Association Between Sleep Disturbance and Behavioral Feeding Problems in Children and Adolescents with Autism Spectrum Disorder.

Abstract

Introduction: Children and adolescents with autism spectrum disorder (ASD) often present sleep and eating problems. However, the relationship between these two factors has seldom been studied.

Objective: This paper aimed to examine the association between sleep disturbances and feeding problems in children and adolescents with ASD.

Methods: This cross-sectional observational study assessed feeding behaviors using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and assessed sleep problems with the Sleep Disturbance Scale for Children (Bruni scale). Bivariate analyses and multivariate logistic and linear regression analyses were performed.

Results: Sleep disturbances were significantly associated with autism severity (p = 0.003), but not with BPFAS subscale scores. Multivariate logistic regression indicated that sleep disturbances were independently associated with autism severity (p = 0.01; OR = 0.23; 95% CI: 0.06-0.77) and the BPFAS frequency subscale score (p = 0.01; OR = 1.04; 95% CI: 1.01-1.07). A secondary logistic regression identified five BPFAS items significantly associated with sleep disturbances: difficulty chewing (p = 0.02, OR = 0.12, 95% CI 0.02-0.74), voluntary attendance at meals (p = 0.01, OR = 0.60, 95% CI 0.39-0.90), tantrums during meals (p < 0.001; OR = 2.08, 95% CI 1.21-3.56), poor appetite (p < 0.001; OR = 2.63, 95% CI 1.43-4.82), and the caregiver's perception that the child's eating habits negatively affected their health (p = 0.03; OR = 1.53, 95% CI 1.03-2.40). No significant associations were found with age, sex, medical comorbidities, behavioral disorders or genetic factors.

Conclusions: The findings suggest that greater autism severity and more pronounced feeding behaviors are independently associated with an increased risk of sleep disturbances in children and adolescents with ASD. Specific maladaptive mealtime behaviors, such as poor appetite, tantrums, and chewing difficulties, may serve as predictors of sleep problems, highlighting the need for integrated screening and early intervention strategies.