The Children's Sleep Habits Questionnaire: Identification of sleep dimensions, normative values, and associations with behavioral problems in Italian preschoolers

Objective: To study the use of the Children's Sleep Habits Questionnaire (CSHQ) to evaluate sleep problems dimensions, norm values, and association of sleep problems with behavioral problems in Italian preschoolers. Design: Sleep dimensions in CSHQ were investigated via parallel and principal component analyses, norm and at-risk values were investigated by exploring the association between CSHQ and the CBCL sleep problems scale, and bivariate associations between CSHQ and internalizing and externalizing behavioral problems were computed. Participants: A total of 725 mothers of preschool children (mean age = 4.59 years; SD = 0.97 years; range: 3-6 years) from 10 kindergartens in Central Italy. Measurements: CSHQ together with the Child Behavior Checklist 1 ½-5 (CBCL). Results: The analyses suggested the existence of 7 sleep dimensions, which were meaningfully interpretable. The CSHQ total score had good internal consistency and showed strong associations with the sleep problems scale of the CBCL. Children scoring in the normative range of the CBCL sleep problems scale had a mean value at the CSHQ total score of 47.03 (6.42), children scoring in the borderline and clinical range (4.4%) of 57.13 (5.11). Moderate associations were found between CSHQ total score and internalizing and CBCL externalizing behavioral problems. Conclusions: CSHQ values were higher than those reported in other countries and with school-age children, but only a small number of children belonged to the at-risk group based on CBCL norms for the sleep problems scale. CSHQ moderately and comparably correlated with internalizing and externalizing problems. The CSHQ is a meaningful tool for the investigation of sleep problems in Italian preschoolers. Given the heterogeneity of item frequencies at a dimension level, considering scores along items and dimensions might be more informative at a clinical and applied level.