Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric illness that affect school age children worldwide. The Diagnostic and Statistical Manual of Mental Disorders - 5th edition (DSM-5TM) defines ADHD as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has symptoms presenting in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities), and negatively impacts directly on social, academic or occupational functioning [1]. Attention-deficit hyperactivity disorder is a common neurodevelopmental and behavioral disorder in childhood and adolescence. The three categories of behaviors associated with ADHD are, a pattern of extreme pervasive, persistent and debilitating inattention, hyperactivity, and impulsivity (American Psychiatric Association). Attention-deficit hyperactivity disorder is associated with a significant impact on social and academic success, and self-esteem. It is often associated with learning disabilities, and other behavioral disorders, which further impede the successful development of those affected [2]. ADHD is diagnosed in a person who shows a persistent pattern of hyperactivity and or inattention that affects their day-to-day functioning. There are three subtypes of ADHD: 1) primarily hyperactive; 2) primarily inattentive; 3) combined hyperactive and inattentive. Two-thirds to three-quarters of those diagnosed are considered to have the combined form of ADHD. In addition, the difficulties must be documented in at least two different situations, be present before age 12 and clearly be interfering with the person’s functioning in life [3]. The symptoms begin by age six to twelve, and cause problems in at least two settings as school, home, or recreational activities. Studies of the prevalence across the globe have generally reported that 5-10% of school aged children are affected and it is 3-5 times more common in boys than in girls [4]. ADHD is reportedly the most pervasive disorder of childhood affecting approximately 3% to 5% of school-aged children with prevalence rates increasing significantly over the past two decades [5]. The school stage plays a very important role in the identification of children with ADHD. It has been confirmed that teachers detect children with ADHD more frequently than do parents or physicians [6]. Teachers are an incredibly important resource in the diagnosis and intervention of children with ADHD. Teachers play a vital role in the early identification, diagnosis, and support of children with ADHD. Teachers may be the first individuals to witness children in a context where there are demands that challenge the attentional capabilities of students (i.e., where children are expected to remain seated in their desks, etc.). As such, teachers are often among the first individuals to identify atypical levels of attention abilities in a student and suggest that further investigation into these issues is warranted [7]. It is therefore important that teachers have a high level of ADHD specific knowledge and positive attitudes towards children who display ADHD type behaviors in order to avoid a potential failure to detect students who require educational/behavioral support and/or a referral for assessment [8]. The current study aims to identify the level of teachers attitudes about attention deficit and hyperactivity disorder.

Descriptive cross-sectional study carried out at 20 primary schools from Al-Karkh and Al-Rusafa districts in Baghdad city. The sample of the study is 200 teachers selected from the primary schools by using of non-probability sampling convenience sample. The researcher explains the study and the objectives to the teacher and take their acceptance to participate in the study, then collect the data. The study instrument is a questionnaire composed of 3 parts. The 1st part is related the general information of the teachers include (age, gender, marital status, and level of education). The 2nd part is related to teachers’ sources of information about ADHD. The 3rd part is related to teachers’ attitudes about ADHD, this scale is self-report questionnaire developed from [9], and compose of 12 items to assess teachers’ attitudes toward ADHD. A 3-point Likert-type scale was used ranging from agree, nature & disagree. 3 points for agree, 2 points for nature, & 1 point for disagree, which assessed by cutoff point (0.66) due to scores (1, 2 and 3) respectively. Scores of responses are categorized according to the following mean score of attitudes: (1-1.66) = negative of attitudes, (1.67-2.33) = neutral attitudes and (2.34-3.00) = positive attitudes. Content validity of the scale done by using panel of expert and the reliability of the scale by using internal consistency. The Cronbach’s alpha of the scale is (0.86). The data analyzed by using descriptive and inferential statistical data analysis.

The result in Table 1 shows that (32%) of teachers at age (29-35) years old, (64%) of them were females, (55%) were married, (50%) had bachelor graduated. Table 1: Distribution of the Teachers Socio-demographic Characteristics Variables Frequency Percent Age 22-28 16 8 29-35 64 32 36-42 44 22 43-49 50 25 50-60 26 13 Gender Female 128 64 Male 72 36 Marital status Single 70 35 Married 110 55 Widowed 14 7 Divorced 6 3 Educational level Diploma 98 49 Bachelor 100 50 Master and above 2 1 The finding in Table 2 shows that (47.5%) of teachers had not sure about information of ADHD, (77.5%) heard about ADHD, and (61%) read about ADHD. Table 2: Distribution of the Teachers Sources of Information about ADHD Variables Frequency Percent Do you have enough information about ADHD No 42 21 Yes 63 31.5 Not sure 95 47.5 Total 200 100 Heard about ADHD No 45 22.5 Yes 155 77.5 Total 200 100 Read about ADHD No 78 39 Yes 122 61 Total 200 100 Assessment =(Ass) , Negative= (Ne) (1-1.66), Neutral =(N)(1.67-2.33), Positive =(Po) (2.34-3). Table 3 shows that teachers had neutral level of attitude toward ADHD, the grand mean was (2.036). Table 3: Distribution of Teachers' Attitudes about ADHD No. Items Agree Neutral Disagree Mean Ass. 1 Training teachers in behavioral management is important 78 51 71 2.04 N 2 Improving the parents' skill would benefit their children 161 30 9 2.76 +ve 3 ADHD child should be treated if recommended by a doctor 118 59 23 2.47 +ve 4 Social skill training can be helpful for a child with ADHD 62 74 64 1.99 N 5 Behavioral management is an effective treatment 85 55 60 2.13 N 6 Clear consistent rules and consequences are helpful in treating ADHD 44 62 94 1.75 N 7 Teaching techniques are helpful in managing ADHD 103 68 29 2.37 +ve 8 ADHD can be the result of the child not trying to control his/her behavior 29 45 126 1.52 -ve 9 ADHD results from parents being inconsistent with rules and consequences 142 48 10 2.66 +ve 10 Family problems may contribute to a child's ADHD 48 47 105 1.72 N 11 I want to learn specialized teaching techniques to treat an ADHD child 19 51 130 1.45 -ve 12 Children develop ADHD as they need attention 31 57 112 1.6 -ve Grand mean 2.036 Assessment Neutral Table 4 shows that (73%) of teachers had neutral level of attitude toward ADHD. Table 4: Distribution of Teachers Attitudes by Mean Score Level of Assessment Level of assessment Frequency Percent Negative (1-1.66) 26 13 Neutral (1.67-2.33) 146 73 Positive (2.34-3) 28 14 Total 200 100 Mean and standard deviation 2.036 & 0.29 \(\chi^{2}\)=chi square, \(d.f\)= degree of freedom, \(P=P\) value, no significant \((p>0.05)\), significant \((P\leq0.05)\), high significant \((P\leq0.01)\) There is no significant relationship the teachers’ attitude and their sociodemographic characteristic (Table 5). Table 5: Relationship between the Teachers' attitudes and their Sociodemographic Characteristics Variables Negative Neutral Positive Total Chi square Age 22-28 3 12 1 16 X2=8.25 d.f=8 P=0.409 29-35 6 51 7 64 36-42 5 32 7 44 43-49 6 33 11 50 50-60 6 18 2 26 Total 26 146 28 200 Gender Female 19 90 19 128 X2=1.46 d.f=2 P=0.48 Male 7 56 9 72 Total 26 146 28 200 Marital status Single 7 55 8 70 X2=5.51 d.f=6 P=0.48 Married 16 76 18 110 Widowed 1 12 1 14 Divorced 2 3 1 6 Total 26 146 28 200 Educational level Diploma 17 69 12 98 X2=5.41 d.f=4 P=0.248 Bachelor 9 76 15 100 Master and above 0 1 1 2 Total 26 146 28 200

According to the socio demographic characteristics of the teachers in table 1. The findings indicate that most of teachers at age (29-35) years. These findings agreed with study done by [4, 10] who reported the ages of the respondents was below 35 years. These findings are disagreed to findings obtained from [5] who stated that the mean of teachers age was at 39 years. Alfageer et al.[9] found that (36.6) years was the mean of teachers age. Regarding to gender more than half of the study samples were females. These findings agreed with findings obtained from other study, who stated that the majority of teachers were married [4]. According to the educational level of the teachers’ half of them were bachelor graduated. Our findings are similar to study done by many researchers who stated. a high percentage of them were bachelor graduate [9, 11]. Regarding to the teachers’ source of information in Table 2. The finding in shows that about half of them not sure about their information of ADHD. Also, three quarter of the sample heard about ADHD, and more than half of teacher read article about ADHD. The authors in [9] found that most of teacher not sure about their information about ADHD, and most of them were heard and read about ADHD. According to teachers’ attitudes about ADHD in Tables 3 and 4most of teachers had neutral attitudes toward ADHD and the grand mean is (2.036) at neutral level. This finding supported by the finding obtained from [11], they found that teachers had neutral attitude about ADHD. These findings are similar to the results of the study that was done by [10, 11, 12], stated our analysis suggests that a large portion of teachers had a positive attitude about children with ADHD. Regarding to the relationship between teachers’ attitudes and the socio demographic characteristics in the Table 5. The finding indicates All demographic data were no significant associated with teachers’ attitudes. The findings are agreed with other studies who indicated that there is no significant relationship between teachers’ attitudes and their age, gender, marital status & level of education [13, 14, 15].

The present study concluded that the teachers at secondary school had neutral attitudes regarding attention deficiency and hyperactivity disorder. Studies should be conducted and gained a lot of attention about teachers’ attitude toward attention deficit hyperactivity disorder. An adequate knowledge will help to identify, refer and help in management of children with ADHD.

The authors would like to thank all the teachers included in this study for their support.

The author declares no conflict of interests. Author read and approved final version of the paper.