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Children with Attention DeficitHyperactivity Disorder and theirTeachers: A review of the literatureJulie M. Kos a , Amanda L. Richdale b & David A. Hay ca Australian Council for Educational Research , Australiab RMIT University , Australiac Curtin University of Technology , AustraliaPublished online: 22 Aug 2006.
To cite this article: Julie M. Kos , Amanda L. Richdale & David A. Hay (2006) Children withAttention Deficit Hyperactivity Disorder and their Teachers: A review of the literature,International Journal of Disability, Development and Education, 53:2, 147-160, DOI:10.1080/10349120600716125
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International Journal of Disability, Development and EducationVol. 53, No. 2, June 2006, pp. 147–160
ISSN 1034-912X (print)/ISSN 1465-346X (online)/06/020147–14© 2006 Taylor & FrancisDOI: 10.1080/10349120600716125
Children with Attention Deficit Hyperactivity Disorder and their Teachers: A review of the literature
Julie M. Kosa*, Amanda L. Richdaleb and David A. HaycaAustralian Council for Educational Research, Australia; bRMIT University, Australia; cCurtin University of Technology, AustraliaTaylor and Francis LtdCIJD_A_171580.sgm10.1080/10349120600716125International Journal of Disability, Development and Education1034-912X (print)/1465-346X (online)Original Article2006Taylor & Francis532000000June [email protected]
There is considerable evidence regarding the academic and social difficulties children withAttention Deficit Hyperactivity Disorder (ADHD) experience, but less is known about what theirteachers do and should know. This article provides a summary of this evidence, including informa-tion on the difficulties experienced by students with ADHD, the relationships between teachers andstudents with ADHD, pre-service and in-service teachers’ knowledge and attitudes toward ADHD,and in-service teachers’ behaviour toward children diagnosed with the condition. Teachers needincreased awareness of the family circumstances of children with ADHD, more knowledge ofthe conditions commonly comorbid with ADHD, and insight into these children’s relationshipwith peers.
Keywords: Attention Deficit Hyperactivity Disorder; Attitudes; Behaviour; In-service teachers; Knowledge; Pre-service teachers
Introduction
The classroom may represent one of the most difficult places for children withAttention Deficit Hyperactivity Disorder (ADHD), most probably because thissetting requires children to engage in behaviours that are contrary to the core symp-toms of the disorder. Much research has been conducted involving children’s behav-iour problems within educational settings, and this article will provide a detaileddescription and analysis of the literature in this area. The article is divided into threeparts. The first focuses on the difficulties experienced by school-aged students with
*Corresponding author. Australian Council for Educational Research, Private Bag 55, Camberwell,VIC 3124, Australia. Email: [email protected]
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ADHD, including academic difficulties (e.g., poor academic performance, beingretained in grade level, suspension, and expulsion), and problems experienced form-ing and maintaining peer relationships. The second part, which describes researchpertaining to teachers and students with ADHD, reviews the existing literatureconcerning teachers’ knowledge and attitudes, along with studies addressing teach-ers’ classroom management of children with ADHD. The final part of the articleprovides a summary of the literature, suggestions for how ADHD can be handledbetter at the level of teachers, schools, and the education system, as well as sugges-tions for future research to increase our understanding of the interrelationshipbetween ADHD behaviours, the education system, and families.
Difficulties Experienced by Students with ADHD
Research has generally focused on the academic and social difficulties students withADHD experience within educational settings (e.g., Barkley, Fischer, Edelbrock, &Smallish, 1990; DuPaul & Eckert, 1997, 1998). The findings from this researchhave shown that children with ADHD often experience a myriad of difficulties atschool related to the core symptoms of the disorder; namely, inattention, impulsiv-ity, and overactivity. However, there may be gender differences regarding the sever-ity of these problems. For example, Abikoff et al. (2002) reported that while boyswith ADHD show significant behavioural problems in the classroom, girls with thedisorder are more likely to have predominantly inattentive symptoms and are littlemore disruptive than typically developing children.
In addition, or possibly as a result of ADHD-related problems, children withADHD frequently experience lowered academic performance, are retained in grade,or are suspended or expelled from school (American Psychiatric Association [APA],2000; Marshall, Hynd, Handwerk, & Hall, 1997; Pfiffner & Barkley, 1990). A childwith ADHD may exhibit various behaviour problems within the classroom that aredependent on their ADHD symptom profile. For example, a child with predomi-nantly inattentive symptoms might have difficulty following teacher instructions andrules, staying on task and completing set work (Pfiffner & Barkley, 1990).Conversely, a child experiencing impulsivity might call out in class without permis-sion or talk with other students at inappropriate times. Finally, an overactive childmight experience problems staying seated, playing with objects not related to the settask (e.g., playing with a pencil when instructed to read silently), rocking in chairs,and repetitively tapping their hands or feet (DuPaul & Stoner, 2003). Most childrenwith ADHD, however, exhibit behaviour problems related to at least two of thesethree core symptom groups (APA, 2000).
Given these behaviours, it is not surprising that these children have considerabletrouble at school (Pfiffner & Barkley, 1990). The academic performance of studentswith ADHD is often compromised because of their difficulties with sustaining atten-tion (DuPaul & Stoner, 2003). Students with ADHD usually find it difficult toconcentrate long enough to complete set tasks, and academic performance mayfurther be impaired by an inherent tendency to be disorganised—to misplace books,
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Children with ADHD and their Teachers 149
stationery, and other materials needed to complete school work (APA, 2000;DuPaul & Stoner, 2003). Moreover, being overactive and impulsive in the class-room can often mean that the student with ADHD is not paying attention to the taskat hand, and this may result in the child first misunderstanding what is required tocomplete that task, and subsequently failing to satisfactorily complete it. Luckily,however, the behavioural difficulties observed in children with ADHD can often bereduced when novel and interesting tasks are presented, especially when the task iseasy or repetitive (Greene, 1995; Zentall, 1993), and when the tasks are presented tothe child at a level they understand (DuPaul & Power, 2000).
ADHD-related behaviours are disruptive in the classroom (Pfiffner & Barkley,1990), not only to teachers but also to other students (DuPaul & Stoner, 2003).This may be one of the reasons why ADHD children have such a difficult time form-ing and maintaining friendships with peers (Barkley, 1998; Kellner, Houghton, &Douglas, 2003). Research has consistently shown that children with ADHD tend tohave a lot of difficulty with peer relationships (e.g., Barkley, 1998; Erhardt &Hinshaw, 1994; Gresham, MacMillan, Bocian, Ward, & Forness, 1998; Hinshaw &Melnick, 1995; Pfiffner & McBurnett, 1997). According to Gresham et al. (1998),up to 70% of children with ADHD experience unreciprocated friendships withpeers. Furthermore, typically developing children report not wanting to befriendtheir peers with ADHD (Wheeler & Carlson, 1994), particularly those who experi-ence difficulties with overactivity (Jenkins & Batgidou, 2003).
There are a number of possible reasons for the difficulties that children withADHD experience with peers. It may be that they tend to perform behavioursconsidered controlling, trouble-making, and aggressive (Erhardt & Hinshaw, 1994;Hinshaw & Melnick, 1995). These behaviours are likely to be perceived by peers asnegative and thus prompt rejection by the peers from play activities. Second, chil-dren with ADHD may have difficulty reading social cues from their peers, andrespond inappropriately as a result (Atkinson, Robinson, & Shute, 1997). Childrenwith ADHD are not purposefully nasty; rather, they often have low self-esteem(Wheeler & Carlson, 1994), report feeling lonely and sad about not being liked bytheir peers, and desperately want to fit in (Chipkala-Gaffin, 1998; Gresham et al.,1998). Finally, research has also suggested that teachers’ attitudes and behaviourtoward a student with ADHD can impact on other students’ perceptions of thatchild (Atkinson et al., 1997).
Teachers and Students with ADHD
While teachers are concerned about the social difficulties experienced by studentswith ADHD, they tend to be most concerned with their problematic behavioursinvolving control, discipline, achievement, and listening to and complying withinstructions (Kauffman, Lloyd, & McGee, 1989). Further, Li (1985) showed thatthere is a general perception among teachers that acting-out behaviours are signifi-cantly more problematic than withdrawn behaviours. This finding might be the resultof withdrawn behaviours being less disruptive to the classroom environment than
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overt problem behaviours, or alternatively teachers believe that internalising prob-lems have a far better prognosis than externalising childhood problems (DeStefano,Gesten, & Cowen, 1977).
Teachers tend to perceive children with ADHD as requiring extra teaching timeand effort (Atkinson et al., 1997), a perception that seems to be a reflection of real-ity. Teachers have been shown to modify their teaching as a result of having astudent with ADHD in their class, particularly by providing greater structure androutine and by preparing work in greater detail (Atkinson et al.).
Given the nature and frequency of the negative behaviours exhibited by studentswith ADHD, it is not surprising that teachers often feel pessimistic about teachingchildren with the condition (Kauffman et al., 1989). Although teachers might bepessimistic, they generally perceive themselves as being competent to handle thesedifficulties in the classroom. Kauffman et al. asked 77 primary and secondary schoolteachers to complete a 30 min questionnaire assessing demographic details andbeliefs about adaptive and maladaptive classroom behaviours. Usable data werecollected from 61 teachers, and results showed that most of the teachers believedthey were capable of both teaching students critical skills such as listening andfollowing classroom rules, and also in managing unacceptable behaviours in theclassroom such as stealing and tantrums. It should be noted, however, that thesample was derived from teachers enrolled in an in-service course in behaviourmanagement. Therefore, it is likely that these teachers’ were not representative oftypical teachers.
Research has also indicated that teachers’ attitudes are mediated by theirperceptions of competence (Brophy & McCaslin, 1992; Li, 1985; Rizzo & Vispoel,1991). Rizzo and Vispoel asked 94 physical education teachers to rate their atti-tude and perceived competence regarding teaching students with disabilities. Find-ings revealed that the more competent a teacher felt, the more favourable theirattitudes were regarding teaching these students. Moreover, while training andattitudes were not related, there was a significant positive correlation betweenperceived competence and years of teaching experience. Further research hasdemonstrated that teachers who have previously taught a student with ADHD aregenerally more confident in their ability to teach students with ADHD than areteachers without this experience (Reid, Maag, Vasa, & Wright, 1994). Reid et al.also showed that severity of student behaviour problems, class size and lack oftraining time were the most troublesome issues to teachers’ management ofADHD within the classroom.
Teachers’ Knowledge and Attitudes Regarding ADHD
ADHD most often presents in the early school years, and is quite pervasive acrossprimary and secondary schooling with an average of one child per classroom havingthe disorder (Barkley, 1998). Therefore, primary school teachers are most likely tobe among the first people to notice ADHD-related behaviours in children (Tannock& Martinuseen, 2001).
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While there are numerous published studies in relation to children with ADHDand issues such as comorbidity (e.g., Jensen, Martin, & Cantwell, 1997; Levy, Hay,Bennett, & McStephen, 2004), its assessment (e.g., Greenhill, 1998), treatment(e.g., Brown & Ievers, 1999), and aetiology (e.g., Levy, Barr, & Sunohara, 1998;Levy & Hay, 2001), very little is known about the knowledge and attitudes of theeducators of these students. It appears that there are very few studies that haveadequately assessed teachers’ knowledge of ADHD (i.e., knowing specific informa-tion about ADHD) and the relationships between teacher characteristics and theirknowledge of the disorder. Even fewer studies have adequately assessed teachers’attitudes toward ADHD (i.e., beliefs and feelings about ADHD).
Over the past 10 years, three Australian (Bekle, 2004; Kos, Richdale, & Jackson,2004; West, Taylor, Houghton, & Hudyma, 2005) and three North American arti-cles (Barbaresi & Olsen, 1998; Jerome, Gordon, & Hustler, 1994; Sciutto, Terjesen,& Bender-Frank, 2000) have been published that assessed teachers’ knowledgeabout ADHD. The dearth of literature in this area is somewhat surprising consider-ing that a common source of information for parents of children with ADHD is theschool system (Bussing, Schoenberg, & Perwien, 1998). Teachers also often provideinaccurate advice to parents, which they frequently follow (DiBattista & Shepherd,1993). Furthermore, not only is there a scarcity of data, the results of these studieshave been mixed. First, the average knowledge scores of in-service teachers (quali-fied teachers currently employed in the classroom), as assessed by the proportion ofquestions correctly answered, have differed across studies. Jerome et al. andBarbaresi and Olsen reported that on average teachers correctly answered 77.5%and 77% of the ADHD knowledge items, respectively. However, Kos et al. reportedthat teachers’ knowledge was 60.7% and Sciutto et al. reported that on average,teachers scored only 47.8% on their respective knowledge questionnaires.
Although the groups of participants in Bekle’s (2004) study were relatively smalland the questionnaire short (a modified version of the Jerome one), the study isinteresting because of the comparison of in-service teachers (N = 30) and under-graduate trainee teachers (N = 40). The two groups had similar levels of endorse-ment of some “myths” about ADHD, such as food additives can cause ADHD,while many more in-service teachers than undergraduate trainee teachers recognisedthat children could be ADHD without having to be overactive. The in-service teach-ers had more accurate knowledge about ADHD, despite only 23% having had someADHD information in their training, compared with 95% of the undergraduates.
The higher proportions of correct responses reported in the two earlier North Amer-ican studies (i.e., Barbaresi & Olsen, 1998; Jerome et al., 1994) compared with thelater studies by Kos et al. (2004) and Sciutto et al. (2000), may be the resultof methodological differences. First, Barbaresi and Olsen and Jerome et al. used20 items to assess teachers’ knowledge, whereas Kos et al. used 27 items and Sciuttoet al. used 36 items. It may be that teachers’ lack of ADHD knowledge is magnifiedwhen a larger number of items and possibly a broader range of issues are tapped. Thishypothesis seems plausible given the progressively lower scores with increasednumbers of items reported across these four studies. The findings do not point to
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national differences since the correct response rate of 83% for in-service teachers inBekle’s (2004) Australian study is even higher than that of the Jerome et al. study withan almost identical questionnaire. Second, respondents were only provided with tworesponse options (true or false) in Jerome et al., Barbaresi and Olsen, and Bekle,whereas Kos et al. and Sciutto et al. used three options (true, false, don’t know). Giventhat teachers had a 50% chance of guessing the correct response in the first three ofthese studies, it is possible that their reported knowledge scores are artificially inflated.
A second difference across the studies is the impact of teaching experience onteachers’ ADHD knowledge. Jerome et al. (1994) assessed the ADHD knowledgeof Canadian and U.S. primary school teachers, and found that the number ofyears of teaching experience predicted higher ADHD knowledge scores for theCanadian sample but not for the United States (U.S.) sample. Furthermore, intheir study of 149 U.S. primary-school teachers, Sciutto et al. (2000) showed thatyears of teaching experience was significantly related to overall knowledge ofADHD. Kos et al. (2004), however, in their sample of 120 Australian primaryschool teachers, found no correlation between ADHD knowledge and years ofteaching experience.
Exposure to children with ADHD in the classroom is an important factor inteachers’ knowledge about the disorder (Kos et al., 2004; Sciutto et al., 2000).Specifically, teachers who reported having prior exposure to children with ADHDrecorded significantly higher total knowledge scores than teachers without suchexposure. Furthermore, the degree of this exposure may also significantly relate toADHD knowledge (Sciutto et al., 2000). That is, Sciutto et al. showed that ADHDknowledge was positively associated with the number of students with ADHD taughtover a teacher’s career. This relationship was not evident in the study of Kos et al.
Research on teachers’ attitudes about ADHD as distinct from knowledge of ADHDis also somewhat limited. Published papers have tended to focus on parents of chil-dren with ADHD (e.g., Johnston & Leung, 2001; Johnston & Patenaude, 1994) andmedical practitioners (e.g., Kwasman, Tinsley, & Lepper, 1995; Wagner, Eastwood,& Mitchell, 2003). While there are some studies purporting to have assessed the atti-tudes about ADHD of primary school teachers, most assess only a limited number ofconstructs such as attitudes toward causes and/or attitudes toward treatment. Otherthan the present article, there appears to be no Australian studies, since the formattingof the questionnaire in Bekle (2004) confounds attitudes with “myths”.
Recently, West et al. (2005) developed and administered the 67-item “Knowledgeabout Attention Deficit Disorder Questionnaire” (KADD-Q) to 256 teachers and92 parents. Teachers and parents knew most about the causes of ADHD, less aboutthe characteristics, and even less about treatment. Parents knew significantly morethan teachers, especially about the causes and treatment of ADHD. Although therewere no significant differences in teachers’ and parents’ levels of knowledge aboutthe characteristics of ADHD, parents scored significantly higher than teachers onthe causes and treatment subscales of the KADD-Q. The findings also revealed thatmisconceptions about ADHD are evident among parents and teachers, but thatprofessional development of teachers is fundamental to increasing knowledge.
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Studies suggesting they are assessing teachers’ attitudes are doing little more thaninvestigating knowledge about ADHD. For example, Barbaresi and Olsen (1998)included the subheading “Teacher Attitudes and Experience” in the results sectionof their paper. However, the study did not really assess teachers’ attitudes towardADHD as the only information provided was basic demographic details, includingadditional training, ADHD-specific teaching experience, and whether or not teach-ers had contact with prescribing physicians.
Another misuse of the term “attitudes” appeared in the Jerome et al. (1994) study,in which the title suggests that teachers’ knowledge and attitudes about ADHD wereassessed. However, in this study no distinction is made between knowledge and atti-tudes. Furthermore, inspection of their survey instrument showed that the majorityof the 20 items used in the study were merely measures of knowledge about ADHD,and that attitude toward the disorder was not adequately assessed. There is alsoambiguity as to the “correct” answers for some of the items. Given the controversialexperience of the Multimodal Treatment Assessment (MTA) study, a reliableanswer to Question 8 about treatment with medication may well be beyond thescope of many teachers and health professionals. The items used in Barbaresi andOlsen (1998) were based on those used by Jerome et al., and similar problems areevident in that survey instrument.
Glass and Wegar (2000) assessed the attitudes of 225 teachers regarding aetiologyand treatment for ADHD. Teachers’ attitudes were not always consistent. Of thesample, 78.2% reported that ADHD was a biological abnormality, 11.1% believedADHD was caused by environmental factors, while 10.7% believed it was normalbehaviour. Regardless of teachers’ perceptions about aetiology, however, treatmentof choice was overwhelmingly to combine medication and behaviour modification.Also, even though over 40 teachers reported that ADHD was caused by environ-mental factors alone, only 11 teachers felt that behaviour modification alone wassufficient to treat ADHD.
Pre-service Teachers’ Knowledge and Attitudes
There is a dearth of research in the area of pre-service (those still undergoingtraining) teachers’ knowledge and attitudes toward ADHD. Considering that theseindividuals will be employed within the education system, and will very probablyhave a student with ADHD in their class (Barkley, 1998), it is important to boththese teachers themselves and their future students to have an understanding of thispopulation’s knowledge about ADHD, as well as any misperceptions they may haveabout the disorder.
There is one brief report that the authors are aware of that has compared in-service and pre-service teachers’ knowledge about ADHD (Jerome, Washington,Laine, & Segal, 1998). The findings of this study suggested there was little differenceacross the two groups in terms of knowledge about ADHD. While it is possible thatpre-service teachers have comparable knowledge about ADHD with that of in-service teachers, it would seem surprising in light of research that has shown knowl-
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edge about ADHD is positively correlated with both the length of a teacher’s careeror years of experience teaching children with ADHD (Jerome et al., 1994; Kos et al.,2004; Sciutto et al., 2000). Therefore, given that, unlike pre-service teachers, in-service teachers have taught before and have had the opportunity to teach studentswith ADHD, one would expect in-service teachers’ knowledge about ADHD to begreater than that of pre-service teachers. However, it might be that university train-ing has improved over time, and as a result pre-service teachers have higher levels ofknowledge about ADHD than in-service teachers. That is, while in-service teachersmay have ADHD-specific teaching experience, many received poor initial training atthe university level regarding ADHD and its management (Kos et al., 2004). On thecontrary, pre-service teachers have not had direct experiences teaching students withADHD, but their knowledge might be compensated by an increased initial teachertraining in the area. These are only possibilities, and to date there appears to be nostudies that have assessed these.
Teachers’ Behaviour toward Children with ADHD
Teachers’ attitudes and knowledge towards children with ADHD may be expectedto influence their resultant behaviour (Glass & Wegar, 2000). For example, if ateacher believes that ADHD is caused by chemical imbalances in the brain, it isunlikely they will use psychological interventions to manage the child’s behaviour.This seems quite plausible in the light of research showing that the behaviourof many teachers reflects their attitudes (Alderman & Nix, 1997; DiBattista &Shepherd, 1993; Greene, 1995, 1996), and that teachers tend to resist new ideas andmethods that are not representative of their belief systems (Westwood, 1996).Furthermore, if people believe they are knowledgeable about a certain topic, theymay be unlikely to seek information about that topic. Therefore, teachers who feelthey know a lot about ADHD may be unlikely to ask for information about the disor-der. However, it is apparent from past studies that teachers’ knowledge of ADHD isnot particularly high (e.g., Jerome et al., 1994; Kos et al., 2004; Sciutto et al., 2000;West et al., 2005), meaning that teachers may pass incorrect information on toothers (DiBattista & Shepherd, 1993).
South Australia’s Department of Education, Training and Employment (DETE)conducted an investigation in 1999 involving the collaboration of health and schoolprofessionals, as well as children with ADHD and their families (DETE, 1999). As aresult, DETE developed a working document to aid teachers in the classroom manage-ment of children with “ADHD-like difficulties”. This document indicated the valueand utility of a few specific behaviour management strategies to the classroom manage-ment of students with ADHD, including corrective strategies, environmental adapta-tion, positive programming and teaching, and emotional bolstering (DETE, 1999).
According to DETE (1999), corrective strategies are specific behavioural strategiesused to increase or decrease target behaviours. Positive reinforcement (e.g., praise,rewards), punishment (reprimands, removal of privileges), and planned ignoringare all examples of corrective strategies. These strategies have been consistently
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shown to be effective in the management of ADHD-related behaviour problems(Anhalt, McNeil, & Bahl, 1998; DuPaul & Eckert, 1997; DuPaul & Power, 2000;Jarman, 1996; Pelham Jr, Wheeler, & Chronis, 1998; Pfiffner, O’Leary, Rosen, &Sanderson, 1985).
DuPaul and Eckert (1997) conducted a meta-analysis of 63 studies and foundthat behavioural interventions, particularly those based on positive reinforcementand punishment, are quite effective in improving classroom behaviour. Anhalt et al.(1998) highlighted the efficacy of using reinforcement for children with ADHD,showing that reinforcement is effective in decreasing overactivity and in increasingon-task behaviour and academic performance in these children. Furthermore, it wasshown that both reinforcement and punishment should be implemented simulta-neously for greatest efficacy. Intensive behavioural modification packages, includingfixed interval schedules of reinforcement, have been developed in the U.S. and havebeen shown to be extremely effective in improving the behaviour of children withADHD (Rabiner, 1999).
DETE (1999) also discussed environmental adaptation, which includes suchthings as ensuring that the classroom is safe and visible, that “active” and “quiet”areas are established within the room, and that distracters (e.g., noise) are identifiedand altered. Positive programming and teaching is related to environmental adapta-tion, and involves strategies such as allowing extra time for tasks, breaking tasks intosmaller steps, and providing set choices during free time activities. Together,environmental adaptation and positive programming and teaching appear to beexamples of antecedent stimulus control.
Research has shown the validity of these strategies in improving children’s class-room behaviour (e.g., Jarman, 1996; Montague & Warger, 1997). According toJarman, children with ADHD perform at their optimal level when the classroom ishighly structured, routines are in place, there are minimal sensory distractions, andthey are seated close to the teacher in the middle-front of the classroom. Jarmanfurther asserted that children with ADHD tend to perform better when the curricu-lum is altered to suit their ability and they are allowed breaks during class time. Thiswas subsequently supported by DuPaul and Power (2000). Finally, as an aid to chil-dren’s learning and to decrease ADHD symptoms, DETE (1999) recommendedteachers recognise and build upon the strengths of a child with ADHD and developstrategies to address issues occurring at home. These types of strategies have beentermed “emotional support” by the current authors, and may include reassurance,using humour, and showing the child care and attention.
Although behaviour modification has been shown repeatedly to be efficacious inthe treatment of ADHD (Chambless & Ollendick, 2001), there has been little inves-tigation of the actual behavioural strategies teachers use in the classroom manage-ment of students with ADHD, or the reasons behind teachers’ use of thosestrategies. Kos (2004) investigated the strategies used by Australian primary schoolteachers and found that of the five classroom management strategies investigated(classroom organisation, reinforcement, negative consequences, planned ignoring,and emotional support), reinforcement was the most commonly used and planned
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ignoring the least commonly used. Common examples of reinforcement used byteachers included praise, a smile, and extra play time.
The School and the Family
While teachers may be becoming more aware of ADHD, they are probably muchless aware of many recent developments concerning the impact of ADHD on thefamily. For example, there is increasing recognition of the financial and emotionalimpact of ADHD on the family (Sayal, Taylor, & Beecham, 2003), which has obvi-ous consequences on the provision by the family of educational resources such aselectronic equipment and excursions. Trying to balance the demands of a child withADHD and the demands of their own work has been identified as a major stressoron parents (Sayal et al. 2003). Teachers need increased awareness of the parentingstyles that children with ADHD may experience. Lange et al. (2005) suggests theremay be a more authoritarian parenting style that is a reaction to the behaviour of thechild with ADHD. Another issue is that of the personalities of the parents of chil-dren with ADHD. Given the very high heritability of ADHD (Levy & Hay, 2001),there is now also a growing recognition of psychopathology in the parents. Chroniset al. (2003) for example, documented a whole range of problems from anxietydisorders to substance abuse to antisocial personality disorder. The increased possi-bility of impulsivity and problems with organisation in these parents (Levy & Hay,2001) may need to be taken into account in the preparation of the child’s assign-ments.
One group that teachers do need to be more aware of is the siblings of childrenwith ADHD. McDougall (2002) obtained extensive qualitative data from siblingsof ADHD children and identified two themes in the data relevant to the school situ-ation: the frequent complaints of the children about their sibling with ADHDdamaging or destroying their school assignments; and an appreciation of stimulantmedication as “giving them back” their sibling with ADHD. More recently,McDougall, Hay, and Bennett (2006) focused on the unique situation of being a co-twin of a twin who had ADHD. Although anxiety problems were greatest in the co-twin of the child with ADHD, even in the non-twin siblings of children with ADHD,there were more problems.
Conclusions
Children with ADHD experience a myriad of difficulties, particularly in regard totheir academic performance and social skills. Teachers tend to hold negative beliefsabout related externalising behaviour problems such as conduct disorder bystudents with ADHD, tend to be pessimistic about teaching these children, and feelthey require extra time and effort to teach them. Teachers’ attitudes also appear tobe mediated by perceptions of competence and other variables, such as teachingexperience in general and ADHD-specific teaching experience, which were relatedto teachers’ knowledge about ADHD. Results have varied regarding teachers’
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Children with ADHD and their Teachers 157
knowledge about ADHD, but all suggest that there is room for improvement inteachers’ knowledge.
At the same time more needs to be done to increase teachers’ awareness of devel-opments in ADHD. Documents such as the recent European guidelines for ADHD(Taylor et al., 2004) present current thinking and empirically-based evidence onmany issues upon which teachers should reflect. These include the extent of agree-ment or disagreement between parent and teacher reports on ADHD symptomatol-ogy, and the most recent evidence on medication versus behavioural interventionsfor ADHD.
Increasing teachers’ insights into the current debates over best practice in themanagement of ADHD includes developing their awareness of the pervasiveness ofcomorbid conditions. They certainly will be aware of the reading problems commonin young people with ADHD, but may be less aware of the high rate of anxietydisorders among these children. While it is not the teacher’s job to diagnosis suchproblems, teachers do have a vital role in supporting such children in the classroomand recognising the fact that ADHD is often only one of their problems (Kellneret al., 2003).
Teachers’ attitudes have not been clearly assessed in the past. Given findingsregarding the link between attitudes and behaviour, there is a strong need to investi-gate teachers’ attitudes regarding ADHD. A series of empirically validated classroommanagement strategies were detailed in this article, as were studies highlighting theirefficacy in the management of ADHD. Overall, although some research has beenconducted in the area of teachers’ knowledge, attitudes, and behaviour toward chil-dren with ADHD, there is a dearth of literature pertaining to a theoretical under-standing of these variables. Understanding these variables within a theoreticalcontext will increase the knowledge of the interplay between various factors andADHD within the education system. It is therefore important that future researchassess teachers’ knowledge, attitudes, and behaviours toward children with ADHDwithin a theoretical framework that combines best teaching practice with best prac-tice in managing ADHD and comorbid conditions.
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