How this instrument works
Eight everyday situations, each rated 0 (would never doze) to 3 (high chance of dozing): reading, watching television, sitting inactive in a public place or classroom, riding as a passenger for an hour without a break, lying down to rest in the afternoon, sitting and talking with someone, sitting quietly after lunch, and sitting in a car stopped briefly in traffic. The eight ratings sum to a total from 0 to 24. Two of the eight are reworded from the standard adult Epworth scale: the classroom setting is added to the public-place item, and the item about sitting quietly after lunch drops the adult version's 'without alcohol' qualifier entirely.
A pediatric-specific version exists because a couple of the adult scale's original situations don't translate cleanly to a teenager's daily life. The alcohol reference in the after-lunch item assumes a context that doesn't apply to most adolescents, and the original public-place item didn't account for the setting where a large share of a teenager's sedentary daytime hours are actually spent — the classroom. Rewording those two items kept the remaining six intact while making the full set answerable and meaningful for a younger population, rather than forcing a scale built around adult routines onto adolescent ones.
The scale was validated specifically for ages 12 to 18 by Janssen, Phillipson, O'Connor, and Johns in a 2017 study using Rasch analysis, and the authors themselves note that validity below age 12 hasn't been established. This site's separate standard Epworth Sleepiness Scale, built for adults, is the appropriate tool from age 18 up; ESS-CHAD occupies the specific adolescent window between childhood, where no validated version yet exists, and adulthood, where the original scale takes over.
- For each of the eight situations, choose the chance of dozing: none, slight, moderate, or high (0-3).
- Enter age in years — the scale is validated for ages 12 to 18 only.
- Read the ESS-CHAD total, 0 to 24, summing all eight ratings.
- If age falls outside 12-18, use the age-appropriate scale instead — the standard adult Epworth scale from 18 up.
Worked example — 15-year-old, mixed situational scores
Eight ratings for a 15-year-old: reading 2, TV 1, public place/classroom 2, car passenger 3, afternoon rest 2, talking with someone 0, after lunch 2, stopped in traffic 1.
Sum: 2 + 1 + 2 + 3 + 2 + 0 + 2 + 1 = 13. A total of 13, out of a possible 24, sits above commonly used thresholds for excessive daytime sleepiness, and age 15 is well inside the scale's validated 12-18 range.
Questions
Is ESS-CHAD valid for children under 12?
No — the 2017 validation study by Janssen, Phillipson, O'Connor, and Johns covers ages 12 to 18 specifically, and the authors explicitly note that validity below age 12 hasn't been established. There isn't currently a validated version of this scale for younger children; a score generated for a child under 12 wouldn't carry the same evidence behind it.
What should someone over 18 use instead?
The standard adult Epworth Sleepiness Scale, available separately on this site. ESS-CHAD's adolescent-appropriate wording and its 12-18 validation range are specifically about that age window; adults should use the original scale, which retains the alcohol-related wording relevant to adult routines.
Why was a pediatric version needed instead of just using the adult scale on teenagers?
Two of the adult scale's eight items didn't transfer cleanly to adolescent life: one referenced alcohol, a context that doesn't fit most teenagers, and the public-place item didn't account for the classroom, where a large share of a student's sedentary daytime hours actually happen. Rewording just those two items — and keeping the other six unchanged — produced a scale that a teenager could actually answer meaningfully.
What does a high ESS-CHAD score mean?
A higher total reflects a greater self-reported tendency to doze across ordinary daytime situations, which can point toward insufficient sleep, a sleep disorder, or another underlying condition affecting alertness. It's a screening signal, not a diagnosis — a persistently elevated score is a reason to raise the topic with a clinician who can look into causes like sleep duration, sleep quality, or a specific sleep disorder.
Does one high answer on a single item matter more than the total?
The published scale is scored and interpreted as a single total across all eight situations rather than by flagging any one item on its own, since a dozing tendency in one specific context, taken alone, is a weaker signal than the pattern across many different situations. A single elevated item alongside seven low ones reads differently than the same total spread more evenly.
How does this differ from the standard adult Epworth Sleepiness Scale in terms of scoring?
The scoring mechanics are identical — eight situations, each 0 to 3, summed to a 0-24 total. What differs is the wording of two items and the age range the scale has actually been validated against, 12 to 18 here versus adulthood for the original.
References
- Janssen KC, Phillipson S, O'Connor J, Johns MW, 2017, Sleep Med — ESS-CHAD validation via Rasch analysis (PubMed)
- Official Epworth Sleepiness Scale site — references for ESS and ESS-CHAD
Read this first: This instrument computes a screening figure from population formulas — it is not a diagnosis, and it cannot see the whole picture a clinician can. Use it to inform a conversation, not to replace one.