Comparative accuracy of sleep disturbance questionnaires in children with autism spectrum disorder: a receiver operating characteristic study

OBJECTIVE: The aim of this study was to investigate the comparative effectiveness of various sleep and wakefulness scales used in children and their usefulness for children with autism spectrum disorder (ASD). DESIGN: Cross-sectional observational study. SETTING: The study was conducted at the Department of Child and Adolescent Psychiatry, University of Health Sciences Research and Training Hospital, Antalya, Türkiye, which serves as a regional referral centre for children and adolescents with developmental and behavioural disorders. PARTICIPANTS: A total of 230 children participated in the study, including 155 children diagnosed with ASD and 75 typically developing peers, aged between 4 and 18 years. PRIMARY OUTCOME MEASURES: Sleep-wake disorders were assessed using five questionnaires: the Children's Sleep Habits Questionnaire (CSHQ), Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), Paediatric Daytime Sleepiness Scale (PDSS), Paediatric Sleep Questionnaire (PSQ) and Sleep Disturbance Scale for Children (SDSC). These tools evaluated sleep patterns, daytime sleepiness, and sleep-related behavioural problems based on caregiver reports. RESULTS: The mean age of children with ASD and the typically developing peer group was 9.0±3.69 years and 9.07±4.25 years respectively. The CSHQ, ESS-CHAD, PDSS, PSQ and SDSC all demonstrated discriminant validity and internal consistency in the assessment of sleep-wake disorders in children with ASD (p<0.05, Cronbach's alpha >0.60). The CSHQ and SDSC showed similar levels of diagnostic accuracy in detecting sleep disorders. The PSQ had a high positive predictive value, the PDSS demonstrated a high negative predictive value and the ESS-CHAD showed a high level of agreement. CONCLUSIONS: A combination of tools such as the CSHQ, ESS-CHAD, PDSS, PSQ and SDSC may be useful for assessing sleep-wake disorders in children with ASD.