Elementary and Middle School Teacher Perceptions of Attention-Deficit/Hyperactivity Disorder Prevalence

Reconceptualizing the approach to supporting students with attention-deficit/hyperactivity disorder in school settings

The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.

State Variation Regarding Other Health Impairment Eligibility Criteria for Attention Deficit Hyperactivity Disorder

The special education eligibility category that has come to be most commonly associated with Attention-Deficit Hyperactivity Disorder (ADHD) in recent years is Other Health Impairment (OHI). However, the eligibility criteria for the OHI disability category have been criticized for being especially vague, given that the disability category incorporates a wide range of health impairments without providing any additional specificity. Because states have the latitude to utilize more specific eligibility criteria than what is provided at the federal level, the purpose of the current study was to review state-level special education eligibility criteria for OHI, with particular interest in identifying the degree to which eligibility guidance exists specific to students with ADHD and the extent to which this guidance varies across states. Results suggested that wide state variation exists regarding eligibility guidance, with 22% of states utilizing the federal definition and only 14% of states providing elaboration regarding all three components of the federal definition. Whereas it was most common for states to provide additional guidance surrounding what is needed to establish that a student has a health impairment, less than half of states provided specific guidance surrounding the other two components of the federal definition. Implications for policy and practice are discussed.

Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review

IMPORTANCE

Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services.

OBJECTIVE

To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions.

EVIDENCE REVIEW

This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality.

FINDINGS

Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms.

CONCLUSIONS AND RELEVANCE

This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms; therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy.

Negev Bedouin Teachers' Attitudes Toward ADHD and Its Pharmacological Treatment

Little is known about the attitudes of Negev Bedouin toward attention-deficit/hyperactivity disorder (ADHD) and its pharmacological treatment. This study examines the perspectives of Negev Bedouin teachers on pharmacological treatment. Thirty-six teachers are asked to consider how their views influence the way they relate to pupils' parents. A grounded-theory analysis of semistructured interviews illuminates ambivalence in teachers' attitudes. Teachers, like the rest of their community, when asked about the implications of an ADHD evaluation for their children, respond that ADHD and its pharmacological treatment cause dishonor. When asked what ADHD means when it is their pupils who are diagnosed and treated, however, teachers, like the education establishment, accept the need for medication. However, they fail to communicate this need to parents because their attempts to do so show parents that they consider their children "flawed"-causing parents to oppose treatment even more lest they succumb to social stigma.

Teachers' Experiences With and Perceptions of Students With Attention Deficit/hyperactivity Disorder

PURPOSE

The purpose of this research was to examine teacher experiences with and perceptions of students with attention deficit/hyperactivity disorder (ADHD). Teachers are integral in helping these children learn effectively and foster healthy relationships, yet little is known about their interactions with these children.

DESIGN AND METHOD

Semi structured interviews were conducted with a purposive sample of fourteen currently practicing or retired elementary and middle schools teachers in North Carolina and South Carolina. All interviews were audio-recorded then analyzed for common themes.

RESULTS

Participants obtained ADHD information from in-services or peer interaction, rather than formal education. Culture and gender influenced teacher perceptions, and ADHD classroom strategies were based on anecdotal experience. Teachers experienced guilt and worry while negotiating student needs, school system constraints, and family issues.

CONCLUSIONS

While teachers have developed effective coping mechanisms through informal means, formal education and support will help teachers better serve students with ADHD.

PRACTICE IMPLICATIONS

Pediatric nurses in many settings can benefit from better understanding how teachers perceive and interact with students who have attentional issues.

South African foundation phase teachers' perceptions of ADHD at private and public schools

This study investigated foundation phase teachers’ perceptions of Attention Deficit Hyperactivity Disorder (ADHD). The teachers’ views on the aetiology, appropriate interventions and incidence rates of ADHD were examined. A total of 130 foundation phase teachers from mainstream private and public schools completed a self-developed questionnaire that had been piloted by the researchers. Both descriptive and inferential statistics were used to analyse the data, specifically to determine whether there were differences in responses between public and private school teachers. Thematic content analysis was used to identify the themes that emerged from the open-ended questions. It was found that the teachers had a limited understanding of ADHD, in terms of what it is as well as the aetiology. In addition, it emerged that medication was the preferred method of intervention despite the participants’ awareness of alternative intervention methods. A comparison of the private and public school teachers’ results indicated no significant difference in their perceptions regarding the aetiology, interventions or incidence rates of ADHD.

A systematic review of meta-analyses of psychosocial treatment for attention-deficit/hyperactivity disorder

The present report synthesizes outcomes across meta-analyses of psychosocial (i.e., non-pharmacological) treatments for ADHD. A total of 12 meta-analyses were identified that met search criteria. The meta-analyses were notable in that there was surprisingly little overlap in studies included across them (range of overlap was 2-46 %). Further, there was considerable diversity across the meta-analyses in terms of the inclusion/exclusion criteria, types of psychosocial treatments reviewed, methodological characteristics, and magnitude of reported effect sizes, making it difficult to aggregate findings across meta-analyses or to investigate moderators of outcome. Effect sizes varied across the outcomes assessed, with meta-analyses reporting positive and significant effect sizes for measures of some areas of child impairment (e.g., social impairment) and small and more variable effect sizes for distal and/or untargeted outcomes (e.g., academic achievement). Results are reviewed in light of the larger literature on psychosocial interventions for ADHD, and specific recommendations for future meta-analyses of psychosocial treatments for ADHD are offered.

S100β in heavy metal-related child attention-deficit hyperactivity disorder in an informal e-waste recycling area

Exposure to lead even at low levels correlates with attention-deficit/hyperactivity disorder (ADHD). However, lead-contaminated environments are often contaminated with other heavy metals that could exacerbate lead-induced ADHD. We conducted this study to evaluate the relationship between multiple heavy metals and child behaviors, and the involvement of S100 calcium-binding protein β (S100β) expression in child ADHD in Guiyu, an internationally-known e-waste contaminated recycling town. Two hundred and forty kindergarten children, 3- to 7-years of age, who lived in Guiyu, were recruited for this study. Child behavioral assessment was derived from parent and teacher ratings. Serum S100β was assayed by an enzyme-linked immunosorbent assay (ELISA). Lead (Pb), cadmium (Cd) and manganese (Mn) levels in whole blood were measured using graphite furnace atomic absorption spectrometry (GFAAS). The prevalence of children with ADHD symptoms in Guiyu was 18.6%, with the percentage of children suspected to have behavior problems being 46.2% or 46.5%, based on the Rutter parents' or teachers' scale scores, respectively. Child blood levels of Pb, Cd, and Mn correlated with certain behavioral abnormalities, such as conduct problems and antisocial behavior. Serum S100β levels were associated with heavy metal levels in blood, and certain behavioral abnormalities. These findings suggest that exposure to various environmental heavy metals in Guiyu might result in child behavior disorders. Results also indicate that S100β may provide information for laboratory evaluation of neurotoxicity.

Self-rated and observer-rated measures of well-being and distress in adolescence: an exploratory study

The evaluation of eudaimonic well-being in adolescence is hampered by the lack of specific assessment tools. Moreover, with younger populations, the assessment of positive functioning may be biased by self-report data only, and may be more accurate by adding significant adults' evaluations. The objective of this research was to measure adolescents' well-being and prosocial behaviours using self-rated and observer-rated instruments, and their pattern of associations. The sample included 150 Italian high school adolescents. Observed-evaluation was performed by their school teachers using the Strengths and Difficulties Questionnaire. Adolescents completed Ryff's Psychological Well-being Scales and Symptom Questionnaire. Pearson' r correlations and Linear regression were performed. Self-rated dimensions of psychological well-being significantly correlated with all observer-rated dimensions, but Strengths and Difficulties Emotional symptom scale. Multiple linear regression showed that the self-rated dimensions Environmental Mastery and Personal Growth, and surprisingly not Positive Relations, are related to the observer-rated dimension Prosocial Behaviour. Adolescents with higher levels of well-being in specific dimensions tend to be perceived as less problematic by their teachers. However, some dimensions of positive functioning present discrepancies between self and observer-rated instruments. Thus, the conjunct use of self-reports and observer-rated tools for a more comprehensive assessment of students' eudaimonic well-being is recommended.