Some sleep questionnaires focus specifically on sleep initiation, maintenance, and quality. The Children’s Sleep Wake Scale (LeBourgeois & Harsch, 2001) is a 40-item, 1 month retrospective parent report measure that has five subscales: going to bed, falling asleep, awakening, reinitiating sleep, and wakefulness. It is designed for children ages 2–8 years of age. LeBourgeois has also developed an adolescent self-report measure of sleep initiation and maintenance (LeBourgeois, Giannotti, Cortesi, Wolfson, & Harsh, 2005). The Adolescent Sleep Wake Scale is a 28-item questionnaire designed for adolescents ages 12–18; it is a 1-month retrospective report that includes 28 items. There are five subscales: going to bed, falling asleep, awakening, reinitiating sleep, and wakefulness.

The Family Inventory of Sleep Habits (FISH) (Malow et al., 2009) is specifically designed for parents of children with ASD ages 4–10. It is the only sleep measure geared toward children with ASD. The items on the FISH assess daytime behaviors that may influence sleep and are amenable to change. Thus, the measure may yield information that can guide behavioral intervention. The items address daytime habits (such as exercise, or caffeine intake later in the day), pre-bedtime habits (including engagement in stimulating activities), sleep setting (amount of light and noise in the bedroom), presence (or lack) of a bedtime routine, and parental behaviors (such as remaining with a child until he or she is asleep.) Some of the items focus on sleep behaviors that are particularly relevant for children with ASD such as needing to wear pajamas made from certain fabrics. For each item the parent is asked to indicate how often the behavior was true during the last month on a five-point scale (1 = never, 2 = occasionally, 3 = sometimes, 4 = usually, 5 = always.) The FISH has been validated as a 12-item scale, although a full version contains 22 items.

Other sleep habits questionnaires are not specifically geared toward children with ASD, but can still provide important information. The Children’s Sleep Hygiene Scale (Harsh, Easley, & LeBourgeois, 2002; LeBourgeois & Harsch, 2001) and the Bedtime Routines Questionnaire (Henderson & Jordan, 2010) are also brief surveys that provide information about bedtime routines and activities and the sleep environment. Both of these questionnaires are parent-report measures for parents of children ages 2–8. The Adolescent Sleep Hygiene Scale (Storfer-Isser, LeBourgeois, Harsh, Tompsett, & Redline, 2013) is an adolescent-report measure for individuals ages 12–18; it was modified from the Children’s Sleep Hygiene Scale and examines behaviors that may interfere with good sleep. These include consumption of caffeine close to bedtime and level of activity before bed.

At times it may be important to specifically assess daytime sleepiness. This may be especially important when examining behaviors that may be indicative of sleep-disordered breathing . Behaviors that may be indicative of sleepiness (versus just being tired) during the day may include falling sleep during daytime activities and overall level of alertness. The Pediatric Daytime Sleepiness Scale (Drake et al., 2003; Nixon, Wawruszak, Verginis, & Davey, 2006) has been validated in children ages 5–15 years of age. It is an 8-item self-report measure that includes questions related to drowsiness, alertness, feeling the need for more sleep, and daytime hyperactivity. The Epworth Sleepiness Scale (Johns, 1991) was first designed as a measure for adults. A modified version for adolescents, The Epworth Sleepiness Scale-Revised for Children , (Melendres, Lutz, Rubin, & Marcus, 2004; Moore et al., 2009) assesses behaviors that are more applicable to teens than to adults. For example, there are items that look at sleepiness while taking a test. This questionnaire may be completed by parents or by adolescents and is designed for children and adolescents from age 2 to 18 years. The Cleveland Adolescent Sleep Questionnaire (Spilsbury, Drotar, Rose, & Redline, 2007) is a self-report measure for teens ages 11–17 years of age. Owens and her colleagues have also developed a teacher-survey, The Teacher’s Daytime Sleepiness Questionnaire, (Owens, Spirito, McGuinn, & Nobile, 2000) to assess classroom behaviors of children ages 4–10 years that may be indicative of poor sleep.

Lewandowski, Toliver-Sokol, and Palermo (2011) and Spruyt and Gozal (2011) provide excellent reviews of parent and child-report sleep measures . They describe a number of limitations of these measures and note that most of these measures need additional information regarding reliability and validity. As noted above, most of these measures have not been validated for use with individuals who have ASD. Additionally, they have not been validated across diverse cultures or ethnic groups. When used clinically, it is important to review responses to survey questions in person to better understand and confirm any sleep difficulties that may be present.

In addition to using surveys that focus exclusively on sleep and sleep-related behavior, clinicians and researchers may use questionnaires that look at a variety of daytime behaviors and also provide some information about sleep. Clinicians may find these questionnaires helpful as an initial screening tool although they will not cover all aspects of sleep that should be examined.

The Child Behavior Checklist (Achenbach & Rescoria, 2000) is a parent-report measure of childhood behavioral difficulties including symptoms that are consistent with an ASD diagnosis. It is the most common screening measure for psychopathology that is used by pediatric psychologists (Holmbeck et al., 2008). Children are rated in terms of internalizing and externalizing behavior; similar questions are grouped into a number of subscales or syndrome scales. There is a version for preschoolers (ages 18 months to 5 years) and a version for children ages 6–18 years of age. The preschool version includes a scale for sleep problems that includes 7 items (does not want to sleep alone, has trouble getting to sleep, nightmares, resists going to sleep, sleeps less than most children during day and/or night, talks or cries out in sleep, wakes often at night.) The CBCL for ages 6–18 includes multiple items that assess various aspects of sleep, but these items do not form a validated sleep scale on the CBCL. The 7 items include nightmares, overtired without good reason, sleeps less than most kids, sleeps more than most kids during the day/or night, talks or walks in sleep, trouble sleeping, and wets the bed. Parents rate their children for how true each item is currently or within the past 6 months using a 3 point scale (0 = not true, 1 = somewhat or sometimes true, 2 = very true or often true.) Research has supported the use of the CBCL as a tool in epidemiological or archival studies that do not include a more comprehensive sleep measure . It may also be useful for clinicians who do not use other validated sleep measures in their practice (Becker, Ramsey, & Byars, 2015). Becker et al. found that individual CBCL items were generally associated with sleep scales on validated sleep measures and with sleep disorder diagnoses. The CBCL sleep composite was associated with total scores on other sleep-specific measures. Some (but not all) CBCL items are also associated with other measures of sleep. For example, the item “trouble sleeping” has been found to be correlated with sleep information obtained from diaries as well as actigraphy data (Gregory et al., 2011). While the CBCL does not cover important aspects of sleep difficulties (including medical comorbidities) and will not provide a thorough evaluation of sleep problems, it does provide the opportunity to have standardized sleep scores for younger children and to directly compare sleep problems to daytime behavior.

Other measures of daytime behavior also include some sleep items. Some of these measures are: the Behavior Assessment System for Children, Second Edition (Reynolds & Kamphaus, 2004), which includes 2–4 items depending on the age of the child being assessed; the Child Depression Inventory (Kovacs, MHS, & Systems, 2003) which includes 2 items; the Pediatric Quality of Life (Varni, Burwinkle, Seid, & Skarr, 2003) which includes 1 item; and the Parental Concerns Questionnaire (McGrew et al., 2007) which includes 1 item. These questionnaires should not, of course, be relied upon for a screening of sleep difficulties, but they may provide a means to begin to identify whether there are concerns about a child’s sleep and to compare sleep problems to other aspects of a child’s functioning. Screening for daytime behavioral difficulties may also help determine whether a more comprehensive psychiatric evaluation is indicated. Psychiatric conditions such as anxiety, bipolar disorder, and depression can affect sleep and may be exacerbated by sleep difficulties. Thus, consideration of these psychiatric comorbidities should also be part of a comprehensive sleep evaluation.