Health-related behaviors and family quality of life in autism spectrum disorders: A systematic review and meta-analysis

Abstract

Health-related behaviors —including sleep quality, physical-activity level, screen time, and mealtime behavior —, are often disrupted in children with Autism Spectrum Disorder (ASD), and may be associated with a lower family quality of life (FQoL). This systematic review and meta- analysis evaluated these associations, recognizing the central role that daily health habits may play in shaping FQoL. A registered protocol in PROSPERO (CRD42023408500) guided a comprehensive search across seven electronic databases and grey literature sources, yielding 12 eligible studies that included 6373 families of children with ASD who were evaluated on health- related behaviors and FQoL. Publication bias was assessed. Moderate correlations were found between FQoL and sleep problems (k = 6,r = .36, p < .001), and moderate positive correla tions with screen-time (k = 3, r = .34, p < .05). Physical activity showed no significant pooled association with FQoL (k = 4,r = .14,p = .49) despite substantial heterogeneity. Mealtime behavior showed a negative association in a single study (k = 1, r = 0.25). Future research should clarify the directionality of these associations and examine how multiple health-related behaviors may interact to influence FQoL. Targeted interventions addressing specific health- related behaviors could enhance existing approaches for improving FQoL in families of chil dren with ASD.