Manual

CAARS 2 Manual

Appendix H: PROMIS® Sleep Assessments


Appendix H: PROMIS® Sleep Assessments

ADHD is commonly accompanied by a host of concerns that can exacerbate symptoms. Conversely, a variety of concerns can resemble ADHD. In addition to common co-occurring diagnoses (e.g., anxiety, depression, and substance use disorders), a comprehensive ADHD evaluation should also consider sleep problems.

Impaired sleep includes difficulty falling or staying asleep, sleep disturbances (e.g., nightmares, sleep-walking), or feeling tired or fatigued during the daytime (Cortese et al., 2009; Kirov & Brand, 2014). Sleep-related impairments can certainly look like ADHD symptoms—for example, both can be associated with difficulty paying attention, restlessness, and impulsive decision-making. Sleep problems can also exacerbate ADHD symptoms, amplifying their effects, and resulting in greater difficulty in daily functioning—and, ultimately, making accurate diagnosis more challenging. For instance, struggling to arrive at school or work on time could result from an ADHD-related difficulty with time management, a sleep-related issue of a late bedtime, or a combination of the two factors. Fatigue from poor sleep habits can be the source of concentration problems or difficulties regulating one’s mood, resulting in anger outbursts.

One of the Conners Adult ADHD Rating Scales 2nd Edition (CAARS™ 2) Impairment & Functional Outcome Items (available in the full-length forms only) refers to sleep problems (i.e., falling asleep, staying asleep, or feeling well-rested). If this item is Elevated, consider further investigation with the PROMIS Sleep Disturbance–Short Form 8a and/or the PROMIS Sleep-Related Impairment–Short Form 8a (Yu et al., 2011), which are available free of charge to CAARS 2 users on the MHS Online Assessment Center+. The full test description and scoring manual can be found here: www.healthmeasures.net.

Sleep Disturbance–Short Form 8a: The PROMIS Sleep Disturbance instrument assesses self-reported perceptions of sleep quality, sleep depth, and restoration associated with sleep. This form includes perceived difficulties and concerns with getting to sleep or staying asleep, as well as perceptions of the adequacy of and satisfaction with sleep. The Sleep Disturbance–Short Form does not focus on symptoms of specific sleep disorders, nor does it provide subjective estimates of sleep quantities (such as the total amount of sleep, time to fall asleep, and amount of wakefulness during sleep). This form is universal rather than disease-specific. It assesses sleep disturbance over the past seven days.

Sleep-Related Impairment–Short Form 8a: The PROMIS Sleep-Related Impairment form focuses on self-reported perceptions of alertness, sleepiness, and tiredness during usual waking hours, and the perceived functional impairments during wakefulness associated with sleep problems or impaired alertness. Though the Sleep-Related Impairment–Short Form does not directly assess cognitive, affective, or performance impairment, it does measure waking alertness, sleepiness, and general daily functioning within the context of the overall sleep-wake function. This form is universal rather than disease-specific. It assesses sleep-related impairment over the past seven days.

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