When it comes to treating a child with attention deficit hyperactivity disorder (ADHD), the parents’ goals tend to drive therapy in a distinct direction, according to new research.
Parents whose main concern is academic performance often will choose medication, but parents who are more concerned about behavior usually will opt for behavioral therapy first.
“If clinicians can bring evidence to parents, and parents can share their values and goals with their child’s doctor, the decision-making process can be easier and it’s likely to yield better outcomes,” said the study’s author, Dr. Alexander Fiks, an assistant professor of pediatrics at Children’s Hospital of Philadelphia and the University of Pennsylvania.
Still, Fiks was surprised that the treatment choices were so distinctly divided in the study. “I don’t know that I expected the choices to be so clear-cut,” he said.
For the study, researchers recruited 148 parents or guardians of children between the ages of 6 and 12 with a diagnosis of ADHD. They accepted parents of children who were already receiving treatment, as well as those just choosing a treatment for the first time. However, they did not accept participants who were already receiving a combination of medications and behavioral therapy.
The researchers developed and validated the ADHD Preference and Goal Instrument — a tool to measure the preferences and goals of parents of children with ADHD.
The findings showed that if parents were most worried about their child’s performance at school, they were more than twice as likely to choose medications as an initial treatment. However, if a parent was most concerned with the behavioral problems associated with ADHD, that parent was 60 percent more likely to choose behavioral therapy.
“Our findings highlight the importance of talking about goals. If people feel like they’ve been heard and valued, they feel like the treatment is working toward something they care about,” noted Fiks.
“This approach could help with conditions like asthma, where there are multiple treatments. Starting with a family’s goals could really be a big innovation in care.”
Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children’s Medical Center of New York in New Hyde Park was also surprised to see such a “distinct delineation” with treatment choices.
He said he was particularly surprised that parents of children with behavior issues were more likely to choose behavioral therapy. Behavior therapy is effective, he said, but it means multiple appointments and can take a bit longer to see any changes.
“These are often the parents I find more receptive to medication,” he added.
Fiks thought that parents might see a behavior problem as separate from a medical problem. “When parents think about behavior problems as non-medical, then non-medical treatments might seem more acceptable,” he noted.
Both experts believed that involving parents in the decision process would likely lead to more parent participation in the chosen treatment, which leads to better outcomes.
“This study drives home the importance of soliciting family preferences around treatment options, and pediatricians would be well-advised to engage parents and try to elicit any treatment preferences and biases they may have,” said Adesman.