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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.