Attitudes Towards Down Syndrome: A National Comparative Study: France, Ireland, Portugal, and Spain

Hugh Gash, S. Guardia Gonzales, M. Pires, & C. Rault
St. Patrick's College Drumcondra, A College of Dublin City University; Universidad Complutense de Madrid; Escola Superior de Educação de Braganca & IUFM de Versailles
Irish Journal of Psychology, 2000, 21, 203-214
Child Development in Ireland. Sheila Greene, Eilis Hennessy & Diane Hogan (Eds.)
Reprinted with the permission of the Irish Journal of Psychology and the principal author.


This study investigated children's attitudes towards children with Down syndrome in Ireland, France, Portugal and Spain. A sample of 805 children divided approximately equally by country, sex, grade level (9 and 11 years of age), and school type (inclusive or non-inclusive) participated in the study. Differences are reported for each independent variable on three dependent variables, sociability, attitude to inclusion and use of negative words to describe a child with Down syndrome. For example, the Iberian sample, younger children, girls and children not in inclusive classrooms were more sociable towards children with Down syndrome. Further, attitude towards inclusive practice was influenced by country, age and school type. Main effects were qualified by some interactions. Results were discussed in terms of their implications for educating children to respect differences.

In school, children's attitudes and friendships towards each other are constructed and the nature of these constructions will have profound implications for the quality of their school experience. Children's development is known to vary in different ecological contexts (Bronfenbrenner & Morris, 1998). The present article is concerned with the development of children's attitudes towards children with Down syndrome in different educationally inclusive contexts.

Children's understandings of and attitudes to disability have been studied with methods including projective techniques, social distance scales, questionnaires, adjective checklists, interviews and sociometric techniques (e.g., Katz, 1982; Siperstein, Bak, & O'Keefe, 1988). During childhood attitudes differentiate as age increases (Katz, 1982). Also competent children are viewed more positively than less competent children and more functionally disabling disabilities elicit stronger negative attitudes (Lewis, 1995).

Gash and colleagues (e.g., Gash, 1992; Gash, 1996a, Gash & Feerick, 1996; Gash, Illán Romeu, & López Pina, forthcoming) have examined primary school children's attitudes towards different others using an adjective checklist and questionnaire. The first investigation was an attempt to promote positive attitudes towards children with a mental handicap using classroom discussion (Gash, 1993). Another examined effects of mixing pupils from an ordinary class with ones from a special class for moderately handicapped children for physical education (Gash & Coffey, 1995). In these studies we sought to understand how to prepare children in ordinary classrooms for inclusive education with children with different types of learning disability1. This was in view of the new official Irish view on inclusion: all children with special educational needs should be educated in ordinary schools, unless this is impractical (Ireland, 1993).

During these investigations it became apparent that there is an ambiguity in interpreting improvements in children's attitudes (Gash, 1996b). For example, is improvement in attitude due to a change in feelings about a child with a mental handicap, or does the image of mental handicap itself change from, for example, an image of profound handicap - to one of mild handicap? The image of profound handicap may provoke fear in children who have little experience of disability. So if the image changes from one of profound to one of mild handicap, a child's attitudes could be expected to improve. In this case the child has learned something important about different types of mental handicap. Of course all improvements are welcome, but it would be interesting to have some insight into whether improvements obtained were due to change of attitude or to change in the representation of mental handicap. In Gash and Coffey (1995), it is likely that improvements were due to a change in attitude rather than image because the school had a special class of pupils with moderate mental handicap. So in this case their representations were based firmly on daily experience. One way to overcome this ambiguity is to use photographs and instead of using the phrase "mental handicap" to refer to children with "Down syndrome".

Children's expectations about friendship develop in a stage like manner (Bigelow, 1977). An initial reward-cost stage (age 6 - 7) includes expectations of friends offering help, sharing common activities and being similar. A normative stage (age 8 - 9 ) finds children expecting friends to admire them, to show commitment and to have similar attitudes to rules, and in an empathic stage (age 10 - 11) children expect some self disclosure, and sharing of common interests and values. We expect that developmental delays experienced by children with Down syndrome are likely to cause problems in their gaining peer social acceptance and have some role in negative attitudes expressed in previous studies cited by Gash and colleagues.

With this in view the present study investigated attitudes towards children with Down syndrome in four countries: France, Ireland, Portugal, and Spain. Data were collected in two types of school (with and without inclusion), and at two age levels to investigate emerging developmental trends. We anticipate some refinements in children's attitudes with increases in age towards children with Down syndrome, and we expect contextual variation in different educational systems to influence both children's attitude to inclusion and to children with Down syndrome.



Questionnaires were given to 806 children in four countries. Comparable schools were selected in each country, in urban areas that were neither advantaged nor disadvantaged, in schools with and without inclusion. In Spain and Portugal children with learning disabilities were included in regular classes. In Ireland this was also the case though they have some individual teaching, and in France the children with disability were educated in special classes but joined the other children for certain activities. Two age levels were selected, children aged about nine years and children about 11 years, and two classrooms were selected at each grade level in each condition (Table 1).

Table 1
Numbers of children by country, gender, school type and age
 Gender   School Type  Age  Ireland   France   Portugal   Spain 
Boys Non-inclusive aged 9 30 19 32 18
  aged 11   32 29 24 35
Girls aged 9 28 29 19 9
aged 11 28 26 36 23
Boys Inclusive aged 9 36 22 28 17
aged 11 28 27 28 25
Girls aged 9 33 23 15 15
aged 11 35 26 14 17

The questionnaire

The questionnaire used was initially presented in Gash (1993), except that references to Down syndrome replace references to mental handicap. Photos of three young people attending a special school were taken for use after permission was obtained from the school board, families and young people involved. Translations were prepared professionally and checked by participating researchers prior to use. There were three parts to the questionnaire. (1) A twenty-item attitude scale concerning a child with a handicap: "I would like you to pretend that a new child came to your class this year. He or she has Down syndrome. Here are some questions for you to answer." Responses to the items were either "yes", or "no". (2) A thirty four adjective checklist, "If you were describing him or her to your other friends which of these words do you think you would use?"; and (3) a section to assess the child's experience of children with mental handicap ("Are there any children with a mental handicap in your school/ class, and do you know anybody who has Down syndrome?") The answers to this last question were used as a covariate later. The 20 questionnaire questions are in the Appendix.

Data were analysed following methods developed in previous studies, particularly in Gash, Illán Romeu & López Pina (forthcoming). Three composite variables were constructed concerning two attitudinal variables based on the 20 questions and one variable based on (negative) words used to describe children with Down syndrome. Attitudinal variables reflect (1) sociability/ unsociability towards children with Down syndrome, and (2) attitude for/ against total inclusion in school. Ten of the first eleven items were found (ibid.) to make a scale of sociability towards, or sociable activities in relation to, children with Down syndrome. The items concerned: smiling at (question 1), sitting beside (question 2), chatting at break (question 3), telling secrets (question 4), making him or her your best friend (question 5), inviting home (question 6), (not) being angry if he or she breaks rules of a game (question 7), inviting to a party (question 8), picking for your team (question 9), and being angry if he or she is teased (question 11). Item seven was recoded (yes = no, no = yes) so as to contribute positively to this item. The six items which were summed to create the variable concerned with schooling were: ability to do the same maths, reading, and hobbies as other children (questions 12 to 14); and items about special schooling (questions 16 - 18). Items 17 and 18 were recoded (no = yes; yes = no) to contribute positively to this variable. These items are about inclusion so that positive (yes) answers reflect acceptance of the ability of the child with Down syndrome to enjoy same hobbies (14) and to cope with same maths (12) and books (13) as other children, in mainstream classrooms (16), and (not to) need special classrooms (17), and (not to go to) special schools (18). In interpreting mean scores for the two attitudinal variables, note that "yes" was scored "one" and "no" was scored "two", so lower scores indicate more positive attitudes (see Table 2).

The reliability (internal consistency) of each scale was checked. Cronbach's a for sociability was 0.69, and a for attitude towards total inclusion was 0.64. It was not possible to augment a by removing any items.

Variables based on children's use of descriptive words have been described previously (Gash, 1993) and reflect positive, negative, descriptive, and sensitive orientations towards children with Down syndrome. Scales were created by summing terms used these categories. Scales show these dimension's salience to pupils thinking about a child with Down syndrome. High scores indicate the dimension's greater salience. Descriptive and sensitive scales had internal consistencies below 0.60 and so were not used in the present study. The positive scale gave analogous results to the negative scale (a = 0.80) reported here consisting of the words: dirty, stupid, untidy, bold, dumb, rough, spa, crazy, geek, thick, simple, scary, dork, retarded, moron, twit, freak, idiot, and nerd.


Three separate four-factor (nationality, age level, gender, and school type (with and without inclusion) analyses of covariance were undertaken with sociability, attitude to schooling, and use of negative words as dependent variables. Experience-inexperience (did the child know) of Down syndrome was used as covariate since this was shown to influence responses in previous studies. Sociability differed on all four independent variables (Table 2)2. Post-hoc Scheffé comparisons (p<0.05) showed the French sample were significantly less sociable than both Portuguese and Spanish samples (F(3, 766) = 6.15, p<0.001). As expected, girls were more sociable than boys (F(1,766) = 6.15, p<0.05); and younger children were more sociable than older children (F(1,766) = 4.01, p<0.05). Children in classes with inclusion were less sociable than children in classes without inclusion (F(1,766) = 33.27, p<0.001). There were two interactions, a two way and a three way interaction, due to French data qualifying these analyses. A country by grade interaction occurred because the usual developmental trend for older children to become less sociable was reversed for the sample of younger French children (F(3,766) = 5.37, p<0.001). Scheffé contrasts of means in this interaction showed that younger French children were less sociable than both younger Portuguese and younger Spanish children. This effect was strong enough to provoke a country by grade by school type interaction (F(3,766) = 4.00, p<0.008) showing the younger French sample in the school with inclusion were the least sociable in these sixteen groups and were significantly less sociable than the five most sociable groups in this analysis. Inspection of means for the two lower grade classrooms with inclusion in France showed that they had virtually identical means, so this result was not just due to one classroom having extreme attitudes.

Table 2
Means for ANCOVAs for Unsociability and Rejection of Inclusive Practices (in italics) on Significant Independent Variables and Interactions
Variable Value Label Unsociability (n)       Inclusion
Mean S.D. Mean S.D.
For Entire Population 12.58 2.15 799 8.34 1.78
COUNTRY Ireland 12.67 2.04 245 7.72 1.68
France 13.03 2.10 201 8.55 1.67
Portugal 12.35 2.20 194 9.04 1.73
Spain 12.16 2.21 159 8.20 1.77
GENDER male 12.72 2.27 424 *8.41 1.81
female 12.42 2.00 375 *8.27 1.74
GRADE lower 12.45 2.15 369 8.56 1.85
   SCHOOL TYPE non-inclusive *12.13 2.05 180 8.46 1.85
inclusive *12.75 2.21 189 8.67 1.86
GRADE upper 12.69 2.14 430 8.16 1.69
   SCHOOL TYPE non-inclusive *12.27 2.05 232 7.65 1.56
inclusive *13.19 2.15 198 8.75 1.65
SCHOOL TYPE non-inclusive 12.21 2.05 412 8.00 1.73
inclusive 12.97 2.19 387 8.71 1.75
COUNTRY Ireland 12.67 2.04 245 7.72 1.68
   GRADE lower 12.36 1.93 125 7.52 1.68
      SCHOOL TYPE non-inclusive 11.88 1.77 56 6.95 1.27
inclusive 12.75 1.97 69 7.99 1.83
   GRADE upper 12.98 2.11 120 7.93 1.67
      SCHOOL TYPE non-inclusive 12.69 2.31 59 7.64 1.87
inclusive 13.26 1.87 61 8.20 1.40
COUNTRY France 13.03 2.10 201 8.55 1.67
   GRADE lower 13.39 2.41 93 8.87 1.62
      SCHOOL TYPE non-inclusive 12.56 1.96 48 9.00 1.58
inclusive 14.27 2.55 45 8.73 1.67
   GRADE upper 12.72 1.75 108 8.28 1.67
      SCHOOL TYPE non-inclusive 12.36 1.56 55 7.64 1.34
inclusive 13.09 1.87 53 8.94 1.73
COUNTRY Portugal 12.35 2.20 194 9.04 1.73
   GRADE lower 11.99 1.92 92 9.72 1.51
      SCHOOL TYPE non-inclusive 12.37 2.17 49 9.76 1.27
inclusive 11.56 1.50 43 9.67 1.77
   GRADE upper 12.68 2.39 102 8.43 1.69
      SCHOOL TYPE non-inclusive 12.18 2.14 60 7.70 1.38
inclusive 13.38 2.58 42 9.48 1.53
COUNTRY Spain 12.16 2.21 159 8.20 1.77
   GRADE lower 11.86 2.10 59 8.49 1.79
      SCHOOL TYPE non-inclusive 11.44 2.39 27 8.26 1.87
inclusive 12.22 1.77 32 8.69 1.73
   GRADE upper 12.33 2.27 100 8.02 1.73
      SCHOOL TYPE non-inclusive 11.84 2.03 58 7.60 1.62
inclusive 13.00 2.44 42 8.60 1.74
N.B. * not significant

There were three main effects in attitudes towards inclusion in school (Table 2). These were for country F(3,766) = 26.43, p<0.001), for grade level (F(1,766) = 14.68, p<0.001), and for school type (F(1,766) = 36.07, p<0.001). Post hoc comparisons showed that the Portuguese sample scored significantly higher rejecting total inclusion more than each other country, and the French rejected inclusion more than the Irish. Generally older children were more favourable disposed towards inclusion and so were children in classes without inclusion. These main effects were qualified by two two-way interactions and one three way interaction. Post hoc analysis of the grade by school type interaction (F(1,766) = 12.05, p<0.001) showed older children in schools without inclusion favoured inclusion and differed from each other group. As for sociability, there was a country by grade interaction showing the increased awareness of difficulties imposed by inclusion in older children was reversed in the Irish sample (F(3,766) = 8.94, p<0.001); and a country by grade by school type interaction (F(3,766) = 6.20, p<0.001) showing that in each country older children in schools with inclusion were more aware of inclusion's difficulties than their peers in schools without inclusion, whereas only in Spain and Ireland did younger children in schools with inclusion show this awareness.

There were four main effects for use of negative descriptors (Table 3). There were significant differences between means for countries (F(3,766) = 9.99, p<0.001), boys used more negative words than girls (F(1,766) = 11.64, p<0.003), older children than younger children (F(1,766) = 5.61, p<0.05); and children in schools with inclusion more than children in schools without inclusion (F(1,766) = 18.08, p<0.001). Post hoc comparisons showed the Spanish sample had significantly higher means than each other country. Main effects must be interpreted in the light of a grade by school type effect (F(1,766) = 7.04, p<0.01), a country by grade by school type effect (F(1,766) = 3.82, p<0.01); and a country by grade interaction (F(3,766) = 2.75, p<0.05). The means imply that older children use more negatives in each country except Ireland, and older children used more negatives in schools with inclusion. The two way interactions combined produced a three way interaction.

Table 3
Means for ANCOVAs for Use of Negative Words on Significant Independent Variables and Interactions
Variable Value Label Mean Std Dev Cases
For Entire Population 1.18 2.51 799
GENDER male 2.11 2.87 424
female 1.47 1.98 375
SCHOOL TYPE non-inclusive 1.48 2.38 4.12
inclusive 2.17 2.60 387
GRADE lower 1.55 2.43 369
   SCHOOL TYPE non-inclusive 1.42 2.60 180
inclusive 1.68 2.26 189
GRADE upper 2.04 2.56 430
   SCHOOL TYPE non-inclusive 1.53 2.20 232
inclusive 2.64 2.82 198
COUNTRY Ireland 1.40 2.19 245
   GRADE lower 1.47 2.56 125
      SCHOOL TYPE non-inclusive 1.43 2.83 56
inclusive 1.51 2.34 69
   GRADE upper 1.33 1.74 120
      SCHOOL TYPE non-inclusive .97 1.49 59
inclusive 1.69 1.89 61
COUNTRY France 1.62 2.02 201
   GRADE lower 1.45 2.00 93
      SCHOOL TYPE non-inclusive .83 1.49 48
inclusive 2.11 2.26 45
   GRADE upper 1.77 2.04 108
      SCHOOL TYPE non-inclusive 1.44 1.84 55
inclusive 2.11 2.18 53
COUNTRY Portugal 1.75 2.77 194
   GRADE lower 1.36 2.35 92
      SCHOOL TYPE non-inclusive 1.59 2.71 49
inclusive 1.09 1.85 43
   GRADE upper 2.11 3.08 102
      SCHOOL TYPE non-inclusive 1.05 1.89 60
inclusive 3.62 3.77 42
COUNTRY Spain 2.75 2.95 159
   GRADE lower 2.17 2.85 59
      SCHOOL TYPE non-inclusive 2.11 3.30 27
inclusive 2.22 2.46 32
   GRADE upper 3.10 2.97 100
      SCHOOL TYPE non-inclusive 2.67 2.92 58
inclusive 3.69 2.98 42


First these findings illustrate developmental change in children's attitudes toward children with Down syndrome. For example, here children restricted their inclination to be sociable as they grow older and, in common with an earlier study on children's perceptions of mental handicap (Gash, 1993), older children viewed inclusive practices more favourably. However, context influenced developmental change too because older children in inclusive classes were more reticent about inclusion than those in regular classes. Older children in general used more negative words describing Down syndrome children, though the Irish children were an exception. Use of negative words was greater with older children in schools with inclusion, especially in Portugal and Spain. It is curious that Spanish children were both most sociable and used negative words more often. Also Irish children were amongst the least sociable and used fewest negative words. Why this paradoxical situation? We wonder if it is that when children are used to inclusion (Spain) then they can be sociable and use negative words without embarrassment; whereas in Ireland where inclusion is rarer, children are reluctant to use negative words and are more restrained socially. If so, this illustrates the important role of ecological context in children's constructions (Bronfenbrenner & Morris, 1998).

In general, we found that children in classrooms with inclusion tended to be less sociable towards children with Down syndrome than children in classrooms without inclusion. So classroom experience played a major role. This is consistent with findings of a meta-analysis of sociometric studies of children with learning difficulties showing low ratings for these children (Ochoa and Olivarez, 1995). Also this illustrates the difficulty of being a member of a minority not valued by the majority in the classroom, described by Deegan (1993) for racial contexts. As found previously with this questionnaire, girls were more sociable than boys and generally younger children were more sociable than older children.

The French children's unsociability, particularly the sample of younger children in schools practising inclusion are anomalous and may result from poor preparation for inclusion by that school. In a previous study (Gash, Illán Romeu, & López Pina, forthcoming) Spanish children were found to be more sociable than Irish children towards children with a mental handicap. The same finding is repeated here, with French samples closer to Irish and Portuguese samples closer to Spanish. Further, Irish and Spanish children sampled were more favourably disposed towards inclusion. It may be that this reflects the success of the Spanish integration project and the tendency in Irish schools to procede with inclusion only with the teacher's agreement. How can we account for this finding? What sort of explanation can we offer? Is it that in Spain, for example, the social consequences of their National integration project that began in 1985 are such that children with mental handicap or Down syndrome are more accepted. If this is the case, could it be that fear associated with prejudice is diminished in Spanish samples?

One purpose of this research was to establish a baseline in each country so that teachers could begin to think about the conditions in which inclusion of children with Down syndrome occurs. The capacity to live with and accept difference is an index of the degree of civilisation in any social group. It may be that the use of negative words is an index of personal fears rather than an expression of hostility towards children with Down syndrome. It may be that the items used here to measure sociability do not in fact reflect the ways children relate to each other in social settings. I have some evidence, however, that these measures may reflect attitudes in observable ways and have validity (Gash, 1996a). This does not exclude the possibility that higher use of negative words may be playful in these Spanish children. The challenge is for teachers to create social settings in schools so children can develop together in mutual respect, valuing both their common humanity and their individual differences.


The data were collected with an Ersamus network co-ordinated by S. Guardia Gonzales Universidad Complutense de Madrid. M. Pires works at Escola Superior de Educação de Braganca, and C. Rault at IUFM de Versailles. Thanks are expressed to the children and teachers who participated in the data collection and Patricia Hanlon at the Educational Research Centre who entered the data. An earlier version of this work was reported at the European Educational Research Conference in Seville in 1996.

1 There is increasing preference in Ireland in professional domains for using the phrase "learning disability", whereas to study prejudice Gash (1993) used the phrase "mental handicap".
2 The tables have been prepared so that means and standard deviations can be read for any significant main effect or interaction. In the interest of brevity each effect is not tabled separately.


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  1. Would you smile at him/her on the first day?
  2. Would you ask him/her to sit beside you?
  3. Would you chat to him/her at break time?
  4. Later on, would you tell him/her secrets that you usually keep for your friends?
  5. Would you make him/her your best friend?
  6. Would you invite him/her to your house to play in the evenings?
  7. Would you feel angry if he/she did not keep the rules of your games at play time?
  8. Would you invite him/her to your birthday party with your other friends?
  9. Would you pick him/her on your team in a competition?
  10. Would you ask him/her questions about themselves?
  11. Would you care if other children made fun of the child with Down syndrome?
  12. Do you think the child with Down syndrome could do the same maths as you?
  13. Do you think that he/she could read the same books as you?
  14. Do you think that he/she would have the same hobbies as the other children in the class?
  15. Would you feel afraid of him/her because they had Down syndrome?
  16. Do you think Down syndrome children should be taught in the same classroom as you?
  17. Should Down syndrome children have their own special classroom in your school?
  18. Should Down syndrome children have their own special school where all the children have Down syndrome?
  19. Do Down syndrome prefer other Down syndrome children as friends?
  20. Can you tell if a child has Down syndrome by looking at his/her face?