Measures of Effectiveness for Single-Question Sleep Problem Screeners in Children with ASD

Background:

50-80% of children with ASD have sleep problems, which are associated behavioral issues and negatively affect well-being in both children and parents. Given this high prevalence and impact on child and family functioning, developing brief and rapid screeners for parents of children with ASD for sleep problems is important.

Objectives:

To evaluate the effectiveness of two single-question sleep issue screeners compared to the Composite Sleep Disturbance Index (CSDI).

Methods:

U.S.-based primary parents of children with ASD were recruited from a validated/verified national autism registry. Parents completed an online survey on co-occurring conditions that incorporated:

• The CSDI, a validated tool that scores the frequency/duration of six sleep habits (scored 0-2) over the previous month; total score range=0-12; score≥4 indicates a severe sleep problem.
• A seventh, non-scored, question on the CSDI asks how satisfied/dissatisfied the parent is with their child’s current sleep pattern (5-category Likert scale).
• A question about the degree to which the child had experienced sleep problems during the past 30 days (4-category Likert scale).

Results:

Demographics

610 parent/child dyads were analyzed. Responding parents were primarily female (94%), white (89%), and non-Hispanic (92%); mean age of 43.3 (SD 7.2; range 25-65) years. Children were primarily male (81%), white (84%), and non-Hispanic (88%); mean age of 12.1 (SD 3.6; range 3-17) years.

Distribution of Scores and Responses (See Table and Figure)

• CSDI scores, parental dissatisfaction, and severity of sleep problems were highly correlated, n=610, p=.000; CSDI-dissatisfaction: r=0.783; CSDI-degree sleep problems: r=0.734; dissatisfaction-degree sleep problems, r=0.750.
• 377 (62%) children had a CSDI score≥4.
• CSDI scores differed between age groups, χ²(2) = 12.292, p = 0.0021. Young children had higher CSDI scores than both school-age children (p=0.0033) and teens (p=0.0002); however, there was no difference between school-age children and teens (p=0.1571).
• 116 (19%) of parents were completely satisfied with their child’s current sleep pattern; of these, 109 (94%) had CSDI score<4. 246 (40%) were neither-satisfied-nor-dissatisfied or dissatisfied; of these, 235 (96%) had CSDI score≥4.
• 181 (30%) of parents indicated their child had no sleep problems; of these, 153 (85%) had CSDI score<4. 229 (38%) had moderate or severe sleep problems; of these, 215 (94%) had CSDI score≥4.

Evaluation

When intermediate categories (parent satisfaction/dissatisfaction=“mostly satisfied” and degree sleep problems=“mild”) were excluded, parent satisfaction/dissatisfaction compared to degree sleep problems proved to be a superior predictor of CSDI severe vs. non-severe sleep problems (satisfaction/dissatisfaction: PPV=96%, NPV=94%, LR+=10.59, LR-=0.03, J=88%; degree sleep problems: PPV=94%, NPV=85%, LR+=10.55, LR-=0.13, J=80%). It is notable that 54% of children whose parents are “mostly satisfied” with their child’s current sleep pattern have a severe sleep problem, and that 67% of children whose parents rate their child’s degree of sleep problems as “mild” have a severe sleep problem.

Conclusions:

Single-question sleep-issue screeners are useful as a preliminary screener for sleep problems. Children with ASD can generally be correctly categorized as having a severe vs. non-severe classification unless they have an intermediate response, such “mostly satisfied” or “mild” degree sleep of problems. Parents may benefit from education relating to recognition of sleep problems.