Equivalence and Agreement Between Child Self-Report and Parent Proxy Report of Vocal Symptoms: A Child–Parent Analysis of the QSV-ES-PY in School and Clinical Settings

Abstract

Introduction: Pediatric dysphonia is a common reason for speech-language pathology consultations and may impact communication, academic performance, and social participation. For a comprehensive assessment, the inclusion of the child’s own perspective through Patient-Reported Outcome Measures (PROMs) is recognized as essential, complemented by parent proxy reports to capture observable aspects of vocal functioning. Objective: To analyze the equivalence between child self-report and parent proxy report of vocal symptoms measured by the Paraguayan Spanish adaptation of the “Questionnaire des symptômes vocaux” (QSV-ES-PY), examining the degree of agreement and systematic discrepancies between informants in a mixed sample from school and clinical settings. Materials and Methods: An analytical cross-sectional study was conducted with 120 child–parent dyads (240 informants), comprising children aged 6 to 12 years recruited from school and clinical contexts. The child (QSV-N) and parent (QSV-P) versions of the QSV-ES-PY were administered independently. Statistical analyses included descriptive statistics for total and domain scores; paired child–parent comparison of the total score using the Wilcoxon signed-rank test and effect size (r); estimation of the intraclass correlation coefficient (ICC; two-way mixed model, consistency, single measures) for the total score and the physical, functional, and emotional domains; Spearman correlation between child and parent total scores; and Spearman correlations between parental scores and child vocal severity (dysphonia/euphonia). The study received ethical approval in Paraguay and Argentina, and informed consent and child assent were obtained. Results: Children reported significantly more vocal symptoms than their parents on the QSV-ES-PY total score (Z = −7.26; p < .001), with a large effect size (r = .66), indicating a clinically relevant discrepancy. Overall child–parent agreement was low (ICC = .27; 95% CI = .10–.43), and Spearman correlations showed a weak positive association between scores (ρ ≈ .22; p = .018). At the domain level, ICCs were also low (physical: .06; functional: .10; emotional: .13), with the emotional domain showing the relatively highest agreement within this pattern. Children obtained higher mean scores than parents across all three domains. Correlations between parental scores and child vocal severity were positive but weak in magnitude (ρ ≈ .19–.24), supporting the convergent validity of the parent version. Conclusions: The child and parent versions of the QSV-ES-PY may not be equivalent or interchangeable; agreement is low, and children systematically report more vocal symptoms than their parents. Child self-report appears more sensitive to internal symptoms and early manifestations, whereas parent proxy reports primarily reflect audible signs and observable behaviors. The complementary use of both versions is recommended in pediatric voice assessment in school and clinical contexts, integrating the child’s perspective with that of the responsible adult.