Teachers are able to recognize ADHD-related behaviours and impairments but conceptualize these as reflecting attentional or emotional difficulties rather than as relating to a disorder (ADHD). Teachers' conceptualization of ADHD and views about medication are important factors that could affect accurate recognition and referral. Improving teachers' knowledge about ADHD, especially the inattentive subtype, could assist in tackling gender-related barriers to care.

Background: This study investigates the ability of primary school teachers to recognise Attention Deficit/Hyperactivity Disorder (ADHD), and the impact of subtype and child gender on recognition and proposed management. Method: Primary school teachers read one of four types of vignette describing the behaviour of a 9-year-old child: either a boy or a girl with inattentive or combined subtype of ADHD. Teachers were asked about their conceptualisation of the child's difficulties and their thoughts about need for specialist referral and other interventions. Results: Of 496 teachers, 99% identified the presence of a problem. Subtype (combined) of ADHD influenced teachers' recognition of ADHD and agreement that medication might be helpful. Only 13% of teachers thought that medication might be helpful. Conclusions: Results suggest a need for better teacher awareness about inattentive subtype of ADHD. Key Practitioner Message:• Epidemiological data show that ADHD is underdiagnosed in girls and in children with inattentive subtype, while research and clinical experience suggest that teachers are important in the process of recognition and referral of children with possible ADHD• Using a case vignette, teachers were more likely to conceptualise the problems as ADHD and think that medication might be helpful for a child with combined subtype than for a child with inattentive subtype of ADHD• We found no evidence that teachers were less likely to recognise ADHD in girls than in boys • Teachers strongly endorsed nonpharmacological intervention approaches for children with ADHD, but few thought that medication would be beneficial; many teachers expressed their views that medication should be 'a last resort'• During the diagnostic process for a child with suspected ADHD, or when offering training to teachers, clinicians should try to increase teacher awareness about inattentive subtype of ADHD

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