Neuropsychology · 2025
Psychometrics of a fear-avoidance measure adapted for youth with persistent postconcussive symptoms: Fear of Concussive Symptoms Questionnaire (FOCSQ) child and parent-proxy versions.
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Chrisman Sara P D, Zhou Chuan, Sahlberg Jordan, Bollinger Beth J, Hansen Colby, Mendoza Jason A, Brooks M Alison, Rivara Frederick P, Palermo Tonya M
Аннотация
OBJECTIVE: This article aimed to examine the psychometric properties of a measure of youth fear-avoidance of concussive symptoms.
METHOD: Fear-avoidance is thought to be a risk factor for prolonged concussion recovery; however, current measures of fear-avoidance focus on pain rather than broader symptoms. We adapted the Fear of Pain Questionnaire to be relevant to concussion symptoms with a new version called the Fear of Concussive Symptoms Questionnaire (FOCSQ). We assessed the psychometrics of this scale with a sample of N = 115 youth with persistent postconcussive symptoms (Mage = 15.1 years, 58% female, 70% non-Hispanic White, 15% Hispanic, M = 79.2 days since injury), including reliability, construct validity, and cross-informant reliability.
RESULTS: Exploratory factor analysis suggested a two-factor model was a good fit for youth report (fear and avoidance) and a three-factor model for parent proxy (fear, school/social avoidance, and movement avoidance). Reliability was excellent, with Cronbach's α for both youth report and parent proxy of 0.93 (95% CI [0.91, 0.95]). Construct validity indicated moderate correlation between youth-report FOCSQ and concussive symptoms 0.55 (95% CI [0.41, 0.66]), headache severity 0.37 (95% CI [0.19, 0.53]), depression 0.62 (95% CI [0.49, 0.72]), and anxiety 0.64 (95% CI [0.51, 0.73]). Criterion-related validity was supported by an inverse correlation between FOCSQ and the Pediatric Quality of Life Inventory: -0.64 (95% CI [-0.74, -0.52]). Youth report and parent proxy were moderately correlated, with Pearson's correlation coefficient r = 0.60 (95% CI [0.47, 0.71]).
CONCLUSIONS: The FOCSQ is a reliable and valid measure of fear-avoidance in youth with concussion, and future research might explore whether this measure could be used to identify youth at risk for prolonged recovery. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
METHOD: Fear-avoidance is thought to be a risk factor for prolonged concussion recovery; however, current measures of fear-avoidance focus on pain rather than broader symptoms. We adapted the Fear of Pain Questionnaire to be relevant to concussion symptoms with a new version called the Fear of Concussive Symptoms Questionnaire (FOCSQ). We assessed the psychometrics of this scale with a sample of N = 115 youth with persistent postconcussive symptoms (Mage = 15.1 years, 58% female, 70% non-Hispanic White, 15% Hispanic, M = 79.2 days since injury), including reliability, construct validity, and cross-informant reliability.
RESULTS: Exploratory factor analysis suggested a two-factor model was a good fit for youth report (fear and avoidance) and a three-factor model for parent proxy (fear, school/social avoidance, and movement avoidance). Reliability was excellent, with Cronbach's α for both youth report and parent proxy of 0.93 (95% CI [0.91, 0.95]). Construct validity indicated moderate correlation between youth-report FOCSQ and concussive symptoms 0.55 (95% CI [0.41, 0.66]), headache severity 0.37 (95% CI [0.19, 0.53]), depression 0.62 (95% CI [0.49, 0.72]), and anxiety 0.64 (95% CI [0.51, 0.73]). Criterion-related validity was supported by an inverse correlation between FOCSQ and the Pediatric Quality of Life Inventory: -0.64 (95% CI [-0.74, -0.52]). Youth report and parent proxy were moderately correlated, with Pearson's correlation coefficient r = 0.60 (95% CI [0.47, 0.71]).
CONCLUSIONS: The FOCSQ is a reliable and valid measure of fear-avoidance in youth with concussion, and future research might explore whether this measure could be used to identify youth at risk for prolonged recovery. (PsycInfo Database Record (c) 2026 APA, all rights reserved).