Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30307, USA.
The Ohio State University Nisonger Center and Department of Psychology, 1581 Dodd Drive, Columbus, OH, 43210, USA.
J Autism Dev Disord. 2024 May;54(5):1792-1803. doi: 10.1007/s10803-022-05865-9. Epub 2023 Mar 1.
Toward the development of a new parent-rating for insomnia, this multi-site qualitative study explored sleep problems and related impacts in children with autism spectrum disorder (ASD) and their families. To ensure content validity of the measure, we conducted six focus groups with caregivers (N = 25) of 24 children (age 3 to 18 years) with ASD. Based on parent report, all children had a history of mild or greater insomnia. The focus group transcripts were systematically coded to identify major themes. Verbatim comments from caretakers were used to generate 134 candidate items. Further review by the research team and an expert panel followed by individual cognitive interviews with 12 parents reduced the item bank to 40. The thematic analysis of focus group transcripts identified 7 categories: (1) Trouble falling asleep; (2) trouble staying asleep; (3) early morning waking; (4) bedtime routines; (5) parental strategies for bedtime management; (6) impact of sleep problems on the child; and (7) impact of sleep problems on the family. The Flesch Kincaid Grade Level of the 40-item version was 7.2 (seventh grade reading level). Insomnia in children with ASD shares features in common with insomnia in the general pediatric population. However, perhaps owing to autistic features such as insistence on sameness, sensory sensitivities, communication impairments, insomnia in children with ASD appears to have unique behavioral manifestations. Content validity and item clarity of the 40-item bank were supported by expert panel review and cognitive interviews with caregivers of children with ASD.
为了开发一种新的父母评定量表来评估儿童失眠，这项多中心的定性研究探讨了自闭症谱系障碍（ASD）儿童及其家庭的睡眠问题及相关影响。为了确保该测量工具的内容效度，我们对 25 名（24 名儿童年龄 3 至 18 岁） ASD 儿童的照顾者进行了六组焦点小组讨论。根据家长报告，所有儿童都有轻度或更严重的失眠史。对焦点小组记录进行了系统编码，以确定主要主题。照顾者的逐字评论被用来生成 134 个候选项目。随后，研究团队和专家小组进行了进一步审查，并对 12 名家长进行了个别认知访谈，将项目库减少到 40 个。焦点小组记录的主题分析确定了 7 个类别：（1）入睡困难；（2）睡眠维持困难；（3）清晨早醒；（4）就寝时间；（5）父母的就寝时间管理策略；（6）睡眠问题对儿童的影响；（7）睡眠问题对家庭的影响。40 项版本的 Flesch-Kincaid 年级水平为 7.2（相当于七年级阅读水平）。ASD 儿童的失眠与一般儿科人群的失眠具有共同特征。然而，也许由于自闭症的特征，如坚持一致性、感官敏感性、沟通障碍等，ASD 儿童的失眠似乎具有独特的行为表现。专家小组的审查和对 ASD 儿童照顾者的认知访谈支持了 40 项库的内容效度和项目清晰度。
