International guiding documents such as the United Nations Convention on the Rights of Persons with Disability and the Sustainable Development Goals emphasise inclusive and equitable quality education for all children (United Nations 2006; United Nations Development Group 2015). Children with disabilities are often denied access to education, particularly in low- and middle-income countries such as Ghana (World Health Organization & World Bank 2011). The situation demands even greater attention for children with intellectual and developmental disabilities (IDDs) who, compared to their peers with other forms of disabilities, record the lowest school enrolment rate (World Health Organization & World Bank 2011).

The Government of Ghana has committed to equal rights to education for children with disabilities enshrined in several of its educational policies. These include article 25 (1) of its 1992 Constitution and Education Strategic Plan of 2003–2015 and 2010–2020 which is committed to include all children with mild to moderate disabilities in mainstream settings (Republic of Ghana 2003, 2012). Despite these provisions, some researchers report that unlike their peers without disabilities, children with disabilities and particularly those with IDDs are discriminated against and institutionalised, with only about 3% of them enrolled in primary education (Ametepee & Anastasiou 2015; Avoke 2002). Children with IDD experience ‘a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills’ (Salvador-Carulla et al. 2011:177).

The Republic of Ghana’s education system operates on the 6+3+3+4 structure representing 6 years of primary education, 3 years each of junior and senior secondary education and 4 years of undergraduate studies (Education System Ghana 2011; Nketsia 2016). English is the official language of instruction and communication throughout Ghana’s educational system (Education System Ghana 2011). Even though the average recommended class size for primary and secondary schools in the country is 30–35, studies (Alhassan 2014; Kuyini & Desai 2008) report teacher challenges with classroom management because of overcrowded classrooms and lack of resources and services. In particular, children with disabilities often lack the adequate resources and services (i.e. inaccessible curriculum, instructional materials) to succeed in educational systems (Kuyini & Desai 2008).

International human rights documents have recognised the rights of children to express their views and participate in matters that concern them. Similarly, childhood studies theorists argue that children are competent and active social actors ‘with an informed and an informing view of respective social worlds’ (James & James 2004:59), and thus, have the right to be informants in the research that concerns them. Incorporating children as social actors in research requires utilising research techniques such as dialogue and drawings that allow researchers to treat them as equals and understand their experiences and interests (Christensen 2004; James & James 2004).

Although children with disabilities are the biggest stakeholders in inclusion (Bennett, Deluca & Bruns 1997), to date, adult participants without disabilities (i.e. teachers, parents and government officials) have predominated research on inclusion in low- and middle-income countries (i.e. Franck & Joshi 2017; Galovic, Brojcin & Glumbic 2014). Studies in high-income countries that utilised children’s voices in inclusive settings have found that children with disabilities experience challenges including marginalisation (i.e. being shouted at by teachers, peer verbal abuse) and loneliness which negatively impacts their emotions (Adderley et al. 2015; Messiou 2002). Beyond education, studies on children with IDDs have often relied on proxies to collect data, rather than soliciting the views of children with IDD themselves (Majoko 2016; Zachary et al. 2016).

Including children with disabilities as active participants in research on inclusion can provide stakeholders with a unique view of opportunities and challenges and inform targeted practices to support inclusion in the future (Coates & Vickerman 2010). Furthermore, as noted by Rose and Shevlin (2004:160), paying attention to children’s views ‘enable[s] us to reflect upon how future developments may afford greater opportunities to those who have been previously denied’. To that end, we sought to engage children with IDD to learn about their experiences in inclusive schools. Specifically, we collected and analysed the data to answer the following question: what are the experiences of children with IDD in inclusive schools in Accra, Ghana?

The theory that guided our study is the bioecological theory of human development, which was first proposed in the 1970s by Urie Bronfenbrenner (Bronfenbrenner & Morris 1998; Rosa & Tudge 2013). Bronfenbrenner developed this theory to focus research on both the individual and context and understand the complex interrelationship between the individual and environment (Rosa & Tudge 2013). The theory depicts that forces at various levels – biosystem (individual child), microsystem (immediate environment), mesosystem (interactional patterns amongst two microsystems), exosystem (indirect environment), macrosystem (social values) and chronosystem (changes over a period of time) – affect the development of the child (Bronfenbrenner & Morris 1998). Strengths of the theory lie in that it is universally applicable and provides a theoretical and research framework through which both personal characteristics and environmental factors can be factored into the complexities of a child’s development. However, considering the various factors that need to be explored, it is often difficult to achieve hierarchical importance when applying the theory in practice (Rosa & Tudge 2013). However, based on its relevance to an understanding of the personal characteristics and all the contextual factors that influence the inclusion of children with disabilities, we utilised the theory to guide the organisation of the themes that emerged from the data. In this process, we mapped emergent themes onto the various levels of Bronfenbrenner’s bioecological theory of human development.

We utilised a qualitative descriptive design as described by Sandelowski (2010), which incorporates overtones or techniques of other qualitative approaches to ensure rigour (Sandelowski 2010). The qualitative descriptive approach stays close to the data and provides a straightforward, rich description and accurate account of the meanings participants ascribe to events (Neergaard et al. 2009). We used this design because it allows flexibility in utilising diverse data collection methods (i.e. observations, drawings and interviews) to derive a detailed account of participants’ experiences about a phenomenon (Sandelowski 2010). We analysed data concurrently with data collection and systematically to identify themes as they emerged. To answer our research question, we used art-based techniques, observations and interviews as the methods of data collection.

We conducted data analysis alongside observations and interviews (Charmaz 2006). Subsequently, we started preliminary data analysis immediately after the first observation and interview. On a regular basis, the authors shared observations, drawing activities, transcribed interviews and analytic memos with each other during biweekly debriefing sessions for ideas and detailed directions for subsequent interviews. These sessions occurred throughout the data collection period and challenged the authors to think critically about the data while documenting reflections and information relevant to yielding rich data. The debriefing process was also significant to the exposure and critical evaluation of biases and positionality throughout data collection and analyses. Furthermore, the process brought different perspectives to the data and identified emerging themes that formed the basis of additional probes and checks for upcoming observations and interviews (Creswell & Miller 2000).

All observations, interview transcripts, field notes and analytic memos were imported into a computerised qualitative data management software program (Nvivo 2011) to assist in the organisation of data, identification of categories and development of themes. Specifically, we shared the database and analyses of observations and interviews amongst the team. In this process, we became familiar with the data, identified and compared initial codes and grouped similar codes into categories and developed themes central to the purpose of the study.

We employed triangulation, peer debriefing, member checks and reflexivity throughout data collection and analysis to ensure trustworthiness and credibility in the study finding. We triangulated data using several data collection techniques (observations, drawings and interviews) from participants in different school settings. The first two authors engaged in peer-debriefing sessions and explored each other’s views and perspectives (Pandey & Patnaik 2014). We conducted member checks wherein we consistently repeated each participant’s responses during interviews to confirm their agreement prior to asking the next or follow-up questions (Pandey & Patnaik 2014). Additionally, at the end of the data collection process, we organised a closing session where we chatted with participants on emerging themes and key findings. Considering the age of the participants, we used a member-checking approach recommended by Simpson and Quigley (2016) for use with young participants. In this process, we asked participants the same questions asked in previous interviews and compared responses. All of participants’ responses reflected those in previous interviews.

Reflexivity entails researchers consciously examining their biases because of previous experiences, knowledge or connections with the study population (Råheim et al. 2016). Being a Ghanaian, one of the authors approached this study as an insider with the same identity as participants and cultural knowledge of the study context. Further, this author came to this study with an enthusiasm and empathy for children with IDD demonstrated through 5 years’ work for their inclusion in Ghana. Specifically, during this time, the author assisted in enrolling and relocating children with IDD into schools and half-way homes. The author’s insider perspectives, experiences with the study population and the importance attached to their accessing quality education may influence the ability to ask further meaningful and insightful questions and also interpret results from a non-biased culture perspective. Subsequently, the author practised reflexivity wherein there are discussions about the knowledge and experiences of working with children with IDD with the co-authors who recommended strategies (i.e. asking questions in diverse ways, probing for further clarifications) to reduce bias. The authors engaged each other in preliminary data analysis and interpretation of the data, wherein all authors coded these same transcripts independently and came together to compare codes and identify any gaps or divergences in understanding.

The primary goal of this study was to understand the experiences of children with IDD in receiving education in inclusive settings in Accra, Ghana. We organised our findings along three main themes: (1) characteristics and struggles at the individual level, highlighting bio- and microsystemic factors, (2) characteristics at the environment level, highlighting macrosystemic factors, and (3) interactional patterns also highlighting microsystemic factors within the Bronfenbrenner’s bioecological systemic framework.

A total of eight girls and eight boys participated in the study. Table 2 gives additional information about participant demographics. All students who met the inclusion criteria in a specific class were included in the study. With the exception of one participant who lived with his father and stepmother, all participants lived with both parents. All interviews were conducted in English as participants spoke English in addition to their local dialects.

We have presented the main findings of the data from our study that sought to understand the experiences of children with IDD in inclusive schools in Accra, Ghana. We identified three major themes along three levels of Bronfenbrenner’s bioecological theory of human development that shape the experiences of children with IDD in inclusive schools. These are individual characteristics at the biosystemic level, environmental factors at the macrosystemic level and interactional patterns at the microsystemic level. Specifically, we found that personal characteristics (i.e. behavioural challenges), immediate environments (school and home) and occurrences and interactions within these environments influence children’s experiences in inclusive schools.

At the microsystemic level, we found that children with IDD benefitted from peer relations and received support with classroom assignments and travelling to and from school. This finding is consistent with previous studies that have established peer support as beneficial to the academic achievements and social and emotional well-being of children with disabilities (Carter et al. 2005; Franck & Joshi 2017). Specifically, these studies found that educating children with disabilities in inclusive schools provided the opportunity for them to interact and partner with their peers without disabilities on classroom assignments and in travelling to and from school, which also contributed to improving their academic and social interactional skills.

Although participants benefitted from peer support, they were also subjected to verbal and physical abuse by their peers without disabilities during and after school hours. The victimisation of children with disabilities and particularly those with IDD is a persistent social challenge consistent across different countries. For example, in a study in Zimbabwe, Majoko (2016) identified peer bullying and victimisation as a major social barrier to the inclusion of children with IDD. Participants in this study also reported that teachers were not responsive to complaints relating to incidences of bullying and victimisation. This confirms research showing that general education teachers view children with IDD with scepticism and act in an unresponsive manner towards their needs because of the child’s behavioural challenges (Lifshitz, Glaubman & Issawi 2004).

It is noteworthy that children with IDD in general education classrooms are at higher risk for victimisation than their counterparts in segregated special schools. Studies have confirmed that compared to other students without disabilities and their counterparts with other forms of disabilities, children with IDD often experience the highest rates of bullying and victimisation in the general education classroom because of factors including behavioural challenges and lack of social skills (Fisher, Corr & Morin 2016; Sreckovic, Brunsting & Able 2014). Despite peer victimisation, our study suggests an overall positive peer interaction in the general education classroom, indicating that there is no one homogenised narrative of inclusion. Therefore, an in-depth exploration of peer support and victimisation is important for effective inclusive practice. Specifically, future studies should explore potential strategies that can build upon peer support and develop targeted interventions that can be implemented to control the victimisation of children with IDD in general education classrooms. There is a great need for this research, as peer victimisation often results in negative outcomes for students with IDD, including increased behavioural challenges and school dropout (Sreckovic et al. 2014).

Many female participants in this study expressed concern about unsupportive microsystems, and specifically the negative impact of multiple household chores on their school attendance, concentration in class and overall academic competence. Participants discussed feeling tired from tasks such as fetching water, cleaning and selling for their parents resulting in low academic performance. This finding is consistent with research in similar low- and middle-income countries that found girls, without consideration of disability, underperform in school because of multiple chores (Assaad, Levison & Zibani 2010). This study demonstrates that girls with disability are not exempted from the burden of household responsibilities, and indeed, gender seems to be the barrier in this example rather than disability. Girls and women in Ghana are often culturally perceived as primarily responsible for household chores and are often engaged in multiple household chores including cooking (Naami 2015). Further, cultural beliefs and practices within the country privilege boys over girls and thus prioritise their education over their female counterparts (Naami 2015). Compared to their male counterparts, females with disabilities experience multiple forms of discrimination on account of gender and disability (Naami 2015). Subsequently, females with disability are considered a double liability, with often fewer educational opportunities (i.e. low enrolment) and low employment rates (World Health Organization & World Bank 2011). Understanding gender disparities relating to cultural beliefs, attitudes and practices is important for informing best approaches that place priority on females with disabilities as they relate to education support. This is significant to supporting female educational development in countries such as Ghana, where cultural beliefs and practices raise gender issues that impact educational and employment outcomes (Tuwor & Sossou 2017). Future research should explore targeted interventions that can be enacted to protect girls from uneven distribution of household chores and advance their educational development and employment outcomes.

It is widely accepted that modifications in teaching approaches, curriculum and learning environments are critical for achieving the successful inclusion of children with disabilities, including children with IDD (UNESCO 2005). The academic achievements of children with IDD in the general education classroom are dependent on modifications in teaching practices, curriculum provisions and school environments (Chowdhury 2011). Consistent with previous studies in similar low- and middle-income countries (Westbrook & Croft 2015), we found no evidence of differentiated instruction, curriculum accommodations and modifications in learning environments at the macrosystemic level. In all participating schools, children with IDD used the same materials and performed the same tasks as other students in the same time period. Also, the placement of participants’ desks, which put them out of proximity of their teachers, seemed to reduce engagement with them. This is noteworthy as modifications and adaptations in the general education classroom to suit the diverse and unique learning needs and styles of each learner are the underlying principle of inclusive education (Adewumi et al. 2014). Generally, teacher and student interaction in school settings across developing countries is low because of large classroom sizes, low wages and the lack of adequate resources and services (Masino & Niño-Zarazúa 2016). However, compared to their peers without disabilities or with physical and sensory impairments, teachers are sceptical towards children with IDD and interact less with them (Gyimah et al. 2009). This is often attributed to the problem behaviours these children present and the extra instructional skills required to teach them (Gyimah et al. 2009). In a recent study that sought to assess the impact of computer technology on the reading abilities of students with intellectual disabilities in South Africa, Mosito, Warnick and Esambe (2017) found that computer-assisted learning has the potential to advance the academic achievements of students with intellectual disabilities. Our study suggests that inclusive school environments are not accommodating macrosystems for the children with IDD. Given the importance children in this study attached to education as it relates to future aspirations, there is a need for accommodating macrosystems that differentiate teaching and adapt curriculum to satisfy each student’s unique needs. Future studies may seek to understand teacher’s experiences to determine how to improve their capacity to make adaptations to improve inclusive education implementation. Further, we recommend that the Government of Ghana explores the use of computer-assisted learning with children with IDD.

One finding noteworthy of discussion is the use of corporal punishment in inclusive schools. In both observations and interviews, we found that teachers caned participants for not satisfying academic expectations and/or engaging in undisciplined acts. Interestingly, participants revealed that teachers also allowed students who responded correctly to questions to physically punish them for their inability to do likewise. This finding resonates with the study by Agbenyega (2006) which also found teachers using corporal punishment in Ghanaian schools.

The United Nations Committee on the Rights of the Child defines corporal punishment as ‘any punishment in which physical force is used and intended to cause some degree of pain or discomfort, however light’ (United Nations 2007:4). Also, the committee perceives corporal punishment as an act of violence that humiliates and degrades the human dignity of all children. Although international human rights organisations have called for an end to corporal punishment, the practice is still prevalent in many low- and middle-income countries including Ghana (United Nations 2007). In contrast to western societies where the practice has been abolished in school systems (Axelrod 2011), corporal punishment is a culturally acceptable and widely employed method of disciplining children in Ghana. Since its independence, the country has disciplined students using corporal punishment as it is also perceived to motivate learning and train children towards morally upright and responsible adulthood (Agbenyega 2006; Twum-Danso 2013).

The corporal punishment used with children with IDD in this study may, although equitable, be disproportionally targeted. This is because unlike their peers without disabilities, children with IDD are at higher risk of exhibiting problem behaviours (i.e. aggressive and self-injurious behaviours) (Ageranioti-Bélanger et al. 2012) and may be more prone, because of differences in ability, to perform below expected standards. This study shows that although children with IDD have access to inclusive educational opportunities, they are subjected to humiliating school environments or macrosystems, which is a disincentive to their participation and likely to impede their academic and social achievements. Furthermore, as inclusion aims to provide environments supportive of diverse learners (Ainscow & Sandill 2010), inflicting corporal punishment on children with IDD in these settings raises questions concerning stakeholders’ (i.e. teachers, school heads and governments) understanding of disability, inclusion and their willingness to include these children.

Although Ghana has engaged in discussions around prohibiting corporal punishment, the practice persists in many schools across the country as recommendations have not been clearly enacted into laws (Global Initiative to End All Corporate Punishment of Children 2017). As earlier noted, this contrasts with western societies where corporal punishment has been abolished in school systems (Axelrod 2011). Empirical evidence indicates corporal punishment as detrimental to the health, emotional and psychological well-being of all children (Gershoff 2010; Talwar & Carlson 2011). Thus, there is the need to support rather than punish children with IDD for their differences in the inclusive classroom. The Government of Ghana must review policies to eliminate the use of corporal punishment on all children in school settings across the country and integrate monitoring and evaluation systems that reprimand educators for the practice.

Consistent with previous research in similar low- and middle-income countries, some participants discussed their family’s lack of engagement with their education. At the microsystemic level, researchers have attributed family non-involvement and support in the education of their children with disabilities to factors including poverty, lower levels of education and absence of partnerships between key stakeholders such as families and teachers in inclusion (Mapuranga, Dumba & Musodza 2015).

Although this study demonstrates that there is more room for improvement as it relates to teachers implementing inclusion best practices, it is important to note that one key best practice for inclusion is that it requires a systematic effort involving multiple and diverse stakeholders at various levels of Bronfenbrenner’s theory in order to be successful (Majoko 2016). Given that the findings also indicated minimal involvement of families in the education system, one potential opportunity for growth would be to explore family–professional partnerships within the education system. Family–professional partnerships have been recommended as an appropriate strategy to: (1) educate and empower both families and professionals and (2) build substantial and trusting relationships between them as it relates to the inclusion of children with disabilities (Beneke & Cheatham 2016). Thus, it is an important area that needs to be explored in future research in countries such as Ghana where there is minimal family involvement and collaborative partnerships with professionals and, specifically, teachers in inclusion (Kuyini et al. 2016). In addition to families, there is the need for a greater systematic involvement of stakeholders, such as governments, school heads and directors, in the inclusion of children with IDD.

This study was not without limitations. Firstly, because of limited time and resources, children with IDD who participated in this study were selected from four schools in one urban district of the country’s capital that has well-resourced schools compared to rural settings. As inclusive education is practised in other districts, future studies should explore the experiences of children with IDD from other districts in the country where inclusion is practised. Also, selection bias may have been introduced into this study as the district inclusive education team were largely involved in the recruitment of children with IDD. Finally, despite efforts to include children with all levels of IDD in the study, all participants were in the mild to moderate range of IDD. Additional research that explores the experiences of children with severe to profound IDD is needed in order to facilitate a broader view of the issue.

In this article, we explored the experiences of children with IDD in inclusive schools in Accra, Ghana. We sought to document children’s experiences using classroom observations and interviews. Although participants seemed to benefit from opportunities in inclusive schools, including receiving peer support in learning, they also experience many challenges in learning. The study suggests an overall stressful classroom environment because of large classroom sizes and inadequate supportive measures and resources which makes it challenging for teachers to respond to the additional needs of children with IDD. The study also suggests absence of parental and governmental support in the inclusion of children with IDD. This demonstrates the need for multiple stakeholder action to improve inclusive best practices for children with IDD in Ghana. A commitment of all stakeholders to address the challenges experienced by teachers in inclusive schools would be an important step towards ensuring the full and successful inclusion of all children in inclusive schools in Accra, Ghana.