Coping strategies as mediators of internalizing symptoms on quality of life in school-aged children with autism spectrum disorder and typical development

Children with autism spectrum disorder (ASD) often report lower quality of life (QoL) than their typically developing peers, yet the coping processes that underlie these differences remain unclear. This study investigated which coping styles mediate the impact of internalizing symptoms (depression, anxiety, anger control difficulties) on children's self-reported QoL and whether these pathways differ between ASD and typically developing groups. A total of 172 school-aged children (80 ASD and 92 typically developing) completed standardized measures of QoL, internalizing symptoms, and four coping styles. Moderated mediation analyses tested coping as parallel mediators and diagnostic group as a moderator. Across both groups, higher internalizing symptoms were linked to poorer QoL. Problem-solving coping emerged as a protective mediator in typically developing children only, while other coping styles did not mediate symptom-QoL links in either group. Problem-focused coping supports QoL in typically developing youth but appears less effective in ASD. Children with ASD derived immediate relief from palliative strategies (e.g., structured calming techniques), yet these strategies did not attenuate the negative impact of internal distress on their broader day-to-day well-being. Interventions that adapt problem-solving strategies to the needs of children with ASD may enhance their well-being.