Moldavsky Maria, Pass Sarah, Sayal Kapil
1Nottinghamshire Healthcare National Health Service (NHS) Trust, UK.
Clin Child Psychol Psychiatry. 2014 Apr;19(2):202-16. doi: 10.1177/1359104513485083. Epub 2013 Apr 26.
Clinical experience and research suggest that teachers' attitudes about attention deficit/hyperactivity disorder (ADHD) are an important factor influencing access to specialist assessment and treatment, including medication.
We performed a thematic analysis of comments written by primary school teachers who participated in a case-vignette study investigating the ability of teachers to recognise ADHD. Teachers read one of four types of vignette describing the behaviour of a nine-year-old child who met diagnostic criteria for ADHD (either a boy or a girl with inattentive or combined subtype of ADHD). They answered questions (identical for all types of vignette) about their views regarding the problems and their management. Teachers were invited to add their own comments.
Altogether 496 teachers from 110 schools completed the questionnaire: 250 (50%) teachers from 94 schools wrote at least one comment, adding up to 341 comments. Regarding their views on the need to refer the child to specialist services, 32 teachers made comments that reflected caution. The most frequent comments were that it was too early to say whether a referral was necessary, the problems were not severe enough or the main support would come from school. Teachers also reported a lack of knowledge about specialist services or criticised them. When asked whether medication might be beneficial for the child, 125 teachers expressed hesitant or negative views: that it was premature to express an opinion about medication or too soon to give medication to the child; that medication was not necessary or should not be used at all; or that the problems were not severe enough or were emotional in nature. Only five teachers reported having a positive experience of the effect of medication.
Teachers' comments suggested a strong preference in using within-school strategies for the management of children with ADHD. Teachers were reluctant to endorse medication for DHD and expressed negative views about its use. Health services should support teachers' management of ADHD-related behaviours in school and provide information to increase teachers' ability to identify the need for a referral to specialist health services.
临床经验和研究表明，教师对注意力缺陷多动障碍（ADHD）的态度是影响获得专科评估和治疗（包括药物治疗）的一个重要因素。
我们对参与一项病例 vignette 研究的小学教师所写的评论进行了主题分析，该研究调查了教师识别ADHD的能力。教师阅读了四种类型的 vignette 之一，这些 vignette 描述了一名符合ADHD诊断标准的九岁儿童的行为（患有注意力不集中型或混合型ADHD的男孩或女孩）。他们回答了关于他们对这些问题及其管理的看法的问题（所有类型的 vignette 问题相同）。教师被邀请添加他们自己的评论。
来自110所学校的496名教师完成了问卷：来自94所学校的250名（50%）教师至少写了一条评论，共计341条评论。关于他们对将孩子转介到专科服务机构的必要性的看法，32名教师的评论反映了谨慎态度。最常见的评论是现在说是否需要转介还为时过早、问题不够严重或者主要支持将来自学校。教师还报告了对专科服务机构缺乏了解或对其进行了批评。当被问及药物治疗对孩子是否有益时，125名教师表达了犹豫或负面看法：表示现在就对药物治疗发表意见还为时过早或现在给孩子用药还太早；认为药物治疗没有必要或根本不应该使用；或者认为问题不够严重或本质上是情绪问题。只有五名教师报告有药物治疗效果的积极体验。
教师的评论表明，他们强烈倾向于在学校内使用策略来管理患有ADHD的儿童。教师不愿意认可对ADHD使用药物治疗，并对其使用表达了负面看法。卫生服务机构应支持教师在学校管理与ADHD相关的行为，并提供信息以提高教师识别转介到专科卫生服务机构必要性的能力。
