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Attention Disorders

Increasing Teachers' Knowledge About ADHD and Learning Disorders: An Investigation on the Role of a
Psychoeducational Intervention
Ana P. Aguiar, Renata R. Kieling, Adriana C. Costa, Neusa Chardosim, Beatriz V. Dorneles, Mariana R. Almeida, Ana C.
Mazzuca, Christian Kieling and Luis A. Rohde
Journal of Attention Disorders published online 30 July 2012
DOI: 10.1177/1087054712453171

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453171
1Aguiar et al.Journal of Attention Disorders
© 2012 SAGE Publications

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Articles
Journal of Attention Disorders

Increasing Teachers’ Knowledge

XX(X) 1­–8
© 2012 SAGE Publications
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DOI: 10.1177/1087054712453171
http://jad.sagepub.com
An Investigation on the Role of a
Psychoeducational Intervention

Ana P. Aguiar1, Renata R. Kieling1, Adriana C. Costa1, Neusa Chardosim1,

Beatriz V. Dorneles1, Mariana R. Almeida1, Ana C. Mazzuca1, Christian Kieling1,
and Luis A. Rohde1

Abstract
Objective: To investigate elementary school teachers’ baseline knowledge about ADHD and learning disorders (LD) and
the impact of a strategy to increase awareness of these disorders. Method: A total of 37 teachers were selected from four
elementary schools in the catchment area of the University Hospital, in Porto Alegre, Brazil.To evaluate teachers’ knowledge,
two self-report questionnaires about ADHD and LD were applied before and after an awareness program on these
disorders. Results: The intervention significantly increased teachers’ knowledge of both disorders, even after adjustment
for confounding factors (p < .001). In the repeated measures ANCOVA, only teachers’ previous knowledge of ADHD/LD
(p < .001) was significant in predicting score change in knowledge before and after the intervention. Conclusion: Results
suggest the efficacy of a brief psychoeducational intervention program for increasing teacher awareness and knowledge
about ADHD and LD. Future studies are warranted to confirm the efficacy and evaluate the long-term impact of this
intervention. (J. of Att. Dis. 2012; XX(X) 1-XX)

Keywords
ADHD, learning disorders, teacher knowledge, awareness

Introduction
ADHD is the most common childhood externalizing disor-
der, characterized by symptoms of inattention, hyperactiv-
ity, and impulsivity. ADHD affects around 4% to 6% of
children and adolescents in Brazil (Anselmi, Fleitlich-Bylik,
Menezes, Araújo, & Rohde, 2010; Rohde et al., 1999), a rate
compatible with international data showing a worldwide
prevalence of 5.29% (Polanczyk, de Lima, Horta, Biederman,
& Rohde, 2007). ADHD causes significant impairment in
affected participants. During school years, the disorder is
often associated with poor academic performance, grade
retention, suspension, expulsion, and difficulties in relation-
ships (Lahey et al., 2004), resulting in a poor quality of life
(Klassen, Miller, & Fine, 2004). Based on the amount of
impairment associated with the disorder, it is considered a
public health problem (Lesesne, Abramowitz, Perou, &
Brann, 2000).
Learning disorders (LD) affect about 5% to 10% of
school-age children and include several different disorders
such as reading, mathematics, written expression, expres-
sive language, and mixed receptive–expressive language
disorders. The most frequent diagnosis associated with LD
is ADHD (Maughan & Carroll, 2006). It is estimated that
15% to 20% of children with LD present criteria for the
diagnosis of ADHD and that 25% to 40% of children with
ADHD present comorbid reading disorder (Maughan &
Carroll, 2006), while 11% to 26% have mathematics disor-
der (Capano, Minden, Chen, Schacher, & Ickowicz, 2008;
Faraone et al., 1993; Gross-Tsur, Manor, & Shalev, 1996).
The comorbidity between ADHD and LD increases the
level of distress caused by each disorder individually for the
1
Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Corresponding Author:
Luis A. Rohde, ADHD Outpatient Program (ProDAH) at the Child and
Adolescent Psychiatric Division, Hospital de Clínicas de Porto Alegre,
Ramiro Barcellos Street, 2350, 90035-003 Porto Alegre, RS, Brazil
Email: lrohde@terra.com.br

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2 Journal of Attention Disorders XX(X)
child, the family, and the community. In addition, it deter-
mines several lifelong impairments with broad social
and economic impacts. Despite the high prevalence and
impact of these disorders, little attention has been directed
toward strategies for awareness and promotion of mental
health in affected subjects, especially in developing coun-
tries (Sherer, 2002).
According to the clinical parameters of the American
Academy of Child and Adolescent Psychiatry, ADHD
requires a multi-informant assessment approach (Pliszka
et al., 2007). Some guidelines for LD assessment suggest
that direct or phone interviews with school professionals can
help in establishing the onset of problems, clarifying their
nature, identifying emotional and behavioral difficulties at
school, and determining the appropriateness of previous
assessments and response to prior interventions (Beitchman,
Cantwell, Forness, Kavale, & Kauffman, 1998). In this con-
text, teachers play a fundamental role in early detection and
should be able to recognize the typical clinical characteris-
tics of the disorders. A higher level of knowledge can also
help reduce misconceptions and prejudices about LD and
ADHD. Nevertheless, there are few studies that investigate
teacher knowledge about ADHD and LD, and even fewer
that evaluate the impact of awareness strategies.
In a search in different databases (PubMed, PsycINFO,
and Web of Science), 29 articles were found dealing specifi-
cally with teacher knowledge about ADHD and LD, or with
the impact of awareness strategies. It is important to stress
that almost all previous studies in this subject were con-
ducted in the United States and European countries, rein-
forcing the relevance of studies in developing countries.
Among the few conducted outside the United States, an
Israeli study showed that 13% of teachers believe that LDs
are the result of parental attitudes, particularly the habit of
“spoiling” the child (Brook, Watemberg, & Geva, 2000). In
Brazil, a survey with 432 teachers found that 59% of them
believed that ADHD was caused by absent parents who can-
not set limits, and 52% believed that sports could replace
pharmacotherapy (Gomes, Palmini, Barbirato, Rohde, &
Mattos, 2007). Syed and Hussein (2009) assessed the knowl-
edge of 49 Pakistani teachers on ADHD signs and symptoms
through questionnaires applied before and after a weeklong
workshop on the subject. Although the intervention was
effective in improving teachers’ knowledge about ADHD,
the external validity (replicability) of the study is arguable,
because long interventions are often not palatable for teach-
ers in school settings from low- and middle-income coun-
tries (Graeff-Martins et al., 2006). Thus, baseline teacher
awareness of ADHD and LD, and how to improve this
knowledge are both important areas of research, especially
considering the few studies available on the subject.
The main objective of this study was to investigate the
baseline knowledge of a sample of elementary school teachers
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about ADHD and LD, and the impact of a psychoeducational
awareness intervention focusing on these disorders. Our
hypothesis was that the intervention would be feasible and sig-
nificantly improve teacher knowledge about ADHD and LD.
Method
An open naturalistic study was carried out to evaluate the
feasibility and efficacy of implementing an intervention to
promote teacher awareness on ADHD and LD. The study
was done in Porto Alegre, the capital of the southernmost
state of Brazil. The project was approved by both the State
Department of Education and the Ethical Committee of our
University Hospital (approved as an institutional review
board [IRB] by the Office for Human Research Protections,
United States of America—IRB 00000921). Written informed
consent was obtained from the teachers.
Sample
First, we mapped all schools localized in the catchment
area of the primary care unit of our University Hospital.
After discussing the project with school principals, we
selected four schools to participate. This was a convenience
sample (not a random sample) based on logistics and
requirements by the State Department of Education. All the
teachers of the first to fourth elementary grade classes of
these four schools (N = 44) were invited, and 37 accepted
to take part of the intervention program.
Measures
To evaluate teachers’ pre- (T1) and postintervention (T2)
knowledge, we adapted two self-report questionnaires used
in previous investigations, one focusing on ADHD and the
other on LD. The questionnaires consisted of two parts. The
first part asked for demographic background including age,
educational level, years of teaching experience, and whether
the teacher had already had a student diagnosed with ADHD
and/or LD in his or her class. The second part contained 20
affirmatives about etiology, symptoms, and treatment of
each disorder, with three possible answers: “true,” “false,”
and “don’t know.”
ADHD. After extensive discussions with experts on
ADHD, we selected the 20 most appropriate affirmatives
to measure teachers’ knowledge on ADHD extracted from
the three instruments previously used in the available lit-
erature (Jerome, Gordon, & Hustler, 1994; Kos, Richdale,
& Jackson, 2004; Sciutto, Terjesen, & Frank, 2000).
These affirmatives included concepts about etiology,
symptom presentation at school, management, and treat-
ment of the disorder. Extra care was taken to keep the
original format of these instruments, and we conducted a
Aguiar et al. 3
careful translation and adaptation of the final instrument
into Brazilian Portuguese.
Learning Disorders. After consultation with LD special-
ists, we selected three previous sources to compose a final
instrument with also 20 affirmatives: (a) learning disability
study’s questionnaire—this scale was used in a North
American research with 1,200 adults (Roper Starch World-
wide, 1995); (b) the report on LD from the National Asso-
ciation of Special Education Teachers (NASET, 2007); and
(c) a chapter about LD written by an experienced psycholo-
gist published in a classic textbook of psychiatry (Tannock,
2007). A LD specialist from our group (A.C.C.) selected
some statements from these three sources out of which our
group again chose the 20 more appropriate affirmatives to
assess teachers knowledge on LD. The affirmatives included
statements about etiology, symptoms presentation at school,
management, and treatment of the disorder. After that, again
our own group conducted a careful translation and adapta-
tion to Brazilian Portuguese. The scales are available online
at www.ufrgs.br/prodah.
Intervention
The intervention program was conceptualized to be a con-
sistent but quick and easy method to implement package of
units of learning on ADHD and LD. The total length of the
intervention was about 6 hr to make it deliverable on a
1-day basis. Our previous experience with school-based
interventions to reduce school dropout in developing coun-
tries (Graeff-Martins et al., 2006; Hoven et al., 2008)
clearly suggests that long interventions lasting several days
are not palatable for teachers in these cultures. The format
includes a well-balanced mixture of lectures on ADHD and
LD, presentations of clinical vignettes specially constructed
for challenging potential misconceptions (Syed & Hussein,
2009), followed by a vivid group discussion about ADHD/
LD issues. The distribution of the contents was done
according to the following schedule:
a. Application of the pretest scales on ADHD and
LD—20 min
b. Introduction to the program and presentation of
clinical vignettes dealing with frequent miscon-
ceptions about ADHD and LD—15 min
c. Discussion of the vignettes—30 min
d. Lecture on ADHD symptoms presentation at
school and etiology—40 min
e. Lecture on LD symptoms presentation at school
and etiology—40 min
f. Coffee break—20 min
g. Presentation and discussion of clinical vignettes
dealing with ADHD/LD symptoms presentations—
30 min
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h. Lecture on strategies for managing ADHD at
school—50 min
i. Lecture on strategies for managing LD at
school—50 min
j. Final discussion on doubts—45 min
k. Application of the posttest scales on ADHD and
LD—20 min
The content of this intervention program was based on
previous material developed by our own group on the recog-
nition and management of ADHD/LD for parents and teach-
ers (Knapp, Rohde, Johanpeter, & Lyzkowski, 2002; Rohde
& Benczik, 1999), as well as on the standard classroom
management programs extensively discussed in the litera-
ture (Barkley, 2006; Pelham, 2002). Before the intervention
program, each teacher received a written manual summariz-
ing the content discussed during the 6-hr program. This
material is available online at www.ufrgs.br/prodah.
Because teachers from four different schools were enrolled
simultaneously, the research team conducted the intervention
program in our University Hospital (Hospital de Clínicas de
Porto Alegre). A senior professor of child psychiatry, a resi-
dent of psychiatry and one of pediatrics, a professor of educa-
tion and a doctoral level student of education (both LD
clinicians), a neuropsychologist, and three research assistants
comprised the research team. To assure that the program
might be deliverable by investigators without extensive expe-
rience in the field (increasing its external validity), the resi-
dents of psychiatry (C.K.) and pediatrics (R.R.K.) and the
doctoral student of education (A.C.C.) conducted the inter-
vention program with the presence of the senior child psy-
chiatrist to guarantee that the integrity of the intervention
was kept. The two residents received a 10-hr training on the
ADHD content of the program by the senior professor of
child psychiatry (L.A.P.R.) and the doctoral student of edu-
cation, and the same 10-hr training in the LD component of
the program by the senior professor of education (B.V.D.).
Teachers were released from their activities at school on
the day of training, so that they could take part in the inter-
vention; no financial incentive was offered. Total cost of the
intervention was approximately US$400, including coffee
break and photocopies of handouts. The auditorium where
the intervention was held was provided free of charge by
our University Hospital, and all lecturers were investigators
from our research group.
Data Analyses
The comparison between pre- and postintervention scores
from the two questionnaires was assessed by repeated mea-
sures ANCOVA, adjusting for school, initial teacher knowl-
edge, and years of teaching experience. An unbiased
estimate of the effect size (ES) was also computed for the
4 Journal of Attention Disorders XX(X)
Table 1. Teachers’ Knowledge About ADHD and Learning Disorders Pre- and Postintervention
Mean score (SD)
Disorder Answer Pre
ADHD (n = 36) Correct 14.94 (2.52)
  Don’t know 3.06 (2.43)
LD (n = 36) Correct 14.81 (2.02)
  Don’t know 1.94 (2.11)
total score from both instruments by partial η2 of
ANCOVA. The level of significance accepted for all com-
parisons was 5%. These analyses were performed using
SPSS, version 18.
Results
All the 37 teachers evaluated were women. The age of the
teachers ranged from 26 to 61 years, with a mean age of 43
years (SD = 8.53 years) and a mean experience of 18 years
(SD = 9.82 years). Most of the evaluated teachers (64.9%)
had already had a student diagnosed with ADHD and/or LD
in their classroom.
The mean preintervention score of correct answers about
ADHD was 15 (SD = 2.52), and the score postintervention
was 17 (SD = 1.93). In the repeated measures ANCOVA,
previous knowledge of the teacher about ADHD (p < .001;
partial η2 = .48) and school affiliation (p = .040; partial η2 =
.24) had a significant effect on score change between pre-
and postintervention, whereas years of teaching did not
show a significant effect (p = .40; partial η2 = .02). In spite
of that, the effect of the intervention on the change in
knowledge scores between T1 and T2 remained significant,
even after adjusting for these confounding factors (p < .001;
partial η2 = .57). Results from correct scores about ADHD
are depicted in Table 1. Findings regarding “don’t know”
scores also showed a significant impact of intervention on
the change in knowledge scores between pre- and postinter-
vention, even after adjusting for confounding factors (p <
.001; partial η2 = .62), as can also be seen in Table 1.
Concerning LD, the mean score of preintervention cor-
rect answers was 15 (SD = 2.02), and the mean score post
intervention was 18 (SD = 1.46). In the repeated measures
ANCOVA, only the previous knowledge of the teacher about
LD (p < .001; partial η2 = .76) had a significant effect in
predicting score change in knowledge between T1 and T2,
whereas years of teaching (p = .15; partial η2 = .07) and
school affiliation (p = .13; partial η2 = .17) did not show a
significant effect. In spite of that, even after adjusting for
these confounding factors, change in knowledge scores
Downloaded from jad.sagepub.com at YALE UNIV on September 9, 2012
Mean difference
Post (CI 95%) p Partial η2
17.36 (1.93) 2.03 [1.37-2.68] <.001 .57
0.22 (0.48) 2.83 [2.06-3.60] <.001 .62
17.61 (1.46) 2.78 [2.21-3.34] <.001 .81
0.14 (0.42) 1.80 [1.05-2.60] <.001 .40
between pre- and postintervention remained significant (p <
.001; partial η2 = .81), as presented in the Table 1, along
with findings regarding “don’t know” scores (p < .001; par-
tial η2 = .40).
A total of 37 teachers participated in the intervention
program, but one of them answered only the preintervention
assessment. The baseline total scores on both instruments
fulfilled by this missing were between 1 SD below or above
the mean (for ADHD = 15; for LD = 16).
Figures 1 and 2 show the percentage of correct answers
in each instrument (ADHD/LD) before and after the inter-
vention. The greatest difference in ADHD was found in the
question regarding the impact of individual psychotherapy
in the treatment of ADHD, and the smallest on the question
about aggressive and cruel behavior being a characteristic
of children with ADHD. Concerning LD, the greatest differ-
ence was found in the following statements: (a) children
with arithmetic disorder show impairments as early as in
preschool years, and (b) very simple essays, with poverty of
details, are characteristic of children with written expres-
sion disorder. The smallest difference was detected in the
question about whether LD affects only the academic life
(see Figure 1 and 2).
Discussion
Our findings have confirmed our a priori hypothesis that a
psychoeducational intervention might significantly impact
teacher knowledge on ADHD and LD, corroborating previous
reports that demonstrate the effectiveness of brief interven-
tions to improve teacher knowledge about ADHD (Barbaresi
& Olsen, 1998; Syed & Hussein, 2009).
As already indicated, we were not able to find previous
studies comparing changes in teacher knowledge about LD
after an intervention, so our study is pioneering in this
aspect. It is also important to stress that the literature is
scarce in this kind of initiative in developing countries,
either for ADHD or LD.
The comparisons between pre- and postintervention
ADHD scores show that teachers were able to increase their
Aguiar et al. 5

100
90
80

% correct answers
70
60
pre
50
post
40
30
20
10
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Answers about ADHD

Figure 1. Percentage of correct answers about ADHD pre- and postintervention

Note: ADHD questionnaire’s answers: 1. Children may have ADHD without being restless; 2. Pharmacological treatment exempts from educational
intervention; 3. If a child can play a videogame attentively, he or she will be able to pay attention to classes; 4. Children with ADHD usually present with
difficulties during elementary school; 5. Aggressive and cruel behavior is characteristic of children with ADHD; 6. Fidgeting with feet and squirming in
seat may be symptoms of ADHD; 7. Children with ADHD present with grandeur and high self-esteem; 8. A history of theft and destruction of property
is common in children with ADHD; 9. There are two dimensions of symptoms (in ADHD): inattentiveness and hyperactivity/impulsiveness; 10. Symptoms
in at least two settings are necessary for the diagnosis of ADHD; 11. Children with ADHD are disorganized; 12. Orienting parents and teachers to cope
with children with ADHD is effective only when combined with medication; 13. If a child can play a videogame for several hours, he or she does not
have ADHD; 14. Individual psychotherapy is sufficient to treat a child with ADHD; 15. ADHD may be caused by inadequate attitudes from parents;
16. Children with ADHD are biologically susceptible to inattention and low control; 17. Children with ADHD benefit from a quiet environment to
improve concentration; 18. Misbehavior of children with ADHD is due to a desire of breaking rules; 19. ADHD can only be treated pharmacologically;
20. If ADHD children worked harder, they could manage to have a better performance continuously.

100
% correct answers

80

60 pre
40 post

20

Answers about LD

Figure 2. Percentage of correct answers about LD pre- and postintervention

Note: Learning disorders (LD) questionnaire’s answers: 1. LD affect academic life only; 2. Reading disorder is the most common LD subtype; 3. Signs of
LD may be present as early as in preschool but become more evident in elementary school; 4. LD cannot be diagnosed in a child affected by ADHD; 5.
If their special needs fail to be recognized, children with LD become more susceptible to school evasion; 6. Children with written expression disorder
have impairment to read words only; 7. LD are a temporary condition; 8. LD are common in children with mental retardation; 9. LD are caused by
neurologic dysfunctions rather than failure of character; 10. Children with LD try to guess words rather than analyze its components; 11. Children
with LD may dissimulate their symptoms when they have good social skills; 12. Adults are not affected by LD; 13. The sooner a child with LD receives
adequate support, the better his or her outcome will be; 14. LD are caused by the environment in which the child is inserted; 15. Children with
arithmetic disorder show impairments as early as in preschool; 16. Sometimes LD are merely the result of laziness; 17. The most important subtypes of
LD are reading, writing, and arithmetic disorder; 18. The main characteristic of reading disorder is the difficulty to understand what is being read; 19. LD
are a permanent condition, but the affected child can learn to compensate for his or her difficulties; 20. Children with written expression disorder write
very simple essays, but are poor in details.

knowledge about ADHD and also to reduce their doubts and baseline, which is consistent with previous literature
uncertainties, despite a good baseline knowledge of ADHD. (Barbaresi & Olsen, 1998; Jerome et al., 1994; Jones &
On average, they answered 75% of questions correctly at Chronis-Tuscano, 2008). Surprisingly, teacher experience

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6 Journal of Attention Disorders XX(X)
had no impact on score changes between T1 and T2, but
there was an impact from baseline knowledge, demonstrat-
ing that better scores were linked to teachers’ prior knowl-
edge, regardless of their years of teaching experience. The
improvement detected corresponds to a large ES in all mea-
sured scores.
In our study, we found that before the intervention, 46% of
teachers believed that children with ADHD are not biologi-
cally susceptible to inattention and low control, and 21.6%
believed that children with ADHD do not benefit from a quiet
environment to improve concentration. Postintervention per-
centages of teachers holding these beliefs were 21.6% and
2.7%, respectively. This is consistent with studies of inter-
vention on the knowledge of teachers about ADHD, which
show that such interventions reduce the number of miscon-
ceptions teachers have about the disorder. Barbaresi and
Olsen (1998) demonstrated that, preintervention, 41% of the
teachers believed that ADHD could be caused by poor par-
enting and 41% by sugar or food additives; and 64% thought
that methylphenidate should be used only as the last thera-
peutic resource. Postintervention percentages of teachers
holding these beliefs were 7%, 5%, and 34%, respectively.
Teacher training has also been shown to increase accept-
ability ratings of medication and behavior management
strategies in the classroom (Vereb & DiPerna, 2004).
Our study has also demonstrated a significant increase in
knowledge of LD and a decrease in doubts and uncertainties
concerning the disorder after the intervention. Again, only
baseline knowledge had an impact on the differences in
scores between T1 and T2. We were also able to detect large
ESs in all measured scores. Regarding misconceptions about
LD, before the intervention, 43.2% of teachers believed that
children with arithmetic disorder do not show impairments
as early as in preschool years, and 48.6% believed that chil-
dren with written expression disorder do not write very
simple, poorly detailed essays. In the postintervention
questionnaire, percentages of teachers holding these beliefs
were 2.7% and 8.1%, respectively. We were unable to find
literature describing interventions for teachers focusing on
LD. The existing studies evaluating teachers’ knowledge
about LD show an overall low level, such as the study by
Brook et al. (2000), which found that 13% of all teachers
considered LD to be the result of parental attitudes, namely,
“spoiling” the children. This demonstrates the importance
of studies that intervene in this reality.
Although our results have shown a significant difference
in scores and large ESs, they should be considered in the
context of some methodological limitations. The interven-
tion program was developed with a small group of teachers,
from four public schools not randomly selected in the catch-
ment area of our University Hospital in Brazil. Other limita-
tions of the study were the lack of more interactive activities,
such as modeling, role-play, and performance feedback, to
obtain best outcomes for knowledge. In addition, we did not
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measure the acceptability and the perceived feasibility of
the intervention, or its long-term impact. All these issues
and especially the impact of increased knowledge in modi-
fying teachers’ attitudes toward affected children warrant
future investigations.
Despite these caveats, our results suggest the efficacy of
a psychoeducational intervention program for increasing
teacher awareness and knowledge about ADHD and LD.
The program was feasible to implement with teachers from
public schools in a developing country. Future studies are
warranted to confirm the efficacy of this kind of interven-
tion, especially to evaluate its long-term impact.
Acknowledgments
The authors thank Conselho Nacional de Desenvolvimento
Científico e Tecnológico (CNPq, Brazil) for financial support.
They also thank the generous cooperation of Charles Ferreira,
Giovanni Abrahão Salum Júnior, and Letícia Petenuzzo.
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest
with respect to the research, authorship, and/or publication of this
article: Dr. Rohde was on the speakers’ bureau/advisory board and
acted as consultant for Eli-Lilly, Janssen-Cilag, Novartis, and Shire
in the past 3 years (received less than US$10 000 per year, which
is less than 5% of LAR’s gross income per year). LAR also
received travel awards (air tickets and hotel costs) from Novartis
and Janssen-Cilag in 2010 for taking part of two child psychiatric
meetings. The ADHD and Juvenile Bipolar Disorder Outpatient
Programs chaired by LAR received unrestricted educational and
research support from the following pharmaceutical companies in
the past 3 years: Abbott, Eli-Lilly, Janssen-Cilag, Novartis, and
Shire. Dr. Christian Kieling also took part in a meeting on the
promotion of editorial capacity among editors from low-income
and middle-income countries sponsored by Deva. Dr. R. Kieling,
Dr. Aguiar, Dr. Almeida, Dr. Mazzuca, Dr. Costa, Ms. Chardosim,
and Dr. Dorneles have no conflict of interest to disclosure.
Funding
The author(s) disclosed receipt of the following financial
support for the research, authorship, and/or publication of this
article: This work was supported by the National Council for
Scientific and Technological Development (CNPq; Process
Number 575239/2008-5).
References
Anselmi, L. A., Fleitlich-Bylik, B. W., Menezes, A. M. B.,
Araújo, C. L., & Rohde, L. A. (2010). Prevalence of psychiat-
ric disorders in a Brazilian birth cohort of 11-year-olds. Social
Psychiatry and Psychiatric Epidemiology, 45, 135-142.
Barbaresi, W. J., & Olsen, R. D. (1998). An ADHD educational
intervention for elementary schoolteachers: A pilot study.
Journal of Developmental & Behavioral Pediatrics, 19,
94-100.
Aguiar et al. 7
Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A
handbook for diagnosis and treatment (3rd ed.). New York,
NY: Guilford.
Beitchman, J. H., Cantwell, D. P., Forness, S. R., Kavale, K. A., &
Kauffman, J. M. (1998). Practice parameters for the assessment
and treatment of children and adolescents with language and
learning disorders. Journal of the American Academy of Child
& Adolescent Psychiatry, 37(10 Suppl.), 46S-62S.
Brook, U., Watemberg, N., & Geva, D. (2000). Attitude and knowl-
edge of attention deficit hyperactivity disorder and learning
disability among high school teachers. Patient Education and
Counseling, 40, 247-252.
Capano, L., Minden, D., Chen, S. X., Schacher, R. J., & Ickowicz, A.
(2008). Mathematical learning disorder in school-age children
with attention-deficit hyperactivity disorder. Canadian Jour-
nal of Psychiatry, 53, 392-399.
Faraone, S., Biederman, J., Krifcher-Lehman, B., Keenan, K.,
Nor-man, D., Seidman, L., . . . Chen, W. J. (1993). Evidence
for the independent familial transmission of attention deficit
hyperactivity disorder and learning disabilities: Results from
a family genetic study. American Journal of Psychiatry, 150,
891-895.
Gomes, M., Palmini, A., Barbirato, F., Rohde, L. A., & Mattos, P.
(2007). Conhecimento sobre o transtorno do déficit de atenção/
hiperatividade no Brasil [Knowledge about attention-deficit
hyperactivity disorder in Brazil]. Jornal Brasileiro de Psiquia-
tria, 56, 94-101.
Graeff-Martins, A. S., Oswald, S., Comassetto, J. O., Kieling, C.,
Gonçalves, R. R., & Rohde, L. A. (2006). A package of
interventions to reduce school dropout in public schools in
a developing country. A feasibility study. European Child &
Adolescent Psychiatry, 15, 442-449.
Gross-Tsur, V., Manor, O., & Shalev, R. S. (1996). Developmental
dyscalculia: Prevalence and demographic features. Develop-
mental Medicine & Child Neurology, 38, 25-33.
Hoven, C. W., Doan, T., Musa, G. J., Jaliashvili, T., Duarte, C. S.,
Ovuga, E., . . . Mandell, D. J. (2008). Worldwide child and
adolescent mental health begins with awareness: A prelimi-
nary assessment in nine countries. International Review of
Psychiatry, 20, 261-270.
Jerome, L., Gordon, M., & Hustler, P. (1994). A comparison of
American and Canadian teachers’ knowledge and attitudes
towards attention deficit hyperactivity disorder (ADHD).
Canadian Journal of Psychiatry, 39, 563-567.
Jones, H. A., & Chronis-Tuscano, A. (2008). Efficacy of teacher
in-service training for attention-deficit/hyperactivity disorder.
Psychology in the Schools, 45, 918-929.
Klassen, A. F., Miller, A., & Fine, S. (2004). Health-related qual-
ity of life in children and adolescents who have a diagnosis
of attention-deficit/hyperactivity disorder. Pediatrics, 114,
e541-e547.
Knapp, P., Rohde, L. A., Johanpeter, J., & Lyzkowski, L. (2002).
Terapia Cognitivo Comportamental no TDAH. Manual do
Terapeuta [Cognitive-behavioral therapy for ADHD. Thera-
pist’s manual]. Porto Alegre, Brazil: Artmed.
Downloaded from jad.sagepub.com at YALE UNIV on September 9, 2012
Kos, J. M., Richdale, A. L., & Jackson, M. S. (2004). Knowledge
about attention-deficit/hyperactivity disorder: A compari-
son of in-service and pre-service teachers. Psychology in the
Schools, 41, 517-526.
Lahey, B. B., Pelham, W. E., Loney, J., Kipp, H., Ehrhardt, A.,
Lee, S. S., . . . Massetti, G. (2004). Three-year predictive
validity of DSM-IV attention deficit hyperactivity disorder in
children diagnosed at 4-6 years of age. American Journal of
Psychiatry, 161, 2014-2020.
Lesesne, C., Abramowitz, A., Perou, R., & Brann, E. (2000). Atten-
tion deficit/hyperactivity disorder: A public health research
agenda. Retrieved from http://www.cdc.gov/ncbddd/ adhd/
Maughan, B., & Carroll, J. M. (2006). Literacy and mental disor-
ders. Current Opinion in Psychiatry, 19, 350-354.
National Association of Special Education Teachers. (2007).
Introduction to learning disabilities. Retrieved from http://
www.naset.org/2522.0.html
Pelham, W. E. (2002). Psychosocial interventions for ADHD. In
P. S. Jensen & J. R. Cooper (Ed.), Attention deficit hyperactiv-
ity disorder: State of the science, Best practice (pp. 12-24).
Kingston, NJ: Civic Research Institute.
Pliszka, S., Bernet W., Bukstein O., Walter H., Arnold V.,
Beitchman J., . . . Stock J. (2007). Practice parameter for the
assessment and treatment of children and adolescents with
attention deficit/hyperactivity disorder. Journal of the Ameri-
can Academy of Child & Adolescent Psychiatry, 46, 894-921.
Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., &
Rohde, L. A. (2007). The worldwide prevalence of ADHD:
A systematic review and metaregression analysis. American
Journal of Psychiatry, 164, 942-948.
Rohde, L. A., & Benczik, E. B. P. (1999). Transtorno de déficit de
atenção e hiperatividade: O que é? Como ajudar? [Attention-
deficit/hyperactivity disorder: what it is? How to help?]. Porto
Alegre, Brazil: Artes Médicas.
Rohde, L. A., Biederman, J., Busnello, E. A., Zimmermann, H.,
Schmitz, M., Martins, S., & Tramontina, S. (1999). ADHD
in a school sample of Brazilian adolescents: A study of
prevalence, comorbid conditions, and impairments. Journal
of American Academy of Child & Adolescent Psychiatry, 38,
716-722.
Roper Starch Worldwide. (1995). Learning disabilities and the
American public: A look at American’s awareness and knowl-
edge (Report No. 60pp). New Haven, CT. Emily Hall Tre-
maine Foundation.
Sciutto, M. J., Terjesen, M. D., & Frank, A. S. B. (2000). Teachers’
knowledge and misperceptions of attention-deficit/hyperactiv-
ity disorder. Psychology in the Schools, 37, 115-122.
Sherer, R. (2002). Mental health care in the developing world. Psy-
chiatric Times. Retrieved from http://www.psychiatrictimes
.com/display/article/10168/52476
Syed, E. U., & Hussein, S. A. (2009). Increase in teachers’ knowl-
edge about ADHD after a week-long training program: A pilot
study. Journal of Attention Disorders, 13, 420-423.
Tannock, R. (2009). Learning disorders. In B. J. Sadock, V. A.
Sadock, (Eds.), Kaplan and Sadock’s Comprehensive Textbook
8 Journal of Attention Disorders XX(X)
of Psychiatry (9th Ed., Vol. 2, pp. 3475-3485). Philadelphia:
Lippincott Williams and Williams.
Vereb, R. L., & DiPerna, J. C. (2004). Teachers’ knowledge of
ADHD, treatments for ADHD, and treatment acceptabil-
ity: An initial investigation. School Psychology Review, 33,
421-442.
Bios
Ana P. Aguiar, MD, is a medical doctor graduated in 2010 at the
Universidade Federal do Rio Grande do Sul, where she works as
a research assistant for the ADHD Outpatient Program (ProDAH)
at the Child and Adolescent Psychiatric Division of Hospital de
Clínicas de Porto Alegre, Brazil.
Renata R. Kieling, MD, is a pediatrician and a PhD student at the
Pontifícia Universidade Católica do Rio Grande do Sul, Brazil.
Adriana C. Costa is a PhD in education and a speech-language
pathologist.
Neusa Chardosim is a clinical psychologist expert in neuropsy-
chology and analytical psychotherapy.
Downloaded from jad.sagepub.com at YALE UNIV on September 9, 2012
Beatriz V. Dorneles, PhD, is an associate professor of educa-
tional psychology at the Universidade Federal do Rio Grande do
Sul, Brazil.
Mariana R. Almeida, MD, is a psychiatry resident and former
research assistant of the ADHD Outpatient Program (ProDAH) at
the Child and Adolescent Psychiatric Division of Hospital de
Clínicas de Porto Alegre, Brazil.
Ana C. Mazzuca is a medical doctor and former collaborator of
the ADHD Outpatient Program (ProDAH) at the Child and
Adolescent Psychiatric Division of Hospital de Clínicas de Porto
Alegre, Brazil.
Christian Kieling, MD, PhD, is a child and adolescent psychia-
trist and a collaborator of the ADHD Outpatient Program
(ProDAH) of Hospital de Clínicas de Porto Alegre, Brazil.
Luis A. Rohde, MD, PhD, is an associate professor of child psy-
chiatry at the Universidade Federal do Rio Grande do Sul and the
director of the ADHD Outpatient Program (ProDAH) of Hospital
de Clínicas de Porto Alegre, Brazil.