{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:41:01Z","timestamp":1790192461328,"version":"4.1.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Autism Spectrum Disorder (ASD) is commonly associated with feeding difficulties and sleep disturbances, yet their co-occurrence remains understudied in Arab and Palestinian contexts. Pica and broader pica-related sensory feeding behaviors are among the most clinically significant feeding problems in children with ASD, carrying serious health risks. This study examined the level of parent-reported sensory feeding problems, pica-related behaviors, and sleep habit disturbances in children with ASD attending care centers in the West Bank, Palestine, and explored their association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional descriptive-correlational survey was conducted. A convenience sample of 105 parents of children with ASD was recruited from care centers in the West Bank during August 2025. Two instruments were used: a 20-item literature-informed Sensory Feeding\/Pica-Related Behaviors Scale developed for this study, and a 21-item Sleep Habits Scale adapted from the Arabic scale developed and validated by Al-Merdasi. The feeding scale underwent expert content review and pilot testing, while internal consistency was assessed for both instruments in the present sample. The feeding scale was designed to describe caregiver-reported sensory feeding difficulties and pica-related behaviors rather than to establish a DSM-5-TR or ICD-11 diagnosis of pica. All sleep items were coded so that higher scores indicated greater sleep disturbance; sleep adequacy items were reverse-scored. Data were analyzed using descriptive statistics, independent-samples t-tests, one-way ANOVA with LSD\n                      <jats:italic>post-hoc<\/jats:italic>\n                      tests, and Pearson correlation in SPSS. Effect sizes were reported as Cohen's d for t-tests and partial\n                      <jats:italic>\u03b7<\/jats:italic>\n                      \u00b2 for ANOVA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sensory feeding problems and Pica-related behaviors scores were at a moderate level overall (M\u202f=\u202f1.946, SD\u202f=\u202f0.307; relative weight 64.9%). Sleep habit disturbances were also moderate (M\u202f=\u202f3.123, SD\u202f=\u202f0.551; 62.5%), with sleep anxiety ranking highest (M\u202f=\u202f3.507). No significant differences in Sensory feeding and pica-related behavior scores were found by any demographic variable. For sleep habits, significant differences were found by child age (F\u202f=\u202f10.038, p\u202f=\u202f0.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      \u00b2\u202f=\u202f0.164), with younger children appearing to score higher, though the oldest age group was small (n\u202f=\u202f7) and the finding should be interpreted cautiously. Significant differences were also found by child sex (t\u202f=\u202f2.195, p\u202f=\u202f0.030, d\u202f=\u202f0.43), with higher sleep disturbance scores among females. A significant positive moderate correlation was found between pica-related problem scores and sleep disturbance scores (r\u202f=\u202f0.463, p\u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This parent-reported cross-sectional study found moderate levels of sensory feeding problems, pica-related behaviors, and sleep disturbances among children with ASD in the West Bank, Palestine, and a significant positive association between them. Because the study used convenience sampling and researcher-developed instruments with preliminary validation only, findings should be interpreted as preliminary and should not be taken as estimates of clinically diagnosed pica or sleep disturbances. They highlight the importance of integrating screening for pica-like behaviors and sleep problems within ASD services, and support the need for future longitudinal studies incorporating clinical diagnosis, gastrointestinal assessment, nutritional biomarkers, and validated measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1899150","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:37:05Z","timestamp":1784871425000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Sensory feeding problems, pica-related behaviors, and sleep habits among children with autism spectrum disorder in palestine: a parent-reported cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Suheir","family":"Sabbah","sequence":"first","affiliation":[{"name":"Psychology Department, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana M.","family":"Namoura","sequence":"additional","affiliation":[{"name":"Psychology Department, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamzeh","family":"Yacoub","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]},{"name":"Faculty of Medicine, Arab American University","place":["Ramallah, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaid","family":"Yacoub","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]},{"name":"SurgiCore-Jerusalem, Surgical Interest Group of Jerusalem, Faculty of Medicine, Al-Quds University, Jerusalem","place":["Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Yacoub","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders, 5th Edn., Text Revision (DSM-5-TR)","year":"2022"},{"key":"B2","volume-title":"Autism [Fact Sheet]","year":"2023"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7202a1","article-title":"Prevalence and characteristics of autism spectrum disorder among children aged 8 years autism and developmental disabilities monitoring network, 11 sites, United States, 2020","volume":"72","year":"2023","journal-title":"MMWR Surveill Summ"},{"key":"B4","doi-asserted-by":"publisher","year":"","DOI":"10.1038\/s41572-019-0138-4"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e20200462","DOI":"10.1542\/peds.2020-0462","article-title":"Pica, autism, and other disabilities","volume":"147","author":"Fields","year":"2021","journal-title":"Pediatrics"},{"key":"B6","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1002\/eat.24111","article-title":"Prevalence and recurrence of pica behaviors in early childhood within the ALSPAC birth cohort","volume":"57","author":"Papini","year":"2024","journal-title":"Int J Eat Disord"},{"key":"B7","doi-asserted-by":"publisher","year":"","DOI":"10.1177\/10883576060210030401"},{"key":"B8","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.dcn.2017.04.010","article-title":"The impact of atypical sensory processing on social impairments in autism spectrum disorder","volume":"29","author":"Thye","year":"2018","journal-title":"Dev Cogn Neurosci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"4199","DOI":"10.1007\/s10803-022-05739-0","article-title":"Prevalence of gastrointestinal symptoms in autism spectrum disorder: a systematic review and meta-analysis","volume":"53","author":"Campbell","year":"2023","journal-title":"J Autism Dev Disord"},{"key":"B10","volume-title":"International Classification of Diseases, 11th Revision (ICD-11)","year":"2019"},{"key":"B11","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1007\/s11910-022-01218-2","article-title":"The neurology and psychopathology of pica","volume":"22","author":"Schnitzler","year":"2022","journal-title":"Curr Neurol Neurosci Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/02537176251331152","article-title":"Gastrointestinal manifestations and associated comorbidities in children with autism spectrum disorder: a cross-sectional analysis from south India","author":"Prabhakaran","year":"2025","journal-title":"Indian J Psychol Med"},{"key":"B13","doi-asserted-by":"publisher","year":"","DOI":"10.3389\/frcha.2023.1099527"},{"key":"B14","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1080\/09540261.2018.1435513","article-title":"Treatment of severe problem behavior in children with autism spectrum disorder and intellectual disabilities","volume":"30","author":"Newcomb","year":"2018","journal-title":"Int Rev Psychiatry"},{"key":"B15","doi-asserted-by":"publisher","first-page":"26","DOI":"10.3390\/hemato6030026","article-title":"Pica syndromes and iron deficiency anemia treatment: a mini review","volume":"6","author":"Mallick","year":"2025","journal-title":"Hemato"},{"key":"B16","doi-asserted-by":"publisher","first-page":"22","DOI":"10.58372\/2835-6276.1184","article-title":"Pica and autism\/pica in developmental disability \u2013 ports of entry","volume":"3","author":"Alexander","year":"2024","journal-title":"Am J Med Clin Res Rev"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12903-024-05371-7","article-title":"Pica practices, anemia, and oral health outcomes: a systematic review","volume":"25","author":"Hashemi","year":"2025","journal-title":"BMC Oral Health"},{"key":"B18","volume-title":"Determining the More Effective Behavior Analytic Intervention for Children with Autism who Exhibit pica Behaviors [unpublished PhD Thesis]","author":"Lanham","year":"2024"},{"key":"B19","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1212\/WNL.0000000000009033","article-title":"Practice guideline: treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder. Report of the guideline development, dissemination, and implementation subcommittee of the American academy of neurology","volume":"94","author":"Buckley","year":"2020","journal-title":"Neurology"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12888-021-03405-w","article-title":"Sleep problems in children with autism spectrum disorder: a multicenter survey","volume":"21","author":"Chen","year":"2021","journal-title":"BMC Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1111\/ped.14496","article-title":"Sleep problems in children with autism spectrum disorder and typical development","volume":"63","author":"Inthikoot","year":"2020","journal-title":"Pediatr Int"},{"key":"B22","doi-asserted-by":"publisher","year":"","DOI":"10.1007\/s40675-015-0012-1"},{"key":"B23","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.copsyc.2019.12.003","article-title":"Sleep problems, behavior, and psychopathology in autism: inter-relationships across the lifespan","volume":"34","author":"Schreck","year":"2020","journal-title":"Curr Opin Psychol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1542\/peds.2015-2851H","article-title":"Sleep difficulties and medications in children with autism spectrum disorders: a registry study","volume":"63","author":"Malow","year":"2016","journal-title":"Pediatr Neurol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1007\/s10803-013-1866-z","article-title":"Parent-based sleep education for children with autism spectrum disorders","volume":"44","author":"Malow","year":"2014","journal-title":"J Autism Dev Disord"},{"key":"B26","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1108\/AIA-12-2019-0049","article-title":"Evaluation of sleep disturbances, gastrointestinal problems and eating behaviors in turkish children with autistic disorder and PDD-NOS","volume":"7","author":"Gok","year":"2021","journal-title":"Adv Autism"},{"key":"B27","doi-asserted-by":"publisher","year":"","DOI":"10.1093\/pch\/17.4.193"},{"key":"B28","doi-asserted-by":"publisher","first-page":"56","DOI":"10.21608\/dapt.2023.326253","article-title":"Pica disorder and its relationship with sleep habits in children with autism spectrum disorder","volume":"6","author":"Mohamed","year":"2023","journal-title":"J Stud Psychol Guid"},{"key":"B29","volume-title":"Population Estimates by Governorate","year":"2025"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"Von Elm","year":"2007","journal-title":"PLoS Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"573","DOI":"10.21608\/psj.2024.315567.1096","article-title":"Pica disorder in children with autism spectrum disorder and intellectual disability","volume":"34","author":"Abd Rabbo","year":"2024","journal-title":"J Psychol Stud"},{"key":"B32","year":""},{"key":"B33","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.cpr.2013.11.002","article-title":"Cognitive, language, social and behavioural outcomes in adults with autism spectrum disorders: a systematic review of longitudinal follow-up studies in adulthood","volume":"34","author":"Magiati","year":"2014","journal-title":"Clin Psychol Rev"},{"key":"B34","doi-asserted-by":"publisher","first-page":"195","DOI":"10.21608\/cpc.2024.352499","article-title":"Sleep disorders between children and adolescents with autism spectrum disorder","volume":"79","author":"Mohamed","year":"2024","journal-title":"J Psychol Counsel Ain Shams Univ"},{"key":"B35","volume-title":"Hidden and Lesser-known disordered Eating Behaviors in Medical and Psychiatric Conditions","author":"Manzato","year":"2021"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1899150\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:37:06Z","timestamp":1784871426000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1899150\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":35,"alternative-id":["10.3389\/fped.2026.1899150"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1899150","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"article-number":"1899150"}}