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).
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 Questions • What 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?
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 Sample • 133 teachers completed the KADDS, demographic questions and VAS; 4 group interviews with 28 teachers; 5 high KADDS and 3 low KADDS individual interviews • 80% 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.
Variable Yes (%) No (%) Missing Data(%) Currently Teaching Child with ADHD 40 n = 53 58 n = 77 2 Any Type of Past Training about ADHD 78 n = 104 20 n = 26 2 Past College Courses about ADHD 26 n = 34 73 n = 97 1 Workshops about ADHD 34 n = 45 64 n = 85 2 Journals Read about ADHD 69 n = 92 29 n = 38 2 Have Relative/ Friend with ADHD 45 n = 59 53 n = 71 2 Experience with ADHD Percentages for Categorical Variables Measuring Experiences with ADHD (N = 133)
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 Experience with ADHD (cont.) Means, Standard Deviations, and Ranges for Variables Measuring Experiences with ADHD
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 KADDS Results KR-20 Results and Descriptive Statistics for the Knowledge of Attention Deficit Disorders Scale (N=133)
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
A Recipe for Disaster Process • Start with one healthy child. • Add a heightened sense of test anxiety. • Trim new schools of excess fat (a.k.a. recess). • Whip into a test frenzy. • Add one scoop of Ritalin. • Mash a dash of hyper-parenting. • Pour in a heaping spoonful of NCLB. • Bring competitive National Test Scoring to a boil. • Reduce exercise and joyful emotionally nourishing play. • Let simmer until good intensions go away. • Let sit perfectly still for 6-5 hours a day.
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 Treatment Strategies and ADHD Themes and Sub-themes of Teachers’ Beliefs About ADHD and Treatment Practices
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.
Strengthsand 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 Research • Create opportunity for teachers’ experience with children with ADHD. • Participatory Action Research: Collaboration, shared ownership, community action • Use of KADDS and demographic tool with larger diversified samples, in other geographic locations • Structural equation modeling to measure relationships between theoretical constructs with models of emergent themes and subthemes • More stories to hear and observations to be made