TYPE Original Research

PUBLISHED 15 December 2023

DOI 10.3389/feduc.2023.1227178

The paradoxes of inclusion:

OPEN ACCESS cognitive and socio-emotional
developmental trajectories of deaf
EDITED BY
Brahm Norwich,
University of Exeter, United Kingdom

REVIEWED BY
Graeme Douglas,
and blind primary education
University of Birmingham, United Kingdom
Alessandra Cecilia Jacomuzzi,
Ca' Foscari University of Venice, Italy
students in mainstream and
Elizabeth Fraser Selkirk Hannah,
University of Dundee, United Kingdom special schools
*CORRESPONDENCE
Ricardo Rosas
[email protected]
Ricardo Rosas 1,2*, Victoria Espinoza 1,2, Camila Martinez 2 and
RECEIVED 22 May 2023
Catalina Santa-Cruz 2
ACCEPTED 14 November 2023
Centre for the Development of Inclusive Technologies, Pontificia Universidad Católica de Chile, Santiago,
1
PUBLISHED 15 December 2023
Chile, 2Centro de Justicia Educacional, Pontificia Universidad Católica de Chile, Santiago, Chile
CITATION
Rosas R, Espinoza V, Martinez C and
Santa-Cruz C (2023) The paradoxes of Introduction: Students with special educational needs (SEN) have historically
inclusion: cognitive and socio-emotional
found participating in the regular education system challenging. Since the 1990s,
developmental trajectories of deaf and blind
primary education students in mainstream and inclusion has been considered the optimal strategy for their development. However,
special schools. the effects of inclusive education on deaf and blind students are still little studied.
Front. Educ. 8:1227178.
doi: 10.3389/feduc.2023.1227178 Methods: In the present article, we report the results of a longitudinal study on
COPYRIGHT
the cognitive and socioemotional developmental trajectories of 23 deaf and 29
© 2023 Rosas, Espinoza, Martinez and Santa- blind primary education students attending mainstream (8 deaf and 10 blind) and
Cruz. This is an open-access article distributed special schools (15 deaf and 19 blind). The study was conducted in Santiago de
under the terms of the Creative Commons
Attribution License (CC BY). The use,
Chile between 2018 and 2019.
distribution or reproduction in other forums is Results: Our descriptive results suggest that deaf students attending special
permitted, provided the original author(s) and
the copyright owner(s) are credited and that
schools perform better on most of the variables studied. For blind students,
the original publication in this journal is cited, those attending traditional schools generally perform better than those attending
in accordance with accepted academic special schools. However, in the case of socio-emotional variables, blind students
practice. No use, distribution or reproduction is
permitted which does not comply with these
attending special schools tend to show fewer problems. However, almost all of
terms. the indicated differences are not statistically significantly different.
Discussion: We then discuss the need to consider the characteristics of each
group of students with SEN when defining an adequate educational system for
their optimal development.

KEYWORDS

cognitive development, socio-emotional development, inclusion, inclusive education,

sensory impairment

1 Introduction
Special education has historically been the solution to provide learning opportunities for
students with disabilities. However, in recent decades there has been a global trend to migrate
from a special education system to an inclusive one (Warnock and Norwich, 2010; Biermann
and Powell, 2016). Many countries in the West, starting with the publication of the Warnock
Report in 1978, began efforts to modify their public policies to move progressively from
segregated to integrated education and then, with the Salamanca Statement (UNESCO, 1994)
to inclusive education (see for example Biermann and Powell, 2014, comparing Iceland, Norway

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Rosas et al. 10.3389/feduc.2023.1227178

and Germany; Rosas et al., 2019, comparing Chile, Spain and Finland). On the other hand, some studies refer to the benefits of inclusive
These modifications have meant, in many cases, as in Chile, the education not only for students with SEN, highlighting the
dissolution of the special education system (Escudero, 2023). However, collaborative work between students with and without SEN and the
in countries such as Chile, not only has a mixed system been benefit of the different educational strategies implemented for all
maintained, but between 2010 and 2020, the number of students students (Hehir et al., 2016; Pocock and Miyahara, 2018; Palacios
enrolled in special education increased (40,000 more students in 2020 et al., 2020).
compared to 2010; Ministry of Eduction, 2010/2020). In Chile, a study by Contreras et al. (2020) addressed the effects
According to Articles 22 and 23 of the General Education Law, of inclusive education policies on students’ academic performance in
there are two alternatives in the special education system to cater for mainstream schools and their peers. The results indicate that before
students with special needs (Ministry of Education of Chile, 2009b). implementing an education reform that provides schools with more
Firstly, special schools are specialised centres for students with special resources to support the inclusion of students with SEN, the
educational needs (SEN) who generally require permanent support in integration of these students had a negative effect on their peers.
specific areas due to their condition. On the other hand, students with Namely, although with small size effects, typically developing children
SEN can attend regular schools as part of the School Integration scores in standardized tests dropped after the inclusion of children
Programme (PIE, Spanish acronym). Through the PIE, the State with SEN in their classrooms. However, the negative effect was
provides financial resources for each school to hire staff and purchase neutralised after the reform, possibly due to greater recognition of
additional materials so that students receive the specialised support SEN and increased resources for inclusion.
they require, according to their SEN (Ministry of Education of Chile, Concerning students with SEN, Rosas et al. (2021) showed that
2009a). The educational system the student enters will be determined deaf and blind students present differences in performance in different
by the family’s decision, or the student’s own decision, when this is tests, according to the educational system they attend. The results
possible given the supply of establishments (Rosas et al., 2018). indicate that students who are blind or have low vision and are
Despite global efforts to implement inclusive education policies, integrated into regular schools have better results in mathematics than
the motivation seems both value-driven as scientifically based. their peers who attend special schools. However, socioemotional
Inclusion is seen as a value in itself, as a way to ensure more equitable results are better in students who attend SE compared to integrated
access to quality education for the population of students with students. With respect to deaf students, the results suggest that
disabilities. This generates a moral paradox about the aims of inclusive students’ performance is highly dependent on their form of
education, which is represented in the question of for whom and why communication and the educational system they attend. The results
educational inclusion is best (Santa-Cruz and Rosas, 2020). The results indicate that students attending special schools, and who communicate
of the limited research conducted to assess whether students with SEN with Chilean Sign Language (ChSL), have the best results in cognitive
benefit from educational inclusion are inconclusive and depend on skills, language precursors and mathematical skills. In addition, the
multiple variables of the study population, including the type and same study indicates that the included students who communicate
degree of SEN investigated, the educational setting (special education, with ChSL are those who present the most diminished results. The
integration at different levels, full inclusion, pedagogical support following will briefly present the international state of the art on the
received), as well as demographic variables such as the age and gender inclusion of students with disabilities and the development of early
of students with SEN (Lindsay, 2007; Hehir et al., 2016; Pocock and skills in this population, with a special interest in deaf and
Miyahara, 2018). Furthermore, from the point of view of the analyses blind students.
conducted for the studies, the results can be affected by the type of
dependent variable used and the instruments used to assess it (socio-
emotional, academic, cognitive, and social; Loreman et al., 2014). 1.1 Deaf students
According to the review by Ruijs and Peetsma (2009), in the case of
students with SEN, such as learning difficulties, intellectual disabilities, Diverse factors influence the needs of deaf children, encompassing
behavioural conditions and mild to moderate psychosocial problems, variations in their degree of hearing loss, the type of hearing assistance
positive or neutral results were found regarding academic used, the permanence of their condition, their preferred mode of
performance. However, the authors advice to consider these results communication, and the age at which they were diagnosed (Terlektsi
with caution due to the lack of comparison groups in the reported et al., 2019). Other variables that may be taken into account are
studies. According to Lindsay’s (2007) meta-analysis, only one study cognitive ability, socio-economic status and parental support. In the
longitudinally compares the academic and psychosocial outcomes of case of deaf children, it is also crucial to know whether their parents
students with SEN attending special schools or regular schools. This are deaf or hearing, the former being paradoxically a considerable
study, carried out by Peetsma et al. (2001), reports that, in the case of advantage, as this allows them to develop sign language as their
students with behavioural and learning difficulties and students with mother tongue early on. This ensures adequate vocabulary
moderate intellectual disabilities, significantly higher performance is development, a central variable for cognitive and social development
observed in students attending regular schools in language and (Powers, 2003).
mathematics after 4 years of follow-up. Regarding psychosocial On the other hand, using cochlear implants has added more
development, no differences were reported between the two types of variables to consider, such as age at implantation and level of hearing
education systems. According to the description in the meta-analysis loss before and after implantation, among others (Archbold et al.,
conducted by Dalgaard et al. (2022), no other longitudinal studies 2015). The development of language and reading skills in deaf
compare the long-term effects of inclusion due to the costs and students, whether implanted or hearing impaired, appear to
difficulties associated with such processes. be strongly determined by the level of hearing loss, as well as the age

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of access to amplification technology, parental or caregiver show social skills equivalent to their peers (Antia et al., 2011). Along
involvement, and access to educational resources that allow for these lines, deaf students with an appropriate level of oral language
adequate language development (Moeller et al., 2007; Nelson and presented psychosocial problems if they attended SE (predominantly
Bruce, 2019). Although there is no consensus, the variables listed sign language). In contrast, they had psychological well-being when
above appear to affect the development of phonological awareness and they attended regular schools with a predominance of oral language.
vocabulary breadth in deaf students (Moeller et al., 2007). Although In addition, students who communicate predominantly with sign
differences in performance or developmental timing have been language showed greater well-being when attending special schools
described, the difficulties mentioned above do not necessarily have a than when attending regular schools (Fellinger et al., 2009).
negative impact on the reading learning of deaf students (Moeller
et al., 2007; Tomblin et al., 2020). In addition to the aforementioned
variables, communication variables such as language preference and 1.2 Visually impaired students
the ability to understand peers are of great importance in the academic
performance of deaf students attending secondary school (Marschark A wide range of different visual impairment conditions are
et al., 2015). defined by the degree of vision loss. There are children with severe
Regarding mathematical skills, there is evidence of difficulty in sight impaired or blind, children sight impaired or partially sighted,
deaf students performing at the level of their hearing peers (Blackorby and children with low vision (Douglas et al., 2019).
and Knokey, 2006; Noorian et al., 2013). One of the possible reasons Unlike those with hearing impairment, students with visual
for difficulties in the development of mathematical skills in deaf impairment do not have the difficulty of being educated in a language
students is related to difficulties in language development, such as to which access is limited. However, the education of blind students
vocabulary and structure of oral and written language (Noorian et al., requires specific accommodations for the mastery of Braille and the
2013; Shelton and Parlin, 2016). use of technological accessibility devices. This led to greater numbers
As with mathematical skills, deaf students seem to see the of blind students in regular schools. For example, in the case of the
development of their executive functions affected due to the language UK, around 70% of blind students attend regular schools (Morris and
difficulties derived from their condition. Although there is no Smith, 2008).
consensus on the cause-effect relationship between language and Despite greater ease in acquiring decoding skills than their deaf
executive functions, several studies have provided evidence supporting peers, many blind students have reading difficulties (Steinman et al.,
language as an essential developmental factor (Daneri and Blair, 2017; 2006; Stanfa and Johnson, 2015). Despite not having hearing
Santa-Cruz and Rosas, 2017). Botting et al. (2017) conducted a study difficulties, in the early pre-reading stages, blind students require a
comparing executive functions in deaf students and typical great deal of support from their caregivers or teachers to expand their
development. Executive functions were assessed with standardised experience of the world, which is restricted by a lack of vision
tests with low verbal load to reduce the burden of oral language on the (Steinman et al., 2006). Similarly, they rely on their caregivers and
results. The researchers found that, despite being ‘non-verbal’ tests, parents for early tactile experiences that bring them closer to the
deaf students showed diminished scores relative to their hearing peers Braille reading experience, in a similar way that typically developing
and that the participants’ language skills mediated this effect. In students are exposed, sometimes unintentionally, to written material
addition, a study that used the BRIEF-EF parent report to assess (Steinman et al., 2006; Savaiano et al., 2014). All of these elements will
problem behaviours associated with different dimensions of executive subsequently affect students’ reading fluency.
functions in typically developing children, showed that deaf children As with reading skills, blind students have presented various
who were native sign language speakers had age-appropriate scores difficulties in developing mathematical skills. However, similar to
similar to those of their hearing peers (Hall et al., 2017). what was presented above, many of these difficulties seem to be related
In the school system, there is evidence that students with hearing to difficulties in the teaching process and not a consequence of the
impairment have problems in school adjustment, even if the hearing disability condition (Gulley et al., 2017; Healy and Fernandes, 2020).
impairment presented is minimal. Among the problems described are Thus, the proper use of Braille and diverse technology and teaching
attentional problems, impaired language development and difficulties techniques can promote the proper development of mathematical
acquiring reading skills (Goldberg and Richburg, 2004; Moeller et al., skills, reaching high levels of abstraction and complexity (Gulley et al.,
2007). In addition, profoundly deaf students have shown lower 2017). In this line, a neuroimaging study conducted on blind
performance than students with mild to moderate hearing loss on professional mathematicians showed that mathematical information
standardised tests (Mitchell and Karchmer, 2012). processing in blind people does not differ from the mathematical
Regarding socioemotional adjustment, the research conducted by processing of typically developing people (Amalric et al., 2018).
Santa Cruz et al. (2021), which focused on Chilean deaf students Concerning the development of executive functions in blind
during their early years of primary education, indicates that they children and adolescents, there is no evidence of differences in their
exhibit higher instances of emotional problems overall, particularly in development concerning typically developing children and
terms of behavioral issues when compared to their typically developing adolescents (Greenaway et al., 2017; Bathelt et al., 2018). Moreover, in
peers. The same study compares socioemotional problems to the type some cases, the performance of blind students exceeds that of typically
of communication used by deaf students, showing no significant developing participants on standardised tests (Greenaway et al., 2017).
differences in whether they used oral or sign language. Specifically, However, good results on standardised tests contrast with reports
when deaf students attend regular schools, it has been found that, with from parents and caregivers about participants’ performance in
specialised professional support, in addition to communication everyday activities involving executive functions (Greenaway et al.,
support and integration in group activities, deaf-included students 2017; Bathelt et al., 2018).

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To our knowledge, few studies have explored cognitive learning criterion that the students had some co-morbidity associated with a
differences in blind students integrated into regular schools and particular educational need. All students, whether they used oral
students educated in special schools. The only study we had access to, language or Chilean Sign Language, were in the process of acquiring
Heyl and Hintermair (2015), showed differences in all domains of written language.
executive functions assessed. Blind students scored lower than their
sighted peers in the normative sample. In addition, the results show 2.1.1 Deaf students
that blind students were underdeveloped in executive function The sample included 23 deaf students ages ranging from 5.42 to
domains of importance for social–emotional development. 11 years, with an average of 7.39 years. Seventeen of the participants
Underdevelopment appears to be especially true for blind students were male, and six were female. Fifteen students were studying in
who attend special schools. the special education system, and eight were included in regular
Regarding mental health and socio-emotional problems in schools. Only one student attending special schools communicated
general, blind students show lower development than their typically using oral language. All the others, 14 students, were ChSL users.
developing peers (Santa Cruz et al., 2021). About socioemotional As for the students integrated in regular schools, four were cochlear
development, it has been shown that, given the difficulty of monitoring implant users and used oral language as the primary means of
their environment, blind students are affected in their interactions and communication, while four used Chilean Sign Language as a means
social skills (Alabdulkader and Leat, 2010; Celeste and Grum, 2010). of communication.
Despite being able to recognise emotions from a self and peer
perspective, blind students are less proficient than their typically 2.1.2 Students with visual impairment
developing peers in recognising more complex mental states (Dyck At the beginning of the research, the sample consisted of 29
et al., 2004; Tadić et al., 2010). In a study by De Verdier (2016), results blind students, ranging in age from 4 to 9.08 years, with an average
show great difficulties related to the social inclusion of blind students age of 6.85 years. Fifteen of the participants were male, and 14 were
that increase throughout the school years. Moreover, although the female. Nineteen students studied in special schools, and 10 were
psychosocial well-being of blind students is equivalent to their peers, integrated in regular schools. Of the total number of students
in-depth interviews showed that blind students were more stressed, attending special school, 7 had low vision, and 12 were blind, and
experienced difficulties and expressed greater feelings of loneliness of the integrated students, attending regular schools, 5 were blind
compared to their typically developing peers. and 5 had low vision.
In summary, there is no conclusive evidence regarding the
outcomes of segregated versus inclusive education in the case of blind
and deaf students. The present study aims to provide longitudinal 2.2 Procedure
evidence in this direction, showing the case of deaf and blind students
attending both inclusive or segregated education. Specifically, we seek Cognitive skill development, precursors to reading, early
to answer the following questions: (1) What is the performance mathematical skills, and emotional and behavioural problems were
trajectory of blind and deaf students in segregated versus inclusive assessed. The first three variables were measured at three points along
contexts in cognitive, linguistic, mathematical and emotional the initial educational trajectory. The first measure was taken during
performance? (2) Are differences in subgroups observed within each the first semester of 2018, when the children were beginning the
disability category? reading process, and then followed up at 6 months and 12 months after
the first assessment. The measurement of emotional and behavioural
problems was carried out at two points, at the beginning and end of
2 Materials and method the research. Previously trained professionals conducted the
assessments. They took place in the educational centres or in the
This study used the quantitative paradigm, with a participants’ homes in two individual sessions of about 45 min.
non-experimental, longitudinal design with three evaluation periods Children were invited to participate through their schools or their
every 6 months from time 1. Descriptive and correlational analyses families, and only children who were authorised by their parents
allow us to answer the research questions. through informed consent and who demonstrated their voluntary
interest in participating through informed assent were included in the
study. This research was approved by the Ethics Committee of Social
2.1 Sample Sciences and Humanities of the Pontificia Universidad Católica
de Chile.
The sampling process of this study is purposive and
non-probabilistic, given the specific characteristics of the variables to
be studied. This longitudinal study was framed within the process of 2.3 Instruments
acquiring reading and mathematical skills in students with sensory
disabilities, which was an inclusion criterion for participation in the The following tools were used to perform the cognitive skills
research. The consequence of this is that, in many cases, students with composite score.
sensory impairment have a wide variance in age and educational level.
This variance depends on the age of entry into formal education, 2.3.1 Analogies subtest of the WISC-V test
forms of communication, degree of disability and type of school This test assesses abstract logical reasoning and verbal
attended. On the other hand, it was considered as an exclusion reasoning. Students are asked to say how two concepts are similar

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and, according to a correction scale, are awarded between 0 and 2 2.3.6 MARKO-D assessment battery
points. The original test has a Cronbach’s alpha = 0.89 (Rosas and This test was applied for the assessment of mathematical
Pizarro, 2018). precursors. In this test, children are asked questions related to various
mathematical skills. The questions are aimed at assessing different
levels of development. One point is awarded for correct answers, and
2.3.2 Cat-Dog subtest of the Yellow Red zero points for errors. The Cronbach’s alpha of the Chilean version of
executive functions assessment battery the test is 0.95. The instrument has been adapted for both children
This test is an adaptation of the Hearts & Flowers test with both DV and AD (Ricken et al., 2011).
(Davidson et al., 2006; Diamond et al., 2007) used to assess the Finally, the following instrument was used to assess
general development of executive functions. The test is emotional problems.
administered on a Tablet and has three stages; the first asks
students to press on the same side of the figure each time a cat 2.3.7 Child behaviour checklist 6–18
appears, the second asks them to press on the opposite side each This test assesses the presence of emotional and behavioural
time a dog appears, and the third stage is mixed. One point is problems. It yields both a total score and a scale of internalising and
awarded for each correct answer, and 0 points for each error. The externalising problems. The original test has a Cronbach’s alpha of
Cronbach’s alpha of the original test is 0.83. This test was 0.74. This instrument was answered by parents and guardians of
administered in its original version to students with AD and in an children with AD and DV (Achenbach and Ruffle, 2000; Achenbach
auditory version to students with DV (Rosas et al., 2022). and Rescorla, 2001).

2.3.3 Digit Retention subtest of the WISC-V test 2.4 Data analysis model
This test assesses short-term auditory memory and working
memory, among other cognitive skills. It has 3 subtests: in direct To assess differences between students attending special or
digits, children are asked to repeat a sequence of numbers in the regular schools, Two-Way Mixed ANOVA was used considering one
same order in which they heard it. In sequenced digits, children between-subjects factor (special school or regular school) and one
are asked to listen to a sequence of numbers and to say it in within-subjects factor (Time 1, 2 and 3). For the analyses of each of
increasing order. And in inverse digits, children are asked to the tests by disability condition, the following assumptions were
repeat a sequence of numbers after hearing it, but in reverse order. tested: (1) outliers in any of the cells of the design, (2) residuals are
A score of one is given for each correct answer and zero for each normally distributed in each cell of the design, (3) the variance of the
error. The total score was made by calculating a composite score dependent variable is equal between the groups of the between-
of the three tasks. The Cronbach’s alpha of the original test is 0.89. subjects factor, (4) homogeneity of covariances, (5) the variance of
It was used for children with DV, and a linguistic adaptation was the between-group differences is equivalent. However, as reported in
made for LS-using children (Rosas and Pizarro, 2018). the text, it was only considered problematic when there was more
The following instruments were used to assess the development of than one test violation because, as explained by Hox (2020), the
reading precursors. assumptions of a test are derived from characteristics of the data in
the population, so in small samples deviations from these
2.3.4 PEFCO phonological awareness assessment characteristics are expected. Following his recommendations, the
An adaptation of 2 subtests of the Phonological Awareness Verbal Reasoning variable was transformed, resulting from violations
Assessment test (Varela and Barbieri, 2015) was used. Initial sound in assumptions 1, 2, and 3. Verbal Reasoning was transformed to a
identification and phonemic synthesis were assessed. Initial sound three-valued ordinal variable, considering low, medium or high
identification is assessed by presenting a stimulus word and then performance on the test. In all cases, the main effect of time was
asking the child to identify which of two alternatives begins with the analysed to determine whether group progress was significant. The
same sound as the stimulus. Phonemic synthesis was assessed by main effect of the group was also analysed to determine the
telling children all the sounds in a word and then asking them to differences between students attending special or regular schools,
identify from two alternatives the word corresponding to the with specific differences between times being reported only in the
synthesis of the above sounds. 1 point was awarded for each correct case where the main effect of time is statistically significant. When
answer and 0 points for errors. The original test has good reliability making pairwise comparisons, the Bonferroni method for multiple
indicators (Cronbach’s α = 0.89). comparisons was used. For this section of the analysis there are no
specific comparisons as there are only two groups. And finally the
2.3.5 Vocabulary breadth test interaction effect was analysed, to define whether differences between
Vocabulary breadth was assessed with an adaptation of the groups could be observed over time, for which the epsilon correction
TEVI-R test (Echeverría et al., 2002). In this test, children are asked to (ε), specifically Greenhouse–Geisser, was applied when the
choose from four images the one that best represents a given word. assumption of sphericity is violated, according to the Mauchly’s test.
One point is awarded for a correct answer and 0 points for errors. It The value of partial eta squared (η2) is included as an indicator of
was applied only to students with AD. effect size. According to Cohen (1988), a value of η2 ≤ 0.06 represents
The following instrument was used for the assessment of initial a low effect, a value of 0.07 ≤ η2 ≤ 0.14 represents a medium effect size
mathematical skills. and a value >0.14 is high.

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Data analyses were performed using the statistical package SPSS students show a lower presence of problems, both at the general level
(version 27), and all analyses were performed separately for the group and with respect to the scale of externalising and internalising problems.
of blind and deaf students.
Due to the loss of sample data, missing values were imputed using
the Mice package in the statistical program R. This package completes 3.2 Students with visual impairment
incomplete multivariate data using linked equations. The missing data
assignment is based on values observed in an individual’s data and According to the assumptions for the analysis, these are mostly
relationships observed in other participants’ data. met for all variables, which is tolerable for the analysis, as ANOVA is
a sufficiently robust test.
In the case of students with visual impairment, there is a main
effect of time for Phonological Awareness (F = 4.19, p = 0.027,
3 Results η2 = 0.134), specifically between T2 and T3 (M = −8.89, SE = 0.341,
p = 0.044, 95% CIs [−1.76, −0.02]), Mathematics (F = 19.97, p < 0.001,
3.1 Deaf students η2 = 0.400), between T1 and T3 (M = −6.12, SE = 0.98, p < 0.000, 95%
CIs [−8.63, −3.61]) and T2 and T3 (M = −3.64, SE = 0.98, p = 0.003,
According to the assumptions for the analysis, these are mostly 95% CIs [−6.13, −1.15]), Verbal Reasoning (F = 6.14, p = 0.004,
met for all variables except for Verbal Reasoning, as mentioned above. η2 = 0.183), only between T1 and T3 (M = −4.02, SE = 1.23, p = 0.009,
Comparing the results we can see that there is a main effect of 95% CIs [−7.16, 5.70]), Working Memory (F = 8.13, p < 0.001,
time for vocabulary (F = 19.12, p < 0.001, η2 = 0.477), with a statistically η2 = 0.231), between T1 and T3 (M = −2.93, SE = 061, p < 0.000, 95%
significant difference between T1 and T2 (M = −4.63, SE = 0.67, CIs [−4.50, −1.36]), and Executive Functions (F = 4.50, p = 0.037,
p < 0.001, 95% CIs [−6.36, −2.90]) and, T1 and T3 (M = −5.77, η2 = 0.115), between T1 and T3 (M = −5.19, SE = 1.94, p = 0.038, 95%
SE = 1.24, p < 0.001, 95% CIs [−8.99, −2.55]), Mathematics (F = 18.51, CIs [−10.16, −0.23]).
p < 0.001, η2 = 0.468), specifically between T1 and T2 (M = −3.45, On the other hand, a main effect of group, corresponding to the
SE = 1.01, p = 0.008, 95% CIs [−6.08, −0.83], T1 and T3 (M = −6.91, type of school students attend, is observed exclusively in the case of
SE = 1.21, p < 0.001, 95% CIs [−10.05, −3.77]) and T2 and T3 Mathematics (F = 6.30, p < 0.018, η2 = 0.189), in which students
(M = −3.46, SE = 1.18, p = 0.024, 95% CIs [−6.53, −0.38]), as well as for attending regular schools average 11.62 points higher in this test than
externalising problems (F = 6.82, p = 0.016, η2 = 0.245), indicating fewer students attending special schools (SE = 4.63).
problems at T3 than at T1 (only two assessments were made). This The analysis between time and type of school attended by blind
indicates that across the different measurements there were significant students reveals that there are no statistically significant interactions
changes in these areas. This is to be expected, given the known effect for any of the tests.
of schooling and time on these variables. It is striking that there was As in the case of deaf students, even though there are no significant
no improvement in Verbal Reasoning (F = 2.36, p = 0.107, η2 = 0.101), differences between the types of schools, there are certain trends that
Working Memory (F = 2.52, p = 0.093, η2 = 0.107) and Executive are repeated between instruments: we can observe that in most cases
Functions (F = 2.33, p = 0.110, η2 = 0.100). the performance of students with low vision who study in regular
When analysing the group effect, understood as the type of school schools is better than that of those who study in special schools,
attended by deaf students, we only found a significant effect with although the former also present a greater number of emotional and
respect to Verbal Reasoning scores (F = 4.72, p = 0.041, η2 = 0.184). This behavioural problems, both at a general level and with respect to
main effect of group is present in favour of students attending externalising and internalising problems (see Figure 2).
regular schools.
Finally, it is necessary to report that for none of the tests analysed
there was a statistically significant interaction. 4 Discussion
Although most of the results do not show statistically significant
differences when analysing the differences between deaf students who The aim of this study was to evaluate possible differences between
attend regular or special schools, it is important to note that this may students with disabilities, those attending special schools or regular
be due to the low number of participants in each group, which schools with School Integration Programme (PIE). To this end, the
decreases the power of the study. Therefore, it is relevant to observe cognitive, linguistic, mathematical and emotional performance of
the trends in the results, as can be seen in Figure 1. In this, we can see blind and deaf students attending each of the aforementioned
that, both in Vocabulary and in Mathematics and Executive Functions, educational systems was evaluated.
the performance of students in the special schools is superior to that In the case of deaf students, only a significant effect of time can
of those belonging to the ER, demonstrating a statistical trend in this be observed for instructional skills, indicating that, in the case of
sense. As for Working Memory, the results at time 1 are in favour of Vocabulary and Mathematics, all students showed progress, regardless
the students who attend the special schools, but this trend is reversed of the group they were in. However, for most skills the results suggest
at time 3, in which the students who attend the regular schools show that the performance of the students attending special schools is
better performance, indicating a tendency towards interaction slightly superior to that of those attending regular schools. This result
between the type of school the student attends and time. Only in the replicates the result reported by Rosas et al. (2021) who report that the
case of Verbal Reasoning, the performance of students who attend ER results obtained by students attending special schools are superior to
is consistently higher than those who attend special schools. And in those attending regular schools. Similarly, the difficulties that deaf
the case of emotional and behavioural problems, special schools students face in the mainstream education system, including regular

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Rosas et al. 10.3389/feduc.2023.1227178

FIGURE 1
(A–H) Performance of deaf students. T1 = Time 1, T2 = Time 2, T3 = T3. Error bars 95%.

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Rosas et al. 10.3389/feduc.2023.1227178

FIGURE 2
(A–H) Performance of blind students. T1 = Time 1, T2 = Time 2, T3 = T3. Error bars 95%.

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Rosas et al. 10.3389/feduc.2023.1227178

classrooms, and their negative impact on the learning of deaf students students who attend regular schools perform better than those who
have been described (Goldberg and Richburg, 2004; Moeller et al., attend special schools, only in the case of Phonological Awareness is
2007). Furthermore, as has been discussed in previous studies, the a compensatory effect observed, where the initial differences disappear
improved performance of deaf students can be explained by specially in the last measure. The statistically significant differences, in
adapted educational methods, and instruction in the students’ native mathematics, in favour of students attending regular schools could
language, for sign language communication learners (Moeller et al., be an indicator of good teaching practices in the teaching of
2007; Marschark et al., 2015; Nelson and Bruce, 2019). mathematics to blind students attending regular schools. However, it
Regarding the cognitive variables, only in the case of analogies did is not entirely excluded that, in the case of blind children, there is a
we observe a significant effect of both time and group. This means process of self-selection, causing children with greater cognitive
that, in addition to showing significant progress between time development to attend regular schools more frequently than those
measures, the students showed significant differences according to the with more diminished development. Previous studies have shown that
type of school they attend, with these differences being in favour of deaf students show mathematical difficulties, most likely due to the
the students attending regular schools. This effect could be explained teaching format and the lack of tools for adequate instruction (Gulley
by the verbal nature of the task and the difficulty in adapting it to et al., 2017; Healy and Fernandes, 2020).
ChSL. In this sense, it is important to mention that in the regular In the case of Executive Functions, although students attending
schools, there was a greater presence of oralised students, and cochlear regular schools start with a lower performance than students attending
implant users. For both Working Memory and Executive Function special schools, their more pronounced progress makes them finish
assessment, no significant effects of time or group were observed. with an advantage over their peers. The results reported in Rosas et al.
Although at a descriptive level, it can be seen that while special schools (2021) showed that blind students attending regular schools
students show a greater increase in Working Memory performance, performed better on all assessments. This replicates the results
special schools students show a sustained higher performance in presented here, as these are the measurements corresponding to the
Executive Functions. As mentioned above, these results align with first assessment time of the first study. It is interesting, then, to know
those reported by Rosas et al. (2021), who showed a trend towards the development of these skills in the two educational contexts, which
better performance of students attending special schools compared to show a greater increase in the performance of students attending RE
integrated students, both those who communicate mainly through compared to students attending special schools.
ChSL and those who communicate mainly orally. Interestingly, these Regarding the presence of emotional and behavioural problems,
differences are maintained over time and are not limited to a point in no significant changes are observed in the period between the
the early learning process. However, this result should be taken with evaluations for any of the groups. However, it is important to highlight
caution, as this study reports the results of the first evaluation of this that, although the differences are not significant between the groups,
longitudinal study, which makes it a related study. in this case the advantage is for the students attending regular schools,
Regarding the presence of emotional and behavioural problems, who present a lower presence of emotional and behavioural problems,
a significant effect of time is only observed for externalising problems, although they present a slight tendency to increase problems at an
indicating that both groups reduced their externalising problems over internalising and general level. This has an impact on closing the
time. In none of the variables related to emotional and behavioural initial gap between students attending regular and special schools,
problems are significant differences observed at the group level. where the differences are significant on the former measure and
However, at the descriptive level we can see that the SE students show non-significant on the latter. Similarly, the study by Rosas et al. (2021)
a lower presence of internalising, externalising and global problems, shows an advantage for students attending special schools, who
results similar to those reported in Rosas et al. (2021). In that article, present fewer problems than their peers attending regular schools.
they reported that integrated students who communicate orally Likewise, other studies have shown the difficulties presented by the
preferentially show a tendency to present greater emotional problems inclusive education system for blind students, and its impact on
than their integrated peers who communicate through ChSL and, than socioemotional well-being (De Verdier, 2016; Santa Cruz et al., 2021).
students attending EE. In turn, integrated students who communicate In the case of students with disabilities, it is very common to find
preferentially through ChSL tend to present more emotional problems studies conducted with small samples, which directly impacts the
than students attending EE. Similar results have been reported possibility of obtaining statistically significant results. Consequently,
internationally, where students’ well-being depends on the school they if these results are statistically significant, they are only found when
attend and their preferred communication (Fellinger et al., 2009; Antia the difference is very large or, in statistical terms, the effect size is very
et al., 2011). large (Cohen, 1988). Thus, the results in this study are especially
In the case of blind children, it can be said that time affects all the noteworthy, particularly regarding the effect of time on the variables
instructional and cognitive variables, which shows that, regardless of of Vocabulary, Mathematics and Total Socioemotional and
the group, the students progress in their learning. Only in the case of Behavioural, in the case of deaf students. Similarly, the differences
Mathematics can we observe a significant effect of the group, which found in Phonological Awareness, Mathematics, Verbal Reasoning,
indicates that there are important differences throughout the entire Working Memory and Executive Functions, in the case of blind pupils,
evaluation period between the members of both groups, these being are noteworthy. In addition, along the same lines, we should highlight
favourable to the students integrated in regular schools. This result the effect of the type of school in the case of Verbal Reasoning for deaf
replicates that Rosas et al. (2021) presented, who showed that blind or students and Mathematics for blind students.
low vision students who attend regular schools perform better than When analysing the results of studies with small samples, especially
students who attend special schools. The results of this article show at when they are exploratory, Hox (2020) recommends considering an
a descriptive level that, with respect to all the learning variables, blind alpha level of around 1.0, instead of the usually used 0.05, assuming the

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Rosas et al. 10.3389/feduc.2023.1227178

greater possibility of committing a type I error. If we review our results Data availability statement
under this criterion, we can observe that there are differences between
students with DA in the performance of the Vocabulary test, being The raw data supporting the conclusions of this article will
higher for students attending special schools (F = 4.05, p = 0.057, be made available by the authors, without undue reservation.
η2 = 0.162). In the case of blind students, students who attend regular
schools present a greater number of internalising problems (F = 2.81,
p = 0.105, η2 = 0.094). Likewise, for blind students there is an interaction
effect for the Working Memory test (F = 2.39, p = 0.101, η2 = 0.081), Ethics statement
resulting in both groups starting with the same score at T1, clearly
distinguishing a faster progress for those who attend regular schools. The studies involving humans were approved by Scientific Ethical
Committee of Social Sciences, Arts and Humanities of the Pontifical
Catholic University of Chile. The studies were conducted in
4.1 Conclusion accordance with the local legislation and institutional requirements.
Written informed consent for participation in this study was provided
This article is an important resource to assist in the understanding by the participants’ legal guardians/next of kin. Written informed
of the learning process of students with SEN, in particular deaf and consent was obtained from the individual(s) for the publication of any
blind, in the context of regular schools with PIE and special schools. potentially identifiable images or data included in this article.
The results presented show that, at the level of instructional
performance, in the case of deaf students, attendance at special schools
leads to better results, while the opposite is true for blind students.
In the case of cognitive assessments, the results of these study are Author contributions
less consistent. While blind students attending regular schools
maintain superior performance in the different tests, deaf students RR and VE: conceptualization, writing-review and editing. CS-C,
show differences between the assessments. In the case of Verbal VE, and CM: methodology. CM, VE, and RR: validation. CS-C and
Reasoning and Working Memory, the overall performance or increase CM: formal analysis, resources, and project administration. CS-C,
in performance is higher in students who attend regular schools, while RR, and VE: investigation. CS-C, and CM: resources. VE and CS-C:
Executive Functions are more developed in students with special data curation. RR, VE, CS-C, and CM: writing-original draft
schools. This could be related to the level of linguistic intervention that preparation. CM: visualization. RR: supervision and funding
the different tests required for their execution. acquisition. All authors contributed to the article and approved the
And finally, at the Socio-Emotional and Behavioural level, the submitted version.
results indicatedthat, both for deaf and blind students, there is a lower
presence of problems in the group of students attending regular
schools. However, it is important to note that, in many cases, the
differences are not significant and decrease over time for both blind Funding
and deaf students.
Although the results of these study are inconclusive, this article This research was funded by ANID PIA CIE160007.
shows that students’ performance depends both on the disability they
have and the educational system they attend. These differences may
be due to the educational tools that teachers have when educating Acknowledgments
students with diverse needs.
What the results of the present study show quite conclusively, We would like to thank Bernardita Ovalle for her great help in
however, is that inclusion at all events must be critically evaluated with proofreading and referencing.
regard to individual characteristics and the particular conditions of
certain groups of students.
Conflict of interest
4.2 Limitations The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could
The present study is a great contribution to the understanding of the be construed as a potential conflict of interest.
development of academic skills in deaf and blind students integrated in
regular schools, in comparison with students attending special schools.
However, the sample is still too small to obtain generalisable conclusions. Publisher’s note
In addition and considering the importance of language in the
development of reading skills, mathematics and executive functions, for All claims expressed in this article are solely those of the authors
future studies, it is important to consider the age of language acquisition and do not necessarily represent those of their affiliated organizations,
and oral expression or through ChSL. Additionally, considering different or those of the publisher, the editors and the reviewers. Any product
approaches to inclusive education in this kind of studies, would also that may be evaluated in this article, or claim that may be made by its
improve the chances for generalisation of the results. manufacturer, is not guaranteed or endorsed by the publisher.

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Rosas et al. 10.3389/feduc.2023.1227178

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