In some cases, the symptoms of ADHD are detected by school teachers (Havey et al, 2005). Despite this, there is a lack of studies focusing on the role of school teachers in the detection of adverse drug reactions (ADRs) in children with ADHD. Moreover, no rating scale has been developed to specifically assess school teachers’ perceptions of the existence of a pharmacovigilance system, and detection of ADRs regarding ADHD. Therefore, this study aimed to explore primary school teachers’ perceptions about the efficacy and safety of ADHD pharmacotherapy, and to understand their knowledge of the Portuguese pharmacovigilance system.
An online survey consisting of 12 questions including socio-demographic variables and open/closed questions about school teachers’ perceptions of ADHD and its therapy was developed. The survey included: perceived impact on children’s behaviour; school teachers’ education and training relative to ADHD therapy; number and type of ADRs identified and to whom they were reported. The survey was sent to the directors of 229 groups of schools, requesting them to disseminate the online survey to all of their first-cycle school teachers (1st to 4th grade, or primary school) in the greater Lisbon area, after assessing the suitability of the survey to their setting. Data collection occurred between 17 July and 15 September 2018. Descriptive statistical analyses and chi-square tests were used to assess association between categorical variables, with the significance level set to 5%.
School teachers’ training about ADHD
Of the 107 survey respondents, 89.7% were women. The mean age of the sample was 47 years, and an average of 21.6 years of teaching experience was reported. In this sample, 42.1% of the school teachers had undergone training on ADHD, and 37.2% of the trained school teachers stated that information on ADHD therapy was included in their training. Most school teachers (86.9%) felt the need for training on this subject, independent of the years of experience (Chi-square: 3.389; p=0.184).
School teachers’ experience of ADRs in students with ADHD
The majority of school teachers (91.6%) stated that they already had students with ADHD, with 71.0% of school teachers declaring that they had students who were medicated after being in their class. Most school teachers (91.9%) reported that the medication produced changes in behaviour; for example, students were less agitated (87.6%), less impulsive (83.7%) and more attentive (76.2%). With regards to awareness of ADRs, 63.6% of school teachers reported to be aware. However, only 26% of school teachers said that they found ≥1 ADR in their students. Approximately one quarter (25.2%) of school teachers observed 42 possible ADRs, an average of 1.6 ADRs per school teacher. Amongst these ADRs, apathy was the most noted (48.1% of school teachers), followed by loss of appetite (25.9%) and stomach/abdominal problems. ADRs that were only noted once included: ‘weight gain’; ‘indifference’; ‘low self-esteem’; ‘anxiety, sadness and depression’; ‘absences’; and ‘prostration’. The more experienced school teachers had a higher rate of detection of ADRs in their students (Chi-square: 3.049; p=0.550).
School teachers’ reporting ADRs in students with ADHD
All of the school teachers that found ADRs in their students reported it to the parents. However, only 29.2% also reported it to the child’s physician and no school teachers reported it to the National Pharmacovigilance System (NPS). When asked about the low rates of reports of ADRs, 72% of school teachers stated that they were unaware of the NPS or of the process of reporting ADRs, while 20% said that they did not consider reporting ADRs to be a school teacher’s responsibility. School teachers’ training about ADHD on ADR detection was found to have no effect on the observation of ADRs (Chi-square: 0.144; p=0.704).
There were some limitations associated with this study. The timing and the way that the online survey was disseminated, as well as the low number of respondents, means that interpreting and extrapolating the results is recommended to be done with caution. The socio-demographics of the respondents do, however, match those of the population of Lisbon teachers; therefore, the authors suggest that the results may be representative of the majority of teachers’ perceptions of ADHD and ADRs detection.
The authors concluded that the results of this study support the perception that more experienced teachers may be better at detecting and managing schoolchildren with ADHD. Furthermore, they suggested that the identification and characterisation of the ADRs related to medications for ADHD need to be improved by increasing teacher training on children with ADHD. The authors noted that teachers’ knowledge of a pharmacovigilance system in this study was non-existent, reinforcing the need to introduce the system to teachers and parents. It was proposed by the authors that community pharmacists may be well positioned to assume the role of trainer and reporter of ADRs for children with ADHD.
Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.
Gregório J, Ferreira R, Fernandes AS. The perception of primary school teachers regarding the pharmacotherapy of attention deficit hyperactivity disorder. Int J Environ Res Public Health 2021; 18: 6233.
Havey JM, Olson JM, McCormick C, et al. Teachers’ perceptions of the incidence and management of attention-deficit hyperactivity disorder. Appl Neuropsychol 2005; 12: 120-127.