Sleep Items in the Child Behavior Checklist: A Comparison With Sleep Diaries, Actigraphy, and Polysomnography

Abstract

Objective The Child Behavior Checklist is sometimes used to assess sleep disturbance despite not having been validated for this purpose. This study examined associations between the Child Behavior Checklist sleep items and other measures of sleep. Method Participants were 122 youth (61% female, aged 7 through 17 years) with anxiety disorders (19%), major depressive disorder (9%), both anxiety and depression (26%), or a negative history of any psychiatric disorder (46%). Parents completed the Child Behavior Checklist and children completed a sleep diary, wore actigraphs for multiple nights, and spent 2 nights in the sleep laboratory. Partial correlations ([pr], controlling for age, gender and diagnostic status) were used to examine associations. Results Child Behavior Checklist sleep items were associated with several other sleep variables. For example, “trouble sleeping” correlated significantly with sleep latency assessed by both diary (pr(113) = 0.25, p = .008) and actigraphy (pr(105) = 0.21, p = .029). Other expected associations were not found (e.g., “sleeps more than most kids” was not significantly correlated with EEG-assessed total sleep time: pr(84) = 0.12, p = .258). Conclusions Assessing sleep using the Child Behavior Checklist exclusively is not ideal. Nonetheless, certain Child Behavior Checklist items (e.g., “trouble sleeping”) may be valuable. Although the Child Behavior Checklist may provide a means of examining some aspects of sleep from existing datasets that do not include other measures of sleep, hypotheses generated from such analyses need to be tested using more rigorous measures of sleep.

Prior sleep problems predict internalising problems later in life

“…We studied a longitudinal sample of community-based children for a period of 18 years where prior sleep problems were measured independently from internalising symptoms and analyses were adjusted for pre-existing individual and familial characteristics. As in many epidemiological studies, our measure of sleep was based on a single CBCL sleep item, which is well correlated with sleep latency assessed by diary and actigraphic measures (Gregory et al, 2011). As others (Gregory et al, 2005;Gregory et al, 2008), we used parental perceptions of sleep problems, which could be different from polysomnographic sleep problems.…”

“…This questionnaire has previously been validated in France (Fombonne, 1991); (Stanger et al, 1994). As suggested by Gregory et al (Gregory et al, 2011), we used the most rigorous CBCL sleep item: "Does your child have sleep problems?" which has been shown to correlate with sleep latency assessed both by diary (P=.008) and actigraphic measures (P=.029).We considered sleep problems to be present when the parents reported them "sometimes" or "often" (vs. never).…”

Sleep Disturbance in Pediatric PTSD: Current Findings and Future Directions

“…In a sample of 122 children aged 7 to 17 years diagnosed with MDD, an anxiety disorder, or both, those who reported "trouble sleeping" were also more likely to have longer sleep onset latency as recorded by actigraphy. 62 Sadeh et al performed actigraphic measurements on 39 children (7 to 14 years old) in a psychiatric inpatient unit. The children were divided into 3 groups, those who had experienced physical abuse, sexual abuse, or no abuse.…”

“…54,55 In a sample of 122 youth, ages 7-17 years, with anxiety disorders (19%), major depressive disorder (MDD) (9%), both anxiety and depression (26%), or no history of any psychiatric disorder (46%), Gregory et al examined how sleep items in the CBCL corresponded to sleep measured via sleep diaries (4-6 days), actigraphy (1 week), and polysomnography (2 consecutive nights). 62 After controlling for age, gender, and diagnostic status, specific items (e.g. being overtired, sleeps less, sleeps more, and trouble sleeping items) correlated well with objective sleep measures of sleep latency and number of arousals.…”

“…However, some items did not correlate with objective measures; for example, "sleeps more" was not associated with total sleep time (TST) as assessed by objective polysomnography. 62 Overall, the CBCL can be a valuable tool in assessing broad sleep disturbance subjectively. However, similar to the PTSD scales mentioned above, the CBCL ultimately is not designed to thoroughly evaluate sleep, and thus cannot always provide important information on the source of sleep disturbances such as breathing related sleep disorders.…”