<![CDATA[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 (functional knowledge of what counts as referral‑relevant evidence, how multi‑informant diagnosis works, and what teachers should/should not do) 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 (checklists/DSM), 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 (“I can’t diagnose”), 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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