Sleep in Children Placed in Out-of-home Care

Sleep problems children: Children's Sleep Habits Questionnaire (CSHQ)

Sleep problems in foster children will be assessed using the Dutch version of the Children's Sleep Habits Questionnaire (CSHQ). The CSHQ is a validated caregiver-report questionnaire that assesses 4- to 10-year-old children's average sleep behaviour during the previous "typical" week. The questionnaire consists of 33 items divided across eight subscales reflecting different domains of sleep problems: bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night awakenings, parasomnias, sleep-disordered breathing, and daytime sleepiness. Items are rated on a threepoint scale: "usually", "sometimes", or "rarely". Total scores range from 33 to 99. Higher total scores indicate greater sleep difficulties. In a pilot study among Flemish foster children, the CSHQ demonstrated good internal consistency (α = .77), comparable to that reported in the original validation study and other research.

Sleep diary: Planned naps and Unplanned naps

Foster parents will be asked to register the number of planned and unplanned naps for a period of 7 consecutive days. Participants will have to specify: number of (un)planned naps and duration (from - to).

Sleep diary: Sleep duration

Participants will be asked to report on the sleep duration of their child for a period of seven consecutive days. Sleep duration will be measured with the following variables: Time in bed (hour + minutes) Time awake in the morning (hour + minutes) Sleep onset latency (minutes) Awakenings (number + minutes) Total sleep duration = Time awake in the morning - time in bed - sleep onset latency - awakenings.

Sleep diary: Sleepiness level

The following options are given: * Awake and alert * Mostly awake * A little sleepy * Sleepy * Too sleepy to stay awake Sleepiness level will be rated on a scale from 0 to 5, with higher scores indicating greater sleepiness.

Sleep problems parent: Pittsburgh Sleep Quality Index (PSQI)

Sleep problems in (foster) parents will be questioned using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is a self-report 19-item questionnaire that measures sleep quality and sleep disturbances over one-month-period. The instrument contains ten questions, divided into seven subscales related to different sleep-related components. In this study, the investigators focus specifically on four aspects of parental sleep: sleep duration, use of sleep medication, daytime sleepiness, and subjective sleep quality. Sleep duration will be assessed as the number of hours of actual sleep per night and will be treated as a continuous variable. Use of sleep medication and daytime sleepiness will each be scored on a 4-point scale ranging from 0 (not during the past month) to 3 (three or more times per week). Subjective sleep quality will be scored on a 4-point scale ranging from 0 (very good) to 3 (very bad), with higher scores indicating poorer sleep quality.

Behavior: Strengths and Difficulties Questionnaire (SDQ)

Behavioral difficulties will be assessed using the Strengths and Difficulties Questionnaire (SDQ). The SDQ is a widely used screening instrument for children and adolescents aged 4-16 years and can be completed by caregivers, teachers, and by children themselves from the age of 11 years onward. The questionnaire contains 25 items grouped into five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peerrelationship problems, and prosocial behavior. Each subscale consists of five items rated on a three-point scale (0 = "not true", 1 = "somewhat true", 2 = "certainly true"), resulting in subscale scores ranging from 0 to 10. A total difficulties score is calculated by summing the scores of the emotional symptoms, conduct problems, hyperactivity/inattention, and peer problems subscales, yielding a total score between 0 and 40.

Adverse Child Experiences (ACE-IQ-10)

The ACE-IQ-10 is a dichotomous self-report measure that retrospectively assesses adverse childhood experiences (ACEs), including maltreatment (e.g., physical, emotional, and sexual abuse, and physical or emotional neglect) and family dysfunction (e.g., parental separation/divorce and household mental illness or suicide attempts). A total ACE score is obtained by summing up all items, resulting in a score between 0 and 10, with higher scores reflecting greater exposure to ACEs. The study of Van Der Feltz-Cornelis and De Beurs provides evidence on the factor structure, reliability, and validity of the Dutch version of the ACE-IQ-10. Forthe present study, the ACE-IQ-10 will be adapted to a parent/caregiver-report version.

Parental stress (OBVL)

The Parenting Stress Questionnaire (OBVL) assesses the extent to which parents experience burden or stress related to raising their children. This caregiver-report instrument consists of 34 items, each scored on a four-point Likert scale ranging from (1) "Not applicable" to (4) "Fully applicable." The OBVL includes five subscales. In the present study, the investigators focused on the three domains most relevant to our research objectives. The first domain, parent-child relationship problems, assesses the extent to which parents experience conflicting feelings or thoughts toward their child. The second domain, parenting problems, captures parents' perceived difficulties and insecurities regarding their parenting skills and effectiveness. The third domain, role restriction, reflects the degree to which parents experience the parenting role as limiting their personal freedom and opportunities. Higher scores indicate greater parental stress.