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Modified Children's sleep habits questionnaire for behavioral sleep problems: A validation study
Karen A Bonuck1, Beth L Goodlin-Jones2, Clyde Schechter1
1Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.
Insights
A new short-form Children's Sleep Habits Questionnaire (SF-CSHQ) effectively screens for behavioral sleep problems in young children. This validated tool aids early identification and management of common childhood sleep issues.
Area of Science:
- Pediatric Sleep Medicine
- Child Psychology
- Behavioral Health Screening
Background:
- Behavioral sleep problems (BSPs) are common in young children and impact family well-being.
- Current screening tools may not adequately identify BSPs responsive to behavioral interventions.
- A validated, brief screening tool is needed to increase early identification and treatment capacity for BSPs.
Purpose of the Study:
- To develop and validate a short-form version of the Children's Sleep Habits Questionnaire (SF-CSHQ).
- To omit items not responsive to behavioral management strategies.
- To establish a threshold score for the SF-CSHQ corresponding to the full CSHQ clinical cut-off.
Main Methods:
- Re-analysis of existing datasets (4-10 year olds and 24-66 month olds).
- Development of a 23-item SF-CSHQ by excluding "medically-based" sleep items from the original 33-item CSHQ.
- Statistical analysis to determine the SF-CSHQ threshold and assess its validity against the full CSHQ cut-off.
Main Results:
- A threshold score of 30 on the SF-CSHQ demonstrated high correlation (0.90-0.94) with the original CSHQ cut-off (≥41).
- The 23-item SF-CSHQ effectively discriminated between children with and without parent-reported behavioral sleep problems.
- The SF-CSHQ also distinguished children with and without prolonged sleep latency, as measured by actigraphy.
Conclusions:
- Preliminary validity of the modified SF-CSHQ was established.
- The SF-CSHQ offers a potentially valuable tool for expanding screening and initial guidance for behavioral sleep problems in young children.
- This tool can assist healthcare professionals, including those without specialized sleep medicine expertise, in identifying and addressing childhood BSPs.
Objectives:
Behavioral sleep problems (BSPs) are prevalent and consequential in young children. There is a need for screening tools that identify BSPs-which are often rooted in the parent-young child relationship-and typically respond to behavior management. Such a tool would increase capacity to identify and treat BSPs. We sought to validate a short-form version of the widely used Children's Sleep Habits Questionnaire (SF-CSHQ) that omitted items that would not be responsive to behavioral strategies.
Methods:
The original 33-item CSHQ elicits parent report of "behaviorally-based" and "medically-based" sleep items (eg, parasomnias and sleep disordered breathing). We conducted analyses to develop a SF-CSHQ that excludes its "medically-based" items, to determine (a) the SF-CSHQ threshold score corresponding to the full CSHQ clinical cut-off score (≥41), and (b) preliminary validity of this SF-CSHQ. Data were re-analyzed from the original data that established the CSHQ's psychometric properties in 4-10 year olds, and a second dataset that established its validity in 24-66 month olds.
Results:
In both datasets, a threshold score of 30 had correlations of 0.90-0.94 with the original cut-off. This 23-item SF-CSHQ cut-off functioned as well as the full CSHQ cut-off in discriminating between children with vs without a parent-reported behavioral sleep problem, and with vs without prolonged sleep latency (per actigraphy).
Conclusion:
We established preliminary validity of modified version of the widely-used CSHQ. This SF-CSHQ may be useful for widening screening and first-line guidance for behavioral sleep problems in young children, among professionals who are not sleep medicine specialists.
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