PROMIS - Sleep Disturbance- Short Form

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* 1. Please fill in the demographic information below

Instructions to the child: On the DSM-5 Level I cross cutting questionnaire that you just completed/ you indicated that during the past 2 weeks you have been bothered by "not being able to fall asleep, stay asleep or waking up too early" at a mild or greater level of severity. The questions below ask about these feelings in more detail and especially how often you have been bothered by a list of symptoms during the past 7 days. Please respond to each item by selecting one box per row.
Please respond to each item by choosing one option per question

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* 2. In the past SEVEN (7) DAYS...

  1- Not at all 2- A little bit 3- Somewhat 4. Quite a bit 5. Very much
My sleep was restless.
I was satisfied with his/ her sleep.
My sleep was refreshing.
I had difficulty falling asleep

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* 3. In the past SEVEN (7) DAYS...

  1- Never 2- Rarely 3- Sometimes 4- Often 5- Always
I had trouble staying asleep.
I had trouble sleeping.
I got enough sleep.

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* 4. In the past SEVEN (7) DAYS...

  5- Very Poor 4- Poor 3- Fair 2- Good 1- Very Good
My sleep quality was ...

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