Cognitive abilities and irritability are the main factors influencing initial placement of autistic preschoolers in special or mainstream education

In many countries, autistic children are placed in either exclusive special education or inclusive mainstream preschool settings following diagnosis. These settings differ in their staff composition and expertise, ability to implement structured autism interventions, ability to integrate autistic and typically developing children, and costs. Here, we examined whether there were significant differences in the behavioral abilities and developmental difficulties of children placed in either setting in Israel. We analyzed data from 165 autistic children, 120 in special and 45 in mainstream education, who completed comprehensive behavioral assessments at a mean age of 37.8 months, as they entered their first preschool setting. Children placed in special education exhibited significantly poorer cognitive abilities and higher irritability and hyperactivity than children in mainstream education while there were no significant differences in autism severity or adaptive behaviors across groups. Moreover, cognitive and irritability scores were sufficient for classifying children across the two settings when using a pruned decision tree algorithm and a 5-fold cross-validation procedure. These findings extend previous research by demonstrating that cognitive abilities and irritability are the strongest predictors of initial educational placement. Further longitudinal research is needed to determine whether these placement decisions benefit the children as they develop.