The Factor Structure and Reliability of the Persian Version of the Children's Sleep Habits Questionnaire in Children with Autism Spectrum Disorder
Iranian Journal of Child Neurology,
Vol. 20 No. 1 (2026),
1 January 2026
,
Page 47-53
https://doi.org/10.22037/ijcn.v20i1.45337
Abstract
Objectives: Sleep disturbance is a common difficulty in children with autism spectrum disorder that can affect daily functioning and quality of life. Research has established an association between the severity of autism and the severity of sleep problems. But the assessment and intervention in this issue are less noticed by therapists. This study aimed to investigate the psychometric properties of the Children’s Sleep Habits Questionnaire (CSHQ) including content validity, factor analysis, internal consistency, and test-retest reliability in children with autism aged 4–10 years.
Materials and Methods: In this descriptive and cross-sectional study, 306 parents of children with autism were selected by convenience sampling. They answered the Persian version of the CSHQ. The content validity index and ratio were assessed through opinions of 11 autism experts. Confirmatory factor analysis was conducted. Cronbach's alpha coefficient was used for internal consistency, and the intraclass correlation coefficient was calculated for test-retest reliability. Data were analyzed by and LISREL 88 and SPSS 26.
Results: The content validity index (0.81-1) and ratio (0.63–1) were confirmed. The confirmatory factor analysis results (RMSEA = 0.74; P < 0.001; Chi-Square =596.85; df = 224) confirmed the model obtained. The total Cronbach's alpha was 0.83. The intraclass correlation coefficient for the test-retest reliability was 0.90 in total and 0.82-0.91 for the domains of the questionnaire.
Conclusion: The Persian version of CSHQ in children with autism has acceptable validity and reliability and can be used by autism therapists as a suitable tool in research and clinical practice.
- Sleep
- Autism Spectrum Disorder
- Psychometrics
- Pediatrics
- Rehabilitation
How to Cite
References
Breedlove SM, Watson NV, Rosenzweig MR. Biological psychology: An introduction to behavioral, cognitive, and clinical neuroscience: Sinauer Associates; 2010.
Richdale AL. Sleep problems in autism: prevalence, cause, and intervention. Developmental medicine and child neurology. 1999;41(1):60-6.
Reynolds AM, Malow BA. Sleep and autism spectrum disorders. Pediatric Clinics. 2011;58(3):685-98.
Malow BA, Marzec ML, McGrew SG, Wang L, Henderson LM, Stone WL. Characterizing sleep in children with autism spectrum disorders: a multidimensional approach. Sleep. 2006;29(12):1563-71.
Matson JL, Ancona MN, Wilkins J. Sleep disturbances in adults with autism spectrum disorders and severe intellectual impairments. Journal of Mental Health Research in Intellectual Disabilities. 2008;1(3):129-39.
Delahaye J, Kovacs E, Sikora D, Hall TA, Orlich F, Clemons TE, et al. The relationship between health-related quality of life and sleep problems in children with autism spectrum disorders. Research in Autism Spectrum Disorders. 2014;8(3):292-303.
Zaidman-Zait A, Zwaigenbaum L, Duku E, Bennett T, Szatmari P, Mirenda P, et al. Factor analysis of the children’s sleep habits questionnaire among preschool children with autism spectrum disorder. Research in developmental disabilities. 2020;97:103548.
Tzischinsky O, Meiri G, Manelis L, Bar-Sinai A, Flusser H, Michaelovski A, et al. Sleep disturbances are associated with specific sensory sensitivities in children with autism. Molecular autism. 2018;9(1):1-10.
Shaw A, Do TNT, Harrison L, Marczak M, Dimitriou D, Joyce A. Sleep and cognition in people with autism spectrum condition: A systematic literature review. Review Journal of Autism and Developmental Disorders. 2022;9(3):416-26.
Moore M, Evans V, Hanvey G, Johnson C. Assessment of sleep in children with autism spectrum disorder. Children. 2017;4(8):72.
Spruyt K, Gozal D. Pediatric sleep questionnaires as diagnostic or epidemiological tools: a review of currently available instruments. Sleep medicine reviews. 2011;15(1):19-32.
Kirkpatrick B, Louw JS, Leader G. Efficacy of parent training incorporated in behavioral sleep interventions for children with autism spectrum disorder and/or intellectual disabilities: A systematic review. Sleep Medicine. 2019;53:141-52.
Owens JA, Spirito A, McGuinn M. The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep-New York-. 2000;23(8):1043-52.
Lionetti F, Dellagiulia A, Verderame C, Sperati A, Bodale G, Spinelli M, et al. The Children's Sleep Habits Questionnaire: Identification of sleep dimensions, normative values, and associations with behavioral problems in Italian preschoolers. Sleep Health. 2021;7(3):390-6.
Esbensen AJ, Hoffman EK. Reliability of parent report measures of sleep in children with Down syndrome. Journal of Intellectual Disability Research. 2017;61(3):210-20.
Parreira AF, Martins A, Ribeiro F, Silva FG. Clinical validation of the Portuguese version of the Children’s Sleep Habits Questionnaire (CSHQ-PT) in children with sleep disorder and ADHD. Acta Med Port. 2019;32(3):195-201.
Johnson CR, DeMand A, Lecavalier L, Smith T, Aman M, Foldes E, et al. Psychometric properties of the children's sleep habits questionnaire in children with autism spectrum disorder. Sleep Medicine. 2016;20:5-11.
Katz T, Shui AM, Johnson CR, Richdale AL, Reynolds AM, Scahill L, et al. Modification of the children’s sleep habits questionnaire for children with autism spectrum disorder. Journal of Autism and Developmental Disorders. 2018;48:2629-41.
Fallahzadeh H, Etesam F, Asgarian FS. Validity and reliability related to the Persian version of the Children’s Sleep Habits Questionnaire. Sleep and Biological Rhythms. 2015;13:271-8.
Bowman KS, Suarez VD, Weiss MJ. Standards for interprofessional collaboration in the treatment of individuals with autism. Behavior Analysis in Practice. 2021;14(4):1191-208.
Ayre C, Scally AJ. Critical values for Lawshe’s content validity ratio: revisiting the original methods of calculation. Measurement and evaluation in counseling and development. 2014;47(1):79-86.
Veatch OJ, Sutcliffe JS, Warren ZE, Keenan BT, Potter MH, Malow BA. Shorter sleep duration is associated with social impairment and comorbidities in ASD. Autism Research. 2017;10(7):1221-38.
Vakili MM, Jahangiri N. Content validity and reliability of the measurement tools in educational, behavioral, and health sciences research. Journal of Medical Education Development. 2018;10(28):106-18.
Knapp TR, Brown JK. Ten measurement commandments that often should be broken. Research in Nursing & Health. 1995;18(5):465-9.
Cortina JM. What is coefficient alpha? An examination of theory and applications. Journal of applied psychology. 1993;78(1):98.
Portney LG, Watkins MP. Foundations of clinical research: applications to practice: Pearson/Prentice Hall Upper Saddle River, NJ; 2009.
Hooper D, Coughlan J, Mullen M. Structural equation modelling: Guidelines for determining model fit. 2008. Dublin Institute of Technology2008[Google Scholar].
Yusoff MSB. A confirmatory factor analysis study on the medical student stressor questionnaire among Malaysian medical students. Education in Medicine Journal. 2011;3(1).
Lemay E. Research in Occupational Therapy: Methods of Inquiry for Enhancing Practice (2006). The Canadian Journal of Occupational Therapy. 2007;74(3):207.
- Abstract Viewed: 39 times