Mainstream or special secondary school for the health, education, and well-being of adolescents with Down syndrome: A systematic review.

Only three studies were included, all observational with no randomized controlled trials. All included studies had at least moderate risk of bias, primarily due to selection bias, missing data, and unmeasured confounding. The studies were conducted in high-income countries (UK and Netherlands), limiting generalizability to other settings. No studies reported health outcomes, leaving a major gap in the evidence base for therapists. The definition of 'mainstream' schooling varied, and details on support levels (like teaching assistants) were often missing, making it hard to know what actually worked. Findings may not apply to adolescents with the lowest levels of pre-existing ability, as they were often excluded or lost to follow-up.

The lead author was funded by the Down's Syndrome Association. Additional support came from the National Institute for Health and Care Research (NIHR). The authors declare no other conflicts of interest.

Do not interpret the academic gains in two of the studies as proof that mainstream schooling is superior. These studies had higher risk of bias and may reflect the selection of children with higher initial ability into mainstream settings. The study with the lowest risk of bias found no significant difference in attainment.