A dual design thinking - universal design approach to catalyze neurodiversity advocacy through collaboration among high-schoolers

Introduction

Neurodiversity describes the fact that humans all have different brains with unique qualities that contribute to society. Though understanding of neurodiversity is gaining traction among the general public, there remains considerable stigma and prejudice toward neurodiverse people. One way to combat these issues is to teach individuals about neurodiversity and encourage them to develop advocacy skills. Development of such knowledge is especially important for adolescents, as they have the capacity to make small (e.g., interpersonal interactions) and large (e.g., school-wide) impacts.

Methods

Eighty-nine high schoolers participated in a two-week virtual summer camp in 2022; research consent/assent was obtained from 19 (11 neurodiverse/neurodivergent). Campers learned about neurodiversity, Universal Design for Learning (UDL), and Design Thinking (DT) through lectures from researchers and neurodivergent people, as well as group activities and discussions. Campers worked in small groups to design a neurodiversity advocacy project based on the principles of UDL and DT. Each group was facilitated by camp counselors-some of whom were neurodiverse-who were all committed to neurodiversity advocacy. Participants completed questionnaires about autism, ADHD, and dyslexia pre- and post-camp. Some also completed optional post-camp interviews.

Results

Pre-camp stigma toward neurodiverse conditions was generally low. However, autism stigma was significantly higher than dyslexia stigma (Z = -2.24, p = 0.025). After camp, autism stigma decreased (Z = -2.98, p = 0.003;) and autism [t(13) = 3.17, p = 0.007] and ADHD [t(13) = 2.87, p = 0.013] knowledge improved. There were no significant changes in ADHD or dyslexia stigma or dyslexia knowledge. Participants reported enjoying collaborating with other campers and learning about UDL and DT. Thematic analysis of interviews generated four themes: Increased Understanding of Neurodiversity; Increasing Empathy and Becoming Less Judgmental; Creating a Neurodiverse Community; and More Awareness is Needed.

Discussion

This pilot investigation suggests that a virtual summer camp can be effective in improving attitudes toward and knowledge of neurodiversity. Qualitative analysis indicated participants became more accepting after the camp, both in terms of being less judgmental toward neurodiverse people and more self-accepting among neurodivergent campers. Future research should investigate the long-term effects of such a program, particularly with diverse samples of students.

A neuroanatomy lab practical exam format in alignment with the universal design for learning framework

The traditional format for neuroanatomy lab practical exams involves stations with a time limit for each station and inability to revisit stations. Timed exams have been associated with anxiety, which can lead to poor performance. In alignment with the universal design for learning (UDL), Timed Image Question and Untimed Image Question exam formats were designed to determine which format supports student success, especially for those who performed poorly in the traditional format. Only the Untimed Image Question format allowed students to revisit questions. All three formats were administered in a randomized order within a course for three cohorts of medical students. When all students' scores were analyzed together, the type of format had no effect. However, when analyses were conducted only on students who performed poorly in the traditional format, the type of format had an effect. These students increased their score, on average, by at least one grade level in the Untimed Image Question format compared to the traditional format. Students who performed well in the traditional format maintained their A, on average, in the two new formats. More students indicated Untimed Image Question as their most preferred format after experiencing all three formats. Most students associated the inability to revisit questions with high levels of anxiety. A neuroanatomy lab exam format was therefore identified as consistent with the UDL framework such that all students, regardless of test anxiety levels, can equally demonstrate what they learned. This format allowed for unlimited time per question and ability to revisit questions.

Towards Universally Designed Communication: Opportunities and Challenges in the Use of Automatic Speech Recognition Systems to Support Access, Understanding and Use of Information in Communicative Settings

Unlike physical barriers, communication barriers do not have an easy solution: people speak or sign in different languages and may have wide-ranging proficiency levels in the languages they understand and produce. Universal Design (UD) principles in the domain of language and communication have guided the production of multimodal (audio, visual, written) information. For example, UD guidelines encourage websites to provide information in alternative formats (for example, a video with captions; a sign language version). The same UD for Learning principles apply in the classroom, and instructors are encouraged to prepare content to be presented multimodally, making use of increasingly available technology. In this chapter, I will address some of the opportunities and challenges offered by automatic speech recognition (ASR) systems. These systems have many strengths, and the most evident is the time they employ to convert speech sounds into a written form, faster than the time human transcribers need to perform the same process. These systems also present weaknesses, for example, a higher rate of errors when compared to human-generated transcriptions. It is essential to weigh the strengths and weaknesses of technology when choosing which device(s) to use in a universally designed environment to enhance access to information and communication. It is equally imperative to understand which tools are most appropriate for diverse populations. Therefore, researchers should continue investigating how people process information in a multimodal format, and how technology can be improved based on this knowledge and users' needs and feedback.

A systematic review of videoconferencing in health professions education: the digital divide revisited in the COVID-19 era

OBJECTIVES

During the COVID-19 pandemic, educators shifted from traditional lectures to videoconferencing. This systematic review explored the use of videoconferencing as a teaching tool in response to the pandemic as well as issues related to digital equity and inclusion.

CONTENT

The review was conducted using the Joanna Briggs Institute for Systematic Reviews methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.

SUMMARY

A total of nine studies met eligibility criteria. The participants in the included studies were medical students from various parts of the world. Technical difficulties and lack of human interactions were identified as barriers to learning through videoconferencing.

OUTLOOK

To achieve full success, pedagogical videoconferencing must prioritize digital equity and a universal design for learning. Although useful for maintaining education during the pandemic, in the future, videoconferencing will present challenges related to the digital divide as well as opportunities as a teaching tool for nurse educators globally.

Universal design for learning in anatomy education of healthcare students: A scoping review

There are concerns among healthcare practitioners about poor anatomical knowledge among recent healthcare graduates. Universal Design for Learning (UDL) is a framework developed to enhance students' experience of learning and help students to become motivated learners. This scoping review identified whether UDL has been utilized in third level healthcare education and if so, whether it had been used to enhance student motivation to study anatomy. Seven online databases were searched for studies reporting the use of UDL in the curricula of medical, dental, occupational therapy (OT) or speech and language therapy (SLT) programs. Studies were screened for eligibility with set inclusion criteria. Data were extracted and analyzed. Analysis revealed that UDL was not specifically mentioned in any of the studies thus there are no published studies on UDL being formally applied in healthcare education. However, the authors identified 33 publications that described teaching methods which aligned with UDL in anatomy curricula and a thematic analysis yielded four main themes relating to teaching strategies being employed. Universal design for learning was not mentioned specifically, indicating that educators may not be aware of the educational framework, although they appeared to be utilizing aspects of it in their teaching. The review revealed that there is a lack of research concerning the anatomy education of OT and SLT students. The role of UDL in enhancing motivation to learn anatomy in medical, dental, OT and SLT programs has yet to be explored.

Awareness of Universal Design for Learning among anatomy educators in higher level institutions in the Republic of Ireland and United Kingdom

There is an increasing need to facilitate enhanced student engagement in anatomy education. Higher education students differ in academic preferences and abilities and so, not all teaching strategies suit all students. Therefore, it is suggested that curricula design and delivery adapt to sustain learner engagement. Enhanced learner engagement is a fundamental feature of Universal Design for Learning (UDL). The aim of this study is to determine if anatomy educators in the Republic of Ireland (ROI) and United Kingdom (UK) are aware of UDL and to assess if, and to what extent, it has been implemented in the design and delivery of anatomy curricula for healthcare students. An anonymous online questionnaire was administered to anatomy educators in higher level institutions in the ROI and UK. Inductive content analysis was used to identify the impact of UDL on student learning, engagement, and motivation, as perceived by the participants. The response rate was 23% (n = 61). Nineteen participants stated they knew of UDL. Of these, 15 had utilized UDL in their teaching of anatomy. Analysis indicated that the perception of UDL was mixed. However, the majority of responses relating to UDL were positive. The majority of the respondents were unaware of UDL but identified the frameworks' checkpoints within their curriculum, suggesting they have unknowingly incorporated elements of UDL in their curriculum design and delivery. There is a lack of information on the benefits of explicit utilization of UDL for engagement and motivation to learn anatomy in healthcare programs in the ROI and UK.

Towards a More Inclusive Learning Environment: The Importance of Providing Captions That Are Suited to Learners' Language Proficiency in the UDL Classroom

Captions have been found to benefit diverse learners, supporting comprehension, memory for content, vocabulary acquisition, and literacy. Captions may, thus, be one feature of universally designed learning (UDL) environments [1, 4]. The primary aim of this study was to examine whether captions are always useful, or whether their utility depends on individual differences, specifically proficiency in the language of the audio. To study this, we presented non-native speakers of English with an audio-visual recording of an unscripted seminar-style lesson in English retrieved from a University website. We assessed English language proficiency with an objective test. To test comprehension, we administered a ten-item comprehension test on the content of the lecture. Our secondary aim was to compare the effects of different types of captions on viewer comprehension. We, therefore, created three viewing conditions: video with no captions (NC), video with premade captions (downloaded from the university website) (UC) and video with automatically generated captions (AC). Our results showed an overall strong effect of proficiency on lecture comprehension, as expected. Interestingly, we also found that whether captions helped or not depended on proficiency and caption type. The captions provided by the University website benefited our learners only if their English language proficiency was high enough. When their proficiency was lower, however, the captions provided by the university were detrimental and performance was worse than having no captions. For the lower proficiency levels, automatic captions (AC) provided the best advantage. We attribute this finding to pre-existing characteristics of the captions provided by the university website. Taken together, these findings caution institutions with a commitment to UDL against thinking that one type of caption suits all. The study highlights the need for testing captioning systems with diverse learners, under different conditions, to better understand what factors are beneficial for whom and when.

Catering to Inclusion and Diversity With Universal Design for Learning in Asynchronous Online Education: A Self-Determination Theory Perspective

The Universal Design for Learning (UDL) guidelines were extensively studied to understand inclusive learning and teaching in higher education. However, to date, there have been few studies that approached UDL-based asynchronous university courses from the needs satisfaction perspective in self-determination theory (SDT). To address this gap, researchers designed and implemented two 15-week asynchronous online courses based on UDL. They then tested their effectiveness with college freshmen (N = 225) by adopting a sequential explanatory mixed method. The study aimed to examine (i) whether asynchronous instruction based on UDL catered to inclusion and diversity across gender and academic background and (ii) whether the instructional design supported learner engagement and needs satisfaction. The findings showed that both male and female students as well as Arts and Sciences students equally engaged in the courses and perceived the needs support from the course design. However, the study also found that although universal design supported autonomy and competence, it nonetheless failed to fully satisfy learners’ relatedness needs. The researchers concluded by discussing empirical and theoretical implications.

Fostering equity, diversity, and inclusion in large, first-year classes: Using reflective practice questions to promote universal design for learning in ecology and evolution lessons

Instructors can deliberately design for equity, diversity, and inclusion, including for large first-year classes, and now instructors have added challenges given COVID-19. Our paper explores the question: How do we integrate equity, diversity, and inclusion and universal design for learning (UDL) into first-year, undergraduate ecology and evolution introductory lessons given the COVID-19 pandemic? Given the large field exploring equity, diversity, and inclusion, we chose to focus on developing reflective practice question rubrics for before, during, and after lessons to encourage UDL for instructors, teaching assistants, and learners. We conducted a focus group within our team and discussed ideas related to online learning, including related pitfalls and solutions. Lastly, we created a figure to illustrate ideas and end with a general discussion. Our reflective practice questions for UDL rubrics, figure, focus group, and discussion aim to increase positive action for equity, diversity, and inclusion in the classroom and beyond.

Extending "Beyond Diversity": Culturally Responsive Universal Design Principles for Medical Education

This commentary follows up on Maduakolam et al. (2020) "Beyond Diversity: Envisioning Inclusion in Medical Education Research and Practice," which introduced Culturally Responsive Universal Design for Learning (CRUDL) as an approach to accounting for learner diversity in educational theory development and curriculum design. We flesh out the principles of CRUDL, using publications in this issue of Teaching and Learning in Medicine as case examples for how the principles work in action. With this scholarly thought exercise, we seek to demonstrate the feasibility and promise of curriculum that is accountable to diverse learners and the impact of historical trauma. We also explore how research inclusive of diverse social identities could inform curriculum design by identifying how social identity, learning environment, educational activities, and learner engagement interact to produce diverse learning experiences and performance. Scholarly thought exercises such as this one may help bridge the gap between professed ideals and action with respect to inclusive medical education; CRUDL principles provide a helpful framework for planning and evaluating accountable curriculum design.

Universal design for learning in inclusive education policy in South Africa

Background

South Africa has undertaken the implementation of inclusive education as a vehicle for achieving enhanced educational outcomes and equity. Universal Design for Learning (UDL) is an instructional design framework that takes into account the wide range of variations in skills and abilities that exist across all learners, and provides a research-based set of principles and guidelines for inclusive curriculum development and delivery.

Objectives

To locate UDL within the specific inclusive education policy context of South Africa and consider how this approach can support policy implementation. We have argued that UDL could serve as a strategy to link policy imperatives with classroom practice, enabling effective communication between the different actors.

Method

We reviewed fundamental inclusive education policies in South Africa and research relating to their implementation, and how they configure support and curriculum differentiation. We then compared this understanding with that proposed by UDL and considered what could be gained in adopting a UDL framework.

Results

We noted that UDL has several advantages in that it allows for a common language between education stakeholders and gives new meaning to the interpretation of levels of support.

Conclusion

The implementation of inclusive education in South Africa could be enhanced by introducing the concepts of UDL into policy, research and teaching practice as a common language and vehicle for packaging support systems.

The Universal Design for Learning Framework in Anatomical Sciences Education

Over the past decades, teaching and learning within the discipline of anatomy has undergone significant changes. Some of these changes are due to a reduction in the number of teaching hours, while others are related to advancements in technology. Faced with these many choices for change, it can be difficult for faculty to decide on which new developments in anatomical education need or indeed can be integrated into their course to enhance student learning. This article presents the universal design for learning (UDL) framework-an informed, evidence-based, and robust approach to underpin new course design and pedagogical reform in anatomy education. Universal design for learning is not a theory but a framework grounded in cognitive neuroscience that focuses on engaging multiple brain networks. The guidelines for UDL are organized into three core principles: (1) provide multiple means of representation, (2) provide multiple means of action and expression, and (3) provide multiple means of engagement. The learning space within the anatomy laboratory provides an excellent opportunity in which to apply this framework. This article also describes current trends employed in the teaching of anatomy. The principles of UDL are then outlined, followed by a description of how UDL approaches have been applied in the design and delivery of anatomy practical teaching to first year medical students at University College Cork. Future implications for this work are a consideration and investigation of how a course designed with the principles of UDL at its heart ultimately benefits student learning.

Implementation of Universal Design for Learning in Occupational Therapy Education

This exploratory research surveyed educators' use of universal design for learning (UDL) in occupational therapy education. Most common methods of engagement were displaying enthusiasm, providing examples, and offering learner feedback; representation was primarily offered through class discussion, lab experiences, and images; methods of action or expression were most frequently class discussion, projects, practicums and tests. The type of program, years of educators' clinical experience and faculty rank influenced some factors of UDL implementation. Further use of UDL principles that could facilitate improved learning outcomes of diverse learners within occupational therapy education is discussed.

Inclusion, universal design and universal design for learning in higher education: South Africa and the United States

Around the world, institutions of higher education are recognising their responsibilities to achieve the full inclusion of individuals with differing needs and/or disabilities. The frameworks of universal design (UD) and universal design for learning (UDL) offer unique ways to build inclusiveness in our systems. The role of UD and UDL to strengthen successful inclusion of persons with differing needs in higher education programmes is presented from literature, inclusive of national and international policies and resources. Examples from South African and US institutions of higher learning are shared. Discussions of online accessibility, environmental issues, professional development, barriers to inclusion and recommendations for future development in an international context provide a vision for developing inclusive learning environments in higher education.

A scoping review to explore how universal design for learning is described and implemented by rehabilitation health professionals in school settings

BACKGROUND

Universal design for learning (UDL) is a framework that provides guidelines to support children with diverse needs in the classroom and promotes inclusion of all children. Although UDL is recognized as a promising approach for school-based rehabilitation health professionals (RHPs), there are no studies that synthesize evidence on the use of UDL by RHPs in the school setting. Therefore, the research question for this study is: How is UDL described and implemented in school settings by RHPs? This study specifically examined literature from occupational therapy, physiotherapy, and speech-language pathology.

METHODS

A scoping review was completed to (a) summarize how UDL is described in the rehabilitation literature, (b) summarize the recommended and reported role of RHPs in the delivery of UDL, and (c) identify gaps in the evidence base. CINAHL, Embase, MEDLINE, PsychINFO, Sociological Abstracts, Web of Science, and ERIC electronic databases were searched. Numerical summaries and theoretical thematic analysis were used to describe the data both quantitatively and qualitatively.

RESULTS

Inclusion criteria were achieved for 45 of the 3,998 screened documents. Most of the included documents lacked a definition of UDL. Analysis suggested that speech-language pathologists and occupational therapists implement UDL in a variety of ways within the school setting. No physiotherapy literature was found, and limited high-level empirical research has been conducted within rehabilitation.

CONCLUSION

This scoping review provides a broad understanding of how RHPs describe and implement UDL-aligned services in school settings. UDL is a promising framework that provides RHPs with guidance on how to support children with diverse needs in the classroom, with the overall aim to promote inclusion of all children. There is a need for further research to determine the effectiveness of UDL as implemented by RHPs and to examine the role of physiotherapists in using UDL-type services.

'Kids need to talk too': inclusive practices for children's healthcare education and participation

AIMS AND OBJECTIVES

To examine how children with chronic medical conditions view healthcare education and decision-making and to propose the application of the universal design for learning in paediatric settings.

BACKGROUND

Children and adolescents with chronic medical conditions tend to be excluded from healthcare decision-making. In schools, the universal design for learning promotes access to education and participation in school communities for all children, regardless of their disabilities or medical needs, rendering it an appropriate model for children's participation in healthcare decision-making.

DESIGN

This article presents findings from a qualitative study with 26 children and adolescents with chronic medical conditions about their views and experiences with healthcare education and decision-making.

METHODS

Twenty-six children and adolescents with chronic medical conditions were interviewed using semi-structured interviews.

RESULTS

Findings provide evidence that clinical practices often fail to provide equal opportunities for paediatric patients to understand their condition, share their views and/or participate in decisions regarding their care.

CONCLUSIONS

In response to ongoing concerns about paediatric decision-making, we propose that the universal design for learning be adapted in paediatrics. The model presents exemplary programmes as inclusive, accounting for the needs of all children through multiple means of engagement and expression.

RELEVANCE TO CLINICAL PRACTICE

A discussion of how the principles of universal design for learning could be applied in paediatric settings is offered for the purpose of advancing ethical and psychosocial care for all children regardless of their age, developmental capacity or condition.