Sleep Intervention in Children With ASD

The Children's Sleep Habits Questionnaire (CSHQ) - parent report is a commonly used measure to assess sleep symptoms in children aged 4-12 years. It consists of 33 items to evaluate a child's sleep behavior over the past week. Items are rated on a 3-point scale to indicate the frequency of each sleep behavior: "usually/five to seven times per week," "sometimes/two to four times per week," and "rarely/zero to once per week." The CSHQ total score is the sum of the 33 questions and ranges from 33 to 99. Higher scores indicate more severe sleep disturbances.

The Social Communication Questionnaire, Current Form - parent report (SCQ-CF-PR) is a 40-item screening instrument designed to assess social communication deficits and repetitive behavioral patterns associated with autism spectrum disorder (ASD). This scale quantifies autistic characteristics aligned with the three core domains of impairment in ASD: communication, reciprocal social interaction, and restricted, repetitive, and stereotyped (RRS) behaviors. The SCQ-CF-PR yields a total raw score ranging from a minimum of 0 to a maximum of 40 points, with higher scores indicating greater severity of ASD-related social communication and behavioral impairments.

The Strengths and Difficulties Questionnaire (SDQ) - parent report is a 25-item instrument for measuring internalising and externalising problems in children and adolescents. It consists of five domains (emotional symptoms, conduct problems, hyperactivity/inattention, peer problems, and prosocial behaviours), with 5 items each rated on a three-point scale [0 ("not true") to 2 ("certainly true")]. The conduct problem and hyperactivity/inattention domains were grouped under the externalizing problem subscale (range 0-20), while the emotional symptoms and peer problems were grouped under the internalizing problem subscale (range 0-20). The total difficulties score is generated by summing the scores from the four problem scales (excluding Prosocial Behavior), yielding a range from 0 to 40. Higher scores indicate more problems, except that a higher prosocial score indicated better prosocial behaviours.

The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) - Parent Report is a 63-item questionnaire designed to assess executive functioning deficits in children and adolescents across everyday home and community settings. The scale generates nine clinical subscale raw scores and a single Global Executive Composite (GEC) raw score (the primary summary measure of overall executive functioning). All raw scores range from a minimum of 0 to subscale/maximum-specific maximum values (total GEC raw score: 0-189). Higher raw scores indicate greater severity of executive functioning impairments.

Pediatric Daytime Sleepiness Scale (PDSS) - parent report is an 8-item self-rated scale measuring daytime sleepiness, ranging in total scores from 0 to 32 with higher scores indicating more sleepiness.

The Pediatric Quality of Life Inventory 4.0 (PedsQL) - parent report is a validated 23-item measure of quality of life for children aged 2 to 18 years. Each item is rated on a 5-point Likert scale from "never" to "almost always" based on the behavior of child in the past month. The scores are transformed on a scale from 0 to 100, with a higher score indicating better quality of life.

Parent-reported child's daily sleep diary for consecutive seven days. Sleep diary derived parameters include: 1) time in bed (TIB) in hours. 2) total sleep time (TST) in hours. 3) sleep onset latency (SOL) in mins. 4) wake after sleep onset (WASO) in mins. 5) sleep efficiency (SE), which is calculated by total sleep time divided by total time in bed, %.

The child's sleep-wake pattern will be objectively measured by 7-day wrist actigraphy. Sleep parameter estimated by actigraphy will include time in bed, total sleep time, sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency.

Clinical Global Impression (CGI) Scale is a clinician-rated scale, comprised of two one-item subscales: Severity of Illness (CGI-S) subscale evaluating the severity of psychopathology, and Clinical Global Improvement Scale (CGI-I) evaluating change from the initiation of treatment. In both cases, the score is given on a seven-point scale, with higher values indicating higher severity of illness and larger improvement respectively.

Insomnia Severity Index (ISI) is a 5-item self-rated scale to measure insomnia symptoms. Possible scores range from 0 to 20, with higher scores indicating higher insomnia severity.

Pittsburgh Sleep Quality Index (PSQI) is a self-rated scale consisting of 19 questions. All items are combined to form seven component scores on different aspects of sleep quality, each of which ranges from 0 to 3 points with higher scores representing more sleep disturbance. The seven component scores are added to one global score, which ranges from 0 to 21, with higher scores indicating more difficulties with sleep.

Depression Anxiety Stress Scales-21 (DASS-21) consists of three self-report scales designed to measure the emotional states of depression, anxiety and stress. Each of the three DASS scales contains 7 items. Each subscale ranges from 0 to 21. Higher scores suggest more depression, anxiety and stress, respectively.

Parenting Stress Index-Short Form (PSI-SF) is a 36-item self-report measure designed to assess stress in the parent-child relationship, derived from the full Parenting Stress Index. It includes three subscales: Parental Distress (PD), Parent-Child Dysfunctional Interaction (PCDI), and Difficult Child (DC). Each subscale has 12 items rated on a 5-point Likert scale, amounting to a total score that ranges from 36 to 180. Higher scores indicate higher levels of stress in the parent-child relationship.

The World Health Organisation- Five Well-Being Index (WHO-5) consists of 5 self-report items designed to measure subjective well-being. Each item is rated on a 6-point scale from 0 ("at no time") to 5 ("all of the time"), resulting in a raw score range of 0 to 25. Higher scores indicate better well-being.

Daily sleep diary for consecutive seven days. Sleep diary derived parameters include: 1) time in bed (TIB) in hours. 2) total sleep time (TST) in hours. 3) sleep onset latency (SOL) in mins. 4) wake after sleep onset (WASO) in mins. 5) sleep efficiency (SE), which is calculated by total sleep time divided by total time in bed, %.

The parental sleep-wake pattern will be objectively measured by 7-day wrist actigraphy. Sleep parameter estimated by actigraphy will include time in bed, total sleep time, sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency.