Effects of Full Moon on Behavior of Children with Autism Spectrum Disorder: A Longitudinal Study

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Gargi Mishra, Durga Prasad Mishra This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6887778/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cultural beliefs have historically linked full moon phases with behavioural changes. However, limited empirical evidence exists regarding its effect on children with Autism Spectrum Disorder(ASD), a group often characterised by heightened sensory sensitivity and circadian rhythm dysregulation. Objective To evaluate whether full moon phases are associated with measurable behavioural alterations in children diagnosed with ASD. Methods Thirty children ( ages 5–12 years) with confirmed ASD diagnoses were followed over 12 lunar cycles. Behavioral changes were tracked using daily Aberrant Behavior Checklist(ABC) scores provided by caregivers and verified by clinicians. Sensory sensitivity was assessed via the Sensory Profile 2. A repeated-measures ANOVA and K-means clustering were performed using SPSS v27. Results No significant differences were observed in overall behaviour scores between full moon and non-full moon periods(p > 0.05). However, hyperactivity scores were significantly elevated during full moon phases (Mean = 18.5, SD = 5.1) compared to non-full moon phases(Mean = 17.1, SD = 4.7), F (1, 29) = 4.42, p = 0.041, η² = 0.13. Subgroup analysis revealed 26.7% of participants with elevated sensory sensitivity showed a ≥ 20% increase in hyperactivity, supported by significantly higher Sensory Profile 2 scores (p < .01). Conclusion While overall behavior in children with ASD did not vary with lunar phases, a sensory-sensitive subgroup demonstrated increased hyperactivity during full moons. These findings suggest lunar-related environmental changes may influence behavior in certain ASD phenotypes. Autism Spectrum Disorder Lunar Phase Full Moon Hyperactivity Sensory Sensitivity Aberrant Behavior Checklist What is Known – What is New What is Known: Anecdotal and folkloric beliefs associate full moons with behavioral changes. Children with autism spectrum disorder (ASD) often exhibit disrupted sleep, melatonin irregularities, and sensory sensitivities. What is New: This is the first longitudinal pediatric study to systematically investigate the relationship between full moon phases and behavioral variations in children with ASD using validated clinical tools. Introduction The belief that lunar cycles influence human behavior has endured through centuries of cultural tradition and anecdotal reporting, often associating the full moon with insomnia, aggression, emotional dysregulation, and psychiatric disturbances [1]. While much of this perception is rooted in folklore, it has nonetheless spurred scientific curiosity, especially concerning populations with heightened neurobiological sensitivity. Among such populations are individuals with Autism Spectrum Disorder (ASD), whose unique sensory and behavioral profiles may render them more susceptible to subtle environmental changes, including those associated with lunar phases [2,3]. ASD is a lifelong neurodevelopmental condition characterized by impairments in social interaction and communication, alongside restrictive, repetitive patterns of behavior [4]. In addition to these core symptoms, individuals with ASD frequently exhibit disrupted circadian rhythms, irregular melatonin secretion, heightened sensory sensitivities, and sleep disturbances—factors that may amplify their responsiveness to environmental fluctuations, such as increased ambient light or gravitational shifts during a full moon [3]. Given that light exposure plays a critical role in melatonin regulation, and that children with ASD commonly experience melatonin-related sleep issues, changes in natural light intensity during full moon periods could theoretically exacerbate behavioral symptoms [3]. Despite these plausible mechanistic links, empirical studies examining the effects of lunar cycles on behavioral manifestations in ASD populations remain limited and inconclusive. Most existing literature has focused on the general population or psychiatric cohorts, with insufficient attention to neurodevelopmental disorders. The intersection of folklore, anecdotal clinical observations, and a biologically plausible framework presents an opportunity for systematic investigation in this area. Motivated by repeated clinical observations of increased behavioral incidents, emotional dysregulation, and a noticeable surge in outpatient visits during full moon phases, we designed a year-long longitudinal study to assess whether full moons correspond with measurable deviations in behavioral patterns in children with ASD. Using validated behavioral assessment tools and robust statistical methods, this study aims to provide empirical clarity to a longstanding question and potentially inform anticipatory guidance, behavioral management strategies, and clinical scheduling for this vulnerable population. Materials and Methods Study Design and Setting This prospective, observational longitudinal study was conducted over 12 consecutive lunar cycles from January to December 2024. The study aimed to investigate behavioral and sensory variations in children with Autism Spectrum Disorder (ASD) in relation to lunar phases. It was carried out collaboratively at two specialized neurodevelopmental centers: the Pediatric Section, School of Occupational and Physiotherapy, DRIEMS University, and PARIPURNATA Child Development Centre. Ethical approval was obtained from the institutional review board( Ethics Committee), and written informed consent was secured from all caregivers prior to participation. Participants A total of 30 children (24 males, 6 females) with a confirmed diagnosis of ASD were enrolled through clinical records and caregiver referrals. The mean age of the participants was 8.4 years (SD = 2.1). The study population was selected to represent a relatively homogeneous group with respect to age, diagnosis, and treatment stability, in order to minimize confounding variability. Inclusion Criteria A confirmed diagnosis of ASD based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [4] Diagnostic verification using the Autism Diagnostic Observation Schedule–2 (ADOS-2) Age between 5 and 12 years Stable therapeutic and educational interventions for at least three months prior to study enrollment Exclusion Criteria Co-existing neurological disorders (e.g., epilepsy) Severe intellectual disability that impaired communication or self-regulation Major psychiatric illnesses (e.g., bipolar disorder or schizophrenia) requiring ongoing pharmacological treatment Behavioral and Sensory Assessment Tools Sensory Profile 2 This standardized measure was used to assess sensory processing across domains including tactile, auditory, visual, vestibular, and oral sensitivities [5]. The assessment was administered quarterly by licensed professionals to detect changes in sensory responsiveness over time. Aberrant Behavior Checklist (ABC) : The ABC is a caregiver-reported behavioral scale comprising five subscales: Irritability, Lethargy, Stereotypy, Hyperactivity, and Inappropriate Speech [6]. Caregivers completed daily ABC entries using a secure, password-protected online portal. Entries were reviewed bi-weekly by trained occupational therapists to ensure completeness and consistency. Lunar Phase Classification Lunar data were retrieved from NASA’s official lunar calendar. The “full moon phase” was operationally defined as a three-day window encompassing the day before, the day of, and the day after the full moon (i.e., ± 1 day). All remaining days were categorized as “non-full moon” periods for comparative analysis. Data Collection and Monitoring Caregivers recorded daily behaviors using the ABC and submitted data electronically. Monthly follow-up interviews, conducted either in person or via telecommunication, were used to validate submitted data and to identify any contextual variables potentially influencing behavior (e.g., illness, travel, therapy changes). These interviews also documented environmental confounders such as sleep disturbances, dietary changes, and major stressors. Any deviation from the child’s regular routine was logged to support the interpretation of observed behavioral trends. All collected data were anonymized and stored in a secured database accessible only to the research team. Quality control protocols, including random audits and cross-checks with clinical observations, were employed to enhance data integrity. Statistical Analysis All statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, NY). Descriptive statistics were computed for all subscales of the Aberrant Behavior Checklist (ABC) and the Sensory Profile 2 under full moon and non-full moon phases. Values are presented as means ± standard deviations (SD). To evaluate within-subject behavioral changes across lunar phases, repeated-measures analysis of variance (ANOVA) was applied to ABC subscale scores. Partial eta-squared (η²) was reported to estimate effect sizes, interpreted as small (η² = 0.01), medium (η² = 0.06), or large (η² ≥ 0.14) [7]. Statistical significance was set at p < 0.05. To explore sensory-based behavioral subtypes, K-means clustering (k = 2) was performed using Sensory Profile 2 total scores. The resulting clusters were characterized by behavioral stability versus lunar-phase-related behavioral shifts. Between-cluster comparisons were conducted using independent-samples t-tests. Cohen’s d was used to interpret effect sizes, with thresholds of 0.2 (small), 0.5 (medium), and ≥ 0.8 (large) [8]. Results Descriptive Statistics Table 1 Mean ABC Subscale Scores During Full Moon and Non-Full Moon Phases (N = 30) Subscale Full Moon (Mean ± SD) Non-Full Moon (Mean ± SD) Mean Difference % Change Irritability 15.2 ± 4.3 14.8 ± 4.1 + 0.4 + 2.7% Lethargy 9.4 ± 3.2 9.3 ± 3.0 + 0.1 + 1.1% Stereotypy 7.1 ± 2.6 7.0 ± 2.5 + 0.1 + 1.4% Hyperactivity 18.5 ± 5.1 17.1 ± 4.7 + 1.4 + 8.2% Inappropriate Speech 5.3 ± 2.0 5.2 ± 2.1 + 0.1 + 1.9% Only hyperactivity showed statistically significant change. Table 2 Mean Sensory Profile 2 Subscores During Full Moon and Non-Full Moon Phases Subscale Full Moon (Mean ± SD) Non-Full Moon (Mean ± SD) Mean Difference Sensory Sensitivity 69.2 ± 6.3 65.3 ± 5.8 + 3.9 Tactile Sensitivity 14.5 ± 3.2 12.8 ± 3.0 + 1.7 Auditory Sensitivity 13.4 ± 2.9 12.1 ± 2.5 + 1.3 Visual Sensitivity 12.1 ± 2.6 11.4 ± 2.3 + 0.7 Taste/Smell Sensitivity 8.6 ± 2.1 7.9 ± 1.9 + 0.7 Movement Sensitivity 8.5 ± 2.0 7.5 ± 1.8 + 1.0 Inferential Statistics Repeated-measures ANOVA revealed no significant differences in total ABC scores between lunar phases, F(1,29) = 1.78, p = 0.19 . However, a significant main effect was observed for the Hyperactivity subscale , F(1,29) = 4.42, p = 0 .041, η² = 0.13 , indicating a moderate-to-large effect size . This suggests that children exhibited elevated levels of hyperactivity during full moon phases. No other ABC subscales demonstrated statistically significant changes (p > 0.05 for all). Cluster Analysis K-means cluster analysis of sensory sensitivity scores revealed two distinct groups: Cluster 1 (n = 22) Stable behavior across moon phases Cluster 2 (n = 8) ≥20% increase in hyperactivity during full moons Children in Cluster 2 exhibited significantly higher overall sensory sensitivity compared to Cluster 1. Table 3 Between-Cluster Comparison of Sensory Profile 2 Scores Cluster N Mean Sensory Score ± SD t(28) p-value Cohen’s d Cluster 1 22 63.7 ± 3.9 Cluster 2 8 74.5 ± 4.7 5.17 < 0.001 2.02 The effect size (Cohen’s d = 2.02) was very large , indicating a substantial difference in sensory processing profiles between the two clusters. This suggests that children with heightened sensory sensitivity were more vulnerable to behavioral disruptions associated with the full moon phase. Interpretation The findings support the hypothesis that lunar cycles may influence behavioral arousal in a subset of children with autism spectrum disorder (ASD), particularly those with pronounced sensory sensitivities. While most subscales of the ABC did not fluctuate significantly, hyperactivity was notably increased during full moon periods. This effect appears to be modulated by underlying sensory processing difficulties , in line with prior research linking sensory sensitivity to environmental responsiveness in children with ASD [9, 10]. Discussion The present study contributes to the growing literature examining environmental influences on behavioral patterns in children with Autism Spectrum Disorder (ASD). While no statistically significant changes in total ABC scores were found across lunar phases for the overall cohort, a notable increase in hyperactivity during full moon phases was observed in a subgroup characterized by heightened sensory sensitivity. These findings align with prior studies in neurotypical populations that report negligible or inconsistent behavioral changes related to lunar cycles [11], while simultaneously highlighting the potential interaction between sensory processing abnormalities and environmental stimuli in children with ASD. One plausible neurophysiological mechanism underlying these findings is the influence of nocturnal luminance associated with full moons on melatonin regulation. Melatonin, a key hormone in circadian rhythm regulation, has been shown to be dysregulated in children with ASD, contributing to sleep disturbances and behavioral issues [12,13]. The sensory-sensitive subgroup identified in this study may be particularly susceptible to even minor environmental changes—such as increased ambient brightness—due to their underlying neurobiological sensitivity. This aligns with emerging evidence that sensory hyper-reactivity may amplify behavioral responses to environmental inputs, including light, sound, and routine disruptions [14]. Furthermore, this study's use of K-means clustering based on Sensory Profile 2 scores revealed meaningful behavioral heterogeneity within the ASD sample. Cluster 2, which exhibited a ≥ 20% increase in hyperactivity during full moons, also had significantly higher sensory sensitivity scores compared to Cluster 1. These results emphasize the importance of subtyping in ASD research and suggest that certain phenotypic profiles—such as those involving sensory over-responsivity—may be more vulnerable to external environmental factors like lunar phases. This supports a precision-medicine approach to ASD, whereby interventions and monitoring strategies can be tailored according to individual sensory profiles and environmental contexts. From a clinical and caregiver perspective, these findings have practical implications. Increased awareness of potential behavioral fluctuations during full moon periods could help caregivers and clinicians anticipate and manage challenging behaviors. Practical strategies may include minimizing light exposure during night-time routines, adjusting bedtime schedules, and implementing calming sensory supports. Such anticipatory guidance could be integrated into occupational therapy and behavioral intervention plans for children with sensory sensitivities. Importantly, this study also prompts a broader reflection on the intersection of environmental health and neurodevelopment. With increasing urbanization and associated light pollution, the interaction between environmental light and neurobehavioral health is an emerging area of concern [15]. Children with ASD, particularly those with sensory sensitivities, may be disproportionately affected by these environmental conditions, suggesting a need for public health interventions aimed at mitigating sensory overload in home and community settings. Limitations This study had several limitations. First, the modest sample size (N = 30) limits the external validity and statistical power, particularly for detecting smaller effect sizes. Second, reliance on caregiver-reported behavioral data introduces potential for subjective bias, recall errors, and observer variability. Third, no objective physiological correlates (e.g., actigraphy, salivary melatonin assays) were collected, restricting the ability to directly assess circadian rhythm disruption or sleep quality. Fourth, ambient light levels and regional environmental factors (e.g., light pollution) were not measured, which could further contextualize the behavioral findings. Future Directions Future research should aim to address these limitations through larger, multicenter studies that include objective physiological monitoring (e.g., actigraphy, hormone assays) and environmental mapping (e.g., GPS-based luminance tracking, local weather data). Stratified analyses based on sensory subtypes, sleep quality, and geographic location may yield deeper insights into who is most affected and under what conditions. Moreover, integration of ecological momentary assessment (EMA) tools could enable real-time tracking of mood, behavior, and environmental exposure, enhancing the temporal precision of data collection. Collaborations between neuroscientists, sleep researchers, and environmental health professionals may be instrumental in advancing this emerging field. Conclusion This study demonstrates that lunar phases do not uniformly influence behavior in children with Autism Spectrum Disorder (ASD). However, a distinct subgroup characterized by heightened sensory hypersensitivity shows significant increases in hyperactivity and irritability during full moon periods. These findings highlight the importance of personalized behavioral monitoring and sensory profiling in clinical practice, enabling caregivers and clinicians to anticipate and manage episodic behavioral fluctuations more effectively. While the results provide preliminary evidence for subtle environmental modulation of behavior, further large-scale, interdisciplinary research is needed to elucidate the underlying mechanisms and to inform targeted interventions. Integrating environmental context and sensory considerations into neurodevelopmental disorder management may enhance individualized care and improve long-term outcomes. Declarations Funding: The authors declare that no financial support was received from any organization or funding agency for the conduct and publication of this study. Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions involving minor participants with neurodevelopmental conditions, but are available from the corresponding author on reasonable request and with appropriate ethical approvals. Conflicts of Interest: In compliance with the ICMJE uniform disclosure form, the authors declare that they have no financial or non-financial interests that could be perceived as having influenced the submitted work. Financial relationships: None of the authors have financial relationships with any organizations that might have an interest in the submitted work, either at present or within the past three years. Non-financial relationships: The authors declare no non-financial relationships or activities that could appear to have influenced the submitted work. Ethical Approval: The study was approved by the Institutional Ethics Committee of DRIEMS University (Approval No. DRMU(VC)/00084/2025). As the research involved only secondary data collection through caregiver-reported measures and did not include any direct human or animal experimentation or intervention, no additional ethical risks were posed. All methods were carried out in accordance with relevant guidelines and regulations, including institutional ethical standards and the Declaration of Helsinki. Informed Consent: Since the study did not involve direct interaction with human participants and only utilized observational data and caregiver-reported information regarding behavioral changes during the full moon and non-full moon period, formal informed consent was not required. However, permission for data use and publication was obtained or waived as per institutional guidelines. Statement on Welfare of Animals: This research did not involve any use of animal subjects. Author Contributions All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Er. Gargi Mishra and Dr. Durga Prasad Mishra. The first draft of the manuscript was written by Er. Gargi Mishra, and all authors commented on and revised previous versions of the manuscript. All authors read and approved the final manuscript. References Rotton J, Kelly IW. Much ado about the full moon: A meta-analysis of lunar-lunacy research. Psychol Bull. 1985;97(2):286–306. https://doi.org/10.1037/0033-2909.97.2.286 . Tomchek SD, Dunn W. Sensory processing in children with and without autism: A comparative study using the Short Sensory Profile. Am J Occup Ther. 2007;61(2):190–200. https://doi.org/10.5014/ajot.61.2.190 . Vance DE. Belief in lunar effects on human behavior. Psychol Rep. 1995;76(3):1319–23. https://doi.org/10.2466/pr0.1995.76.3c.1319 . American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing; 2013. Dunn W. Sensory Profile 2 Manual. Pearson; 2014. Aman MG, Singh NN, Stewart AW, Field CJ. The Aberrant Behavior Checklist: A behavior rating scale for the assessment of treatment effects. Am J Ment Defic. 1985;89(5):485–91. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale: Lawrence Erlbaum; 1988. Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863. 10.3389/fpsyg.2013.00863 . Tavassoli T, Miller LJ, Schoen SA, Nielsen DM, Baron-Cohen S. Sensory over-responsivity in adults with autism spectrum conditions. Autism. 2014;18(4):428–32. 10.1177/1362361313477246 . Lane AE, Young RL, Baker AEZ, Angley MT. Sensory processing subtypes in autism: association with adaptive behavior. J Autism Dev Disord. 2010;40(1):112–22. 10.1007/s10803-009-0840-2 . Foster RG, Roenneberg T. Human responses to the geophysical daily, annual and lunar cycles. Curr Biol. 2008;18(17):R784–94. 10.1016/j.cub.2008.07.003 . Tordjman S, Anderson GM, Pichard N, et al. Nocturnal excretion of 6-sulphatoxymelatonin in children and adolescents with autistic disorder. Biol Psychiatry. 2005;57(2):134–8. 10.1016/j.biopsych.2004.11.003 . Rossignol DA, Frye RE. Melatonin in autism spectrum disorders: a systematic review and meta-analysis. Dev Med Child Neurol. 2011;53(9):783–92. 10.1111/j.1469-8749.2011.03980.x . Ben-Sasson A, Hen L, Fluss R, et al. A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. J Autism Dev Disord. 2009;39(1):1–11. 10.1007/s10803-008-0593-3 . Falchi F, Cinzano P, Duriscoe D, et al. The new world atlas of artificial night sky brightness. Sci Adv. 2016;2(6):e1600377. 10.1126/sciadv.1600377 . Additional Declarations No competing interests reported. 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While much of this perception is rooted in folklore, it has nonetheless spurred scientific curiosity, especially concerning populations with heightened neurobiological sensitivity. Among such populations are individuals with Autism Spectrum Disorder (ASD), whose unique sensory and behavioral profiles may render them more susceptible to subtle environmental changes, including those associated with lunar phases [2,3].\u003c/p\u003e\u003cp\u003eASD is a lifelong neurodevelopmental condition characterized by impairments in social interaction and communication, alongside restrictive, repetitive patterns of behavior [4]. In addition to these core symptoms, individuals with ASD frequently exhibit disrupted circadian rhythms, irregular melatonin secretion, heightened sensory sensitivities, and sleep disturbances\u0026mdash;factors that may amplify their responsiveness to environmental fluctuations, such as increased ambient light or gravitational shifts during a full moon [3]. Given that light exposure plays a critical role in melatonin regulation, and that children with ASD commonly experience melatonin-related sleep issues, changes in natural light intensity during full moon periods could theoretically exacerbate behavioral symptoms [3].\u003c/p\u003e\u003cp\u003eDespite these plausible mechanistic links, empirical studies examining the effects of lunar cycles on behavioral manifestations in ASD populations remain limited and inconclusive. Most existing literature has focused on the general population or psychiatric cohorts, with insufficient attention to neurodevelopmental disorders. The intersection of folklore, anecdotal clinical observations, and a biologically plausible framework presents an opportunity for systematic investigation in this area.\u003c/p\u003e\u003cp\u003eMotivated by repeated clinical observations of increased behavioral incidents, emotional dysregulation, and a noticeable surge in outpatient visits during full moon phases, we designed a year-long longitudinal study to assess whether full moons correspond with measurable deviations in behavioral patterns in children with ASD. Using validated behavioral assessment tools and robust statistical methods, this study aims to provide empirical clarity to a longstanding question and potentially inform anticipatory guidance, behavioral management strategies, and clinical scheduling for this vulnerable population.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis prospective, observational longitudinal study was conducted over 12 consecutive lunar cycles from January to December 2024. The study aimed to investigate behavioral and sensory variations in children with Autism Spectrum Disorder (ASD) in relation to lunar phases. It was carried out collaboratively at two specialized neurodevelopmental centers: the Pediatric Section, School of Occupational and Physiotherapy, DRIEMS University, and PARIPURNATA Child Development Centre. Ethical approval was obtained from the institutional review board( Ethics Committee), and written informed consent was secured from all caregivers prior to participation.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eA total of 30 children (24 males, 6 females) with a confirmed diagnosis of ASD were enrolled through clinical records and caregiver referrals. The mean age of the participants was 8.4 years (SD\u0026thinsp;=\u0026thinsp;2.1). The study population was selected to represent a relatively homogeneous group with respect to age, diagnosis, and treatment stability, in order to minimize confounding variability.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eA confirmed diagnosis of ASD based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [4]\u003c/p\u003e\u003cp\u003eDiagnostic verification using the Autism Diagnostic Observation Schedule\u0026ndash;2 (ADOS-2)\u003c/p\u003e\u003cp\u003eAge between 5 and 12 years\u003c/p\u003e\u003cp\u003eStable therapeutic and educational interventions for at least three months prior to study enrollment\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003eCo-existing neurological disorders (e.g., epilepsy)\u003c/p\u003e\u003cp\u003eSevere intellectual disability that impaired communication or self-regulation\u003c/p\u003e\u003cp\u003eMajor psychiatric illnesses (e.g., bipolar disorder or schizophrenia) requiring ongoing pharmacological treatment\u003c/p\u003e\n\u003ch3\u003eBehavioral and Sensory Assessment Tools\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eSensory Profile 2\u003c/strong\u003e\u003cp\u003eThis standardized measure was used to assess sensory processing across domains including tactile, auditory, visual, vestibular, and oral sensitivities [5]. The assessment was administered quarterly by licensed professionals to detect changes in sensory responsiveness over time.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAberrant Behavior Checklist (ABC)\u003c/b\u003e: The ABC is a caregiver-reported behavioral scale comprising five subscales: Irritability, Lethargy, Stereotypy, Hyperactivity, and Inappropriate Speech [6]. Caregivers completed daily ABC entries using a secure, password-protected online portal. Entries were reviewed bi-weekly by trained occupational therapists to ensure completeness and consistency.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLunar Phase Classification\u003c/h2\u003e\u003cp\u003eLunar data were retrieved from NASA\u0026rsquo;s official lunar calendar. The \u0026ldquo;full moon phase\u0026rdquo; was operationally defined as a three-day window encompassing the day before, the day of, and the day after the full moon (i.e., \u0026plusmn;\u0026thinsp;1 day). All remaining days were categorized as \u0026ldquo;non-full moon\u0026rdquo; periods for comparative analysis.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection and Monitoring\u003c/h3\u003e\n\u003cp\u003eCaregivers recorded daily behaviors using the ABC and submitted data electronically. Monthly follow-up interviews, conducted either in person or via telecommunication, were used to validate submitted data and to identify any contextual variables potentially influencing behavior (e.g., illness, travel, therapy changes). These interviews also documented environmental confounders such as sleep disturbances, dietary changes, and major stressors. Any deviation from the child\u0026rsquo;s regular routine was logged to support the interpretation of observed behavioral trends.\u003c/p\u003e\u003cp\u003eAll collected data were anonymized and stored in a secured database accessible only to the research team. Quality control protocols, including random audits and cross-checks with clinical observations, were employed to enhance data integrity.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, NY). Descriptive statistics were computed for all subscales of the Aberrant Behavior Checklist (ABC) and the Sensory Profile 2 under full moon and non-full moon phases. Values are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (SD).\u003c/p\u003e\u003cp\u003eTo evaluate within-subject behavioral changes across lunar phases, repeated-measures analysis of variance (ANOVA) was applied to ABC subscale scores. Partial eta-squared (η\u0026sup2;) was reported to estimate effect sizes, interpreted as small (η\u0026sup2; = 0.01), medium (η\u0026sup2; = 0.06), or large (η\u0026sup2; \u0026ge; 0.14) [7]. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eTo explore sensory-based behavioral subtypes, K-means clustering (k\u0026thinsp;=\u0026thinsp;2) was performed using Sensory Profile 2 total scores. The resulting clusters were characterized by behavioral stability versus lunar-phase-related behavioral shifts. Between-cluster comparisons were conducted using independent-samples t-tests. Cohen\u0026rsquo;s d was used to interpret effect sizes, with thresholds of 0.2 (small), 0.5 (medium), and \u0026ge;\u0026thinsp;0.8 (large) [8].\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive Statistics\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean ABC Subscale Scores During Full Moon and Non-Full Moon Phases (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFull Moon (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-Full Moon (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean Difference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e% Change\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrritability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e+\u0026thinsp;2.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLethargy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e+\u0026thinsp;1.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStereotypy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e+\u0026thinsp;1.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHyperactivity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e17.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u0026thinsp;1.4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u0026thinsp;8.2%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInappropriate Speech\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e+\u0026thinsp;1.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eOnly hyperactivity showed statistically significant change.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean Sensory Profile 2 Subscores During Full Moon and Non-Full Moon Phases\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFull Moon (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-Full Moon (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean Difference\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSensory Sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e69.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e65.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;3.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTactile Sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuditory Sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e13.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual Sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTaste/Smell Sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMovement Sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eInferential Statistics\u003c/h2\u003e\u003cp\u003eRepeated-measures ANOVA revealed no significant differences in total ABC scores between lunar phases, \u003cb\u003eF(1,29)\u0026thinsp;=\u0026thinsp;1.78, p\u0026thinsp;=\u0026thinsp;0.19\u003c/b\u003e. However, a \u003cb\u003esignificant main effect\u003c/b\u003e was observed for the \u003cb\u003eHyperactivity subscale\u003c/b\u003e, \u003cb\u003eF(1,29)\u0026thinsp;=\u0026thinsp;4.42, p\u0026thinsp;=\u0026thinsp;0 .041, η\u0026sup2; = 0.13\u003c/b\u003e, indicating a \u003cb\u003emoderate-to-large effect size\u003c/b\u003e. This suggests that children exhibited elevated levels of hyperactivity during full moon phases.\u003c/p\u003e\u003cp\u003eNo other ABC subscales demonstrated statistically significant changes (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eCluster Analysis\u003c/h2\u003e\u003cp\u003eK-means cluster analysis of sensory sensitivity scores revealed two distinct groups:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCluster 1 (n\u0026thinsp;=\u0026thinsp;22)\u003c/strong\u003e\u003cp\u003eStable behavior across moon phases\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCluster 2 (n\u0026thinsp;=\u0026thinsp;8)\u003c/strong\u003e\u003cp\u003e\u0026ge;20% increase in hyperactivity during full moons\u003c/p\u003e\u003c/p\u003e\u003cp\u003eChildren in \u003cb\u003eCluster 2\u003c/b\u003e exhibited significantly higher overall sensory sensitivity compared to Cluster 1.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBetween-Cluster Comparison of Sensory Profile 2 Scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCluster\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean Sensory Score\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et(28)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCluster 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e63.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCluster 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe effect size (Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;2.02) was \u003cb\u003every large\u003c/b\u003e, indicating a substantial difference in sensory processing profiles between the two clusters. This suggests that \u003cb\u003echildren with heightened sensory sensitivity were more vulnerable to behavioral disruptions\u003c/b\u003e associated with the full moon phase.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eInterpretation\u003c/h2\u003e\u003cp\u003eThe findings support the hypothesis that lunar cycles may influence behavioral arousal in a subset of children with autism spectrum disorder (ASD), particularly those with pronounced sensory sensitivities. While most subscales of the ABC did not fluctuate significantly, hyperactivity was notably increased during full moon periods. This effect appears to be \u003cb\u003emodulated by underlying sensory processing difficulties\u003c/b\u003e, in line with prior research linking sensory sensitivity to environmental responsiveness in children with ASD [9, 10].\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study contributes to the growing literature examining environmental influences on behavioral patterns in children with Autism Spectrum Disorder (ASD). While no statistically significant changes in total ABC scores were found across lunar phases for the overall cohort, a notable increase in hyperactivity during full moon phases was observed in a subgroup characterized by heightened sensory sensitivity. These findings align with prior studies in neurotypical populations that report negligible or inconsistent behavioral changes related to lunar cycles [11], while simultaneously highlighting the potential interaction between sensory processing abnormalities and environmental stimuli in children with ASD.\u003c/p\u003e\u003cp\u003eOne plausible neurophysiological mechanism underlying these findings is the influence of nocturnal luminance associated with full moons on melatonin regulation. Melatonin, a key hormone in circadian rhythm regulation, has been shown to be dysregulated in children with ASD, contributing to sleep disturbances and behavioral issues [12,13]. The sensory-sensitive subgroup identified in this study may be particularly susceptible to even minor environmental changes\u0026mdash;such as increased ambient brightness\u0026mdash;due to their underlying neurobiological sensitivity. This aligns with emerging evidence that sensory hyper-reactivity may amplify behavioral responses to environmental inputs, including light, sound, and routine disruptions [14].\u003c/p\u003e\u003cp\u003eFurthermore, this study's use of K-means clustering based on Sensory Profile 2 scores revealed meaningful behavioral heterogeneity within the ASD sample. Cluster 2, which exhibited a\u0026thinsp;\u0026ge;\u0026thinsp;20% increase in hyperactivity during full moons, also had significantly higher sensory sensitivity scores compared to Cluster 1. These results emphasize the importance of subtyping in ASD research and suggest that certain phenotypic profiles\u0026mdash;such as those involving sensory over-responsivity\u0026mdash;may be more vulnerable to external environmental factors like lunar phases. This supports a precision-medicine approach to ASD, whereby interventions and monitoring strategies can be tailored according to individual sensory profiles and environmental contexts.\u003c/p\u003e\u003cp\u003eFrom a clinical and caregiver perspective, these findings have practical implications. Increased awareness of potential behavioral fluctuations during full moon periods could help caregivers and clinicians anticipate and manage challenging behaviors. Practical strategies may include minimizing light exposure during night-time routines, adjusting bedtime schedules, and implementing calming sensory supports. Such anticipatory guidance could be integrated into occupational therapy and behavioral intervention plans for children with sensory sensitivities.\u003c/p\u003e\u003cp\u003eImportantly, this study also prompts a broader reflection on the intersection of environmental health and neurodevelopment. With increasing urbanization and associated light pollution, the interaction between environmental light and neurobehavioral health is an emerging area of concern [15]. Children with ASD, particularly those with sensory sensitivities, may be disproportionately affected by these environmental conditions, suggesting a need for public health interventions aimed at mitigating sensory overload in home and community settings.\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study had several limitations. First, the modest sample size (N\u0026thinsp;=\u0026thinsp;30) limits the external validity and statistical power, particularly for detecting smaller effect sizes. Second, reliance on caregiver-reported behavioral data introduces potential for subjective bias, recall errors, and observer variability. Third, no objective physiological correlates (e.g., actigraphy, salivary melatonin assays) were collected, restricting the ability to directly assess circadian rhythm disruption or sleep quality. Fourth, ambient light levels and regional environmental factors (e.g., light pollution) were not measured, which could further contextualize the behavioral findings.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eFuture Directions\u003c/h2\u003e\u003cp\u003eFuture research should aim to address these limitations through larger, multicenter studies that include objective physiological monitoring (e.g., actigraphy, hormone assays) and environmental mapping (e.g., GPS-based luminance tracking, local weather data). Stratified analyses based on sensory subtypes, sleep quality, and geographic location may yield deeper insights into who is most affected and under what conditions. Moreover, integration of ecological momentary assessment (EMA) tools could enable real-time tracking of mood, behavior, and environmental exposure, enhancing the temporal precision of data collection. Collaborations between neuroscientists, sleep researchers, and environmental health professionals may be instrumental in advancing this emerging field.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that lunar phases do not uniformly influence behavior in children with Autism Spectrum Disorder (ASD). However, a distinct subgroup characterized by heightened sensory hypersensitivity shows significant increases in hyperactivity and irritability during full moon periods. These findings highlight the importance of personalized behavioral monitoring and sensory profiling in clinical practice, enabling caregivers and clinicians to anticipate and manage episodic behavioral fluctuations more effectively. While the results provide preliminary evidence for subtle environmental modulation of behavior, further large-scale, interdisciplinary research is needed to elucidate the underlying mechanisms and to inform targeted interventions. Integrating environmental context and sensory considerations into neurodevelopmental disorder management may enhance individualized care and improve long-term outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no financial support was received from any organization or funding agency for the conduct and publication of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions involving minor participants with neurodevelopmental conditions, but are available from the corresponding author on reasonable request and with appropriate ethical approvals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn compliance with the ICMJE uniform disclosure form, the authors declare that they have no financial or non-financial interests that could be perceived as having influenced the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial relationships:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNone of the authors have financial relationships with any organizations that might have an interest in the submitted work, either at present or within the past three years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNon-financial relationships:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no non-financial relationships or activities that could appear to have influenced the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Ethics Committee of DRIEMS University (Approval No. DRMU(VC)/00084/2025). As the research involved only secondary data collection through caregiver-reported measures and did not include any direct human or animal experimentation or intervention, no additional ethical risks were posed. All methods were carried out in accordance with relevant guidelines and regulations, including institutional ethical standards and the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince the study did not involve direct interaction with human participants and only utilized observational data and caregiver-reported information regarding behavioral changes during the full moon and non-full moon period, formal informed consent was not required. However, permission for data use and publication was obtained or waived as per institutional guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement on Welfare of Animals:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not involve any use of animal subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Er. Gargi Mishra and Dr. Durga Prasad Mishra. The first draft of the manuscript was written by Er. Gargi Mishra, and all authors commented on and revised previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRotton J, Kelly IW. Much ado about the full moon: A meta-analysis of lunar-lunacy research. 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Hillsdale: Lawrence Erlbaum; 1988.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyg.2013.00863\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2013.00863\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTavassoli T, Miller LJ, Schoen SA, Nielsen DM, Baron-Cohen S. Sensory over-responsivity in adults with autism spectrum conditions. 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Dev Med Child Neurol. 2011;53(9):783\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1469-8749.2011.03980.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1469-8749.2011.03980.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBen-Sasson A, Hen L, Fluss R, et al. A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. J Autism Dev Disord. 2009;39(1):1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10803-008-0593-3\u003c/span\u003e\u003cspan address=\"10.1007/s10803-008-0593-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFalchi F, Cinzano P, Duriscoe D, et al. The new world atlas of artificial night sky brightness. Sci Adv. 2016;2(6):e1600377. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1126/sciadv.1600377\u003c/span\u003e\u003cspan address=\"10.1126/sciadv.1600377\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Autism Spectrum Disorder, Lunar Phase, Full Moon, Hyperactivity, Sensory Sensitivity, Aberrant Behavior Checklist","lastPublishedDoi":"10.21203/rs.3.rs-6887778/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6887778/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCultural beliefs have historically linked full moon phases with behavioural changes. However, limited empirical evidence exists regarding its effect on children with Autism Spectrum Disorder(ASD), a group often characterised by heightened sensory sensitivity and circadian rhythm dysregulation.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate whether full moon phases are associated with measurable behavioural alterations in children diagnosed with ASD.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThirty children ( ages 5\u0026ndash;12 years) with confirmed ASD diagnoses were followed over 12 lunar cycles. Behavioral changes were tracked using daily Aberrant Behavior Checklist(ABC) scores provided by caregivers and verified by clinicians. Sensory sensitivity was assessed via the Sensory Profile 2. A repeated-measures ANOVA and K-means clustering were performed using SPSS v27.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eNo significant differences were observed in overall behaviour scores between full moon and non-full moon periods(p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, hyperactivity scores were significantly elevated during full moon phases (Mean\u0026thinsp;=\u0026thinsp;18.5, SD\u0026thinsp;=\u0026thinsp;5.1) compared to non-full moon phases(Mean\u0026thinsp;=\u0026thinsp;17.1, SD\u0026thinsp;=\u0026thinsp;4.7), F (1, 29)\u0026thinsp;=\u0026thinsp;4.42, p\u0026thinsp;=\u0026thinsp;0.041, η\u0026sup2; = 0.13. Subgroup analysis revealed 26.7% of participants with elevated sensory sensitivity showed a\u0026thinsp;\u0026ge;\u0026thinsp;20% increase in hyperactivity, supported by significantly higher Sensory Profile 2 scores (p\u0026thinsp;\u0026lt;\u0026thinsp;.01).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eWhile overall behavior in children with ASD did not vary with lunar phases, a sensory-sensitive subgroup demonstrated increased hyperactivity during full moons. These findings suggest lunar-related environmental changes may influence behavior in certain ASD phenotypes.\u003c/p\u003e","manuscriptTitle":"Effects of Full Moon on Behavior of Children with Autism Spectrum Disorder: A Longitudinal Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-26 15:00:16","doi":"10.21203/rs.3.rs-6887778/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1668bb8-bfdc-4160-84d9-83487cd6e656","owner":[],"postedDate":"July 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-18T10:53:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-26 15:00:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6887778","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6887778","identity":"rs-6887778","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}