Parent-proxy EQ-5D ratings of children with attention-deficit hyperactivity disorder in the US and the UK
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Background: The symptoms of attention-deficit hyperactivity disorder (ADHD) are associated with impairment in multiple domains of health-related quality of life (HR-QOL). HR-QOL of children with ADHD has been assessed by relatively long multidimensional questionnaires. A review of the literature found no studies using the brief, well established EuroQoL Five-Dimension Questionnaire (EQ-5D) to estimate the HR-QOL of children with ADHD. The objective of this study was to assess the HR-QOL of children with ADHD using parents’ responses to the proxy version of the EQ-5D.
Methods: Participants were recruited in the midwestern US and in the vicinity of London, England. All parents completed three questionnaires: the EQ-5D proxy version; a measure of ADHD symptoms based on Diagnostic and Statistical Manual of Mental Disorders (4th Edition) [DSM-IV] criteria (the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV — Parent Version [ADHD-RS]); and either the Child Health Questionnaire — Parent Form 50 (CHQ-PF50) or the Child Health and Illness Profile — Child Edition (CHIP-CE), which are both generic multidimensional paediatric HR-QOL questionnaires.
Results: A total of 126 parents of children with ADHD participated in the study: 43 in the US and 83 in the UK. On the EQ-5D, participants indicated that 78.6% of their children experienced some problems or extreme problems performing usual activities, while 64.8% believed their child demonstrated some or extreme anxiety or depression. The mean EQ-5D index score was 0.75 and the mean visual analogue scale (VAS) score was 73.9. The EQ-5D index and VAS scores were found to be significantly correlated (p < 0.05) with several domains of the CHQ-PF50 (e.g. Mental Health, Self-Esteem, Family Activities, Psychosocial Summary Score) and the CHIP-CE (e.g. Satisfaction, Comfort, Academic Performance, Peer Relations). The EQ-5D scales were also significantly correlated with the ADHD-RS scales (p < 0.001).
Conclusion: The proxy version of the EQ-5D, completed by parents, was able to detect impairment in children diagnosed with ADHD in the US and the UK. Furthermore, the EQ-5D index and VAS scores demonstrated construct validity among this sample through significant correlations with an ADHD symptom measure and previously validated multidimensional QOL instruments. These results suggest that parent-proxy EQ-5D ratings are feasible and valid for use as part of an overall health outcomes assessment in clinical studies of childhood ADHD.
KeywordsVisual Analogue Scale Visual Analogue Scale Score ADHD Symptom Child Health Questionnaire Proxy Version
The authors would like to thank Christine Thompson for statistical programming and Jodi Shorr for production assistance in the preparation of this manuscript. We would also like to thank Dennis Revicki, Donald Gilbert, Michael Cannon, Jessica Brewster and Anne Rentz for assistance with data collection and study design.
Louis Matza and Kristina Secnik co-directed this project, sharing primary responsibility for study design, analysis/interpretation of data and drafting of the manuscript. Sally Mannix and F. Randy Sallee played integral roles in the design and implementation of data collection.
The Child Health Questionnaire (CHQ) is copyrighted © 1991, 1996, 1999 Landgraf and Ware. The CHQ is a health outcomes measure used across a variety of paediatric conditions and is not an ADHD-specific instrument.
Funding for this study was provided by Eli Lilly & Company.
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