 and 0.96 for the total and subscales of the Social Skills Scale and the Problem Behavior Scale.

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Teacher Rating Scale of School Adjustment-Short Form

This tool is a short form of the Teacher Rating Scale of School Adjustment (TRSSA) including 52 items (Betts & Rotenberg, 2007). It has three factors, namely, on-task classroom involvement (6 items), maturity (5 items), and positive orientation subscales (5 items). The Teacher Rating Scale of School Adjustment-Short Form (TRSSA-SF) demonstrates acceptable internal consistency (α = .89), and it has significant correlations (r = .93, p < .001) with children's self-reported school adjustment and academic performance. Teachers respond to the items using a 3-point Likert scale (0 = doesn't apply, 1 = sometimes applies, 2 = certainly applies). A group of researchers (Bakkaloğlu, Sucuoğlu, & Ertürk, 2015) translated the instrument into Turkish and examined the factor structure of the Turkish Form (TRSSA-SF-T). Because of the low factor loading (<0.32), one item was excluded from the Turkish Form. Finally, the instrument used in the research consisted of two factors, namely, involvement (10 items) and positive orientation (five items). Cronbach's α values of the TRSSA-SF-T were found to be at acceptable levels for total score (0.94), classroom involvement (0.94), and positive orientation and maturity scores (0.84).

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Student–Teacher Relationship Scale—Short Form

The short-form of the Student–Teacher Relationship Scale (STRS; Pianta, 2001) measures the quality of student–teacher relationship based on teacher's perception related to the child's behaviors and his or her feelings. In the research, it is used to assess the relationship between preschool teachers and CWD and CWOD at 3–5 years of age. This 15-item instrument comprises two factors, namely, closeness (seven items) and conflict (eight items). The conflict factor measures the degree of negative and conflicting relationships and lack of connection with the child, whereas the closeness factor represents the teacher's feeling of affection and open communication with the child. The Student–Teacher Relationship Scale—Short Form (STRS-SF) has sufficient test–retest reliability for closeness, 0.88, conflict, 0.92, and the total score 0.89. Teachers are required to rate the STRS-SF items on a scale ranging from 1 (definitely not applies) to 5 (definitely applies). Higher scores indicate higher quality relationships with less conflict and more closeness between the teacher and the child. The STRS-SF was translated into Turkish and the psychometric properties of the Turkish Form (STRS-SF-T) were investigated by Şahin and Ocak-Karabay (2015). Their analysis indicated that the factor structure of the Turkish Form was similar to the original form and the two factors accounted for 45.97% of the variance. Cronbach's α values were found to be 0.84 for the conflict factor, 0.76 for the closeness factor, and 0.82 for overall scale score. In addition, the correlations between the test–retest scores for closeness, conflict, and total scores were .83, .87, and .83, respectively.

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The Abilities Index

The Abilities Index (AI) was developed by Simeonsson and Bailey (1988), who stated that a traditional classification system was useful in identifying a child's disability category but is limited in addressing other areas in which the child may have needs. This index is accepted as a useful and functional measure that provides information about the level of the skills of babies and young children in nine domains using 19 items: audition (left and right ears), behavior, intellectual functioning, limbs (right and left hands, arm, and leg), intentional communication, tonicity (degree of looseness and tightness), integrity of physical health, eyes (right and left eyes), and structural status (shape, body form, and structure). Teachers, parents, and other professionals who know the child rate each domain ranging from 1 (normal functioning) to 6 (profound disability). The AI scores vary between 0 and 114, with the highest score indicating lower function and a greater need for early childhood special education services (Chambers, Pérez, Socías, Shkolnik, & Esra, 2004). Studies that have used the AI for data collection have shown that it had strong validity and reliability (Bailey Jr., Simeonsson, Buysse, & Smith, 1993 ; Buysse & Bailey, 1993 ; Buysse, Bailey, Smith, & Simeonsson, 1994). The index was translated into Turkish (AI-T) and the psychometric properties were investigated during the course of another project involving the developmental needs of the CWD and the CWOD (Sucuoğlu, 2016). The analysis indicated that the alpha value of the AI-T was 0.89 and test–retest reliability value was .82. In addition, the r value indicating the congruence of the evaluation of the mothers and the teachers was .74.

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In the current study, all data were collected twice, 6 months apart, in the Fall and the Spring data point of the 2015–2016 school year. In other words, each instrument was completed for CWD and CWOD, who were recruited from the same classroom and matched with CWD in terms of age and gender, by the teachers and the trained researchers in the Fall and in the Spring. Having obtained consent from the MoNE, the graduate students assessed the children's development using the GECAT in a separate room of the preschools. The participant teachers completed the forms related to children's development (AI-T, TRSSA-SF-T, and PKBS-T) and their relationships with the children (STRS-SF-T). Using information forms, the teachers and the parents also presented demographic information regarding the children's, teachers', and parents' characteristics.

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Data analysis

For this research, to determine descriptive statistics for the study, we initially calculated means and standard deviations of dependent variables for the independent variables and the Spring and Fall data point and then calculated the composite score, including the combined GECAT subscale scores (raw scores were used for all analysis), by using factor analysis, to present information regarding the overall development of children. Then, we decided to use the gain scores (difference score or change score) for comparing the development of CWD and CWOD in terms of the amount of change in the GECAT composite and subscale scores (Jennings & Cribbie, 2016). Therefore, the gain scores were calculated by subtracting the Fall scores from the Spring scores for both groups. Following this, as the gain scores were not distributed normally, Mann–Whitney U tests were used to investigate whether there were significant differences between the gain scores of the CWD and the CWOD.

Regarding the second question of the study, to determine the predictors of the GECAT Spring scores of the study group, it was decided to run forward stepwise regression analysis. The initial scores (Fall scores) of the Social Skill Scale, the Problem Behaviors Scale, the Teacher Rating Scale of School Adjustment, the Student–Teacher Relationship Scale, and Abilities Index were included in a regression analysis as the independent variables. The GECAT composite score and four developmental scores obtained at the Spring data point were dependent variables. Before conducting the regression analysis, two groups of descriptive analysis were performed:

  1. Both independent and dependent variables were examined for the whole group to determine whether they were normally distributed by using histogram, skewness, and kurtosis values. Although we excluded the outliers from the data, there were still violations of the normality assumption for some of the data; therefore, it was decided to repeat the normality analysis for the data of the CWD and CWOD groups separately. The results indicated that the normality assumptions were met for all variables except the GECAT language scores of the typically developing children.
  2. To investigate the relationships between predictor variables and each dependent variable, Pearson correlation values were calculated for the two groups separately. The results indicated that there were no relationships between independent variables and each dependent variable for the CWOD, whereas strong and positive relationships were found between two groups of variables for the CWD. Therefore, we decided to run stepwise regression analysis only for CWD.
  3. Because the correlations among our predictor variables were large, multicollinearities in the data were examined by calculating Variance Inflation Factor (VIF), tolerance value (TV), and condition index (CI) values. Calculations indicated that there were no multicollinearity problems for the GECAT composite sores and four subscale scores (VIF ≤ 10, TV > 0.20, and CI ≤ 30; Field, 2009).
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Differences in developmental gain scores of CWD and CWOD attending inclusive preschools

Descriptive statistics

Table 3 includes all means and standard deviation values for the two groups of children and this table shows the differences from Fall to Spring in all scores. In addition, as it can be seen in Table 3 that means of children with CWD and CWOD in all domains of GECAT (psychomotor, cognitive, language, and socioemotional development) increased. Because we calculated the gain scores as explained in the data analysis section, results regarding gain scores were only presented. Table 4 presents the correlation values between dependent and independent variables for the CWD. With regard to CWOD, because Pearson correlations coefficients showed that none of the independent variables was related to either GECAT composite scores or subscale scores, these values were not presented in the table. According to Table 4 the GECAT composite scores, together with the subscale scores, were significantly related to all of the independent variables for the CWD. The problem behaviors and level of functions of the CWD were found to be negatively correlated with all developmental scores, whereas social skills, school adjustment of the CWD, and teacher–student relationship for this group were significantly associated with not only composite scores but also the GECAT subscale scores and the correlations were large. In addition, social skills and problem behaviors were found to be negatively related, as expected. As can be seen in Table 4, because the normality tests showed that the outliers were different for each subscale and composite score, the numbers of the CWD included in each correlation analysis were not the same.

Table 3

Table 3

Table 4

Table 4

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The differences between the gain scores of the CWD and the CWOD

As the increase in the gain scores in both groups was not normally distributed, the Mann–Whitney U tests were employed to determine the extent to which the gain in developmental scores of the CWD differs from the gain scores of the CWOD. The findings indicated that psychomotor (median = 2.00), language (median = 2.00), and socioemotional (median = 2.00) development gain scores were greater for CWD than for CWOD (for psychomotor: median = 1.00; for language and socioemotional development: median = 0.00; for psychomotor: U = 1331.00; for language: U = 1052.00; and for socioemotional development: U = 1,061.50, p < .05); however, the gain scores of cognitive development and general development (composite scores) of the two groups of children were found not to be significant (p > .05). That is, although two groups of children gained developmental benefits, there were no differences between their level of developmental gain in their cognitive development and general development. Table 5 presents the findings of the results of the Mann–Whitney U test run for the gain scores.

Table 5

Table 5

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The predictors of the development of the CWD in inclusive preschools

According to the results of the forward stepwise regression analysis run for the CWD, two variables emerged as significant predictors of the development of children over the 6 months. In CWD, social skills as the sole predictor explained 53% of the variance in the GECAT composite score, as well as 60% of the variance in cognitive development and 51% of the variance in language development. In addition, social skills and school adjustment significantly contributed to the prediction and explained 54% of the variance in the psychomotor development, whereas school adjustment was a marginal predictor of social–emotional development (21% of the variance) of these children. Problem behaviors, teacher–student relationship, and level of functions are not found to be significant factors for the children's development. The results of the stepwise regression analysis are summarized in Table 6.

Table 6

Table 6

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The main purpose of the current study was twofold: determine the developmental gains of CWD and CWOD in inclusive preschools and reveal the predictors of the development of the CWD who enrolled in preschools using forward stepwise regression analysis. Therefore, prior to the regression analysis, in an attempt to answer the first question of the study, the researchers investigated to what extent the CWD developed over 6 months and whether there was a difference between the developmental gains of the CWD and the CWOD. And later, the predictors of the development of the CWD and the CWOD were examined by conducting regression analysis. In the following sections, the results of this study are discussed addressing the research questions:

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Developmental gains of the CWD and the CWOD

The analyses conducted to examine the developmental gains of CWD and CWOD over 6 months showed that all children, both CWD and CWOD, developed in four developmental domains during the time they spent in preschool and their developmental scores increased from pretest (Fall scores) to posttest (Spring scores). In addition, the gain scores of the CWD were found to be significantly higher than those of their peers with typical development in language, socioemotional, and psychomotor domains (see Table 5). Considering that there are problems and challenges regarding inclusive preschool practices in Turkey, it can be said that these findings for the benefits of placing the CWD in the preschool classroom where they can interact with their more able peers might be very promising.

Previous studies focusing on inclusive practices have frequently emphasized that access to the general education environments are not enough to support the development of the CWD (Carta & Kong, 2007). Therefore, it is accepted that successful inclusion needs planning, training, and support not only for CWD but also for teachers who work with the children who have a variety of skills and abilities. In addition, for the successful teaching of children, effective inclusion requires special techniques and strategies that should be embedded in ongoing classroom activities (Carta & Kong, 2007 ; Müller & Ahern, 2005 ; Odom et al., 2011). In Turkey, studies investigating inclusive preschool practices have shown that in general, preschool settings are not appropriately designed for inclusive practices and the needs of CWD are not met because of teachers' lack of knowledge and experience and a lack of systematic support for teachers, children, and parents (Akalın et al., 2014 ; Batu, 2010 ; Diken et al., 2016 ; Sucuoğlu et al., 2015). Taken together, in the current study, the fact that the CWD showed unexpectedly good progress in all developmental scores including the GECAT composite scores was a surprise for the researchers. In addition, according to anecdotal notes taken by the researchers during the project, statements by several mothers such as “being in the preschools had affected not only the language of their children but also their behaviors in a positive way, even though the teachers were not willing to have their children in their classrooms” appear to clearly support our findings related to the children's development in the preschools. For example, one mother made the following statement:

It has been only two months since my child came to this school with his friends, but his vocabulary and his behaviors have already changed amazingly in a positive way.... It is fortunate that I decided to send my child to preschool.

We consider that our findings might emphasize the importance of a rich environment for the development of CWD, in that there were children with skills at different levels. However, we think that these findings should be interpreted by taking several issues into consideration.

First, we think that the difference in the gain scores of the CWD and the CWOD in favor of the CWD could be partly attributed to the characteristics of the GECAT, the measure that was used to collect our data for the CWD and CWOD. This instrument provides valuable information about the levels of child development between the ages of 0 and 72 months, and its psychometric properties seem to be at acceptable levels (Temel et al., 2005). In addition, in the current study, the interrater reliability (correlation) values calculated across the three evaluators were found to be very high (>.90). However, we realized that some CWOD, aged 4–5 years, had very high scores in developmental domains, especially on socioemotional development, at the beginning of the year and they reached the highest scores at the Spring data point. Therefore, it was thought that the fact that some gain scores of the CWOD were less than or equal to that of the CWD could be related to the ceiling effect (i.e., having the top scores from the instrument; Uttl, 2005) or the structure or wording of some items of the instrument. In addition, we established that some items that assess the development of the children based on parents' opinions appeared to be problematic. For example, an item from socioemotional development subscale asked mothers “Does your child dress and undress independently?” and some mothers said “yes” to this question. However, when the researcher asked another question that was not included in the instrument, such as “Does she/he put on and take off all clothes, (e.g. pants, T-shirts or jacket) independently?” in order to verify the mother's answer, the mothers changed their answer and stated that their child could not put on or take off a sweater, shoes, or T-shirt. Similarly, the mothers inconsistently responded to several more items from the language and socioemotional development subscales of the instrument. It could be the case that either the mothers have difficulties in understanding some questions or these items of the GECAT are problematic in terms of their wording. Therefore, although the GECAT is a comprehensive developmental instrument commonly used for research studies in Turkey (Bayraktar & Temel, 2014 ; Çiftci, 2013 ; Kapçı, Küçüker, & Uslu, 2010 ; Yazıcı, 2007 ; Zeteroğlu, 2006), we suggest that items that require replies based on parents' opinions should be reviewed. The psychometric properties of the instrument could then be examined further by gathering data on heterogeneous groups of children at different developmental levels.

Second, the project was conducted in middle and low socioeconomic neighborhoods of the city of Ankara, and almost all the children were from families with lower socioeconomic status. However, the monthly salaries and levels of education of mothers of the CWD were significantly lower than those of the mothers of the CWOD and almost half of them were receiving the minimum wage. In addition, according to the mothers, most of the CWD had few previous opportunities to interact and to communicate with their highly skilled typically developing peers apart from their brothers and sisters. Taking into consideration the socioeconomic levels of the parents and the developmental disabilities of the children in the current study and the previous literature on early intervention, which emphasizes the greater benefits for poor (Kelleher, 2009) and below average children (Lee, Brooks-Gunn, Schnur, & Liaw, 1989) from the Head Start programs, one inference that could be drawn from our findings might be that the preschool environment could have been providing richer and more stimulating learning opportunities for the CWD than their home environment. Thus, being in the inclusive environment might have resulted in more gains across developmental domains for the CWD.

Third, preservice and in-service professional development contributes to highly effective teachers in inclusive classrooms (Campbell & Milbourne, 2005 ; Snyder, Hemmeter, & Fox, 2015) and increasing the teachers' knowledge regarding inclusive practices can lead to more positive attitudes toward both CWD and inclusion (Crane-Mitchell & Hedge, 2007). In our study, 44% of the preschool teachers had completed 1-week in-service training or one preservice course related to inclusive preschool. However, both pre- and in-service courses are generally based on transferring information regarding elements of inclusion and characteristics of the CWD and do not offer real-life experiences to teachers who work with children with a variety of levels of functioning (Akalın et al., 2014 ; Gök & Erbaş, 2011). Nevertheless, in the current study, it may be the case that the teachers' theoretical knowledge of CWD and preschool inclusion might have contributed to the development of CWD.

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Predictors of development of the CWD and the CWOD

As for the second question of the study, a forward stepwise regression analysis was planned to determine the predictors of the GECAT spring scores for the study group, due to the fact that there were no relationships between predictors and the dependent variables for the CWOD. Two important predictors that emanated from our study were social skills and school adjustment. That is, social skills significantly contributed to the prediction of the GECAT composite scores and all developmental scores apart from socioemotional development, which was predicted by only school adjustment. Social skills also referred to as prosocial behaviors and are defined as positive social behaviors that enable effective interaction with others (Gresham & Elliot, 1990). They include interaction skills such as helping, sharing, displaying positive initiation and responding behaviors, communicating with others, problem solving, and engaging in activities (Gresham & Elliot, 1990 ; Webster-Stratton & Reid, 2004). According to studies addressing the importance of social skills in the early years, these skills play important roles in achievement by directly regulating motivation, which in turn affects engagement and study skills (DiPerna & Elliot, 2000). Children who have better social skills are more likely to interact positively with their peers and may learn new social behaviors through peer modeling (Birch & Ladd, 1997 ; Hamre & Pianta, 2001). On the contrary, school adjustment is defined in terms of academic achievement, attitudes, and involvement in school activities, including participations in lessons (Ladd & Burgess, 2001 ; Wentzel, 1991). In addition, friendship quality is accepted as a predictor of young children's school adjustment, and social behaviors are strongly correlated with peer acceptance (Ladd, Kochenderfer, & Coleman, 1997 ; Ladd, Price, & Hart, 1990). Moreover, a study examining the predictors of school adjustment for children with and without intellectual disabilities (developmental delays) revealed that parent- and teacher-reported social skills were strongly related to the school adjustment of children who had a mean age of 63 months (McIntyre, Blacher, & Baker, 2006). Furthermore, our findings showed that the social skills and school adjustment of the CWD were strongly correlated (see Table 3) and these skills could not be separated from other skills included in the developmental domains (Allen & Cowdery, 2015). In sum, the finding of the current study that indicated social skills as a strong predictor of the developmental scores of the CWD could be accepted as parallel to those of earlier studies that emphasized the role of social skills in the development of young children (Bulotsky-Shearer, Bell, Romero, & Carter, 2012 ; McClelland & Morrison, 2003 ; McIntyre et al., 2006 ; Montroy, Bowles, Skibbe, & Foster, 2014).

In Turkey, the main objectives of preschool education are supporting physical, mental, and emotional development; establishing an awareness of reading and writing; and preparing children for elementary school through the creation of an effective and high-quality learning environment, especially for children from disadvantaged homes. Although the preschool system takes a child's total development into consideration, in recent years the curriculum appears to be mainly focusing on school readiness and emphasizes the importance of being prepared for the elementary schools in terms of basic academic skills (TEDMEM, 2016). For this reason, despite their frequent statements about the importance of social skills for preschool children, many preschool teachers concentrate on teaching preacademic skills (Tutkun & Dinçer, 2015). Teachers believe that instruction in social, self-care, and daily life skills is sufficient for the CWD and they should work on socially adaptive behaviors instead of academic skills in preschools; however, they seem to have difficulties in assessing and teaching social and adaptive skills (Akalın et al., 2014). Moreover, although most of the preschool teachers stated that teaching social skills is the responsibility of the parents, the parents indicated that guiding them in how to teach these skills is the responsibility of the teachers (Özyürek & Ceylan, 2014). Nevertheless, taking our results into account, which are similar to the existent research mentioned previously, social skills appeared to significantly impact the psychomotor, language, and cognitive development of the CWD, and it is possible to predict the development of children by investigating their social skills. As preschools play an important role in the development of social skills of all children by providing many opportunities to engage in activities and acquire and practice new social skills with their peers, these findings led us to consider the content of pre- and in-service teacher training programs. That is, if the preschool teachers were trained and empowered in the teaching of social skills that addressed the needs of young CWD and CWOD, and if they were able to concentrate more on teaching and reinforcing these skills during the preschool years, in addition to teaching academic skills, the benefits of inclusive preschools in terms of development of the CWD might be increased, even though preschool teachers are not necessarily equipped to teach CWD.

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One important limitation of this study should be considered in reading and discussing our findings. Extant literature strongly emphasized that length of the school day, attendance, the services offered to CWD and severity of disabilities might affect the development of CWD who were placed in inclusive preschools (Holahan & Costanbader, 2000 ; Odom et al., 2004). In addition, the severity of disability that refers to the magnitude of a child's developmental delay (Odom et al., 2004) is accepted as an important influence on developmental gains of CWD who are placed in both segregated and inclusive environments, and benefits of CWD from inclusive classrooms might change according to the degree of disabilities (Holahan & Costanbader, 2000 ; Odom et al., 2004 ; Rafferty, Piscitelli, & Boettcher, 2003). Moreover, children with mild disabilities are more likely to be placed in inclusive programs than children with sensory, severe, and multiple disabilities (Odom et al., 2004). Similarly, in Turkey, according to the related laws and regulations, only young children with mild disabilities can attend inclusive preschools (MoNE, 2012). Therefore, in the current study, because all children have a variety of mild disabilities, it was impossible to consider the severity of disability as a variable and to investigate whether there was a relationship between the degree of disability and developmental progress of the participants.

Finally, the number of variables that are to be included in a regression analysis is one of the major assumptions and with the small sample size, the results of the regression cannot be generalized to other samples (Pallant, 2010). For this reason, because our sample size was relatively small, we excluded some variables and decided to limit the number of independent variables to five, namely, developmental functions, social skills, problem behaviors, school adjustment, and student–teacher relationship of the CWD group. In the future, with a larger sample size study group, the effects of all variables related to the progress of the improvement of CWD attending inclusive preschools might be examined.

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The findings of the current study that are in line with the previous literature have suggested that, even though preschool inclusion practices in Turkey have many challenges and problems regarding settings and teachers' preparedness (Bakkaloğlu et al., 2016 ; Diken et al., 2016 ; Sucuoğlu et al., 2015 ; Yılmaz, Bakkaloğlu, & Sucuoğlu, 2016), CWD showed increases in the means regarding all developmental domains and they learned many skills. However, these findings might mislead us into believing that the gains from which the CWD benefitted at the preschools were achieved without either setting the stage or preparing and supporting the teacher. Preparing preschools and teachers and establishing systematic support for teachers and children are essential for successful inclusion (Odom et al., 2004 ; 2011). Therefore, we think that our results have highlighted only the importance of CWD being with typically developing children and fostering social skills of all children in preschools. We hope that in the future, our teacher training programs will strongly emphasize the importance of social skills in preschools and include an assessment of the social skill deficits and teaching strategies to be used by preschool teachers.

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children with disabilities; development; inclusion; predictors; preschools

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