Two teams of the authors—a professor working with an undergraduate research intern and two Master's level researchers working together—independently abstracted information. The two team's initial classifications were in more than 80% agreements. After discussions to reconcile differences, the remaining unresolved classifications (12% of total and 11% of unique instruments) were discussed with a fifth author, a developmental psychologist, until consensus was achieved. The following guidelines were used for abstracting: (a) teacher/childcare provider items were excluded, given our primary focus on nighttime sleep and secondary focus on 24-hour sleep patterns; (b) nap items were included only if there was a statement about frequency, and in this case they were classified under “sleep duration”; (c) items that satisfied criteria for two BIC categories were classified in both, for example, a question about needing a parent in the room to fall asleep was classified as “sleep anxiety” and “bedtime resistance,” and (d) different age versions of the same instrument were abstracted separately.
We conducted a separate analysis of sleep-related items in the most commonly used instruments in EI/ECSE programs. These were identified by other researchers to measure progress toward outcomes related to social-emotional skills, knowledge and skill acquisition and use, and use of appropriate behaviors to meet needs. (Hebbeler, Mallik, & Kahn, 2008).
Data were entered and analyzed in Microsoft Office Excel (version 2007; Redmond, Washington).
Characteristics of the 67 total (ie, counts multiple-age versions separately) and 47 unique instruments included in the review are shown in Table 1. The authors directly examined 71% of total and 60% of unique instruments. The mean number of sleep-related items was 1.5. Overall, 38% (26/67) of total and 47% (22/47) of unique instruments contained no sleep-related items. None included any SDB items, for example, pertaining to snoring or apnea.
We examined the frequency and type of sleep-related items in the most commonly used instruments in state EI and ECSE programs (Hebbeler et al., 2008) (Table 3). Again, none included any SDB-related items. The Battelle was the most commonly used, and had the most (n = 6) BIC items, followed by the Bayley (n = 3), and the Hawaii Early Learning Profile (n = 2). Overall, 70% (7/10) of these commonly used instruments included 1 or less sleep-related item.
We reviewed 47 unique and 67 total (multiple age versions of unique) instruments used by EI/ECSE programs to determine whether and how they screened for behavioral (BIC) and respiratory-related (SDB) sleep disorders. About half did not ask any BIC-related items; of those that did, there were a mean of 1.5 items. Particularly troubling is the fact that there was not one SDB-related item on any of the instruments. Given the significant “shared co-morbidity” between sleep problems and developmental disorders (Bonuck & Grant, in press), our findings have implications for early intervention programs. In particular, since 2005, EI/ECSE programs must report on progress related to developmental domains that both BIC and sleep problems affect (a) positive social-emotional skills (including social relationships), (b) knowledge and skill acquisition and use (eg, early language/communication/literacy), and (c) use of appropriate behaviors to meet their needs (Early Childhood Outcomes Center, 2011). Thus, without systematic assessment of sleep problems, employing items and/or instruments validated for that purpose, the field of early intervention will underascertain remediable risk factors for delayed development.
Limitations of the current review include our inability to view all instruments (we directly examined 71% of the total instruments) and the fact that the instruments reviewed were designed for purposes other than the assessment of sleep, and as such were not validated for that purpose. We also limited our focus to nighttime sleep behaviors and focused on total sleep, including naps, as a secondary measure. While we made this decision given that the former appears to be more critical in the development of cognitive function (Lam et al., 2011), we may have overlooked important information regarding daytime sleep.
Pediatric sleep problems have documented adverse effects upon behavior, cognition, and growth and thus have implications for the developmental domains targeted by EI and ECSE programs. Yet, about half of current instruments used to assess eligibility in EI/ECSE programs do not systematically address BIC, and none address sleep disordered breathing. Research is needed on the effectiveness of screening and intervention for both behavioral and respiratory sleep problems within the heterogeneous EI and ECSE populations using validated pediatric sleep questionnaires.
American Academy of Sleep Medicine (Ed.). (2006). International classification of sleep disorders
, revised; diagnostic and coding manual (2nd ed). Darien, IL: American Academy of Sleep Medicine.
Arens R., Muzumdar H. (2010). Sleep, sleep disordered breathing
, and nocturnal hypoventilation in children
with neuromuscular diseases. Paediatric Respiratory Reviews, 11(1) 24–30.
Aronen E. T., Liukkonen K., Simola P., Virkkula P., Uschakoff A., Korkman M., Pitkäranta A. (2009). Mood is associated with snoring in preschool-aged children
. Journal of developmental and behavioral pediatrics, 30(2), 107–114.
Bass J. L., Corwin M., Gozal D., Moore C., Nishida H., Parker S., Kinane TB. (2004). The effect of chronic or intermittent hypoxia on cognition in childhood: A review of the evidence. Pediatrics, 114(3), 805–816.
Beebe D. W. (2006). Neurobehavioral morbidity associated with disordered breathing during sleep in children
: a comprehensive review. Sleep, 29(9), 1115–1134.
Blunden S. L., Beebe D. W. (2006). The contribution of intermittent hypoxia, sleep debt and sleep disruption to daytime performance deficits in children
: Consideration of respiratory and non-respiratory sleep disorders
. Sleep Medicine Reviews, 10(2), 109–118.
Blunden S. L., Chervin R. D. (2008). Sleep problems are associated with poor outcomes in remedial teaching programmes: A preliminary study. Journal of Paediatrics and Child Health, 44(5), 237–242.
Bonuck K., Chervin R.D., Cole T., Emond A., Henderson J., Xu L., Freeman K. (2011). Prevalence and persistence of sleep disordered breathing
symptoms in young children
: A 6 year population-based cohort study. Sleep, 34(7), 875–884.
Bonuck K., Grant R. (in press). Sleep problems and early developmental delay
: Implications for early intervention
programs. Intellectual and Developmental Disabilities.
Bonuck K., Parikh S., Bassila M. (2006). Growth failure and sleep disordered breathing
: A review of the literature. International Journal of Pediatric Otorhinolaryngology, 70(5), 769–778.
Bonuck K. A., Freeman K., Henderson J. (2009). Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis. Archives of Disease in Childhood, 94(2), 83–91.
Byars K., Apiwattanasawee P., Leejakpai A., Tangchityongsiva S., Simakajornboom N. (2011). Behavioral sleep disturbances in children
clinically referred for evaluation of obstructive sleep apnea. Sleep Medicine, 12(2), 163–169.
Calhoun S. L., Vgontzas A. N., Mayes S. D., Tsaoussoglou M., Sauder K., Mahr F., Bixler EO. (2010). Prenatal and perinatal complications: Is it the link between race and SES and childhood sleep disordered breathing
? Journal of Clinical Sleep Medicine, 6(3), 264–269.
Carskadon M. A., Acebo C., Jenni O. G. (2004). Regulation of adolescent sleep: Implications for behavior. Annals of the New York Academy of Sciences, 1021, 276–291.
Carson D. K., Klee T., Perry C. K., Muskina G., Donaghy T. (1998). Comparisons of children
with delayed and normal language at 24 months of age on measures of behavioral difficulties, social and cognitive development. Infant Mental Health Journal, 19(1), 59–75.
Chervin R. D., Archbold K. H., Panahi P., Pituch K. J. (2001). Sleep problems seldom addressed at two general pediatric clinics. Pediatrics, 107(6), 1375–1380.
Couturier J. L., Speechley K. N., Steele M., Norman R., Stringer B., Nicolson R. (2005). Parental perception of sleep problems in children
of normal intelligence with pervasive developmental disorders: prevalence, severity, and pattern. Journal of the American Academy of Child and Adolescent Psychiatry, 44(8), 815–822.
de Serres L. M., Derkay C., Sie K., Biavati M., Jones J., Tunkel D., Weinberg A. D. (2002). Impact of adenotonsillectomy on quality of life in children
with obstructive sleep disorders
. Archives of Otolaryngology-Head & Neck Surgery, 128(5), 489–496.
Dorris L., Scott N., Zuberi S., Gibson N., Espie C. (2008). Sleep problems in children
with neurological disorders. Developmental Neurorehabilitation, 11(2), 95–114.
Duby J. C., Lipkin P. H., Macias M. M., Wegner L. M., Duncan P., Hagan J. F., Swignonksi N., et al. (2006). Identifying infants and young children
with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118(1), 405–420.
Galland B. C., Mitchell E. A. (2010). Helping children
sleep. Archives of Disease in Childhood, 95(10), 850–853.
Garetz S. L. (2008). Behavior, cognition, and quality of life after adenotonsillectomy for pediatric sleep-disordered breathing: Summary of the literature. Otolaryngology-Head and Neck Surgery, 138(1), S19–S26.
Goodlin-Jones B. L., Sitnick S. L., Tang K., Liu J. Y., Anders T. F. (2008). The Children
's Sleep Habits Questionnaire in toddlers and preschool children
. Journal of Developmental and Behavioral Pediatrics, 29(2), 82–88.
Goodlin-Jones B. L., Tang K., Liu J., Anders T. F. (2008). Sleep patterns in preschool-age children
with autism, developmental delay
, and typical development. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 930–938.
Halbower A. C., Marcus C. L. (2003). Sleep disorders
. Current Opinion in Pulmonary Medicin, 9(6), 471–476.
Hebbeler K., Mallik S., Kahn L. (2008). State approaches to collecting outcomes data for young children
wtih disabilities in state early intervention
and EC special education programs. Paper presented at the Conference on Research Innovations in Early Intervention
. Retrieved from http://www.fpg.unc.edu/∼eco/pages/archive.cfm#2008
Henderson J. M. T., France K. G., Owens J. L., Blampied N. M. (2010). Sleeping through the night: The consolidation of self-regulated sleep across the first year of life. Pediatrics, 126(5), E1081–E1087, Pub L. 108–446, U.S.C. § et seq C.F.R.
Jan J. E., Reiter R. J., Bax M. C. O., Ribary U., Freeman R. D., Wasdell M. B. (2010). Long-term sleep disturbances in children
: A cause of neuronal loss. European Journal of Paediatric Neurology, 14(5), 380–390.
Krakowiak P., Goodlin-Jones B., Hertz-Picciotto I., Croen L. A., Hansen R. L. (2008). Sleep problems in children
with autism spectrum disorders, developmental delays, and typical development: A population-based study. Journal of Sleep Research, 17(2), 197–206.
Lewandowski A., Toliver-Sokol M., Palermo T. (2011). Evidence-based review of subjective pediatric sleep measures. Journal of Pediatric Psychology, 36(7), 780–793.
Lundeborg I., McAllister A., Samuelsson C., Ericsson E., Hultcrantz E. (2009). Phonological development in children
with obstructive sleep-disordered breathing. Clinical Linguistics & Phonetics, 23(10), 751–761.
Matson J. L., Fodstad J. C., Mahan S. (2009). Cutoffs, norms, and patterns of comorbid difficulties in children
with developmental disabilities on the Baby and Infant Screen for Children
with aUtIsm Traits (BISCUIT-Part 2). Research in Developmental Disabilities, 30(6), 1221–1228.
McGreavey J. A., Donnan P. T., Pagliari H. C., Sullivan F. M. (2005). The Tayside children
's sleep questionnaire: a simple tool to evaluate sleep problems in young children
. Child Care Health and Development, 31(5), 539–544.
Meltzer L. J., Johnson C., Crosette J., Ramos M., Mindell J. A. (2010). Prevalence of diagnosed sleep disorders
in pediatric primary care practices. Pediatrics, 125(6), e1410–1418.
Meltzer L. J., Moore M., Mindell J. A. (2008). The need for interdisciplinary pediatric sleep clinics. Behavioral Sleep Medicine, 6(4), 268–282.
Mitchell R. B., Kelly J. (2006). Behavior, neurocognition and quality-of-life in children
with sleep-disordered breathing. International Journal of Pediatric Otorhinolaryngology, 70(3), 395–406.
Montgomery P., Stores G., Wiggs L. (2004). The relative efficacy of two brief treatments for sleep problems in young learning disabled (mentally retarded) children
: A randomised controlled trial. Archives of Disease in Childhood, 89(2), 125–130.
Morgenthaler T. I., Owens J., Alessi C., Boehlecke B., Brown T. M., Coleman J. Jr., Swick T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children
. Sleep, 29(10), 1277–1281.
Ng D. K., Hui H. N., Chan C. H., Kwok K. L., Chow P. Y., Cheung J. M., et al. (2006). Obstructive sleep apnoea in children
with Down syndrome. Singapore Medical Journal, 47(9), 774–779.
Owens J., Palermo T. (2008). Introduction to the special issue: Sleep in children
with neurodevelopmental and psychiatric disorders. Journal of Pediatric Psychology, 33(4), 335–338.
Owens J., Spirito A., McGuinn M. (2000). The Children
's Sleep Habits Questionnaire (CSHQ): Psychometric properties of a survey instrument for school-aged children
. Sleep, 23(8), 1043–1051.
Quine L. (2001). Sleep problems in primary school children
: comparison between mainstream and special school children
. Child Care Health and Development, 27(3), 201–221.
Ramchandani P., Wiggs L., Webb V., Stores G. (2000). A systematic review of treatments for settling problems and night waking in young children
. BMJ, 320(7229), 209–213.
Ravid S., Afek I., Suraiya S., Shahar E., Pillar G. (2009). Kindergarten children
's failure to qualify for first grade could result from sleep disturbances. Journal of Child Neurology, 24(7), 816–822.
Sadeh A. (2004). A brief screening questionnaire for infant sleep problems: Validation and findings for an Internet sample. Pediatrics, 113(6), e570–e577.
Sadeh A., Mindell J. A., Luedtke K., Wiegand B. (2009). Sleep and sleep ecology in the first 3 years: A web-based study. Journal of Sleep Research, 18(1), 60–73.
Schechter M. S. (2002). Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 109(4), e69.
Spruyt K., Gozal D. (2011). Pediatric sleep questionnaires as diagnostic or epidemiological tools: A review of currently available instruments. Sleep Medicine Reviews, 15(1), 19–32.
Touchette E., Petit D., Paquet J., Boivin M., Japel C., Tremblay R. E., Montplaisir J. Y. (2005). Factors associated with fragmented sleep at night across early childhood. Archives of Pediatrics & Adolescent Medicine, 159(3), 242–249.
Touchette E., Petit D., Tremblay R. E., Montplaisir J. Y. (2009). Risk factors and consequences of early childhood dyssomnias: New perspectives. Sleep Medicine Reviews, 13(5), 355–361.
Wiggs L. (2009). Behavioral aspects of children
's sleep. Archives of Disease in Childhood, 94, 59–62.
Wiggs L., Stores G. (1996). Sleep problems in children
with severe intellectual disabilities: What help is being provided? Journal of Applied Research in Intellectual Disabilities, 9(2), 160–165.
Wiggs L., Stores G. (1998). Behavioural treatment for sleep problems in children
with severe learning disabilities and challenging daytime behaviour: Effect on sleep patterns of mother and child. Journal of Sleep Research, 7(2), 119–126.
Appendix: List of Data Sources Used to Identify Instruments for Review
- (ABCD) M. s. A. B. C. H. a. D. (Producer). (2009, August 2010). Developmental Screening Tools Selection. [PowerPoint Presentation] Retrieved from http://ihcs.msu.edu/quality/abcd_secondary_page.php#presentations
- Alfonso, V., & Flanagan, D. P. (2009). Evidence-based practice in infant and early childhood psychology. In Mowder BA, Rubinson F & Yasik AE (Eds.), Evidence-based practice in infant and early childhood psychology (pp. 792). Hoboken, NJ: John Wiley & Sons Inc.
- Assessment Instruments Approved to be Appropriate for Screening or Evaluating the Needs of Infants and Toddlers (M. A. D. Initiative, Trans.). (2005). West Virginia birth to three resources (pp. 1–16). Charleston, WV: West Virginia Birth to Three.
- Bergman, D. (2004). Screening for behavioral developmental problems: Issues, obstacles, and opportunities for change (pp. 1–36). Portland, ME: National Academy for State Health Policy.
- Bridges, L. B. D., Johnson, R., Calkins, J., Margie, N., Cochran, S., Ling, T., Zaslow, M.; Child Trends. (2008). Early childhood measures profiles. Washington, DC: Child Trends.
- Carter, A. S., Briggs-Gowan, M. J., & David, N. O. (2004). Assessment of young children's social-emotional development and psychopathology: Recent advances and recommendations for practice. Journal of Child Psychology and Psychiatry, 45(1), 109–134.
- Caselman, T. D., & Self, P. A. (2008). Assessment instruments for measuring young children's social-emotional behavioral development. Children & Schools, 30(2), 103–115.
- Developmental and Social-Emotional Screening of Young Children in Minnesota. Developmental and social-emotional screening of young children (0–6 years of age) in Minnesota. Retrieved August 10, 2010, from http://www.health.state.mn.us/divs/fh/mch/devscrn/glance.html
- Drotar, D., Stancin, T., Dworkin, P. H., Sices, L., & Wood, S. (2008). Selecting developmental surveillance and screening tools. Pediatrics in Review/American Academy of Pediatrics, 29(10), e52–e58.
- Duby, J. C., Lipkin, P. H., Macias, M. M., Wegner, L. M., Duncan, P., Hagan, J. F., ... Swignonksi, N. (2006). Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118(1), 405–420. doi:10.1542/peds.2006–1231
- Filipek, P. A., Accardo, P. J., Baranek, G. T., Cook, E. H., Dawson, G., Gordon, B., ... Volkmar FR. (2000). The screening and diagnosis of autistic spectrum disorders (Vol. 29, pp. 439, 1999). Journal of Autism and Developmental Disorders, 30(1), 81–81.
- Ghazvini, A. S. (2004). Birth to three screening and assessment resource guide. In F. P. F. S. Readiness (Ed.), Florida Institute of Education (pp. 1–120). Tallahassee, FL: Florida Partnership for School Readiness.
- Gilliam, W., & Mayes, L. (2004). Integrating clinical and psychometric approaches: Developmental assessment and the infant mental health evaluation. In A. C. Rebecca DelCarmen-Wiggins (Ed.), Handbook of infant, toddler, and preschool mental health assessment (2nd ed., pp. 185–204). New York, NY: Oxford University Press.
- Grant R., & Brito A. (2001). Developmental and mental health screening instruments for use in pediatric primary care (pp. 1–25). New York, NY: Children's Health Fund.
- Grant R., & Nozyce M. (2001). Compendium of assessment instruments for use with infants and toddlers (birth to 36 months). New York, NY: New York City Department of Mental Health.
- Hamilton, S. (2006a). Applied evidence: Screening for developmental delay: Reliable, easy-to-use tools. The Journal of Family Practice, 55, 415–422.
- Hamilton, S. (2006b). Screening for developmental delay: Reliable, easy-to-use tools—Win-win solutions for children at risk and busy practitioners. Journal of Family Practice, 55(5), 415–422.
- Henderson, J., & Strain, P. (2009, January). Screening for social emotional concerns: Considerations in the selection of instruments. Challenging Behavior: Roadmap to Effective Intervention Practices. Retrieved August, 2010, from http://www.challengingbehavior.org/do/resources/documents/roadmap_1.pdf
- Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. (2006). Pediatrics, 118(1), 405–420. doi:118/1/405 [pii]10.1542/peds.2006–1231.
- Johnson, S., & Marlow, N. (2006). Developmental screen or developmental testing? Early Human Development, 82(3), 173–183. doi: S0378–3782(06)00034-X
- Kienapple, K. L. M., Sorley, A., Morse, P., Smith, M. (2005). Commonly used assessment tools for children with special needs ages birth to six and their families (C. o. E. f. C. and & A. w. S. Needs, Trans.). Halifax, Nova Scotia: Early Intervention Task Force, Mount Saint Vincent University.
- Lidz, C. (2003). Early childhood assessment. Hoboken NJ: John Wiley & Sons.
- Mesh, S. L., J. (2003). A Practical guide to early childhood assessment: Conduction developmental and psychological evaluations in the early intervention program. New York, NY: Los Ninos Press.
- Minke, K. (2008). Universal screening for social-emotional and behavioral difficulties: Delaware PBS Project. Retrieved 2 June, 2010, from www.udel.edu/cds/pbs/downloads/Universal_Screening_For_Website.ppt.
- Nash, P. L., & Coury, D. L. (2003). Screening tools assist with diagnosis of autistic spectrum disorders. Pediatric Annals, 32(10), 664–670.
- Ringwalt, S. (2008). Developmental screening and assessment instruments with an emphasis on social and emotional development for young children ages birth through five. National Early Childhood Technical Assistance Center (NECTAC). Retrieved July 28, 2010, from http://www.nectac.org/∼pdfs/pubs/screening.pdf
- Romanczyk, R., Gillis, J., Noyes-Grosser, D., Holland, P., Holland, C., & Lyons, D. (2005). Clinical clues, developmental milestones, and early identification/assessment of children with disabilities: Practical applications and conceptual considerations. Infants and Young Children, 18(3), 212–221.
- Rosenbaum, P. (1998). Screening tests and standardized assessments used to identify and characterize developmental delays. Seminars in Pediatric Neurology, 5(1), 27–32.
- Rydz, D., Shevell, M., Majnemer, A., & Oskoui, M. (2005). Developmental screening. Journal of Child Neurology, 20(1), 4–21.
- Rydz, D., Srour, M., Oskoui, M., Marget, N., Shiller, M., Birnbaum, R., Shevell, M. I. (2006). Screening for developmental delay in the setting of a community pediatric clinic: A prospective assessment of parent-report questionnaires. Pediatrics, 118(4), E1178-E1186. doi:10.1542/peds.2006–0466
- Screening and Diagnostic Assessment Instruments. (2003). Screening and diagnostic assessment instruments. Retrieved July 20, 2010, from http://dese.mo.gov/divspeced/FirstSteps/pdfs/DEScreeningDiagnostic.pdf
- Shevell, M. (2006). Office evaluation of the child with developmental delay. Seminars in Pediatric Neurology, 13(4), 256–261. doi: S1071–9091(06)00129-X [pii]10.1016/j.spen.2006.09.006
- Sices L. (2007). Developmental screening in primary care: The effectiveness of current practice and recommendations for improvement. Retrieved August 22, 2010, from http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/Dec/Developmental-Screening-in-Primary-Care–The-Effectiveness-of-Current-Practice-and-Recommendations-f.aspx
- Sosna, T., & Mastergeorge, A. (2005). Compendium of screening instruments for early childhood social-emotional development (P. The Infant, Family, Mental Health Initative, Trans.). Sacramento, CA: California Institute for Mental Health.
- Stainback-Tracy, K. (2004). Social and emotional screening for infants, toddlers, and preschoolers in Colorado (U. o. C. H. S. Center, Trans.). Denver, Colorado: Substance Abuse Mental Health Services Agency.
- TeKolste, K. R. M., & Wakeley, J. (2002). Low birth weight neonatal intensive care unit graduate (C. w. S. H. C. N. P. Washington State Department of Health, Trans.). Seattle, WA: Washington State Department of Health, Children with Special Health Care Needs Program; University of Washington Center on Human Development and Disability; Mary Bridge Hospital and Health Center. Neurodevelopmental Program & High Risk Infant Follow Up Program.
- Yarbrough, K. (2001). Step by step: Incorporating developmental screening into programs and services for young children. Birth-2–3 best practices. Chicago, IL: Robert Wood Johnson Foundation.
- Zeanah, Z. (Ed.). (2005). Handbook of infant mental health (2nd ed.). New York, NY: The Guilford Press.