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?

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.

A comparative study on the neurophysiological mechanisms underlying effects of methylphenidate and neurofeedback on inhibitory control in attention deficit hyperactivity disorder

“…Yet, it has also been shown that >40–60% of patients discontinue this treatment for several reasons (Duric et al, 2017; Garbe et al, 2012; Pappadopulos et al, 2009). Even though similar discontinuation rates have been observed in one non-pharmacological treatment study (Duric et al, 2017), these treatment approaches are steadily gaining popularity (Dosreis et al, 2017; Ng et al, 2017; Schatz et al, 2015). Amongst non-pharmacological approaches, neurofeedback (NF) has gained increasing acceptance and interest.…”

“…While the neurophysiological mechanisms associated with treatment effects seem to be different between MPH and NF interventions, the behavioral results suggest that both interventions are equally effective to treat inhibitory deficits as examined using the Go/Nogo task in the current study. This is of high clinical relevance because it has been shown that a significant proportion of patients discontinue MPH treatment for several reasons and prefer non-pharmacological treatment approaches (Dosreis et al, 2017; Garbe et al, 2012; Ng et al, 2017; Schatz et al, 2015). The finding that both interventions seem to target complementary cognitive-neurophysiological processes and functional neuroanatomical structures may provide the basis for a combined MPH + NF intervention.…”

Stakeholder-Engaged Derivation of Patient-Informed Value Elements

“…It is possible to evaluate the rank-order importance in a descriptive assessment of the value elements. The research team used stated-preference methods to quantify preferences using regression models [16][17][18][19]. The resulting beta estimates, or preference weights, inform their relative importance in patient-informed value-based decisions.…”

Adult Patient Preferences for Long-Acting ADHD Treatments: A Discrete Choice Experiment

“…Most studies only examined a single attribute versus multiple aspects related to various stimulant preparations, and they often lacked rigorous methods for assessing preference. [15][16][17][18][19][20][21][22][23][24][25] Largely missing from these studies is the voice of the adult patient with ADHD 17 The primary aim of this study was to evaluate preferences for specific features associated with long-acting stimulant treatment among adult patients with ADHD in the US.…”