UC Merced

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.