Autism spectrum disorder (ASD) poses significant challenges to children, affecting various aspects of their functioning and overall quality of life (QOL). While factors such as social support and access to interventions play crucial roles in determining the QOL, coping strategies are fundamental in shaping the experiences and outcomes of individuals with ASD. This case-control study aimed to address this gap by exploring the nexus between QOL and coping strategies in children with ASD. This cross-sectional study included 214 children with and without, who were ASD enrolled in different rehabilitation centers in the Al-Hasa region of Saudi Arabia. QOL was measured using the Short Form-12 (SF-12) health survey to assess the physical and mental components. Coping strategies were assessed using the validated Brief COPE inventory. We examined the association between the SF-12 and coping strategies in children with autism and healthy children using binary logistic regression analysis. QOL measures indicated that children with ASD had poorer scores across various domains compared to healthy children. Children relied more on substance abuse, emotional support, and religious coping. Logistic regression indicated that among the QOL dimensions, role physical [odds ratio (OR) = 1.04, 95% confidence interval (CI): 1.01-1.07, P = 0.01], bodily pain (OR = 1.02, 95% CI: 1.00-1.04, P = 0.02), social health (OR = 1.04, 95% CI: 1.02-1.07, P = 0.00), role emotion (OR = 1.02, 95% CI: 1.01-1.03, P = 0.00), and mental health (OR = 1.03, 95% CI: 1.00-1.06, P = 0.03) were associated with ASD. Certain coping strategies, such as self-distraction (OR = 2.40, 95% CI: 1.64-3.51, P = 0.01), substance abuse, (OR = 0.51, 95% CI: 0.31-0.86, P = 0.02), emotional support (OR = 0.47, 95% CI: 0.30-0.73, P = 0.00), venting (OR = 2.05, 95% CI: 1.22-3.42, P = 0.01), and religion (OR = 0.73, 95% CI: 0.54-0.99, P = 0.04), were linked to ASD. Children with ASD had a poorer QOL and relied more on substance abuse, emotional support, and religious coping compared to normal children. The findings of this study have implications for mental health professionals and clinicians, as children with autism and poor QOL may require greater levels of emotional support and services.
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