CAREGIVERS' PREFERENCES FOR TREATMENT OPTIONS IN ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD): A BEST-WORST SCALING STUDY

Purpose: As the primary decision-makers of their child's treatment for attention deficit hyperactivity disorder (ADHD), caregivers have a significant impact on treatment engagement. Treatment preferences are important antecedents for treatment engagement, yet few studies have investigated caregiver treatment priorities. The objective of this study is to elicit and prioritize caregivers' preferences for evidence-based treatment options for their child's ADHD and to assess heterogeneity in treatment priorities.    

Method: Caregivers (n=108) with a child aged 4-14 and in care for ADHD were recruited from organizations, outpatient settings and family support groups located statewide. Preferences were measured using a best-worst scaling (BWS) case 2 survey comprising 18 choice task profiles that were based on an orthogonal main effects design. Each profile displayed seven treatment attributes: medication administration, therapy location, school involvement, caregiver behavior training, physician management, provider communication, and out-of-pocket costs. Every attribute has 3 levels. Utility scores were estimated from conditional logit models using effects coding and assuming sequential best-worst responses. Conditional relative attribute importance was determined by the proportion of variation within attribute levels. Latent-class analysis was conducted to explore heterogeneity in preferences, and identify segments of caregivers with similar preferences for evidence-based ADHD treatment.

Result: The sample of 108 caregivers was on average 42 years old (SD 8.7), predominantly female (94%), white (65%), married (61%) with at least college education (73%).  Overall, the conditional relative importance of the attributes, in rank order, was out-of-pocket costs (24.0%), caregiver behavior training (22.2%) and medication administration (14.1%). The latent class analysis identified a two-segment solution that best described the data, where the two segments differed on priorities for medication administration. Segment one comprised 28.5% of the sample and appeared to be caregivers who were medication-inclined whereas the other segment with 71.5% of the sample appeared to be the medication-averse. A larger proportion of caregivers in the medication-averse segment were <45years old (70%) compared to 55% of medication-inclined who were <45 years old.

Conclusion: This study suggests heterogeneity among caregivers' priorities for ADHD treatment centers on the use of medication for their child. This preference-elicitation method potentially could advance the capacity for patient/family-centered shared decision-making by alerting providers of priorities that may guide treatment planning.