Related Experiment Video
Updated: Jan 16, 2026
Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression
Published on: April 26, 2024
LEKSHIA-Sleep Disturbance Scale for Children: A simplified and culturally adapted pediatric sleep screening tool for
Lekshmy S R Nair1, Sageena George
1Department of Pediatric and Preventive Dentistry, PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India.
Insights
A new 10-item pediatric sleep screening tool, LEKSHIA-SDSC, was developed for community health workers in India. This culturally adapted instrument effectively screens children
Area of Science:
- Pediatric Sleep Medicine
- Global Health
- Health Screening Tools
Background:
- Children's sleep disturbances are poorly understood in community settings with limited access to specialized care.
- The existing Sleep Disturbance Scale for Children (SDSC) is lengthy and may be challenging for frontline healthcare providers.
- There is a need for a brief, culturally appropriate screening tool for pediatric sleep issues in diverse populations.
Purpose of the Study:
- To develop LEKSHIA-SDSC, a streamlined, 10-item version of the SDSC.
- To create a culturally appropriate tool in English and Malayalam for Indian community health workers.
- To facilitate early identification of pediatric sleep disturbances in community settings.
Main Methods:
- A two-phase modification process based on the SDSC's established structure, reliability, and validity.
- Phase I involved expert-guided item reduction, literacy-focused rewording, and resequencing based on behavioral observability.
- Phase II adapted the Malayalam SDSC, requiring minimal rewording based on caregiver feedback for clarity and contextual fit.
Main Results:
- The LEKSHIA-SDSC is a 10-item tool with a 4-point Likert scale (0-3), yielding a score range of 0-30.
- Revised risk thresholds are: 0-8 (low risk), 9-15 (mild risk), and ≥16 (high risk).
- The tool demonstrated strong content validity (CVI ≥0.78), high inter-rater agreement (Kappa >0.85), and positive caregiver feedback on usability in low-literacy environments.
Conclusions:
- LEKSHIA-SDSC is a simple, culturally appropriate pediatric sleep screening instrument.
- It is suitable for integration into routine community health screening initiatives.
- This tool can improve the identification and management of sleep disturbances in children within community settings.
Background:
Children's sleep disturbances are not well understood, especially in the community settings where access to specialized care is limited. Although thorough, the Sleep Disturbance Scale for Children (SDSC) might be too difficult for frontline healthcare providers to administer. The purpose of this study was to develop LEKSHIA-SDSC, a streamlined and culturally appropriate 10-item version of the SDSC, available in both English and Malayalam, and specifically designed for use by Indian community health workers.
Methodology:
A two-phase modification process was carried out building on the SDSC's previously established factorial structure, interrater reliability, and content validity. Expert-guided item reduction, literacy-focused rewording, and behavioral observability-based resequencing (from sleep onset to daytime symptoms) were all carried out in Phase I. In Phase II, the previously created Malayalam version of the SDSC was adapted for the shortened tool. As the original translation had undergone forward-backward translation, expert review, and cognitive debriefing, only minimal rewording of two items was required based on fresh caregiver feedback to improve clarity and contextual fit.
Results:
The final LEKSHIA-SDSC tool has 10 streamlined items with a 4-point Likert scale (0-3), resulting in a score range of 0-30. The definitions of risk thresholds were changed to 0-8 (low risk), 9-15 (mild risk), and ≥ 16 (high risk). Strong prior content validity (item-level content validity index ≥0.78) and high inter-rater agreement (Kappa > 0.85) were demonstrated by the items that were kept. Caregivers' comments affirmed the tool's usability and suitability for low-literacy environments.
Conclusion:
LEKSHIA-SDSC is a simple and culturally appropriate pediatric sleep screening instrument that can be incorporated into regular community health screening initiatives.
Related Concept Videos
01:27Insomnia
Multiple factors contribute...
01:24Substance Use Disorders Affecting Sleep
Understanding the concepts of physical dependence,...
01:13Insufficient Sleep and Sleep Deprivation
Sleep deprivation is a more severe form of sleep loss...