Child Sleep Related Impairment Questionnaire

This measure is intended for children/adolescents ages 8 to 17 years old. Please respond to each item by selecting an option from each dropdown menu.

In the past 7 days...

If you would like a copy of your answers and results emailed to you, please provide your email address here:

1. I was sleepy during the daytime.

2. I had a hard time concentrating because I was sleepy.

3. I had a hard time getting things done because I was sleepy.

4. I had problems during the day because of poor sleep.

5. I had trouble staying awake during the day.

6. It was hard to have fun because I was sleepy.

7. I could not keep my eyes open during the day.

8. I was in a bad mood because I was sleepy.

Lakeview
(312) 508-3645
1438 West Belmont Ave.
Chicago, IL 60657

River North
(312) 584-2144
311 W Superior St., Suite 402
Chicago, IL 60654

Highland Park
(847) 241-1195
1160 Park Avenue W., Suite 6E
Highland Park, IL 60035

Wilmette
(847) 610-6763
3330 Old Glenview Rd., Suite 14
Wilmette, IL 60091