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Technology-enhanced and game based learning for children with special needs: a systematic mapping study

• Survey Paper
• Open access
• Published: 07 July 2021
• Volume 22 , pages 227–240, ( 2023 )

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• Jose A. Gallud   ORCID: orcid.org/0000-0002-6616-8055 1 ,
• Monica Carreño 2 ,
• Ricardo Tesoriero 1 ,
• Andrés Sandoval 2 ,
• María D. Lozano 1 ,
• Israel Durán 2 ,
• Victor M. R. Penichet 1 &
• Rafael Cosio 2  

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Technology-based education of children with special needs has become the focus of many research works in recent years. The wide range of different disabilities that are encompassed by the term “special needs”, together with the educational requirements of the children affected, represent an enormous multidisciplinary challenge for the research community. In this article, we present a systematic literature review of technology-enhanced and game-based learning systems and methods applied on children with special needs. The article analyzes the state-of-the-art of the research in this field by selecting a group of primary studies and answering a set of research questions. Although there are some previous systematic reviews, it is still not clear what the best tools, games or academic subjects (with technology-enhanced, game-based learning) are, out of those that have obtained good results with children with special needs. The 18 articles selected (carefully filtered out of 614 contributions) have been used to reveal the most frequent disabilities, the different technologies used in the prototypes, the number of learning subjects, and the kind of learning games used. The article also summarizes research opportunities identified in the primary studies.

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1 Introduction

Technology-enhanced learning [ 1 ] and related educational technologies are an important element in the education system. Moreover, they have become particularly useful during the recent COVID-19 pandemic, by helping to maintain educative activity with the support of online teaching systems.

Children with disabilities form one of the most marginalized and excluded groups in society, whose rights are generally ignored [ 2 ]. In recent years, the number of children and young people with disabilities has dramatically increased all over the world.

Previous research articles have presented literature reviews focused on children with special needs [ 3 ], inclusive education or technology and inclusion [ 4 ]. In [ 5 ], the authors present a systematic review of multi-device inclusive environments. Our study is not limited to multi-device systems. Collaborative tools are the research topic of another review [ 6 ], which only analyzes contributions from the ACM Digital Library. Some authors have performed a similar study but focused on higher education [ 7 ]. In spite of the number of similar literature reviews, key questions such as what the most successful technology applied in the education of children with special needs is, or what learning subjects receive the most attention of researchers, among others, have not yet been answered.

The main goal of this article is to analyze the state-of-the-art of technologies used to support the learning process of people with special needs. The study is focused on educational activities for children in kindergarten and primary education (between 3 and 12 years old).

We start with the definition of a research method, and then define a set of research questions (RQs), performing a comprehensive literature search based on the goal of the research, and answering each research question by showing the results. The systematic mapping presents a group of results in the form of tables and figures. These results can be useful for the research community that works in the field of technology-enhanced and game-based learning applied with children with special needs.

The structure of the article is as follows. Section  2 describes the background and related work. Section  3 defines the research methodology applied in this study, and Sect. 4 contains the answers to the research questions. Section  5 includes a discussion of the results. After the discussion, Sect.  6 analyzes the limitations of this research. Finally, Sect.  7 presents the conclusions and lines for future work.

2 Background and related work

This section presents the key terms that are part of the main goal of this study. We have identified three main subsets: technology-enhanced learning, technology applied in the learning process of children with special needs, and game-based learning and gamification in this context.

The term Technology-Enhanced Learning (TEL) refers to the use of technology to enhance the students’ learning process. The foundations and assumptions of technology-enhanced student-centered learning environments are presented in [ 8 ].

Information and Communication Technologies (ICTs) is a term employed to stress the role of telecommunications supporting computer software that enable users to access, store, transmit and manipulate information.

ICTs are a key factor when dealing with the learning process of people with special needs due to the advantages of involving psychologists, therapists, traumatologists, neurologists, etc. A review of seven educational technology journals from 1970 to 2011 in which ICTs are used to support learning activities for people with special needs is presented in [ 9 ].

The use of TEL in the learning process for people with autism is one of the most widely explored fields. The authors of [ 10 ] examine the current state of provision of learning technologies for autistic people and makes recommendations for the design of new technologies and the need for further research. Efforts to enhance the learning process for people with autism are not limited to software design. For instance, the ways in which ICTs are employed to perform technology-enhanced interventions for children with autism can be found in [ 11 ].

The assessment of educational activities is a key task to perform during the learning process. A systematic literature review of accessibility recommendations and practices concerning interactive assessment tasks for Science, Technology, Engineering and Mathematics (STEM) is carried out in [ 12 ].

Virtual Learning Environments (VLEs) provide a good way of performing learning activities because they can be used in both formal and informal learning scenarios. An analysis of the navigation and exploration of a virtual urban environment comparing autistic children with non-autistic children is presented in [ 13 ].

Surveys about how people with special needs interact with computers are also available. The authors of [ 14 ] conducted a large-scale survey that collected computer usage information from the parents of approximately six hundred children with Down syndrome.

Serious games have proved to be an effective mechanism for improving learning processes. The potential of serious games as effective and engaging learning resources for people with intellectual disabilities is presented in [ 15 ]. In addition, the authors of [ 16 ] combine elements of gamification with aspects of accessibility to conceptualize the challenges and possibilities associated with gamified instructional approaches. Gamification models are used in primary education as a learning strategy. In [ 17 ], the authors explore the effect of digital games on students’ scientific competencies. In [ 18 ], the authors investigate the effectiveness of gamification in teaching numeracy in primary school.

From a technological perspective, the usage of digital games in the learning experience of students with Intellectual Disability (ID) is discussed in [ 19 ]. Technologies can be used to assist students with disabilities in accessing the information required to perform the learning process successfully. For instance, AudioLink [ 20 ] is an interactive audio-based virtual environment for children with visual disabilities that supports science learning.

Considering these previous works, the experience of applying technologies in schools can be considered positive. However, a recent study [ 21 ] shows that technology is used to replicate past teaching practices.

The selection of related works presented in this section shows that (a) there is an actual interest in the research community to explore the possibilities of technology and gamification in the education of children in general and children with special needs in particular, and (b) researchers and practitioners could benefit of studies that analyze how technology is been applied in the learning process of children with special needs.

3 Research methodology

This section describes the research methodology applied in this study, which has been adapted from different sources. The backbone has been taken from [ 22 ], and the final details have been inspired by [ 23 ].

Research methodology used in this systematic review

Figure  1 shows the steps followed in the research methodology, and the main outcomes obtained in each step.

3.1 Definition of research questions

As a first step in the methodology, we defined a set of Research Questions (RQs), which are listed in Table  1 .

3.2 Search conduct

After the definition of the RQs, we conducted several searches on the main research databases using selected keywords related to the topic under study. The search strings used on each database can be found in Table  2 .

Table  3 shows the number of articles found in each database. The total number of articles is 614, including duplicates.

3.3 Screening of papers for inclusion and exclusion

In this step we performed the screening of the papers obtained in the previous steps, to exclude those that are not considered relevant to answer the research questions.

The inclusion criteria were the following:

The study should be written in English

The study should be published between 2009 and December 2019

The study directly answers one or more of the research questions of this study

The study should clearly state its focus on children with special needs;

The study should describe the elements and the approach used to implement technology-based systems in primary education.

If the study has been published in more than one journal or conference, the most recent version is included

Among the exclusion criteria, we applied the following:

Short papers

Duplicate articles

Articles not written in English

Articles not focused on children with special needs in primary education

Non-peer-reviewed articles, such as book chapters or technical reports.

Screening of papers

Some of the criteria will have been successfully applied with the correct definition of the search string, which are included in the previous subsection. The rest of the criteria are applied by following the process described below (see Figure  2 ), which has been adapted from that of Dybå and Dingsøyr in [ 24 ]:

Stage 1: Eliminate duplicates

Download the references (citations in BibTex in our case) from each database

Convert the BibTex files into JSON format via scripting

Extract relevant information (title, DOI, type of contribution), from each database separately

Generate a single list by joining the results obtained from each database and eliminating duplicates taking the DOI as primary key

Stage 2: Exclude studies on the basis of titles

Stage 3: Exclude studies on the basis of abstracts

Stage 4: Select studies by assessing their quality.

After performing the process described in Stage 1, the list of articles without duplicates contained 354 contributions.

The second stage was performed by two groups of two researchers, working separately and comparing the results afterward. The titles of the 354 studies retrieved were read and any titles that clearly indicated that the article was outside the focus of this study were excluded. At the end of this activity 238 papers remained.

In Stage 3, some papers were excluded on the basis of their abstracts. This process was carried out in the same way as in the second stage. The abstracts were revised to exclude articles whose focus was not in line with the main goal of our research (is it applied to children with special needs? does it use technology? is it applied in educational settings?). At the end of this process, 140 articles remained.

The last stage in this phase consisted in assessing the quality of the remaining 140 articles by using a checklist adapted from [ 24 ]. This checklist consists of 11 questions about key aspects of the research, method, participants, data collection method, analysis, and findings. At the end of this stage, only 18 works were selected.

One of the important aspects when applying the filtering process is to determine who children with special needs are. A proper answer to this question can be found in [ 25 ].

The final collection of articles is the main outcome of the Screening of Papers stage. The complete list of primary studies can be found in 7, where the articles are ordered alphabetically.

4 Answering the research questions

Once we have the list of the primary studies, the next step is to answer the research questions.

4.1 RQ1 What is the state of the contributions addressing the use of technology to support educational activities for children with special needs published between 2009 and 2019?

In this section the primary contributions are analyzed to find the number of publications per year (RQ1.1), the main publication channels such as journals or conference proceedings (RQ1.2), and, finally, to identify the quality of the primary contributions (RQ1.3).

4.2 RQ1.1 How many academic studies on technology to support educational activities for children with special needs were published between 2009 and 2019?

The first research question analyzes the distribution of the primary contributions over the period 2009-2019. Figure  3 shows the number of articles (vertical axis) distributed over the 10-year period (horizontal axis).

Publications per year (period 2009-2019)

The data shown in Figure  3 reveals that there is no particular pattern in the distribution of the primary studies over the period 2009-2019, though over 45% of the primary studies were published in the last two years of this period. On the other hand, the number of related articles (n=354), after the elimination of duplicates, indicates a high degree of interest on this topic on the part of the research community.

4.3 RQ1.2 What are the publication channels used to publish studies on technology to support children with special needs?

This research question summarizes the publication channels of the primary studies. The list of journals and conferences used by the primary studies can be useful to other researchers working on similar topics.

Table  4 shows 11 journal articles (corresponding to 10 journals) and 7 conference papers. The list of journals and conferences is diverse and there is only one journal with two primary studies (Universal Access in the Information Society).

A closer look at the list of journals allows us to categorize them according to the main topic of each journal. In the categorization we used the initials of each journal as they appears in Table 4 :

Accessibility (n=1): UAIS;

Disabilities (n=2): ARID, ADD;

Human-Computer Interaction (n=1): CHI;

Health (n=2): ERPH, CMPB;

Sensors (n=1): DSN;

Multimedia (n=2): EC, MTA;

Misc (n=1): TT.

The main topic was selected according to each journal’s title. Some of the journals can be grouped under a more general topic, and some journals share the same topic. For instance, UAIS, ARID, ADD and CHI share an interest in the more general area of Human-Computer Interaction. On the other hand, the general area of Health is included in ARID, ADD, ERPH and CMPB.

There are 8 primary studies that have been published in international conferences (Table  4 ). The conferences can also be organized according to a main identified topic.

Games (n=3): SeGAH, ITG and GEM;

Learning (n=1): ECTEL;

Human-Computer Interaction (n=1): Interact;

Multimedia (n=1): ISM;

Accessibility (n=1): ECCE.

In the conference grouping list we find the term “learning,” which is one of the keywords of this study. Also the term “games” is relevant among the conferences of the primary studies. The field of Human-Computer Interaction represents the main area of the primary studies.

4.4 RQ1.3 What is the quality of the selected contributions?

To answer this research question we define a quality indicator, and to do so we assigned a relevance number, which is based on the PlumX metrics [ 26 ]. This indicator will help us to establish a quality metric, which is based on the citation count, the article usage data and the number of captures. To balance these measures, we applied the following formula to obtain a single value ( 1 ), where the citations represent 60%, the usage represents 20% and the captures represent 10%.

Table  5 shows the ordered list of primary studies according to our quality indicator. As expected, the most cited article is the first item in the list according to our quality metric. The three MAX values have been taken from the third stage of the screening (140 articles), where MAX_CITATIONS is 120, MAX_USAGE is 10834 and MAX_CAPTURE is 1447.

The quality indicator of Equation  1 could take into account those articles published during the last year of the period under study, since the number of citations require some time. In the same way, the data shown in Table  5 represent the relative position of each primary study on the exact date when the data were captured. The three values (citations, captures and usage) increase with time until they reach a top value.

This metric reveals that PS17 can be considered a relevant article with 50 citations, and it is also the reference article in captures and usage. The metric also reveals that there is a considerable distance between PS17 and the group formed by the primary studies 1, 11, 6 and 15, whose relevance is only around 20% of PS17.

4.5 RQ2 What are the disabilities that have been the focus of the primary studies?

This research question analyzes the disabilities that have been the object of research in the primary studies (Figure 4 ). Some authors prefer to use the term special need condition [ 6 ].

Disabilities researched in the primary studies

It can be observed that 36.4% of the articles focus on intellectual disability, followed by 22.7% for autism and 18.2% for Down syndrome. On the other hand, very few articles focus on visual, hearing and motor disabilities. We could have considered Down syndrome as a specific kind of intellectual disability (ID), which would mean that this type of disability is addressed by up to 54.6% of the articles.

4.6 RQ3 What are the hardware technologies applied to support educational activities for children with special needs?

The goal of this research question is to find and classify the hardware technologies described in the primary studies. Figure 5 shows the different technologies applied in the primary studies.

Main hardware technologies employed by the primary studies

Table  6 shows the primary studies grouped by technologies. It can be noted that over 31.5% of the primary studies base their prototypes on Microsoft Kinect [ 27 ].

Both, Figure  5 and Table  6 show one main hardware technology as reference in each primary study. However, some primary studies combine the mentioned technology with another hardware and software component. For instance, PS04 uses sensitive resistors and pressure sensors, PS05 uses an electric circuit together with a bracelet, and PS18 also uses a video projector. PS14 is a special case since it applies different educational games without the support of any hardware technology.

4.7 RQ4 What kind of learning games are applied in the primary studies?

This research question summarizes the games used in the prototypes of the primary studies. Table  7 shows the learning game applied in each primary study, together with the associated goal.

Some 50% of the articles are focused on a cognitive therapeutic objective. Articles PS2, PS4 and PS8, focus on games to improve memory.

The following list summarizes the therapeutic goals pursued by primary studies: Cognitive (n=9, 50%), Motor (n=6, 33%), and Social (n=5, 27%).

It can be noted that cognitive skills are the main focus of 50% of the primary studies. However, some games classified as cognitive could also be considered as social, as is the case of “Manage money” or “Identify fruits.” Therefore, the distinction between groups is quite subtle.

4.8 RQ5 What learning subjects are used in the primary studies?

The aim of this research question is to find out what are the learning subjects or academic areas that were the focus of the attention in the primary studies (Table  8 ).

Table  8 shows the learning subject as it appears in each article (column 2). In the third column we have added an Area, which groups similar learning subjects. For example, a set of learning subjects whose main goal is communication, basic hygiene, money management, etc. have been grouped under Civics Education.

There are fuzzy limits between groups. For instance, money management skills has been considered as Civic Education, but it could also have been considered as Mathematics.

4.9 RQ6 Are the interventions defined in the primary studies effective?

This research question has the goal of analyzing to what extend the interventions proposed in the primary studies are effective.

Table  9 shows a list of results selected from each primary study. The selection was based on their relevance to the objective of this study. Several primary studies claim their prototypes help children to improve learning (01, 03, 05, 06, 07, 08. 09, 10, 12, 13, 15, 17, and 18). The rest of the contributions indicate their intervention promotes motivation (02, 04, 11, 14, and 16), which is also a result observed in the first group of articles.

4.10 RQ7 What are the research opportunities identified in the primary studies?

The goal of this research question is to enumerate research opportunities in the primary studies (Table  10 ).

As can be observed in Table  10 , most of the primary studies propose future research directions related to their presented study (02, 03, 04, 05, 07, 09, 11, 12, 13, and 16). In some cases, the proposal is to increase the sample size (01, 02, 11), the scope (11, 17), or to perform long-term studies (08, 09, 18).

5 Discussion

This systematic mapping review has allowed us to select 18 primary studies out of 354 articles. The selected primary studies were focused on the main goal of this study, which is the use of technology-enhanced and game-based learning for children with special needs. We only considered research studies on children in kindergarten, primary and secondary education levels.

Regarding the state of the contributions in this field (RQ1), considering the number of publications in the last 10 years, we can conclude that there is a growing interest in the research community (RQ1.1). The channel of dissemination (RQ1.2) preferred by the primary studies is journals, whose main scope is related to the fields of Human-Computer Interaction, Accessibility, and Health. However, the primary studies belong to a variety of journals, which covers fields ranging from software applications to hardware systems, showing a multidisciplinary nature. The conference papers, according to our quality indicator (based on captures and usage), draw less attention from the readers (RQ1.3).

Research question 2 (RQ2) focuses on the hardware technologies used in the primary studies. The number of prototypes that make use of Kinect [ 27 ] is relevant, which can be useful for future works in this field. It is worth to highlight the little use made of visual patterns such as QR-codes. We can also highlight that there is not a single prototype that makes use of NFC/RFID, a technology that is quite popular and widely available in mobile devices. It is striking that there are no prototypes based on tablets or smartphones. Finally, we can also point out the little use made of sensors and, in general, wearable devices.

The next research question (RQ3) analyzes the disabilities addressed in the primary studies. The main interest (77.3%) of the primary studies is focused on intellectual disability, autism and Down syndrome. Some other disabilities have received minor attention (motor, visual and hearing impairment). This fact points to new possibilities for future research. The attention received by autism is noteworthy, and similar results were reported in [ 6 ], although in our study, autism is the second disability.

As explained in Sect.  2 , in this research we have only considered articles focused on children with a well-defined disability (according to [ 25 ]). However, during the screening process, many articles with technology-based proposals to help children with learning problems were excluded.

The research outcomes show the interest of primary studies in intellectual disability (ID). As a consequence, over 50% of the learning games (RQ4) used in the primary studies have cognitive goals, followed by motor and social goals. Some games have been designed to pursue different goals (motor and social, or cognitive and social), which, on the one hand, has the advantage of improving several skills with the same game and, on the other hand, makes it difficult to analyze the effect of the game concerning different conditions.

Among the prototypes that focus on cognitive aspects, games to improve memory and learning geometric figures stand out. To a lesser extent, games to teach money and fruit management also stand out. However, no prototypes of games were found with the aim of learning colors, letters, numbers, mathematical operations, etc. Likewise, no prototypes were found with the aim of learning about nature, the environment or geography.

Research question 5 analyzes learning subjects in the primary studies. According to the results, it is difficult to find works with the aim of improving some of the subjects included in the primary school curriculum, on the contrary, most of them are focused on therapeutic aspects. By analyzing the results, we can see that the main focus is on the area that we have called Civics Education, with 7 primary studies focused on it. Among the traditional subjects only Mathematics and Natural Sciences appear. Another important group of primary studies is focused on cognitive skills. According to these findings, we can conclude that our study has detected a possible gap within this field, namely works that address subjects in the official curriculum in primary and secondary education.

Research question 6 shows a selection of accomplishments extracted from the primary studies. We can point out that some primary studies use conditional sentences to express their findings, which could indicate a non-conclusive result. One of the most common results is that the technology used in each prototype motivates and encourages children with special needs (5 out of 18), which could be considered a good but minor result. Future studies of technology-enhanced learning in children with special needs should focus on improving learning activities and methods, with motivation being a big first step on this road.

The last research question (RQ7) analyzes the research opportunities described by the primary studies. Some articles suggest performing the research on a larger sample, although it is not easy to find a large group of children with special needs. Some articles suggest performing long-term studies (PS02, PS08, PS13, and PS18). PS06 and PS11 highlight the need to develop more educational and serious games. In the primary study 08, the authors point out the opportunity to use bio-signal sensors and wearable devices, aspects that were also mentioned in the discussion of research question 2. Regarding the research method employed, PS14 indicates that future validations should use quantitative methods. This could apply to those articles that base their findings on subjective qualitative methods.

Finally, it is possible to identify promising research lines by crossing the results obtained in this study. For instance, a research line could focus on crossing RQ2 and RQ3 to get a connection between technology (device or software) and type of disability, which could identify the most suitable technology for a particular disability. Another interesting point could be to identify the capabilities needed in future gadgets to be used in special education. We think our study can contribute to this goal by generalizing some of the capabilities that have been successfully applied in children with special needs

6 Validity of the study: limitations and threats

Any research work involves a series of validity threats and limitations ([ 28 , 29 , 30 ]). In this section, we analyze them and describe the strategies followed to reduce their effects. The validity of this study has been assessed by applying the validity framework presented in [ 29 ]. This assessment covers the following aspects: (a) validity of construction, (b) external validity, (c) internal validity, and (d) validity of conclusion.

The validity of construction refers to the correctness of the measures used for the concept under study [ 28 ] [ 29 ] [ 30 ]. To reduce this threat, we defined a data collection process to ensure the correct selection of items (e.g., inclusion and exclusion criteria), which was used to filter the contributions according to the criteria defined. To guarantee the coherence of the process and manage this threat, one of the authors was in charge of auditing the protocol throughout the whole process. If any inconsistency was found, the process was repeated from the beginning. The protocol required three iterations to reach the final set of primary studies.

The external validity refers to the extent to which the results of the study can be generalized [ 28 ] [ 29 ]. To know to what extend the results of a study can be generalized, it is extremely important to describe the context of the research [ 31 , 32 ]. To minimize the impact of this threat, we applied a rigorous research methodology by adapting the guidelines in [ 22 ], and we performed the extraction of data (data collection procedures) by following the guidelines in [ 28 ] and [ 24 ].

The internal validity refers to the fact that researchers may not be aware of the connections between the different aspects under study when analyzing causal relations among them. In this study, this has not been a real threat as the different factors under investigation are presented independently and the relationships among them are explicit.

The validity of conclusion refers to the influence introduced by the researchers in the analysis of the data. This risk cannot be completely avoided, though it has been reduced by taking the following measures: (a) four researchers participated in the analysis of the primary documents; (b) we conducted a complete audit of the process that filtered 614 documents to identify the 18 primary documents; (c) as stated above, the 140 relevant articles (Stage 4 of the screening) were reviewed by at least two authors, and the conclusions drawn from the analysis of the 18 primary studies were checked by all the authors.

Apart from these four validity threats, we also have to consider the bias in the findings related to the fact that positive research results are more likely to be published than negative results [ 33 ]. In this study, this kind of bias has a minimal effect as the objective of the study is to present the outcomes of a systematic review of technology-enhanced and game-based research applied on children with special needs in primary education. However, we recognize that the publication bias could have affected our results with respect to the benefits and challenges of using technology with children with special needs.

We have limited the research study to the period 2009-2019, which could also be considered a limitation as we have not included the most recent contributions in this field published in 2020.

The data sources and their publication channel may also produce bias in the outcomes. In this work we have used the following research databases: ACM digital library, IEEE Xplore, ISI Web of Science, Science Direct and Scopus, since it is well known that these sources contain most of publications and have been used in similar approaches in literature reviews in areas such as software engineering ([ 23 , 34 ]).

Other types of research works such as scientific studies, short articles, experience reports and assimilation studies, which are not peer-reviewed, were excluded, as they usually present work in progress or preliminary studies whose relevance in the field is considered low.

There is an alternative method proposed in [ 35 ] for conducting Systematic Literature Reviews that could be worth exploring.

7 Conclusions and future work

This systematic mapping study of technology-enhanced and game-based learning for children with special needs is based on a selection of 18 articles out of a total of 354 papers published during the period 2009-2019. The primary studies are distributed over the period, although the last two years account for almost 50%, which shows the current and increasing interest of the research community in this field.

Among the findings, we can highlight the considerable importance given to Intellectual Disability (ID), Autistic Spectrum Disorder (ASD), and Down Syndrome by the primary studies. As far as technological devices are concerned, the Microsoft Kinect device is the most commonly used hardware platform, followed by different software apps. Over 45% of the prototypes found in the primary studies are focused on improving cognitive skills. Improving social skills in children with special needs is also relevant. Regarding the learning subject, it can be observed that Mathematics (numbers, geometric shapes, money management) and Civic Education are the most frequent academic areas of interest. The article also enumerates a list of research opportunities that could be the seed for future research works.

The research method includes a thorough analysis of the limitations of the research method applied. For instance, the study shows the relative relevance of the primary studies among the selected group of contributions from the screening (n=140 in Stage 3), which is used to measure the quality of the contributions.

A systematic review is a research activity that should promote and inspire new lines of research. In the course of this article, different areas to explore in future works have been pointed out, such as the disability under consideration, the most common hardware devices used in prototypes, the academic subject that should be improved, or the learning game used in the research. All these aspects offer new research possibilities, some of which can be found in the corresponding section of this article.

Change history

11 november 2021.

The original version was revised due to update in funding note.

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Gallud, J.A., Carreño, M., Tesoriero, R. et al. Technology-enhanced and game based learning for children with special needs: a systematic mapping study. Univ Access Inf Soc 22 , 227–240 (2023). https://doi.org/10.1007/s10209-021-00824-0

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Editorial article, editorial: insights in special educational needs: 2022.

• 1 School of Education, University of Exeter, Exeter, United Kingdom
• 2 Educational Studies, University of Warwick, Coventry, United Kingdom

Editorial on the Research Topic Insights in special educational needs: 2022

The four papers making up this Research Topic on Insights into SEN: 2022 illustrate new ideas, results and perspectives from different countries (England, Scotland, Chile and Estonia) in diverse areas of this field: identification of SEN, the limitations of survey research, and two papers about students with sensory impairments (academic and social-emotional outcomes in special and ordinary schools and perspectives on engaging in leisure activities outside school). These papers reflect the diverse issues and methodological approaches in this specific field that parallel similar diversity in other areas of educational research.

Taberner addresses the basic issue about identifying SEN in terms of an argument that there are too many kids with special educational needs. She sets the growth in the numbers identified in England in the context of competing tensions within the school system. Her argument calls for rigorous accountability in a system that would adapt to meeting needs rather than pupils meeting system needs.

Seema and Varik-Maasik make an important research methodological point about the limitations of surveys involving students with learning difficulties using broad samples, in their paper : Students' digital addiction and learning difficulties: shortcomings of surveys in inclusion . In an e-survey of teenagers' digital addiction they show higher predictability of perceived learning difficulties in terms of screen time and digital addiction for average students, but poor prediction for students whose scores are very different from the mean. Their study shows, they conclude, that reliable data about students with SEN might not be collected by wide scale e-surveys, especially if these students' participation needs are not addressed.

Rosas et al. report and discuss a small scale comparative study of deaf and blind students' cognitive and social-emotional outcomes in Chilean special and ordinary school settings in their paper: The paradoxes of inclusion: Cognitive and socio-emotional developmental trajectories of deaf and blind primary education students in mainstream and special schools . They report that deaf students attending special schools perform better on most of the studied outcomes. By contrast, blind students generally perform better in ordinary schools, though for socio-emotional variables, they had fewer problems in special schools. Though these differences were not statistically significant, they use their results to discuss how student characteristics need to be considered in deciding on an adequate setting for optimal development.

Hannah explored the perspectives of children and young people with a sensory loss in one locality in Scotland about opportunities to participate in leisure activities in her paper: Perspectives of children and young people with a sensory loss: Opportunities and experiences of engagement in leisure activities . Using virtual focus groups she reports that they enjoyed having opportunities to be with other children outside school. This was about not feeling alone and being understood. However, other research has indicated that, despite the benefits, children and young people with disabilities participate less in physical and leisure activities out of school than children without disabilities. The results of the qualitative study reported provide rich findings from the focus groups (28 subthemes grouped into 12 subthemes). These are taken to imply the importance of raising awareness of the needs of individuals with sensory loss for engaging in leisure activities in accessible environments, and identify opportunities, facilitators and barriers relevant to achieving this.

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Keywords: insights, SEN identification, survey methods, inclusion paradox, leisure engagement

Citation: Norwich B and Lindsay GA (2024) Editorial: Insights in special educational needs: 2022. Front. Educ. 9:1375182. doi: 10.3389/feduc.2024.1375182

Received: 23 January 2024; Accepted: 29 January 2024; Published: 06 February 2024.

Edited and reviewed by: Margaret Grogan , Chapman University, United States

Copyright © 2024 Norwich and Lindsay. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Brahm Norwich, b.norwich@exeter.ac.uk

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Parental stress in families of children with special educational needs: a systematic review

Associated data.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

This systematic review aimed to identify the risk factors and protective factors for parental stress in families with children with special educational needs. Studies have indicated that the wellbeing of families is related to the physical, psychological, and social conditions of the children, as well as the family functioning, stress coping strategies, and social and professional support of their parents. The parents of children with special educational needs experience high levels of parental stress. Identifying the associated risk factors and protective factors may shed light on the provision of interventions to promote the mental wellbeing of these parents.

Boolean operators were used to search multiple online databases, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied in this systematic review. Data were extracted into categories of population, age, region, the child's diagnosis, the stress-measuring instrument, and the risk factors and protective factors.

Twenty-six studies, including 5,169 parents and 3,726 children, were reviewed. The following four major risk factors and protective factors were found to be associated with parental stress: the sex of the parents, diagnosis-related coping issues, socioeconomic characteristics, and social isolation of the parents.

Conclusions

This systematic review identified four significant risk factors and protective factors related to social support from couples, family members, and social circles. Various agencies may provide financial and manpower assistance and professional support and services to improve the parents' knowledge and coping skills, as well as affectional support, early screening, and continuous assessment of the parents' progress. Social policies and interventions offering continuous and diagnosis-related support to the parents of children with special educational needs are highly recommended.

Introduction

Over 291 million children and adolescents younger than 20 years globally were estimated to have developmental disabilities and special educational needs ( 1 ). These children may have disabilities, such as intellectual disability, epilepsy, hearing or vision loss, autism spectrum disorder (ASD), or attention deficit hyperactivity disorder ( 2 ). Parenting a child with SEN may be a wonderful journey with a sense of accomplishment and excitement, but it may also be challenging or even impose a caregiving burden ( 3 ).

Parents of children with SEN may be prone to psychological distress, such as anxiety, sleep disturbances, and frustration, when facing the behavioral problems of their children ( 4 , 5 ). For example, a study by Caley ( 6 ) found that the mother, as the primary caretaker of SEN experienced higher stress levels. Stress may come from managing the challenging behavior and special needs of children. Aif et al. ( 7 ) concluded that parents bringing up children with SEN face overall family life changes, and burdens affect many aspects of life. Prolonged stress from handling children's daily-life problems and diverse and challenging needs may affect family functioning and wellbeing ( 8 , 9 ). Parents may also feel stress and experience additional financial strain when taking care of their children who have SEN in combination with fluctuating health conditions or the requirement for repeated hospitalization ( 10 – 12 ).

The impact of taking care of children with SEN is multifaceted. It is not uncommon for such parents to have marital problems, physical and psychological distress, or mental health issues ( 13 – 15 ). Studies have provided some hints of the possible factors contributing to the mental wellbeing of the parents of children with SEN. For example, families who receive services designed based on person-centered and family-centered approaches have been found to experience less marital stress. These families may develop more appropriate or adaptive techniques to take care of their children and may feel more supported by healthcare service providers ( 3 ). Psychoeducation programs designed to address the challenging behavior and health conditions of children with SEN (e.g., ASD) have been shown to effectively reduce the maternal burden ( 16 ).

To improve the wellbeing of the parents or informal caregivers of children with SEN, it is essential to identify the risk factors and protective factors for stress in this population. The aim of this study was to identify the risk factors and protective factors affecting the stress level of the parents of children with SEN. A better understanding of these factors may help to provide guidelines for service providers to design effective interventions ( 17 – 19 ).

Operation definition

This is a systematic review of studies on stress experienced by the parents of children (aged 3–17) with SEN. In this paper, SEN include specific learning difficulties, intellectual disability, ASD, attention deficit hyperactivity disorder, physical disability, visual impairment, hearing impairment, and speech and language impairments ( 20 ). Parent-related stress represents the level of dysfunction in the parent–child system related to the parent's functioning ( 15 ).

Article selection

The initial search was first applied to the Cochrane Database of Systematic Reviews to determine if any previous reviews covered our topic. After confirming that there was no equivalent review, an extended search was conducted.

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols ( 21 ). Boolean searches were used to interrogate PubMed, Embase, Cochrane Library, PsycINFO (via ProQuest), and Web of Science databases. Studies published from 1960 to 2021 were searched. The following search terms were entered into the databases: “parental stress,” “special educational needs,” “risk factor,” and “stress level measurement.” The detailed search terms included “parental stress AND special educational needs,” “parental stress AND special educational needs and/or disabilities,” “parental stress AND special educational needs AND measuring risk level,” “parental stress AND special educational needs AND level of risk,” “parental stress AND special educational needs AND risk factor,” “parental stress AND special educational needs AND stress level measurement,” “parental stress level measurement AND special educational needs,” “parenting stress level measurement AND special educational needs,” and “parent stress level AND special educational needs.”

Articles were included in the analysis if:

• they reported primary research investigating stress experienced by the mother, father, or both parents of children with SEN, with at least one quantitative measurement or in a qualitative format;
• they were published in a peer-reviewed journal; and
• the full-text publication was available in English.

Articles were excluded if:

• they reported a study unrelated to parental stress or
• they reported secondary research or were a conference presentation or unpublished thesis.

The primary database search identified 3,092 records. Information was imported to EndNote 20 (Clarivate, London, UK) for the deduplication process to eliminate redundant data. After completing this process, 2,524 articles were excluded. In addition, 169 articles were excluded as they were not relevant. Another 169 articles were excluded as they did not evaluate both parental stress and SEN. Another 204 articles were excluded because they reported secondary research, consisted of a manuscript or conference material with an abstract only, or did not report parental stress. No further eligible studies were identified during the manual screening process. Finally, 26 articles were included in this systematic review. The details of the screening process, which followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines ( 22 ), are described in Figure 1 .

Preferred reporting items for systematic reviews and meta-analyses flow chart of the screening process.

Description of the articles reviewed

After screening the articles, relevant data were extracted and summarized in tabular format. The characteristics of the included studies are summarized in Table 1 .

Characteristics of the reviewed articles.

This review covered 26 studies, which included seven studies from the USA; five from Europe; and 14 from Asia, including five from China and Hong Kong. Of these 26 studies, 11 involved ASD, six involved ADHD, and 11 involved intellectual disability. For the articles involving intellectual disability, different terms, such as cognitive delay ( 34 ), intellectual disability ( 30 , 31 ), and mental disability ( 42 ), were applied.

Risk factors and protective factors

The following four major categories of risk factors and protective factors were identified: the sex of the parents, diagnosis-related coping issues, socioeconomic characteristics, and social isolation of the parents.

Sex of the parents

Mothers were reported to perceive more parental stress than fathers in four studies, mainly due to their labor workload and their need to handle unpredictable situations ( 28 – 30 , 36 ). Only one study reported the same stress level between mothers and fathers in 15 families ( 39 ). Parental stress was found to increase with the increasing age of the parents ( 29 ).

Diagnosis-related coping issues

Twelve studies reported that the major risk factors were the challenging behavior or maladaptive behavior of children with SEN. Behavioral problems related to ASD or ADHD or the emotional problems of children with SEN were related to higher levels of parental stress ( 23 – 25 , 27 , 28 , 31 , 33 , 35 , 39 , 47 ). Higher levels of emotional problems of SEN children, higher parental stress were recorded. Parents who do not have adequate professional or social support may develop poor parenting practices. Negative coping habits or handling methods may result from the lack of appropriate knowledge and competence to handle stressful situations ( 24 , 31 , 32 , 43 ).

Protective factors, such as professional support ( 23 , 25 , 27 – 32 , 34 , 35 , 41 , 44 ), and positive coping skills and techniques, such as stress management strategies, were related to lower levels of parental stress ( 31 , 42 , 45 , 47 ). That is, a better understanding of the child's progress and gaining knowledge and skills to manage the behaviors of children with SEN were also protective factors.

Furthermore, a study of parents reported that those who knew the diagnosis of their child since birth were able to adjust their expectations ( 23 ). For example, the parents were able to cope better if the cognitive deficits of their children were identified at birth, rather than acquired later.

Socioeconomic characteristics

Having financial problems ( 31 , 34 , 45 ) and a family's lower socioeconomic level ( 44 , 46 ) were related to higher levels of parental stress in parents of children with SEN compared with parents of typically developing children.

Five studies ( 31 , 34 , 44 – 46 ) from countries including Israel, Vietnam, Malawi of Africa, and China reported that financial issues were a risk factor, but parents demonstrated hesitation and resistance to seek financial assistance due to social pressure and associated feelings of shame about disclosing the family's situation. Another two studies found that the self-disclosure of the family's information and needs when approaching government services was a source of shame and conflict with other family members.

Social isolation of parents

Five studies reported that social isolation and a poor social life were sources of parenting burdens and increased the stress level of parents ( 24 , 31 – 33 , 43 ). This occurred because the lack time for oneself and insufficient social support may increase perceived levels of stress. Another three studies reported that poor family support induced extra stress during the caregiving journey ( 37 , 38 , 43 ). Four studies indicated that stigma and judgment from others induced stress in the parents of children with SEN ( 25 , 31 , 40 , 47 ).

However, it was found that supportive family and marital relationships and sufficient labor help were protective factors. Support from professionals ( 25 , 27 – 29 , 31 , 32 , 37 , 41 , 42 , 45 , 47 ) and family members ( 7 , 26 , 27 , 29 , 44 ) were factors contributing to a reduction in the levels of parental stress. Regarding family support, four studies showed that positive marital relationships and support from spouses were essential protective factors ( 35 , 38 , 39 , 44 ). Three studies conducted in the Asian region: Jordan, Malaysia, and Israel ( 30 , 37 , 40 ) indicated that strong family support promoted a positive perception of the parental task as a challenge rather than a burden. Sufficient professional services were found to be useful for improving the mindfulness and attitudes of the parents ( 25 ) and their knowledge of disease and behavioral management ( 29 , 32 , 45 , 47 ). Ongoing assessments of the parenting situation ( 41 ) and stress management techniques ( 30 , 42 , 47 ) may also reduce parental stress. Thirteen studies applied the Parenting Stress Index–Short Form to evaluate parental stress.

The results indicated that there were differences in parental stress levels between fathers and mothers, with mothers perceiving higher stress levels than fathers. A higher stress level may be induced by closer interactions with children to handle behavior related to their diagnosis. Role identification within the family may be one of the underlying reasons for this finding; that is, the father may focus on breadwinning rather than caring or daily house activities. A heavy workload for the daily care of children and more frequent interactions with problematic behavior were some of the sources of parental stress. The major caring role was shouldered by the mother, leading to higher stress levels for mothers. Studies ( 48 , 49 ) have shown that parental stress is induced by heavy physical and psychological burdens related to daily caring and continuous worrying about the child's future. This may have negative effects on the entire family system and directly impact the quality of life of the whole family ( 50 – 52 ). In China, mothers generally take greater responsibility for childcare than fathers ( 45 ). Mothers face unique challenges in handling SEN children's emotional and behavioral symptoms. The mothers may perceive being left alone in the caring duties as they play a significant role in raising SEN children. When adequate external support is available, the mothers may gain confidence to adopt a more positive living style. Professional support may include caring techniques, knowledge of SEN, and information on available services. Direct intervention from different professions may reduce parental stress more effectively.

The father was identified as an immeasurable source of support ( 39 ), Further studies on how the family role and the father–child relationship affect parental stress are recommended. In the meanwhile, service providers may consider to actively involve father into training as a partner, to fully utilize their strengths to support their spouses. Adequate support to fathers and recognitions afterwards are therefore foundations to development of fathers.

For diagnosis-related issues, one of the identified risk factors was handling the challenging behavior of the children. The underlying deficits leading to the challenging behavior of children with SEN are varied. The lack of knowledge and skills in behavioral management of children with SEN may induce negative coping behaviors (e.g., reacting with anger), which cause further anxiety and stress to the parents ( 6 , 53 ). Therefore, diagnosis-specific psychoeducation programs (e.g., knowledge of the specific conditions of children with SEN and parenting, behavioral management, problem-solving, and stress management skills) would be helpful to reduce the stress levels of the parents ( 5 , 10 , 54 ).

Formal support from professionals and government policy may provide structured and sustainable assistance to parents to improve their knowledge and skills to handle problems or crisis in daily care. The informal support system, on the other hand, including support from family members, relatives and friends, and even neighborhoods, can act as a moderating factor to reduce parental stress and improve the wellbeing of mothers ( 40 ). Multiple studies indicated social support is an essential protective factor to reduce perceived parental stress ( 39 , 44 , 47 ). Some parents may consider their social life is being sacrificed. Muñoz-Silva et al. ( 24 ) found that the strongest predictor of mothers' stress is the negative impact on their social life, but not the children's emotional problems nor the mothers' perceived social support. Therefore, the parent's social life should be considered when designing an improvement plan for the family.

Because of negative coping habits or handling methods, parents have a feeling of shame when children exhibit uncontrollable challenging behavior in a social environment ( 40 ) and they blame themselves ( 7 , 38 ) or have low confidence in managing their children with SEN ( 46 ). Long-term follow-up by a professional is recommended. For example, professionals may provide ongoing monitoring of the parents' stress levels and refer them to suitable professional services as required.

Financial and human resource constraints may be some of the major risk factors for parental stress, as parents from lower socioeconomic levels need extra support for expenses and manpower to care for their children with SEN ( 55 ). For example, the parents of children with SEN may perceive extra physical, time, and financial concerns when bringing their children to receive treatment. To minimize the traveling costs, telehealth or tele-rehabilitation may be alternative options to support the parents. However, further enhancement of telehealth or tele-rehabilitation systems is needed. Government policies on financial support for the parents of children with SEN are also recommended.

Emotional support was one of the main protective factors identified. Professional staff may provide opportunities for parents to express their concerns, unmet needs, and worries. Social groups were able to provide opportunities for parents to share their unique stories with others with similar experiences. Studies have also suggested the importance of social relationships in reducing parental stress ( 3 , 6 ).

Chu et al. ( 37 ) conducted a study which recruited 110 parents of children with ASD, with 80 mothers and 30 fathers, with ages mainly around 21–50, from an online support group. It was found that although stressful situations and parenting difficulties occurred due to time-demanding tasks required by the children, parents expressed that affiliate stigma does not affect their stress levels and even quality of life. It is worth to note that the participants were active support group members who shared knowledge and offered social support in caring for ASD children. The members of this support group were also exposed to massive amounts of information and experience sharing and also receiving therapy from different professionals. Sharing positive coping strategies can tackle stress associated with feelings of helplessness and isolation ( 56 ). This indicates some essential features of peer support group that may help reducing parental stress. Cultural factors should be considered as 93.6% of the participants in that study are Malay. Malay perceives the child as a form of test from God, and parents will be judged in the afterlife ( 57 ). This may have an impact on the view of caring duties of caring for their children with SEN.

Limitations

This systematic review has several limitations. First, most of the research participants were mothers (3,585 mothers and 699 fathers). The participants joined the studies voluntarily, but actively participating attendants may have a more positive attitude, which may have biased the results. Second, not all studies included a control group or applied a randomized control trial in the research design. Third, the screening, selection, and data extraction processes were performed by a single researcher. Therefore, further studies on parental stress experienced by fathers, performed with the involvement of a second researcher are recommended.

This systematic review synthesized recent findings on the risk factors and protective factors for parental stress in the families of children with SEN. Regarding risk factors, handling the challenging behavior of children is the major component of diagnosis-related coping issues. Financial problems and lower socioeconomic levels restricted the time and resources to care for SEN children. Social isolation of parents is considered as a risk factor caused by poor social life, insufficient family support, and even stigma and judgment from others. On the other hand, protective factors such as professional support can improve positive coping skills and gain a better understanding of a child's progress. Supporting family systems and positive marital relationships can lead to better resilience and coping techniques for parents, leading to better wellbeing.

Healthcare professionals have a unique role in remediating parents' burdens. Parents expected a gracious explanation or time from professionals. Parents treasured being taken by the professionals seriously. Considering the parental stress induced by taking caring of SEN children, healthcare professionals can act as a source of information and direct support as well as assisting parents in developing positive coping techniques. A valid parental stress assessment is essential. It is noticed that the most commonly applied parental measurement tool by healthcare professionals was the Parenting Stress Index-Short Form. Moreover, measurement tool identifying the risk factor and protector factor would be needed to promote the resilience of the parents.

Parenting a child with SEN may be a complicated and demanding task, which may lead to additional financial, physical, psychological, and social burdens. This review identified the possible risk factors and protective factors for parental stress, with the aim of identifying ways to relieve this stress.

The findings from the reviews suggest when identified parents of SEN with high stress, service provider should provide choices of stress-relieving programs, direct assistance in manpower or financial issue, and also provide professional opinion to develop positive handling technique. When existing services cannot fulfill particular needs, referral to health care professionals should be considered, in order to design custom made program. It may guide the practice of service providers. The development of diagnosis-specific parental support programs and future studies on their impact on parents with different family roles are recommended.

Data availability statement

Author contributions.

AC and CL designed the review. AC conducted the systematic review and prepared the tables and figures. CL edited the review. All authors contributed to the article and approved the submitted version.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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