ORIGINAL ARTICLE
Year : 2023 | Volume
: 6 | Issue : 1 | Page : 51--57
Knowledge about attention deficit hyperactivity disorder among primary school teachers in Riyadh, Saudi Arabia
Noura Abouammoh1, Afnan Younis1, Layan Alwatban2, Marwah Alkhalil2, Rawan Alharbi2, Reham AlHalabi2, Shahad Alzahrani2, Shikah Alrwais2,
1 Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 College of Medicine, King Saud University, Riyadh, Saudi Arabia
Correspondence Address:
Noura Abouammoh
King Saud University, Riyadh
Saudi Arabia
Abstract
Context: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders affecting children. As ADHD symptoms affect the learning process of children at schools, teachers have an important role in identifying children who may have ADHD. Aim: This study aims to estimate knowledge level of primary school teachers in Riyadh about ADHD and to correlate the level of knowledge to demographic characteristics. Settings and Design: A cross-sectional study including 448 male and female teachers from 20 primary schools. Materials and Methods: Schools were sampled using multistage random sampling technique. The Knowledge of Attention Deficit Disorder Scale questionnaire was used for data collection. Data collection continued for 1 month starting from January 30, 2020. Statistical Analysis Used: Association between main outcome and different demographic variables was tested using analysis of variance test for more than two groups, categorical variables and t-test for nominal binary variables using SPSS. Results: The mean of the overall knowledge about ADHD was 43.1%. The mean of ADHD general knowledge, diagnosis, and treatment was 32.3%, 61%, and 36%, respectively. Regarding general knowledge about ADHD, teachers between 22 and 30 years of age and males scored significantly higher than the other groups. Regarding teachers' knowledge about ADHD treatment, statistically significant higher scores were found male teachers. Previous experience with ADHD child had significantly higher scores than those who did not have experience in all three knowledge categories. Conclusions: Knowledge about ADHD has a positive correlation to previous experience with ADHD which proves the importance of implementing a training program to help the teachers identify students with ADHD leading to earlier diagnosis and better outcomes.
How to cite this article:
Abouammoh N, Younis A, Alwatban L, Alkhalil M, Alharbi R, AlHalabi R, Alzahrani S, Alrwais S. Knowledge about attention deficit hyperactivity disorder among primary school teachers in Riyadh, Saudi Arabia.J Nat Sci Med 2023;6:51-57
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How to cite this URL:
Abouammoh N, Younis A, Alwatban L, Alkhalil M, Alharbi R, AlHalabi R, Alzahrani S, Alrwais S. Knowledge about attention deficit hyperactivity disorder among primary school teachers in Riyadh, Saudi Arabia. J Nat Sci Med [serial online] 2023 [cited 2023 Mar 21 ];6:51-57
Available from: https://www.jnsmonline.org/text.asp?2023/6/1/51/366997 |
Full Text
Introduction
The diagnostic and statistical manual of mental disorders defines attention deficit hyperactivity disorder (ADHD) as "a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning and development."[1] ADHD is one of the most common mental disorders affecting children worldwide with a world point prevalence of 7.2%,[2],[3] and a prevalence of 3.4% among school children in Riyadh, Saudi Arabia.[4]
Inattention and hyperactivity in children with ADHD are noticeably greater than that of their peers. ADHD causes difficulties functioning at home and school that lingers even throughout adult life.[2] These include lower self-esteem, lower scores on standardized tests, in addition to higher chances of dropping out of school, being involved in motor vehicle accidents, and suffering from comorbidities such as major depressive and anxiety disorders; which all have negative effects on their social relationships.[5] Many ADHD children suffer from long-term consequences because their symptoms are not discovered and treated promptly,[6] whereas early detection and intervention might stop or ameliorate the progression of the disorder and scale back its lifelong impact.[7]
Teachers form a crucial part of the multidisciplinary team needed in diagnosing ADHD as they are involved in the environment where strong regulatory skills are demanded from the children.[8],[9] In addition, ADHD symptoms typically affect the process of learning at school. A child with ADHD exhibits difficulty maintaining attention in class and faces trouble completing assignments and homework thus, teachers can be the first to detect children with ADHD.[10],[11],[12] Consequently, it has been found that the majority of ADHD patients are referred by their school teachers to ADHD assessment.[13] Thus, it is important to educate teachers about characteristics if ADHD that assist in establishing effective diagnosis. Furthermore, assessing teachers' knowledge about ADHD is initial step in establishing a school-based education interventions targeting teachers.[14]
Published studies about the knowledge of primary school teachers about ADHD, especially in the middle east, are few.[15],[16],[17],[18]
As teachers are the first to recognize learning, and sometimes behavioral, related symptoms of ADHD and as early detection of the disorder is crucial to minimize its negative effects, this study aims to estimate knowledge level of primary school teachers in Riyadh about ADHD and to correlate the level of knowledge to demographic characteristics. For the current study, it was hypothesized that the level of knowledge about ADHD among teachers during 2019–2020 is higher than the previous studies in Riyadh; 17.2% and 13% in 2013 and 2018, respectively. In addition, prior experience with ADHD and the age of the teacher (younger teachers) has higher knowledge about ADHD.
The results of this study will help in determining the need for appropriate interventions required to bridge the gaps of knowledge among teachers, which have been proven to result in better emotional outcomes.[10],[19],[20]
Materials and Methods
Study design and setting
This is a descriptive cross-sectional study conducted in primary governmental schools in Riyadh the capital city of Saudi Arabia, which is divided by the Ministry of Education into five educational sectors; northern, southern, eastern, western, and middle. There is no available data regarding the socioeconomic status of sector, however, based on local knowledge that each sector in Riyadh belong to different socioeconomic level. Different regions can be identified which represent different socio-economic levels. North and East of Riyadh City represent middle to high socio-economic levels and South and West represent lower socio-economic levels. According to the local cultural norm, female and male students have separate schools. This study included all the five educational sectors of Riyadh, at both male and female schools, by selecting teachers of both genders from primary governmental schools in Riyadh, Saudi Arabia.
Study population
All teachers working in government primary schools in Riyadh. The inclusion criteria were all male and female teachers who were working in primary governmental schools in Riyadh. As the purpose of this study was to assess the knowledge of those who are in daily contact with students and directly observe their regulatory skills, other workers including student advisors, and administration department workers were not included. Private schools were excluded as they may have separate training programs organized by the school.
Sampling
The following formula was used to calculate the sample size.
n = Z2 [p (1-P)]/d2
n = (1.96)2 [0.38 (1–0.38)]/(0.05)2
Where the average percentage of overall knowledge score about ADHD was 38, based on a previous local study with 95% confidence interval (CI) and 5% margin of error, the optimal sample size calculated was 362 and 10% was added to compensate for no-response making the sample size to be 398 ≈ 400 teachers.[17]
A multistage random sampling technique was used. For the first stage, all five educational sectors were included in our study. In the second stage, 20 schools (two male primary government schools and two female primary governmental schools) were selected from each sector using simple random sampling technique. Then, 20 teachers from the teacher's list of each school were approached for data collection using a simple random sampling technique [Figure 1].{Figure 1}
Data collection
The data were collected by a self-administered prevalidated and translated questionnaire electronically.[15] Data collection started on January 30, 2020, until March 1, 2020. The questionnaire is divided into two parts first: demographic data questionnaire covering age, gender, education level, years of experience and experience in teaching ADHD students, second: the knowledge of attention deficit disorder scale (KADDS) developed by Sciutto et al. and it is one of the most widely used study tools to assess teachers' knowledge of ADHD.[21] The KADDS is a 36item questionnaire which covers teachers' knowledge in three areas: general knowledge of ADHD (15 items), symptoms and diagnosis of ADHD (9 items), and treatment of ADHD (12 items) with a score of 36 for a total correct answers. A prevalidated and translated copy was developed by Alkahtani and permission was obtained from the author to use the data collection tool. This tool uses true, false and I don't know as the answer options to avoid guessing the answer thus giving more accurate results and giving 50% chance of guessing the answer.
Participants need to choose between true, false or I don't know. For the knowledge score, correct answers were given a score of "1" and incorrect or do not know answers were given a score of "0." The total score of overall knowledge and score percentages were computed for each participant. No missing data were reported as teachers were only transferred to the next question if they choose an answer for each question.
Data analysis
Data were analyzed by Statistical Package for the Social Science SPSS version 25.0, (IBM, New York). The dependent variable was the knowledge of teacher about ADHD and the independent variables were age, sex, educational sector, years of teaching experience, level of education, and previous experience with ADHD child. Descriptive statistics included the mean and standard deviation for continuous variables and frequencies and percentages for categorical variables. For analytical statistics, the association between main outcome and different demographic variables was established using analysis of variance test for more than two groups categorical variables, and t-test for nominal binary variables (sex groups and previous experience with an ADHD child). Multiple linear regression was performed to measure the effect of each independent variable on the outcome. The regression model included independent variables with any subcategory that has a P ≤ 0.1. These variables are age, teaching experience, sex, and experience with an AHDH child. A P < 0.05 and 95% CI were used to report the statistical significance and precision of results. The overall knowledge score was calculated as the mean percentage of knowledge in each category. A mean percentage of correct answers was considered insufficient if it is 60% or less.[12]
Ethical approval
Ethical approval for this study was obtained on December 8, 2019, from the King Saud University institutional review board following ethical standards of Helsinki Declaration. Approval number: E-19–0194. All participants were informed about the study purpose and their consent was taken electronically before filling the questionnaire. Participants had the right to withdraw at any time during the study. The data were anonymous, and the confidentiality was taken into consideration.
Results
This study included 448 teachers from all over Riyadh with a response rate of 100%. Although 400 questionnaires were distributed, 448 were received from teachers. It has been decided to include all the responses since all participants fulfilled the included criteria and belong to the previously included schools. Of the participants, 59% were above 40 years old, 54% were females and 73.7% had bachelor's degree. The majority had a teaching experience of more than 15 years 61.4%, whereas 5.4% had an experience of <5 years [Table 1].{Table 1}
The outcome measured three different categories, general knowledge about ADHD, diagnosis knowledge, and treatment knowledge. For each category, we measured the mean and the standard deviation of the percentage of knowledge [Table 2].{Table 2}
The differences in the general knowledge, treatment, and diagnosis for ADHD according to the study variables are shown in [Table 3]. Regarding general knowledge, individuals more than 40 years scored significantly lower than those between 22 and 30 years of age (P = 0.02). Male teachers scored significantly higher than female teachers (P = 0.00). Teachers who had experience with ADHD child scored significantly higher than those who did not (P = 0.00). There were no significant differences in regard to the educational sector, teachers' educational level, or previous experience with an ADHD child.{Table 3}
Regarding ADHD knowledge about diagnosis/symptoms [Table 4], statistically significant higher scores were shown among those who had a previous experience with an ADHD child (P = 0.001), but no significant differences regarding teachers' age, sex, educational sector, educational level, or years of experience in teaching.{Table 4}
As shown in [Table 5], male and those with previous experience with ADHD child teachers scored significantly higher levels of knowledge regarding ADHD treatment (P = 0.002) and (P = 0.002), respectively. Moreover, there were no significant differences regarding teachers' age, educational sector, educational level, or years of teaching experience.{Table 5}
Multiple linear regression [Table 6] showed that experience with an ADHD child was associated with more than 5 times increased levels of general knowledge, diagnosis knowledge, and treatment knowledge with P < 0.01. Male gender is associated with 5 times higher levels of general knowledge (P < 0.00) and 4 times higher levels of treatment knowledge (P = 0.01). Increasing age and teaching experience were associated with decreased levels of general, diagnostic, and treatment knowledge but were not statistically significant.{Table 6}
Discussion
The current study showed that the average percentage of the overall insufficient knowledge of primary school teachers about ADHD (43.1%).
Previous experience with ADHD significantly associated with all three categories of ADHD knowledge among teachers. Being a male teacher is associated significantly with better general knowledge and knowledge about ADHD treatment.
The current study showed an overall knowledge to be higher than comparable results recorded from previous studies using the same survey tool in Riyadh and Al-Madinah.[15],[17] The current study reported a higher percentage of general knowledge than that recorded in 2013 in the same city (16.8%). Lower level of knowledge recorded previously can be attributed to the low response rate reported by the study and the restricted geographical area included.[16],[17] Similar study conducted in Makkah showed a higher percentage of correct answers in general knowledge (37%).[18] The latter study, however, was carried out in a small district and included primary school and kindergarten female teachers, and used a different study tool, thus results might not be comparable with those of the current.[18] In the current study, teachers who fall within the following categories: male gender, 22–30-year age group and having previous experience with ADHD child, scored significantly higher on ADHD general knowledge items of the survey, proving a significant association between general knowledge and these variables. A similar study conducted in Al-Madinah, Saudi Arabia revealed that having 6–10 years of teaching experience, and previous experience with a child having ADHD or special needs were also found to be significant variables that affect the general knowledge of the teachers.[17] Using a different survey, another study on teachers assessed other variables and proved to associate significantly with an increase in the level of knowledge including undergraduate information and those who read about ADHD, whereas demographic characteristics did not affect the level of general knowledge.[18] Our study revealed that while younger teachers have higher knowledge about ADHD compared to older teachers, teachers with more teaching experience also had lower knowledge of ADHD. This can be attributed to differences in accessing information about ADHD.
In regard to knowledge about diagnosis/symptoms, teachers scored an average percentage of knowledge of 61%, which is higher than what is reported previously in Riyadh and Al-Madinah,[15],[17] but less than the mean percentage of correct answers reported in Makkah (71.75%).[18] It should be mentioned, however, that the study conducted in Makkah was only restricted to female schools in one district of the city. Previous experience with a child with ADHD is significantly associated with higher scores in the current study, which goes in line with what was reported previously.[17] The age variables were proven nonsignificant under the category of knowledge about diagnosis/symptoms in our study whereas in Makkah, teachers of 25-years-old, or less, were more knowledgeable about symptoms and diagnosis than older teachers.[18] This could be attributed to the new teaching curriculum which pays more attention to neurobehavioral disorders that may affect children.[20]
In regards to knowledge of treatment, the mean percentage of correct answers was 36%. This percentage is higher than what was reported in Riyadh earlier in 2013, in addition to in Al-Madinah.[15],[17] Makkah showed the highest level of knowledge regarding ADHD treatment (48.2%).[18] In this study, knowledge of treatment is higher among male teachers, whereas no differences were found in previous studies which included both genders.[14] Knowledge about ADHD among teachers was significantly higher among those who read about ADHD.[18] A possible explanation for the gender significance is symptom expression in boys and girls, and adults' perception of the same symptom in boys and girls could vary.[22]
Our study supported that male gender was associated with a higher percentage of correct answers. The overall percentage of correct answers in a study conducted on male teachers only,[16] showed an overall knowledge score of more than 60% While another conducted on only female teachers showed a score of 58.9% which was considered insufficient.[15]
On the other hand, previous experience with ADHD child was always associated with a higher overall percentage of correct answers.[15],[16],[17],[18]
As reported previously,[15],[16] overall knowledge about ADHD among teachers is expectedly higher among those with prior training, experience with ADHD and higher level of confidence in teaching students with ADHD. Another previous study in Riyadh found a significant correlation between the education level of the teachers and attending courses on ADHD with the level of overall knowledge about ADHD.[16]
Results in this study can be generalized among teacher population in Riyadh. Private schools were not included in the target population of the study. However, the tool used in this research is valid, and this study included male and female governmental schools in all educational sectors of Riyadh city with a high response rate. However, more similar studies should be conducted to assess not only the knowledge but also the attitude of teachers towards ADHD. Implementing a training program to help the teachers identify students with ADHD could help in diagnosis and treatment, hence better outcomes.
This study was not without limitations. Lacking information about the target population made it difficult to use a stratified random sampling technique that could better reflect the teachers' population in the city. We experienced the disadvantage of distributing the questionnaire electronically to targeted teachers as some shared it with colleagues. However, data about the sector and other demographic data were collected which assessed in the decision to include all responses.
Conclusion and Recommendations
The overall knowledge about ADHD among primary school teachers is higher than the level of ADHD overall knowledge among primary school teachers reported previously in the same region.[16]
This study gives an idea about the level of ADHD knowledge; however, further studies using stratified random sampling could better reflect the knowledge of the teacher population. Moreover, further studies should be conducted to assess teachers' attitude toward ADHD.
Implementing a training program to help the teachers identify students with ADHD and performing workshops at schools to teachers of students with ADHD to train them on how to deal with a child with ADHD is crucial. This cooperation could play a major role in diagnosis, treatment and ultimately lead to better health and social outcome.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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