Preferences related to attention-deficit/hyperactivity disorder and its treatment

Figures & data

Table 1 Studies assessing preference for treatments directly experienced by the respondents or their children

Citation	Preference assessment method	Preference content	Respondent (N)	Key results
Efron et al^Citation46	Single-item assessment of preference at end of treatment period in a crossover trial (no further details provided)	Children received treatment with MPH and DEX, each for 2 weeks in a double-blind, crossover trial. After both treatment periods, parents were asked to specify which treatment they preferred	Parents of children (mean age of 8.73 years) with ADHD (N = 125)	46 of 104 parents (36.8%) indicated that they preferred the DEX treatment period, and 58 parents (46.4%) indicated that they preferred the MPH treatment period
Fredericks and Kollins^Citation49	Double-blind choice procedure	Participants received double-blind treatment with either placebo or MPH during four study ‘sampling sessions’. During eight subsequent ‘choice sessions’, participants chose which treatment they would receive: placebo, MPH, or neither	Adults with ADHD (N = 10)	MPH was preferred in 50% of the choices; placebo 32.5%, neither 17.5% (significant difference among choices; χ^2 = 52.5, P < 0.001)
MacDonald Fredericks and Kollins^Citation50	Double-blind choice procedure	Participants received double-blind treatment with either placebo or MPH during six study ‘sampling sessions’. During six subsequent ‘choice sessions’, participants chose which treatment they would receive: placebo, MPH, or neither	Children/adolescents (aged 10–14) with ADHD (N = 5)	MPH was preferred in 60% of the choices; placebo 20%; neither 20% (significant difference among choices; χ^2 = 9.6, P < 0.01)
Pelham et al^Citation48	Unspecified preference assessment completed at end of double-blind, placebo-controlled, clinical trial	Children received treatment with placebo, IR MPH (three times daily), and a once daily MPH formulation in a randomly selected order. At the end of the three 7-day treatment periods, parents were asked to choose which of the treatment weeks they preferred for their child	Parents of children with ADHD (aged 6–12) (N = 68)	47% of the parents selected once daily MPH as the treatment of choice, 31% selected IR MPH, 15% chose their child’s previous MPH treatment, and 7% either chose placebo or had no preference
Quintana et al^Citation47	Unspecified preference assessment completed at end of clinical trial	In this 6-week study, children and adolescents with incomplete response or intolerance to stimulant treatment switched to atomoxetine after the first week. The two treatments were compared using an unspecified preference assessment method	Children and adolescents (aged 6–17 years) with ADHD (N = 58)	65.5% of subjects reported a preference for atomoxetine treatment over their previous psychostimulant

Abbreviations: MPH, methylphenidate; DEX, dexamphetamine; ADHD, attention-deficit/hyperactivity disorder; IR, immediate release.

Table 2 Studies assessing preference for general treatment approaches

Citation	Preference assessment method	Preference content	Respondent (N)	Key results
Dos Reis et al^Citation51	ASK-ME survey (a 47-item, self-administered questionnaire)	Parents recruited from six pediatric primary care clinics completed the ASK-ME. One item asks respondents to indicate level of agreement with the following statement: ‘[I] prefer medication over counseling’. Study results were presented by racial/ethnic comparison groups (white vs nonwhite parents)	Parents of youth diagnosed with ADHD (N = 254)	Nonwhite parents were less likely than white parents to ‘prefer medication over counseling’ for their children (59% of white parents vs 36% of nonwhite parents, P < 0.0001)
Glass and Wegar^Citation52	Surveys distributed to teachers	Surveys assessed teachers’ perceptions of ADHD etiology and treatment options. Teachers were given a choice of the following treatment options: medication, behavior modification, medication plus behavior modification, and no treatment	Teachers of children in kindergarten through fifth grade (N = 225)	94.7% of respondents (N = 213) chose the ‘medication and behavior modification’ option as the most appropriate treatment regimen
McLeod et al^Citation53	A short battery of questions included in the 2002 General Social Survey, followed by face-to-face interviews	A subset of respondents to the 2002 General Social Survey’s National Stigma Study (Children module) who had indicated a prior knowledge and awareness of ADHD and participated in follow-up face-to-face interviews. Interviews included yes/no questions relating to ADHD beliefs and treatment preferences, including ‘Should children be given counseling for ADHD?’ and ‘Should children be given medication to treat ADHD?’ Authors used respondents’ answers to the above yes/no questions to indicate beliefs and treatment preferences	General public survey respondents (N = 725)	Most respondents believed that children with ADHD should be given a combination of counseling and medication (65%, N = 471). 21% expressed a preference for counseling only (N = 151), 5% expressed a preference for medication only (N = 39), and 9% (N = 64) indicated that children with ADHD should receive neither counseling nor medication
Pham et al^Citation54	Questionnaire developed specifically for this study	Parents of children with and without ADHD completed a survey on ADHD-related beliefs and treatment. The survey included an item on treatment preference that asked parents to select from one of the following treatment options: medication only, counseling only, and a combined treatment approach. If parents did not have a child with ADHD, they were provided with a hypothetical situation in which their child did have ADHD	Ethnically diverse parents of children (aged 5–12) with ADHD (N = 58) and without ADHD (N = 61)	53.8% of parents preferred a combined treatment approach for their child, 24.4% preferred counseling only, 16.8% preferred medication only, and 5.0% responded ‘none of the above’ to the provided treatment options

Abbreviations: ASK-ME, attitudes, satisfaction, knowledge, and medication experiences survey; ADHD, attention-deficit/hyperactivity disorder.

Table 3 Studies assessing preference for treatment attributes or treatment outcomes

Citation	Preference assessment method	Preference content	Respondent (N)	Key results
Matza et al^Citation56	SG utility interviews	Parents of children with ADHD indicated preferences among 11 hypothetical health states that contained variations of the following five domains: ADHD symptom profile (mild, moderate, and severe symptoms), typical ADHD behaviors, impact on school functioning, impact on family functioning, and type of treatment with corresponding side effect profiles (stimulant, nonstimulant, and no treatment)	Parents of children (mean age of 10.2 years) diagnosed with ADHD (N = 43)	When both treatments were associated with an adequate response and tolerable side effects, parents significantly preferred the nonstimulant health state over the stimulant health state (t = 2.3, P = 0.03). When either the treatment response was inadequate or the side effects were intolerable, there were no significant differences in preferences for the stimulant and nonstimulant health states
Muhlbacher et al^Citation55	DCE and questionnaire	Parents’ preferences of therapy characteristics were evaluated using a DCE and a 23-item questionnaire assessing importance of ADHD-therapy characteristics (including duration of effect, impact on school performance, and dosing options). The following therapy characteristics were included in the DCE: duration of treatment effect (long vs short), side effects (weight loss vs none), dosage form (always the same vs variable/combinable), discretion (intake of drug obvious vs not obvious), emotional state (mood swings vs none), social situation (problems with friends, hobbies vs no problems)	Mothers and fathers of adolescents (mean age 15 years) with ADHD (N = 219)	Results from the 23-item questionnaire found the following therapy characteristics to have the greatest relevance to parents: ‘improving the child’s emotional state’, ‘little or no addictive potential’, and ‘improved ability to concentrate’. Results of the DCE found the following characteristics to influence the selection of treatment: ‘enabling social contacts’ and ‘emotional state: no mood swings’ (relative importance 40%). ‘Duration of effect: long (all day)’ was also desirable (relative importance 18%), as were the characteristics of ‘discretion’, ‘dosage’, and ‘side effects’
Secnik et al^Citation57	SG utility Interviews	Parents indicated preferences among 14 hypothetical health states, which described ADHD-related characteristics that varied according to treatment option (untreated ADHD, ADHD treated with a nonstimulant, immediate-release stimulant, or extended-release stimulant) and the nature of response (responder or nonresponder, with or without side effects)	Parents of children (mean age of 12.6 years) with ADHD (N = 83)	Generally, nonstimulant health states were preferred over otherwise identical stimulant health states
Stockl et al^Citation58	Survey mailing of a 30-item questionnaire	A survey was mailed to 1000 physicians who had prescribed stimulant medications to children and adolescents. The following preference-related questions asked clinicians to indicate their level of agreement with the following statements: Question 17: ‘If available and with a FDA indication for treating ADHD in children or adolescents, I would prefer prescribing a medication that is not a stimulant versus a stimulant’. Question 18: ‘If available and with a FDA indication for treating ADHD in children or adolescents, I would prefer prescribing a noncontrolled medication that does not have evidence of abuse potential versus one that is controlled [and has] evidence of abuse potential’	Physicians treating children and adolescents with ADHD (N = 365)	38% of physicians strongly agreed or agreed that they would prefer prescribing a nonstimulant instead of a stimulant if a nonstimulant with an FDA indication were available. 58% of physicians strongly agreed or agreed that they would prefer prescribing a noncontrolled medication that does not have evidence of abuse potential versus one that is controlled and has evidence of abuse potential

Abbreviations: SG, standard gamble; ADHD, attention-deficit/hyperactivity disorder; DCE, discrete choice experiment; FDA, Food and Drug Administration.

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