A Discrete Choice Conjoint Experiment to Evaluate Parent Preferences for Treatment of Young, Medication Naive Children with ADHD

Abstract

The current study examined treatment preferences of 183 parents of young (average age = 5.8 years, SD = 0.6), medication naive children with ADHD. Preferences were evaluated using a discrete choice experiment in which parents made choices between different combinations of treatment characteristics, outcomes, and costs. Latent class analysis yielded two segments of parents: (a) medication avoidant parents constituted 70.5% of the sample whose treatment decisions were strongly influenced by a desire to avoid medication, and (b) outcome oriented parents constituted 29.5% of the sample whose treatment decisions were most influenced by a desire for positive treatment outcomes. Parents in the outcome oriented segment were more stressed and depressed, had lower socioeconomic status and education, were more likely to be single parents, and had more disruptive and impaired children. Simulations predicted that parents would prefer treatments with behavior therapy over treatments with stimulant medication only.

Acknowledgments

This research was supported by grant R01MH069614 from the National Institute of Mental Health to Dr. William E. Pelham. We thank the parents who participated in the study and the many research assistants who worked on the project.

Notes

Note: Means are adjusted for the covariates (standard behavior therapy, enhanced behavior therapy). Treatment component attributes are arranged by rank order of the medication avoidant segment. Treatment outcome attributes are arranged by the rank order of the outcome oriented segment. Rnk = rank order of importance score within each segment; F values are from one-way analyses of covariance; ES = effect size (Hedges g) coded so that higher values indicate the mean is larger for the medication avoidant segment.

*p < .05. ***p < .001.

Note: Means are adjusted for covariates (standard behavior therapy, enhanced behavior therapy). F values are from one-way analyses of covariance. ADHD = attention/deficit hyperactivity disorder; ES = effect size (Hedges g) coded so that higher values indicate larger means for the medication avoidant segment.

*p < .05. **p < .01. ***p < .001.

Note: Values in tables are adjusted means (standard deviations in parentheses) or percentages. Odds ratios for variables with zero frequency cells were computed by adding a .5 constant to all cells. F = F values (df) from one-way analysis of covariance (ANCOVA); B = regression coefficient from logistic regression, each of which is a single degree of freedom test; ES =effect size (Hedges g for ANCOVAs and odds ratios for regressions); effect sizes coded so that higher values indicate the mean or percentage is larger for the medication avoidant segment.

^a n = 129.

^b n = 54.

^c Hauser (1994).

*p < .05. **p < .01.

Notes: Values in tables are adjusted means (standard deviations) or percentages. F = F values (df) from one-way analysis of covariance (ANCOVA); B = regression coefficient values, each tested with a single degree of freedom; ES = effect size (Hedges g for ANCOVA and odds ratios for logistic regressions). Effect sizes coded so that higher values indicate the mean or percentage is larger for the medication avoidant segment.

^a n = 66.

^b n = 40.

^c Mean symptom score (range = 0–3) on the Disruptive Behavior Disorders Rating Scale (Pelham, Gnagy, Greenslade, & Milich, 1992).

^d Impairment rating (range = 0–6) on the Impairment Rating Scale (Fabiano et al., 2006).

*p < .05. **p < .01. ***p < .001.

Note: Values in tables are adjusted means (standard deviations). ES = effect size computed as Hedges g coded so that higher values indicate the mean is larger for the medication avoidant segment.

^a Parent Readiness for Change Questionnaire (Cunningham, 1997).

^b ADHD Knowledge and Opinion Survey-Revised (Bennett, Power, Rostain, & Carr, 1996; Rostain, Power, & Atkins, 1993). The ADHD–Knowledge subscale from the ADHD Knowledge and Opinions Survey-Revised was not analyzed due to low internal consistency.

^c Caregiver Strain Questionnaire (Brennan, Heflinger, & Bickman, 1997).

^d Centers for Epidemiological Studies of Depression Scale (Radloff, 1977).

^e Adult ADHD Self-Report Scale (Kessler et al., 2005).

*p < .05. **p < .01. ***p < .001.

Daniel A. Waschbusch, William E. Pelham, Jr., Andrew R. Greiner, Elizabeth M. Gnagy, and Jessica A. Robb are now at the Department of Psychology and the Center for Children and Families, Florida International University. James Waxmonsky is now at the Department of Psychiatry and the Center for Children and Families, Florida International University.