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MohamadTaghi Badeleh Faculty Member of Golestan UniversityofMedical Sciences, Iran
Research
pjpcr
J.Med. Sci., 2013 DOI:10.3923/jms.2013.
Attention Deficit
Hyperactivity Disorder and
Elementary Teachers
awarenessMohamadTaghi Badeleh
About8.7%ofchildrensuffer fromAttentionDeficitHyperactivity Disorder and 20to 30%ofthem havelearning disability.Sinceelementary teacher is thefirst
one who recognize this problem,we aimedatevaluating Teachers Knowledge about AttentionDeficitHyperactivity Disorder.Inthisdescriptive-analytic study, thesubjectswere245elementary teachers selected viastratifiedrandomsampling. Having theirconsent,they wereinterviewedusingafewopen-ended questions validatedby psychiatrist and psychologist. We encoded the data, considering DSMIV18-point criteria and analyzed bydescriptive andinferentialstatistics.Of 245, 190 (77.55%)arestateteachers and55(22.45%)arenon-stateteachers. The teachersaremales(60; 24.5%)andfemales (185; 75.5%). Onehundred andten (45.83%)donotknow about thecauseofthis disorder. Themean scoreofboth state (1.91)annon-state(2.18)isvery low. There isno significantdifference between Teachersknowledge and variables suchas school,gender and record ofservices (p<0.05), but it is meaningfulforlevelofeducation (p<0.05). Teachers knowledge results in rapid recognizing of ADHD children and consequently preventing from educational and social difficulties; therefore, we recommend holdingsomein-servicetraining workshopforteachers.
Keywords:Knowledge, inattention, hyperactivity, impulsivity, teachers
ANSI«£
J.Med.Sci, 2013 INTRODUCTION
ADHDisaquitecommondisorderin whichachild displays hyperactive, impulsive, and/or inattentive behavior(NassandLeventhal,2010). Intermsof different researches, the prevalence of ADHDhas been reported differently.Brownetal.(2001)reported it between4%and 12%among 6-12-year-old children.Spenceretal.(2007)in theirstudy estimated the PrevalenceofchildhoodADHD in the USA 5 to 8%. Kaplan andNewcorn(2011) by quoting Barkli reported8.7%inAmerica. TherateinIran
wasreported significant by Jamahetal.(2012)and has been reported differently; for example, by Yoosefi and Yoosefi (1998)6.2%amongtheelementary students While by Bahreinian and Macoo (2000) 19.9% among boys studiedinelementary school and by Golmirzaei et al. (2012)20.19%.
The high prevalence ofthis disorder indicates the leadingeffect of ADHDonthe health anddevelopmentof community and the possibility of being faced with academicundergrowth in theprocess oflearning in that the National Institute of Mental Health indicates that 20-30% of childrenwithADHD also have a learning disability and their academic progress is weak at the school.Mostof the children who suffer from learning disabilityareengaged in mental and emotional problems such as anxiety, depression and social disorder (FaraoneandBiederman,1997).Their self-esteemhave beenfoundtobe impaired(Graetz etal., 2005). Those afflictedwithADHDare moresubjectedtothedangerof smoking and narcotics.Inmostofthecases,teachersare thefirstwhorecognize this disease(Dulcan, 1997)
Since ADHDisadisorderhaving undesirableeffect
onthe academic achievementofstudents in theprocess oflearning (Barkley,2006),teacherplaysamain rolein helping these students aimedatadapting them with this problem(AmericanAcademyofPediatrics,1992).Inspite of the importance of teachers' knowledge on their supporting behaviors towards preventing the complications of this disorder (Ohan et al., 2008), Unfortunately, teachers' knowledge regardingADHD is notadequate(Akrametal.,2009;Peroldetal., 2010).
This isahardfactthatknowledge ispowerandany factor resulting in conditions that increase the levelof education, surely will upgrade the growth and developmentofthecommunity. Therefore, the evaluating of teachers' knowledge and holding some specialized workshops will beeffectiveinrecognizing and treatingof studentsafflictedwithADHD; Ontime diagnosisofthis disorder can prevent from academic underachievement and social problems of at least 10% of school-aged children.
Inlightofhigh prevalenceof ADHDinschool-aged children, this study aimed at evaluating elementary teachers' knowledge about the Attention Deficit Hyperactivity Disorder and consequently informing both the managers of education centers and elementary teachers.
MATERIALSAND METHODS
Inthis descriptive-analytic study, the subjects were
245elementary school teachersof Gorgancity inGolestan province,Iran.Theywereselected viastratifiedrandom sampling, by considering their gender and their school, stateandnon-state.By having theofficialconsentofthe departmentofEducationinGorgancity, the teacherswere interviewedby utilizing open-ended questions basedon studying the specializedtexts and articles validatedby psychiatrist and psychologist. After finishing the interview, the extractedinformationand the datawere encodedby taking in to consideration DSM-IV 18-point-criteria and analyzed by descriptive andinferential statistics.
Data collection instrument: A questionnaire was provided including several open-ended question based onthestudyofspecializedtextsand articles validatedby psychologist and psychiatrist. It is worthpointing out that for validating the data gathering method, all interviewswereperformed by onlyoneinterviewer. DSM-IV 18-point-criteriawere taken into consideration for measuring the teachers' knowledge regarding the AttentionDeficitHyperactivity Disorder. This criterion has18points: less than6,weak;6-12, average;above12, good.
Findings: The total subjectswere245elementary school teachers.Outof 245, 190werestate(77.55 %), 55
non-stateteachers(22.45 %).Considering their gender,60were male(24.5 %)and185female (75.5).Theaverage age of state teachers was 41.60 andnon-state 46.88. Of 241 expressed their maritalstatus,225(93.4 %)weremarried and16 (6.6)single.Fromthestandpointofacademic level (Table 1-1), 35teachers(41.3 %)hadhigh schooldiploma, 103 (42)associatedegree,103 (42 %)bachelordegree and onlyfour ofthem(1.6 %)hadmasterdegree. The major courseofparticipantswaselementary education(142)and non-elementary education(103).Their recordsofservice werereported less than5 years (22), 5-10 years (13), 10-15 years (411), 15-20 years (87)and above20 years (82).
RegardingADHDrelatededucations,191(%78)did nothaveanytraining intheir academicyearsandonly54 (22 %)mentioned thatthey hadpassedjustabrief course
aboutADHD during their educational periods. About in-servicetraining,229(93.5 %)teachers havenottaken partinanyeducationalcourses,13onesparticipated in1 to 2workshops and only one ofthem claimedto have beeninmorethan6workshops.
Teachers' awareness about etiology of ADHD: 129 (52.7%) of them didnotbelieve itas a disorder; 110 (44.9%)announced thatthey didnothaveanyknowledge about the cause of this disorder; only 31 (12.7%) mentioned that itmaybenearly genetic and inheritance and therestofthe teachers believedinsomethingwrong about thecauseof ADHD.
Look on the six-points related to hyperactivity that are mentioned in DSM-IV, of 190stateteachers, 34teachers didnotpointedout toanything,102teachers tooneitem,49to twoandjustfive ofthemtothree items. of 55non-stateteachers,fourteachersreferredtonoitem, 20toone,30to twoandonlyoneofthemtothree items. Theaverage state teachers' knowledge was reported 1.13 andnon-state teachers 1.51. The average female teachers' knowledgewas reported1.28opposedto 1.03 formale teachers.
Viewpoint on the DSM-IV nine-points associated with Inattention,of 190state teachers, 103referredto none,70toone,17to twoandnoneofthemtomorethan two items. Of 55 non-state teachers, 33 referred to nothing,17teacherstoone,fiveto twoandnoneofthem to more thantwo items. Of the ninepoints relatedto inattention, themeanofstateteacherswas0.55and
non-state0.49.Females'knowledgewasreported0.56opposed to0.45formales'.
Forthreepointsofimpulsivity,of 190stateteachers, 146mentionedtonone,44toone andnoneofthemto
more than one item. Among non-state teachers, 45 teachersreferredtononeand10tooneitem.Ofthe three points relatedtoimpulsivity, the meanofstateteachers was 0.23andnon-state0.18.Inthiscase,both male and femaleteachers'knowledgewasreported0.22of 3points. With regard to DSM-IV 18-point-criteria about ADHD,the reports of state teachers (Table 1-2)were
23referredtonone,43-1, 67-2, 45-3, 9-4and3-5items. The femaleteachers'knowledgewas1.98while the males'was
1.66point. About non-state teachers (Table 1-3),three referredtonone,6-1, 30-2, 11-3, 4-4andonlyoneteacher referredto five items. Female teachers' knowledgewas
1.98while male teachers1.80.Generally, themean scoreof stateteacherswasreported1.91whilenon-stateteachers 2.18point and totally itwasreported1.97.Theaverage femaleteachers' knowledgewas 2.05 while males'1.70 point.
Table1:Frequencyofteachersintermsofthe levelofeducation Levelofeducation Frequency Percent Master 4 1.6
Bachelor 103 42.0
Associate 103 42.0
Diploma 35 14.3
Total 245 100.0
Table2: Generalawarenessofstate-teachers about"ADHD"
Generalawareness Frequency Percent 0outof 18 23 12.10 1outof 18 43 22.63 2outof 18 67 35.26 3outof 18 45 23.68 Outof 18 9 4.74 5outof 18 3 1.58
Table3:Generalawarenessofnon-stateteachers about the signof "ADHD" Generalawareness Frequency Percent 0outof 18 3 5.45 1outof 18 6 10.90 2outof 18 30 54.54 3outof 18 11 20.00 Outof 18 4 7.27 5outof 18 1 1.81
InaccordancewithDSM-IV18-point checklist, both stateteachers' knowledge(1.91)andnon-stateteachers' (2.18)werereported strongly weak.Forinferentialanalysis ofthedata,firstKolmogorov-Smirnovtestwasconducted andafter makingsure about thenormality ofthe data, parametrictestswereused. Performingindependentt test witha95%confidencelevel, itwasdetermined that there isnomeaningful significanceofknowledge betweenstate andnon-stateteachers and also between male andfemale teachers.Forcomparing the teachers' knowledge interms of the record of services, the Analysis of Variance (ANOVA)with theconfidence of95%showed that there was no meaningful difference, but ANOVA indicated teachers' knowledge at different academic levels was meaningfullydifferent(p<0.05). Basedonposthoctestfor ANOVA(p<0.05), thehighest knowledgewasrelatedto thehighest educational levels.
DISCUSSIONAND CONCLUSION
The resultsofthis study have shown that teachers' awareness about the cause of ADHD and the main symptoms,basedonDSMIV18-point checklist,ofthis disorder isprettyweekinthat44.9%ofthem havenotany knowledge about the etiology and theirmean scoreabout ADHD symptomsis1.97outof 18points.
According to Das et at (2011), ADHD is quite genetic related disorder while presentstudy shows that nearly thehalf (44.9%)arenotinformedabout thecause
J.Med.Sci, 2013 maybegenetic.Ourfindingssupportthe resultsofsome
ofthe earlier studies including Brooket al. (2000) and Shermonetal.(1997). Therestofteachers inourstudy believe insomethingwrong about the cause of ADHD that is congruentwith the study of West et al. (2005), using the Knowledge about AttentionDeficit Disorder
Questionnaire
(KADD-Q)on256teachers, in whichthey mentionedtosomefalse beliefsaboutADHD.ConsideringDSMIV18-point checklist, the mean knowledge of the teachers participated in the present studywas 1.97out of 18,which isstrongly weak. This result is in line with the results of some researchers including Brooketal.(2000)reported that the teachers' knowledge about AttentionDeficitHyperactivity Disorder islow;Ghanizadehetal.(2006)inastudy conductedon
196elementary school teachers reported that the teachers' knowledge in relationtoAttentionDeficitHyperactivity Disorder isrelatively low;Ramos(2008)indicated that teachers have problems with symptoms and signs of ADHD and theirinformationisnotenough in this field andMoldavskyetal.(2013)suggestedaneedforbetter teacherawarenessabout inattentivesubtypeof ADHD.
Regarding teaching experience, the findings ofthe present study show that the experience does not have significant effect onthe level of teachers' knowledge, which areconsistent with the results ofearlier studies: Jerome et al. (1994) reported that both American and Canadian teachers did not have in-service training regarding ADHD; Bekle (2004) carried out an investigationamong in-service teachers and students of teachers'trainingcenter.Basedonthisinvestigation both groups showed their interest to pass a comprehensive course associated with ADHD andKos et al. (2004), highlighted that deficits in teachers' knowledge about ADHD are commonfor both in-service andpreservice teachers. Anderson et al. (2012) reported differently: relativetopre-service teachers, in-service teachers show more overallknowledgeof ADHD, moreknowledgeof characteristics and treatments for ADHD and higher perceivedknowledge.
Perspective on the importance of teachers' knowledge, Liesveld(2007) reported the teachers who have thehigher knowledgeof ADHD possessgeneral and positivebeliefstowards children who are afflictedwith this problem, they also have more confidence in their diagnosis, theyareinsupport ofmulti-pattern approach forthetreatmentofthis disorder and havemoreflexibility inapplyingdifferenteducational methods. Teachers with moreinformationhavemorewillingness to supportthe useofstimulants for thetreatment of childrenafflicted with this disorder. Furthermore, Ohan et al. (2008) reported that the teachers with high and to some extent average,knowledge aboutADHDreportedmorehelpful
behaviors (e.g., help-seeking for their students) and Froelich et al. (2012) concluded that teacher training programs maybe helpful in improving teachers' skills in addressing attentional and disruptive behavioural problems inthe classroom.
Inthe end, the adequate knowledge relatedADHD leadingtoaforementionedpositive resultsmayhelp the teachers to encounter these children the same as those suffering from hearing and vision defects, who are definitely neededtobe helped in the class. Thus, it is recommended strongly upgrading the teachers' knowledge by holdingsomeconsistent in-servicetraining programstoachieve its positive impactsonchildren and avoidoflater complicationsofthis disorder.
ACKNOWLEDGMENT
Thewritingofthis articlewasfundedbyagrant from the Research and Technology Affair of Golestan UniversityofMedical Sciences,Iran.The author wishes tothank allelementary teachers who willingly participated inthisproject.
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