Pediatric Composite Autonomic Symptom Score-Caregiver Questionnaire (Ped-COMPASS-CQ): a new Italian tool for the assessment of dysautonomy in children

Objective To obtain the standardization and validation of Ped-COMPASS-CQ (Pediatric Composite Autonomic Symptom Score - Caregiver Questionnaire); this new tool was formulated to assess the autonomic symptom profile in the pediatric population. Specifically, we started with the validated COMPASS-31 questionnaire and adapted it for caregiver completion. We added questions to explore additional dysautonomic symptoms not covered in the original questionnaire, including headache, sleep disturbance, neuropathic pain, fatigue, and thermoregulation. Methods We recruited 1888 caregivers of children aged between 5 and 16 years in the period from August 2022 to February 2024. In order to develop a statistically valid instrument, we corroborated the internal structure of the questionnaire through a confirmatory factor analysis; the construct validity of the questionnaire was also confirmed through generalized linear regression models. The internal consistency of the subscales was analyzed by estimating the Cronbach's Alpha as well as by computing Spearman's inter-scale and item-scale correlation coefficients. Results We obtained the standardized reference values of the general population of children, expressed as mean and standard deviation in each autonomic domain and in the total score of the questionnaire. Conclusion Ped-COMPASS-CQ seems to be a sensitive tool for early detection of autonomic dysfunction in children, easy to use and with a low economic impact. The scores obtained represent a starting point to study the function of the autonomic nervous system in pediatric subjects. It could be an ecological tool to be adopted as a first approach to the symptomatic patient with dysautonomia or for monitoring an autonomic dysfunction.