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The Child Sleep Habits Questionnaire in Children with Autism Spectrum Disorders

Friday, 3 May 2013: 14:00-18:00
Banquet Hall (Kursaal Centre)
T. Katz1, S. E. E. Goldman2, B. A. Malow2, A. M. Shui3, S. J. Asghar2, A. Bennett4, K. Byars5, H. Connolly6, D. Glaze7, S. E. Levy8, M. T. Ott9, I. Perez10, A. M. Reynolds1, K. Sohl11, M. C. Souders12, S. Weiss13 and M. Witmans14, (1)University of Colorado Denver, Aurora, CO, (2)Vanderbilt University, Nashville, TN, (3)Biostatistics Center, Massachusetts General Hospital, Boston, MA, (4)Children's Hospital of Philadelphia, Philadelphia, PA, (5)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (6)University of Rochester Medical Center, Rochester, NY, (7)Baylor College of Medicine, Houston, TX, (8)Divsion of Child Development, Children's Hospital of Philadelphia, Philadelphia, PA, (9)Division of Child Development, Children's Hospital of Philadelphia, Philadelphia, PA, (10)Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, (11)University of Missouri - Thompson Center, Columbia, MO, (12)University of Pennsylvania School of Nursing/The Children's Hospital of Philadelphia, Philadelphia, PA, (13)Hospital for Sick Children, University of Toronto, Toronto, ON, Canada, (14)University of Alberta and Stollery Children's Hospital, Edmonton, AB, Canada
Background:   The Child Sleep Habits Questionnaire (CSHQ) asks caregivers to describe their children’s sleep behaviors. The CSHQ has been validated for typically developing children ages 4-10 (Owens, Spirito, McGuinn, 2000), but there is little research examining its psychometric properties in children with autism spectrum disorders (ASD). 

Objectives: To examine the factor structure, sensitivity, and specificity of the CSHQ in children with ASD from ages 2 to 17.

Methods: We analyzed data from children enrolled in the Autism Treatment Network (ATN) Registry.  Parents of children ages 2 to 17 who had clinical diagnoses of ASD (based on DSM-IV criteria) confirmed by the Autism Diagnostic Observation Schedule and a DSM-IV interview completed the CSHQ.  The sample was divided into three age groupings:  954 children ages 2-3, 2036 children ages 4-10, and 397 children ages 11 to 17.  Cut-off values for sensitivity and specificity of the CSHQ were determined using published normative data (Owens, et al) and ROC analyses of the ATN data.  The factor structure of the CSHQ was examined in each of the three age groups specified. 

Results:   After first identifying poor sleepers by parent report of sleep concerns on an intake questionnaire,  ROC analysis of the CSHQ indicated that cut-off scores for optimal sensitivity and specificity fell within the range of 47-50 (ages 2-3), 46-55 (ages 4-10), and 44-46 (ages 11 to 17).  We used a cut-off score of 47 for all three groups.  Specificity was higher in all three groups when compared with the published cut-off score of 41 (51.48 vs. 81.03 for ages 2-3; 50.57 vs. 79.16 for ages 4-10, and 62.31 vs. 86.15 for ages 11 to 17.)  Increasing the cut-off score decreased sensitivity (89.87 vs. 74.05 for ages 2-3; 90.94 vs. 66.96 for ages 4-10, and 83.21 vs. 67.18 for ages 11 to 17.)  We examined a 2 and 3 factor solution of the CSHQ. Bedtime Resistance and Sleep Anxiety had the highest loadings for both the 2 and 3 factor solution for all three groups.  Night Wakings also loaded onto the first factor in the 2 factor solution for children ages 11+.  Depending on the age grouping and number of factors, Parasomnias, Sleep-Disordered Breathing, Sleep Onset Delay, Night Wakings, Sleep Duration, and Daytime Sleepiness loaded onto either the second or third factor for the 2 or 3 factor solutions.

Conclusions: Based on our findings, a cut-off score of 47 greatly increases the specificity of the CSHQ. Factor analyses indicate that insomnia questions as well as questions related to other sleep difficulties (such as sleep disordered breathing and Parasomnias) are important for all age groups.

This research was conducted as part of the Autism Speaks Autism Treatment Network. Further support came from a cooperative agreement (UA3 MC 11054) from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program, to the Massachusetts General Hospital. The views expressed in this publication do not necessarily reflect the views of Autism Speaks, Inc.

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