Mr.

NARASAREDDY P B
I YEAR M.Sc. NURSING,
CHILD HEALTH NURSING
AKSHAYA COLLEGE OF
NURSING ,2ND CROSS,
ASHOK NAGAR,TUMKUR

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 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE Mr. NARASAREDDY P B

CANDIDATE I YEAR M.Sc. NURSING,
AND ADDRESS AKSHAYA COLLEGE OF NURSIN
2ND CROSS,ASHOK NAGAR,
TUMKUR.

2. NAME OF THE AKSHAYA COLLEGE OF NURSING

INSTITUTION 2ND CROSS, ASHOK NAGAR,TUMKUR.

COURSE OF STUDY I YEAR M.Sc. NURSING,

3.
AND SUBJECT CHILD HEALTH NURSING

DATE OF
4. ADMISSION TO 28 -06 -2012
COURSE
5. TITLE OF THE “A COMPARATIVE STUDY TO ASSESS THE
STUDY : KNOWLEDGE REGARDING ATTENTION DEFICIT
HYPERACTIVITY DISORDER IN CHILDREN
AMONG TEACHERS IN SELECTED RURAL AND
URBAN PRIMARY SCHOOLS AT TUMKUR
DISTRICT WITH A VIEW TO DEVELOP SELF
INSTRUCTION MODULE”.

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6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION
There is no health without mental health. The future of the country, therefore
depends on the mental health and strength of young people.1

Justice Anant Mane

Children spend most of their time in classrooms and other school settings. Here
they are expected to follow rules, behave in socially appropriate ways, participate in
academic activities and refrain from disrupting the learning process or activities of
others. Teachers do not only have to teach learners the skills and knowledge that form
part of the curriculum but they also have to teach them to behave in a manner that meets
organizational, cultural and social expectations. However, the work of the teacher
becomes much more demanding when there are learners in the classroom that have
Attention Deficit Hyperactivity Disorder (ADHD). Their problems with attention span,
impulse control and activity level frequently interfere with both classroom and social
activities.

Attention deficit hyperactivity disorder (ADHD) is a medical condition

characterized by difficulties with inattention or hyperactivity and impulsivity. Attention
deficit hyperactivity disorder can have a profound effect on a person’s quality of life.
Children and adolescent with the disorder often have difficulty with socialization,
school performance and behavior. Attention deficit hyperactivity disorder was first
described by Dr. Hoffman in 1845.A physician who wrote books on medicine and
psychiatry.3 Attention deficit hyperactivity disorder has been recognized in some form
for at least a century, particularly in children and adolescent. The first well documented
clinical description was in a series of 20 pediatric patients reported by physician George
Still in London in 1902. In united states, Attention deficit hyperactivity disorder affects
from three to seven percent of the population. However, Attention deficit hyperactivity
disorders exist throughout the world. Children with attention deficit hyperactivity
disorder have been identified in every country in which this condition has been studied.

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 The attention deficit hyperactivity disorder child’s school success is often
dependent on his or her ability to attend to tasks and teacher and classroom expectations
with minimal distraction. When a child exhibits behaviors associated with attention
deficit hyperactivity disorder, consequences may include difficulties with school and
with forming relationships with his or her peers. The teacher must be firmly in control
of the class, while being a sympathetic and warm person. ADD/ADHD children
generally are very emotional and loving. They respond well to praise and individual
attention. Negative attitudes can be very harmful, particularly to a child with already
low self esteem. Small class size is beneficial for these children as they offer less
distraction, allowing them a better opportunity to build relationship with their peers and
the teacher.

ADHD is a neuro‐developmental disorder that is diagnosed in 3 to 6% of the

childhood population in a diversity of cultures and a variety of geographical locations.
It presents as a persistent pattern of inattention and/or hyperactivity‐impulsivity, with
boys being over‐represented by approximately 3 to 1. High levels of co morbidity
between ADHD and a number of other disorders, including Oppositional Defiant
Disorder, Conduct Disorder, and learning disabilities, have been identified. This review
will examine the historical development of the understanding of ADHD, knowledge of
its etiology, and most importantly contribute to raising awareness of the influence of
this disorder in the school environment. The literature will be used to provide evidence
of the difficulties that children diagnosed with ADHD experience in the behavioral
components needed for academic success, and the role that teachers might play in the
process of identification, assessment, and management of this disorder. Finally, this
review will examine the implications of these findings for the provision of training of
teachers in regards to ADHD.4

Early identification and interventions provided appropriately will bring about

plenty of changes. If parents and teachers are equipped with adequate knowledge and
appropriate skills in handling these children and their attitude of accepting the child
with learning disabilities it will help the child to improve in the future. To help the child

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 with learning disabilities, it is not only the responsibility of the teachers and parents; it
is the responsibility of mental health professionals to march forward and reach the
unreached people not only in the urban community but also in rural community where
the services are in scarce. Even the education board is functioning inadequately in this
area in our country.

6.1. Need for the study:

Attention deficit hyperactivity disorder [ADHD] is the phrase that is used to

describe children who have significant problems with high levels of distractibility or
inattention, impulsiveness, and often with excessive motor activity levels.7 Attention
deficit hyperactivity disorder is one of the most commonly diagnosed psychiatric
childhood disorder and international studies reveal that it affects nearly 8% in US
children aged 4 to 7 years.

In India it affects nearly about 3% of school age children’s. Boys are 6 to 8

times more often affected. The onset occurs before the age of 7 years and a large
majority of children’s exhibit symptoms by the 4th year of age.2

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.
Teachers find aggressive behavior to be of a more serious nature than withdrawn
behavior and that is why children with emotional disturbances are often ignored at
schools.

A study was conducted on knowledge and attitude of teachers towards Attention

deficit hyperactivity disorder in Iran. The result shows that knowledge about Attention
deficit hyperactivity disorder was relatively low 46.9% of respondents agreed that
Attention deficit hyperactivity disorder is due to biological and genetic vulnerabilities
and caustion.53.1% of all the teachers considered Attention deficit hyperactivity
disorder to be the result of parental spoiling. The attitude score towards Attention

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 deficit hyperactivity disorder children was low. 64.8% agree that the same disciplinary
rules used for all students should also be applied to Attention deficit hyperactivity
disorder students.3

A study was conducted to know the prevalence of Attention deficit

hyperactivity disorder in an inner city elementary school in Pedro. The result shown
that prevalence of Attention deficit hyperactivity disorder in a sample of 403 school
aged children was 17.1%.In which 65.2% were boys and 34.8% were girls.

A research was carried out on teachers’ knowledge, misconception, and lacks

concerning Attention deficit hyperactivity disorder in Barcelona. Nearly 193 teachers
were interviewed to measure knowledge, symptoms/diagnosis, and treatment. Result
indicated an average of correct responses of 31.67, 63.88 and 40.46% in general
knowledge,symptoms/diagnosis, and treatment respectively. Teachers displayed
significantly more knowledge in the symptoms/diagnosis scale than in the other scale.4

Based on the review of literature and the observation made by the investigator
that rural school teachers have low knowledge as compared to otherson Attention deficit
hyperactivity disorder. So the investigator felt the need to conduct this study to determine
the knowledge among urban and rural primary school teachers regarding Attention deficit
hyperactivity disorder.

6.2 REVIEW OF LITERATURE

Review of Literature is a key step in research process. Nursing research may be

considered as a continuing process in which knowledge gained from earlier studies is an
integral part of research in general. In review of literature a researcher analyses existing
knowledge before delving into a new study and when making judgment about application
of new knowledge in nursing practice. The literature review is an extensive, systematic,
and critical review of the most important published scholarly literature on a particular
topic.14

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 A study was conducted to define the prevalence of Attention deficit hyperactivity
disorder in children from four Brazilin public elementary schools.602 students were
interviewed of age 6 to 12 years. The result showed that 13% children of school aged
were affected. Male to female ratio was 2:1. Boys were more frequently affected than
girls.5

A prospective study was conducted to investigate school pupil’s knowledge and

attitudes in the areas of Attention deficit hyperactivity disorder and learning disabilities in
Holon. One hundred and four high school pupils were interviewed, pupils’ knowledge on
the topic of Attention deficit hyperactivity disorder was low [62%]; they showed a better
knowledge about learning disabilities [75%]. They showed a partially tolerant attitude
[62.7%] towards pupils suffering from Attention deficit hyperactivity disorder; There was
no correlation between pupils’ knowledge and attitude.7

A comparative study was done to know the knowledge about Attention deficit
hyperactivity disorder between in-service and preservice teachers in Australia.
Participants included 120 primary school teachers and 45 final year education
undergraduates who were asked to complete a questionnaire. The highlight of this study
shows that deficit in teachers’ knowledge about Attention deficit hyperactivity disorders
are common for both in-service and preservice teachers.8

A study was conducted to investigate teacher’s knowledge and attitudes towards

Attention deficit hyperactivity disorder and learning disabilities in Israel. Forty-six high
school teachers were interviewed in this regard. The 46 teachers 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 Attention deficit hyperactivity
disorder and learning disabilities case regularly. The result shown that score for attitude
and understanding of Attention deficit hyperactivity disorder children was relatively low
[72.5%] for both groups. In relation to learning disabilities cases the overall scoring for

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positive attitude was 75%: There was no correlation between teachers, knowledge of
Attention deficit hyperactivity disorder and learning disabilities and their attitude.9

Furman L (2005), conducted study on attention-deficit hyperactivity

disorder(ADHD) which is described as the most common neurobehavioral condition of
childhood. ADHD is not a disease but rather a group of symptoms representing a final
common behavioral pathway for a gamut of emotional, psychological, and/or learning
problems. Methodical review of the literature, however, raised concerning issues."Core"
ADHD symptoms of inattentiveness, hyperactivity and impulsivity are not unique to
ADHD. Rates of "co morbid" psychiatric and learning problems, including depression
and anxiety, range from 12 to 60%, with significant symptom overlap with ADHD,
difficulties in diagnosis, and evidence-based treatment methods that do not include
stimulant medications. The validity of the Conner’s' Rating Scale-Revised has been
seriously questioned, and parent and teacher "ratings" of school children are frequently
discrepant, suggesting that use of subjective informant data via scale or interview does
not form an objective basis for diagnosis of ADHD. In summary, the working dogma that
ADHD is a disease or neurobehavioral condition does not at this time hold up to scrutiny
of evidence. Thorough evaluation of symptomatic children should be individualized, and
include assessment of educational, psycho logic, psychiatric, and family needs.8

Karande S, Kulkarni M(2005),conducted study on poor school performance.

Education is one of the most important aspects of human resource development. Poor
school performance not only results in the child having a low self-esteem, but also causes
significant stress to the 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, emotional problems, poor socio-
cultural home environment, psychiatric disorders and even environmental causes. The
information provided by the parents, classroom teacher and school counselor about the
child's academic difficulties guides the pediatrician to form an initial diagnosis. However,
a multidisciplinary evaluation by an ophthalmologist, otolaryngologist, counselor, clinical
psychologist, special educator, and child psychiatrist is usually necessary before making
the final diagnosis. It is important to find the reason(s) for a child's poor school

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 performance and come up with a treatment plan early so that the child can perform up to
full potential.9

A comparative study was conducted on American and Canadian teachers'

knowledge and attitudes regarding ADHD. The results indicated 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. While
most teachers did well on knowledge-based questions regarding the etiology and
educational implications of the condition, many still perceived non-medical therapies
such as diets as being effective. The implications of improved in-service training for all
professionals involved with children with ADHD are discussed.10

A descriptive cross sectional study was conducted in randomly selected

schools of Gampha district using a Stratified sampling method . The knowledge and
attitude of primary school teachers on ADHD teachers were Assessed by self
administered questionnaire distributed among all the primary school teachers in the
selected schools. Teachers who had training in the child psychology recorded
significantly higher knowledge Had favorable knowledge. The study concluded that
the knowledge of ADHD and its treatment among primary school teachers need
to be improved that will help in educational and social development of child.11

6.3. STATEMENT OF THE PROBLEM:

“A COMPARATIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING

ATTENTION DEFICIT HYPERACTIVITY DISORDER IN PRIMARY SCHOOL
CHILDREN AMONG TEACHERS IN SELECTED RURAL AND URBAN
PRIMARY SCHOOLS AT TUMKUR DISTRICT WITH A VIEW TO DEVELOP
SELF INSTRUCTION MODULE”.

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6.4. OBJECTIVES OF THE STUDY:

 To assess the knowledge of school teachers regarding attention deficit hyperactivity

disorder of children’s before administering structured teaching programme.
 To find out the association between knowledge of rural and urban school teachers
regarding ADHD in children with selected socio demographic variables.

6.5. HYPOTHESES:

H1: There will be statistically significant difference between scores obtained by school
teachers of urban and rural on the level of opinion about ADHD.

H2: There will be a significant association between urban and rural school teachers with
selected socio demographic variables.

6.6. OPERATIONAL DEFINITIONS:

 Effectiveness: Refers to gain in knowledge as determined by the significant

difference in pre-test and post-test knowledge scores.
 Knowledge: Refers to the correct responses or feedback obtained from the school
teachers regarding ADHD.
 Teachers: Refers to the persons who were undergone teacher training course or
Diploma in Education or bachelor’s of education and currently working in selected
schools of tumkur.
 ADHD (attention deficit hyperactivity disorder): Refers to the child condition
characterized by persistent pattern of inattention and or hyperactivity more frequent
than is typical of children.
 Children’s: Refers to persons who are the age between 5 to 14 years and currently
studying in schools.
 Self Instructional Module (SIM)
It refers to an instructional material prepared by the investigator to enhance the
knowledge level of primary school teachers regarding Attention deficit hyperactivity
disorder.

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7. MATERIALS AND METHODS:

7.1 Source of data:

The information will be collected by means of structured knowledge questionnaire for
primary school teachers.

7.2 Method of data collection:

7.2.1 Research design:

Descriptive study
7.2.2 Setting:
Selected schools at Tumkur district.
7.2.3 Population:
Primary school teachers.
7.2.4 Sample:
Primary school teachers.
7.2.5 Sampling technique:
Convenient sampling.
7.2.6 Sample size:
100 primary school teachers.
Urban-50
Rural -50

7.2.7 Duration
4 weeks

7.2.8 Sampling criteria:

Inclusive criteria
1. The primary school teachers who are willing to participate in the study.
2. Primary school teachers who are available at the time of data collection.
Exclusive criteria
1. Primary school teachers who are sick and absent.

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7.2. 9 Tools for data collection:

Data will be collected using structured knowledge questionnaire.

The tool consists of two sections, section A section B.
Section A: socio- demographic data of primary school teachers.
Section B: Questions related to knowledge on ‘ADHD among primary school teachers.

7.3 Method of data collection:

The data will be collected from primary school teachers by using structured
knowledge questionnaire.

7.3.1 Data analysis and interpretation:

Data analysis and interpretation will be done based on the objectives of the study by
using descriptive and inferential statistics.
Descriptive statistical techniques such as frequency, mean, median, percentage,
standard deviation are used.
Inferential statistical tests such as unpaired t test and chi-square tests are used.

7.4 Does the study require any investigations and interventions to be conducted on
patients or other humans?
NO

7.5 Has ethical clearance been obtained from your area in case of 7.4?
Yes, ethical clearance will be obtained by the respondents.

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8 BIBLIOGRAPHIC REFERENCE:

1. Justice Anant Mane. Mental health of young children; available from

http://www.mshrc.maharashtra.gov.in. Feb 2004.

2. Association of child and adolescent psychiatry and American psychiatric. ADHD Parents
Medication Guide[document on internet]. Arlington: the institute;2007[cited 2011 nov
26]. Available from: www.parentsmedguide.org/ ParentGuide_English.pdf
3. Shreevani. R. A guide to mental health and psychiatric nursing.3rd ed . Newdelhi: jaypee
brother publisher;2010.pp. 234
4. Taylor & Francis Review of research on teachers' knowledge and attitudes about
attention‐deficit hyperactivity disorder (ADHD), Australasian Journal of Special
Education Volume 25, Issue 1-2, 2001
5. Suvarna. BS, Kamath.A, prvelance of of attention deficit disorder among preschooler age
children.nepal med coll J[serial online].2009(cited 2011 nov 26);11(1):1-4. Available
from: www.nmcth.edu/images/gallery/Editorial/ cursivol11 no1.pdf
6. Schweifer C. Attention deficit and hyperactivity in school children--knowledge, resources
and cooperation among professions concerned. Wien Med Wochenschr. 2009;159(7-
8):183-7. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/ 19412691
7. Meyer. M, Vogeli C, et al; Department of computer science, ETH Zurich,
[email protected]. Restor Neurol Neurosci.2007; 25 (3-4): 355-369.
8. Furman L, Attention-deficit hyperactivity disorder. Department of Pediatrics, Case
Western Reserve University School of Medicine, Rainbow Babies and Children's
Hospital, Cleveland, OH 44106, USA. 2005 Dec;20(12):994-1002.
9. Karande S, Kulkarni M. Indian J Pediatr. Poor school performance. Learning Disability
Clinic, Division of Pediatric Neurology, Department of Pediatrics, Lokmanya Tilak
Municipal Medical College and General Hospital, Sion, Mumbai, India. 2005
Nov;72(11):961-7.
10. Jerome L, Gordon M, Hustler P. A comparison of American and Canadian teachers'
knowledge and attitudes towards Attention Deficit Hyperactivity Disorder (ADHD). Can
JPsychiatry.1994Nov;39(9):563-7. Available from:http://www.ncbi.nlm.nih.gov/pubmed/
7874659.
11. Rodrigo MD, Perera D, Eranga VP, Williams SS, Kuruppuarachchi KA. The knowledge
and attitude of primary school teachers in Sri Lanka towards childhood attention deficit

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 hyperactivity disorder.Department of Psychiatry, Faculty of Medicine, University of
Kelaniya, Sri Lanka. [email protected] Ceylon Med J. 2011 Jun;56(2):51-4
12. Bob gates, Robert Newell. Behavior modification and gentle teaching workshop.
Management of children with learning disabilities exhibiting challenging behavior and
implications for learning disability nursing. J adv nurs 2001; 34(1):86-95

13. G.L.Wood and J .Haber, Nursing research methods, critical appraisal and utilization.1st
edition; St Louis: Mosby; 1990,510.

14. Basavantappa BT. Nursing research. 2nd ed. New Delhi: Jaypee Brothers; 2009. p.
168-188.
15. Polit DF, Beck CT. Nursing research. 8th ed. Newyork: Lippincott Williams and Wilkins;
2010.P.132-6.

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9. Signature of the candidate

10. Remarks of the guide

Name and designation of

11.1 Guide

11.

11.2 Signature

11.3 Head of the department

11.4Signature

12.1 Remarks of the

principal
12.

12.2 Signature

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