Knowledge and Attitude of Female Teachers Toward ADHD at Elementary Schools, Jeddah, KSA, 2017

Full text

January, 2019 2019; Vol3; Issue 1 http://iamresearcher.online
To Cite This Article: Manal Basudan; Naeema Akbar; Waled El-Ghamdi; Adel Ibrahim. Knowledge and Attitude of Female Teachers Toward
ADHD at Elementary Schools, Jeddah, KSA, 2017. International Annals of Medicine. 2019;3(1). https://doi.org/10.24087/IAM.2019.3.1.693
Knowledge and Attitude of Female Teachers Toward
ADHD at Elementary Schools, Jeddah, KSA, 2017
Manal Basudan1; Naeema Akbar2; Waled El-Ghamdi3; Adel Ibrahim2
1 Joint Program of Family and Community Medicine, Jeddah, KSA.
2Consultant Community Medicine.
3Consultant psychiatry
Corresponding Author: Manal Basudan
Dr.manal.k@hotmail.com
ABSTRACT
Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatry disorders in
children, it has negative impact on the academic, familial and social functioning of the child. The recent advances in
its treatment calls for social intervention including school-based activities, which necessitates knowledgeable teachers.
Aim: The main aim of this study is to explore the level of knowledge and attitude of the school teachers of female
primary schools in Jeddah about ADHD. Subjects and methods: Through a cross sectional design, 376 school
teachers were selected by multistage sampling from female primary schools in Jeddah, they were invited to fill a
predesigned valid questionnaire reflecting their knowledge and attitude towards ADHD. SPSS ver 21 was used for
data entry and statistical analysis which included descriptive as well as analytic analysis using Chi square test. P
value<0.05 was considered an indication for significance. Results: Almost one half of the teachers (47.6%) aged
between 40-49 years, who were mostly married (81.1%) and having children (84.3%). Out of them, 8.2% reported
that they have ADHD child. Although that more than one half of the teachers (54.3%) thought that they had knowledge
about ADHD, the true knowledge test questions revealed a much lower percentage (24.5%) who showed good
knowledge about ADHD. Only older teachers had significant better knowledge. More than one half of the teachers
(57.2%) perceive that the first step in the management policy when suspecting ADHD is the referral of the child to
advisor and asking for attendance of the parents. Conclusion and recommendations: Most of the teachers have
insufficient level of knowledge about ADHD. There is a tangible need for training programs provided to the teachers
about early recognition and policy of care of ADHD children.
Keywords: Attention deficit hyperactivity disorder, ADHD, Teachers, Knowledge, Attitude
1. INTRODUCTION
Attention deficit hyperactivity disorder (ADHD) is one of the most common child psychiatry disorders, it begins in
childhood and can continue to adolescence; characterized by persistent pattern of inattention and/or hyperactivity-
impulsivity beyond the range of developmental norms, which may have an impact on personal, academic, familial and

International Annals of Medicine
Vol1;3(1);2019
To Cite This Article: Manal Basudan; Naeema Akbar; Waled El-Ghamdi; Adel Ibrahim. Knowledge and Attitude of Female Teachers Toward
ADHD at Elementary Schools, Jeddah, KSA, 2017. International Annals of Medicine. 2019;3(1). https://doi.org/10.24087/IAM.2019.3.1.693
societal functioning [1]. Since the second half of the
twentieth century, ADHD recognized significant
advances in its diagnosis and treatment [2], together
with great concern of the researchers to identify its
prevalence and risk factors, however, the reported
prevalence showed remarkable variations due to
differences in the adopted methodologies [3]. In Saudi
Arabia, the prevalence of ADHD ranged between
2.7% among primary school children aged 7-9 years in
Riyadh [4], up to 16.4% in Dammam, with a
prevalence of 12.4% for hyperactivity-impulsivity and
16.3% for inattention disorders respectively [5].
Although medication treatment has been widely used
as an effective treatment for ADHD, significant
residual post-medication symptoms had been detected,
which necessitates further psychological treatments, in
addition to the medications, in order to provide
comprehensive treatment [6]. Among promising
psychosocial treatments, Evans et al. (2014)
developed a school-based treatment program for
ADHD, they found considerable effect on inattention
and school functioning, family functioning and peer
relations. The authors divided suggested psychosocial
treatments into “behavioral treatments” in which
activities are provided by others (e.g., parents and
teachers) and “training interventions” in which skills
are taught to the patients themselves [7]. In this respect
teachers are expected to have adequate level of
knowledge about recognition, referral and dealing
with children with ADHD, as they play a major role in
creating an environment that is conducive to
academic, social and emotional success of these
children [8]. Previous studies in Saudi Arabia showed
controversial level of knowledge of the teachers about
ADHD students, while Aldawodi and his colleagues
(2017) reported on average good knowledge of
teachers in Riyadh [9], Abed et al (2014) noted
insufficient level of knowledge of the teachers about
possible intervention for ADHD [10]. Therefore, the
current study aims at exploring the level of knowledge
and attitude of the teachers in female schools in Jeddah
about ADHD, in an attempt to provide scientific
background that could help in good planning for care
of ADHD students.
2. METHODS
Through a cross sectional study design, the study
targeted female teachers working in elementary
schools in Jeddah, Saudi Arabia (n=16,825), sample
size was calculated by using Raosoft calculation
website considering target population as 16.825. The
estimated sample size was 376, with ±5 margin of
error and 95% confidence level. Sampling was carried
out by Multistage sampling technique. In stage I, one
governmental school was selected by simple random
sample from each sector, in stage II, we selected
participants who fulfilled the inclusion criteria by
simple random sampling. In this research, the
researcher defined ADHD according to DSM5 as
chronic neuro-developmental disorder with
persistence of six or more symptoms of inattention
and/or hyperactivity-impulsivity in two or more sitting
(home, school) or (home, work) in the last six month
that interferes with functioning or development with
negatively impacts on social, academic or
occupational achievement. For this reason, the
researcher used a modified version of constructed
questionnaire developed for a previous study (The
effect of health education on knowledge and suspicion
index about ADHD among kindergarten female
teachers), an attitude section was added by using the
psychiatric scale DSM5 (diagnostic statistical manual
of mental disorders). Finally, the questionnaire
included three sections: the first section that was
modified to include information about the attitude
among female teachers toward ADHD suspicion
cases. the other two sections included case scenarios
about ADHD behavior and general questions about
knowledge and diagnostic criteria toward ADHD. The
researcher visited the targeted school for collection of
data after ensuring all relevant ethical and
administrative approval. For data entry and statistical
analysis, we used SPSS software 21version, the
questionnaire used in this study to assess the
knowledge “consisted of Thirty-eight questions;
twenty-one around general information about ADHD
and the remaining seventeen were about symptoms of
ADHD. A score of 60% correct answers was required
to be considered as having good knowledge.
Descriptive categorical data was analyzed using
frequency distribution. Analytic part of categorical
data was done by using chi square, level of significant
was determined at p0.05>.
3. RESULTS
The study included 376 female teachers. Their age
ranged between 20 and 59 years. Almost half of the
participants (47.6%) aged between 40 and 49 years.
Majority of them (81.1%) were married. Most of them
had children (84.3%), with only (8.2%) who were
diagnosed with ADHD. Children with ADHD in the
family represented (14.6%). Educational level showed

International Annals of Medicine
Vol1;3(1);2019
To Cite This Article: Manal Basudan; Naeema Akbar; Waled El-Ghamdi; Adel Ibrahim. Knowledge and Attitude of Female Teachers Toward
ADHD at Elementary Schools, Jeddah, KSA, 2017. International Annals of Medicine. 2019;3(1). https://doi.org/10.24087/IAM.2019.3.1.693
that (71.5%) achieved bachelor’s degree. Most of the
participants (77.1%) were currently working as
teachers and among those (36%) had more than 15
years of experience. Only (7%) of the participants
reported that they had previously taught in special
education schools (Table 1).
Table 1: Demographic characteristics of the study group (n=376)
Category
Frequency
Percent %
Age
20-29
11
2.9
30-39
146
38.8
40-49
179
47.6
50-59
40
10.6
Nationality
Saudi
375
99.7
Non-Saudi
1
0.3
Social Status
Married
305
81.1
Single
23
6.1
Divorced
35
9.3
Widowed
13
3.5
Have Children
Yes
317
84.3
No
59
15.7
Have Child with ADHD
Yes
31
8.2
No
345
91.8
Family Children with ADHD
Yes
55
14.6
No
321
85.4
Educational Level
Bachelor’s degree
269
71.5
Postgraduate
6
1.6
Diploma
80
21.3
Currently Teacher
Yes
290
77.1
No
86
22.9
Previously taught in special
education schools
Yes
27
7
No
349
93
Experience Years
<2 years
5
1.3
3-5 years
42
11.2
6-10 years
95
25.3
11-15 years
98
26.1
>15 years
136
36.2
Before answering the questionnaire, the participating
teachers were asked if they have knowledge about
ADHD using a “yes” or “no” question. Among those
participating teachers (54.3%) reported they had
information about ADHD and slightly lower
percentage (45.7%) reported that they did not having
information. (Figure 1). However, regarding the actual
level of knowledge based on the questionnaire, only
one quarter of the teachers (24.5%) had overall good
knowledge about ADHD versus (75.5%) who had
poor knowledge (Figure 2).
Figure 1: Participants perceived having knowledge
About ADHD
Yes, 204,
54.3%
No, 172,
45.7%

International Annals of Medicine
Vol1;3(1);2019
To Cite This Article: Manal Basudan; Naeema Akbar; Waled El-Ghamdi; Adel Ibrahim. Knowledge and Attitude of Female Teachers Toward
ADHD at Elementary Schools, Jeddah, KSA, 2017. International Annals of Medicine. 2019;3(1). https://doi.org/10.24087/IAM.2019.3.1.693
Figure 2: Participants’ actual level of knowledge
About ADHD
The most reported source of information was media
(22.9%). Others reported that they learned about
ADHD during educational years (12.2%), educational
book about ADHD (6.4%). Meanwhile, few reported
that they had more than one source (9.8%). Only 3
participants (0.8%) learned about ADHD from cases
in their families (Table 2). As shown in (Table 3),
among the factors influencing the actual level of
knowledge of the teachers about ADHD, only age had
significant difference (p-value 0.037). Other factors;
social status, have children, having a child diagnosed
with ADHD, children in family with ADHD,
educational level, taught previously in special
education school and years of experience had no
significant effect (p value >0.05).
Table 2: Reported sources of information about ADHD
Source of information
Frequency
Percent %
More than one source
37
9.8
During educational years
46
12.2
Educational book
24
6.4
The media
86
22.9
Training courses
22
5.9
Other
5
1.3
Does not have information
151
40.2
Learning difficulties teacher
1
0.3
From ADHD cases in family
3
0.8
Reading about ADHD
1
0.3
Table 3: Socio-demographic factors related to having true information about ADHD
Parameter
Category
Information About ADHD
Good (N=92)
Poor (N=284)
p-value
Freq.
%
Freq.
%
Age (years)
20-29
0
0
11
11
0.037*
30-39
29
19.9
117
80.1
40-49
54
30.2
125
69.8
50-59
9
22.5
31
77.5
Social status
Married
76
24.9
229
75.1
0.141
Not married
3
13
20
87
Divorced
12
34.3
23
65.7
Widow
1
7.7
13
92.3
Have Children
Yes
83
26.2
234
73.8
0.073
No
9
15.3
50
84.7
Have child diagnosed
with ADHD
Yes
8
25.8
23
74.2
0.856
No
84
24.3
261
75.7
Children in Family with
ADHD
Yes
13
23.6
42
76.4
0.877
No
79
24.6
242
75.4
Good, 92,
24.5%
Poor, 284,
75.5%

International Annals of Medicine
Vol1;3(1);2019
To Cite This Article: Manal Basudan; Naeema Akbar; Waled El-Ghamdi; Adel Ibrahim. Knowledge and Attitude of Female Teachers Toward
ADHD at Elementary Schools, Jeddah, KSA, 2017. International Annals of Medicine. 2019;3(1). https://doi.org/10.24087/IAM.2019.3.1.693
Educational level
Bachelor
Degree
68
25.3
201
74.7
0.256
Post Graduate
1
16.7
5
83.3
Diploma
19
23.8
61
76.3
Other
0
0
2
100
High School
4
21.1
15
78.9
Taught Previously in
Special Education
Schools
Yes
3
20
12
80
0.681
No
89
24.7
272
75.3
Years Of Experience
<2
0
0
5
100
0.169
3-5
6
14.3
36
85.7
6-10
25
26.3
70
73.7
11-15
21
21.4
77
78.6
>15
40
29.4
96
70.6
Regarding attitude of teachers towards ADHD, their
viewpoints on the proper policy is presented in (Table
4) where (57.2%) chose referral to advisor and
attendance of parents, (8.8%) chose to notify school
principal, (2.9%) chose referral to PHC or hospital,
(2.1%) chose referral to psychiatry, (0.8%) chose to
transfer the student from school and (0.5%) chose
referral to learning difficulties teacher. The
participating teachers were evaluated on how they
manage students with ADHD in class, most responded
by giving her leading tasks (33.8%) and making them
sit in front row (22.9%). Others made summaries to
help them focus in case of distraction (14.4%), re-
explanation of facilitate explanation (15.4%),
transferred them from class (2.4%) and (11.2%) didn't
know how to manage (Table 5).
Table 4: Participants’ response regarding the first step in the policy when suspecting ADHD in a student.
First step in the policy when suspecting ADHD in a student
Frequency
Percent %
Referral to advisor and attendance of parents
215
57.2
Referral to PHC or hospital
11
2.9
Referral to psychiatry
8
2.1
Transfer the student from school
3
0.8
Notify school principal
33
8.8
Referral to learning difficulties teacher
2
0.5
Table 5: Shows how the participating teachers manage students with ADHD in the class room.
If there was a student with ADHD in the class how she will be
managed
Frequency
Percent %
Does not know
42
11.2
Sit in front row
86
22.9
Transfer from class
9
2.4
Give her leading tasks
127
33.8
Make summaries to help them focus in case of distraction
54
14.4
Re-explanation or facilitate explanation
58
15.4
4. DISCUSSION
One of the primary objectives of this study was to
assess the knowledge of elementary school teachers
about ADHD. Two major types of knowledge were
assessed perceived and actual knowledge. The
perceived knowledge reported by the participating
teachers was (54.3%) meanwhile, the actual
knowledge (24.5%) calculated by our questionnaire
indicate that there is a substantial knowledge gap
about ADHD among teachers in elementary schools in
Jeddah Saudi Arabia. These wide-ranging results
propose that the perceived knowledge did not reflect
the actual knowledge, thus suggesting that the
participating teachers have misperceptions about their
knowledge. (75.5%) of the participating teachers

International Annals of Medicine
Vol1;3(1);2019
To Cite This Article: Manal Basudan; Naeema Akbar; Waled El-Ghamdi; Adel Ibrahim. Knowledge and Attitude of Female Teachers Toward
ADHD at Elementary Schools, Jeddah, KSA, 2017. International Annals of Medicine. 2019;3(1). https://doi.org/10.24087/IAM.2019.3.1.693
scored poor in knowledge with less than 60% correct
answers. This result is lower than other reported study
results. For instance, Munshi (2014), conducted a
cross sectional study to evaluate the knowledge of
primary school and kindergarten teachers towards the
diagnosis and the management of ADHD More than
half of the female teachers (55.4%) had insufficient
information regarding ADHD during their
undergraduate stage [11]. Furthermore, a research
done by Youssef MK, (2015) reported that teachers
had poor knowledge about ADHD with the mean total
correct knowledge score being less than 50% [12]. The
reasons responsible for these low scores are
ambiguous. Age was the only significant factor
associated with teachers having good knowledge. This
finding was different than Youssef MK (2015) in his
study, which stated that age had no impact on
knowledge scores [12]. Other factors such as social
status, having children, having a child diagnosed with
ADHD, having children in family with ADHD,
educational level, taught previously in special
education school and years of experience had no
significant effect on the actual knowledge scores. On
the other hand, research (Aguiar AP, 2014 and
Youssef MK, 2015) suggested that education level
may be influential. Teachers with a master’s level
education scored highest, as did those who received
ADHD specific training [1,12]. Knowledge scores
were largely affected by having previous experience
of teaching a child with ADHD, findings in keeping
with other research [13,14]. Perhaps the challenges of
teaching children with ADHD triggered teachers to
seek out information and additional training resources,
again a very positive finding in the context of future
training interventions. Predominantly though, large
number of the participants in our study selected the
choice “I don’t know” this may be due to a high level
of uncertainty about the correct information, rather
than a high level of misperception about ADHD. This
is an important point to consider for future training
programs and policies. The teachers’ attitude towards
ADHD was another objective in our study. Teachers
were uncertain whether existing policies around
proper action when suspecting ADHD in a student
exist. The majority of the participants chose either to
refer to advisor and demand attendance of parents or
notify school administration when suspecting a child
with ADHD. Correspondingly, Visser et al (2014)
stated that one of the main approaches used by
teachers is communicating with the parents of students
with ADHD advising them to undergo evaluation for
their child [15]. In fact, research shows that teachers
are the most common source of early referral. In regard
to dealing with students with ADHD in the class room,
most responded by giving them leading tasks (33.8%),
making them sit in front row (22.9%), making
summaries to help them focus in case of distraction
(14.4%), re-explanation of facilitate explanation
(15.4%), transferred them from class (2.4%) and
(11.2%) didn't know how to manage. Conclusively,
the overall knowledge about ADHD among teachers
was poor. Putting into consideration that the
prevalence of ADHD in Saudi Arabia is 11.6%, which
is similar to worldwide prevalence, teachers must be
educated and prepared to properly interact with
children with ADHD.
REFERENCES
1. Aguiar AP, Kieling RR, Costa AC, Chardosim N, Almeida MR, et al. Increasing teachers knowledge about ADHD and learning
disorders: an investigation on the role of a psychoeducational intervention. Journal of Attention Disorders 2014;18(8):691-8.
2. Singh I. Beyond polemics: science and ethics of ADHD. Nature Reviews Neuroscience 2008;9(12):957.
3. Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated
systematic review and meta-regression analysis. International Journal of Epidemiology 2014 Apr 1;43(2):434-42.
4. Alqahtani MM. Attention-deficit hyperactive disorder in school-aged children in Saudi Arabia. European Journal of Pediatrics
2010;169(9):1113-7.
5. Al Hamed JH, Taha AZ, Sabra AA, Bella H. Attention deficit hyperactivity disorder (ADHD) among male primary school children in
Dammam, Saudi Arabia: prevalence and associated factors. J Egypt Public Health Assoc 2008;83(3-4):165-82.
6. Chronis AM, Jones HA, Raggi VL. Evidence-based psychosocial treatments for children and adolescents with attention-
deficit/hyperactivity disorder. Clinical psychology review 2006;26(4):486-502.
7. Evans SW, Owens JS, Bunford N. Evidence-based psychosocial treatments for children and adolescents with attention-
deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology 2014;43(4):527-51.
8. Topkin B, Roman NV. Attention Deficit Disorder (ADHD): Primary school teachers knowledge of symptoms, treatment and
managing classroom behaviour. South African Journal of Education 2015;35(2):988.

International Annals of Medicine
Vol1;3(1);2019
To Cite This Article: Manal Basudan; Naeema Akbar; Waled El-Ghamdi; Adel Ibrahim. Knowledge and Attitude of Female Teachers Toward
ADHD at Elementary Schools, Jeddah, KSA, 2017. International Annals of Medicine. 2019;3(1). https://doi.org/10.24087/IAM.2019.3.1.693
9. Aldawodi MD, Alfageer HH, Al Queflie SA, Masud N, Al Harthy NA, Alogayyel N, et al. Knowledge and Attitude of Male Primary
School Teachers about Attention Deficit and Hyperactivity Disorder in Riyadh, Saudi Arabia. 2017.
10. Abed M, Pearson S, Clarke P, Chambers M. Saudi Arabian Teachers' Knowledge and Beliefs about ADHD. Journal of the
International Association of Special Education 2014;15(1).
11. Munshi AMA. Knowledge and misperceptions towards diagnosis and management of attention deficit hyperactivity disorder (ADHD)
among primary school and kindergarten female teachers in Al-Rusaifah district, Makkah city, Saudi Arabia. International Journal of
Medical Science and Public Health 2014;3(4):444-51.
12. Youssef MK, Hutchinson G, Youssef FF. Knowledge of and attitudes toward ADHD among teachers: insights from a Caribbean
Nation. Sage Open 2015;5(1).
13. Kos JM, Richdale AL, Jackson MS. Knowledge about Attention Deficit/Hyperactivity Disorder: A comparison of in-service and
preservice teachers. Psychology in the Schools 2004;41(5):517-26.
14. Sciutto MJ, Terjesen MD, Frank ASB. Teachers' knowledge and misperceptions of attention deficit/hyperactivity disorder.
Psychology in the Schools 2000;37(2):115-22.
15. Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, et al. Trends in the parent-report of health care provider-diagnosed
and medicated attention-deficit/hyperactivity disorder: United States, 2003G_ô2011. Journal of the American Academy of Child &
Adolescent Psychiatry 2014;53(1):34-46.