Attention deficit hyperactivity disorder is an impaired function in at least two settings: home and school due to impulsivity, hyperactivity, and inattention (1). It has three subtypes: a hyperactive type, an inattentive type, and a combined hyperactive and inattentive type (2).
It is one of the most commonly diagnosed childhood psychiatric disorders and is estimated to affect 5% of children globally (3).
There seems to be a strong genetic predisposition for developing ADHD since children of affected parents have a higher risk (4). In addition, those suffering from conditions such as Klinefelter’s, Turner’s, fragile-X, and neurofibromatosis type I tend to have a higher risk (5). Moreover, environmental factors like low socioeconomic status and living in foster care increase the risk of developing ADHD. Prematurity and low birth weight also come with a higher risk (6).
The diagnosis of ADHD can be a real challenge since there is no single blood test or imaging modality that can help reach an accurate diagnosis of ADHD, so even professional physicians might face difficulties. In addition, symptoms of ADHD can differ according to age, context, and gender (7). It is usually diagnosed before the age of 7 based on the clinical picture and diagnostic criteria, and 30–50% of children diagnosed with ADHD continue to exhibit symptoms into adulthood, contrary to the popular belief that children outgrow ADHD (8).
ADHD can present a unique set of difficulties and challenges through each stage of development. In preschool, children with ADHD tend to find difficulty interacting with their peers and lag in their social skills compared to other children. They also tend to be non-compliant with adult requests (9)(10). In elementary school, those children struggle with social interactions and have difficulty paying attention during classes and performing tasks impacting their academic performance (11)(12). During adolescence, they struggle with hyperactive and impulsive behavior, engage in high-risk activities, and have poor social skills (13). During adulthood, they tend to have occupational and marital problems, and unstable relationships and are at increased risk for other co-morbid psychiatric diseases such as depression, anxiety, and substance abuse (14).
Primary school teachers play an essential role in assessing children's behavior and are often the first to recognize a child with ADHD as they are exposed daily to children (15). They also play a role in evaluating treatment plans at school (16). Parents also genuinely tend to follow recommendations about ADHD from teachers which can be misleading as teachers with low knowledge about ADHD can give inappropriate advice (17)(18)(19)
Treatment of ADHD is multimodal and consists of stimulant therapy, family education, and behavioral strategies at home and school in which teachers play a key role (20). Thus lack of knowledge and negative attitude toward ADHD among teachers can result in treatment failure (21)(22)
In a study conducted in Khartoum state, the prevalence of ADHD inattentive subtype among school children was 3.5%, the hyperactive subtype was 6.9%, and the combined type was 1%. The prevalence increases dramatically with an increase in age and in rural areas (23). About half of the children with ADHD also meet the criteria for at least another psychiatric disorder (24). They also have an increased risk of suicidal attempts during adulthood (25).
The goal of this study is to shed some light on the level of teachers’ knowledge about ADHD. Teachers are considered the first who perform referrals of ADHD children. Therefore, they must possess a high knowledge and awareness about ADHD and its symptoms. Having sufficient knowledge enables the teacher to deal better with ADHD children and significantly increases their chances of recovery. This study aims to assess the knowledge, perception, and misconceptions of elementary school teachers in the locality of Khartoum regarding ADHD and to examine the differences in teachers’ knowledge in terms of sociodemographic variables.