Teachers’ Knowledge, Beliefs, and Values about

Children with ADHD

Judy A. Liesveld

August 16, 2007

Background for the Study

ADHD is a complex disorder with neurological and genetic factors comprising a sound but still unproven explanation for the cause (Anastopoulos & Shelton, 2001; Biederman & Faraone, 2005).

ADHD has profound effects at the individual, family, school, and societal levels (Chan et al., 2002; Kendall, 1998; Kendall et al., 2003; Leibson et al., 2001).

Why Teachers are Important

Most elementary school classrooms have at least one child with ADHD (Barkley, 1998).

ADHD viewed as a medicalized phenomenon (Conrad, 1992).

“Medical gaze” (Foucault, 1976) partially transferred to teachers

Why Teachers are Important (Continued)

A high percentage of children referred for ADHD evaluations are first identified by teachers (Pilling, 2000).

Teachers are asked to complete rating scales or questionnaires regarding symptoms.Teachers are asked to carry out recommended treatment regimens or to monitor effectiveness of treatment (Tannock & Martinussen, 2001).

The Albuquerque JournalMarch 22, 2007, Page A1

Purpose of the Study

The purpose of the study was to sequentially determine elementary teachers’ knowledge regarding ADHD and to then explore teachers’ beliefs and values vis-à-vis knowledge regarding children with ADHD and treatment practices.

Quantitative Research Questions

What do teachers know about ADHD?

How do teachers rate their knowledge about ADHD?

How does age, gender, ethnicity, number of teaching years, past ADHD training, and number of children taught with ADHD affect teachers’ knowledge about ADHD?

Qualitative Research QuestionsWhat are elementary school teachers’ beliefs and values regarding children with ADHD?How do school environments influence teachers’ knowledge, beliefs, and values regarding children with ADHD?What are their beliefs and values regarding treatment practices for children with ADHD? How do teachers think that their cultural beliefs and values influence their actions taken in working with children with ADHD?

Combining Quantitative and Qualitative Data

Does knowledge about ADHD influence teachers’ beliefs and values about ADHD and if so, how?

Methodology

quantitative: KADDS, visual analog,demographic information

qualitative: group interviews, field notes

Qualitative: Individual interviews, participant observations, documentary evidence, field notes

concurrentsequential

Study Design

Ethnographic Paradigm

The upper/lower case notations of “q” indicate the majorand minor methods of data collection and analysis in thestudy design sequence (Morse, 2003).

Data Collection Strategies

The Knowledge of Attention Deficit Disorders Scale (KADDS)—criterion based tool (reliability .82 to .90).

Demographic Questionnaire

Visual Analog Tool

Group Interviews and Individual Interviews

Field Notes

Setting for the Study

Gallup McKinley County School District

(2nd largest geographical school district in US in the 3rd poorest county in the US)

Nine elementary schools participated.

Demographics of the Sample133 teachers completed the KADDS, demographic questions and VAS; 4 group interviews with 28 teachers; 5 high KADDS and 3 low KADDS individual interviews80% Female. Ages ranged from 22 to 72 (M = 44.00, SD = 12.43).80% White, 8% American Indian, 7% Hispanic, 2% Asian, 1% African American, 2% Unreported.Years taught: 1 to 39 (M = 12.50, SD = 9.47)Standard Licensure (82%), Alternative (13%), and (5%) unreported.

Experience with ADHD

Percentages for Categorical Variables Measuring Experiences with ADHD (N = 133)

Currently Teaching Child with ADHD

40n = 53

58n = 77

2

Any Type of Past Training about ADHD

78 n = 104

20n = 26

2

Past College Courses about ADHD

26 n = 34

73n = 97

1

Workshops about ADHD 34 n = 45

64 n = 85

2

Journals Read about ADHD 69 n = 92

29 n = 38

2

Variable Yes (%) No (%) Missing Data (%)

Have Relative/ Friend with ADHD

45 n = 59

53 n = 71

2

Experience with ADHD (cont.)Means, Standard Deviations, and Ranges for Variables Measuring Experiences with ADHD

Variable M SD Range

Number of Past Taught Children with ADHD

10.1 13.6 0 - 76

Number of Children Currently Taught with ADHD

1.08 2.40 0 - 20

Number of College Courses about ADHD

.30 .627 0 - 3

Number of Workshops/ Conferences about ADHD

.65 1.26 0 – 8

Number of Years Past Taught

12.49 9.47 1 – 38

KADDS ResultsKR-20 Results and Descriptive Statistics for the Knowledge of Attention

Deficit Disorders Scale (N=133)

Scale No. Items M (%) SD KR-20

KADDS

Total 36 59.23 % 17.36 .84

General Information 15 53.13 % 19.42 .70

Symptoms/ Diagnosis 9 68.69 % 17.36 .53

Treatment 12 59.91 % 20.31 .66

General Descriptions and Thoughts about ADHD

‘Hyper’ as catch-all descriptor

Negative descriptors

Gender issues and ADHD

‘Challenging’ for the child’

Negative and positive beliefs about ADHD

Difficulty Recognizing ADHD Symptoms

ADHD or ADD?

Normal development

Co morbidities/Look Alikes

Home versus School Symptoms

Beliefs about Causes of ADHD

ADHD as a biological condition

Parenting style and lack of discipline

Nutrition affecting Behavior

Technology/Fast Society

Beliefs about the Diagnosis

Label of ADHD

Easy label

Over diagnosis

Questioning the diagnosis

Diagnosis as a relief

ADHD as a new phenomenon

ADHD behaviors as a continuum

Teachers’ Values about ADHD

Valuing children

Valuing individuality

Valuing knowledge, education, and research about ADHD

Steps to Help a Child with ADHD

Teachers as gatekeepers (Intentional or unintentional)

Broaching the subject about ADHD with parents

The School Environment and ADHD

A Recipe for DisasterProcess

1. Start with one healthy child.2. Add a heightened sense of test anxiety.3. Trim new schools of excess fat (a.k.a.

recess).4. Whip into a test frenzy.5. Add one scoop of Ritalin.6. Mash a dash of hyper-parenting.7. Pour in a heaping spoonful of NCLB.8. Bring competitive National Test

Scoring to a boil.9. Reduce exercise and joyful emotionally

nourishing play.10. Let simmer until good intensions go

away.11. Let sit perfectly still for 6-5 hours a

day.

Treatment Strategies and ADHDThemes and Sub-themes of Teachers’ Beliefs About ADHD and Treatment Practices

Treatment as Medication Alternative Strategies (“It’s not just the pill.”)

Ritalin not seen as ‘cure all’ Instructional

The amazing Ritalin Environmental

A day without Ritalin Punitive

Concerns with Ritalin Use of coffee

Teachers’ Cultural Beliefs about ADHD

Hyperactivity is normal

Then and Now

Environment and Culture

Teachers Characteristics

The Influence of Knowledge on Beliefs and Values about ADHD

Teachers with higher knowledge seemed to have more positive general beliefs about children with ADHD, had more confidence in the diagnosis, and supported a multimodal approach. They also had more willingness to support the use of stimulant medication in children with ADHD and had flexibility in using various teaching strategies.

Experience Ties Knowledge, Beliefs, and Values Together

Teachers with higher ADHD knowledge were influenced by experiences with ADHD through teaching children with ADHD, through workshops/journals/books, through friends or relatives.Interest and experience fueled the value of acquiring more education and knowledge.Experience and knowledge had an additive quality: Experience promoted knowledge and + beliefs, and in turn, more knowledge stimulated the quest for more experience in teaching children with ADHD.

Creating Niche Valance

The Importance of Partnerships

Child with ADHD: distinct patterns, movements, rhythms, and spatial awareness.

+/-Proxi mal

Processes

Teacher with or without high knowledge and positive beliefs regarding ADHD.

Macrosystem +/- providing support for teachers and multiple ways of learning

=

Stabl e (microsystem) advantaged environment

Enriched classroom/ honoring diversity/ novelty

Low classroom size and time for teacher preparation.

Niche valance +/-

expanding informational capacity of ADHD child

experiencing (+) academic success and school peer relationship.

Fusing Theories/ Ideas (Newman, Brofenbrenner, Agar)

Child/Teacher/Environment Model

Area where reframing and discourse occurs if differences or hidden agendas are present.

Strengths and Limitations of the Research

Emic/Etic views

Mixed Methods: pros and cons

Theory-driven approach: pros and cons

Reliability issues with KADDS subscales

Sampling issues

Timing of the research

Lack of thick description about cultural beliefs

Implications for Future ResearchCreate opportunity for teachers’ experience with children with ADHD.Participatory Action Research: Collaboration, shared ownership, community actionUse of KADDS and demographic tool with larger diversified samples, in other geographic locationsStructural equation modeling to measure relationships between theoretical constructs with models of emergent themes and subthemesMore stories to hear and observations to be made

Questions