From: Effect of animated movie in combating child sleep health problems
 | Questionnaire | Answers | ||
---|---|---|---|---|
1 | Who in your family sets the rules about when you got to bed? | Â | Â | Â |
2 | Do you have trouble sleeping | Yes (2) | No (1) | Â |
3 | Do you like to sleep | Yes (1) | No (2) | Â |
 | Block 1—bedtime resistance | |||
4 | Â Do you go to bed at same time every night on school nights? | Usually (1) | Sometimes (2) | Rarely (3) |
5 | Â Do you fall asleep in the same bed every night? | Usually (1) | Sometimes (2) | Rarely (3) |
6 | Â Do you fall asleep alone? | Usually (1) | Sometimes (2) | Rarely (3) |
7 |  Do you fall asleep in parents’, brother’s or sister’s bed? | Usually (3) | Sometimes (2) | Rarely (1) |
9 | Â Do you fight with your parents about going to bed? | Usually (3) | Sometimes (2) | Rarely (1) |
10 | Â Is it hard for you to go to bed? | Usually (3) | Sometimes (2) | Rarely (1) |
11 | Â Are you ready for bed at your usual bedtime? | Usually (1) | Sometimes (2) | Rarely (3) |
15 | Â Do you stay up late when your parents think you are asleep? | Usually (3) | Sometimes (2) | Rarely (1) |
 | Block 2—sleep onset delay | |||
8 | Â Do you fall asleep in about 20 minutes? | Usually (1) | Sometimes (2) | Rarely (3) |
 | Block 3—sleep anxiety | |||
12 | Â Do you have a special thing you bring to bed? | Usually (3) | Sometimes (2) | Rarely (1) |
13 | Â Are you afraid of the dark? | Usually (3) | Sometimes (2) | Rarely (1) |
14 | Â Are you afraid of sleeping alone? | Usually (3) | Sometimes (2) | Rarely (1) |
 | Block 4—sleep duration | |||
16 | Â Do you think you sleep too little? | Usually (3) | Sometimes (2) | Rarely (1) |
17 | Â Do you think you sleep too much? | Usually (3) | Sometimes (2) | Rarely (1) |
 | Block 5—night waking’s | |||
18 | Â Do you wake up at night when parents think you are asleep? | Usually (3) | Sometimes (2) | Rarely (1) |
19 | Â Do you have trouble falling back to sleep if you wake up during the night? | Usually (3) | Sometimes (2) | Rarely (1) |
20 | Â Do you have nightmares? | Usually (3) | Sometimes (2) | Rarely (1) |
21 | Â Does pain wake you up at night? Where is that pain? | Usually (3) | Sometimes (2) | Rarely (1) |
22 | Â Do you sometimes go to someone else bed during the night? If yes who? | Usually (3) | Sometimes (2) | Rarely (1) |
 | Block 6—daytime sleepiness | |||
23 | Â Do you have trouble waking up in the morning? | Usually (3) | Sometimes (2) | Rarely (1) |
24 | Â Do you feel sleepy during the day? | Usually (3) | Sometimes (2) | Rarely (1) |
25 | Â Do you take naps during the day? | Usually (3) | Sometimes (2) | Rarely (1) |
26 |  Do you feel rested after a night’s sleep? | Usually (1) | Sometimes (2) | Rarely (3) |