From Symptom Recognition to Referral Readiness: Teachers' Diagnostic Literacy for Attention-Deficit/Hyperactivity Disorder in a Mainstream South African Primary School
Abstract
Teachers are “primary identifiers” in Attention-Deficit/Hyperactivity Disorder (ADHD) identification in schools, yet evidence suggests that recognising symptoms does not automatically translate into evidence-based referral practices. This study examines how mainstream primary teachers construct and enact diagnostic literacy and what supports strengthen referral readiness. A qualitative narrative inquiry case study was conducted in a public primary school in Phoenix, Durban. Six teachers, each representing a different classroom, generated data through collage elicitation, reflective journals, and semi-structured interviews; data were re-analysed thematically with attention to diagnostic talk, artefacts and system constraints. Results show a consistent pattern: teachers demonstrated strong symptom recognition and classroom accommodations but uneven engagement with diagnostic processes, including role boundary confusion, reliance on informal checklists, and limited confidence using DSM-based constructs. Teachers located referral breakdowns in overcrowding, limited specialist access, and weak school–clinic feedback loops. This article proposes a preliminary Referral Readiness Framework derived from the thematic re-analysis of arts-based narrative data and informed by existing literature on teacher diagnostic literacy, referral decision-making, inclusive education implementation, and teacher professional development. The framework offers a conceptual interpretation of how symptom recognition, diagnostic literacy, referral practices, school support structures, and feedback processes may interact within a mainstream primary school context.
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