Using Best–Worst Scaling to Measure Caregiver Preferences for Managing their Child’s ADHD: A Pilot Study

Susan dosReis, Xinyi Ng, Emily Frosch, Gloria Reeves, Charles Cunningham, John F.P. Bridges

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Management of attention-deficit/hyperactivity disorder (ADHD) is a trade-off between caregivers’ concerns about the benefits versus the risks of evidence-based treatment. Few studies have used choice-based methods to assess what treatment attributes matter most to caregivers. Objective: The aim was to develop and to pilot an instrument to elicit caregivers’ preferences for evidence-based management of their child’s ADHD. Methods: Mixed methods were used to develop a Best–Worst Scaling (BWS) instrument, and quantitative methods were used to pilot the instrument. Primary caregivers of children with ADHD from two community organizations were recruited for the development (n = 21) and pilot (n = 37) phase. The instrument was a BWS case 2, where 18 management profiles are presented one at a time, with respondents indicating the one best and one worst feature of each profile. Profiles were developed using a main effects orthogonal array. The mean of best-minus-worse scores was estimated, and attribute importance was based on the sum of maximum minus minimum scores for each attribute. Feasibility of eliciting stated preferences was evaluated with t tests and 95 % confidence intervals. Results: Seven attributes (medication, therapy, school, caregiver training, provider specialty, provider communication, and out-of-pocket costs) with three levels each were identified. All mean scores were significant except for pediatrician management of the child’s ADHD (p = 0.089). Caregiver training had the highest relative importance, followed by medication and provider communication. Conclusions: The BWS instrument was a relatively simple measure, caregivers completed it independently, and it distinguished the relative importance of different attributes in managing a child’s ADHD.

Original languageEnglish (US)
Pages (from-to)423-431
Number of pages9
Issue number5
StatePublished - Oct 26 2015

ASJC Scopus subject areas

  • Nursing (miscellaneous)


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