INTRODUCTION:

Children are the most precious and potential unit of the country. Proper nourishment in childhood both physically and psychologically helps them to develop as a productive and adjustable adult who is useful to the society and country. Children in this modern era are forced to be the victims of psychological disorders. They are grown up with undue pressures from the school, social and cultural environment. The surging trends in the family and society indirectly affect the psychological development of the children. Attention deficit hyperactivity disorder is one of the greatest common neurobehavioral disorders of childhood and can affect the academic achievement, well-being and social interactions of children¹.

NEED FOR THE STUDY:

According to Centers for Disease Control and Prevention, the number of school-aged children diagnosed with ADHD has gradually increased by 42% between 2003 and 2011, and has annually increased by 5% each year, indicating that at least one child in an average- sized classroom will have the disorder. Research suggests that genetics and heredity play a large part in determining who gets ADHD. However, scientists are still investigating whether certain genes, especially ones linked to the neurotransmitter dopamine, play a defined role in developing ADHD. Additional research suggests that exposure to toxins and chemicals may increase a child’s risk of having ADHD. The symptoms of ADHD are spelled out in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which lists nine symptoms that suggest ADHD–Primarily Inattentive and nine that suggest ADHD–Primarily Hyperactive/Impulsive. Doctors may diagnose the child with ADHD only if he or she exhibits at least six of nine symptoms from one of the lists, and if the symptoms have been noticeable for at least six months in two or more settings .Teachers are often the first to detect ADHD – type behaviours, and the diagnostic process often begins with a referral from a class teacher (Norviliis and Fang, 2005). Thus it is vital that teacher’s level of ADHD specific knowledge and attitude are able to be adequately assessed. It is well known that the teacher’s perceptions of students who display ADHD type behaviors are affected by their knowledge of ADHD. It is therefore important that the teachers have a high level of ADHD -specific knowledge and positive attitude towards children who display ADHD -type behaviors in order to avoid a potential failure to detect student who require educational /behavioral support and or a referral for assessment. ²

PROBLEM STATEMENT:

A descriptive study to assess the knowledge on attention deficit hyperactivity disorder (ADHD) among primary school teachers in selected schools, kottayam

OBJECTIVES:

The objectives of the study are:

· Assess the knowledge regarding attention deficit hyperactivity disorder (ADHD) among primary school teachers.

· Find the association between knowledge regarding attention deficit hyperactivity disorder among primary school teachers and selected demographic variables.

OPERATIONAL DEFINITIONS:

Attention deficit hyperactivity disorder (ADHD): Attention deficit hyperactivity disorder (ADHD) is a disorder marked by an ongoing pattern of inattention and or hyperactivity-impulsivity that interferes with functioning or development.³

Primary school teachers: Primary school teachers are those who are responsible for teaching approved national curriculum subjects to pupils aged 5-11, guiding them through what is arguably the most important stage of their education.⁴

Knowledge: In this study knowledge refers to the awareness or understanding of the primary school teachers regarding attention deficit hyperactivity disorder.

HYPOTHESIS:

The hypothesis is tested at 0.05 level of significance.

H1: There is significant association between the knowledge level of primary school teachers regarding attention deficit hyperactivity disorder and selected demographic variables.

ASSUMPTIONS:

· Primary school teachers may have basic knowledge regarding attention deficit hyperactivity disorder.

· Selected variables influence knowledge of primary school teachers.

· Adequate knowledge of primary school teachers may help to identify and manage the early symptoms of attention deficit hyperactivity disorder.

· Primary school teachers will cooperative to the study conducted by the researchers.

DELIMITATIONS:

The study is delimited to primary school teachers who are above 21 years, teaching in private schools, teaching I-VI standard and willing to participate in the study.

REVIEW OF LITERATURE:

A cross-sectional research study was conducted to assess prevalence of attention deficit hyperactivity disorder among 3253 primary schoolchildren in selected schools in Kancheepuram district. Children aged between 8 and 11 years were enumerated from the selected six schools after obtaining informed consent from their caregivers. The presence of ADHD was assessed using Conners' Teacher–Parent Rating Scale given to caregivers and teachers and confirmed with the Diagnostic and Statistical Manual of Mental Disorders-5 criteria for ADHD. The analysis revealed the overall prevalence of ADHD to be 8.8%. The subtypes of ADHD were categorized as 124 (43.3%) for inattentive type, 124 (43.3%) for hyperactive type, and 38 (13.2%) for combined type of ADHD. The study findings showed a high prevalence of ADHD among primary schoolchildren.⁵

A study was conducted to assess the knowledge and Misperceptions about Attention Deficit Hyperactivity Disorder (ADHD) among School Teachers in Mumbai, India. A total of 106 teachers from 12 English-medium schools completed the Knowledge of Attention Deficit Disorders Scale and a demographic questionnaire. Overall, the teachers lacked adequate knowledge of ADHD, with only 49% of the responses being correct. Repeated measures ANOVA results indicated that the teachers’ scores on the three subscales of the measure were significantly different (F = 7.96, p < .01), with the score being highest on the symptoms subscale. In conclusion, teachers in Mumbai needed training on general information and treatment of ADHD, with a focus on correcting common misperceptions that they have with regards to ADHD.⁶

A cross-sectional, descriptive, population-based study was carried out to assess the knowledge of ADHD among 62 primary school teachers in public schools in Sabaneta, Antioquia, Colombia. Teachers correctly answered just under half of all the items in the questionnaire (48.52%). Specifically, the most correct answers were on the symptoms / diagnosis subscale (69.35%) followed by the treatment subscale (45.30%) and finally the general information subscale (38.60%). The data obtained underlines the need for initiatives to be implemented in this area to ensure that it is reflected in new teaching techniques that facilitates learning and development of children who suffer from the disorder.⁷

RESEARCH DESIGN:

The research design is the overall plan for obtaining answer to the questions being studied and for handling some of the handling difficulties encountered during the research design.⁸ A non-experimental descriptive survey design was selected to achieve the objectives of the study.

SETTING OF THE STUDY:

The study was conducted in Kottayam district, which consisted of three private primary schools namely Marian Senior Secondary School, Sacred Heart Public School and St. Marcellinas L P School.

Population:

The population in this study is primary school teachers teaching between standard I-VI.

SAMPLE SIZE:

A total number of 30 primary school teachers teaching between standard I-VI was the sample size. The sample size was estimated based on the previous studies and considering the time frame of present study.

Sampling Technique:

Sampling technique used in the study was non-random convenience sampling. This entitles using the most conveniently available people on study participants. The sample who met the inclusion criteria and available at the time of study was taken.

CRITERIA FOR SAMPLE SELECTION:

Inclusion criteria:

Primary school teachers who are:

· Above 21 years.

· Willing to participate in the study.

· Teaching in private schools

· Teaching I-VI standard

Exclusion criteria:

Primary school teachers who are:

· Absent at the time of study.

· Teaching in government schools

TOOL:

The tool used for this study was a socio-demographic datasheet of teachers and questionnaire for assessment of knowledge (KADDS) regarding ADHD among primary school teachers in selected institutions, Kottayam. This instrument consists of two parts;

Part-1:

A semi structured demographic data questionnaire for primary school teachers which covered age, gender, highest educational level, type of job, experience in teaching, school location, previous experience with a child with ADHD, any special training/course in child psychology and any conference/workshop attended on ADHD were included.

Part-2:

A self- administered standardized knowledge questionnaire, knowledge of attention deficit disorder scale (KADDS) developed by Sciutto et al. is one of the most widely used study tools to assess teachers’ knowledge of ADHD, and it has been adapted for this study.

Score Interpretation:

The tool used in the study 36-item questionnaire which covers teachers’ knowledge in three areas: 1) general knowledge of ADHD-15 items, 2) symptoms and diagnosis of ADHD -9items, and 3) treatment of ADHD-12 items. Knowledge score was computed in the way that correct answers were given a score of “1” and incorrect or do not know answers were given a score of “0”. Thus the possible scores ranged from 0, for the lowest level of knowledge, to 36, for the highest. Total score and score percentage were computed for each participant. According to the score obtained by each subject knowledge is classified into;

Score Category

0-12 : Poor

13-24 : Average

25-36 : Good

RESULTS:

Table 1: Frequency and percentage distribution of subjects based on age, sex, education, type of job, experience in teaching and school location.

(n=30)

Demographic variables	Frequency	Percentage (%)
Age(Years)
21-30	11	36.7
31-40	8	26.6
>40	11	36.7
Sex
Male	4	13.4
Female	26	86.6
Education
Bachelor	12	40
Master	13	43.3
Doctorate	0	0
Others	5	16.3
Type of job
Regular teacher	28	93.3
Part time teacher	2	6.6
Experience in teaching.
≤5	13	43.4
06-Oct	6	20
Nov-15	7	23.3
>15	4	13.3
School location
Rural	14	46.6
Urban	16	53.4

Table 2: Frequency and percentage distribution of subjects based on previous experience with a child with ADHD, special training in child psychology and conference / workshops attended

(n=30)

Demographic variables	Frequency	Percentage (%)
Previous experience with a child with ADHD
Yes	20	66.6
No	10	38.3
Special training in child psychology
Yes	22	73.4
No	8	26.6
Conference / workshops attended
Yes	4	13.4
No	26	86.6

The above table reveals that among the primary school teachers, an equal number (36.7%) belonged to the age group between 21-30 and > 40. 86.6% were females, less than half (43.3%) of samples had masters degree, majority (93.3%) were regular teachers, less than half (43.4%) had ≤5 years of experience in teaching, majority (53.4 %) of them worked in schools located in urban area, more than half (66.6%) of the samples had previous experience with a child with ADHD, 73.4% did not have any special training in child psychology and 86.66% of the subjects had not attended any conference / workshops on ADHD

Table 3. Frequency and percentage distribution of subjects according to level of knowledge.

(n=30)

Level of Knowledge	Frequency (f)	Percentage (%)
Poor	6	20%
Average	24	80%
Good	0	0

Table 3 shows that among 30 samples, 80% of the samples had average knowledge, 20% had poor knowledge and none had good knowledge regarding Attention Deficit Hyperactivity Disorder

Table 4. Mean, Standard Deviation, Maximum score and range of knowledge score

(n=30)

Overall knowledge score
Mean	Standard deviation	Range	Maximum score	score
14.6	3.49	Jul-23	36

The data presented in table 4, depicts shows that mean knowledge score was 14.6 and standard deviation was 3.49. The range of score was between 7-23. The maximum score of questionnaire was 36.

Table 5. Mean, standard deviation, maximum score and Mean % of knowledge score in different domains

(n=30)

Knowledge Score
Domains	Mean	Standard	Mean %	Maximum
	Deviation		score
General Information	5.73	1.49	19.10%	15
Symptoms and diagnosis	5.06	1.5	16.86%	9
Treatment	3.86	1.47	12.86%	12

Data presented in table 5 shows that the mean knowledge score for the domain general information regarding attention deficit Hyperactivity Disorder was 5.73 and standard deviation was 1.49. The analysis revealed that among 30 subjects 6(20%) had poor level of knowledge, 24 (80%) had average level of knowledge and none of them had good level of knowledge regarding attention deficit hyperactivity disorder. Result indicated that teachers’ greatest area of knowledge dealt with general information of ADHD. Teachers had lower scores related to identifying the symptoms and diagnosis and knowledge of treatments for the disorder. There is significant association between level of knowledge of primary school teachers and selected demographic variables such as gender, type of job, and any special training in child psychology.

CONCLUSION:

The result of the study highlighted the fact that primary school teachers were having average level of knowledge regarding Attention Deficit Hyperactivity Disorder. Result also indicated that teachers’ greatest area of knowledge dealt with general information of ADHD. Teachers had lower scores related to identifying the symptoms and diagnosis and knowledge of treatments for the disorder.

NURSING IMPLICATIONS:

Nursing Implication:

The finding of the study has implications in the field of nursing education, nursing practice, nursing administration, and nursing research.

Nursing Education:

· Curriculum should prepare the nursing students to attend up to date knowledge regarding management technique.

· Nurses play a major role in providing health teaching on Attention Deficit Hyperactivity Disorder for primary school teachers in community setting.

Nursing Administration:

· The administrators should teach the staff nurses and motivate them to provide health education to primary school teachers regarding Attention Deficit Hyperactivity Disorder.

· Awareness programs must be planned and conducted in schools.

Nursing Practice:

· In-service education can be conducted to improve knowledge of health professionals regarding attention deficit hyperactivity disorder.

· As a vital part of the health team, nurses can give greater contributions in improving the knowledge regarding attention deficit hyperactivity disorder.

· Nurses can use self-administered questionnaires which can be used to assess the knowledge regarding attention deficit hyperactivity disorder among teachers and parents, and can provide structured teaching program to improve the knowledge

Nursing research:

· Extensive research programs should be conducted periodically in the schools to assess knowledge and misperceptions regarding ADHD with which teachers can effectively participate in the process of the assessment and treatment decision-making for children with ADHD.

RECOMMENDATIONS:

· Further research can be recommended to assess the attitude of primary school teachers regarding ADHD.

· A similar study can be conducted to assess the knowledge and attitude of parents regarding ADHD.

· Further research can be recommended to assess the effectiveness of teaching program regarding attention deficit hyperactivity disorder for teachers to improve their knowledge about ADHD.

· In-service training courses can be offered for teachers about ADHD.

· Further research can be recommended to enhance teachers, parents and community awareness about ADHD through mass media.

· The nurse, family and teachers should be cooperated to detect what exact problems are facing child with ADHD and give proper intervention.

· Enhance future policies and interventions aimed at understanding, assisting and supporting children with ADHD and their teachers

REFERENCE:

1. American Academy of Pediatrics (AAP), (2011). ADHD: Clinical Practice guideline for the diagnosis, evaluation, and treatment of ADHD in children and adolescents. American Academy of Pediatrics, 128, 1007-1022

2. Strine TW, Lesesne CA, Okoro CA, McGuire LC, Chapman DP, Balluz LS, Mokdad AH. Peer reviewed: emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder. Preventing chronic disease. 2006 Apr;3(2).

3. Biederman J. Attention-deficit/hyperactivity disorder: a selective overview. Biological psychiatry. 2005 Jun 1;57(11):1215-20.

4. Kelkay AD, Mola S. The status of teachers’ motivation and process of quality education: The case of primary school teachers, Ethiopia. Global Journal of Guidance and Counseling in Schools: Current Perspectives. 2020 Apr 30;10(1):01-11.

5. Catherine TG, Robert NG, Mala KK, Kanniammal C, Arullapan J. Assessment of prevalence of attention deficit hyperactivity disorder among schoolchildren in selected schools. Indian journal of psychiatry. 2019 May;61(3):232.

6. Shroff HP, Hardikar-Sawant S, Prabhudesai AD. Knowledge and misperceptions about attention deficit hyperactivity disorder (ADHD) among school teachers in Mumbai, India. International Journal of Disability, Development and Education. 2017 Sep 3;64(5):514-25.

7. Padilla AM, Cuartas DB, Henao LF, Arroyo EA, Flórez JE. Knowledge of ADHD among primary school teachers in public schools in Sabaneta, Antioquia, Colombia. Revista Colombiana de Psiquiatría (English ed.). 2018 Jul 1;47(3):165-9.

8. Sharma S. K. Nursing Research and statistics. 3^rd ed. New Delhi: Elsevier publications; 2014. p.46.

Received on 10.01.2022 Modified on 24.01.2022

Research J. Science and Tech. 2022; 14(1):30-36.

DOI: 10.52711/2349-2988.2022.00004