RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. JUSTIN. J
1ST YEAR M.SC NURSING
BGS COLLEGE OF NURSING
MYSORE
2. / NAME OF THE INSTITUTION / BGS COLLEGE OF NURSING
MYSORE
3. / COURSE OF STUDY AND SUBJECT / DEGREE IN MASTER OF NURSING,
MENTAL HEALTH NURSING.
4. / DATE OF ADMISSION TO COURSE / 30/6/2011
5. / TITLE OF THE TOPIC / A STUDY TO ASSES THE EFFECTIVNESS OF VIDEO ASSISTED TEACHING PROGRAMME ON KNOWLEDGE REGARDING “ATTENTION DEFICIT HYPERACTIVITY DISORDER IN SCHOOL CHILDREN” AMONG B.ED STUDENTS AT SELECTED B.ED COLLEGE IN MYSORE

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION:

Education is one of the most important aspects of human resource development. The inability to successfully navigate the educational system can cause serious problems for children and their parents. There are many reasons for children to underperform at school such as, medical problems, below average intelligence, specific learning disability, attention deficit hyperactivity disorder (ADHD), emotional problems, psychiatric problems, poor home environment etc.1

Attention deficit hyperactivity disorder was described by Dr. Hoffman in 1845, a physician who wrote books on medicine and psychiatry. The main causes for attention deficit hyperactivity disorder are minimal brain damage, malnutrition, genetic factors, early developmental psychodynamic factors etc.2

Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder characterized by inattention, hyperactivity, impulsivity, and cognitive, behavioural, and emotional deficits. ADHD is also closely related to learning disabilities, lack of self-control, and social skill deficits. Approximately half of ADHD children show overt symptoms by the time they are 5 years old, and most begin to display behavioural problems during the early school years when they have to follow instructions from teachers and obey school rules. Attention deficit hyperactive disorder may become a common learning disability. If this is so teachers may resort to punishing and bullying pupils with traces of ADHD without necessarily understanding the problems many of the pupils may be going through in the process of learning. In the school system no provisions have been made regarding these attention deficit/hyperactivity disorder pupils who may exhibit behaviour contrary to the expectation in a learning environment.3

Six days- a- week children spend most of their time in classroom and other school settings. The work of the teacher becomes much more demanding when some learners have attention deficit hyperactivity disorder. When a child exhibits behaviors associated with attention deficit hyperactivity disorder, consequences may include difficulties with academics and with forming relationship with peers and teachers. Approximately 3-5% of elementary school children have been diagnosed with this disorder.4

Teachers play a major role in the identification and assessment of children’s academic and behavioral problems and make primary decision how to help them. Snider, Busch and Arrowood claim that teachers are involved in making the initial referral in 40-60% of the times and thus it is of critical importance that teachers are knowledgeable and objective if they have to play a role in the diagnosis of childhood problems.5

6.1 NEED FOR THE STUDY:

Attention deficit hyperactivity disorder is a very common disorder occurring in children between the ages of 5 – 12 yrs. Attention deficit hyperactivity disorder (ADHD) comprises of an important childhood psychiatric disability, and is well characterised on the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and International Classification of Disease (ICD)-10 criteria of psychiatric disorders. The prevalence of ADHD in India is approximated to be around 5%.6

Attention deficit hyperactivity disorder is one of the most commonly diagnosed psychiatric childhood disorders and international studies which reveal that it affects nearly 8% in the US children aged 4-7 years.7

A study was conducted in Nigeria to assess the prevalence of ADHD among pupils in primary schools. The data was collected from 400 pupils selected from 3 public schools by using Disruptive Behaviour Disorder rating scale. The study results showed that (23.15%) were screened as having symptoms of ADHD of which 45 (47.87%) had the Hyperactivity type, 20 (21.28%) had the Inattention type and 29 (30.85%) had ADHD combined type. The sex ratio for ADHD combined type and Inattention type was about 2:1, while hyperactivity was about 1:1. The study suggested that there was a prevalence of ADHD in Edo State.8

In India Attention deficit hyper activity disorder affects nearly about 3% of school children; boys are 6-8 times more often affected. The onset occurs before the age of 7 years and a large majority of children exhibits symptoms by the fourth year of their age.9

In India the knowledge about attention deficit hyper activity disorder among primary school teachers were relatively low. 46.9% of the school teachers agreed that attention deficit hyper activity disorder was due to biological and genetic vulnerabilities. 53.1% of the teachers considered attention deficit hyper activity disorder are the result of parental spoiling. The attitude score towards attention deficit hyper activity disorder children was low; 64.8% of teachers agreed that the same disciplinary rules used for all students should also be applied to attention deficit hyper activity disorder students.10

An empirical study was conducted to assess the knowledge and misperceptions of ADHD of primary school teachers in 35 primary schools in the periphery of the Cape Town. A demographic questionnaire was administered along with the KADDS (Knowledge of Attention Deficit Disorders Scale) to 824 teachers at 35 selected schools. The response rate was 67%. The study findings revealed that teachers overall knowledge of ADHD was poor (42.6%). The study revealed that overall knowledge of ADHD is significantly related to teachers sense of self efficacy. Both knowledge and attitude greatly determines the outcome of the diagnosis and treatment of ADHD. Hence it is highly important to identify the knowledge of primary school teachers regarding ADHD in children.11

Based on the review of literature and observation, the investigator noticed that the school teacher, as well as teacher trainee students has low knowledge on attention deficit hyperactivity disorder. As the B.Ed. students are going to be the future teachers in the school, it is very essential for them to have enough knowledge about ADHD to identify and manage effectively with ADHD.

6.2 REVIEW OF LITERATURE:

A study was conducted to determine the prevalence rate of attention deficit hyperactivity disorder (ADHD) in preschool age children in Mumbai. The data was collected from teachers and parents of each child by using Conner's index. Parents of children whose scores were positive for ADHD (>15) were interviewed by a psychiatrist and the ADHD was diagnosed based on DSM-IV criteria Schedule for affective disorders. The study results showed prevalence of ADHD in preschool age school in southwest of Mumbai is 12.2%.12

A cross-sectional study was conducted to determine the prevalence of ADHD in India. The data was collected from 238 children of age group 5-12years was studied. The result revealed that 15.5% was the prevalence rate. The male to female ratio was 6.4:1. Most of the (27.0%) children had developmental problems.13

A study was conducted to determine the teacher reports of DSM-IV ADHD, ODD and CD symptoms in school-children in New York. 3006 children aged between 3 and 8years were screened and the teachers completed a DSM-IV referenced symptom inventory. The result showed that prevalence rate of ADHD was 15.8%; rates for individual sub types were 9.9% for inattentive, 2.4% for hyperactive-impulsive and 3.6% for combined.14

A study was conducted on knowledge and Attitudes towards ADHD among primary school teachers. The data was collected from sample 120 Catholic and private primary school teachers by using Questionnaires. The results showed that teachers' actual knowledge was better than their perceived knowledge, and also showed that teachers' attitudes about ADHD can be grouped into seven main clusters; lack of control, negative classroom effects, diagnostic legitimacy, perceived competence, influences to management, expectations, and external control.15

A study was conducted to measure teachers attitudes and expectations toward students with ADHD. The method used to test knowledge about ADHD (KADD) was constructed based on the error- choice method, which is an indirect method of attitude measurement. This psychometric approach was utilized to reduce patterns of response distortions that produce systematic errors in direct attitudinal assessment. Elementary school teachers (N = 103) completed the error-choice instrument. The study results revealed that adequate to good internal consistency reliability for the KADD with a Cronbach's coefficient alpha of 0.82.16

A study was conducted to assess the knowledge and attitudes in pre-service primary school teachers' towards children with ADHD, which were then compared to the in-service sample. This study result showed that when compared to in-service teachers, pre-service teachers perceived and actual knowledge scores were significantly lower that is range from about 48 - 70% and attitudes were similar across pre-service and in-service teachers. The study concluded that conducting various programmes may enhance teacher training and classroom management of child with ADHD.17

A study was conducted in Aga Khan University, Pakistan to increase the knowledge of teachers about ADHD. The data was collected from 49 teachers after 1 week training programme by using a questionnaire. The study results revealed that the knowledge of teachers after training programme was significantly higher than their previous knowledge level about ADHD.18

A study was conducted in Shiraz, Iran to knowledge and attitude towards attention deficit hyper activity disorder among elementary school. The data was collected from 196 elementary school teachers by using a self-report questionnaire on ADHD. The study results showed that knowledge about ADHD was relatively low. The study concludes that knowledge and attitudes towards attention deficit hyperactivity disorder found to be very low. Health and/or Educational Ministry should promote a special course on ADHD for teachers and education should be part of the curriculum in faculty training. Providing these educational programs on television and radio may be highly effective as they were the most common source of information.19

A study was conducted on Attitude and knowledge of attention deficit hyperactivity disorder and learning disability among high school teachers. The data was collected from forty-six high school teachers who were divided into two groups: 25 teachers taught at an academic school (School 1); and 21 teachers taught at special education school (School 2) and dealt with ADHD/LD cases regularly. The study results showed that general knowledge about ADHD (71%) and about LD (74%) was relatively low among both groups. The score for attitude and understanding of ADHD children was relatively low (72.5%) for both groups. Almost 40% considered that ADHD children should be rebuked and/or punished in a manner similar to non-ADHD kids. Regarding long-term outcome, 45.7% of the teachers expected ADHD children to experience multiple difficulties in family life during adulthood.20

A descriptive study was conducted to assess the teacher’s knowledge regarding attention deficit hyperactivity disorder in five schools of the San Juan metropolitan area. The data was collected from one hundred thirty two school teachers by using questionnaires. The study results showed that thirty five per cent of the teachers reported to have had previous knowledge about ADHD. Seventy two per cent (72) reported a low level of knowledge about the disorder. The findings evidence the limited information and confusion that teachers have about ADHD. The study concludes that teachers observations are important sources of information for child psychiatrists in the process of evaluation and diagnosing children with ADHD. Therefore, is critical that teachers in the public and private sectors become aware of these characteristics so they are able to identify these children as early as possible.21

A study was conducted on teachers' knowledge, misconceptions, and lacks concerning Attention Deficit Hyperactivity Disorder. The data was collected from 193 teachers by using Knowledge of Attention Deficit Hyperactivity Disorder (KADDS) to measure knowledge of ADHD in three content areas: general knowledge, symptoms/diagnosis, and treatment. The study results showed an average of correct responses of 31.67, 63.88 and 40.46% in general knowledge, symptoms/diagnosis and treatment, respectively.22

A comparative study was conducted on American and Canadian teachers' knowledge and attitudes towards Attention Deficit Hyperactivity Disorder (ADHD).The data was collected from both samples by using a self-report questionnaire. The study results showed that both samples had little in-service training regarding ADHD. Despite this, most teachers regarded ADHD as a valid diagnosis with educational implications and wanted more formal training.23

A study was conducted on Identification of children at risk of Attention Deficit/Hyperactivity Disorder: a School based intervention. This study results showed that there was an increase in the proportion of children regarded by teachers as having probable ADHD. There was also improved agreement between teacher recognition and the diagnostic algorithm. Teacher views that a child had probable ADHD were based on both the severity of symptoms and the impact of these problems on the teacher and the class. The study concludes it is feasible to deliver an educational intervention addressing teacher identification of ADHD in routine practice. This was associated with an improvement in the ability of teachers to more accurately identify children at risk of ADHD. The provision of a brief educational intervention for teachers could assist in improving the identification of undiagnosed children with ADHD in the community.24

A comparative study was conducted between practicing teachers and undergraduate education students on knowledge and attitudes regarding Attention deficit hyperactivity. The data was collected from both samples by using self-report questionnaire. The study results showed the existence of some knowledge gaps, although both practicing teachers and undergraduate education students possessed sound information about ADHD. Attitudes and knowledge were significantly correlated and most participants regarded ADHD as a valid diagnosis with implications for the school setting, and expressed a desire for comprehensive training. Despite similar results for both samples, teachers achieved higher accuracy on knowledge-based questions. Implications of these findings for curriculum development in academia and in-service teacher training are highlighted.25

A descriptive cross sectional study was conducted to assess the knowledge and attitudes of primary school teachers in Sri Lanka towards childhood attention deficit hyperactivity disorder. The data was collected from 202 primary school teachers by using a self-administered questionnaire. The study results shows that very less teachers had adequate knowledge about ADHD and its treatment. Teachers who had training in child psychology recorded a significantly higher knowledge and had a more favourable attitude. The researcher concludes that the knowledge of ADHD and its treatment among primary school teachers needs to be improved. Particular focus should be on improving attitudes and disseminating the message that timely interventions can make a difference in the educational and social development of the child.26