Child:

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Review
care, health and development
doi:10.1111/cch.12376

Subjective sleep measures for adolescents: a

systematic review
X. Ji and J. Liu
School of Nursing University of Pennsylvania, Philadelphia, PA, USA
Accepted for publication 11 June 2016

Abstract
Background Sleep disturbances in adolescents have received significant attention because of their
high prevalence and the negative health outcomes. Relative to objective measures, subjective sleep
instruments have been the most practical tools used to identify sleep problems and assess
responses to interventions in research and clinical settings. This systematic review aims to examine
the psychometric properties of subjective measures that are used to assess sleep quality and
disturbances among adolescents, identify the strength and limitation of each measurement and
inform recommendations for practice.
Methods PubMed, Embase and PsycInfo were searched from 2000 through May 2016. The
reference lists of important articles were included if they met the inclusion criteria. The available
measures were evaluated and classified as positive, intermediate or poor according to the quality
criteria for health status questionnaires.
Results Thirteen self-reported or parent-reported sleep measures met the inclusion criteria. Of the
measurements reviewed, six were generic instruments assessing overall sleep quality and
disturbances; five were dimension-specific instruments measuring daytime sleepiness, sleep
Keywords
insufficiency and sleep hygiene; and two were condition-specific instruments for insomnia. None of
adolescent, assessment,
measure, patient- the subjective sleep measures for adolescents has a psychometric profile with all essential
reported outcomes, measurement properties. Specifically, the generic sleep measurements capture multiple dimensions
review, sleep
but face issues of participant burden and compatibility. Among the domain-specific tools, the
Correspondence:
Cleveland Adolescent Sleepiness Questionnaire and the Chronic Sleep Reduction Questionnaire have
Xiaopeng Ji, School of achieved good psychometric merits but need further evaluation for responsiveness. Likewise,
Nursing University of
essential measurement properties of condition-specific tools for insomnia have yet to be established.
Pennsylvania, 418 Curie
Blvd, Philadelphia, PA Conclusions Because of the limited evidence, no definite recommendations can be made at this
19104, USA point. However, each available measurement has its own uniqueness and strength despite the
E-mail:
[email protected].
limitations. Future research on measurement development and evaluation for adolescent sleep is
edu needed to ensure the relevance and suitability to different stages of adolescence and social contexts.

adolescents have reported some aspects of sleep issues and

Introduction
sleep-related daytime impairment (Gradisar et al. 2011; Eaton
Optimal sleep is essential for healthy brain development and et al. 2010; Chung & Cheung 2008), including a marked
physical growth in adolescents (Dahl & Lewin 2002). However, tendency for later bedtimes (Chung & Cheung 2008),
cross-sectional studies suggest that between 14% and 68.9% of insufficient sleep (Eaton et al. 2010; Chung & Cheung 2008),

© 2016 John Wiley & Sons Ltd 1

2 X. Ji and J. Liu

large weekday-weekend variability in sleep patterns and subjective instruments, such as questionnaires, remain the
excessive daytime sleepiness (National Sleep Foudation 2007). most practical tools to characterize sleep for two reasons
Sleep disturbances have been linked to impaired daytime (Buysse et al. 2010). First, subjective sleep measures allow
attention (Lehto & Uusitalo-Malmivaara 2014), depressive researchers and clinicians to assess not only the quantitative
symptoms (Lehto & Uusitalo-Malmivaara 2014), somatic facets of sleep, but also individual’s perception of insufficient
complaints (Simola et al. 2014), as well as poor cognitive sleep and sleep disturbances. To that regard, subjective and
function (Liu et al. 2012) and academic performance (Dewald objective sleep measures complement each other in providing
et al. 2010). information on patient- or participant-centred health needs
The vulnerability to sleep disturbances in adolescence and responses to sleep intervention. Second, subjective sleep
highlights the importance of research and clinical assessment measures are suitable for use in clinical screening and
tools that can accurately identify adolescent sleep disturbances large-scale research in terms of their cost-effectiveness.
and measure responses to sleep interventions. A reliable and Despite the wide application, studies using subjective sleep
valid instrument may also contribute to the comparability and measures face challenges in selecting a psychometrically
replicability of study results on adolescent sleep disturbances. established instrument to measure adolescent sleep. Sleep
However, because of the multidimensional nature and behaviours and sleep quality in adolescents represent a
individual variability, complex concepts such as sleep complex exhibition of biological, developmental and psycho-
quality/disturbances are often difficult to operationalize and social influences (Carskadon et al. 2004). Some self-reported
measure. Factors related to sleep quality and sleep disturbances tools originally designed for adults have documented reliability
vary from quantitative parameters of sleep to subjective in adolescent population (Zhou et al. 2012); however, the
perception of sleep experience and from the variations in constructs and scaling may not capture the unique character-
sleep itself to the perceived daytime function associated with istics of adolescent sleep. Regarding paediatric instruments,
nocturnal sleep (Blunden & Galland 2014; Buysse et al. 2010). they often use a parental-report format. Because of the
Researchers often assume that variations in the experience of increasing independence in sleep behaviours among adoles-
sleep are reflected in the amount or distribution of sleep and cents, parent-reported sleep measures may not be consistently
wakefulness. A current study, however, suggests that sleep reliable and valid when reporting on adolescents’ subjective
latency, total sleep time and wake after sleep onset do not experience of sleep. For example, the 2006 Sleep Poll by the
necessarily characterize perceived sleep experiences (Krystal & National Sleep Foundation’s (National Sleep Foudation 2007)
Edinger 2008). Despite the possible discrepancies between reported very low agreement (4%) about the presence of a
quantitative and qualitative characteristics of sleep, they both sleep problem between adolescents and their parents. Sleep
provide important information to fully assess the construct of measurements that are not psychometrically sound may lead to
adolescent sleep (Blunden & Galland 2014). biased results, and in turn affect the understanding of the
Researchers have developed a number of objective and nature of adolescent sleep.
subjective assessment tools to measure adolescent sleep. Very few studies have critically evaluated the psychometric
Polysomnography (PSG) and wrist actigraphy are commonly properties of sleep measures used for the adolescent popula-
used objective measures in studies on adolescent sleep (Spruyt tion. Lewandowski et al. (2011) summarized the subjective
& Gozal 2011). PSG is known as the ‘gold standard’ for paediatric sleep measures used between 1990 and 2010, but did
quantifying sleep architecture and identifying sleep distur- not include adolescent sleep characteristics in the evaluation
bances. It requires neuromuscular measurements recorded by criteria, and thus could not specifically address issues
specialized equipment (Buysse et al. 2010). Thus, PSG is surrounding adolescent sleep measurement. With a focus on
usually performed in sleep laboratories with relatively high adolescents with cancer, Erickson (2009) reviewed objective
cost, and not feasible for sleep assessment in studies with a and subjective sleep measurement used in adolescent sleep
large population. Actigraphy involves a wristwatch-like device studies published between 1998 and 2007. However, because of
that measures movement as a proxy for wakefulness, and thus a recent growth in the number of studies aiming to evaluate the
is less reliable in distinguishing between quiet wakefulness and application of patient-reported outcome measures in children
sleep (Meltzer et al. 2012). Additionally, PSG and actigraphy with sleep disturbances, it is worthwhile to further examine the
cannot capture perceived experience in sleep, which is an updated status of subjective sleep measures for adolescents.
essential component of adolescent sleep. Despite the The aims of this review are to comprehensively examine the
importance of objective sleep measures in clinical diagnostics, psychometric properties of subjective measures that are used to

© 2016 John Wiley & Sons Ltd, Child: care, health and development
 Subjective sleep measures for adolescents 3

evaluate sleep quality and disturbances among adolescents, questionnaires without any aspect of psychometric validation;
describe the application of each measurement in different (d) the article was a unpublished thesis or dissertation; (e)
context, and identify the strength and limitation of each narrative literature reviews.
measurement. This review will ultimately inform health
practice, and shed light on the full extent of the consequences
Data extraction and analysis
of sleep disturbances on pubertal development.
Extracted data included general characteristics of the subjective
sleep measures (construct, the number of items, administra-
Methods
tion time, recall period, etc.), study populations in which the
measurement properties were evaluated (age, sex and setting)
Search methods
and psychometric properties. The evaluation of the available
Three databases were searched to identify studies developing or instruments was based on a brief checklist for choosing a
examining subjective measures of adolescent sleep. PubMed patient-reported outcome questionnaire, including documen-
was searched using MeSH terms sleep and adolescent, as well as tation, development, validity, reliability, target population,
the key words measure, assess, scale, instrument, and question- feasibility, language and culture, scoring and interpretation
naire to indicate measurements. The literature searches in (Cappelleri et al. 2013). Responsiveness that reflects an
Embase and PsycInfo involved key words sleep, adolescent, instrument’s ability to detect clinically important change over
measure, assess, scale, instrument, and questionnaire. All searches time (Guyatt et al. 1989) was also evaluated in this study. The
were then limited to English language, humans, full text and methodological quality of studies providing evidence of
journal articles published between 2000 and May 2016. responsiveness were reviewed based on the COnsensus-based
Standards for the selection of health Measurement Instruments
checklist (Mokkink et al. 2009; Mokkink et al. 2010). Finally,
Inclusion and exclusion criteria
the reliability, validity and responsiveness of each measure
This review included studies that provided evidence of were classified as positive, intermediate or poor according to
development and evaluation of self-reported or parent- the quality criteria for health status questionnaires (Terwee
reported measures for adolescent sleep. Studies were excluded et al. 2007; Schellingerhout et al. 2012).
from the analysis based on the following criteria: (a)
measurements developed to clinically diagnose a physiological
Results
sleep disorder, such as obstructive sleep apnoea and restless leg
syndrome; (b) sleep items under evaluation were subdomains As shown in Fig. 1, the number of results yielded by PubMed,
of an instrument assessing a phenomenon other than sleep; (c) Embase and PsycInfo was 1230, 495 and 233, respectively.

Figure 1. Flow diagram of article selection process.

© 2016 John Wiley & Sons Ltd, Child: care, health and development
4 X. Ji and J. Liu

Table 1. Characteristics of reviewed subjective sleep measures (n = 13)

Questionnaire Construct Target population Respondent Recall period Time of completion

Generic measures:
Children’s Report of Sleep 76 items (Likert/frequency); Originally for children Self Last night N/A
Patterns (Meltzer et al. 2014) 3 subscales (Sleep Patterns, Sleep aged 8–12 years;
Hygiene, and Sleep Disturbances). validated in adolescents
13–18 years
School Sleep Habit Survey 63 items, 6 domains: sleep schedule 13–19 years old; healthy Self Last 2 weeks N/A
(Carskadon, Seifer, & Acebo, regularity, school performance, adolescents
1991; Wolfson & Carskadon daytime sleepiness, sleep-wake
1998; Wolfson et al. 2003) behaviour problems, depressive
mood, and habitual sleep schedules
(bedtime, rise-time, total sleep
time, et al).
Sleep Disturbance Scale for 26 items (Likert/frequency); English: 6–18 years Parent Last 6 months 10–15 min
Children (Ferreira et al. 2009; 6 domains: disorders of initiating and Portuguese: 3–18 years
Bruni et al. 1996) maintaining sleep, sleep breathing
disorders, disorders of arousal, sleep/
wake transition disorders, excessive
somnolence, and sleep hyperhydrosis.
Sleep Disorders Inventory 43 items (Likert/frequency); 11–18 years Parent N/A N/A
for Students-Adolescent 4 domains: obstructive sleep apnoea
Form (Luginbuehl et al. syndrome, periodic limb movement
2008) disorder, delayed sleep phase
syndrome, narcolepsy
Pittsburgh Sleep Quality 19 items (Likert/frequency); Original for adults Self Last 2 weeks 5–10 min
Index (Zhou et al. 2012) 7 domains: subjective sleep quality, validated in adolescents
sleep latency, sleep duration, sleep of 12–18 years (Chinese)
efficiency, sleep disturbances, use of
sleeping medication and daytime
dysfunction.
Adolescent Sleep Wake 28 items (Likert/frequency); 12–18 years Self Last 1 month NA
Scale (LeBourgeois et al. 5 behavioural dimensions: going to
2005; Essner et al. 2015; bed, falling asleep, maintaining sleep,
Sufrinko et al. 2015) reinitiating sleep, and returning to
wakefulness.
Short version: 10 items, 3 domains:
falling asleep and reinitiating sleep;
returning to wakefulness; and going
to bed.
Domain specific- Sleep Hygiene
Adolescent Sleep Hygiene 32 items (Likert/frequency), including 12–18 years Self Last 1 month N/A
Scale (Lebourgeois et al. 4 qualitative items to ascertain usual
2005; Storfer-Isser et al. bedtime and wake time on weekdays
2013; de Bruin et al. 2014) and at weekends, and 28 quantitative
items that are used to calculate 9
subscale scores: physiological,
cognitive, emotional, sleep
environment, daytime sleep,
substances, sleep stability, bedtime
routine and bed sharing.
Domain specific- Daytime Sleepiness
Cleveland Adolescent 16 items, 4 domains: sleep in school, 11–17 years; both normal Self Last 1 week 5–10 min
Sleepiness Questionnaire alert in school, sleep in the evening, and OSA adolescents
(Spilsbury et al. 2007) and sleep during transport.
Modified Epworth 8 items (Likert/likelihood) Modified to 13–16 years Self N/A 2–5 min
Sleepiness Scale
(Moore et al. 2009)

Continues

© 2016 John Wiley & Sons Ltd, Child: care, health and development
 Subjective sleep measures for adolescents 5

Table 1. (Continued)

Questionnaire Construct Target population Respondent Recall period Time of completion

Paediatric Daytime 8 items (Likert/frequency) 11–15 years; Self N/A 5 min

Sleepiness Scale
(Drake et al. 2003)
Domain specific- Sleep Insufficiency
Chronic Sleep Reduction 20 items, 4 domains: shortness of 12.2–16.5 years Self Last 2 weeks N/A
Questionnaire sleep, irritation, loss of energy
Dutch: Meijer (2008) and sleepiness.
English (Dewald et al. 2012)
Condition specific – insomnia
Athens Insomnia Scale 8 items: the first 5 items assess Original for adults Self Last 1 month N/A
(Chung et al. 2011; difficulty with sleep induction, adaptation to
Yen et al. 2010) awakening during the night, early 12–19 years
morning awakening, total sleep time,
and overall quality of sleep, while the
last 3 items pertain to the sense of
well-being, overall functioning and
sleepiness during the day.
Insomnia Severity Index 7-item scale assessing the perceived Original for adults Self Last 2 weeks N/A
(Chung et al. 2011) severity of insomnia symptoms (initial, adaptation to
middle, terminal), the degree of 12–19 years
satisfaction with sleep, interference
with daytime functioning,
noticeability of impairment, and
concern caused by the sleep problems.

Duplicates were identified and detected by using Ref Works dimension-specific instruments (n = 5) and condition-specific
(ProQuest LLC, USA) licensed by Penn Library, yielding a total instruments (n = 2). Generic instruments assess comprehensive
of 1845 results. Each title and abstract was reviewed for sleep quality/disturbances in adolescents, while dimension-
relevance, which yielded 23 results. We then manually searched specific instruments focus on one aspect of sleep health, such as
the reference lists of the 23 articles, and identified additional 3 sleep behaviour/hygiene, sleep insufficiency and daytime
articles that met the inclusion criteria. Although these three sleepiness among adolescents. Two available condition-specific
articles were published before the year of 2000, we included instruments are primarily used for insomnia diagnosis and
them in the review. screening. The application of existing subjective sleep measures
A final sample of 26 articles that covered 13 questionnaires has been tested in different contexts depending on the purpose
assessing adolescent sleep was identified for review. Table 1 of assessment, such as diagnostics, screening, characterization
represents the constructs, method of administration, target and capturing outcomes for clinical trials. The psychometric
population, and the respondent burden of each instrument. properties of each subjective sleep measure, including reliability,
The majority of questionnaires available are self-reported tools validity, and responsiveness, were summarized in Tables 2–4.
by adolescents, except the Sleep Disturbance Scale for Children None of the subjective sleep measures for adolescents has a
(SDSC) (Ferreira et al. 2009; Bruni et al. 1996) and the Sleep psychometric profile with all essential measurement properties.
Disorders Inventory for Students-Adolescent (SDIS-A) Whereas all instruments were evaluated for internal consistency,
(Luginbuehl et al. 2008), which are parent proxy measures. only 5 (out of 13) measures have evidence of responsiveness, and
Current questionnaires are mostly retrospective with varying one study reported content validity.
recall periods ranging from 1 day to 6 months. However, the
SDIS-A, the Paediatric Daytime Sleepiness Scale (PDSS) and
Discussion
the Modified Epworth Sleepiness Scale (ESS) do not have a
time frame explicitly specified (Moore et al. 2009; Luginbuehl
Generic measures for sleep disturbances and sleep quality
et al. 2008; Drake et al. 2003).
The concepts measured in the available questionnaires are Six sleep measurements, designed as screening tools for overall
classified into 3 categories: generic instruments (n = 6), sleep quality and disturbances in large-scale school or

© 2016 John Wiley & Sons Ltd, Child: care, health and development
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Table 2. The reliability and validity of subjective sleep measures for adolescents

Questionnaire Article (First author) Sample Reliability Validity

Generic measures:
CRSP Meltzer (2014) Adolescents aged Internal consistency: subscales: α ≥ 0.70 (except Criterion validity: only self-reported sleep quality was
X. Ji and J. Liu

13–18 years/US and the bedtime fears/worry scale α = 0.61) significantly correlated with the OSA severity by PSG
Australia (n = 570) (r = 0.467).
Test-retest: subscales of sleep hygiene/disturbances: Convergent validity: Significantly associated with
r = 0.34–0.82 the ASHS (all r < 0.60)
Construct validity: Group differences (e.g. clinical vs.
community) in Sleep Hygiene/Sleep Disturbances were
significant. Moderate to good fit was shown in CFA.
SSHS Carskadon (1991) Adolescents aged Internal consistency: N/A
14–20 years/US (n = 581) Subscales: α = 0.45–0.77
Wolfson (1998) Adolescents aged Internal consistency: sleepiness subscale: α = 0.7; N/A
13–19 years/US (n = 3120) sleep–wake behaviour: α = 0.75; depressive mood:
α = 0.79
Wolfson (2003) Adolescents aged The SSHS variables were significantly correlated both
13.8–19.9 years old/US with diary and actigraphy variables, with greater

© 2016 John Wiley & Sons Ltd, Child: care, health and development
(n = 302) consistency on school days (r = 0.53–0.77) than weekend
days (r = 0.31–0.52).
SDSC Bruni (1996) Children aged Internal consistency: The factor analysis explained 44.21% of the variance.
5.8–15.3 years/Rome Healthy control group: α = 0.71; sleep disorder Scores were significantly different between sleep
(n = 1304) children: α = 0.79 disorder group and the control.
Test-retest: r = 0.71 Diagnostic accuracy: AUC = 0.91
Ferreira (2009) Children aged Internal consistency: Discriminatory validity was only attested for the
3–18 years/Brazilian Full scale: α = 0.78 subscale of SDB.
Portuguese (n = 100) Subscales: α = 0.55–0.82
SDIS-A Luginbuehl (2008) Adolescents aged 11–18 Internal consistency: full scale: α = 0.92; subscales: Convergent validity was 0.64 with PSG snoring score.
years/US (n = 182) α = 0.71–0.92. CFA: the χ2 tests suggested the model was not
Test–retest: r = 0.86 significant; but the CFI and RMSEA showed good fit.
All the subscales had good sensitivity and specificity,
except the sensitivity of PLMD (0.55).
PSQI Zhou (2012) Adolescents aged Internal consistency: The cumulative variance of principal components
12–18 years/China (n = 1221) Full scale: α = 0.87; subscales: α = 0.46-0.85 was 70.72%
Test-retest reliability:
Full scale: ICC = 0.86; subscales: ICC = 0.67–0.87
ASWS LeBourgeois (2005) Italian (n = 776) and Internal consistency: N/A
American adolescents Italians: full scale: α = 0.80, subscales: α = 0.60 to 0.81;
(n = 572) aged 12–17 years Americans: full scale: α = 0.86; subscales: α = 0.64-0.82
old.
ASWS-short Essner (2015) Adolescents aged Internal consistency: The three-factor model explained 57.1% of the variance.
12–18 years/US (n = 491) Total sample: subscales: α = 0.71–0.87 All items had primary factor loadings of > 0.50.
Health conditions sample: α = 0.74–0.84 Adolescents with chronic pain reported poorer overall
Healthy sample: α = 0.64–0.89 sleep quality (P < 0.01), et al.
Sufrinko (2015) Adolescents aged Internal consistency: CFA: χ2 test indicated that the structure was not a good
12–18 years/US (n = 467) Total sample: full scale: α = 0.72; subscales: fit (P = 0.005); but the RMSEA, CFI and TLI = 0.96 indicated
α = 0.54–0.78 a good fit.
 Table 2. (Continued)

Questionnaire Article (First author) Sample Reliability Validity

African American: full scale: α = 0.73; subscales:

α = 0.48–0.75
Caucasian: full scale: α = 0.73; subscales: α = 0.67–0.78
Latino: full scale: α = 0.60; subscales: α = 0.40–0.81
Biracial: full scale: α = 0.80; subscales: α = 0.49–0.83
Domain specific- Sleep Hygiene
ASHS LeBourgeois (2005) Italian (n = 776) and Internal consistency: N/A
American adolescents Similar for the American and Italian samples, with
(n = 572) aged 12–17 years the exception of the sleep-environment domain
old. (Italian: α = 0.37; American: α = 0.52).
All adolescents: full scale: α = 0.80, subscales:
α = 0.46–0.74.
Storfer-Isser (2013) Adolescents aged Internal consistency: full scale: α = 0.84; subscales: CFA: did not have minimally adequate fit. Total ASHSr
(revised ASHS) 6–19 years/US (n = 514) α = 0.60–0.81; scores were associated with sleep patterns measured
by actigraphy (r = 0.26–0.17), the scores by the
Epworth Sleepiness Scale, and the CBCL
behavioural measure.
de Bruin (2014) Adolescents with (n = 186) Internal consistency: A nine-component solution explained 58.35% of the
and without clinically Full scale: α = 0.67 variance; only three interpretable components.
diagnosed insomnia Subscale: α = 0.26–0.82, only the cognitive and the Moderate to strong correlations of the ASHS (domains)
(n = 112)/Amsterdam bed/bedroom-sharing domains showed sufficient with sleep quality, sleep duration and chronic sleep
reliability. reduction. Adolescents with insomnia had significantly
lower score than normal sleepers.
Domain specific- Daytime Sleeping
CASQ Spilsbury (2007) Adolescents aged Internal consistency: EFA revealed a final solution consisting of four factors
11–17 years/US (n = 411) Full scale: α = 0.89 that explained 55% of the variance; CFA with
modification indicates revealed a satisfactory fit.
The CASQ was significantly associated, albeit weakly, with
AHI and sleep efficiency derived from the PSG.
ESS (modified) Moore (2009) Adolescents aged Internal consistency: N/A
13–16 years/US (n = 247) Full scale: α = 0.75
PDSS Drake (2003) Adolescents aged Internal consistency: Convergent validity: expected associations with
11–15 years/US (n = 450) Full scare: α = 0.80 outcomes linked to sleepiness (e.g. decreased sleep
time, poor grades, and negative moods).
Factor analysis on the 13 questions related to
daytime sleepiness yielded one primary factor
(32% of variance).
Yang (2010) Healthy adolescents with Internal consistency: α = 0.66 (school samples), Discriminative validity: PDSS scores were significantly
mean age 12.55 years 0.61 (OSA patients), 0.81 (narcoleptic group) different across the three groups (normal controls, OSA,
(n = 34), adolescents with Test–retest correlation was 0.78 and narcolepsy);
OSA averagely (13.07 years, The AUC for differentiating narcolepsy from normal
n = 28) or narcolepsy controls was 0.877, discrimination of OSA patients
(13.97 years, n = 31)/China
Subjective sleep measures for adolescents

Continues

© 2016 John Wiley & Sons Ltd, Child: care, health and development
7
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Table 2. (Continued)

Questionnaire Article (First author) Sample Reliability Validity

X. Ji and J. Liu

from normal controls was 0.68

Domain specific – Sleep Insufficiency

CSRQ Meijer (2008) Children with mean Internal consistency: CFA: The chi-square test was significant (P = 0.00),
age = 11 years Full scale: α = 0.83; however, other parameters showed a good fit
5 months/(n = 436) Subscales: α = 0.62–0.68 (CMIN/DF = 1.49; CFI = 0.94; RMSEA = 0.034).
Test–retest reliability: r = 0.76 Convergent validity: significant but relatively small
correlations with Time in Bed, sleep quality and
circadian preference.
Dewald (2012) Adolescents aged Internal consistency: Both CSRQ versions showed good validity concerning
12.2–16.5 years/Dutch Dutch: α = 0.85; Australia: α = 0.87 the same overall structure of the two CSRQ versions, and
samples (n = 166) significant correlations with subjective and objective
Australia samples (n = 166) sleep variables.

© 2016 John Wiley & Sons Ltd, Child: care, health and development
Condition specific – insomnia
AIS Chung (2011) Adolescents aged Internal consistency: full scale: α = 0.81 Factor analysis yielded a 2-factor structure, with factor
12–19 years/Hong Kong Test–retest reliability: r = 0.80 1 explained 37.9% of the variance, and factor 2
(n = 1516) explained 21.5%.
The AUCs of the ROC curves for the AIS was 0.80
(95% CI: 0.72–0.89). The optimal cut-off for AIS was a
total score ≥ 7, yielding a sensitivity of 0.78 and
a specificity of 0.74;
The Pearson’s r with the presence of DSM-IV-TR of
clinical insomnia was 0.3.
Yen (2010) Adolescent students aged Internal consistency: EFA found two factors: insomnia symptoms,
12–19 years/Taiwan Subscales: α = 0.645–0.714 and subjective sleep and daytime distress (47.524%
(n = 8319) Test-retest reliability: r = 0.718 (P < 0.001) of the variance);
ISI Chung (2011) Adolescents aged Internal consistency: full scale: α = 0.83 EFA found a 2-factor structure, with factor 1 explained
12–19 years/Hong Kong Test–retest reliability = 0.79 35.4% of the variance, and factor 2 explained 30.2%.
(n = 1516) The AUCs of the ROC curves for the ISI was 0.85 (95%);
the ROC suggested a cut-off of
total score ≥ 9, which had a sensitivity of 0.87 and
specificity of 0.75.
The Pearson’s r with the presence of DSM-IV-TR of clinical
insomnia was 0.37.

AHI, Apnoea–Hypopnoea Index; AIS, Athens Insomnia Scale; AUC, area under the curve; ASHS, Adolescent Sleep Hygiene Scale; ASWS, Adolescent Sleep Wake Scale; CASQ, Cleveland Adolescent
Sleepiness Questionnaire; CBCL, Child Behavior Checklist; CFA, confirmatory factor analysis; CFI, Comparative Fit Index; CMIN/DF, ratio of chi-square X 2 to the degrees of freedom; CRSP, Children’s
Report of Sleep Patterns; CSRQ, Chronic Sleep Reduction; DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision; EFA, exploratory factor analysis; ESS, Epworth
Sleepiness Scale (modified); ICC, intraclass correlation coefficient; ISI, Insomnia Severity Index; OSA, Obstructive Sleep Apnoea; PDSS, Paediatric Daytime Sleepiness Scale; PLMD, periodic limb
movement disorder; PSG, Polysomnography; PSQI, Pittsburgh Sleep Quality Index; RMSEA, root mean square error of approximation; ROC, receiver operating characteristic; SDB, sleep-disordered
breathing; SDSC, Sleep Disturbance Scale for Children; SDIS-A, Sleep Disorders Inventory for Students-Adolescent; SSHS, School Sleep Habit Survey; TLI, Tucker–Lewis Index.
 Table 3. The responsiveness of subjective sleep measures for adolescents

Intervention/criterion
Questionnaire Article Sample for changes Time interval Responsiveness statistics COSMIN

PSQI John (2016) Mean age: 14.02 ± 2.15 years; Hypothesis: the sleep 1. Baseline No follow-up sleep values reported; test Fair
CASQ intervention group, n = 34; promotion program would 2. At 2-week of intervention statistics only.
control group, n = 24. improve adolescents’ sleep 3. At 6-week of intervention PSQI: between group differences were significant
hygiene practices, sleep in the sleep onset latency, sleep duration, and
quality, and daytime overall sleep quality (P < 0.01), whereas other
functioning. subscales did not show significant improvement
(P > 0.05).
CASO: between group differences were significant
in daytime sleepiness score at 2 weeks, but not
at 6 weeks.
Comparator measures: Significant improvement
was shown in emotion as estimated by the PedsQL_
VAS at 2 weeks. There was no change in sleep
hygiene practices assessed by the SHI.
PSQI Bei (2013) Adolescent girls aged Hypothesis (deduced): 1. Baseline Post-intervention global PSQI scores were Poor
13–15 years/Australia (n = 9) the six-session group 2. Within 2 weeks of significantly lower than that of pre-intervention,
program would improve program completion. with significant improvement in subjective SOL,
sleep outcomes. sleep quality and sleep-related daytime
dysfunction.
Comparator measures: participants showed
significant improvement on objective SOL, sleep
efficiency and total sleep time measured
by actigraphy.
PSQI Tan (2012) Adolescents aged Hypothesis (deduced): Twice before (1 and ASHS scores were significantly improved (P = 0.005) from Fair
ASHS 10–18 years/Australia (n = 33) one-on-one sleep hygiene 2 weeks) and three times a baseline mean (SD) of 4.70 (0.41)–4.95 (0.31)
SDIS-A program would improve after (6, 12 and 20 weeks) post-intervention; PSQI, PDSS, SDSC scores were
PDSS sleep outcomes. the intervention significantly decreased post-intervention
(P < 0.001).
Comparator measures: Similar improvement was
reported for ASHS, PSQI, SDSC and PDSS scores.
Sleep duration as estimated by Actical
accelerometry did not change.

ASHS, Adolescent Sleep Hygiene Scale; CASQ, Cleveland Adolescent Sleepiness Questionnaire; COSMIN, COnsensus-based Standards for the selection of health Measurement Instruments; PDSS,
Paediatric Daytime Sleepiness Scale; PedsQL VAS, PedsQL Present Functioning Visual Analogue Scales; PSQI, Pittsburgh Sleep Quality Index; SD, standard deviation; SDSC, Sleep Disturbance Scale for
Children; SOL, sleep onset latency.
Subjective sleep measures for adolescents

© 2016 John Wiley & Sons Ltd, Child: care, health and development
9
10 X. Ji and J. Liu

Table 4. Evaluation of the measurement properties of subjective sleep measures for adolescents (n = 13)

Reliability Validity
Responsiveness
Measure Internal consistency Test retest Content Cross cultural Structural Convergent/divergent

CRSP + +/ ? N/A ? ? N/A

SSHS +/ N/A N/A N/A N/A S*:+; W*: N/A
SDSC + + N/A + ? N/A
SDIS A + + N/A N/A ? + ?
PSQI + + N/A ? + ? ?
ASWS +/ N/A N/A N/A + + N/A
ASHS +/ N/A N/A + + ?
CASQ + N/A N/A N/A + + ?
ESS + N/A N/A N/A N/A N/A N/A
PDSS +/ + N/A N/A + ?
CSRQ +/ + N/A + + N/A
AIS + + N/A N/A +/ + N/A
ISI + + N/A N/A + + N/A

AIS, Athens Insomnia Scale; ASHS, Adolescent Sleep Hygiene Scale; ASWS, Adolescent Sleep Wake Scale; CASQ, Cleveland Adolescent Sleepiness
Questionnaire; CRSP, Children’s Report of Sleep Patterns; CSRQ, Chronic Sleep Reduction Questionnaire; ISI, Insomnia Severity Index; ESS, Epworth Sleepiness
Scale (modified); PDSS, Paediatric Daytime Sleepiness Scale; PSQI, Pittsburgh Sleep Quality Index; SDIS A, Sleep Disorders Inventory for Students-Adolescent;
SDSC, Sleep Disturbance Scale for Children; SSHS, School Sleep Habit Survey.
Rating: +, positive rating; ?, indeterminate rating; , negative rating; N/A, no information available (Terwee et al. 2007); +/ , conflicting results in studies or
inconsistent results across subscales.
*S, school day; W, weekend

community populations, are generic in nature. The Children’s literature has not reported the response time and nonresponse
Report of Sleep Patterns (CRSP) (Meltzer et al. 2014) and the rate of these two screening tools. Additionally, the evidence of
School Sleep Habit Survey (SHS) (Wolfson & Carskadon 1998; responsiveness of the SHS and the CPSP is thus far lacking.
Wolfson et al. 2003) enable researchers to measure multiple The authors of the SDSC (Ferreira et al. 2009; Bruni et al.
sleep dimensions that are reflective of sleep disturbances in 1996) and the SDIS-A (Luginbuehl et al. 2008) strongly
adolescents. The CRSP is a self-reported measurement with a advocate screening for sleep disturbances. The SDSC was
relatively complete psychometric profile. Studies using the initially developed for Italian children, and was then translated,
CRSP reported good internal consistency and intermediate test- culturally adapted and validated for Brazilian Portuguese
retest reliability in most of the subscales, a moderate-to-good fit children aged 3–18 years through rigorous procedures
of theoretical and operational constructs, acceptable convergent (Ferreira et al. 2009; Bruni et al. 1996). Researchers have
validity with the Adolescent Sleep Hygiene Scale (ASHS) and reported its good reliability and discriminatory validity for
agreement with PSG outcomes (Meltzer et al. 2014). Empirical sleep disorders (Bruni et al. 1996), especially the domain of
evidence also supports that the CPSP has the ability to sleep disordered breathing (Ferreira et al. 2009). These
discriminate adolescents clinically diagnosed with sleep distur- findings, however, were based on a heterogeneous sample
bances from those with normal sleep patterns (Meltzer et al. including both young children and adolescents. The psycho-
2014). As the CRSP has also been recognized as a reliable and metric properties of the SDSC specific to adolescent popula-
valid self-report measure in children aged 8–12 years (Meltzer tion remain unknown. The SDIS-A includes screening items
et al. 2013), the CRSP can be used in longitudinal studies to for the most common sleep disorders in adolescents: obstructive
capture the trajectory of sleep patterns from early childhood to sleep apnoea, periodic limb movement disorder, restless leg
adolescence. Relative to the CRSP, the SHS has only received syndrome, delayed sleep phase syndrome, and narcolepsy
limited psychometric evaluation, with reliability tests for (Luginbuehl et al. 2008). Overall, the tool scored well on
subscales, and convergent validity tests for six quantitative sleep validity and reliability, except for the structural validity. The
items (Wolfson et al. 2003). Therefore, the SHS cannot be exploratory factor analysis reported dual or multiple loadings,
recommended as a well-established instrument. It should be which may result from the symptom clusters shared in different
noted that participant burden and nonresponse may be a sleep disorders. Thus, the SDIS-A may be only moderately
concern for both instruments, given that the SHS and the CPSP accurate in predicting the exact type of sleep disorder, but is still
contain 63 and 76 items, respectively. However, current likely to capture the presence of a sleep disorder.

© 2016 John Wiley & Sons Ltd, Child: care, health and development
 Subjective sleep measures for adolescents 11

Both the SDSC and SDIS-A are parent-reported measures. et al. 2007), nor tested the correlation of the changed scores
Parents are often involved less frequently with children’s sleep between the PSQI and the comparators.
routines as their children enter adolescence, and they may be
not aware of their children’s sleep status during the night. For Domain-specific instruments
example, a recent study suggested that approximately 40% of
parents did not identify child-reported difficulties with sleep Sleep hygiene
onset latency, night waking or poor sleep quality (Meltzer et al.
Sleep hygiene refers to behavioural practices (e.g. refraining
2013). Therefore, the SDSC and SDIS-A, relying solely on
from caffeine consumption during the day or limiting
parents’ report, may underestimate their child’s sleep distur-
technology usage in the bedroom) that promote adequate
bances in both clinical and research settings. Furthermore, the
sleep quantity and quality as well as daytime alertness
SDSC and the SDIS-A cannot be recommended as a tool to
(LeBourgeois et al. 2005). The ASHS, modified from the
capture longitudinal sleep disturbances at this point because of
Children’s Sleep Hygiene Scale by LeBourgeois et al. (2005),
the limited evidence of their responsiveness property.
uses a self-report format assessing sleep practices that are
The Adolescent Sleep Wake Scale (ASWS) (LeBourgeois
theoretically important for optimal sleep. Negative sleep
et al. 2005; Essner et al. 2015; Sufrinko et al. 2015) and the
hygiene behaviours do not directly indicate sleep quality, but
Pittsburgh Sleep Quality Index (PSQI) (Zhou et al. 2012) have
can identify problematic behaviours to target for intervention.
been used to self-assess global sleep quality in adolescents. The
The ASHS has shown acceptable psychometric properties
ASWS is a modified version of the Children’s Sleep-Wake
(LeBourgeois et al. 2005; Storfer-Isser et al. 2013; de Bruin
Scale, with 28 items assessing behavioural domains of
et al. 2014). However, researchers have reported discrepancies
adolescent sleep. LeBourgeois et al. (2005) found good internal
in the reliability of the ASHS across cultures; and thus, have
consistency for the full scale of the ASWS. Essner et al. (2015)
challenged its inclusiveness and consistency in different
shortened the ASWS to a 10-item version, which exhibited
language versions. Specifically, the statistics indicated
acceptable fit (Sufrinko et al. 2015). However, the ASWS
acceptable internal consistency of sleep-environment domain
showed inconsistent internal consistency in different ethnical
in American adolescents but low in a sample of Italian
groups, with poor property in Latino adolescents (Sufrinko
adolescents (LeBourgeois et al. 2005). Sleep hygiene reflects
et al. 2015). The evidence of responsiveness property for the
behavioural norms at a given time in a given cultural context
ASWS has not been found in the literature. The PSQI, on the
(LeBourgeois et al. 2005). This may explain the discrepancy in
other hand, was initially developed as a tool to quickly assess
the ASHS reliability across countries, but also raise the
overall sleep quality in the adult. Although researchers have
question that whether it is plausible to compare sleep hygiene
preliminarily validated the PSQI in adolescents (Zhou et al.
across cultures using a one-size-fits-all measurement. In terms
2012), researchers should interpret results from the original
of the responsiveness, although an interventional study
PSQI cautiously as they may not reflect the nature of
provided evidence for significant changes in the ASHS scores
adolescent sleep quality. Specifically, the PSQI does not
after intervention (Tan et al. 2012), the minimal important
measure the possible discrepancy between weekday and
change and how the ASHS changes correlate with that in its
weekend sleep parameters, which is one of the major trends
comparative instruments were not reported.
of sleep pattern in adolescents. Moreover, the normative values
of sleep parameters in adolescents differ from those in adults.
Daytime sleepiness
The scoring method and the cut-off of good/poor sleep quality
may not be applicable to the adolescent population. For Domain specific measurements, such as the Modified ESS
example, the PSQI rates 7 h as good sleep duration; however, it (Moore et al. 2009), the Cleveland Adolescent Sleepiness
is well below the recommended 9.2 h for adolescents (Wolfson Questionnaire (CASQ) (Spilsbury et al. 2007) and the PDSS
& Carskadon 1998). The responsiveness of the PSQI has (Drake et al. 2003; Yang et al. 2010) have offered methods to
received more attention as compared with other measurements quickly measure daytime sleepiness among adolescents. The ESS
reviewed in this study. Three studies provided evidence for the used in adolescents was usually modified from the initial version
significant changes in scores of the PSQI and its comparative for adults. For example, Moore et al. (2009) replaced the last
instruments across time (Bei et al. 2013; Tan et al. 2012; John item ‘in a car while stopped for a few minutes in traffic’ with
et al. 2016). However, these studies neither defined the ‘doing homework or taking a test’ when using the ESS with an
minimal important change/smallest detectable change (Terwee adolescent sample aged 13–16 years. Whereas this study

© 2016 John Wiley & Sons Ltd, Child: care, health and development
12 X. Ji and J. Liu

reported good reliability, the construct validity of the modified frequently use insomnia instruments originally designed for
ESS was not tested by exploratory or confirmatory factor adults in studies of insomnia in community-residing
analysis. The PDSS, a simple instrument designed for use with adolescents (Yen et al. 2010; Chung et al. 2011; Chung &
children in early adolescence, contains the same number of Cheung 2008). Whereas such adaptation may result in
items as the ESS (Drake et al. 2003). The PDSS showed the good measurement bias, two self-reported questionnaires, the
discriminating ability for sleep disorders (Yang et al. 2010). Athens Insomnia Scale (AIS) and the Insomnia Severity
However, the internal consistency of the PDSS was inconsistent Index (ISI), showed acceptable psychometric parameters for
between American and Chinese adolescents, as well as healthy assessing and screening insomnia problems in Chinese
school samples and those with clinically diagnosed sleep adolescents. Supported evidence included good internal
disorders (Drake et al. 2003; Yang et al. 2010). Additionally, consistency, test–retest reliability, convergent validity, and
some of the individual PDSS items, such as ‘How often do you adequately discriminating ability for adolescents with insom-
fall asleep or get drowsy during class periods?’, actually contain nia diagnosed by the Diagnostic and Statistical Manual of
two different behaviours. This creates difficulties for respon- Mental Disorders, 4th Edition (Yen et al. 2010; Chung et al.
dents to understand and answer as one question, especially when 2011). However, the fact that the studies were set in an Asian
the frequency of each behaviour is different. Relative to the country limits the generalizability of research findings to
PDSS and the ESS, Spilsbury et al. (2007) developed the CASQ to other countries. These two instruments, therefore, need to be
measure experiences of sleepiness and alertness in a variety of validated in future studies within different sociocultural
situations in adolescents over a broader age range (10–17 years contexts. Additionally, the responsiveness of the AIS and
old). Although researchers have reported high internal consis- the ISI remains unclear.
tency, convergent validity with other sleep measures, as well as
the ability to detect clinical samples with obstructive sleep
Cross validation between measures
apnoea, the CASQ has not been widely used in current sleep
studies. Additionally, among the instruments assessing daytime Current studies have provided empirical evidence to support
sleepiness, only the CASQ and the PDSS reported limited the validity of some measurements by comparisons between
evidence of the property of responsiveness (Tan et al. 2012; John subjective questionnaires. For example, the ISI, AIS and Sleep
et al. 2016). Quality Index were compared in the study by Chung et al.
(2011); and the CASQ was validated against the PDSS and the
Sleep insufficiency SSHS in a study by Spilsbury et al. (2007). Cross comparisons
also exist across different formats of sleep assessment. Many
The problem of chronic sleep deprivation during adolescence is
of the subjective questionnaires showed good convergent
a worldwide phenomenon. Researchers have deconstructed the
validity against the gold standard of PSG, such as the CRSP,
concept of sleep deprivation, and developed the Chronic Sleep
the SDSC and the SDIS-A (Meltzer et al. 2014; Ferreira et al.
Reduction Questionnaire (Dewald et al. 2012; Meijer 2008) to
2009; Luginbuehl et al. 2008); and subscales of the SSHS were
measure symptoms of chronic sleep reduction that account for
compared with both actigraphic reports and sleep logs
sleep needs and sleep debt. The CSRQ has two versions: Dutch
(Wolfson et al. 2003). However, it is worthwhile to note
and English. Both versions have shown good psychometric
that subjective and objective measures of sleep may not
properties with high internal consistency, good construct
highly correlate, but rather complement each other (Berger
validity and significant correlations with subjective and objective
et al. 2007). Understanding the relationships between sleep
sleep variables. Because of the insufficient evidence and limited
measures will provide the ability to better compare and
application, this questionnaire has not reported norm scores in
interpret results based on sleep data collected by different
different social contexts as well as its responsiveness property
instruments.
yet. However, the initial support from the two studies
mentioned represents a significant step in providing a reliable
indicator for adolescents’ sleep insufficiency. Implications for future research and practice

The results from this review have important implications for

Condition-specific instruments for insomnia
future research and practice. First, the robust evidence of all
Adult diagnostic criteria are often applied to adolescents in essential measurement properties is lacking in most of the
clinical practice (Chung et al. 2011). Likewise, researchers measures, particularly the content validity and responsiveness.

© 2016 John Wiley & Sons Ltd, Child: care, health and development
 Subjective sleep measures for adolescents 13

Similar to the patient-reported outcome measures for other Conclusions

health systems, subjective sleep measures can provide
This review demonstrates that heterogeneity in measure-
information on participants’ perception of their sleep quality
ment properties is present in self-reported or parent-
or health needs. However, none of the studies reported the
reported sleep measures used in adolescent studies. Because
content validity with the target population. Additionally,
of the limited evidence and aforementioned uncertainties,
although subjective sleep quality and disturbances represent
no definite recommendations can be made at this point.
one of the most important patient-centred outcomes for
The generic sleep measurements capture multidimensional
evaluating the effectiveness of sleep treatments and changes in
characteristics of adolescent sleep, but face critical issues of
disease trajectory, the evidence of responsiveness is limited
participant burden and compatibility. Among the domain-
for existing subjective sleep measures. Hence, future research
specific tools, the CASQ and the CSRQ have achieved good
with an active involvement of adolescents and a rigorous
psychometric merits but need further evaluation for the
design is needed to modify and validate the existing
property of responsiveness. Likewise, essential psychomet-
inadequate measures, and ensure their psychometric proper-
ric properties of condition-specific tools for insomnia have
ties and clinical relevance to the target groups. Second, the
yet to be established. Future research is needed to
self-reported or parent-reported measures reviewed in this
incorporate developmental characteristics of adolescent
study primarily focus on the frequency of certain sleep issues.
sleep into sleep measures, involve adolescents in content
As severity also reflects the level of sleep disturbances and
validation, and further validate existing sleep measurements
sleep-related impairment, developing new measures on
with rigorous design in different social contexts and
perceived severity of sleep quality and disturbances is
adolescent stages.
warranted. Third, in sleep studies with self-reported mea-
sures, nonresponse is an unintentional by-product of data
collection. Particular attention should be given to the Key Messages
response rate, the approach used to handle the problem • Common sleep concepts measured by existing sleep
and how the generalizability of their results may be affected instruments include overall sleep quality and sleep
in future studies. Shortening instruments based on the item disturbances, daytime sleepiness, sleep insufficiency,
response theory may be a strategy to minimize respondent sleep hygiene and insomnia.
burden, reduce nonresponse rate and develop more appro- • Whereas most of the instruments have been evaluated for
priate screening instruments in clinical practice and sleep reliability, the rigorous tests for validity and
research for adolescents. responsiveness are lacking in most of the instruments,
Future research should also address challenges specific to thus preventing a recommendation for future use.
adolescent assessment. Adolescent sleep patterns change • The majority of current measures are scaled in terms of
throughout the course of adolescence. Thus, the psychometric frequency. The perceived severity should also be
properties and response trends in terms of early, middle and incorporated into sleep assessment to assess the full
late adolescence need to be addressed by future research. dimension of sleep problems.
Adolescence is also characterized by night-to-night variations • Instruments originally designed for children and adults
in sleep patterns. As the time-frame of existing subjective should be modified to address the developmental
sleep measures does not allow an assessment of the night-to- challenges specific to adolescent assessment. Future
night variation, future studies on adolescent sleep may use research on subjective measures is needed to test their
validated sleep logs or actigraphy to provide such comple- content validity with adolescents, further evaluate
mentary information. Furthermore, mischievous responding subjective sleep measures in different social contexts,
behaviours are more likely to be present in adolescents, and compare differences across adolescent stages.
including providing ‘extreme, and potentially untruthful,
responses to multiple questions’ (Robinson-Cimpian 2014;
Fan et al. 2006). Health providers and researchers can use
self-report measures that contain ‘lie detector items’, such as
Conflicts of interest
the special item in the SDIS, to detect intentional false
responses and evaluate rater-reliability in self-reports None of the authors declare any conflict of interest that may be
(Luginbuehl et al. 2008). relevant to the materials presented in this paper.

© 2016 John Wiley & Sons Ltd, Child: care, health and development
14 X. Ji and J. Liu

Author’s contributions Carskadon, M. A., Acebo, C. & Jenni, O. G. (2004) Regulation of

adolescent sleep: implications for behavior. Annals of the New York
Xiaopeng Ji developed the idea for the study, performed the Academy of Sciences, 1021, 276–291.
systematic searches and the article retrieval, analyzed the data Carskadon, M. A., Seifer, R. & Acebo, C. (1991) Reliability of six
and wrote the article. Jianghong Liu mentored the review scales in a sleep questionnaire for adolescents. Sleep Research, 20,
process, including conceptualizing research question, literature 421.
Chung, K. F. & Cheung, M. M. (2008) Sleep-wake patterns and
search and the interpretation of results. Jianghong Liu also
sleep disturbance among Hong Kong Chinese adolescents. Sleep,
critically revised the article.
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Chung, K. F., Kan, K. K. K. & Yeung, W.-F. (2011) Assessing
insomnia in adolescents: comparison of insomnia severity index,
Athens insomnia scale and sleep quality index. Sleep Medicine, 12,
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Dahl, R. E. & Lewin, D. S. (2002) Pathways to adolescent health sleep
This study was supported by the ONR Research Grant Award regulation and behavior. Journal of Adolescent Health, 31, 175–184.
from the Office of Nursing Research at the School of Nursing de Bruin, E. J., Van Kampen, R. K., Van Kooten, T. & Meijer, A. M.
University of Pennsylvania. We would like to thank Professor (2014) Psychometric properties and clinical relevance of the
Therese Richmond, PhD and doctoral student Cynthia Adolescent Sleep Hygiene Scale in Dutch adolescents. Sleep
Paidipati, PhD (C) for their helpful comments on the initial Medicine, 15, 789–797.
Dewald, J. F., Meijer, A. M., Oort, F. J., Kerkhof, G. A. & Bögels, S. M.
draft of this paper.
(2010) The influence of sleep quality, sleep duration and sleepiness
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