ABSTRACT:

 Objective

To test the hypothesis that the knowledge base of graduating pre-service teachers has improved in comparison to the previous sample of practising teachers in a defined geographical area as a result of improvements in the curriculum regarding ADHD in the main teachers training course that serves the catchment area of the original sample of practising teachers.

 Method

 A sample of 42 teachers in-training, just completing their pre-service training modules prior to beginning to teach, was sampled using the original questionnaire.  Results were compared to the original Canadian sample of teachers who completed this questionnaire. 

 Results

 The overall score of both pre-service teachers in-training and practising Canadian teachers was very similar.  However in some areas the pre-service training teachers knowledge of the natural history of ADHD and its persistence into adolescence was less accurate than that of practising teachers.  Both groups performed poorly on questions relating to dietary management.

 Conclusions

 The hypothesis of this study was not supported.  There was no evidence that current pre-service training had significantly improved the knowledge base of teachers in-training in comparison to previous samples of practising Canadian teachers.  The original result of younger practising Canadian teachers obtaining better scores on the questionnaire could not be supported by current pre-service training experience based on this samples performance on the questionnaire.  These findings, if confirmed by further studies with larger, more representative samples, have implications for both  curriculum development for teachers as well as community education of teachers by child psychiatrists.

Introduction

 Whilst previous studies (1,2) have examined knowledge and attitudes of patients and their families about ADHD the only known study examining teacher’s knowledge in this area was a questionnaire survey conducted in 1992 (3) to examine the knowledge and attitudes regarding ADHD of practising elementary school teachers.  The survey described in this paper was designed as a follow-up to the original study conducted by Jerome, Gordon, and Hustler (3).  The original study suggested that teachers who are more recently qualified and exposed to more recent in-service training regarding ADHD had a better knowledge base regarding this subject than teachers who had been practising for a longer period of time without benefit of in-service training.  Thus the hypothesis under investigation was that recent pre-service training regarding ADHD would lead to an improved knowledge base beyond that of practising teachers as measured by the original survey of 850 elementary school teachers conducted in August 1992.   This survey sampled teachers in-training in the same geographical area as the original sample of practising teachers and was drawn from the graduating class of the main teachers training college in that geographical area in 1997.  

 Method

 Subjects

                The sample consisted of 42 teacher trainees taken from a Faculty of Education, completing a course in educational psychology, within a southwestern Ontario university.  This  is a compulsory core course within the Ministry of Education Ontario Teacher Certification curriculum.  The survey was conducted in April late in the academic year, one week before termination of classes.   Students would have completed most of their in-service professional training, and an accurate evaluation of knowledge base could be assessed.   The bulk of the sample teacher-trainees were aged in the 20-30 range (93%), with the remaining (7%) in the 31+ age  range and 95% were females.  In comparison the original Canadian teaching sample was composed of 83% female with 87% being in the age range of 31+.  The majority (98%) had no previous special education training, which would be expected as special education training is offered primarily as post-certification courses within the Ontario education system. Some 2% were enrolled in an introductory special education elective course. In addition the trainees had already completed two in-school practicum placements totaling 10 weeks.

 Survey Questionnaire

                The data for this survey was collected by self report questionnaires which were completed by teacher trainees. The survey questionnaire was the same as given by Jerome et al (3).   The questionnaire was divided into two parts, the first part obtained information regarding demographic background regarding age, sex, and teaching panel (i.e. elementary or secondary). The second part consisted of 20 true/ false questions regarding knowledge about ADHD.

                Trainees participated on a voluntary basis and the survey was conducted at the beginning of a regular class session.    It was stressed that the information collected was confidential, and not being used for examination purposes.  Following the collection of the survey questionnaire, the answers were discussed, and used for in-class instruction purposes.

 Results

 Demographics

                The main demographic differences with the original study sample of practising teachers were as follows:  there was an overrepresentation of females in this current sample;  95% versus 85% in the original study.  By definition, this study sample were all in full time pre-service training and had no active in-service experience.  The average age of the sample was younger with 93% being in the 20 to 30 age range in comparison to 80% of Canadian teachers being older than 30.

 Teacher-Trainee Knowledge regarding ADHD

                Both this sample and the original sample have similar scores on the true/false survey.  This teacher-trainee sample had a mean score of 15.4 (77%).   This compares to 15.5 (78%) in the original sample.  Both data sets showed a positive skewed distribution with similar standard errors 2.34 (2.17 for practising teachers).

               Table 1 shows teacher response to the questionnaire  expressed as a percentage correct score to the 20 true/false questions regarding ADHD.   A statistical comparison for each question comparing the scores for pre-service teachers and practising teachers from the original study was performed using a 2 tailed z-test of proportions (4).   Trainee subjects responses are compared with the original responses of practising Canadian teachers.   The scores represent mean percentages for each group.

 1.  Biological and non-volitional factors:  Data suggested that most in-service trainees and practising teachers agree that ADHD is due to biological causation and not weakness of character. There were no significant differences between the  86% of trainees and 83% teachers who agreed with the statement that " ADHD children are born with biological vulnerabilities towards inattention and poor self control". And  an overwhelming 93% of trainees and 88% teachers (P<0.001) responded that " the inattention of ADHD children is not primarily a consequence of defiance, oppositional behaviour, or an unwillingness to please others".

 2.  Family influences: Trainees appeared better informed than practising teachers regarding family influences.   Remarkably 98% of trainees and only 74% teachers (P<0.001)  agreed that ADHD was not caused by poor parenting.   However, some 83% of trainees and 76% teachers  (P<0.001)  did not agree that ADHD often resulted from a chaotic, dysfunctional family life. Additionally, 95% of trainees and 92% of teachers (P<0.001)  did not agree that "ADHD children could do better if they would only try harder".

 3.  Causation: Results indicate that trainees and teachers appeared to share similar opinions in this area. 91% trainees and 97% teachers  (P<0.001) agreed that ADHD seemed unrelated to racial background. There were no significant differences between the 69% of trainees 67% teachers who saw ADHD as being an inheritable condition. However 36% of trainees and only 20% of teachers (P<0.001) saw ADHD as occurring equally as often in girls as in boys.

 4.  Medical and Educational Interventions: Mixed results were obtained in this area, especially regarding the use of medication.  Only 69% of trainees but 82% of teachers (P<0.001) marked as false the statement “ADHD is a medical disorder that can only be treated with medication”. However there was no significant difference between the  83% of trainees and 80% of teachers who disagreed with the item that “if medication is prescribed, educational interventions are often unnecessary”.  Some 83% of trainees and 88% of teachers (P<0.001) recognized that “ADHD children are typically better behaved in one-to one interactions than in a group situation”.  Encouragingly 86% of trainees disagreed that "ADHD children always need a quiet, sterile environment in order to concentrate on tasks", compared to 73% of teachers (P<0.001).   

 5.  ADHD Myths:  This area appears to be the weakest in ADHD knowledge  within the educational field. Similar findings were observed by Jerome et al (1).   Some 9.5% of trainees and 8% of teachers (differences not significant)  believed that "if a child can play Nintendo for hours, he probably does not ADHD".  Furthermore 52% of trainees as compared to 66% of teachers (P<0.001) agreed that,"ADHD can often be caused by sugar or food additives". Similarly 68% of trainees and 77% of teachers (P<0.001) saw diet as being useful in the treatment of ADHD children.  However in two areas trainee teachers had a less accurate view of the natural history of ADHD regarding the persistence of symptoms into adolescence.  A majority, 69% of trainees when compared to 41% of teachers (P<0.001)  agreed with the statement that "most ADHD children outgrow their disorder and are normal as adults".  Unlike the 70% response of teachers, only 40% of trainees (P<0.001) agreed that "ADHD children have a high risk for becoming delinquent as teenagers".      

 Discussion

                 The findings in this survey do not support our hypothesis that recent pre-service training regarding ADHD was contributing to an improved knowledge base when compared to previous samples of practising teachers.   The generalizability of the these findings to other pre-service teacher samples is limited by a small sample size.   Whilst there is an overrepresentation of females of younger age compared to the original sample of practising teachers, the original study did not find any correlation with gender and accuracy on the questionnaire.

                 The main findings in this further study of trainee-teacher’s knowledge regarding ADHD suggested that the knowledge base is very similar to that of practising teachers.  The knowledge profiles of the two samples suggest that trainee-teacher’s  have a similar perception of biological and family influences with very similar profiles on knowledge of causation, medical and educational intervention and in the area of  ADHD myths a less accurate view of the persistence of problems into adolescence.   Both groups perform poorly on questions relating to dietary treatments.   Caution should be exercised in interpreting the statistical significance of differences between the two groups on each question because of the small number of  pre-service teachers in comparison to the original study sample with multiple tests of significance.

                In the original study (3) younger Canadian teachers were noted to have higher scores in comparison to their older cohorts which suggested that these differences may be related to an increase in knowledge acquired through recent in-service teacher training.  The results from this additional survey with newly trained teachers does not support the original finding.  The reasons for this difference between the two studies is unclear. 

            The results can be interpreted to show an improvement in practising teachers knowledge based on experience, i.e. questions relating to efficacy of medication, sex ratio, and ethnic distribution, and outcome in adolescence.  However in twelve out  of  the twenty questions, practising teachers did worse than pre-service teachers, implying the faulty training, possibly compounded with prejudices developed over the course of teaching results in worse scores on the questionnaire.  In the area of dietary myths both groups do poorly.   Here the impact of poor training compounded by media myths may be relevant. 

                As Laine (5) found, attitudes about children held by teachers changed little over time and concluded that “one may speculate that unless their consciousness is raised during their teacher education program, they may hold inappropriate attitudes in their practice”.  The extent to which teachers knowledge of ADHD biases there response to questionnaires from clinicians or influences their interaction with patients regarding medical treatments is unknown.  However, as other studies (2) have shown an improved educational knowledge base in patients can lead to improved collaboration with treatment and compliance with medication. Since psychiatric assessment of ADHD and subsequent psycho-educational and medical management is heavily dependent on teacher information, an understanding of teachers knowledge and myths regarding this condition is likely to be important in developing a more effective collaboration between professional groups.   These findings merit replication and, if confirmed in larger samples, have implications for curriculum development, in particular for pre-service teachers.  

 

References

  

1) Rostain, AL, Power TJ, Atkins MS.  (1993) “Assessing Parents’ Willingness to Pursue Treatment for Children with Attention-deficit Hyperactivity Disorder”.   J. Am Acad Child Adolesc Psychiatry 32:175-181.

 2) Bastiens, L.  (1992) “The impact of an intensive educational program on knowledge, attitudes and side effects of psychotropic medications among adolescent inpatients”.   J Child Adoles Psychopharm, 2,249-258.

 3)  Jerome, L., Gordon, M.,  Hustler, P.  (November 1994) “Comparison of American and Canadian Teachers’ Knowledge and Attitudes towards Attention Deficit Hyperactivity Disorder (ADHD).  Canadian Journal of Psychiatry, vol. 39, 563-566.

 4) Rosenthal, R, Rosnow, RL. (1991) “Essentials of Behavioural Research: Methods and Data Analysis”.   (2^nd edition) McGraw-Hill: New York.

 5) Laine, C. J. (1991)  “Attitudes toward children by student teachers over the duration of their training.  Orbit (Journal of the Ontario Institute for Studies in Education), 22(3), 22-23.

 

 TEACHER RESPONSE EXPRESSED % CORRECT SCORE TO 20 TRUE/FALSE QUESTIONS  REGARDING ADHD

 

	Questions	Practising Teachers n=850	Pre-Service Teachers n=42
1	ADHD can be caused by poor parenting practices.	74	98
2	ADHD can often be caused by sugar or food additives.	35	48
3*	ADHD children are born with biological vulnerabilities toward inattention and poor self-control.	83	86
4	A child can be appropriately labelled as ADHD and not necessarily present as over-active.	81	93
5	ADHD children always need a quiet, sterile environment in order to concentrate on tasks.	73	86
6	ADHD children misbehave primarily because they don’t want to follow rules and complete assignments.	96	100
7	The inattention of ADHD children is not primarily a consequence of defiance, oppositionality, and an unwillingness to please others.	88	93
8	ADHD is a medical disorder that can only be treated with medication	82	69
9	ADHD children could do better if they only would try harder.	92	95
10	Most ADHD children outgrow their disorder and are normal as adults.	59	31
11*	ADHD can be inherited.	67	69
12	ADHD occurs equally as often in girls as boys.	79	64
13	ADHD occurs more in minority groups than in Caucasian groups.	97	90
14*	If medication is prescribed, educational interventions are often unnecessary.	80	83
15	If a child can get excellent grades one day and awful grades the next, then he must not be ADHD.	98	95
16	Diets are usually not helpful in treating most children with ADHD.	23	32
17*	If a child can play Nintendo for hours, he probably isn’t ADHD.	92	90
18	ADHD children have a high risk for becoming delinquent as teenagers.	70	60
19	ADHD children are typically better behaved in 1-to-1 interactions than in a group situation.	88	83
20	ADHD often results from a chaotic, dysfunctional family life.	76	83

 

*z-test non-significant.   All other questions showed significant differences; p<.001.

 Critical values of z - +/- 1.96; p<.05.