Individual Adjustment Needs for Students in Regular Upper Secondary School

ABSTRACT

The aim of this study was to investigate student-environment fit and perceived need of adjustments for students in the regular upper secondary school, with and without a diagnosis. The students (n = 419) were interviewed with the assessment School Setting Interview. The results showed that for seven of the 16 items, 60% or more of the students experienced that the demands of the school environment were not consistent with their abilities. Girls had a greater need of adjustments in eight of nine SSI school activities. The findings put an emphasis on the importance of recognizing the student's individual’s need of adjustments, and on offering flexible support in order to enhance the student-environment-fit and well-being of students in need of special educational support.

KEYWORDS:

• Disability
• school Setting interview
• special educational needs
• support

Introduction

Education for Further Opportunities

Education is not only important for young peoples’ opportunities for further studies and work, it is also crucial for personal development and psychosocial well-being (Kvalsund & Velsvik Bele, 2010). Accordingly, it is important to maximize opportunities for students in need of special educational support by creating a supportive environment to promote young people’s participation in school activities. The concept of participation can be described as an individual’s involvement in life situations (WHO, 2007), and has been frequently used in psychological and pedagogical literature in relation to the constructs of well-being and health (Granlund, 2013).

To graduate from upper secondary school implies difficulties for many students in need of special educational support. Furthermore, these students are overrepresented among adolescents that transit directly from school to unemployment (Gustafsson, Katz, & Österberg, 2016; Raggi & Chronis, 2006; Ungdomsstyrelsen, 2013). A lack of support in upper secondary school often results in poor self-confidence and decreased motivation to attend school (Korhonen, Linnanmäki, & Aunio, 2014), and is an important reason for dropping out of school (Dooley & Schreckhise, 2016; Trampush, Miller, Newcorn, & Halperin, 2009). Absence from school implies a risk of not reaching the educational objective, and an increased risk for mental health issues (Holen, Waaktaar, & Sagatun, 2017). A prerequisite for participating in school, on the basis of the student's own abilities, is the students’ integration in the physical, social, cultural and emotional environment (Moen, Nilssen, & Weidemann, 2007).

Special Educational Support

The prevalence of school-aged children in need of special educational support is between 2% and 20%, depending on the definition (Leeber et al., 2010). In this study, “special educational needs” is used in relation to students who temporarily or permanently are experiencing difficulties in their school situation, e.g., due to cognitive, mental health, emotional, or social difficulties, or more specific learning difficulties, such as reading or writing.

According to the Swedish School Act (SFS, 2010:800), schools are obliged to provide a learning environment of high quality, and meet the needs of and offer special support to boys and girls who do not reach the lowest goal of education. However, many students in need of special educational support often struggle with completing school activities such as reading, writing, planning, organizing and finishing tasks due to cognitive difficulties (Gillespie, Best, & O’Neill, 2012). Furthermore, these difficulties could cause problems of focusing on and retaining attention on an activity (DuPaul, Weyandt, O'Dell, & Varejo, 2009; Kofler, Rapport, & Alderson, 2008). These students may, for example, have a neuropsychiatric disorder, such as Attention-Deficit/Hyperactivity Disorder (ADHD), learning disabilities, or dyslexia. When the fit between demands in the environment do not match the abilities of the student, the risk of school failure is high (Jitendra, DuPaul, Someki, & Tresco, 2008; Schultz, Storer, Watabe, Sadler, & Evans, 2011), which in turn may imply difficulties in the transition to work or further education (Jitendra et al., 2008; Lindsay, 2011). This means that the student-environment fit, i.e., the match between characteristics of the student and the demands of the student's school environment, needs to be balanced (Asbjørnslett & Hemmingsson, 2008; Egilson & Hemmingsson, 2009; Hemmingsson & Borell, 2002). In the present study a low “fit” means that a student reporting unmet needs for adjustments in different school activities, is due to mismatches between the characteristics of the student and the environment (Hemmingsson, Egilson, Lidström, & Kielhofner, 2014).

The Swedish Educational Context

In Sweden, upper secondary school for young people aged 16-20, is voluntary but even so, almost all, (98%), go to upper secondary school after comprehensive school. In order to gain a place in upper secondary school, passing grades from compulsory school in a number of comprehensive school subjects are necessary. In upper secondary school, students are provided with vocational programs, providing specific training for different occupations, and more “academic” programs which prepare them for further studies at universities or university colleges. The length of the programs is 3 years. For students, not eligible for a national upper secondary school program, e.g., students with incomplete certificates, an introductory program is an alternative (Skolverket, 2018a). Statistics show that 295,809 students attended upper secondary school in Sweden during the academic year 2013/2014 (Skolverket, 2018b). However, about two out of three students graduate from upper secondary school, the rest have dropped out along the way.

The school has a compulsory assignment to support students with some kind of difficulty in achieving the educational objectives, which means that the student is to be supported, even if he or she achieves the minimum knowledge requirements (SFS, 2010:800; Skolverket, 2013). Additional adjustments, and Special support, are the most common forms of support. Additional adjustments are minor interventions that are for teachers and other school staff to implement. Special support concerns individual adjustments, which are difficult to implement for teachers and other school staff in the context of regular teaching. Special support is often more extensive or has a longer duration, and is decided by the school principal and documented in an individual plan (Skolverket, 2014).

Boys and Girls in Education

To offer the best learning opportunities for boys and girls with special educational needs, the learning environment and teaching methods have to be adapted, based on the student's individual needs (Gülbahar, 2007; Simeonsson, Carlson, Huntington, Sturtz McMillen, & Lytle Brent, 2001). However, research shows differences between boys and girls in respect of accessing support at school (Havik, Bru, & Ertesvåg, 2015; Vantieghem & Van Houtte, 2018). A higher proportion of boys receive special educational support, and assistive technology devices (SOU, 2017:43). Another difference is that boys in general get lower grades in school (Beaman, Wheldall, & Kemp, 2006; SOU, 2010:51), and also have a higher risk of dropping out of school at a lower age than girls (Pijl, Frostad, & Mjaavatn, 2014). In addition, mental health problems have increased for young people, particularly for young girls, which may have a negative influence on their schoolwork and long-term consequences on post education opportunities (Socialstyrelsen, 2013).

Knowledge concerning perceived adjustment needs among boys and girls in need of special educational support, as well as knowledge regarding in which areas the schools need to improve, would benefit the individual student as well as societal and educational resource allocation with respect to students.

Aim

The aim of this study is to investigate student-environment fit and the perceived need of adjustments for students in upper secondary school, who have shown difficulties in managing their education.

The following research questions were addressed:

• What are the student-environment fit and the perceived need of adjustments for students in Swedish upper secondary schools who have shown difficulties in managing their education?

• Are there differences in need of adjustment between boys and girls?

• Are there differences in need of adjustment between students with or without a medical diagnosis?

Methods

The Regional Ethical Review Board, Linköping, Sweden approved the study (reg.no 2013/409-31). A descriptive cohort study design was used (Polit & Beck, 2008). This study is the first part of a national intervention project, initiated by the Swedish Government, conducted from 2011 to 2014. The participants were students in 12 different upper secondary schools, from five municipalities in the south of Sweden, with a recruitment base of approximately 10,000 students. Project-employed staff, such as special education teachers, teachers, and occupational therapists identified students in need of special support.

Participants

The inclusion criteria for participants in the present study were: students in regular upper secondary school between 16 and 20 years of age, with the ability to understand and speak Swedish. Furthermore, personnel at each upper secondary school identified and asked students to participate in the research study, based on their knowledge of students having difficulties in managing their education, i.e., students having low attendance in school, had not achieved passing grades, or students who were temporarily or permanently experiencing difficulties in the school setting, such as difficulties in planning, performing and finishing tasks. The identified cohort was comprised of 433 students in regular upper secondary school. The occupational therapists or the special education teacher employed in the national project gave all students in the cohort written and oral information about the study. Of the 433 students included in the national intervention project, a total of 419 agreed to participate in the current research study, entailing a response rate of 97%.

The characteristics of the 419 study participants are presented in Table 1. Fifty-seven percent (n = 238) were boys and the mean age for the whole group was 17 years (SD 0.924), and the mean age was also 17 years for boys and girls, respectively. Among the participants, 55% had no formal diagnoses, 21% had a neuropsychiatric diagnosis, 19% had a diagnosis of Dyslexia or other symbolic dysfunctions, and 5% had a diagnosis related to either physical disability or a mood, anxiety, or a stress-related disorder. No significant differences were found between boys and girls with respect to age, Swedish as first language, or when comparing all diagnosis groups. When comparing students with or without neuropsychiatric diagnoses, the boys had a statistically significant higher level of representation in the group with neuropsychiatric diagnoses (p = 0.015). No significant differences were found between students with and without a diagnosis of Dyslexia or other symbolic dysfunctions (p = 0.524).

Table 1. Demographic information about the participants.

Demographics	Total n (%)	Boys n (%)	Girls n (%)	p-value
Participants	419 (100)	238 (57)	181 (43)
Age (mean)	17.3	17.3	17.3	0.511^d
Language
Swedish as first language	348 (83)	200 (84)	148 (82)	0.706^e
Other first language	53 (13)	29 (12)	24 (13)
Missing (n = 18)
Diagnosis				0.052^e
No diagnosis	231 (55)	128 (30)	103 (25)
Neuropsychiatric diagnosis^a	88 (21)	60 (14)	28 (7)
Dyslexia^b	80 (19)	42 (10)	38 (9)
Other diagnosis^c	20 (5)	8 (2)	12 (3)
Educational program				0.196^e
Vocational program	285 (68)	168 (40)	117 (28)
Higher education preparatory program	134 (32)	70 (17)	64 (15)

Note:

^aDiagnosis of ADHD, ADD or Autism spectrum disorder (F90 or F84 in ICD-11).

^bDiagnosis of Dyslexia or other symbolic dysfunctions (R48 in ICD-11).

^cPhysical diagnosis or diagnosis of mood, anxiety, or stress-related disorder.

^dStudent’s t-test for independent samples was applied, α = .05.

^eChi-square (χ² ) test was applied, α = .05.

Data Collection

For all participants, the assessment School Setting Interview, (SSI) (Hemmingsson et al., 2014), was used. The SSI is a psychometrically sound and person-centred assessment developed to examine the level of student-environment fit of school-aged children and adolescents (Hemmingsson, Kottorp, & Bernspång, 2004; Yngve, Munkholm, Lidström, Hemmingsson, & Ekbladh, 2018). The SSI consists of a semi-structured interview designed to identify how students experience their school activities and the environment where those activities are performed. The theoretical basis of the SSI is the Model of Human Occupation (Taylor, 2017), claiming that the interaction between the person and the environment strongly influences occupational participation. The interaction is dependent on the social and physical characteristics of the school environment and on each students’ personal characteristics, e.g., motivational aspects and routines in daily life. Thus, the SSI focuses on the students’ views and experiences of the student-environment-fit. Further, the SSI identifies if the student perceives need of adjustments in order to enable participation in the school environment. The SSI contains 16 items concerning everyday activities in school and provide information about the student’s functioning and need of adjustments (see Table 2). The SSI include academic items, (e.g., Write, Read, Take exams, Do mathematics), and items concerning other school activities, (e.g., Social break activities, Participate in the classroom, Interact with staff). In the SSI the student’s experiences regarding barriers to activity and participation at school are in focus and the student takes an active part in the rating process, as well as in the suggestions and planning for environmental adjustments. A semi-structured approach was utilized, and for each item the occupational therapist/special education teacher asked the students: How do you act/ manage at school when you (insert item, e.g., Write)? Do you have any support or adjustments? If so, what kind? Are you satisfied with the present situation? If not, what kind of change do you think would help you the most? The SSI interviews took between 30 min and one hour to complete. To meet the needs of students with attention and concentration difficulties assistive technology devices were used, (e.g., time-table, ball cushion seat), during the SSI interview and sometimes the interview was broken up in two parts.

Table 2. Number of needs in the SSI items for the students in the study group.

SSI Items	Unmet needs n (%)	Partly met needs n (%)	Met needs n (%)	Total needs n (%)	No need n (%)
Remember things	210 (50)	127 (30)	35 (9)	372 (89)	47 (11)
Write	162 (39)	144 (34)	52 (12)	358 (85)	61 (15)
Do homework	174 (42)	97 (24)	48 (12)	319 (78)	92 (22)
Take exams	163 (39)	72 (17)	73 (18)	308 (74)	106 (26)
Read	164 (39)	98 (23)	33 (8)	295 (70)	124 (30)
Do mathematics	86 (23)	86 (23)	83 (21)	255 (67)	127 (33)
Get assistance	50 (14)	76 (21)	92 (25)	218 (60)	147 (40)
Participate in the classroom	75 (18)	44 (11)	41 (10)	160 (39)	256 (61)
Speak	68 (16)	31 (7)	51 (12)	150 (35)	269 (65)
Participate in sports activities	43 (11)	29 (8)	29 (8)	101 (27)	277 (73)
Participate in practical subjects	42 (12)	13 (4)	23 (6)	78 (22)	283 (68)
Interact with staff	25 (6)	42 (10)	19 (5)	100 (21)	332 (79)
Participate in practical activities during breaks	34 (8)	23 (6)	11 (3)	75 (17)	333 (83)
Go on field trips	7 (2)	20 (6)	17 (5)	44 (14)	277 (86)
Access the school	11 (3)	4 (1)	8 (2)	23 (6)	383 (94)
Participate in social activities during breaks	13 (3)	0 (0)	7 (2)	20 (5)	398 (95)

Note. The number of ratings for each item differs between 321 and 419.

Then the level of student-environment fit of each SSI item was rated by the occupational therapist/special education teacher, based on the student’s perceived needs on a four-step rating scale, ranging from No needs to Unmet needs, (rating 1–4). No needs imply a Perfect fit (rating 4), i.e., when the student perceives that the school-environment fit is ideal, and the student does not need any adjustment at all. Met needs imply a Good fit, (rating 3), i.e., when the student perceives that the school environment had been adapted to meet his or her needs. Thus, the student has received the needed adjustments and is satisfied with the adjustments made. Partly met needs imply a Partial fit, (rating 2) i.e., when the student perceives that the school-environment fit needs to be modified, although he or she has already received some adjustments. The students need some additional adjustments. Unmet needs imply an Unfit (rating 1) i.e., when the student perceives that the school environment needs to be modified and he or she has not received any adjustments at all (Hemmingsson et al., 2014). The SSI has been tested in regard to psychometric properties such as construct validity and internal consistency reliability with satisfactory results (Hemmingsson et al., 2004; Yngve et al., 2018).

In conjunction with the SSI interview, the students were also asked about their age, if they had any medical diagnoses, their first language and their current educational program. The medical diagnoses reported were recorded according to the International Classification of Diseases, ICD-11 (WHO, 2018).

Statistical Analysis

Descriptive statistics in terms of frequency and percentage were used to describe SSI ratings for each item, i.e., the level of student-environment fit for the study group and for the aggregated number of total adjustments needs for each SSI item (SSI rating of 1–3). Non-parametric statistics have been used for comparing different groups since the SSI generates data on ordinal level and the collected SSI-data were not normally distributed on any of the 16 items. However, in order to make sense to differences between groups, (sex and diagnosis), mean values of the SSI ratings were computed. Mann–Whitney U test was used to test statistical differences in the SSI ratings between boys and girls. The Kruskal–Wallis test was applied to analyze statistical differences in the SSI ratings between students with different diagnoses, i.e., for the following groups: students with no diagnoses, students with Dyslexia or other symbolic dysfunctions, and students with neuropsychiatric diagnoses. The Mann–Whitney U test with Bonferroni correction was applied for pairwise post-hoc comparisons between diagnosis groups. The rejection limit of the null hypothesis for the statistical tests was set to α = 0.05, except the post-hoc comparisons for which the corrected alpha was set to 0.017. All tests were two-sided (Field, 2013). The data was analyzed using the SPSS, version 22.

Results

The students’ Perceived Need of Adjustments

The total of identified environment adjustments needs for the students in the study group, and also separated into Unmet needs, Partly met needs, Needs met and No needs, are reported in Table 2. For seven of the 16 items, 60% or more of the students reported adjustment needs (having an SSI rating of 1–3). The student-environment fit was the lowest, (that is, the highest number of unmet and partially met needs, with scores of 1 and 2), in the following items: Remember things (80%), Write (73%), Do homework (66%), Read (62%), and Take exams (56%). The items Participate in social activities during breaks and Access the school showed the best student-environment fit with respectively 95% and 94% of the students reporting no need for adjustments.

Comparison of Adjustment Needs between Boys and Girls

Nine of the 16 SSI items showed significant differences in need of adjustments between boys and girls in the study group, namely Remember things, Do mathematics, Get assistance, Speak, Participate in sport activities, Participate in practical subjects, Interact with staff, Participate in practical activities during breaks and Participate in social activities during breaks (see Table 3). As these items were rated, the girls had a greater need of adjustments except for the item Remember things in which the boys showed a greater need of adjustments.

Table 3. Comparison between boys and girls of adjustment needs in SSI items

SSI items	Total (n: 321–419)	Boys (n: 182–238)	Girls (n:139–181)	p-value^b
	Mean^a SSI rating	Mean^a SSI rating	Mean^a SSI rating
Remember things	1.81	1.72	1.92	.006
Write	2.03	2.07	1.98	.467
Do homework	2.14	2.14	2.14	.766
Read	2.28	2.29	2.26	.991
Take exams	2.29	2.29	2.30	.876
Do mathematics	2.66	2.77	2.51	.024
Get assistance	2.92	3.06	2.74	.006
Participate in the classroom	3.15	3.17	3.12	.651
Speak	3.24	3.37	3.08	.014
Participate in sports activities	3.43	3.53	3.29	.022
Participate in practical subjects	3.52	3.65	3.33	.007
Interact with staff	3.57	3.71	3.39	.000
Participate in practical activities during breaks	3.60	3.68	3.49	.030
Go on field trips	3.76	3.81	3.69	.175
Access the school	3.88	3.91	3.84	.172
Participate in social activities during breaks	3.89	3.93	3.84	.044

Note:

^aPossible SSI ratings between 1 and 4, the lower the mean value, the more need of adjustments, i.e., the poorer student-environment fit.

^bMann–Whitney U was applied, α = .05, significant values in bold.

Comparison of Adjustment Needs between Students in Different Diagnosis Groups

For eight of the 16 SSI items there were statistically significant differences between diagnosis groups, see Table 4. The group of students with neuropsychiatric diagnoses showed a statistically significant higher level of adjustment needs in seven items, compared to the non-diagnosed group, and in five items compared to the group with Dyslexia or other symbolic dysfunctions. The statistically significant differences between the diagnosis groups also showed that the group of students with Dyslexia or other symbolic dysfunctions had fewer adjustment needs than the other groups.

Table 4. Comparisons of adjustment needs in SSI items between students with different diagnoses.

SSI items	Group 1 No diagnosis (n: 199–273) Mean	Group 2 Dyslexia^1 (n: 73–101) Mean	Group 3 Neuro-psychiatric diagnosis^2 (n: 81–113) Mean	Difference between groups^3	Pairwise differences between groups^4 (1–2, 2–3, 1–3)
Remember things	1.72	2.45	1.40	0.000	1-2, 2-3, 1–3
Write	2.11	2.92	1.80	0.545
Do homework	1.99	2.96	1.83	0.000	1-2, 2-3, ns
Take exams	2.36	2.36	2.00	0.054
Read	2.37	1.93	2.33	0.077
Do mathematics	2.67	2.69	2.59	0.840
Get assistance	2.98	2.91	2.87	0.690
Participate in the classroom	3.26	3.29	3.02	0.010	ns, 2-3, 1–3
Speak	3.23	3.39	3.10	0.241
Participate in sports activities	3.50	3.81	3.01	0.000	1-2, 2-3, 1–3
Participate in practical subjects	3.59	3.59	3.29	0.015	ns, ns, 1–3
Interact with staff	3.61	3.79	3.48	0.146
Participate in practical activities during breaks	3.68	3.82	3.27	0.000	ns, 2-3, 1–3
Go on field trips	3.82	3.85	3.54	0.012	ns, ns, 1–3
Access the school	3.92	3.90	3.79	0.018	ns, ns, 1–3
Participate in social activities during breaks	3.91	3.88	3.83	0.344

Discussion

This study investigates the student-environment fit, i.e., the match between characteristics of the student with special educational needs and the demands in the student's school environment in regular upper secondary school. The findings show that the demands in the school environment were not consistent with the studentś abilities. Thus, according to the research question about the student-environment fit and the perceived need of adjustments for students in Swedish upper secondary schools, almost all students perceived that they needed adjustments in order to manage school, and among these, few students declared that their needs were satisfactorily met by the school. These findings indicate a lack of individualized support, due to a gap between the students’ perceived need of adjustment and what they actually have access to, indicating restricted participation. Pijl and co-workers (2014), describes support as important for maintaining motivation and interest in school, and consequently not dropping out from school. It could also be one explanation as to why previous research show that students in need of special educational support often experience restricted participation in educational activities at school (Bolic, Lidström, Thelin, Kjellberg, & Hemmingsson, 2013; Eriksson, Welander, & Granlund, 2007; Ferguson, 2008; Lidström, Granlund, & Hemmingsson, 2012; Raggi & Chronis, 2006; Trampush et al., 2009). The result of the study, that many students had not received the adjustments and support they perceived they needed should be taken seriously, since research also have shown that students in need of special educational support are largely overlooked (Pijl et al., 2014). However, the effects of individual adjustments on students’ participation in school activities need to be studied further.

As far as we know, the research has not convincingly been able to explain why school results differ between boys and girls. One explanation is that the gender variable includes two heterogeneous groups, due to different personal preferences (Fallan & Opstad, 2014). In addition, previous research tended to focus on boys’ failure in school, and less attention has been paid to girls’ schooling (Biederman, 2013), and research demonstrates that boys have less academic success than girls (Duckworth & Seligman, 2006; Korhonen et al., 2014). Despite this, a higher proportion of boys receive special educational support than girls (Beaman et al., 2006), as well as assistive technology devices (SOU, 2017:43). It has also been found that teachers do not pay attention to girls to the same extent as to boys (Beaman et al., 2006), and this may explain why the girls in this study perceive a lower student-environment fit. Further, Duckworth and Seligman (2006), found that girls tended to be more self-disciplined than their male peers and earned higher grades in all courses. The fact that girls in general have higher grades than boys may be due to girls having a higher motivation to study (Vantieghem & Van Houtte, 2018). An assumption is that girls compare themselves to other girls, whose goal for their studies are higher than boys. This may imply that it is more difficult for girls with special educational needs to achieve student-environment-fit. The consequences may be health problems, and as Havik et al. (2015), found, there is a correlation between girls with special educational needs and absence from school. This draws attention to the need for further research in order to explain how schools can improve to better meet adjustment needs for girls and boys respectively.

Only half of the students in this study had a medical diagnosis. The findings demonstrate that a high proportion of students in need of special educational support, whether or not they have had a diagnosis, had an extensive need for adjustment. Nevertheless, the group of students with a neuropsychiatric diagnoses displayed a higher level of adjustment needs compared to those without diagnosis and those with a diagnosis of dyslexia/speech impairment. The results are not surprising, since students with neuropsychiatric diagnoses often have cognitive difficulties which impacts on their remembering, planning and organizing abilities (de Schipper et al., 2015; McCoy, Banks, & Shevlin, 2012). These abilities are often essential for managing schooling, e.g., in planning and organizing schoolwork, following instructions, remembering what to do and arriving to class on time. Thus, the result indicates that many of the students had difficulties with these kinds of cognitive challenges in their school activities. The young people of today are expected to be single-minded and independent at school, and at the same time ready to adjust to the society and labor market needs. The main part of the students handle these demands well and succeed in school, but there are many students, who struggle academically due to cognitive difficulties (MacArthur, 2009; Trampush et al., 2009). Furthermore, cognitive difficulties could cause problems in focusing and retaining attention on an activity (DuPaul et al., 2009; Kofler et al., 2008). When a student has these difficulties and when the fit between the demands of the environment does not match the abilities of the student, the risk of school failure is high. This in turn often results in poor self-confidence and decreased motivation to attend school, which consequentially constitute a risk for absence from school (Korhonen et al., 2014; Patrick, Schulenberg, & O’Malley, 2016), not reaching the goals of education, and an increased risk for health problems (Greene, Miller, Crowson, Duke, & Akey, 2004).

It is an interesting find that a high number of students without diagnoses had an extensive need of adjustments in school which was not met. No matter what the reason is, the findings show that their schooling is not working optimally. However, the diagnosis has become a widely accepted “instrument” for dealing with failure at school, and as a qualification for service and support (Hjörne & Säljö, 2014). Ferguson (2008), highlighted the challenge for teach each one everyone to make inclusive practices available to everybody, everywhere, and all the time. One way to achieve this is to separate disability from “diagnosis”, toward an assessment of the student-environment fit. This change moves the “problem” from within the student to an interaction between demands in the educational environment and the student’s ability (Leeber et al., 2010). This viewpoint is also in line with the International Classification of Function, Disability and Health – Child and Youth version, (ICF – CY) (WHO, 2007), where disability is not described just as a medical disturbance, but as a product of impairments and functions, activity and participation limitations, influenced by external and personal factors.

The SSI-items Remember things and Homework are related to the school as well as the environment outside school. This means that students in need of special educational support may need adjustments related to facilitate participation in school activities, but also directed toward the home and societal participation in. The consequences in daily life for persons with cognitive difficulties may include difficulties managing daily activities such as eating, getting to bed and sleeping, handling homework, and social relationships (Rodger & Ziviani, 2006), i.e., activities indirectly affecting academic performance (Bolic Baric, Hellberg, Kjellberg, & Hemmingsson, 2016; Simmerborn Fleischer, Adolfsson, & & Granlund, 2013). Examples of adjustments are assistive technology, personal support, and strategies to plan and organize the student's school and home activities. However, the effects of individual adjustments on students’ participation in school activities need to be studied further. However, more research is needed to investigate whether more students in need of special educational support in upper secondary school would reach the goals of education if they had better access to individual adjustments and support, and whether it also could impact opportunities for work and further education (Patrick et al., 2016).

Methodological Considerations

The use of the semi-structured interview with the SSI as a data collection method implied a structured method was used to collect information to identify the areas where students in need of special educational support perceived they needed adjustments. The SSI assessment was considered to be useful since it reflected each student’s perceptions of adjustment needs in everyday activities at school. Furthermore, the SSI has been shown to be a psychometrically sound assessment for students in need of special educational support in order to identify student-environment fit (Hemmingsson et al., 2004; Yngve et al., 2018). However, several limitations must be kept in mind while interpreting the results of this study. One of the limitations is the cross-sectional design, which implies that this study does not provide any information about the causes of the identified adjustment needs. Furthermore, the identified differences in adjustment needs between boys and girls should be interpreted with caution since this result could be due to selection bias. It was the personnel at school and project-employed staff who identified the students in need of special educational support included in the study. No specific objective measure was used in the selection, and the girls might have to have more adjustment needs to be considered for inclusion in this study even if all personnel had the same information about the inclusion criteria.

It is gratifying that the participating schools managed to identify so many students, based on the inclusion criteria of low attendance and not achieving passing grades, even though few students currently have support. Scholars state that it is important to find methods that can identify students in need of special educational support (Leeber et al., 2010).

Implications for Practice

This study shows that the demands of school activities are not consistent with the abilities of students in need of special educational support. The findings emphasize the importance of recognizing individual needs for adjustments and offering support in order to enhance the student-environment fit and well-being for students. Furthermore, the results indicate that schools have to be extra attentive to meet adjustments needs for girls and for students with neuropsychiatric disorders. The findings are likely to be of interest to personnel at school health units, researchers, and teaching personnel who wish to enhance their everyday practice. More research is needed to investigate whether individual adjustments and support promote opportunities for work and further education after school for students in need of special educational support.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Helene Lidström http://orcid.org/0000-0002-1545-3876

Helena Hemmingsson http://orcid.org/0000-0003-1281-6392

Elin Ekbladh http://orcid.org/0000-0001-9365-7033