Family Adaptation in Families with Autistic Members: A Scoping Review and Thematic Synthesis of Relational Systems, Context, and Development.

This scoping review synthesizes empirical research on how autistic family members shape family dynamics across relational subsystems, cultural contexts, and developmental stages. A comprehensive search conducted in January 2025 across five databases using the SPIDER framework yielded 102 studies analysed through convergent integrated three-stage thematic analysis informed by family systems theory. Five interconnected themes emerged: family identity reconstruction and role adaptation; emotional climate and communication patterns; cultural, societal, and structural contexts; pathways to resilience and positive adaptation; and developmental trajectories across the lifespan. These themes were integrated into an interpretive conceptual model in which communication emerged as a cross-cutting relational process, family adaptation unfolded across developmental time, and contextual conditions shaped which adaptive pathways were more or less available. Across studies, adaptive flexibility was a recurring feature of more positively adapting families, and caregiver mental health, especially maternal mental health in a mother-dominated evidence base, appeared closely linked to family emotional climate. A dedicated analysis reinterprets findings through a neurodiversity-informed lens, proposing foundational shifts toward investigating family adaptation with rather than to autism. Critically, autistic perspectives remain largely absent: of the 102 included studies, only five included autistic self-report as a primary data source. Future research must centre autistic voices, employ integrated longitudinal designs, and address structural barriers supporting equitable family systems.