Association Between Healthy Lifestyle Behaviors and Mental Health Symptoms in Children With Autism and <scp>ADHD</scp> : A Latent Profile Analysis

Healthy lifestyle behaviors, including physical activity, screen time, sleep, and diet quality, are important determinants of mental health, yet little is known about how these behaviors cluster among children with neurodevelopmental disorders. This study identified lifestyle profiles in children with autism and ADHD and examined associations with internalizing, externalizing, and irritability symptoms. Parents of children with a diagnosis of autism and ADHD (n = 523, 7-12 years, 67% male) reported on lifestyle behaviors and mental health outcomes. Latent profile analysis supported a four-profile solution that balanced statistical fit, parsimony, and theoretical interpretability. Profile 1 (19%) was characterized by very high levels of physical activity, moderate sedentary screen time, relatively high sleep, and above average diet quality. Profile 2 (50%) represented a balanced lifestyle, with moderate activity and sedentary screen time, adequate sleep, and the highest diet quality. Profile 3 (20%) showed low activity, elevated sedentary screen time, adequate sleep, and poor diet quality, while Profile 4 (11%) was defined by extremely high sedentary screen time, low activity, adequate sleep, and poor diet. Children in less healthy profiles characterized by high screen time and poor diet quality reported significantly higher internalizing symptoms compared to the highly active group. However, externalizing symptoms were highest in the highly active profile, and irritability was lowest in the balanced profile relative to both high activity and high screen time groups. Findings suggest that while very high physical activity may protect against internalizing symptoms, a balanced lifestyle combining moderate activity, limited screen use, adequate sleep, and good diet quality may best mental health in children with autism and ADHD.