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Caregiver Treatment Preferences for Children with a New Versus Existing Attention-Deficit/Hyperactivity Disorder
Susan dosReis1, Alex Park1, Xinyi Ng1
11 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland.
Insights
Caregiver preferences for managing childhood attention-deficit/hyperactivity disorder (ADHD) evolve over time. Early in diagnosis, medication is less prioritized, while later, school accommodations and provider specialty become more important for ADHD treatment.
Area of Science:
- Pediatric Psychology
- Neurodevelopmental Disorders
- Behavioral Health
Background:
- Parental experiences significantly shape treatment priorities for children with attention-deficit/hyperactivity disorder (ADHD).
- Understanding caregiver preferences is crucial for effective, patient-centered ADHD management.
- Preferences may vary based on how long a child has been diagnosed with ADHD.
Purpose of the Study:
- To identify the most preferred ADHD management options among caregivers.
- To examine how preferences for ADHD treatments differ based on the time since initial diagnosis.
Main Methods:
- A Best-Worst Scaling (BWS) experiment was used with 184 primary caregivers of children (aged 4-14) diagnosed with ADHD.
- Caregivers selected the best and worst attributes from 18 ADHD management profiles.
- Preference weights were estimated using a conditional logit model, stratified by time since diagnosis.
Main Results:
- The most preferred ADHD management options included one-on-one caregiver behavior training, daily medication, clinic-based therapy, and individualized education programs.
- Caregivers of children diagnosed for less than two years showed lower prioritization for medication compared to other attributes.
- Caregivers of children diagnosed for two or more years favored school accommodations, medication, and provider specialty.
Conclusions:
- Caregiver preferences for managing childhood ADHD are dynamic and change over the course of the child's diagnosis.
- Tailoring care plans to evolving preferences can enhance patient and family-centered approaches.
- A multidisciplinary team and diverse resources are essential for addressing varying needs in ADHD management.
Objectives:
Parental experiences with managing their child's attention-deficit/hyperactivity disorder (ADHD) can influence priorities for treatment. This study aimed to identify the ADHD management options caregivers most prefer and to determine if preferences differ by time since initial ADHD diagnosis.
Methods:
Primary caregivers (n = 184) of a child aged 4-14 years old in care for ADHD were recruited from January 2013 through March 2015 from community-based pediatric and mental health clinics and family support organizations across the state of Maryland. Participants completed a survey that included child/family demographics, child clinical treatment, and a Best-Worst Scaling (BWS) experiment to elicit ADHD management preferences. The BWS comprised 18 ADHD management profiles showing seven treatment attributes, where the best and worst attribute levels were selected from each profile. A conditional logit model using effect-coded variables was used to estimate preference weights stratified by time since ADHD diagnosis.
Results:
Participants were primarily the mother (84%) and had a college or postgraduate education (76%) with 75% of the children on stimulant medications. One-on-one caregiver behavior training, medication use seven days a week, therapy in a clinic, and an individualized education program were most preferred for managing ADHD. Aside from caregiver training and monthly out-of-pocket costs, caregivers of children diagnosed with ADHD for less than two years prioritized medication use lower than other care management attributes and caregivers of children diagnosed with ADHD for two or more years preferred school accommodations, medication, and provider specialty.
Conclusions:
Preferences for ADHD treatment differ based on the duration of the child's ADHD. Acknowledging that preferences change over the course of care could facilitate patient/family-centered care planning across a range of resources and a multidisciplinary team of professionals.
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