Attention deficit hyperactivity disorder (ADHD) within a South Indian (Keralian) mainstream school context

Attention Deficit Hyperactivity Disorder (ADHD) is a widely discussed special educational issue in Western contexts and developed countries. By contrast, limited information is available about ADHD in Eastern contexts and developing countries. In India in particular, the only available information is about the medical perspective of ADHD; little or no attention is given to social or educational perspectives. DSM IV criteria are the most commonly used standard assessment procedures. However, limited research is reported to discuss the potential cultural influences of this North American model. The present study examines the incidence and interpretation of ADHD within the context of five mainstream schools in Trivandrum, South India. It also explored cultural influences impact upon the cultural validity and reliability of DSM IV criteria when introduced into a South Indian context. In order to identify children with ADHD characteristics, culturally valid assessment tools such as behaviour checklist and behaviour rating scales, were developed from DSM IV (TR) symptoms criteria. Qualitative data was gathered from the five sample schools during the academic year of 2006-07 using a variety of methods including in-depth interviews (with 21 teachers), classroom observations (of 26 children), rating scale and document scrutiny. The case study method was adopted to gain in-depth information about the identified children. Informal interviews with parents (24) were also utilised to triangulate the information gathered from the school contexts. Qualitative data analysis techniques such as open coding and case analysis were used to assess children's behavioural characteristics and difficulties. The findings indicate that three percent of children (21) had ADHD characteristics within the sample schools. Some of the findings are consistent with the studies reported in Western contexts. There are also some contrasting results: a) most of the identified children had inattention rather than hyperactivity characteristics, b) a higher number of children with ADHD characteristics were from lower socio-economic backgrounds, c) teachers used coercive methods of physical punishments and sanctions as they interpreted the children's ADHD characteristics as a result of their lack of interest in learning. Most importantly, though DSM IV (TR) criteria are useful in identifying ADHD, two items of the 'symptoms' criteria were not identifiable within the present context of the sample schools. The findings suggest that socio-cultural factors do influence the validity and reliability of DSM IV criteria. The study has implications not only for further research but also for planning and policy making in the field of education for all. The conclusions suggest that an educational provision should be considered with regards to the varied and complex needs of children with special educational needs such as ADHD. Teacher education programmes should be enhanced with positive intervention strategies.