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 metaanalysis 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 healthrelated 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 correlations 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 healthrelated behaviors could enhance existing approaches for improving FQoL in families of children with ASD.