Brief report: Measures of effectiveness for single-question sleep problem screeners in children with autism spectrum disorder

Background: Although screening for sleep problems in children with ASD is recommended, primary care providers generally ask parents a single, high-level screening question about their child's sleep. Can this capture whether a child has severe sleep problems? Method: Parents of children with ASD ages 3-17 years recruited from a validated and verified US-based autism research registry completed an online survey on co-occurring conditions, including "degree of sleep problems". The Composite Sleep Disturbance Index (CSDI) and its question on "parent satisfaction with current sleep pattern" were also incorporated. Results: 610 parent/child dyads were analyzed. 377 (62%) children had severe sleep problems per CSDI; 215 (57%) were parent-rated with Moderate/Severe sleep problems. 219 (93%) of 233 children without a severe sleep problem on CSDI were parent-rated as having None/Mild sleep problems. 94% with Moderate/Severe sleep problems per parents had severe sleep problems per CSDI. However, 15% of those whose parents rated as None had a severe sleep problem. 200 (33%) children had a Mild sleep problem rating; of these, 134 (67%) had CSDI severe sleep problem and 66 (33%) did not. Conclusions: A single question about sleep was good at classifying severe vs. non-severe sleep problems in children with ASD, especially with extreme responses. However, a single question was poor at classifying intermediate/non-extreme responses, and a significant number of children with severe sleep problems were missed. Screening with a short, validated questionnaire or asking more probing questions would assist in diagnosing most children with sleep problems. Parents may benefit from sleep education.