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The Pediatric Sleep Clinical Global Impressions Scale—A New Tool to Measure Pediatric Insomnia in Autism Spectrum Disorders

Malow, Beth A. MD, MS; Connolly, Heidi V. MD; Weiss, Shelly K. MD, FRCPC; Halbower, Ann MD; Goldman, Suzanne PhD; Hyman, Susan L. MD; Katz, Terry PhD; Madduri, Niru MD; Shui, Amy MA; Macklin, Eric PhD; Reynolds, Ann M. MD

Journal of Developmental & Behavioral Pediatrics: June 2016 - Volume 37 - Issue 5 - p 370–376
doi: 10.1097/DBP.0000000000000307
Special Issue–Sleep in Pediatric and Developmental Conditions

Objective: To pilot a clinician-based outcome measure that provides complementary information to objective measures and parent-based questionnaires for insomnia in children with autism spectrum disorders (ASD).

Method: The authors developed a Pediatric Sleep Clinical Global Impressions Scale (CGI). Questions included (1) the child's ability to fall asleep and remain sleeping independently (i.e., apart from parents); (2) bedtime resistance; (3) sleep onset delay; (4) night awakening; (5) parental satisfaction with their child's current sleep patterns; (6) family functioning as affected by their child's current sleep patterns; and (7) clinician's overall concern with the child's sleep. After refining the instrument through the evaluation of vignettes by ASD and sleep experts, the authors piloted the Pediatric Sleep CGI in a 12-week randomized trial of iron supplementation in children with ASD. Clinicians completed Pediatric Sleep CGIs and structured sleep histories, parents completed the Children's Sleep Habits Questionnaire (CSHQ), and children wore actigraphy watches.

Results: In repeated measures models, the Pediatric Sleep CGI and CSHQ were correlated for sleep onset delay (r = .66, p < .001), night wakings (r = .40, p < .001), and total score (r = .29, p < .001). The CGI-S sleep onset delay and actigraphy sleep onset delay scores (r = .75, p = .0095) were also correlated. The overall CGI-S showed improvement with therapy (p = .047).

Conclusion: The Pediatric Sleep CGI shows promise in measuring clinician-rated outcomes in pediatric insomnia in children with ASD. Larger samples will be necessary to examine reliability, validity, and measure to change, as well as applicability to other populations with pediatric insomnia.

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*Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN;

Department of Pediatrics, University of Rochester, Rochester, NY;

Department of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON;

§Department of Pediatrics, University of Colorado Denver, Aurora, CO;

Biostatistics Center, Massachusetts General Hospital, Boston, MA.

Address for reprints: Beth A. Malow, MD, MS, Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, Room A-0116 MCN, Nashville, TN 37232-2551.

Disclosure: The authors report no conflicts of interest or financial relationships relevant to this article. This research was conducted as part of a multicenter trial funded through the Autism Intervention Research Network on Physical Health (Cooperative agreement UA3 MC 11054 from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program, to the Massachusetts General Hospital) and the Autism Speaks Autism Treatment Network. The views expressed in this publication do not necessarily reflect the views of Autism Speaks, Inc. Additional support was provided by CTSA award numbers UL1TR000445, UL1 TR000042, and UL1 TR001082 from the National Center for Advancing Translational Sciences. Contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

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Received August , 2015

Accepted March , 2016

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