Including children with autism in general education in China.
Since the occurrence of autism is not subject to such factors as race, ethnicity, or social backgrounds, the prevalence of autism used by Western countries is also applicable in China. If we use the current conservative prevalence of autism (i.e., 15 per 10,000 births) to calculate, it can be estimated that China, with a population of 1.3 billion, has approximately 1.95 million individuals with autism at various levels of functioning. Considering that 75 to 80 percent of the Chinese population resides in remote, rural areas and might experience financial and technical constraints related to identification of autism (e.g., lack of expertise and unavailability of systematic framework for identification and diagnosis), it is reasonable to estimate that approximately 75 to 80 percent of the 1.95 million individuals with autism have not yet been identified or diagnosed properly.
In reality, many individuals with both autism and cognitive impairments have been simply diagnosed with cognitive disabilities (e.g., mental retardation), due to psychiatrists' lack of knowledge about autism (Tao, 1987). In China, so far, no official data have been released regarding the number of individuals with a diagnosis of autism. According to experts from the Institute of Mental Health, Beijing University, it is estimated that China has approximately 400,000 to 500,000 children (between ages 3 to 18) with autism at various levels of functioning (M.X. Jia, personal communication, November 26, 2005).
However, due to the lack of knowledge and awareness, autism has been misunderstood in Mainland China for years and often has been thought of as a rare illness that is contracted by relatively few individuals. Therefore, it has not been officially specified under the category of mental disorders until recently. Currently, the official diagnostic criteria for autism in China are listed in the Chinese Classification and Diagnostic Criteria of Mental Disorders, Version 3 (CCMD-3rd, Chinese Psychiatry Association, 2001).
Consequently, the education of children with autism has become a major concern in the field. Today, most school-age children with autism are still kept out of both regular and special schools for several reasons. First, approximately 75 percent of children with autism also have cognitive impairments (Gray, 1998). In China, students with such impairments usually go to a special school, since regular schools do not address the needs of children with autism. However, special schools also fail to educate children with autism, especially those with high functioning autism and without significant cognitive and language delays, because these schools were initially established for children with physical, visual, hearing, and speech-related disabilities, or moderate cognitive impairments.
In most places in China today, children with severe, multiple disabilities and mental retardation are still being institutionalized and kept away from community life. Since the publication of the 1986 Education Law (National People's Congress, 1986), the State Department of Education has made great efforts to increase the number of students with disabilities included in public education. Of these, Suiban Jiudu, the practice of inclusion, has become an important means to achieve this goal since 1994.
Background Information on Suiban Jiudu
Suiban Jiudu, translated as "attending school in regular classrooms" or "learning in regular classrooms" (Deng & Manset, 2000), was first developed in rural remote areas as a major initiative to promote the implementation of 9-year compulsory education for all children. The major goal of Suiban Jiudu is to increase school enrollment and retention of children with disabilities nationwide (McCabe, 2003). Currently, quantity (the number of students attending school) rather than quality (appropriate education) is considered as more important in China. Unlike mainstream educational practices in Western countries, Suiban Jiudu does not guarantee an appropriate education for children with disabilities, nor does it require parental involvement or the development and implementation of Individualized Educational Programs (IEPs) (Deng & Manset, 2000). As Xu, Piao, and Gargiulo (1995) have pointed out, "This strategy does not necessarily reflect allegiance to the concept of Mainstream, rather it more accurately reflects a shortage of personnel, limited fiscal resources, and facilities in addition to geographical considerations" (p. 11). Therefore, to ensure that every child receives a free, 9-year compulsory education, the essential primary step is the establishment and enforcement of relevant legislation.
Although China's special education programs began to improve in the late 1970s, the government did not officially initiate any related legislation until the mid-1980s. After the establishment of the People's Republic of China, the first important legislation for education, the 1986 Compulsory Education Law (National People's Congress, 1986), stated that all children with and without disabilities are entitled to a 9-year compulsory education, consisting of 6 years of elementary school and 3 years of middle school. For the first time in the history of modern China, the issue of education for children with disabilities was addressed by law. The word "inclusion" was not directly used in the legislation, however; regular schools were encouraged rather than mandated to accept children with disabilities (Wang, Rule, Latham, & Fiechtl, 1993).
In addition, in the early 1990s, two other comprehensive pieces of legislation for individuals with disabilities--the law of the People's Republic of China on the Protection of Persons With Disabilities (National People's Congress, 1990) and the 1994 Regulations on Education for Persons With Disabilities (Chinese State Council, 1994)--were initiated to protect and safeguard the rights of individuals with disabilities. Both laws re-emphasized implementation of 9-year compulsory education for students with disabilities.
In 1988, to increase the number of students with disabilities receiving education, the Chinese National Institute of Educational Research Special Education Center began the first experimental projects involving children with disabilities in regular schools in several different locations across the country (McCabe, 2003). In 1994, a national meeting examined and summarized the results of these pilot studies. After the meeting, the 1994 State Education Commission Number 16 officially called for Suiban Jiudu as the major means to deliver educational services for children with disabilities (McCabe, 2003).
Current Practices of Inclusion
Although articles on practices of inclusion serving children with mild cognitive disability and sensory impairments can be found in Chinese and English journals (e.g., Wu, 1997; Zhao, Guo, & Zhou, 1997; Zhou & Cheng, 1995, 1997), reports on practices involving children with autism have limited availability in Chinese journals. This article intends to fill the void in the literature.
As Suiban Jiudu has become a common practice in Mainland China, more educational opportunities have been established for children with autism. However, parents, especially mothers, must remain persistent in advocating for their child's placement into an inclusive school (McCabe, 2002). As reported by parents, personal connections (e.g., acquaintances or friends working as administrators or teachers who are willing to include the child in the school) are often the major reason for their children's acceptance by local regular schools (McCabe, 2003).
China's educational system is standardized and test-oriented, and teacher performance is evaluated based on students' academic performance (Deng & Manset, 2000). Under this pressure, all teachers are particularly motivated to increase students' test scores (Deng & Manset, 2000). To facilitate the process of including more children with autism in regular schools, the State Department of Education decided to disregard the test scores of children with disabilities in the evaluation of general education teacher performance. Although this practice can promote regular schools' acceptance of more children with autism, it fails to ensure quality and appropriate education for this population. In practice, students with disabilities, including autism, in regular schools use the same curriculum as typically developing students, but are exempt from taking tests designed for their typically developing peers (Sun, 1990). This practice also impedes the proper documentation and assessment of their behavioral and academic progress.
Because the typical class size in Chinese schools is often between 50 to 75 students, it is unrealistic to expect that teachers can pay individual attention to children with autism. Based on previous experience with inclusive practices involving children with other disabilities, the most effective and practical approaches for teaching children with autism in an inclusive classroom include whole-group teaching and cooperative learning, followed by individual instruction/tutoring (Chen, 1997; Deng, Poon-McBrayer, & Farnsworth, 2001; McCabe, 2003). For example, general education teachers working in inclusive settings are encouraged (but not required by law) to set different learning objectives and specific educational plans, similar to an IEP in the United States, for each child with a disorder. In practice, these teachers usually place priority on modifications in both curriculum (e.g., dividing curriculum content into smaller chunks) and the use of task analysis, and on environmental accommodations, such as providing priority seating that allows more teacher attention, rather than on the delivery of instruction. The most common practice in inclusive classrooms is combining whole-class teaching with individual instruction/tutoring for the student with autism. Sometimes, teachers arrange an extra 15 to 30 minutes after class time for individual tutoring, either offered by the teacher or by student peers, to the student with autism.
Although a growing number of children with autism are currently attending regular schools, this number is probably relatively small compared to the proportion of children with other disabilities who are included in regular schools. As expected, high-functioning children with autism, such as children with Asperger's syndrome, are more likely to be accepted by regular schools, while children with moderate to severe or profound autism probably attend special schools, or most likely stay at home. Unfortunately, no official statistics have been released by China's central government regarding the number of students with autism at regular schools. In fact, it is difficult to count accurately, given the fact that so many individuals with autism have not been properly diagnosed or have been misdiagnosed with a cognitive disability, as mentioned earlier.
Current Challenges and Possible Solutions for Effective Inclusion
Presently, the practice of inclusion is at an early stage of development in Mainland China. Many factors affect its implementation nationwide. The following section will address several current challenges and discuss possible solutions, based on the actual sociocultural and economic situations in China.
Social Awareness and Acceptance. For generations, children with disabilities in China have been hidden at home and kept away from community life. Most people do not have a real understanding of disabilities because they seldom interact with people with disabilities (Deng, 1992; Deng & Manset, 2000; Na, 1993). General education teachers also might be reluctant to include children with autism in their classrooms because of their lack of knowledge regarding such students' characteristics and learning styles. In addition, parents of typically developing children worry about including children with autism in regular classrooms, due to the possible negative impact on their children's academic and behavioral performance (Deng & Manset, 2000). Even some parents of children with disabilities, and especially those having low-functioning children, still hold the belief that teaching children like theirs is not worth the expense and energy involved (Deng & Manset, 2000; McCabe, 2003; McCabe & Tian, 2001). Thus, it is estimated that the number of children with autism currently included in regular classrooms is relatively small.
One possible solution to this problem is promoting disability awareness and acceptance through a variety of means (Deng & Manset, 2000), including introducing various disabilities and sharing life stories of people with special needs through mass media, and displaying talents and strengths of individuals with disabilities in public. Researchers have found that this approach can help clarify issues and diminish misunderstanding, confusion, and discrimination toward people with disabilities (Deng & Manset, 2000).
Teacher Preparation. As Deng et al. (2001) have reported, few schools and teachers in China have the necessary resources and competence to teach children with autism in regular classrooms. The next challenge, therefore, is to persuade more schools to accept the practice of Suiban Jiudu. Yet, this aim must be approached in an environment in which most general education teachers are unfamiliar with the term "autism," and have had limited exposure to children with such a disorder. In addition, general education teacher preparation programs in China rarely otter special courses related to children with disabilities.
The lack of both experience and expertise suggests that general education teachers need to receive related inservice training, prior to teaching in inclusive classrooms. Most general education teachers attend intensive, short-term professional development opportunities, including lectures by special teachers from local special schools and observation of classes in local special schools during summer or winter holidays (Deng & Manset, 2000). The content of teacher preparation may include the following: introduction to characteristics and learning styles of children with disabilities, instructional and tutoring methods specified for teaching students with disabilities, behavior management skills, and performance measurement techniques specified for students with disabilities. For teachers unable to attend such training sessions, their schools may invite special education teachers to offer on-site instruction and coaching as well as consultation and technical assistance (Qian, 1992; Zhang, 1993).
After receiving training, regular teachers reported that they gained a better understanding of students with disabilities and were more comfortable having them in their classrooms (Deng et al., 2001). However, such inservice training can only temporarily meet the urgent need for expertise (Deng & Manset, 2000). From a long-term perspective, only solid teacher preparation programs specifically focusing on inclusive practices might ensure more successful implementation of Suiban Jiudu in the future.
Special Curriculum and Assessment. The nonexistence of an official curriculum indicates that general education teachers in China do not have guidance regarding the content and process of instruction for children with autism in regular schools. In addition, in the absence of an appropriate assessment/evaluation system, these students' behavior and academic performance are not measured. These two factors play essential roles in successful inclusive practice. Therefore, to ensure quality education for all children with disabilities in inclusive schools, it is essential to develop and implement a nationwide special curriculum based on these children's strengths and needs, as well as an appropriate assessment/evaluation system.
Legislation and Financial Support. The ambiguous status of related legislation is one of the major reasons for the lack of related educational services for school-age children with autism (McCabe, 2002). More comprehensive legislation is urgently needed (as well as strict enforcement) in order to ensure that the fundamental human rights of these disadvantaged individuals are respected.
In China, financial constraints have always been a major barrier to quality educational services for all children. For decades, the central government has provided limited financial support to improve the development of fundamental education, including primary and secondary education, while local governments have been primarily responsible for covering education expenses. Educating children with autism is not only the parents' obligation, but the society's responsibility as well. More funding needs to be allocated for both special education research and practices.
Providing an appropriate education to every child with autism is a challenging task to accomplish in developing countries. Inclusion might offer the appropriate educational opportunities and resources for children with disabilities. Western researchers suggest that children with special needs will gain better academic, social, and developmental outcomes in inclusive settings, rather than in segregated classrooms (Mastropieri & Scruggs, 2004). China has begun creating more educational opportunities for children with autism. Considering the financial constraints and lack of expertise with autism in China, however, international collaboration in research might be needed to improve China's current practices related to inclusion. While implementing inclusive educational practices adopted from other nations, such factors as social values, cultural differences, and local resources also should be considered. Inclusive practice is a long journey. It requires ongoing joint efforts from all relevant stakeholders for achieving the ultimate goal of quality education for all children with autism.
Note: The authors would like to express their special thanks to Dr. Michael Mayton for his assistance with the revision of this manuscript.
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Ann X. Huang and John J. Wheeler Ann X. Huang is Assistant Professor, Department of Counseling, Psychology, and Special Education, Duquesne University, Pittsburgh, Pennsylvania. John J. Wheeler is Dean, Tennessee Technological University, Cookeville.