Monday, October 19, 2015
Grand Ballroom EH (Hyatt Regency St. Louis at the Arch)
Poster Board # PS2-37

Melissa Ross, MA1, John F.P. Bridges, PhD2, Xinyi Ng, BSc (Pharm)3, Emily J. Frosch, M.D.4, Gloria M. Reeves, M.D.5 and Susan dosReis, PhD1, (1)University of Maryland School of Pharmacy, Baltimore, MD, (2)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (3)University of Maryland Baltimore, Baltimore, MD, (4)Johns Hopkins School of Medicine, Baltimore, MD, (5)University of Maryland School of Medicine, Baltimore, MD
   Purpose: To understand the relationship between treatment-initiation concerns and outcomes of an evidence-based treatment among caregivers of a child with attention-deficit/hyperactivity disorder (ADHD).

   Methods: Caregivers of a 4-14 year-old child diagnosed with ADHD were recruited from pediatric primary and mental health clinics and family support groups across Maryland.  A case 1, balanced incomplete block design (BIBD), best-worst scaling (BWS) experiment assessed caregivers' most important concerns when initiating ADHD treatment.  Participants completed 16 choice tasks, each showing 6 of the 16 concerns from which one most and one least important concern was selected.  Demographic characteristics, caregiver-reported improvements resulting from medication, and additional desired ADHD changes also were reported. Preference utilities were estimated using conditional logit, effects coding, and assuming sequential best-worst responses. Scores were ranked to assess relative importance. Latent class analysis (LCA) was conducted to determine if there were distinct segments that prioritized concerns differently.  Reported outcomes were estimated based on the observed impact of treatment and additional desired changes.    Results: The 184 participants (m=42 years) were primarily the biological mother and Caucasian (68%).  Children were mostly male (71%) and using medication (81%).  The top-ranked utility scores influencing whether to engage in treatment were the child becoming a successful adult (1.71, p<.0001), school behavior improvements (1.55, p<.0001), and the doctor addressing their concerns (1.39, p<.0001).  Least important to treatment initiation were school pressures to medicate (-2.01, p<.0001) followed by issues related to stigma.  LCA yielded a three segment solution: short-term impact (36%), long-term impact (40%), and side-effects/safety (24%).  When considering caregiver-reported outcomes behavioral (48%), executive functioning (57%), and mood (10%) improvements were noted.  Of those reporting improvement in behavior, executive functioning, and school, 60%, 60%, and 45%, respectively, desired additional improvement in their child's ADHD (p<.05).       Conclusions: While 76% of caregivers' priorities when considering engaging in ADHD treatment were focused on outcome improvement, the majority had not realized full improvement, despite using an evidence-based medication treatment.  Those whose priorities and expectations are not met over the course of treatment are at high risk for disengagement from care. Additional research is needed to implement a shared-decision making process over the course of care to ensure that stated preferences for treatment outcomes correspond with observed patient-reported outcomes.