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A Latent Class Analysis to Identify Variation in Caregivers’ Preferences for their Child’s Attention-Deficit/Hyperactivity Disorder Treatment: Do Stated Preferences Match Current Treatment?

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Abstract

Objectives

To investigate variation in caregiver preferences for their child’s attention-deficit/hyperactivity disorder (ADHD) care and to determine if their stated preferences align with current care management.

Methods

Caregivers of a child aged 4–14 years and in care for ADHD were recruited from pediatric outpatient clinics and advocacy groups across the state of Maryland. Participants completed a survey collecting demographics, the child’s treatment, and caregiver preferences—elicited using a best-worst scaling experiment (case 2). Latent class analysis was used to identify distinct preference segments and bivariate analyses were used to compare the association between segment membership with what the child was currently receiving for their ADHD.

Results

Participants (n = 184) were predominantly White (68%) and the child’s mother (84%). Most children had ADHD for 2 or more years (79%). Caregiver preferences were distinguished by two segments: continuous medication (36%) and minimal medication (64%). The two groups had very different preferences for when medication was administered (p < 0.001), but they had similar preferences for provider-oriented and non-medication interventions (p > 0.05 for the caregiver behavior training, provider communication, provider specialty, and out-of-pocket costs). One third of the sample did not receive the preferred individualized education program and 42% of the minimal medication group reported using medication 7 days a week all year round.

Conclusions

Although behavior management training and school accommodations aspects of an ADHD care plan are more important to caregivers than evidence-based medication, fewer families had access to educational accommodations. Further research is needed to clarify how stated preferences for care align with treatments used in actual practice settings.

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Acknowledgements

Ms. Xinyi Ng coordinated the study, collected, analyzed, and interpreted the data, and wrote this manuscript. Dr. Susan dosReis conceptualized the study, collected research data, interpreted the research results, and edited the manuscript. Dr. John Bridges assisted with the conceptualization of the study, the development of the attributes, created the best-worst scaling instrument design, interpreted the research results, and edited the manuscript. Ms. Melissa Ross assisted with data collection, interpreted the research results, and reviewed the manuscript. Dr. Charles E. Cunningham assisted with the identification of the attributes, conceptualized the study design, and reviewed the manuscript. Drs. Gloria Reeves and Emily Frosch contributed to the conceptualization of the study, provided clinical implications to the study findings, and edited the manuscript.

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Authors and Affiliations

  1. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA

    Xinyi Ng, Melissa M. Ross & Susan dosReis

  2. Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    John F. P. Bridges

  3. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Emily Frosch

  4. University of Maryland School of Medicine, Baltimore, MD, USA

    Gloria Reeves

  5. McMaster University, Hamilton, ON, Canada

    Charles E. Cunningham

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  1. Xinyi Ng
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  2. John F. P. Bridges
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  4. Emily Frosch
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  5. Gloria Reeves
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  6. Charles E. Cunningham
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  7. Susan dosReis
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Corresponding author

Correspondence to Susan dosReis.

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Funding

This study was funded by a grant from the National Institute of Mental Health (R34-MH093502; PI: dosReis). Charles E. Cunningham’s participation was supported by the Jack Laidlaw Chair in Patient-Centered Health Care. Charles E. Cunningham receives royalties from workshops and materials for COPE, a large community parent education program. He is a shareholder and receives salary support from BCFPI Inc., which provides screening and outcome measures for children and youth.

Conflict of interest

Susan dosReis, Xinyi Ng, John Bridges, Melissa Ross, Gloria Reeves, and Emily Frosch have no conflicts of interest to declare.

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Ng, X., Bridges, J.F.P., Ross, M.M. et al. A Latent Class Analysis to Identify Variation in Caregivers’ Preferences for their Child’s Attention-Deficit/Hyperactivity Disorder Treatment: Do Stated Preferences Match Current Treatment?. Patient 10, 251–262 (2017). https://doi.org/10.1007/s40271-016-0202-z

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