The Children's Sleep Habits Questionnaire: Evaluating Subscales for Sleep Problems in Children with Autism Spectrum Disorder
Objectives: We aimed to explore the basic psychometric properties of CSHQ subscales in a sample of children with ASD. We further aimed to determine whether these subscales were useful in screening pediatric sleep problems.
Methods: This study included 41 children with ASD between the ages of 2-10 (M= 5.5). Caregivers completed the CSHQ as part of a larger study of sleep and behavior in the context of early intervention. The CSHQ includes 33 parent-report items with eight empirically derived subscales (Owens et al. 2000). This measure was recently validated in children ages 2-5, resulting in five subscales for use in toddlers and pre-school aged children (CSHQ-T; Sneddon et al., 2013). Children were first grouped into ‘sleep problem’ and ‘non-problem’ categories via parent reports at time of enrollment (Does your child have a sleep problem?). Using data from published validation studies (Owens et al., 2000; Sneddon et al., 2013), mean subscale scores for the ‘sleep problem’ group were compared to a clinical sample, and mean subscale scores from the ‘non-problem’ group were compared to a community sample. Differences between samples were evaluated using Welch’s t tests.
Results: Cronbach’s alpha ranged from .64 to 1.00 for Owens’ subscales, and .78 to 1.00 for the CSHQ-T. When comparing Owens’ community sample with the ‘non-problem’ group, two subscales were significantly different (p < .05): Parasomnias and Daytime Sleepiness (Table 1). In this comparison, mean subscale scores were higher in the ‘non-problem’ group than the community sample. When comparing Owens’ clinical sample with the ‘sleep problem’ group, only sleep duration was significantly different (p < .01). Duration difficulties (mean scores) were higher in our ‘sleep problem’ group than the clinical sample (Table 1). Finally, two subscales differed significantly when comparing the CSHQ-T community sample and the ‘non-problem’ group, with higher mean scores in the ‘non-problem’ group. However, there were no significant differences between our ‘sleep problem’ group and the clinical sample (Table 2).
Conclusions: This work contributes to a growing body of literature on sleep problems in children with ASD. Specifically, this is the first known study to explore basic psychometric properties of the CSHQ-T in a sample of children with ASD, including statistical comparisons with published clinical and community samples. Overall, both sets of subscales had acceptable psychometric properties and accurately distinguished between problem and non-problem sleepers in our sample. Significantly higher scores for children in the ‘non-problem’ group compared to community samples may reflect under-reporting of ASD sleep problems at time of enrollment. Future directions include validating the CSHQ-T with a larger, representative sample of children with ASD.