Introduction

ADHD is the most common psychiatric disorder in childhood, affecting approximately 3–7% of school-age children. These predominantly display inattentive behaviours. The core-symptoms of ADHD frequently lead to academic difficulties. The teacher often is the first one to suspect the disorder and to initiate a referral to a health care professional. As the use of medication may be influenced in part by the teacher having suggested the diagnosis, it is important to look at the impact of teacher attitudes, beliefs and practices on treatment, behavior and education of children with ADHD. The first goal of this review is to determine how teacher factors influence education and health outcomes. The second goal is to describe factors that influence teachers’ acceptability, understanding and tolerance of ADHD and treatment options for their students, as well as teacher factors that relate to their likelihood to refer students for diagnosis.

Review process

Search strategy and inclusion criteria

Medical, educational and psychological databases were used for the review, including peer-reviewed articles, dissertation abstracts, review and opinion papers, and conference presentations or posters. Teacher factors were considered the predictor. The population of interest was North American elementary school-aged children with ADHD. Only studies with North American students were included to increase the generalisibility of conclusions. The dependent variable was changed from student outcomes to related issues such as diagnosis, teacher detection and implementation of treatments.

Screening and categorising

All english sources were screened and reviewed if they met the inclusion criteria. Selected sources were divided among the authors for review and summarizing. Two goals of the review were defined:

1. Finding out more about the influence of teacher factors on various health and education outcome measures for elementary children with ADHD

2. Examining factors that influence teachers' views and referral decisions when it comes to treating or diagnosing stzudents with ADHD symptoms.

Results

The relation between teacher factors and student outcomes

Teacher factors include teachers’ perceptions of ADHD, philosophies on interventions, job satisfaction, experience and tolerance levels with respect to behaviour in the classroom. They are not included in the "gold standard of ADHD research", which is the Multimodal Treatment Study of Children with Attention-deficit/Hyperactivity Disorder (MTA). However, as Greene (1995) notes, that teachers rate children differently and thereby can affect children's behaviour and academic performance, it is important to identify teacher factors. He reviewd two types of compatibility issues that have been largely ignored in the literature: teacher–treatment compatibility and teacher–student compatibility. How teachers react to ADHD-typical behaviour is suggested to be associated with how children with ADHD perceive social acceptrance and support from their peers. It is also suggested, that children with ADHD might benefit from teachers who employ a more preventative outlook with respect to disruptive behaviours. This preventative outlook incorporates the notion that classroom problems are temporary, and can be modified with interventions. The perception about intervention effectiveness may then influence treatment outcomes and the information that teachers provide for parents. Furthermore, the perceived social appropriateness and acceptability of treatment procedures by students, teachers and parents are important factors in designing interventions.For example, teachers' time involvement may be a critically important factor for determining how acceptable treatments are in the classroom. 

The relation between teacher factors and ADHD: belief in, referrals for and tolerance of the disorder

Examining the knowledge about and belief in the effectiveness of particular treatment options of teachers is useful for understading the factors thatinfluence teacher's acceptability of treatment and their likelihood to manage behvaiours or refer for diagnosis. Teachers are often the primary source of referral for students with ADHD. Teacher factors have been identified as characteristics that can relate to how teachers refer, tolerate, rate and view students with ADHD. however, not only teacher factors are important to consider, but also child characteristics, such as gender, can influence teachers' acceptability ratings for treatment options. Thus, teachers’ perceptions of treatment acceptability in relation to student characteristics – in this case, gender – can directly impact the type of treatment they support in the classroom, as well as the extent to which teachers pursue a referral (or not). For example, teachers are more likely to refer boys than girls for clinical diagnosis.

Conclusion

First, teacher factors (e.g. tolerance, teaching style, experience with students who have ADHD, communication style, but also potentially subtle factors such as the degree to which teachers use hand gestures in coordination with speech) can significantly impact a variety of outcomes among students with ADHD. Second, there are too few sources that directly assess the important link between various teacher factors and many critical cognitive, health, social and academic outcomes.There has been a ot of literature relevant to the study, but not directly related to the two main goals. More research is needed to understand the various factors that contribute to successfully identifying and treating ADHD. The challenge of ensuring optimal development is multifaceted.