B – 29 Associations Between Self-Reported Cognitive Symptoms and Cognitive Performance Testing in Pediatric Concussion

Abstract Objective The extant literature shows inconsistent associations between self-reported cognitive complaints and neurocognitive test performance following concussion. Characterizing this relationship is needed because discrepancies may lead to under-treatment or over-medicalization of distress-driven symptoms. This analysis examined the association between self-reported cognitive symptoms and cognitive performance testing in a large cohort of concussed youth as part of the CARE4Kids longitudinal study. Method The sample included 324 symptomatic concussed youth aged 11 to 17 years evaluated 7–35 days post-injury. Self-reported pre-injury and post-injury cognitive symptoms (attention, memory, processing speed, mental fog) were measured by the PCSI-2 (Post Concussion Symptom Inventory, 2nd Ed) producing the Retrospective Adjusted Post-Injury Difference (RAPID) score which represents the injury-related symptom load. Cognitive performance was measured by various subtests of the NIH Toolbox measuring attention, processing speed, memory, executive functions, vocabulary knowledge. Results A consistent pattern of statistically significant, inverse associations was found between the cognitive performance tests and self-reported pre-injury and post-injury symptom reports, but these associations yielded negligible effect sizes, ranging from η2 of .01 to .04. Notably, these associations were absent when cognitive performance tests were correlated with the injury-related symptom load (RAPID scores). Conclusion Self-reported cognitive symptoms are negligibly associated with cognitive performance measures in concussed youth, with this discrepancy even more apparent when injury-specific symptom burden is evaluated. These results underscore the importance of using clinical judgement when considering both self-reported and performance data in the assessment of post-concussive cognitive functioning to guide psychoeducation, treatment planning, and research.