B-123: Feeling Foggy, Testing Fine? Subjective-Objective Incongruence in Pediatric Patients With Persisting Symptoms Following Concussion
Abstract
Objective: Subjective cognitive complaints following pediatric concussion are common, yet links to objective neurocognitive performance remain unclear. Adult literature demonstrates weak associations between subjective and objective cognition, with stronger ties to psychological factors. We examined similar incongruence in pediatric concussion and associations between symptom reporting, perceived exertion, time since injury, and psychosocial factors. Method/Data Selection: Participants included 72 youth (ages 5-17) evaluated in an outpatient concussion clinic 2-12 months post-mTBI (GCS≥13). The Post-Concussion Symptom Inventory (PCSI) and the Children’s Exertional Effects Rating Scale (ChEERS) indexed subjective symptoms. Objective measures assessed brief attention, working memory, verbal fluency, and rote verbal memory. Correlations and t-tests examined associations with time since injury, psychotherapy referral, and preinjury anxiety/depression. Results/Data Synthesis: Subjective cognitive symptoms were not significantly associated with objective neurocognitive performance (all p>.05). PCSI cognitive change was associated with self-reported pre- (r=.47, p=.016) and post-exertion (r=.54, p=.004) concentration difficulties. Days since injury was positively associated with symptom change (r=.37, p=.046), post-exertion concentration difficulties, and psychotherapy referral (r=.34, p=.004). Youths with preinjury anxiety/depression reported significantly higher PCSI cognitive symptoms at the time of visit compared to those without, t(29)=-2.79, p=.009, but no significant difference was found when pre-injury symptoms were accounted for t(28)=-1.175, p=.13. Conclusions: Findings demonstrate incongruence between subjective cognitive symptoms and objective cognitive performance in pediatric concussion patients with persisting symptoms. Results highlight the clinical importance of considering preinjury ratings of symptoms due to significant overlap in post-concussion and mental health symptomatology. Neuropsychologists are uniquely positioned to provide multimodal assessment and consider the role of psychological factors when assessing functional recovery post-concussion.