Valuation of Child Behavioral Problems from the Perspective of US Adults

Objective: To assess preferences between child behavioral problems and estimate their value on a quality-adjusted life year (QALY) scale.

Methods: Respondents, age 18 or older, drawn from a nationally representative panel between August 2012 and February 2013 completed a series of paired comparisons, each involving a choice between 2 different behavioral problems described using the Behavioral Problems Index (BPI), a 28-item instrument with 6 domains (Anxious/Depressed, Headstrong, Hyperactive, Immature Dependency, Anti-social, and Peer Conflict/Social Withdrawal). Each behavioral problem lasted 1 or 2 years for an unnamed child, age 7 or 10 years, with no suggested relationship to the respondent. Generalized linear model analyses estimated the value of each problem on a QALY scale, considering its duration and the child's age.

Results: Among 5207 eligible respondents, 4155 (80%) completed all questions. Across the 6 domains, problems relating to antisocial behavior were the least preferred, particularly the items related to cheating, lying, bullying, and cruelty to others.

Conclusions: The findings are the first to produce a preference-based summary measure of child behavioral problems on a QALY scale. The results may inform both clinical practice and resource allocation decisions by enhancing our understanding of difficult tradeoffs in how adults view child behavioral problems. Understanding US values also promotes national health surveillance by complementing conventional measures of surveillance, survival, and diagnoses.