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

Milagros Fuentes-Albero1, Mayra Alejandra Mafla-España2, José Martínez-Raga3

  • 1Ripalda Clinic, 46001 Valencia, Spain.

Diseases (Basel, Switzerland)
|September 26, 2025
PubMed

Insights

Children and adolescents with autism spectrum disorder (ASD) experience sleep disturbances linked to feeding problems and autism severity. Maladaptive mealtime behaviors like poor appetite and tantrums predict sleep issues, indicating a need for integrated interventions.

Area of Science:

  • Pediatric Neurology
  • Developmental Psychology
  • Sleep Medicine

Background:

  • Autism spectrum disorder (ASD) is frequently associated with sleep and eating difficulties in children and adolescents.
  • The interplay between sleep disturbances and feeding problems in this population remains under-explored.

Purpose of the Study:

  • To investigate the association between sleep disturbances and feeding problems in children and adolescents diagnosed with ASD.
  • To identify specific feeding behaviors that correlate with sleep issues in the ASD population.

Main Methods:

  • A cross-sectional observational study utilizing the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) for feeding behaviors and the Sleep Disturbance Scale for Children (Bruni scale) for sleep problems.
  • Bivariate and multivariate logistic and linear regression analyses were employed to assess associations.

Main Results:

  • Sleep disturbances were significantly associated with autism severity (p=0.003) and independently predicted by autism severity (p=0.01) and feeding frequency (p=0.01).
  • Specific feeding behaviors, including difficulty chewing, tantrums during meals, poor appetite, and caregiver-perceived negative health impacts, were significantly associated with sleep disturbances.
  • No significant associations were found with age, sex, comorbidities, behavioral disorders, or genetic factors.

Conclusions:

  • Increased autism severity and specific feeding behaviors are independently linked to a higher risk of sleep disturbances in children and adolescents with ASD.
  • Maladaptive mealtime behaviors such as poor appetite, tantrums, and chewing difficulties may act as predictors for sleep problems.
  • Integrated screening and early intervention strategies addressing both feeding and sleep issues are recommended for this population.
Abstract

Keywords:
autism spectrum disordereating disorderssleep disorders

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