Systematic Review of Patients’ and Parents’ Preferences for ADHD Treatment Options and Processes of Care
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Patient preferences are an important topic of study with respect to attention-deficit hyperactivity disorder (ADHD) interventions, as there are multiple treatment choices available, multiple developmental levels to consider, and multiple potential individuals involved in treatment (children, parents, and adults with ADHD). Stated preference methods such as discrete choice experiment (DCE), best-worst scaling (BWS), and other utility value methods such as standard gamble interview (SGI) and time trade-off (TTO) are becoming more common in research addressing preferences for ADHD treatments. A synthesis of this research may facilitate improved patient-centered and family-centered treatment for ADHD.
The purpose of this review was to synthesize reports across existing DCE, BWS, TTO, and SGI studies to assess which aspects of ADHD treatment are most studied as well as most preferred and influential in treatment decisions.
A total of 41 studies referring to preferences for ADHD treatment were identified through the initial search and contact with researchers. Of these, 13 reported ADHD treatment preference data from a study using DCE, BWS, or SGI methods. No TTO studies were identified that met inclusion criteria.
Methods and designs varied considerably across studies. Relatively few studies focused on preferences among children, adolescents, and adults compared with those that focused on the preferences of parents of children with ADHD. The majority of studies focused primarily on medication treatments, with many fewer focused on psychosocial treatments. Some studies indicated that parents of children with ADHD prefer to avoid stimulant medications in favor of behavioral or psychosocial interventions. Others report that parents see medication as a preferred treatment. Treatment outcome is a particularly salient attribute for treatment decisions for many informants.
Potential outcomes of various treatments play a proximal role in patients’ and families’ decisions for ADHD treatment. Because the majority of studies focus on medication treatments for children with ADHD, more research is necessary to understand preferences related to behavioral and other psychosocial treatments both as stand-alone interventions and used in combination with medication. Additional research is also needed to assess the treatment preferences of adults with ADHD. In general, DCE, BWS, and SGI methods allow measurement of patient preferences in a manner that approximates the uncertainty and trade-offs inherent in real-world treatment decision making and provides valuable information to inform patient-centered and family-centered treatment.
KeywordsADHD Symptom Treatment Characteristic Treatment Preference Latent Class Analysis Choice Task
Dr. Gregory Fabiano receives funding through grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the Administration for Children and Families Office of Planning, Research, and Evaluation; the Department of Education; and the Institute of Education Sciences. Dr. Fabiano has also received consulting fees from Health and Wellness Partners related to school-based interventions for ADHD and he receives royalties from Guilford Publications. Dr. Charles Cunningham has been the recipient of workshop fees and publication royalties for the Community Parent Education (COPE) Program, which has been used as a psychosocial intervention for parents of children with ADHD. Dr. Cunningham’s participation was supported by the Jack Laidlaw Chair in Patient-Centered Health Care, Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University.
Dr. Nicole Schatz, Dr. Susan dosReis, Dr. Daniel Waschbusch, Stephanie Jerome, Kellina Lupas, and Karen Morris report no conflicts of interest.
Dr. Nicole Schatz served as the lead author for this manuscript, conducted the initial literature search, and is the guarantor for the overall content. Drs. Schatz, Fabiano, Cunningham, dosReis, and Waschbusch contributed to the formulation of the research questions, development of the coding manual used to extract data, and identification of papers for inclusion in the review. Dr. Schatz, Dr. Fabiano, Stephanie Jerome, Kellina Lupas, and Karen Morris, were responsible for reviewing papers and applying the coding manual to extract data. Dr. Schatz drafted the manuscript, and all authors were involved in providing input on the interpretation of the data and the overall organization and conceptualization of the manuscript. All authors reviewed and approved the final manuscript.
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