Teachers' Attitudes toward Attention-Deficit or Hyperactivity Disorder in Primary Schools of Kirkuk, Iraq: A Cross-Sectional Study

Salih Ali  Redha; Bestoon M  Ahmad

doi:10.17605/cajmns.v6i4.2872

Salih Ali Redha University of Kirkuk, Iraq
Bestoon M Ahmad University of Kirkuk, Iraq

DOI: https://doi.org/10.17605/cajmns.v6i4.2872

Keywords: Attention Deficit Hyperactivity Disorder, Attitude, Primary School Teachers

Abstract

Among school-age children, Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental diseases. Attention Deficit Hyperactivity Disorder (ADHD) has a substantial influence on academic and social outcomes, with teachers playing an important role in early detection and intervention. Despite its global prevalence (5-11%), teachers' attitudes, which are crucial for inclusive education, have received little attention in Iraq. This descriptive cross-sectional study was conducted among 419 primary school teachers across Kirkuk City, Iraq, from November 2024 to May 2025. Using random sampling, participants were recruited from 88 schools (36 public, 47 special public, and 5 private special education institutions). Data were collected through a validated 22-item questionnaire assessing, Sociodemographic, and Attitudes toward ADHD (3-point Likert scale, Cronbach's α=0.81) Statistical analysis in IBM SPSS v 20 included, Descriptive statistics and independent t-tests, ANOVA, Pearson's r). Most teachers (97.9%) held neutral attitudes, with only 2.1% expressing strong positive/negative views. Male teachers reported significantly more positive attitudes than females (mean difference = 1.45, p < 0.001). Class size weakly correlated with attitudes (r = 0.132, p = 0.007), while age, religion, and education level showed no significant associations (p > 0.05). While ADHD awareness is prevalent, attitudes remain largely neutral, influenced more by gender and classroom context than sociodemographic. Findings underscore the need for mandatory ADHD training programs to fill the gap between proactive aid and awareness.

References

Agnew‐Blais, J., & Michelini, G. (2023). Taking stock of the present and looking to the future of ADHD research: A commentary on Sonuga‐Barke et al. (2023). Journal of Child Psychology and Psychiatry, 64(4), 533–536. https://doi.org/10.1111/jcpp.13758

Akdağ, B. (2023). Exploring Teachers’ Knowledge and Attitudes Toward Attention Deficit Hyperactivity Disorder and Its Treatment in a District of Turkey. Cureus, 15(9). https://www.cureus.com/articles/187300-exploring-teachers-knowledge-and-attitudes-toward-attention-deficit-hyperactivity-disorder-and-its-treatment-in-a-district-of-turkey.pdf

Al-Amarei, H. M., & Mohamed, S. H. (2020). Assessment of Knowledge and Attitudes toward Attention Deficit/Hyperactivity Disorders among Primary Schools’ Teachers in AL-Najaf City.

Alarcón, R. D., Collins, P. Y., Collins, M. G., First, M. B., Malaspina, D., Martin, G., Schultz, S. K., Skodol, A. E., & Yonkers, K. A. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TRTM. 2022.

Al-Hendawi, M. K., Keller, C., & Alqahwaji, A. (2024). Special Education Teachers’ Self-Efficacy and Knowledge of Learning Disabilities in inclusive Education in Qatar. Journal of Educational Sciences–Qatar University, 24(2). https://journals.qu.edu.qa/index.php/jes/article/view/4544

Amha, H., & Azale, T. (2022). Attitudes of primary school teachers and its associated factors toward students with attention deficit hyperactivity disorder in Debre Markos and Dejen Towns, Northwest Ethiopia. Frontiers in Pediatrics, 10, 805440.

Arjmandi, S., Akikhavandi S, & Sayehmiri K. (2015). Prevalence of attention deficit hyperactivity disorder among primary school children according to teachers’ and parents’ reports: A systematic review and meta-analysis study Fundamentals of Mental Health, 17(5), pp. 213-221.

Castanho, J. M., Polanczyk, G, & Rohde LA. (2020). attention deficit hyperactivity disorder. IACAPAP Textbook of Child and Adolescent Mental Health.

Center for Diseases Control and Prevention. (2024, October 25). Treatment of ADHD. Attention-Deficit / Hyperactivity Disorder (ADHD).

central intelligence Agency. (2025, May 21). Iraq. The World Factbook.

Cormann, M. (2024). Education at a Glance 2023 OECD INDICATORS. OECD.

Fitzallen, G. C., Taylor, H. G., Liley, H. G., & Bora, S. (2024). Within-and between-twin comparisons of risk for childhood behavioral difficulties after preterm birth. Pediatric Research, 96(3), 723–730.

Francés, L., Quintero, J., Fernández, A., Ruiz, A., Caules, J., Fillon, G., Hervás, A., & Soler, C. V. (2022). Current state of knowledge on the prevalence of neurodevelopmental disorders in childhood according to the DSM-5: A systematic review in accordance with the PRISMA criteria. Child and Adolescent Psychiatry and Mental Health, 16(1), 27. https://doi.org/10.1186/s13034-022-00462-1

Guillory, A. B. (2023). Educators’ Perceptions of Mental Illness in Elementary Schools: A Phenomenological Study. Lamar University-Beaumont. https://search.proquest.com/openview/30a4d9713117436df918226f3f9fcea0/1?pq-origsite=gscholar&cbl=18750&diss=y

Gutman, L. M., & Codiroli McMaster, N. (2020). Gendered Pathways of Internalizing Problems from Early Childhood to Adolescence and Associated Adolescent Outcomes. Journal of Abnormal Child Psychology, 48(5), 703–718. https://doi.org/10.1007/s10802-020-00623-w

Hamed, A. S., & Ghafel, H. H. (2022). Evaluation of Elementary School Teachers’ Knowledge about Attention Deficit Hyperactivity Disorder (ADHD). J Contemp Med Sci| Vol, 8(4), 235–238. https://www.iasj.net/iasj/download/7cab0db870833084

Harrison, J. R., Evans, S. W., Baran, A., Khondker, F., Press, K., Noel, D., Wasserman, S., Belmonte, C., & Mohlmann, M. (2020). Comparison of accommodations and interventions for youth with ADHD: A randomized controlled trial. Journal of School Psychology, 80, 15–36. https://doi.org/10.1016/j.jsp.2020.05.001

Hu, L., & Chen, G. (2021). A systematic review of visual representations for analyzing collaborative discourse. Educational Research Review, 34, 100403. https://doi.org/10.1016/j.edurev.2021.100403

Hussain, E. N., Ashour, Q. K., & Abdulkarim, E. A. (2023). Teachers’ Knowledge about Attention Deficient Hyperactivity Disorder (ADHD) among Student at Primary School in Karbala City. Journal of Population Therapeutics and Clinical Pharmacology, 30(3), Article 3. https://doi.org/10.47750/jptcp.2023.30.03.068

Jabar, A. H., Saleh, A. A., & Akmoosh, S. I. (2024). Knowledge and Attitude of Attention-deficit Hyperactivity Disorder among Parents Attending Primary Health-care Centers in Al-Karkh/Baghdad City, 2023. Iraqi Journal of Community Medicine, 37(1), 21–26. https://journals.lww.com/ircm/fulltext/2024/01000/knowledge_and_attitude_of_attention_deficit.5.aspx

Justus, S. A., Pogue, E. M., & Simanovich, V. (2025). Pre-K–12 Teachers’ Views on ASD+ ADHD: Prevalence Estimates and Teaching Preparedness. Children, 12(3), 342. https://www.mdpi.com/2227-9067/12/3/342

Kennedy, I. (2022). Sample size determination in test-retest and Cronbach alpha reliability estimates. British Journal of Contemporary Education, 2(1), 17–29. https://www.researchgate.net/profile/Muftah-Elbahloul-2/post/What-is-minimum-required-sample-size-to-compute-Cronbachs-alpha-reliability-for-questionnaires-scales/attachment/6461e86597e2867d50912028/AS%3A11431281158392461%401684138084979/download/sample+size+for+relaibility.pdf

Kong, F., Meng, S., Deng, H., Wang, M., & Sun, X. (2023). Cognitive Control in Adolescents and Young Adults with Media Multitasking Experience: A Three-Level Meta-analysis. Educational Psychology Review, 35(1), 22. https://doi.org/10.1007/s10648-023-09746-0

Mahone, E. M., & Denckla, M. B. (2017). Attention-Deficit/Hyperactivity Disorder: A Historical Neuropsychological Perspective. Journal of the International Neuropsychological Society: JINS, 23(9–10), 916–929. https://doi.org/10.1017/S1355617717000807

Milledge, S. V., Cortese, S., Thompson, M., McEwan, F., Rolt, M., Meyer, B., Sonuga-Barke, E., & Eisenbarth, H. (2019). Peer relationships and prosocial behaviour differences across disruptive behaviours. European Child & Adolescent Psychiatry, 28(6), 781–793. https://doi.org/10.1007/s00787-018-1249-2

Muhe-Aldeen, A. L. (2022). The Effect of Psycho-Educational Program on the Beliefs and Attitudes of Primary School Teachers toward Epilepsy in Children in Kirkuk city. Azerbaijan Medical Journal, 1589–1599.

Ohan, J. L., Cormier, N., Hepp, S. L., Visser, T. A., & Strain, M. C. (2008). Does knowledge about attention-deficit/hyperactivity disorder impact teachers’ reported behaviors and perceptions? School Psychology Quarterly, 23(3), 436.

Pollak, Y., Dekkers, T. J., Shoham, R., & Huizenga, H. M. (2019). Risk-Taking Behavior in Attention Deficit/Hyperactivity Disorder (ADHD): A Review of Potential Underlying Mechanisms and of Interventions. Current Psychiatry Reports, 21(5), 33. https://doi.org/10.1007/s11920-019-1019-y

Saadoon, N. Y., & Salih, H. S. (2017). Assessment of primary school teachers’ knowledge regarding child abuse in Kirkuk city. Research Journal of Pharmacy and Technology, 10(6), 1929–1933.

Sciarra, D. S., Austin, V. L., & Bienia, E. J. (2022). Working with students with emotional and behavioral disorders. Vernon Press. https://storage.vernonpress.com/files/web/d94485dd-842a-4ea5-8e68-8e42921e9407/1657895042.pdf

Senol, V., Unalan, D., Akça, R. P., & Basturk, M. (2025). Prevalence of attention-deficit/hyperactivity and other disruptive behaviour disorder symptoms among primary school-age children in Kayseri, Turkey. ResearchGate. https://doi.org/10.1177/0300060517712865

Shehata, A., Mahrous,E., & Hassan,Z. (2016). Effectiveness of Structured Teaching Program on Knowledge, Attitude, and Management Strategies among Teachers of Primary School toward Children with ADHD. Journal of Nursing and HealthScience,5(6),29 37.

Smith, Z. R., & Langberg, J. M. (2018). Review of the Evidence for Motivation Deficits in Youth with ADHD and Their Association with Functional Outcomes. Clinical Child and Family Psychology Review, 21(4), 500–526. https://doi.org/10.1007/s10567-018-0268-3

Soltan, M. H., Albalawi, R. A., Alnawmasi, N. S. M., Alshammari, W. F. D., AlOmari, L. H., Ibrahim, M. I. F. B., Alshammari, S. H. M., Al Makir, M. K. A., Albalawi, W. M. B., & Sabir, S. A. H. A. (2023). Association between Migraine and Attention Deficit Hyperactivity Disorder: Systematic Review. Pharmacophore, 14(2–2023), 58–64.

Uchida, M., DiSalvo, M., Walsh, D., & Biederman, J. (2023). The Heritability of ADHD in Children of ADHD Parents: A Post-hoc Analysis of Longitudinal Data. Journal of Attention Disorders, 27(3), 250–257. https://doi.org/10.1177/10870547221136251

UNESCO, L. C. (UK). (2022). Disability-inclusive comprehensive sexuality education in Asia and the Pacific: An assessment of teacher needs. https://unesdoc.unesco.org/ark:/48223/pf0000383924?posInSet=1&queryId=fa1de887-cacb-4a83-8a21-f9e4e5eb5ef6

Walpert, M., Zaman, S., & Holland, A. (2021). A Systematic Review of Unexplained Early Regression in Adolescents and Adults with Down Syndrome. Brain Sci. 2021, 11, 1197. Down Syndrome, 107. https://www.academia.edu/download/73353131/pdf.pdf

Yumi, L., & Witruk, E. (2016). Teachers’ knowledge, perceived teaching efficacy, and attitudes regarding students with ADHD: A cross-cultural comparison of teachers in South Korea and Germany. Health Psychology Report, 4(2), 103–115.