Examining Caregiver-Adolescent Symptom Agreement and Its Influence on Treatment Outcomes: A Quantitative Analysis

Elizabeth Kroll^1*Sara Hessdorf²Alyson Brandis²Klint Kanopka³Jonathan Kohlmeier¹Hannah Heard¹Izabella Zant¹Stephanie Stolzenbach¹Caroline Fenkel¹

• ¹Charlie Health, Inc., Bozeman, United States
• ²New York University, New York, United States
• ³New York University Steinhardt School of Culture Education and Human Development, New York, United States

Caregivers play an essential role in identifying and interpreting adolescent mental health symptoms, yet their perspectives often differ from those of adolescents themselves. These discrepancies can impact treatment engagement and outcomes, underscoring the importance of understanding what factors influence agreement. This study examined baseline depression and anxiety symptom reports from 763 caregiver-adolescent dyads enrolled in a virtual intensive outpatient program. Agreement between adolescent self-reports and caregiver proxy reports was assessed, and potential moderating variables including adolescent age, gender identity, race, neurodivergence, caregiver well-being, and family functioning. Additionally, analyses explored whether agreement predicted treatment outcomes. Results indicated a low to moderate correlation between caregiver and adolescent reports overall (CCC = 0.215). Within this sample, adolescents identifying as non-binary showed the largest discrepancies, more often rating their symptoms as more severe than their caregivers did., Higher family functioning was associated with reduced directional disagreement for depression, but this relationship was not observed for anxiety. Interestingly, dyads in which caregivers reported higher symptom severity than adolescents themselves showed greater symptom improvement by discharge. However, agreement levels did not significantly predict whether treatment was completed. These findings highlight that informant discrepancies are both common and clinically meaningful, particularly among gender-diverse adolescents and families reporting lower functioning.Although alignment in symptom perception did not impact treatment completion rates, caregiver perceptions of higher severity were linked to greater reductions in adolescent depression and anxiety symptoms. Incorporating caregiver perspectives into assessment and treatment planning may improve outcomes, particularly in high-acuity virtual care settings. Future research should explore mechanisms by which caregiver engagement influences symptoms over time.