Screening for sleep problems in early intervention and early childhood special education: A systematic review of screening and assessment instruments

Behavioral insomnias of childhood (BIC) and sleep disordered breathing (SDB) disorders cause disrupted and/or inefficient sleep. Left untreated in early childhood, both conditions increase the risk of compromised development, particularly in the areas of behavior, cognition, and growth. This systematic review determined whether and how current developmental screening and assessment instruments ("instruments") used in Part C Early Intervention (EI) and Part B Early Childhood Special Education (ECSE) programs of the Individuals with Disabilities and Education Act assess BIC and/or SDB. Independent abstracting teams reviewed 47 unique and 67 total (ie, includes multiple-age versions of unique) instruments. Overall, 47% of unique and 38% of total instruments contained no sleep-related items. None (0%) included any SDB items. "Resistance to bedtime," "night waking," and "parental concerns regarding the child's sleep" were the most frequently asked types of items. Yet, fewer than 20% of instruments addressed even these items. Among the 10 most often used instruments in EI and ECSE programs, only 40% contained BIC-type items-none asked about SDB. Given the symptom overlap between sleep problems and developmental disorders, early detection is critical. Yet, current instruments used in EI and ECSE do not adequately assess either behavioral or respiratory-related sleep disorders. Individuals with Disabilities and Education Act early childhood and related programs could serve as a portal for identifying sleep disorders.