B – 49 Sleep Difficulties After Concussion: Do Parents and Adolescents Agree?

Abstract Objective Sleep difficulties after concussion may be underrecognized by caregivers, as prior research has shown parent-child disagreement for internalized symptoms like anxiety and fatigue. This study examined post-concussion agreement between parent and adolescent reports on the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (SD) and Sleep-Related Impairment (SRI) scales. We hypothesized that parent and adolescent reports would significantly differ. Method Data were from 316 adolescents aged 11-17 years (53.5% female) who underwent evaluation within 35 days of concussion as part of the NIH-funded CARE4Kids study. Participants and their parents completed the PROMIS pediatric and parent proxy versions of the SD and SRI scales. Agreement was assessed via intra-class correlation coefficients (ICCs) and comparisons of PROMIS cut point means. Results Dyad agreement was only fair for both scales, as ICCs fell below the threshold for "moderate” agreement levels. The ICC was 0.41 (95% CI [0.31, 0.50]), and 0.31 (95% CI [0.20, 0.40]) for the SD and SRI scores, respectively. Comparatively, parents reported fewer sleep concerns for their adolescent, as 65.8% of the parent SD and SRI proxy scores fell “within normal limits” compared to only 37.7% (SD) and 22.5% (SRI) of the adolescent scores. Conclusion Parent proxy reports of their adolescent’s sleep following concussion can differ significantly from adolescent reports. The finding that parents may underestimate their adolescent’s perceived sleep difficulties shows the importance of gathering multi-informant data when assessing post-concussive symptoms and tailoring sleep-related interventions in pediatric concussion care.