Parents' Preferences for School- and Community-Based Services for Children at Risk for ADHD
This study used conjoint analysis, trade-off methodology employed by marketing researchers and health economists, to examine preferences of parents for school- and community-based interventions for childhood ADHD. Participants were 29 mothers (86.2% Caucasian) of boys aged 5–13 years with or at risk of ADHD. Mothers completed a conjoint survey that examined trade-offs across 15 attributes of service content (e.g., materials, resources), process (e.g., time demand, format/delivery mode), and outcome (e.g., improvement in children's behavioral functioning). Findings suggest that parents preferred services maximizing children's behavioral and social outcomes (relative to family functioning). Parents were willing to give up services with desirable delivery features (such as daily homeschool notes and child's frequent participation in therapy) for programs optimizing outcomes. Simulation analyses, forecasting tools that predict how respondents would behave in the real world, revealed that 62.1% of parents were predicted to prefer a standard, evidence-informed school-based service involving daily teacher involvement and monthly parent involvement, while 37.9% of parents were predicted to use a standard, evidence-informed community-based service involving daily parent involvement and monthly teacher involvement. Findings from this study show that parents value improved social and behavioral outcomes more than desirable service delivery features. However, results suggest that if the treatment package includes school-based services in which there is greater teacher involvement and less parent involvement, a majority of parents prefer school services, especially if they involve children's ongoing use of self-control strategies. Results suggest ways in which the delivery of effective treatments needs to be altered to make them more palatable and acceptable by parents. Other implications for school-based practitioners are discussed.
KeywordsSchool-based services Community-based services ADHD in children Parent preferences Conjoint analysis
The author would like to extend gratitude to the parents who participated in the project, the graduate students who coded information from focus groups, and the research assistants and camp staff who helped administer the survey. The author would also like to thank the consultants at Sawtooth Software for their input on statistical analysis. The author would also like to thank Steven W. Evans, Julie Owens, Brian Wymbs, and Theresa Egan for providing feedback on the manuscript.
This study was funded by the Ohio University Research Committee.
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). ISBN 978-0-89042-554-1.Google Scholar
- Atkins, M. S., Frazier, S. L., Birman, D., Abdul-Adil, J., Jackson, M., Graczyk, P. A., et al. (2006). School-based mental health services for children living in high poverty urban communities. Administration and Policy in Mental Health and Mental Health Services Research, 33, 146–159.CrossRefPubMedGoogle Scholar
- Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). Adult ADHD: What the science says. New York: Guilford Press.Google Scholar
- Centers for Disease Control and Prevention. (2010). The association between school-based physical activity, including physical education, and academic performance. Atlanta: U.S. Department of Health and Human Services.Google Scholar
- Conners, C. K. (1997). Conners' rating scales—revised: Short form. North Tonawanda, NY: Multi-Heath Systems.Google Scholar
- Cunningham, C. E., Chen, Y., Deal, K., Rimas, H., McGrath, P., Reid, G., et al. (2013). The interim services preferences of parents waiting for children's mental health treatment: A discrete-choice conjoint experiment. Journal of Abnormal Child Psychology. https://doi.org/10.1007/s10802-013-9728-x.PubMedGoogle Scholar
- Cunningham, C. E., Deal, K., Rimas, H., Gold, M., Sdao-Jarvie, K., & Boyle, M. (2008). Modeling the information transfer preferences of parents of children with mental health problems: A discrete choice conjoint experiment. Journal of Abnormal Child Psychology, 36, 1123–1138.CrossRefPubMedGoogle Scholar
- Cunningham, C. E., Rimas, H., Chen, Y., Deal, K., McGrath, P., Lingley-Pottie, P., et al. (2015). Modeling parenting programs as an interim service for families waiting for children’s mental health treatment. Journal of Clinical Child & Adolescent Psychology, 44(4), 616–629. https://doi.org/10.1080/15374416.2014.88866.CrossRefGoogle Scholar
- Evans, S., Owens, J., & Bunford, N. (2014a). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 43(4), 527–551. https://doi.org/10.1080/15374416.2013.850700.CrossRefPubMedGoogle Scholar
- Evans, S. W., Rybak, T., Strickland, H., & Owens, J. S. (2014b). The role of school mental health models in preventing and addressing children's emotional and behavioral problems. In H. M. Walker & F. M. Gresham (Eds.), Handbook of evidence-based practices for students having emotional and behavioral disorders. New York, NY: Guilford Press.Google Scholar
- Fabiano, G., Pelham, W., Waschbusch, D., Gnagy, E., Lahey, B., Chronis, A., et al. (2006). A practical measure of impairment: Psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples. Journal of Clinical Child and Adolescent Psychology, 35, 369–385.CrossRefPubMedGoogle Scholar
- Hart, K., Fabiano, G., Evans, S., Manos, M., Hannah, J., & Vujnovic, R. (2016). Elementary and middle school teachers' self-reported use of positive behavioral supports for children with ADHD: A national survey. Journal of Emotional and Behavioral Problems. https://doi.org/10.1177/1063426616681980.Google Scholar
- Orme, B. K. (2013). Getting started with conjoint analysis: Strategies for product design and pricing research (3rd ed.). Madison: Research Publishers.Google Scholar
- Owens, J., Holdaway, A., Smith, J., Evans, S., Himawan, L., Coles, E., et al. (2017). Rates of common classroom behavior management strategies and their associations with challenging student behavior in elementary school. Journal of Emotional and Behavioral Disorders. https://doi.org/10.1177/106342661771250.Google Scholar
- Page, T., Pelham, W., III, Fabiano, G., Greiner, A., Gnagy, E., Hart, K., et al. (2016). Comparative cost analysis of sequential, adaptive, behavioral, pharmacological, and combined treatments for childhood ADHD. Journal of Clinical Child & Adolescent Psychology, 45(4), 416–427. https://doi.org/10.1080/15374416.2015.1055859.CrossRefGoogle Scholar
- Patterson, M., & Chrzan, K. (2004). Partial profile discrete choice: What's the optimal number of attributes? (pp. 173–185). In 2003 Sawtooth Software conference proceedings. San Antonio, TX.Google Scholar
- Reisberg, D. (2006). Cognition: Exploring the science of the mind. New York: Norton.Google Scholar
- Ryan, M., & Gerard, K. (2003). Using discrete choice experiments to value health care: Current practice and future prospects. Applied Health Economics and Policy Analysis, 2, 55–64.Google Scholar
- Shelton, T., Barkley, R., Crosswait, C., Moorehouse, M., Fletcher, K., Barrett, S., et al. (2000). Multimethod psychoeducational intervention for preschool children with disruptive behavior: Two-year post-treatment follow-up. Journal of Abnormal Child Psychology, 28(3), 253–266.CrossRefPubMedGoogle Scholar
- Smith, E., Koerting, J., Latter, S., Knowles, M., McCann, D. C., Thompson, M., et al. (2015). Overcoming barriers to effective early parenting interventions for attention-deficit hyperactivity disorder (ADHD): Parent and practitioner views. Child: Care, Health and Development, 41(1), 93–102.Google Scholar
- Vannest, K. J., Davis, J. L., Davis, C. R., Mason, B. A., & Burke, M. D. (2010). Effective intervention for behavior with a daily behavior report card: A meta-analysis. School Psychology Review, 39(4), 654.Google Scholar
- Waschbusch, D. A., Cunningham, C. E., Pelham, W. E., Rimas, H. L., Greiner, A. R., Gnagy, E. M., et al. (2011). A discrete choice conjoint experiment to evaluate parent preferences for treatment of young, medication naïve children with ADHD. Journal of Clinical Child and Adolescent Psychology, 40(4), 546–561. https://doi.org/10.1080/15374416.2011.581617.CrossRefPubMedPubMedCentralGoogle Scholar
- Wymbs, F., Cunningham, C., Chen, Y., Rimas, H., Deal, K., Waschbusch, D., et al. (2016). Examining parents' preferences for group versus individual parent training programs versus a minimal information alternative for children with ADHD symptoms using a discrete choice conjoint experiment. Journal of Clinical Child and Adolescent Psychology, 45(5), 614–631.CrossRefPubMedGoogle Scholar
- Xinyi, N., Bridges, J., Ross, M., Frosch, E., Reeves, G., Cunningham, C., et al. (2016). A latent class analysis to identify variation in caregiver preferences for their child's attention-deficit/hyperactivity disorder: Do stated preferences match current treatment? The Patient: Patient-Centered Outcomes Research, 10, 251–262.Google Scholar