Studies on non-pharmacological, classroom-based interventions for children with ADHD have often focused on the effectiveness of such interventions for improving academic achievement and reducing ADHD-related behaviors in these children (Fabiano et al., 2021) and on teachers’ knowledge about and willingness to implement such interventions (Poznanski et al., 2018; Strelow et al., 2020). Additionally, these studies, which are usually quantitative in nature (Moore et al., 2017), have often neglected to take into account the environment in which teachers and students interact (Tegtmejer, 2019). In practice, teachers are rarely able to implement comprehensive plans of action but rather come up with ad hoc, nonsystematic strategies that fit the present-day educational context (Arcia et al., 2000; Nowacek & Mamlin, 2010).

Previous qualitative studies have identified which actions teachers undertake and have shown that these actions can be classified in multiple ways, for example, based on what is targeted, the child’s behavior or academic progress, or who is targeted, the child with ADHD or the whole classroom (Arcia et al., 2000; Moore et al., 2017). In these studies, some factors were revealed that hindered teachers in adequately responding to the needs of children with ADHD. For example, researchers found that teachers made modifications with the available resources in mind (Nowacek & Mamlin, 2007) and that they experienced tension between implementing individualized interventions for particular students and managing and instructing the whole classroom (Moore et al., 2019). The study of Moore and colleagues (2017) specifically focused on factors that helped and hindered teachers in managing children with ADHD in the classroom, however, this was the only study we could find in this regard. Tegtmejer (2019) expresses the need for an understanding of teachers’ actions within the complex interplay of the classroom.

This qualitative study investigates which contextual factors teachers consider in undertaking actions when they are confronted with children whom they suspect have ADHD or who have an ADHD diagnosis. We aim to demonstrate that these actions should be understood in relation to the educational context in which they take place. Specifically, we hypothesize that teachers’ actions regarding ADHD are shaped by factors at multiple levels: Teachers belong to a certain classroom, which is nested within a school, and, in turn, this school operates within the boundaries and regulations of governmental policies. 

The data for this research were collected in elementary schools in East-Flanders, a province in Flanders, the Dutch-speaking part of Belgium, as part of an international comparative project. In Flanders, ADHD is most often identified and diagnosed in the first two years of primary school and children are preferably diagnosed by a multidisciplinary team of medical professionals in organizations that are recognized and subsidized by the government (ZitStil Kenniscentrum, 2015). Flemish teachers do not have the authority to initiate a diagnostic process, rather they are stimulated to deal with and remedy behavioral, emotional, or learning difficulties with a child inside of the classroom (Prodia, 2021). Compared to the percentages of ADHD diagnoses worldwide, Flanders scores on the low side with a diagnosis prevalence of 2.19% in children in elementary education (Geerts et al., 2012). We conducted focus groups in four elementary schools in the fall of 2018, reaching 23 teachers in total. The participating schools were randomly selected based on a list of stratified characteristics, such as their socioeconomic composition, location, and size. The transcriptions of the focus groups were analyzed in the tradition of conventional content analysis with the software package NVivo 12. To ensure systematics in the analysis process, we rigorously followed the series of steps of conventional content analysis as described by Schreier (2012). With conventional content analysis, code development and application are thus performed separately (Schreier, 2012). Hence, after we had formulated the research question ‘which contextual factors teachers consider in undertaking actions when they are confronted with children whom they suspect have ADHD or who have an ADHD diagnosis?’, we identified which parts of the focus groups we should mainly focus on. Concretely, we focused on the answers teachers gave when they were asked which actions they took when they were confronted with a child whom they suspect had ADHD or who had an ADHD diagnosis. Next, we generated a coding frame during a thorough reading of the data. Once the coding frame was completed, it was used during the main coding process, which was repeated several times to ensure the reliability of the analyses.

Preliminary results show that teachers took into account factors situated at the level of the classroom, the school, and governmental policies in undertaking actions for children whom they suspect have ADHD or who have an ADHD diagnosis. At the classroom level, teachers considered their own comfort, the needs of the other children in the classroom, and the relationships between the targeted students and their peers to a more or less extent. Teachers also reported being hindered by structural factors, such as class size, the proportion of children with special educational needs, and a lack of physical space in the classroom. At the school level, teachers in two schools denounced the lack of a clear school policy concerning the implementation of concrete actions for children with ADHD in the classroom. In the remaining two schools, teachers said they enjoyed the freedom and felt supported to try out new things. Infrastructural shortcomings of the school building were mentioned as hindering. At the level of governmental policies, teachers reflected on the high expectations put on students and teachers in elementary education. They reported experiencing tension between dealing with ADHD in children, the workload associated with active teaching methods, time pressure, and academic goals. We conclude that teachers’ actions, their ability and willingness to implement those actions, should be understood in relation to their educational context, and, specifically, at the level of the classroom, the school, and governmental policies. Additionally, it seems as if the factors considered by teachers can be characterized as either social/cultural or structural.

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