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Parent Reports Versus Objective Behavioral Measures in Pediatric Sleep-Disordered Breathing
Daniel C Fong1, Nithya Navarathna1,2, Sophia Uddin1
1Department of Otorhinolaryngology-Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA.
Insights
Parent reports of behavioral issues in children with sleep-disordered breathing (SDB) show weak links to objective response inhibition tests. Clinical decisions for pediatric SDB should include objective assessments, not just parent feedback.
Area of Science:
- Pediatric Sleep Medicine
- Neuropsychology
- Child Psychology
Background:
- Sleep-disordered breathing (SDB) in children can impact behavior and executive functions.
- Parental reports of behavioral problems are often used to guide clinical decisions in pediatric SDB.
- The relationship between parent-reported behaviors and objective measures of executive function, like response inhibition, is not well understood.
Purpose of the Study:
- To investigate the association between parent-reported problem behaviors and objectively measured response inhibition in children diagnosed with SDB.
- To determine if parent reports align with objective performance on tasks measuring inhibitory control.
- To inform clinical decision-making by clarifying the concordance between subjective and objective behavioral assessments in pediatric SDB.
Main Methods:
- A prospective observational study involving 84 children aged 5-11 years with SDB symptoms.
- Parent-reported problem behaviors were assessed using the Behavior Rating Inventory of Executive Function (BRIEF), focusing on the inhibit T-score.
- Objective response inhibition was measured using the Flanker Test of Inhibitory Control and Attention.
- Pearson correlation and linear regression analyses were employed to examine relationships, adjusting for covariates.
Main Results:
- A small, statistically significant correlation (r = -0.23, p = 0.04) was found between parent-reported inhibitory problems and objective response inhibition in unadjusted analyses.
- This association was attenuated after adjusting for demographic and socioeconomic factors.
- Parent reports explained minimal variance in objective scores (adjusted R² = 0.14–0.16), indicating limited concordance.
Conclusions:
- Parent-reported behavioral problems demonstrate limited agreement with objective measures of response inhibition in children with SDB.
- Relying solely on parent-reported behavioral symptoms for treatment decisions in pediatric SDB may be insufficient.
- Integrating objective assessments alongside subjective reports is recommended for comprehensive evaluation and effective clinical management of pediatric SDB.
Objectives:
To determine the association between parent-reported problem behaviors and objectively measured response inhibition in children with sleep-disordered breathing (SDB). Understanding this concordance could facilitate better clinical decision-making, as parent reports often guide treatment decisions despite unclear relationships with objective behavioral measures.
Methods:
This prospective observational study was conducted at a tertiary care pediatric otolaryngology clinic from 1/1/24-12/1/2024. Children aged 5-11 years with SDB symptoms were included, while those with clinically significant psychiatric or neurologic disorders were excluded. Parent-reported problem behaviors were measured using the Behavior Rating Inventory of Executive Function (BRIEF), with the inhibit T-score as the primary predictor. The primary outcome was performance on the Flanker Test of Inhibitory Control and Attention, which measures response suppression to irrelevant stimuli while maintaining attention to target stimuli. Relationships between BRIEF scores and Flanker Test performance were assessed using Pearson correlation and linear regression, adjusting for sociodemographic factors.
Results:
Among 84 participants (mean age: 93 months [95% CI, 89-98], 56% male), parent-reported inhibitory problems showed a small but statistically significant correlation with response inhibition performance (r = -0.23, p = 0.04) in unadjusted analyses. This relationship was attenuated after adjusting for demographic and socioeconomic factors. Other behavioral domains showed weaker associations. Adjusted R 2 values ranged 0.14-0.16, indicating parent reports explained minimal variance in objective scores.
Conclusion:
Parent-reported behavioral problems showed limited concordance with objective measures of response inhibition in children with SDB. Treatment decisions for pediatric SDB should not rely solely on parent-reported behavioral symptoms, highlighting the need for integrating objective assessments when feasible.
Level Of Evidence:
3.
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