The Parent Treatment Preference Questionnaire (PTPQ): Evaluation of a New Tool to Assess Attitudes to Interventions

Background: In most cases, a patient has agency to make decisions about the treatment plan they undergo when they receive a psychiatric diagnosis, but not when the patient is a child. Children, particularly those with developmental disabilities, defer to their parents or caregivers. There is ample evidence that parental views, on both the diagnosis and the treatment options available, influence where and when they pursue treatment for their child.

Objectives: The PTPQ was developed to assess parental attitudes about pharmacotherapy and behavior interventions as well as parental willingness to actively participate in a given intervention. Such a scale would be useful to clinicians in determining the treatment(s) that are most preferred by the family, which may then the highest rates of compliance.

Methods: 122 PTPQs were completed by the parents of children enrolled in a study of combined treatment with a pharmacologic agent and parent management training. Each child had and autism spectrum disorder and significant problem behavior. The data were entered into a polychoric correlation matrix, which is recommended for interval or categorical data.  Exploratory factor analysis with maximum likelihood estimation and oblique rotation was used to obtain the best factor structure. The resulting subscales were correlated with variables expected to support the validity of the subscale scores.

Results:  A two-factor model provided the best fit for the data. Items meeting the 0.35 loading threshold were adopted onto the two subscales: “Feelings About Medication” and “Feelings About Behavior Therapy”. Analyses demonstrated that the RMSEA was “acceptable” according to established standards. When compared to a measure of vignettes called “Treatment Acceptability”, the Medication subscale (where higher values represent more negative attitudes) was negatively correlated with combined medicinal and behavioral therapy. The Behavior subscale (where higher values represent more positive attitudes) was positively correlated with combined medicinal and behavioral treatment.

Conclusions: The scale appears to be accessing parental thoughts about the most common treatment options for persons with disabilities: medication, behavior therapy, and the combination. This is an encouraging result, particularly since this is the first time the scale has been used. The sample size was relatively small and there was relatively little variability in PTPQ ratings, which may have affected the factor analysis. Measures of buy-in or adherence to treatment would have been welcome in determining the validity of the resulting structure. However, the results do suggest that the scale is tapping underlying attitudes held by parents, which should be confirmed in a larger sample. Future research on the PTPQ should explore additional items to “flesh out” the existing subscales.