Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in childhood, with a global prevalence estimated at 7.2%,¹ consistent with findings in sub-Saharan Africa.² Attention deficit hyperactivity disorder is a neurodevelopmental disorder characterised by developmental deficits and changes in brain function beginning in early childhood. Recent dimensional approaches to measuring ADHD symptoms encompass a broad range of severity but lack clear boundaries distinguishing the condition from typical development.^1,3

A diagnosis of ADHD requires a persistent pattern of inattention, hyperactivity or impulsivity severe enough to impair academic functioning in school-aged children in structured environments.¹ Symptoms often become more apparent at school, where demands on self-regulation are high.⁴ In addition to academic difficulties, children with ADHD frequently experience strained relationships with peers and family, higher rates of suspension or expulsion and comorbid psychiatric conditions,⁵ all of which can contribute to long-term challenges if unaddressed.⁶

Educators play a critical role in identifying, assessing and referring children who exhibit ADHD-type behaviour.⁷ Educators’ perceptions of ADHD are shaped by their knowledge of ADHD,⁷ which correlates with their attitudes and classroom practices.^8,9 Therefore, educators must possess accurate knowledge of ADHD and positive attitudes to support and refer students who need assistance.¹⁰

A study conducted in the Caribbean found that educators in Trinidad and Tobago had below-average knowledge of ADHD, with those holding master’s degrees or prior training scoring highest.¹¹ This finding aligns with a cross-national study conducted across nine countries (the Czech Republic, Germany, Greece, Iraq, Vietnam, Saudi Arabia, the United States, South Africa and the Republic of Korea), which showed that while knowledge levels varied greatly, exposure to ADHD and training consistently improved understanding.¹²

In South Africa, studies on educators’ knowledge of ADHD have produced mixed results. Some studies reported average to above-average knowledge, especially regarding symptoms,^13,14 while others highlighted significant gaps.^7,15,16 Studies showing limited knowledge typically had larger samples and included public sector schools.¹⁴ Educators in private schools were generally better informed,¹⁷ likely because of more in-service training.¹⁴ A study in Soweto found that educators’ knowledge of ADHD did not vary by years of experience,¹⁶ contrasting with findings by Sciutto et al.,¹² who reported that prior experience teaching students with ADHD was associated with higher knowledge levels.

Research indicates that educators often hold negative attitudes towards children exhibiting ADHD-type behaviours.^10,18 Prior exposure to such children has been linked to less tolerance, suggesting that such attitudes may become more negative over time.¹⁰ This aligns with the findings that younger educators have more positive attitudes towards children with ADHD in their classrooms.¹⁹ Yarde-Leavett¹⁸ reported that experienced and knowledgeable educators generally have more positive attitudes and a willingness to learn about ADHD. Conversely, limited knowledge can lead to stereotyping children with ADHD as simply needing stricter discipline.¹⁶

The recognition of ADHD is growing, and educators are increasingly serving as key figures in early identification and support. In South Africa, few studies have examined educators’ knowledge and attitudes towards ADHD. This study addresses this gap using the ADHD-specific Knowledge and Attitudes of Educators (ASKAT) scale to assess educators in the Tshwane district, Gauteng, South Africa, an under-researched area. Secondary objectives included comparing private schools with public schools, secondary schools with primary schools and exploring how teaching experience influences attitudes.

Participant characteristics are presented in Table 1. One hundred educators participated in the study, with 76% identifying as female and 24% as male. According to the Shapiro–Wilk test for normality, participant age did not follow a normal distribution (W = 0.800, p < 0.0001). Therefore, the median age was 39.5 years (interquartile range [IQR]: 31–54.5).

Participants varied in educational attainment: 51% held undergraduate degrees, while 31% had completed postgraduate qualifications. The median teaching experience was 11 years (IQR: 6–22.5). Of the participants, 37% taught in private schools and 63% in public schools.

Ninety per cent of educators reported teaching children exhibiting ADHD-type behaviour, and 57.6% of these educators verified that some learners had received a formal diagnosis. Common challenges included a lack of discipline, disruptive classroom behaviour, poor participation and difficulty maintaining concentration. Overcrowded classrooms and limited training further impeded educators’ ability to effectively support and accommodate these learners.

In this study, educators demonstrated adequate knowledge of ADHD, achieving an average score of 70% on the ASKAT. This performance was notably higher than that reported in several South African studies, where participants averaged below 60%, as well as in some international studies with similarly low scores.^{7,11,12,15,17,22} Participants performed best on questions related to symptomatology and least well on treatment-related items, consistent with Mulholland et al.’s findings that educators are generally more knowledgeable about symptoms.¹⁰ Additionally, most educators (94%) believed that diet is an effective treatment for ADHD, reflecting a widespread misconception frequently documented in the literature.⁷

Similar to the current study, research conducted in Johannesburg, South Africa, found that educators in private schools were more knowledgeable about ADHD than their counterparts in public schools, attributing this to greater access to in-service training.¹⁷ This pattern was also evident here, as 48% of private school educators reported receiving ADHD training compared to 29% of public school educators.^17,23 To emphasise this point, a study in Tshwane assessing pre- and post-training knowledge among educators indicated that semi-rural schools had less knowledge than urban schools before training, but these differences disappeared after training.²⁴

Educators in this study generally expressed negative perceptions of ADHD-type behaviours, with most describing them as irritating and stressful in the classroom. Furthermore, 84% of educators reported that teaching children who display such behaviour is challenging, a finding consistent with previous studies.^18,20 Educators also identified overcrowded classrooms, limited resources and a lack of training as factors that restricted their ability to meet learners’ needs, contributing to frustration. These concerns were echoed by educators in a 2021 study conducted in Soweto.¹⁶

Encouragingly, most of the educators in this study believed that ADHD was a valid diagnosis and a legitimate educational concern. Although knowledge levels varied between private and public schools, these differences did not affect educators’ beliefs in the validity of the diagnosis. This finding aligns with research conducted in Trinidad and Tobago.¹¹ Despite these challenges, most educators expressed positive sentiments about working with children with ADHD, noting that such experiences are rewarding and contribute to their professional development, consistent with other studies.^10,23

Although many participants had extensive exposure to learners with ADHD and varying teaching experience, we found no significant association between experience and attitudes. This contrasts with studies in Australia, which reported that educators with more experience and knowledge tended to have more positive attitudes.^25,26

Educators also expressed a willingness to refer students displaying ADHD-type behaviours for further assessment and endorsed combining stimulant medication with behavioural interventions as an effective management approach, similar to findings in Yarde-Leavett’s¹⁸ study.

No significant correlation emerged between knowledge and attitudes in this study. However, gaps in understanding remain, particularly concerning classroom management and persistent misconceptions about diet and parenting. Most educators have a strong desire for better ADHD training and classroom interventions to support learners with ADHD. This finding aligns with previous studies,^18,19 underscoring the importance of targeted professional development.

This study had several limitations. The results cannot be generalised beyond Tshwane, Gauteng, South Africa, as the unique socio-economic and educational environment in Tshwane may differ from conditions elsewhere. The exclusive use of quantitative data limited deeper exploration of educators’ experiences and perceptions. Additionally, the imbalance in sample sizes between public and private schools prevented meaningful comparisons. Finally, some schools may not have responded because of the use of multiple contact details during recruitment.

This study supports existing evidence that educators’ knowledge of ADHD is generally adequate, with private school educators demonstrating higher levels of knowledge than those in public schools. Unlike many other studies, we did not find a correlation between knowledge and attitudes. While educators held generally favourable attitudes towards the diagnosis of ADHD and children with the condition, their personal attitudes towards managing ADHD-type behaviours in the classroom were unfavourable. Educators also reported that working with these students was rewarding and expressed a desire to develop more effective classroom management strategies. Practical actions are required to convert knowledge into efficient practice. We suggest a dual approach focusing on the provision of easily accessible classroom management resources and required practical in-service training. Such investments are critical to reduce educator frustration, improve classroom environments and empower learners with ADHD to thrive both academically and socially.