Variations in Physician Attitudes Regarding ADHD and Their Association With Prescribing Practices

Abstract

Objective: The objective of this study was to test whether physicians' attitudes regarding the impact of ADHD on health-related quality of life (HRQL) explain differences in practices for prescribing psychostimulants in children.

Method: In a cross-sectional survey, U.S.-based pediatricians and psychiatrists ("physicians") used the Paper-Standard Gamble--a widely used preference-based assessment of HRQL--to rate four vignettes describing ADHD health states of varying severity. Associations between standard gamble scores and questions about prescribing practices were analyzed using ordinal logistic regression.

Results: Surveys were mailed to 291 physicians; 127 (44%) returned complete forms. Lower standard gamble scores were associated with more emphasis on children's ADHD symptoms (p = .03) and less emphasis on parents' concerns about stimulant side effects (p = .03) when prescribing psychostimulants.

Conclusion: Differences in physician perceptions of the severity of ADHD symptoms and in their emphasis on parental concerns about side effects may help explain variations in ADHD psychostimulant prescription patterns.

Keywords: ADHD; quality of life; standard gamble; utility.

Figure 1

Associations between P-SG utility variables from multivariate model Note. The y-axis displays that proportion of utilities reported by physicians using the Paper-Standard Gamble that fell above the overall median. Lower percentages in one x-axis category indicate that respondents were more likely to report lower utilities, suggesting that they expect children with ADHD to have lower HRQL and hence, more disease burden from their ADHD. Figure 1a confirms that physicians reported progressively lower utilities with increasing severity of symptom descriptions. Figures 1b and 1c show that physician willingness to prescribe was related to their perception of the burden of disease. In those for whom severity of ADHD symptoms weighed "a lot" in their willingness to prescribe, their HRQL estimates were lower. Conversely, in physicians for whom parental concerns did not influence their willingness to prescribe ("not at all"), their HRQL estimates were lower.