Associations between subjective cognitive difficulties, cognitive test performance, psychiatric symptoms, and quality of life in pediatric long COVID

Objective: This retrospective study examined the associations between subjective cognitive difficulties, performance scores on standardized cognitive tests, and quality of life (QoL) among pediatric patients with long COVID. Method: This study included 82 pediatric patients with long COVID referred for a neuropsychological evaluation by a specialty pediatric Post-COVID clinic (50 F, M_age = 14.52 years, SD = 3.04, range = 6-19). Patients completed standardized neuropsychological assessments of intellectual functioning, learning/memory, working memory, auditory attention, processing speed, executive function, and performance validity, as well as the Pediatric Quality of Life Inventory (PedsQL^TM). Other outcomes of interest included subjective cognitive impairment and psychiatric symptoms. Relationships between subjective cognitive difficulties and cognitive performance on QoL were analyzed using hierarchical multiple linear regressions, with COVID course factors and psychiatric symptoms as covariates. Results: Our pediatric cohort reported very low overall QoL (M = 52.41, SD = 16.95), with the average score surpassing the published clinical cutoff for children with major chronic health conditions. Subjective cognitive difficulties significantly predicted lower QoL, even after controlling for psychiatric symptoms. Cognitive test performance on any domain did not significantly determine QoL. Conclusions: These findings offer initial support that subjective cognitive difficulties, but not cognitive test performance, significantly correlate with lower QoL in pediatric patients with long COVID. The results highlight the importance of screening for perceived subjective cognitive impairment beyond mental health screening in youth with long COVID. Treatment and school planning for children with long COVID should consider self-reported cognitive difficulties and psychological health and how these impact their daily functioning across home, school, and social settings.