الفهرس 
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Abstract
Childhood disability continues to be a significant public health issue across the world. Although disabled children can lead full and fulfilling lives, unfortunately, disability can limit their development, social participation and lead to poor educational, health and employment outcomes. It can also create difficulties and sometimes pain for them and, indeed, for their families. Students with disabilities have diverse developmental, life style, and disability related needs. Furthermore, disability often makes individual vulnerable to a wide range of problems or health threats rather than the rest of the society.
Moreover, Children with disabilities are more likely to be out of school than any other group of children. They have very low rates of initial enrolment, and are often more likely to DROP out and leave school early. Different modalities of education were adopted for children with disabilities, beginning with segregation, integration, and then inclusive education. Unfortunately, there are many barriers that hinder the effective implementation of inclusion which focused mainly on sacristy of needed infrastructure and supportive services, and negative attitudes of school personnel.
Thus, the aim of the study was to assess needs and problems of students with disabilities enrolled at governmental inclusive schools in Alexandria.
A descriptive design was adopted to carry out this study. It was conducted in sixteen inclusive governmental schools representing the eight educational zones in Alexandria governorate. Multistage sampling technique was used to select study sample. ”One primary and one preparatory school” of high enrollment of students with disabilities were chosen from each educational district.
The sample size of the study comprised 462 persons (192 students and 192 guardians, 38 most interactive teachers from each students’ grade were selected randomly , 15 social workers and 9 psychologists who were responsible for disabled children, and 16 school health nurses).Four tools were utilized to conduct the present study;
• Tool I Bio-socio demographic structured interview schedule. It included the following parts:
Part I: Socio-demographic characteristics of the student with disability and their families, part II: Student’s physical health status data, Part III: Students’ disability profile, part IV: Students’ life style and nutritional status data, part V: Students’ Social relations data, part VI: Educational profile data, part VII: Students’ needs, part VIII: Students’ problems. Part IX: Awareness of the students’ guardians about school inclusion system and part X: Guardians’ satisfaction with school services.
• Tool II School personnel perspectives. It included the following parts:
Part I: Socio-demographic data about school personnel, part II: School personnel’s perspectives about inclusion system, part III: School personnel’s perspectives about student’s needs and problems, part IV: Role of school personnel toward students’ with disabilities and part V: Satisfaction of school personnel with school services.
• Tool III: Child Behavior Checklist (CBCL).
• Tool IV: School physical environment observation checklist. It included the following parts:
Part I: General characteristics of the studied schools and part II: School physical environment observation data.
• Tools were tested for validity and reliability.
• Approvals were obtained for conducting the study at the selected settings. A pilot study was carried out on a sample of 19 students and their guardians, two teachers, one social worker, one psychologist and one school nurse from two schools that were not included in the original study sample.
• Data were collected in about eleven months during the academic years (2014-2015/ 2015-2016).The collected data was coded, entered, and analyzed using computer with Statistical Package for Social Sciences version 20.
The main findings obtained from the study were as follows:
Part I: Students’ and their families’ data
A. Students’ and their families’ socio-demographic data:
• Students’ age ranged from ten to fifteen years, with a mean of 11.86± 2.057 years.
• Nearly equal percentages (50.5%, 49.5%) were males and females respectively.
• More than two thirds (69.7%) of the students were enrolled at primary schools, while the rest (30.3%) of them were at preparatory schools.
• The majority (84.9%) of the studied students live with both parents.
• Secondary or technical education had the highest percentage for both father and mother (30.6%, and 36.2% respectively), while 26.1% of fathers, compared to 21.6% of mothers were either illiterate or read and write.
• Less than two thirds (61.5%) of the students were of low social class while those of high social class constituted 18.2% of them.
B. Students’ health and disability profile.
• Less than half (44.8%) of the students had a family history of many hereditary diseases. While 27.6% of them had a family history of disability.
• More than three quarters (77.1%) of students had past health problems, mainly; chronic diseases and eye problems (36.5 %, and 34.5% respectively).
• More than one tenth (16.7 %) of the students were exposed to accidents.
• More than three quarters (77.1%) of the students had current health complaints mainly; Sleep problems (53.4%) and infectious diseases (21.6%).
• Less than three quarters (73.0%) of the students received medical care during illness, mainly; private services (60.4%), followed by health insurance services (55.7%)
• More than half (53.6%) of the students had intellectual disability, while sensory and learning disabilities were equally reported by one quarter (25.0%) of the students.
• One quarter (25.0%) of the students had congenital disabilities, while 37.5% of students had idiopathic disabilities, on the other hand, those with multiple disabilities constituted 27.6% of them.
• IQ level for studied students ranged from 65 to 85, with a mean of 72.76 ±6.4.
• One third of the students (33.3%) were receiving rehabilitative care, and 31.2% of them were using assistive devices.
• More than half (51.7%) of the students had regular follow up visits.
C. Students’ nutritional status and life style.
• Less than one tenth (6.8%) of the students were underweight, compared to less than one quarter of them who were overweight, and obese (23.4%, and 20.8% respectively).
• The majority (81.8%) of students were not practicing any sports.
• More than three quarters (77.1%) of the students were doing dental follow up at irregular basis.
• None of the studied students reported that they ever experience cigarette smoking or substance abuse.
• More than one tenth (13.5 %) of the students had suicidal thoughts. The main cause of such thoughts was parental maltreatment as expressed by more than half (53.8%) of the students.
• The majority (83.3%) of the students reported that they were exposed to abuse, mainly physical and psychological abuse as mentioned by (81.3%) of them for each type, and the main perpetrator was their classmates (73.1%).
D. Students’ social profile.
• Good relationship with mothers was reported by the majority (90.5%) of the students followed by, their siblings (80.2 %), and fathers (65.6%).
• Less than three quarters (72.9%) of the students reported bad relationship with their schoolmates.
• Less than two fifths (38.5%) of the students reported that they had bad relationship with their teachers because of feeling rejected from teachers (93.2%).
• The majority (81.3%) of the students reported non participation in extracurricular activities; the main cause was the exclusion from such activities (56.4%).
F. Students’ scholastic profile.
• Three quarters (75.0%) of the guardians viewed the child academic performance as poor, because of non-special care of disabled children as stated by 72.4% of them.
• The main problems faced by the students were unavailability of needed services and facilities (83.9%), poor scholastic achievement (71.4%), defective inclusion system (63.0%), school maltreatment (62.0%) and lack of experience of school personnel (57.8%).
G. Students’ needs mentioned by themselves and their guardians.
• More than two thirds of the students had unmet psychological, and educational needs (69.8%, 68.2% respectively) compared to 63.5% of them who had unmet social needs, and 5.7% of them who had unmet needs for daily living activities.
H. Students’ problems mentioned by themselves and their guardians.
• More than two fifths of the students (43.2%) had many health related problems, compared to 39.6% of students who had many social problems.
• More than one tenth (15.1%) of them had many educational problems, while 4.7% of students had many psychological problems.
• More than one tenth (15.6%) of the students had behavioral problems, where externalized and internalized behavioral problems were reported by the same percentage of 16.7%.
I. Students’ guardians’ awareness about educational inclusion and satisfaction with school services.
• Less than two thirds (58.9%) of the students’ guardians prefer inclusive schools.
• The majority of the students’ guardians reported that the main problems of inclusion were lack of teaching facilities and supportive services and diminished special care for disabled students (89.6%, and 83.9% respectively).
• The main suggestions for improving inclusion system as reported by students’ guardians were availability of supportive and rehabilitation services (94.8%), followed by curriculum modification (79.7%) and administrative supervision for maltreatment prevention (73.4%).
• More than three quarters (77.1%) of the guardians were not satisfied by the total school services.
Part II: School personnel data
A. Socio-demographic characteristics
• The age of the school personnel ranged between thirty to fifty nine years with a mean of 42.88±8.33 years.
• Less than half (48.7%) of them were teachers and around one fifth of them were either nurses or social workers (20.5%, 19.2% respectively), and 11.5% were psychologists.
• Less than two thirds (64.1%) of them had more than one year experience with disabled students, while 19.2 % of them didn’t have any experience.
• Half (50%) of the studied school personnel supported educational inclusion because it improves psychological status of disabled students (46.1%) and improves communication and socialization of students with disability (41.0%).
• Half (50%) of the studied school personnel rejecting educational inclusion system because of lack of resources (51.3%), lack of trained personnel (43.6%), followed by defective inclusion system (38.5%).
B. Students with disabilities’ needs and problems as mentioned by school personnel and opinion about school services.
• Unmet educational needs were reported by 76.3% of teachers, while unmet social needs were mentioned by the majority (91.7%) of social workers and psychologists.
• All social workers and psychologists rated psychological needs of disabled students as unmet. While 75.0% of nurses reported unmet health needs of the disabled students.
• Many educational problems of disabled students were reported by 68.4%of the teachers.
• Less than half of the teachers, social workers, and psychologists reported many psychological and social problems of students (37.1%, 41.9% respectively).
• More than one third (37.5%) of studied nurses reported many health problems of disabled students.
• Only less than half (42.3%) of the school personnel reported that total school services were unsatisfactory.
D. Roles and responsibilities of school personnel towards students with disabilities.
• More than one quarter (26.3%) of teachers reported that they fully met their roles, compared to the majority (86.7%) of social workers, and 77.8% of studied psychologists reported that they fully met their assumed roles.
• More than half (56.3%) of the studied nurses reported that they fully met their roles as the majority (87.5%) of them stated that vision screening and weight and height measurement were done for students with disabilities.
E. Most common problems of disabled students.
• The most common problems reported by the studied school personnel were students’ behavioral problems (33.3%), followed by poor scholastic achievement (19.2%) and family lack of cooperation and follow up (16.7%).
• Less than one tenth (7.7%) of them reported that unavailability of supportive services was the main inclusion related problem.
F. Suggestions for improvement of inclusion system.
• The majority of the school personnel suggested provision of resources either human or non-human (85.9%), followed by raising community awareness about disability/inclusion system (51.2%), and curricular modification (33.3%).
Part III: School physical environment characteristics.
• More than two thirds (68.8%) of the observed schools had no special education teachers or resource rooms.
• Three quarters (75.0%) of the observed schools had poor environmental condition for inclusion of the students with disabilities.
Part IV: The results also revealed the following:
A. Relationship between students’ socio-demographic data and students’ needs.
• There was a significant relation between students’ age, sex and educational grade and students’ needs.
(MCP =0.018 & MCP=0.013&P =0.000respectively).
• No significant relation was observed between; place of residence, social class and family income and the students’ needs.
(P =0.691& MCP =0.764& P =0.381 respectively).
B. Relationship between students’ socio-demographic data and students’ problems.
• No significant relation was observed between students’ age, educational grade, social class and family income and students’ problems.
(MCP =0.065 & P =0.854 & MCP =0.183& P =0.240 respectively).
• A significant relation was observed among students’ sex and place of residence and their problems (P=0.018&P =0.048 respectively).
C. Relationship between number and onset of disability and students’ needs.
• No significant relation was ascertained between age of onset of disability, number of disabilities and type of disability and students’ needs (P =0.237 & P =0.916& P =0.305respectively).
D. Relationship between number, onset of disability and type of disability and students’ problems.
• A significant relation was observed between age of onset of disability and students’ problems (P =0.046).
• No significant relation was noticed between number of disabilities and type of disability the student had and students’ problems.
(P =0.724& P =0.176 respectively).
In the light of the present findings it could be concluded that; children with disabilities are deprived of their basic needs as most of students had unmet health, psychological, social, and educational needs. Furthermore, it is apparent from the study that children with disabilities suffer from many health, psychosocial, and educational related problems with varying degrees.
Based on the current findings the following recommendations were suggested:
• Role of family.
Dealing equally, respectively with their disabled children as their normal siblings, and utilization of all available community services for them.
• Ministry of education.
Graduate convenient number of competent well prepared special education teachers to provide special education services in inclusive schools.
Support and encourage continuing education of school teachers such as attending training courses about innovative methods for educating disabled.
Training and monitoring of social workers, and psychologists with respect to their role change in dealing with disabled students in inclusive school settings.
Provision of sustainable fund for meeting the requirements of applying quality school inclusive programs.
• Ministry of Health and Population.
Conducting periodic on the job training programs for school nurses about disability related issues, disabled’s health needs and problems.
Provision of all health care services required by disabled students as physiotherapy, speech therapy, and behavioral therapy.
• Ministry of Social Solidarity.
Increase financial assistance to disabled children and their families.
• Ministry of Youth and Sports.
Enhance sports participation among disabled children through collaborative efforts between youth sport centers and schools to arrange specific days for disabled students.
• National Council for Disability Affairs.
Advocate for disabled rights and needs through responsible authorities and mass media.
Increase community awareness about importance of inclusion of disabled children within community life and diverse settings.
• Media developer.
Combating negative attitudes and stigma toward disabled by planning effective informational media that would correct misconceptions and myths about disabled capabilities and strengths.
• Policy and legislations.
Ensure the enforcement of legislations pertaining to child rights, especially those related to children with disabilities, as well as, legislations and policies regarding to appropriate application of school inclusive education.
• Disability related Non-governmental organization.
Ensure collaboration of all governmental and non-governmental organizations in order to raise public awareness about the disability related needs and affairs through development and dissemination of informational guidelines.
• Recommendations for future research.
Comparative research studies about disabled’s needs and problems are needed among different age groups, and in different geographical areas.