OBJECTIVES: To identify parent/caregiver priorities when initiating ADHD medication for their child and clinicians’ perceptions of parental priorities and the concordance between the two. METHODS: Clinicians treating and caregivers of a child aged 4-14 years diagnosed with ADHD were recruited from primary care and mental health clinics and support groups across Maryland.  A case 1 best-worst scaling (BWS) experiment assessed considerations when initiating ADHD treatment via 16 choice tasks, each displaying 6 considerations. Caregivers selected one most and one least important consideration. Clinicians completed the same BWS, but selected items based on a typical patient’s caregiver. Estimated mean scores were tested for statistical significance using two-tailed t-tests. The concordance between clinicians’ expectations of caregivers’ priorities and caregivers’ self-report was examined. RESULTS: The 184 caregivers (m=42 years) were Caucasian (68%) and the biological mother. Children were mostly male (71%) and using medication (81%).  Among caregivers, most important considerations were the child becoming a successful adult (0.41, p<.0001), school behavior (0.37, p<.0001), the doctor addressing their concerns (0.31, p<.0001), and better grades (0.30, p<.0001). Caregivers’ least important considerations were others thinking badly of the child (-0.49, p<.0001), school pressures to medicate (-0.37, p<.0001), and friends supporting their decision (-0.36, p<.0001).  Clinicians (n=40) were mostly female (68%) and equally a child psychiatrist (33%) or general pediatrician (33%). Clinicians perceived caregivers’ most important considerations were school behavior (0.67, p<.0001), better grades (0.38, p<.0001), and the doctor addressing their concerns (0.33, p<.0001), while least important considerations were ADHD medicine limiting career options (0.57, p<.0001) and hurting the child’s self-esteem (0.37, p<.0001) and others thinking badly of the child (0.36, p<.0001). CONCLUSIONS: Caregivers’ and clinicians’ considerations when initiating ADHD medicine were mostly consistent. However, caregivers’ concerns focus on long-term outcomes, suggesting the importance of providers making clear connections between short- and long-term goals to effectively engage families in treatment.