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Background  This study aimed at investigating the possible confounding effect of children’s gender on the parents’ dyads perception of their child HRQoL at both item and scale levels of PedsQL TM 4.0 questionnaire.    Methods  The PedsQL™ 4.0 Generic Core Scales were completed by 573 children and their father-and-mother dyads. An iterative hybrid ordinal logistic regression/item response theory model with Monte Carlo simulation was used to detect differential item functioning (DIF) invariance across mothers/fathers and daughter/sons.    Results  Assessing DIF across mother–daughter, father–daughter, mother–son, and father–son dyads revealed that although parents and their children perceived the meaning of some items of PedsQL TM 4.0 instrument differently, the pattern of fathers’ and mothers’ report does not vary much across daughters and sons.    Conclusion  In the Persian version of PedsQL TM 4.0, the child’s gender is not a confounding factor in the mothers’ and fathers’ report with respect to their daughters’ and sons’ HRQoL. Hence, paternal proxy-reports can be included in studies, along with maternal proxy-reports, and the reports can be combined short of concerning children gender, when looking at parent–child agreement.

health and quality of life outcomes

Assessing the effect of child’s gender on their father–mother perception of the PedsQL™ 4.0 questionnaire: an iterative hybrid ordinal logistic regression/item response theory approach with Monte Carlo simulation