Teachers’ ADHD Endorsement and Symptom Severity Ratings: The Role of Culture, Knowledge, and Attitudes

OBJECTIVE: Although cross-cultural disparities in teachers' ADHD reports are well documented, the factors underlying these differences remain poorly understood. Accordingly, this study examined the unique and combined contributions of teachers' experience and training, cultural orientation, ADHD knowledge, and attitudes to their endorsement and severity ratings of ADHD. METHOD: Four hundred and eighteen currently employed K-12 teachers from 15 culturally distinct nations (Australia, Brazil, Canada, Chile, Greece, India, Ireland, Italy, Mexico, Poland, Portugal, South Africa, Spain, the United Kingdom, and the United States) viewed four videos depicting children exhibiting inattentive-type behaviors, hyperactive-impulsive-type behaviors, and two control videos depicting typical development. Following each video, teachers rated the likelihood that the child displayed ADHD behavior (endorsement) and the severity of their symptoms. Teachers also reported their professional background and completed measures assessing their cultural values, ADHD-specific knowledge, and attitudes. Hierarchical regression analyses were used to identify predictors of ADHD endorsement and symptom severity ratings. RESULTS: Reliable differences emerged in teachers' ADHD ratings of identical behaviors. Teaching experience and training, individualism-collectivism, perceived ADHD knowledge, and negative ADHD beliefs significantly predicted the likelihood of endorsing an ADHD label and symptom severity ratings, though the strength and pattern of these effects varied across behavioral presentations. CONCLUSIONS: Teachers' ADHD ratings of identical behaviors are shaped, in part, by their professional experience, cultural orientation, and attitudes about ADHD, which may lead to disparities in identifying students with ADHD. Improving equity in school-based assessments may therefore require approaches that address teachers' beliefs, diagnostic confidence, and culturally informed expectations of classroom behavior. Directions for future research, including the need to replicate these findings using observational methodologies to assess whether similar patterns emerge in teachers' real-world assessments, are discussed.