Childhood routines are frequently emphasized in the popular press as important to numerous aspects of healthy child development (Eisenberg et al. 1996; Nelson et al. 2007). But remarkably little empirical evidence is available to evaluate these claims, which may partly be due to insufficient tools for assessment of children’s routines. Given early, but promising support for bedtime routines in the treatment of childhood bedtime and sleep-related problems (Kuhn and Weidinger 2000), systematic evaluation of bedtime routines is greatly needed. Thus, the aim of the present study is to develop and evaluate a comprehensive parent report measure of children’s bedtime routines.

Typical child routines such as a morning, mealtime, or bedtime routine are purported to promote a general sense of security and stability (Greenman 2005), ease behavioral problems during times of transition (Handler 1997), and promote good sleep habits (Nelson et al. 2007). Yet routines are rarely subjected to scientific inquiry. Efforts to study general childhood routines and aspects of child adjustment have been advanced recently by the development of psychometrically sound measures of children’s routines (Evans et al. 1997; Sytsma et al. 2001; Wittig 2005) and supportive evidence is beginning to emerge (Jordan 2003).

Behavioral theory suggests that consistent routines may act as a setting event for child compliance, with a predictable sequence of daily activities increasing the likelihood of subsequent compliance with parental instructions (Plaud and Plaud 1998; Sytsma et al. 2001). Thus, consistency of antecedent factors such as location of the routine, caregiver supervising the routine, and sequence of activities comprising a routine may each serve as discriminative stimuli for child compliance. Presumably, the more consistent each of these aspects, the stronger the quality of the routine; however, the differential influence of each of these antecedent factors has not been empirically examined. To date, all existing routines assessment instruments focus on multiple routines or rituals (e.g., Fiese and Kline 1993; Jensen et al. 1983; Sytsma et al. 2001; Wittig 2005). None examine detailed antecedent factors comprising a specific daily routine, such as a bedtime routine.

Sleep disturbance is reported in approximately 25 to 40% of preschool and elementary-school-aged children (Meltzer and Mindell 2006) and up to 80% of children with developmental disabilities (Cotton and Richdale 2006). Due to high rates of sleep difficulties, researchers have examined a number of treatments for childhood sleep disturbances including consistent bedtime routines (Kuhn and Weidinger 2000; Mindell et al. 2006).

For the present study, a bedtime routine consists of a set of observable, repetitive behaviors which directly involve the child and at least one adult acting in an interactive or supervisory role in a consistent environment, and which occur with predictable regularity in the hour preceding bed each night. Researchers conceptualize bedtime routines as one component of sleep hygiene (Harsh et al. 2002). Yet, bedtime routines focus on the consistency of a sequence of activities immediately preceding bedtime, including going to bed at a regular time and place, and involvement of a consistent caregiver. The construct of sleep hygiene is much broader and includes temporally distant activities such as limiting daytime naps and reducing intake of substances that could interfere with sleep (e.g., caffeine, medication) in addition to more proximal issues of setting a conducive sleep environment (i.e., cool and dark) and restricting the bedroom to sleep-related activities (Ellis et al. 2002).

As with general child routines, bedtime routines have undergone limited scientific evaluation. However, disruptions in bedtime routines are associated with sleep disturbance. Fiese et al. (2007) reported that when children go to bed late, they are 66% more likely to wake during the night than when they go to bed early or on time. Sleep disruption including variable bedtime, variable amount of sleep, and late bedtime, is linked to school adjustment difficulties in preschoolers even after controlling for family stress and management practices (Bates et al. 2002). Finally, bedtime routines reduce bedtime problems, sleep onset latency, and frequency of night wakings (Adams and Rickert 1989; Kuhn and Weidinger 2000; Mindell 1999) among children with sleep disturbance. However, less is known about their use and impact among typical children.

Previous studies of bedtime routines also have a number of limitations. First, many studies fail to operationally define bedtime routines or use narrow definitions that are not comparable across studies (Fiese et al. 2002). Second, most studies rely on observational methods, which can be costly and time consuming, or parent report sleep diaries, which are associated with rater fatigue (Sadeh 1996). In addition, sleep diaries often are devised for a particular study, leading to differences that limit comparisons across studies and unexamined psychometric characteristics. Finally, when a questionnaire format is employed, assessment of bedtime routines typically is limited to a single item (e.g., Williams et al. 2004). This does not allow for assessment of different antecedent factors comprising bedtime routines that may differentially impact effectiveness.

Despite high rates of sleep disturbance among young children, little is known about sleep parameters among preschool and early school-age children (Harsh et al. 2002). A number of parent-report questionnaires were developed recently to study aspects of childhood sleep (e.g., Harsh et al. 2002; LeBourgeois et al. 2001; Owens et al. 2000; Sadeh 2004). However, existing measures of sleep hygiene such as the Children’s Sleep Hygiene Scale (Harsh et al. 2002) account for only a few aspects of bedtime routines, such as going to bed at a consistent time and sleeping in the same place each evening. Similarly, the Childhood Sleep Habits Questionnaire (Owens et al. 2000) includes a subscale on bedtime resistance but does not focus on the routine nature of pre-sleep activities; furthermore, the purpose of the scale is to identify children with clinical sleep disturbances rather than to assess sleep hygiene or bedtime routines. A more comprehensive, standalone measure of bedtime routines that includes additional theoretically relevant aspects of routines such as a consistent sequence of pre-sleep activities may permit more systematic study of routines as a treatment for childhood sleep disturbance, while also contributing to the literature on routines. Such an instrument may also have future clinical utility in identifying problematic aspects of bedtime routines and guiding treatment among children with sleep disturbance.

Consistent with behavioral theory, aspects in addition to those defined by a bedtime routine are examined including factors such as consistency of specific activities preceding going to bed, the sequence of those activities, the caregiver present during the routine, and time the child actually goes to bed. As differences in weeknight and weekend bedtimes occur (Snell et al. 2007; Yang and Spielman 2001), these aspects of routines are examined separately for weeknights and weekends. The impact of the types of activities children engage in before bed are also of interest, as a child may have consistent activities and sequencing, but may routinely engage in activating behaviors that may delay sleep onset or quality such as watching television, playing video games, or active play. Finally, reactivity to changes in the routine were assessed because some researchers suggest that highly structured routines may be associated with lower adaptability (Boyce et al. 1977), and resistance to changes in routine are common among children with certain developmental disorders (APA 2000) who are reported to have high rates of sleep problems (Williams et al. 2004). Accordingly, the present study aims to incorporate these theoretically and practically relevant elements and to evaluate the psychometric properties of the new measure.

Thus, the purpose of this study is to develop and evaluate a comprehensive parent-report questionnaire of bedtime routines of preschool and early school-age children ages 2 to 8 for research and clinical use in the evaluation of children’s sleep. It was hypothesized that the Bedtime Routines Questionnaire (BRQ) would yield three independent scales: 1) routine consistency, 2) reactivity to changes in routines, and 3) a two-factor scale comprised of adaptive and maladaptive activities. The measure was not intended to yield a total score, as scales were conceptualized as independent constructs. Adequate psychometric properties as evidenced by internal consistency and construct validity were expected. As evidence of convergent validity, moderate positive correlations between the BRQ scales of consistency and adaptive activities preceding bedtime and the constructs of general child routines, sleep hygiene, and sleep quality; and moderate inverse correlations with child behavior problems were predicted (Brown et al. 2002; Jordan 2003; Sytsma et al. 2001). No predictions were made regarding the reactivity or maladaptive activities domains.

Method

Participants

A heterogeneous community sample of 226 primary caregivers of children between the ages of 2 and 8 years (M = 4.98, SD = 1.92) were recruited through university students in the southeastern United States. The children were 54.4% boys. Caregiver informants ranged in age from 18 to 64 years (M = 31.54, SD = 7.42) and were predominantly women (86.5%) and married (61.5%). Racial distribution was mainly White (52.2%) and Black (43.8%). Mean socioeconomic status (SES) of the sample was middle to upper SES (M = 40.98, SD = 11.86), corresponding to medium-sized business, minor professional, and technical occupations (Hollingshead 1975), yet approximately 37% of the sample reported an annual household income less than $25,000.

Measures

Demographic Form

A demographic form was used to gather descriptive information about the target child and caregiver. Items included the child’s age, gender, and race, as well as the caregiver’s gender, age, race, marital status, educational background, occupation, and household income.

Bedtime Routines Questionnaire (BRQ)

The BRQ (see Appendix A) was developed as a parent-report measure of children’s bedtime routines. The initial BRQ (prior to panel review) consisted of 29 items specific to consistency of the child’s weekday and weekend bedtime routines, reactivity to changes in the routine, and frequency of adaptive and maladaptive activities before bedtime. Consistency and Activities items are scored on a 5-point Likert scale ranging from 1 “Almost never” to 5 “Nearly always.” Reactivity items are scored from 1 “Not at all” to 5 “Extremely.”

Children’s Sleep-Wake Scale (CSWS)

The CSWS (LeBourgeois et al. 2001; LeBourgeios and Harsh 2001) consists of 42 items measuring sleep quality in typically developing children between the ages of 2 and 8, 26 of which comprise a total score. Items, such as “your child has trouble going to sleep,” are scored on a 6-point Likert scale ranging from 0 “never” to 5 “always.” Initial studies have supported the factor structure, internal consistency, and construct validity of the CSWS (LeBourgeois et al. 2001; LeBourgeois and Harsh 2001). Coefficient alpha in the present sample was .89.

Children’s Sleep Hygiene Scale (CSHS)

The CSHS (Harsh et al. 2002) consists of 25 items measuring activities surrounding sleep of children age 2 to 8. Items, such as “my child sleeps in a darkened room,” are scored on a 6-point Likert scale ranging from 0 “never” to 5 “always.” One domain of the CHSH consisting of 4 items relates to bedtime routines. The CSHS has displayed adequate internal consistency, α = .76 (Harsh et al. 2002). Coefficient alpha in the present sample was .79.

Child Routines Questionnaire (CRQ)

The CRQ (formerly named the Child Routines Inventory; Jordan 2003; Sytsma et al. 2001) is a 39-item parent-report measure of common routines of 5- to 12-year-old typically developing children. Items, such as “my child eats meals with family at the table each day,” are scored on a 5-point Likert scale measuring frequency ranging from 0 “never” to 4 “nearly always.” One of the 39 items on the CRQ relates to bedtime. The CRQ has demonstrated good psychometric properties including excellent internal consistency, α = .90; good test-retest reliability, r = .86; and initial support for construct validity (Jordan 2003; Sytsma et al. 2001). Coefficient alpha in the present sample was .92.

Child Routines Questionnaire-Preschool version (CRQ-P)

The CRQ-P (Wittig 2005) is a 35-item parent-report measure of common routines of typically developing children age 1 to 5. Items, such as “my child eats at least one meal a day with the family,” are scored on a 5-point Likert scale measuring frequency ranging from 0 “never” to 4 “nearly always.” One of the 35 items on the CRQ-P relates to bedtime. Initial results indicated good internal consistency, α = .89; adequate test-retest reliability, r = .74; and support for construct validity (Wittig 2005). Coefficient alpha in the present sample was .90.

Behavior Assessment System for Children, Second Edition (BASC-2)

The BASC-2 (Reynolds and Kamphaus 2004) is a broadband measure of child psychopathology commonly used in clinical research. The measure consists of 134 items for children ages 2 to 5 and 160 items for children ages 6 to 11. Items are scored on a 4-point Likert scale ranging from 0 “never” to 3 “almost always.” Psychometric properties of the Externalizing Problems composite of the BASC-2 have shown good internal consistency, α > .90; test-retest reliability, r = .81 to .91; and construct validity, correlating .78 to .83 with the externalizing problems scale of the Child Behavior Checklist (Reynolds and Kamphaus 2004).

Procedure

Items for the BRQ were generated by consulting previous sleep diaries (e.g., National Sleep Foundation 2003), evaluating current sleep and routines literature, and including theoretically relevant domains, such as consistency and reactivity to changes in the routine. A list of both adaptive and maladaptive activities that children might perform in the hour preceding bedtime was generated and sent to a panel of three master’s and four doctoral level individuals with research experience in child development and/or sleep. All members of the panel reviewed the items and provided feedback on redundancy and wording; indicated whether each item was clear and concise; and listed additional relevant items (DeVellis 1991). Panel feedback was incorporated in revision of the initial item pool prior to administration.

Following Institutional Review Board approval, participants were approached by undergraduate students, the first author, or a trained research assistant. In exchange for extra credit, students were trained to find a caregiver of a child in the community, obtain informed consent, and ask the caregiver to complete a packet regarding their child. In addition to the demographic form and revised BRQ, caregivers were asked to complete the CRQ-P (for children 2 to 5 years) or CRQ (for children 5 to 8 years), CSHS, CSWS, and BASC-2 to evaluate construct validity. No incentives were offered to caregivers.

Of the 226 caregivers included, 35 were directly recruited by research staff and 191 were indirectly recruited through students. Indirectly recruited caregivers were contacted by phone between 1 and 4 weeks later to verify their participation. Caregivers were asked to provide the child’s date of birth and responses to incomplete items; 176 (92%) passed the phone verification and the remaining 15 could not be reached but were included due to lack of obvious indication of invalidity. An additional 22 participant packets (making a total of 248 recruited) were excluded for being ineligible/invalid (n = 13) or incomplete (n = 9).

Results

BRQ Development and Content Validation

BRQ items were generated based on theoretically relevant aspects of bedtime routines and review of the sleep and routines literature. Ten items related to routine consistency (i.e., same location, caregiver, time, activities, and order of activities), 5 items regarding reactivity to changes in routine, and 14 items listing possible activities occurring in the hour preceding bedtime. The “activity” items were then evaluated by a panel of judges as described previously (see Method). Two items were modified, two items were combined into one, and seven items were added based on panel feedback, for a total of 20 activity items (35 total items across the three scales). The 15 Consistency and Reactivity items were not subject to panel review as all items were included for theoretical reasons.

Data Analysis Plan

Following administration of the 35-item BRQ to caregivers, psychometric properties were evaluated to determine if the item pool required further refinement. Separate exploratory principal components analyses (PCA) were performed for each of the three scales (Consistency, Reactivity, and Activities) to determine if items grouped together into expected scales and to identify potential items for elimination. Once the final set of items was established, descriptive features, reliability, and validity coefficients were evaluated.

Scale Refinement

PCA with Promax rotation was used as factors within each scale were theoretically related, so items were allowed to correlate. Because each scale was perceived to measure a distinct construct, PCA was performed three separate times: (a) the 10 consistency items, (b) the 5 reactivity items, and (c) the 20 activities items. Criteria for extraction included Scree plot examination and Eigenvalues greater than one. As one of the goals of this study was to reduce the item pool to a cohesive, internally consistent measure with non-overlapping scales, items failing to meet simple structure criteria, loading greater than .40 on a primary component and less than .40 on other components (Hair et al. 2006), were further examined for possible deletion. Items with low item-total correlations (<.20), items whose deletion would improve coefficient alpha (DeVellis 1991), and/or those loading at equal magnitude and > .4 on more than one component were deleted one at a time and subsequent PCA iterations were examined.

Although PCA was expected to yield a unitary scale of Consistency, two principal components emerged accounting for 64.64% of the variance (see Table 1). The first component (Routine Behaviors) included activities comprising the routine and order of activities during both weeknights and weekends, and the second component (Routine Environment) included place of the routine, time of the routine, and person participating with the child throughout the routine during both weeknights and weekends. The two factors were intercorrelated (r = .44), suggesting a higher order factor of Consistency. Thus, corrected item-total correlations were based on the entire Consistency scale and ranged from .50 to .73.

Table 1 Bedtime routines questionnaire –pattern coefficients by scale
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With respect to reactivity to changes, PCA yielded a unitary principal component (Reactivity) comprised of all five items, accounting for 52.79% of the variance (see Table 1). Corrected item-total correlations ranged from .50 to .61.

Within the Activity scale, PCA yielded two principal components representing Adaptive and Maladaptive Activities, as expected. In the final solution, 10 items loaded on Adaptive Activities, while 6 items loaded on Maladaptive Activities; 4 items (ask for/locate object to sleep with, pick up toys, get things ready for the next day, and throw a tantrum) were deleted for failure to load per simple structure criteria in combination with low item-total correlations, improved alpha upon deletion, and/or equal loadings on both components (see Table 1). In addition, these items all had low means relative to other items on their respective subscales, suggesting these were less typical activities comprising bedtime routines, providing additional theoretical support for their deletion. The two components comprised 36.11% of the variance. The factors were not significantly intercorrelated (r = -.06), and were considered to be theoretically distinct. Thus, corrected item-total correlations were calculated separately within each factor and ranged from .26 to .56.

To summarize, the final version of the BRQ consisted of 31 items across 3 scales: Consistency (10 items; Routine Behaviors and Routine Environment), Reactivity (5 items), and Activities (16 items; Adaptive and Maladaptive Activities). The measure yielded four separate scales (Consistency Total, Reactivity, Adaptive Activities, and Maladaptive Activities) and two subscales of consistency (Routine Environment and Routine Behavior) which are calculated by summing items comprising respective scales and subscales. Greater scores suggest greater Routine Consistency (range 10 to 50), Reactivity to changes in routine (range 5 to 25), and more frequent Adaptive (range 10 to 50) and Maladaptive Activities (range 6 to 30). The final version had a Flesch-Kincaid reading grade level of 5.2. Descriptive statistics and reliability coefficients are presented in Table 2.

Table 2 Descriptives of measures and reliability of the bedtime routines questionnaire
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Descriptive Analyses

Interrelationships among family demographic characteristics in the present sample are provided in Table 3. Correlational analyses indicated significant relations between child race (Black) and both lower SES, r = -.33, and younger parent age, r = -.22.

Table 3 Correlation matrix of sample demographic characteristics
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Intercorrelations among the BRQ scales and subscales suggest that the subscales comprising Consistency are moderately positively correlated with Adaptive Activities; however, Reactivity and Maladaptive Activities were unrelated to Consistency, providing further support for four distinct BRQ scales (see Table 4). To determine if any demographic characteristics were systematically related to bedtime routines that would impact interpretation and use of the scale, correlations and t-tests were examined between the BRQ scales and child demographic variables, including the age, gender, race, and SES. Race was dichotomized as White and Black due to the small number of participants within other racial categories (n = 9). Child age was not related to BRQ Consistency, but was related to Reactivity, r = -.27, p < .001 and modestly associated with Maladaptive Activities, r = .14, p < .05. Boys had higher levels of Maladaptive Activities before bed, t (213.67) = -2.36, p < .05. Racial differences in bedtime routines were also noted with White children demonstrating significantly greater Consistency, t (165.16) = 5.88, p < .001, more Adaptive Activities, t (158.08) = 5.41, p < .001, and fewer Maladaptive Activities, t (205) = -3.97, p < .001, relative to Blacks. SES was correlated with BRQ Consistency, r = .23, p < .01; Adaptive Activities, r = .27, p < .001; and Maladaptive Activities, r = -.24, p < .001. Since Black participants were more likely to be of lower SES in the present sample, the sample was split by race and correlations between BRQ scales and SES re-examined, and compared for significance following Fisher’s r-to-z transformations. There were no differences across race, z = 0 to -.98, ns.

Table 4 Validity coefficients of the bedtime routines questionnaire
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Reliability

Means and standard deviations (SDs) of BRQ scales and subscales are provided in Table 2. Internal consistency was evaluated by calculating coefficient alpha for each primary scale of the BRQ and was acceptable to excellent, α = .69 to .90 (n = 222; see Table 2).

Validity

Means and SDs for the validation measures are also provided in Table 2. All validation measures were comparable to their respective normative samples, with the exception of the CSWS, which was slightly higher in the present sample, t = 8.61, p  < .001. Mean comparisons were not available for the CSHS. To examine construct validity, bivariate correlations between the BRQ and various measures theoretically related to bedtime routines, including the CRQ Total, CRQ-P Total, CSHS Total, CSWS Total, and BASC-2 Externalizing T scores were calculated. Although the CRQ and CRQ-P were both administered to caregivers of 5 year olds, only the CRQ was used to evaluate construct validity in 5 year olds, as internal consistency was found to be higher on the CRQ than the CRQ-P in this age group (Henderson et al. 2006). Results are provided in Table 4. As expected, the BRQ Consistency scale and subscales and the Adaptive Activities scale were moderately positively correlated with child routines, sleep hygiene, and sleep quality. The Reactivity scale was not correlated with general child routines or with sleep hygiene. However, Reactivity was significantly inversely correlated with sleep quality and showed a modest, but significant positive relationship with externalizing behavior problems. Similarly, the Maladaptive Activities scale was not correlated with child routines or with externalizing behavior problems, but showed modest to moderate inverse relationships with sleep quality and sleep hygiene, respectively. These findings provide preliminary support for the convergent validity of the BRQ given moderate expected relations with similar constructs. Yet contrary to predictions, BRQ Consistency was not significantly correlated with externalizing behavior.

A preliminary examination of the discriminative validity of the BRQ was also conducted by testing for differences in bedtime routines among children with good and poor sleep quality. Good sleepers were classified as children with a CSWS Total score in the upper quartile, whereas poor sleepers were classified as children with scores in the lower quartile. A multivariate analysis of covariance (MANCOVA) was conducted with sleep quality as the grouping variable and the four BRQ scales as the dependent variables, after removing covariates of BRQ-related demographic characteristics (child age and SES). Child race was initially included as a covariate, but did not significantly contribute to the model and was subsequently removed. Overall model results were significant for sleep quality group, Hotelling’s Trace = .46, F (4, 85) = 9.90, p < .001. Univariate ANCOVAs revealed group differences on all four BRQ scales, F (3, 88) = 2.74 to 9.87, p < .05. After controlling child age and SES, good sleepers had greater consistency and more adaptive activities comprising their routines; whereas, poor sleepers had greater reactivity to changes in routine and more maladaptive activities comprising their routines. Overall, good and poor sleepers exhibited differences in bedtime routines.

Discussion

This study provided preliminary evidence for the reliability and validity of a new measure of bedtime routines in young children. Based on PCA, the BRQ yielded two subscales comprising Bedtime Routine Consistency, Routine Behaviors and Routine Environment. These findings support defining routines as comprising both child behaviors and aspects of the environment, and extend the literature on general child routines by providing evidence that multiple factors uniquely contribute to routine consistency.

PCA also supported a unitary BRQ Reactivity scale, pertaining to the child’s reaction to changes in the bedtime routine, and an Activity scale comprised of two independent subscales, pertaining to Adaptive and Maladaptive Activities typically involved in children’s bedtime routines. Although prior researchers have recommended positive routines involving quiet activities (Adams and Rickert 1989), the present study offers initial evidence suggesting that type of activities children engage in before bed may be related to the quality of their bedtime routine, sleep hygiene, and to a lesser extent, sleep quality.

In examining descriptive characteristics of the BRQ, child age was related to Reactivity and Maladaptive Activities, but child gender differences were only found with respect to Maladaptive Activities; racial differences were identified on the Consistency, Adaptive Activities, and Maladaptive Activities subscales, all of which were also correlated with SES. However, when the sample was divided by race, the magnitude of the correlation between SES and BRQ scales was not significantly different across Black and White participants. Therefore, racial differences observed on the BRQ may be best accounted for by SES, given the relationship between race and SES observed in the present sample. This is consistent with higher rates of poverty among Blacks found in the general population (U.S. Census Bureau 2006).

Previous studies of general child routines have not revealed significant relationships with child age, gender, or race (Jordan 2003; Sytsma et al. 2001) and relationships with SES have been inconsistent (Fiese and Kline 1993; Jordan 2001; Sytsma et al. 2001). Theoretically, families of higher SES may have greater structure and consistency, as well as more resources to help maintain stability in the environment. They are also more apt to be educated about the importance of regular sleep habits and sleep needs of children.

Significant relationships have been reported between sleep behaviors and both race and SES in children, with minority race and lower SES relating to later sleep onset time, later morning waking time, longer duration of naps, more frequent naps, greater total amount of sleep (Lavigne et al. 1999), and napping at older ages (Crosby et al. 2005). Studies also show racial differences in the location of children’s sleep and activities comprising bedtime routines. Relative to White children, Black children are more likely to sleep with a sibling and less likely to sleep in their own bedroom (Milan et al. 2007). Black families are less likely than White families to give a comfort toy, read a story, or brush teeth, and more likely to bathe the child as part of a bedtime routine (Milan et al. 2007).

Studies also suggest that race and SES moderate direct and indirect relations between sleep variables and cognitive functioning (Buckhalt et al. 2007; El-Sheikh et al. 2007).When children’s sleep is disrupted, higher SES children perform better than lower SES children on cognitive tasks and when SES is controlled, Black children perform worse than White children (Buckhalt et al. 2007). In addition, sleep efficiency mediates the relationship between children’s emotional arousal in response to marital conflict and math achievement among lower SES and African American children but not among higher SES or European American children (El-Sheikh et al. 2007). These studies may suggest true racial and socioeconomic differences regarding children’s sleep and routines that warrant further evaluation to guide appropriate usage and interpretation of the BRQ.

Initial support for discriminative and construct validity was offered, as children with good and poor sleep quality differed on all four BRQ scales after controlling for child age and SES, and expected relationships between the consistency of bedtime routines, adaptive activities preceding bedtime, and measures of routines and sleep practices were supported. Although no specific a priori predictions regarding relationships between reactivity to changes in routines and maladaptive activities were made, the pattern of correlations observed was theoretically and intuitively consistent. However, the predicted inverse relation between consistency of bedtime routines and child behavior problems was not supported; this may indicate that specific routines are not correlated with overall behavior problems in the same way as are general routines. Alternatively, daytime behavior may be too global and distal a focus with multiple influences. Bedtime routines may directly influence more proximal factors, such as bedtime behavior, sleep hygiene, or sleep quality and through these factors, indirectly impact daytime functioning. Finally, these preliminary findings should be interpreted cautiously until further validation studies can be conducted, as alpha inflation could have led to detection of some spurious relationships.

There were several issues related to sampling that may have limited the present findings. First, children evaluated in this study were drawn from a heterogeneous community sample and may not be representative of children with sleep disturbance. Moreover, bedtime routines may be of greater importance in children experiencing poor sleep quality. Research indicates that bedtime routines decrease bedtime problems, sleep onset latency, and frequency of night wakings (Adams and Rickert 1989; Kuhn and Weidinger 2000; Mindell 1999). However, bedtime routines have been used as an intervention only in children experiencing bedtime or sleep problems. Some children may have less difficulty at bedtime regardless of the circumstances, while other children may benefit from a consistent bedtime routine. Although children reported to have high and low sleep quality did differ on BRQ scales, sleep disturbance was not directly measured in the current sample. Thus, additional validation of the BRQ with children with sleep disturbance is necessary, particularly in guiding the clinical utility of the measure. Further evaluation of the Reactivity scale may be of particular interest among children with developmental disabilities, including children with pervasive developmental disorders, as a higher incidence of sleep disturbance and resistance to changes in routines has been identified in this population (APA 2000; Williams et al. 2004).

Second, reliance on a single informant and format (e.g., self-report) for data collection may result in problems associated with response sets and method variance. Future studies should use multiple informants and methods (e.g., observation). Third, the majority of participants were White or Black, limiting the ability to generalize findings to other ethnic groups. In addition, further evaluation of potential differences in bedtime routines based demographic characteristics (e.g., number of children in the home, birth order of the participating child, etc.) in a new sample is warranted. Additional family demographic information is necessary to insure that bedtime routines are not serving as a proxy for another variable, such as having to share a bedroom. Finally, construct validity of the BRQ was only examined with respect to convergent validity. Thus, future validation efforts should attempt to evaluate divergent validity.

In conclusion, despite emphasis commonly placed on the importance of child routines to proper child adjustment, data regarding efficacy of specific child routines remain limited. This study represents an attempt to develop a measure of a specific routine, bedtime routines, and explore components comprising the routine, including consistency of the routine, reactivity to changes in the routine, and activities comprising the routine. Such a measure of bedtime routines may assist in future research studying the impact of bedtime routines on bedtime behavior.