The data analysis produced (n
= 20) 20 categories (listed in Table 2
) grouped into 6 (n
= 6) macro-categories: (1) psychophysical characteristics
; (2) learnings
; (3) relational aspects
; (4) collaborations
; (5) extracurricular activities
; and (6) teacher training.
In the first phase of the analysis, the qualitative data were codified through the coding method defined as “open” to indicate the action of opening the text and letting ideas emerge from it. This analysis led to the attribution of 408 codes to the concepts that emerged from the interviews. Two other phases of analysis then followed: in the first phase, these codes were grouped into 20 categories, and in the second, 6 macro-categories were identified. They are explained in Table 2
below. Finally, the literature review was taken into consideration in order to make comparisons and build an interpretative structure that took into account linguistic expressions and the interpretative models used within the psychological sciences and the studies on collusive arrangements [23
5.1. Theme 1: Psychophysical Characteristics of Pupils
In the first macro-category identified, the teachers described aspects of the student relating to physical health and to the emotional–behavioral level, also making comparisons with other disabilities with which they came into contact during their working career. As far as health problems are concerned, the interviews show that those of a cardiac nature prevail and, in some cases, even heart surgery was necessary. In particular, two individuals received heart surgery at birth and another during primary school years. Another support teacher (n.4) states: “she was absent for a long time because she underwent heart surgery, due to heart problems from which she suffered” (n.4).
Other problems associated with DS are hematological, renal, and bronchial. Support teacher n.3 recalled a student suffering from bronchial issues, claiming “she was in intensive care” and therefore “for a long time she was absent from school” (n.3).
Another teacher expressed: “my pupil suffers from severe dermatitis with flaking and therefore sometimes we have to intervene to put plasters on” (n.15), and teacher n.9 claimed that “when she does physical activity she gets tired because of her heart problems […]” and her being “[…] overweight […]” (n.9).
As far as the emotional–behavioral level is concerned, some peculiarities emerge which are repeated in several descriptions. In particular, several teachers speak of students who are “very affectionate both with her classmates and with the teachers” (n.6). Furthermore, they claim that “she seeks physical contact with everyone” (n.7), thus establishing a relationship between teacher and pupil. However, it seems that most individuals with DS do not always manifest themselves in this way right away, considering that at the beginning, in most cases, the pupil “was very closed, she even turned her back on me” (n.12), and “he tended to always assume an oppositional attitude towards me because he had little confidence in me” (n.6), as well as the pupil supported by teacher n.11, who states: “the first months were characterized by refusals, crises of opposition and scarce collaboration.” These oppositional attitudes, in some cases, are also manifested in other specific contexts, as well as in the first phase of knowledge. In particular, “it was never necessary to intervene in a very abrupt way otherwise the wall would be raised. Dramatically imposing an activity implied its refusal” (n.11). Among the weak points of the pupil described by teacher n.14 is his “difficulty in not accepting a reprimand or an imposition.”
A similar affirmation is typical of teacher n.10, who also supported a pupil with behavioral problems and, in comparing them, she states: “a characteristic of the other child I follow is the character malleability. Instead, the biggest stumbling block of the child with DS is the very tough temperament, sometimes he manages to manipulate you easily.”
In addition to stubbornness, another element shared by various teachers’ descriptions of their pupils with DS concerns the desire to “be noticed and acclaimed by others because they like being the center of attention” (n.10). This also applies to the pupil supported by teacher n.9: “when she finishes a task, she goes to her colleague at the desk and receives applause because she is a pupil who seeks consensus” (n.9). Furthermore, in several interviews teachers claimed they had to encourage the pupil to participate “in group life” because they did do so of their own free will. An example is the child followed by teacher n. 11, which “by itself did not initiate anything, there was a constant need for support and mediation. This year I have a very serious case and that is a non-verbal autistic. Paradoxically, he takes more autonomous initiatives than last year’s child with DS” (n.11).
However, from the various descriptions it emerges that this difficulty is also present in some children with DS, so much so that the pupil followed by teacher n.11 “was not always able to express his needs affective with explicit requests” (n.11). Furthermore, there are those who are unable to communicate their own needs, such as going to the bathroom. Teacher n.6 underlines: “One of his difficulties is instead that of being able to communicate his emotions and his needs, especially those of a physiological nature” (n.6). For this reason, it is the teachers themselves who, in this case, must remind the child to go out to the bathroom.
In general, although the picture is heterogeneous, the difficulty in acquiring autonomy is highlighted by several teachers.
Additionally, some support teachers made comparisons between DS and other disabilities they had witnessed in their career. In particular, they mainly referred to a child with autism spectrum disorder that they had in their care, focusing mainly on the affective, behavioral, and language-related areas. Teacher n.7 compared her student with DS with a previous student who had autism spectrum disorder and claimed: “If the first one really wants compliments and hugs, he instead was very detached, he didn’t even want to shake my hand” (n.7).
5.2. Theme 2: Learnings
The linguistic competence was very compromised in most cases. Specifically, the major difficulties were highlighted at the phonological level. In fact, interviewee n.4, when speaking of her student with Down syndrome, stated: “She showed various difficulties in the linguistic area, she spoke little and when she tried to do so, it was difficult to understand her because she could not pronounce many sounds and words” (n.4). This was based on the fact that “it is hard to understand” (n.1) and on the “problems with articulation” stated by teacher n.7, and there were frequent anomalies in the auditory and oral structure. Teacher n.3 commented: “The girl has a lot of difficulty pronouncing some sounds and words, due to some somatic traits typical of Down syndrome, including a large tongue and small mouth” (n.3). Thanks to targeted interventions, improvements are possible in this area. Teacher n.2 states: “However, also thanks to the work carried out in collaboration with the center she attends, she has made numerous progresses, above all from a linguistic point of view” (n.2).
Although verbal production is compromised in many individuals with DS, some teachers claim that they are still able to understand the pupils because they resort to gestural means of communication, such as the child supported by teacher n.7: “he manages to communicate everything with non-verbal communication” (n.7).
To a lesser extent, many other pupils with DS supported by the teachers interviewed also showed various problems in the logical–mathematical field. This is demonstrated by comments such as: “He has difficulty in the logical-mathematical area”
(n.13), or such as: “Another compromised area is that of abstract thinking, in fact, especially for mathematics he has always need to have concrete references”
(n.3). The need to make abstract concepts concrete is underlined by various teachers, many of whom, especially for learning mathematics, use a lot of concrete material. In addition to the difficulties encountered in linguistic and logical–mathematical areas, almost all interviewees highlighted others at the motor level, saying, for example, that the “motor-practical”
area is among the very compromised areas (n.11), regarding difficulty with coordination and dynamic balance. In this regard, teacher n.5 states: “sometimes she is a bit clumsy, especially in managing her balance, because she tends to fall into certain stereotypes”
moreover, in the case of the pupil supported by teacher n.3, it was also necessary to use orthopedic aids: “she has problems walking and therefore wears braces”
(n.3). The “somewhat awkward posture”
(n.6) and difficulties in “global coordination”
(n.12) are highlighted by various teachers; however, the element that most unites almost all stories concerns the presence of “difficulties with the fine-motor coordination that he shows above all in the writing process”
(n.2) or when the student has to “cut even small pieces of paper”
(n.6). In light of these difficulties, several interviewees underline the need for specific tools and targeted interventions, when, for example, they say: “We are working a lot on pen/pencil grip”
(n.7) and “the little girl used the handle and, thanks to it, she was able to obtain improvements”
in the writing process. Furthermore, one teacher deemed it necessary to intervene with total physical guidance of the movement of the child’s hand: “To work on fine motor skills, on the correct grip and pressure to apply on the pen, I had the need to work a lot with prompting, therefore in close contact with him”
(n.11). Similarly, teacher n.13 claimed that they “had to accompany him with their hand” (n.13)
. In fact, prompting is considered a very suitable teaching technique when working with children with intellectual disabilities, especially if these are severe and profound [17
]. Overall, there is an evident need to materialize mathematical concepts and to create playful environments, as teacher n.10 explains: “We have come to associate number with physical quantity and to count. We proposed several times to the whole class to play bingo and the child with DS did the bingo, fishing and saying the numbers. Other times we all play together with the game of the goose or with the sponge dice.”
Another useful element for children with intellectual disabilities and which several interviewees also talked about is “the visual agenda that scans the moments of the day” (n.8) which allows the student to “orient himself in time and understand the lessons of the day” (n.14). Thanks to visual agendas, the children are able to understand which lesson they will have in a given hour and, therefore, which notebook they will have to use. Interviewee n.8, like others, explains that the student “uses the diary so as to be able to identify the exercise book to take. Each notebook is of a different color and each color represents a discipline” (n.8).
5.3. Theme 3: Relational Aspects
This macro-category includes categories relating to the type of relationship established between the pupil with Down syndrome and the teachers and that established with classmates.
As far as the relationship between the student with disabilities and the teacher is concerned, a fairly homogeneous picture emerges, as in all cases it is described by the teachers in positive terms. Differences are identified only in relation to the time taken to create a relationship of this type. In some cases, a strong bond was created between the teacher and the child from the beginning, and this is demonstrated in the sentiments of teacher n.8: “We met in September and immediately established a solid relationship. He trusts me and I am his point of reference” (n.8), and those of teacher n.13: “harmony and synergy was created with me right away” (n.13). Positive relationships also emerge from the other stories, but for some it took longer for them to be created. An example is that of interviewee n.6, who states: “Initially it was a bit difficult to establish a relationship with her then over time, after a few months, I managed to get accepted. Now the relationship is much better. It is a relationship of empathy and affection between me and her” (n.6). A similar description is given by teacher n.5: “during the first months of school she was sitting with her back to her […] we had no response from her, not even with gestures. Subsequently, little by little she showed herself more available and the relationship between us undoubtedly improved” (n.5).
The relationship created with classmates is also positive. In fact, some teachers state: “he has established a good relationship with his classmates” (n.14) and “He is fully integrated into the class group, his classmates involve him in every activity, they are supporters of his growth path, in fact, they always help him in the learning processes and for the discourse linked to autonomy” (n.8).
The other pupils are therefore real resources for the child with disabilities, as explained by teacher n.12: “The class group was fundamental. It is a class that has easily welcomed the little girl, who joke, play and have fun with her.”
However, not all teachers interviewed were satisfied with the work carried out for the purpose of promoting inclusion, above all due to the anti-contagion restrictions and particular behaviors of colleagues, as stated by interviewee n.12: “The problem of Inclusion in this class involves teachers who complain that the child and I are annoying others and therefore invite us to stay at the back of the class. Unfortunately, this somewhat limits the process of inclusion” (n.12).
Another criticism is made explicit by teacher n.3, who, after having stated: “The relationship with classmates is positive” and that they “are affectionate and inclusive”, then points out: “I however, there are specific inclusive interventions proposed by the teachers, in the sense that the girl carries out work separated from the rest of the class-group and sometimes even outside the classroom when it is not possible to work in class because there are situations in which teachers wish to have absolute silence in the classroom” (n.3). Furthermore, many teachers apply collaborative strategies in order to facilitate curricular learning, enhance self-esteem, social skills, and promote inclusive processes within the class group. Teacher n.4 states: “We often used a peer-to-peer strategy. Many jobs were carried out in small groups, in each of which a child occupied the role of tutor and therefore had the task of helping the other classmates. In this way, the girl felt more accepted and included by her classmates” (n.4).
5.4. Theme 4: Collaborations
The fourth macro-category includes aspects relating to programming, the type of relationship established between colleagues, between teachers and family, and between health specialists. These elements and the coordination between the various figures that come into play are of fundamental importance for the promotion of a truly inclusive school.
The panorama relating to the teaching team is not entirely homogeneous because many support teachers stated that “the colleagues are very collaborative” (n.10) and that “the learning area is tackled thanks to teamwork with all the other colleagues in the class” (n.1), but there are others who are dissatisfied with the type of relationship established with the colleagues, as the activities carried out are not always shared. Specifically, teacher n.3 stated: “The girl could perform certain exercises, but she should be constantly involved and my colleagues lack this” (n.3) and another teacher explained how sometimes she received “the request by some colleagues to leave the classroom with the disabled child” (n.4). Even during the planning phase, several interviewees point out that “there is no collaboration and comparison” (n.15) within the team, and for this reason there are those who claim to have “drafted the Individualized Education Program by herself without collaborating with the other teachers” (n.8).
However, according to the teachers, their decisions are not always shared by the family, even with reference to the individual education program (IEP). For example, the father of a child, contrary to the teacher’s choices, “wanted his son to follow the class schedule for all disciplines” (n.14). Another teacher, speaking of the mother of the child she is in charge of, said: “she doesn’t trust us. She does not listen to our advice, on the contrary it is she who tells us what we must do” (n.12). In fact, in some cases parents appear to be too demanding, even going so far as to give explicit indications to teachers. Confirming this are the words of teacher n.5: “Parents are very present, but sometimes they come to give you directives on how you have to work at school to try to follow the work done at home” (n.5). Teacher n.4 also claims: “the mother necessarily wanted her daughter to do everything her classmates did, even when it was not possible to treat her in the same way as the others” (n.4). Teachers believe that the reason for these two attitudes, and that of other parents, derives from the fact that the family “has very high, unbalanced expectations, as if it wanted to go beyond its limits. In fact, sometimes his mother asked me to assign him more tasks” (n.11).
Attitudes of this type, implemented by the family, could have repercussions on the child. This was the case with the child supported by teacher n.11 who showed a lot of performance anxiety which, according to the teacher, “probably derives from the pressure of the mother who has very high expectations” (n.11).
Despite the strong desire for the child to achieve uncalibrated goals, interviewees suggested that almost all families were aware of the child’s skills. Several teachers, speaking of the pupil’s family, confirmed that they were “very aware of the girl’s strengths and weaknesses” (n.3).
Overall, in most cases the confrontation between the family and the teachers was constant, yet there was also collaboration. A different situation, however, emerges with reference to the relationship between the school and the specialists who support the child. In fact, there were few cases in which teachers state that “a network has been created between operators, school and family” (n.9) and that “the dialogue with the therapist is constant” (n.1). From the speeches of the interviewees concerning the GLO meetings, it emerges that in several cases “the figures outside the school who look after the child were not present” (n.14).
5.5. Theme 5: Extracurricular Activities
Among the extracurricular activities carried out by children with DS supported by the support teachers interviewed, it appears that those of a sporting and therapeutic type prevail. Specifically, the most practiced sports are swimming and dance, even if the latter is attended only by females. In addition to these two sports others are also practiced, but there is great variability. For example, teacher n.13 states: “he plays football and swims to try to improve his coordination above all” (n.13), and teacher n.12 claims that “before Covid he used to dance, an activity that she likes it a lot” but on some afternoons she is busy because “she is followed by a speech therapist” (n.12). Similar to this last child, many others attend speech therapy courses considering their linguistic difficulties. Furthermore, the therapeutic path of some also includes psychomotricity due to motor problems Only a few children attend activities aimed at developing socialization skills, despite "greater contact with their peers also in other contexts, would allow them to learn new relational competences" (n.6). Another fundamental objective to aim for according to some teachers concerns the acquisition of greater autonomy, above all in a perspective of future life. Teacher n.5 states: “With the child with Down syndrome there is a need to work a lot on affectivity, on relationships and get them used to autonomy also for the future of society” (n.5). Teacher n.15 also projects herself beyond the years spent within the school context and believes “it is necessary to work on autonomy and communication because it is necessary to prepare it in view of a future life project” (n.15).
Overall, it emerges that only some reflections on what could be implemented to improve the overall life of the pupil with DS are shared by several teachers. In particular, they are those in reference to organizing laboratory activities, to work on the area of language and autonomy.
5.6. Theme 6: Training of Teachers
On the subject of training, the picture is very homogeneous. The interviewees share a lack of specific and targeted training on the syndrome of the pupil they are in charge of, and none of the support teachers interviewed stated that they had followed any specific training on DS. Teacher n.11, for example, clearly states: “Neither the school supported us, nor I have ever participated in specific courses” (n.11). This emotion was shared by several others.
One teacher points out that “we need more information on this syndrome, because we only have information from a clinical point of view.” Furthermore, another teacher truly believes that “at least one compulsory course is necessary for teachers who follow children with DS” (n.10). This request is also typical of many other teachers who explicitly asked for greater training to improve the teaching process aimed at pupils with DS. Always reflecting on the training aspect, another teacher interviewed (n.3) points out: “we should focus a lot on the training of teachers who are already in school and not only, as usually happens, on those who have yet to enter” (n.3).
Many of the teachers interviewed in relation to training referred to the knowledge acquired during their university course and to the specialization course for support, saying: “the school has not activated any courses. For me it is all the result of the degree and the TFA” (n.8), as well as “[…] the school has never offered me specific courses on DS, however, I am attending the TFA and it is helping me a lot because it gives a general picture of disability” (n.6). Furthermore, most of the teachers spoke of independent training “above all through research, reading and discussions with colleagues” (n.7), and claimed that they documented themselves “by buying and studying books” (n.12) and that “it is all the fruit of my common sense which led me to inform myself” (n.10).
Other elements which were considered fundamental by several teachers for the purposes of their work with the pupil with DS concerned personal experience, comparison with colleagues, and observation. Overall, the teachers’ words show the lack of support from the school towards them.
The study was conducted to detect the peculiarities of the didactic–educational and emotional relationship between support teachers and pupils with DS in primary school. The results illustrated below suggest interesting information about the peculiarities of the didactic and relational learning processes of students with DS and the coping strategies that the support teachers implement to address the critical issues that this specific disability entails.
With regard to the first theme (Psychophysical characteristics of pupils
), which considered the limits in socialization and learning processes of pupils, the study underlines that the linguistic area is most compromised in DS students, in both written and oral production. This fact, states [4
], is documented by numerous experimental studies [4
], and difficulties in abstraction and fine motor coordination have also been identified by many studies. To answer the first difficulty, it appears that many teachers present concrete material and try to create situations that are very close to reality, especially to deal with mathematical concepts. In referencing Piaget’s stadial theory, we could say that we stop at the concrete operational stage, without reaching the formal operational stage [21
Instead, regarding the difficulties relating to fine-motor coordination, from what the teachers say, they are visible above all in the writing process. In fact, several studies show that in subjects with Down syndrome the fine-motor components, as well as the gross-motor ones, occur much later than in typically developing peers. Specifically, it appears that if children with typical development learn to copy letters of their name between 36 and 48 months of age, children with DS acquire this skill between 108 and 144 months of age [4
]. In addition to the need to make abstract concepts concrete, many teachers also underline the value of using many images, as it seems that they are effective for the learning process of the pupils with DS and their orientation over time. This could be due to the fact that visuo-spatial abilities are preserved in subjects with DS, as stated by Davis [6
]. Another aspect underlined by Davis [6
] and also emerging from this research, again with reference to children with DS, concerns their being less inclined to start a game than their peers. For this reason, some teachers highlight the need to encourage the student to participate in various activities, otherwise he/she will not do so. In fact, according to many teachers interviewed, pupils with Down syndrome in their care need to spend more time with their peers in extracurricular environments to be able to acquire social skills. This need confirms the mistake often made in generalizing and stating that people with DS are sociable. This feature could occur in some individuals, but it is not a trait attributable to the syndrome itself [25
A further need that the participants highlighted concerns the need for specific training on Down syndrome, especially in relation to the didactic aspects. They state that they have never attended courses focused on this syndrome, but only on disability in general and on some disabilities specifically (such as autism spectrum disorder). Furthermore, with the exception of a couple of cases, all other teachers report the absence of support from the school for the management of pupils with DS. This negatively affects the inclusive process. Having more information on the learning characteristics of children with DS also means being able to improve the inclusion of these pupils [28
In addition to the training aspect, teachers who participated in the study by McFadden [29
] stated that they were able to better include the student with DS within the class thanks to the collaborative support received from colleagues. However, referring to the teachers interviewed, this last aspect was found to be absent in several cases. In several situations, the support teacher did not receive collaborative support from the class teachers. Other critical issues highlighted by various teachers were linked to the impossibility of applying some collaborative strategies, the absence of specialists during intervention planning meetings, and the families’ high expectations [30
At this juncture, it is not possible to discuss the development path and of the pupils or to rely on taking charge of aspects concerning the pupils’ health and learning. The individualized education program should be co-constructed and shared between the school, the services that come into play, and the family [32
], whose expectations unfortunately sometimes appear too high, idealizing the recovery processes of their children and devaluing the abilities of the teachers.