Executive Function’s Association with Mental Health Outcomes, Caregiver Strain, and Well-Being in Parents of Autistic Children: A Dyadic Analysis
Authors and Affiliations:
Journal of Neurodevelopmental Disorders (IDDRC 2026 Special Issue)
A
Leonardo
Dominguez
Ortega
1✉
EmailL.DominguezOrtega@usc.edu
Meghan
M.
Krushena
2
Amanda
C.
Gulsrud
Ph.D.
3
Alexandra
Sturm
Ph.D.
4
1
A
A
Department of Psychology
University of Southern California
3620 McClintock Ave SGM 501
90089
Los Angeles
CA
United States
2
College of Medicine
Central Michigan University
1200 S. Franklin St., Mount Pleasant
48859
Michigan
United States
3
Semel Institute for Neuroscience and Human Behavior
University of California, Los Angeles
760 Westwood Plaza
90024
Los Angeles
CA
United States
4
A
A
Department of Psychological Science
Loyola Marymount University University Hall
5
Loyola Marymount University Dr
90045
Los Angeles
CA
United States
Leonardo Dominguez Ortega,1 Meghan M. Krushena,2
Amanda C. Gulsrud, Ph.D.3 & Alexandra Sturm, Ph.D.4
1Department of Psychology, University of Southern California
3620 McClintock Ave, Los Angeles, CA 90089, United States
2College of Medicine, Central Michigan University
1200 S. Franklin St., Mount Pleasant, Michigan 48859, United States
3Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
760 Westwood Plaza, Los Angeles, CA 90024 United States
4Department of Psychological Science, Loyola Marymount University
University Hall, 1 Loyola Marymount University Dr., Los Angeles, CA 90045 United States
Corresponding Author: Correspondence concerning this article should be addressed to Leonardo Dominguez Ortega (L.DominguezOrtega@usc.edu), Department of Psychology, University of Southern California, 3620 McClintock Ave SGM 501, Los Angeles, CA 90089, United States.
Abstract
Background
Parents of autistic children report higher levels of depression and anxiety symptoms, more caregiver strain, and poorer well-being than parents of non-autistic children. Though more research has begun to investigate how parent-specific factors may influence these outcomes, few consider cognitive factors like executive function (EF). Emotion regulation and self-inhibition, two kinds of EF skills, may be particularly relevant given their documented benefits and associations with these constructs in the general population. Another important consideration when investigating the needs of parents is the interconnectedness of the family unit. Extant literature has documented the many links between parents’ mental health, stress, and well-being. Thus, methodologies that consider this shared context within parenting dyads is needed to appropriately address their needs.
Methods
Our sample consisted of 263 different-sex parenting dyads with at least one child formally diagnosed with autism spectrum disorder. Using the Actor-Partner Interdependence Model, we assessed the association between parents’ EF (emotion regulation and self-inhibition) and their own and their partner’s depression and anxiety symptoms, caregiver strain, and well-being. Interdependence was established using correlations given the distinguishable nature of our dyads.
Results
Both mothers’ and fathers’ emotion regulation were associated with their own depression and anxiety symptoms, caregiver strain, and well-being. Increased EF deficits were associated with more symptoms and caregiver strain, and poorer well-being. There was only one significant association for self-inhibition: lower self-inhibition scores in fathers were linked to poorer well-being. We did not observe any associations between parents’ EF and their partner’s outcomes after false discovery rate correction.
Conclusions
Emotion regulation, and not self-inhibition, emerged as an important cognitive factor to consider when assessing the mental health and well-being of parents of autistic children. Previous work has looked at reducing caregiver strain in parents of autistic children through EF. Our findings can build off this work by isolating specific aspects of EF (i.e., emotion regulation) to streamline such supports and extend them to other domains, though we caution against overinterpretation given the cross-sectional nature of our analyses. Future work should investigate the causal relationship between EF and the mental health and well-being of parents of autistic children.
Keywords:
executive function
parents of autistic children
actor-partner interdependence model
depression
anxiety
caregiver strain
well-being
Executive Function’s Association with Mental Health Outcomes, Caregiver Strain, and Well-Being in Parents of Autistic Children: A Dyadic Analysis
Background
It is well established that parents of autistic children are more likely to report poorer well-being, more negative mental health outcomes (e.g., depression and anxiety), and higher caregiver strain than parents of children with other neurodevelopmental disorders and neurotypically developing children.1–5 The prevalence of elevated psychopathological symptoms, caregiver strain, and poor well-being not only affects the individual but extends to impact other family members. Parents may engage in maladaptive parenting practices because of these outcomes, negatively affecting children,6 whilst marital relationships may also be negatively impacted within this context.7–8 Thus, research that considers the interconnectedness of the family unit is essential to understanding the mental health and well-being needs of parents of autistic children.
Beyond the normative stressors of parenthood, research suggests these outcomes in parents of autistic children may stem from children’s symptom severity,1,9 difficulties accessing necessary care,10–11 a lack of respite,12–13 and financial strain,14 amongst other factors. Much of this research, either directly (e.g., symptom severity) or indirectly (e.g., financial strain), focuses on child-related factors. However, more studies that investigate parent characteristics are needed to assess how parent traits may influence depression and anxiety symptoms, caregiver strain, and well-being in this vulnerable population. A growing body of work has undertaken this task, but it has largely focused on parenting-related factors like parenting self-efficacy or parenting styles.15 These studies have not examined the potential effects of cognitive attributes like executive function (EF), a set of skills that guide the planning and execution of thoughts and behaviors.16 With many documented benefits and notable vulnerabilities for those with deficits in this domain, EF may be particularly useful to study (e.g., 17–19). Emotion regulation and self-inhibition, two kinds of EF skills, are of note given their relevance to parenting and role in managing stressful experiences.
Executive Functioning: Emotion Regulation and Self-Inhibition
EF is a much-researched topic with noted positive associations across different contexts. A literature review by Williams and colleagues17 emphasizes that EF skills can help prevent adverse mental health outcomes and promote well-being, particularly in individuals who experience higher levels of stress. Limited but important work has extended these findings to parents of autistic children as trainings aimed at improving EF skills have been associated with reduced caregiver strain.19–20 The effects of EF are not isolated to individual experiences, however, as parents’ skills serve as scaffolding for children’s EF.21–22 Further, EF can influence parenting behaviors, with maladaptive parenting practices noted in individuals who report EF deficits. These findings are of note given their potential to exacerbate behavioral issues in autistic children, further highlighting the interconnected nature of the family unit.23–24
At their core, EF skills are critical tools that aid in responding to one’s environment. These tools are particularly salient for parents as they look to meet the many demands of their role. EF becomes even more relevant with the added complexity of parenting an autistic child as parents look to manage behavioral challenges,3–4 complex medical and educational systems,25 and stigma.10 Two EF skills that may be particularly relevant for parents of autistic children are emotion regulation and self-inhibition. Emotion regulation focuses on emotion processing and management and can support reappraisal and the processing of negative material.26 Studies in the general population have found that emotion regulation may aid depression and anxiety symptom management,1,27– 31 promote well-being,32 and reduce caregiver strain.23 Whilst emotion regulation focuses on emotion processing, self-inhibition focuses on control over one’s impulsivity and emotional urges to act.33 Self-inhibition has been associated with better well-being34 and better response to depression treatment in the general population.35 Simultaneously, deficits in EF can play a critical role in blunting one’s ability to manage stress, which is particularly relevant to parents of autistic children.17 Given these findings and the vulnerability of this population, a deeper exploration of EF and its relationship to psychopathological symptoms, well-being, and caregiver strain in parents of autistic children is needed.
A More Complete Perspective: The Actor-Partner Interdependence Model
Whether interrogating the effects of parent characteristics on their own outcomes or their children’s outcomes, studies focused on parents of autistic children face a critical limitation common in parenting research: fathers are heavily understudied.36 One systematic review found that mothers outnumbered fathers in research participation by a factor of eight.37 Theories to explain this disparity include fathers being more inaccessible (e.g., employment restrictions, lack of time) and difficult to recruit than mothers,38 fathers not being asked to participate,39 and mothers often fulfilling the role of primary caregiver.40 The latter theory highlights that mothers’ increased role in childrearing provides them with a perspective most relevant to inform pediatric research.41 Regardless of these barriers, it is critical to include fathers in research to consider their unique and important perspectives and help address issues specific to their role.
Another important and related limitation in this research is that a single parent’s perspective is often all that is considered. This leaves an important gap as much work has found that parenting dyads are highly interconnected, and members often influence one another.42 At a basic level, a shared child will present a similar influence over the parenting dyad. Within these circumstances, parents may work together to manage their specific parenting situation. For example, it has been found that partners can serve as a primary source of support when addressing parenting needs.15 Additionally, various theoretical models have been proposed to explain how couples interact in the face of illness and other stressors, like a child’s autism diagnosis (e.g., the systematic transactional model, the developmental-contextual model).43 This serves to inform consistent trends of couples influencing each other’s physical and mental health, like depression.44 Thus, a more complete assessment of the parenting dyad is needed to understand how parents influence each other, highlight fathers’ unique experiences, and address these topics through germane methodologies.
The Actor-Partner Interdependence Model (APIM)45 is one such method that considers interdependence by assessing the way parents’ influence themselves (actor effects) and the way they influence their partner (partner effects). The APIM framework has grown in popularity since its introduction given its aptness in analyzing dyadic groupings, like parent-parent and parent-child dyads (e.g.,15,42,46). A benefit of this statistical model is its standardization of calculating interdependence amongst paired observations through correlations and its flexibility in fitting data from distinguishable (e.g., different-sex parent dyads) and indistinguishable dyads (e.g., same-sex parent dyads).45 With this approach, not only are fathers’ perspectives incorporated, but a more complete analysis is executed as both dyad members are included. This model also considers dyad members’ shared context by controlling for partners’ predictor scores when estimating actor effects and tests for additional factors that could increase model fit by correlating residuals from each dyad member.45 Thus, the APIM, and methods like it are critical when looking to understand the complex interplay between parents’ experiences.
Aims & Current Study
The current study sought to investigate the effect of parents’ EF (emotion regulation and self-inhibition) on their own and their partner’s anxiety and depression symptoms, caregiver strain, and well-being using the Actor-Partner Interdependence Model.45 A large United States-based sample of parent dyads with at least one biological, autistic child was leveraged. This study fills important gaps in the existing literature by including fathers, assessing the role of parent cognitive characteristics on their mental health outcomes, and by considering the interdependent nature of the parenting dyad. We hypothesized that increased deficits in parents’ EF would result in more anxiety and depression symptoms, caregiver strain, and poorer well-being in themselves (actor effects). Additionally, we hypothesized that increased deficits in parents’ EF would result in more anxiety and depression symptoms, caregiver strain, and poorer well-being in their partners (partner effeects).
Methods
SPARK and Research Match
A
A
Simons Powering Autism Research for Knowledge (SPARK) is an ongoing nationwide study, funded by the Simons Foundation Autism Research Initiative (SFARI), that collects survey measures and biospecimens from autistic individuals (probands) of any age and their immediate, biological family members. The study’s goal is to create a large data repository with the intention of improving our understanding of autism and better serving the community through their direct involvement and the development of services. Individuals with a professional diagnosis of autism (e.g., diagnosed by a medical professional, clinical psychologist) who reside in the United States are eligible for study participation. Registration, collection of biospecimens, and surveys may be completed remotely or at one of 30 + affiliated clinical sites across the country. Registration consists of creating a profile with basic demographic and diagnostic information, along with providing consent (parent/guardian for minors and conserved adults, or self for independent adults) for the phenotypic and genetic portions of the study separately. Additional surveys regarding proband behavior and family and proband medical information may be completed upon registration or at later dates, with select surveys available at regular intervals (e.g., yearly). See Feliciano et al.47,48 for additional SPARK protocol information.Research Match, a service of SFARI, allows approved researchers to contact subsets of the SPARK cohort with additional volunteer research opportunities to supplement standard SPARK data collection. The current study utilized data collected from a subset of the SPARK cohort upon approval from the SPARK Participant Access Committee (PAC). The SPARK PAC is comprised of SPARK staff, independent researchers, and community representatives who review applications on a quarterly basis. A battery of online surveys was provided to qualified participants (defined below) who accepted a study invitation and consented to participation.
Participants
At the time of data collection, SPARK had enrolled 106,577 probands of all ages. Our Research Match sample included N = 263 probands along with both biological parents (N = 263 parent-child triads; N = 789 individuals). The current study utilized a subset of data from the parent dyads (N = 263 different-sex parent dyads, N = 526 individuals). Inclusion criteria included participation from both biological parents, though cohabitation or legal partnership was not required. All probands were required to be under 18 years old at the time of Research Match data collection (January through February 2021).
Measures
Demographic Questionnaire
Information on proband biological sex, diagnosis (official diagnosis, age of diagnosis), and language level were collected during initial SPARK registration. Our study-specific survey included an additional demographic questionnaire that queried parents’ age, autism diagnostic status (self-identifying, professionally diagnosed, or no diagnosis), marital status (married, widowed, divorced, separated, never married, living with partner), and number of children under the age of 18 years in the household.
Barkley Deficits in Executive Functioning Scale
The Barkley Deficits in Executive Functioning Scale (BDEFS),49 completed by parents, is a self-report questionnaire of adult EF abilities that contains five subscales: self-management of time, self-organization/problem-solving, self-restraint, self-motivation, and self-regulation of emotions (N = 89 items). Items from the self-restraint (also referred to as self-inhibition; n = 19 items) and self-regulation of emotions (also referred to as emotion regulation; n = 13 items) subscales were selected for the current study. The self-inhibition subscale aims to measure participants’ impulsivity and ability to inhibit responses, and the emotion regulation subscale focuses on respondents’ ability to manage emotions. All items were answered on a 4-point Likert scale (1 = “Never or rarely” to 4 = “Very often”). The BDEFS had excellent internal consistency in the current sample (self-inhibition, α = 0.93; emotion regulation, α = 0.92), replicating psychometrics from prior studies (α = 0.92 for the entire measure).49 An item sum was calculated for each subscale to create a subscale score, with higher scores indicating greater EF deficits. Possible scores for self-inhibition and emotion regulation ranged from 19–76 and 13–52, respectively.
Generalized Anxiety Disorder-7
The Generalized Anxiety Disorder-7 (GAD-7)50 was used to assess the presence and severity of anxiety symptoms in parents. Participants were asked to report how often they were bothered by anxiety symptoms in the past two weeks using 7 items rated on a 4-point Likert scale (0 = “Not at all” to 3 = “Nearly every day”). The GAD-7 has been found to have strong psychometric properties, with excellent internal consistency in the current sample (α = 0.91), similar to prior studies (Cronbach α = 0.92),50 and good test-retest reliability in the reference sample (ICC = 0.83).50 Additionally, this measure has been found to have strong evidence of criterion, construct, and factorial validity.50 The GAD-7 yields a total sum score with possible scores ranging from 0–21 with higher scores indicating greater levels of anxiety.
Patient Health Questionnaire-9
The Patient Health Questionnaire-9 (PHQ-9)51 was used to assess depression symptoms in parents. Each of the nine items represents an established criterion for major depression as listed in the DSM-IV. The PHQ-9 is a tool that can establish depressive disorder diagnoses and grade the severity of depression symptoms (e.g., minor to major symptom presentation) in the previous two weeks. Individuals responded to each item on a 4-point Likert scale (0 = “Not at all” to 3 = “Nearly every day”). The PHQ-9 was found to have good internal consistency in the current sample (α = 0.89), similar to prior studies (α = 0.86–0.89; test-retest reliability in the reference sample, 0.84).51 It has also been found to have strong construct and criterion validity.51 We removed item nine that references suicidality due to a lack of active clinical monitoring of survey data and upon the recommendation of the PAC. Thus, our measure yielded a total sum score that ranged from 0–24 using eight items that represent the severity of respondents’ depression symptoms. Higher scores indicated more depression symptoms. Given the exclusion of item nine, raw scores should be interpreted with caution and should not be compared to studies that include the full scale.
Caregiver Strain Questionnaire–Short Form
Internalized caregiver strain from the previous six months was assessed using the Caregiver Strain Questionnaire-Short Form (CGSQ-SF),52 an abbreviated version of the Caregiver Strain Questionnaire.53 It consists of 10 items that query objective strain (n = 6 items) and subjective internalized strain (n = 4 items). Responses were measured using a 5-point Likert scale (1 = “Not at all” to 5 = “Very much a problem”). Items were prefaced with “In the past 6 months, how much of a problem was the following…”. The internal consistency of the CGSQ-SF is comparable to that of the original form (α = 0.90),52 which was replicated in the current sample (α = 0.91). Total scores were calculated by summing measure items, with higher scores indicating increased caregiver strain. Possible scores ranged from 10–50.
Wellbeing Scale
The Wellbeing Scale is a modified version of Ryff’s Scales of Psychological Well Being54,55 and was used to assess parent well-being. This self-report questionnaire consists of 18 items assessing six aspects of well-being: self-acceptance, autonomy, environmental mastery, purpose in life, positive relations with others, and personal growth. Responses were measured on a 7-point Likert scale (1 = “Strongly agree” to 7 = “Strongly disagree”) and item scores were averaged to create a total score. The Wellbeing Scale demonstrated good internal consistency in the current sample (α = .86), similar to prior studies.56 Possible scores ranged from 18 to 126 with higher scores representing greater well-being.
Analytic Plan
RStudio version 4.2.357 was used to calculate descriptive statistics, bivariate raw correlations, and t-tests (see Tables 1–3). The Actor-Partner Interdependence Model45 guided our main analyses interrogating the impact of parents’ EF on their own and their partner’s depression and anxiety symptoms, caregiver strain, and well-being. As specified by Cook & Kenny,45 our first step was to establish interdependence between mothers’ and fathers’ corresponding variables (e.g., mothers’ and fathers’ well-being). Given our dyads were distinguishable (i.e., there is a meaningful difference between dyad members – their biological sex) we employed a series of two-tailed Pearson’s raw correlations. We also specified a liberal alpha of 0.20 as highlighted in Cook & Kenny’s45 work where a statistically significant finding would indicate interdependence.
Subsequently, APIM models were conducted using path analysis in Mplus software.58 We assessed the effects of parents’ EF skills (self-inhibition, emotion regulation) on their own and their partner’s anxiety and depression symptoms, caregiver strain, and well-being. Four models were run in total: all used parents’ EF as predictors and either depression, anxiety, caregiver strain, or well-being as the outcome variables. See Figs. 1a-1d for visualizations of these models. Given the large number of estimated parameters (32), we accounted for false discovery rate (FDR) using the Benjamini-Hochberg procedure. The proportion of false positives was set to q = 0.05. Results below represent standardized coefficients and FDR corrected p-values.
Figures 1a-1d
Schematics of Actor-Partner Interdependence Models (APIMs)
Results
Preliminary Analyses
Mothers in our sample averaged 40.6 years old (SD = 7.01) and fathers averaged 42.9 years old (SD = 7.74). Most parents reported being married (481; 91.44%), 19 reported living with a partner (3.61%), 15 were divorced (2.85%), 6 were never married (1.14%), 4 reported being separated from their partner, and 1 parent was widowed. As mentioned before, parent dyads were not required to be legally married, meaning their reported marital status may reflect their relationship with a partner who is not the other biological parent of their autistic child registered in SPARK. For proband demographic information, see Table 1.
|
Proband Demographic Characteristics
|
|||
|---|---|---|---|
|
Female
|
Male
|
Total
|
|
|
Counts
|
56
|
195
|
251
|
|
Age at Registration (Years)
|
7.59 (3.82)
|
7.95 (3.94)
|
7.87 (3.91)
|
|
Language Level
|
|||
|
Longer Sentences
|
34
|
100
|
134
|
|
Combines 3 Words
|
7
|
37
|
44
|
|
Uses Single Words
|
5
|
31
|
36
|
|
No Words
|
9
|
27
|
36
|
|
Missing
|
1
|
0
|
1
|
|
Cognitive Impairment
|
7
|
15
|
22
|
|
Race
|
|||
|
Asian
|
3
|
8
|
11
|
|
Black or African American
|
3
|
7
|
10
|
|
Native American
|
0
|
2
|
2
|
|
Native Hawaiian or Pacific Islander
|
1
|
0
|
1
|
|
White
|
27
|
126
|
153
|
|
Other
|
1
|
6
|
7
|
|
Missing
|
21
|
46
|
67
|
|
Ethnicity
|
|||
|
Hispanic
|
4
|
24
|
28
|
|
Not Hispanic
|
31
|
125
|
156
|
|
Missing
|
21
|
46
|
67
|
| Note: Proband demographics collected during SPARK registration, not during Research Match data collection. Data were missing for 12 probands. | |||
Table 2
|
Parent Means and SDs for Variables of Interest
|
||||||
|---|---|---|---|---|---|---|
|
Self-Inhibition (BDEFS)
|
Emotion Regulation
(BDEFS)
|
GAD-7
|
PHQ-9
|
CGSQ-SF
|
Well-being Scale
|
|
|
M (SD)
|
M (SD)
|
M (SD)
|
M (SD)
|
M (SD)
|
M (SD)
|
|
|
Mothers
|
30.25
(9.83)
|
22.98
(8.31)
|
8.08
(5.70)
|
7.64
(5.86)
|
28.08
(9.76)
|
5.10
(0.84)
|
|
Fathers
|
33.75
(9.53)
|
23.32
(8.00)
|
6.61
(5.23)
|
6.73
(6.00)
|
26.28
(9.20)
|
5.02
(0.88)
|
| Note: PHQ-9 scores have a truncated range of 0–24 as item 9 was excluded. Raw scores should not be compared to other studies that use the full scale. | ||||||
|
Correlation Matrix of Outcome Variables (Tests of Interdependence)
|
||||
|---|---|---|---|---|
|
Mothers’ Anxiety
|
Mothers’ Depression
|
Mothers’ Caregiver Strain
|
Mothers’
Well-being
|
|
|
Fathers’
Anxiety
|
r = 0.12,
p = 0.05*
|
r = 0.14
p < 0.001*
|
r = 0.06
p = 0.19*
|
r = -0.11
p = 0.02*
|
|
Fathers’ Depression
|
r = 0.15
p = 0.01*
|
r = 0.24,
p < 0.001*
|
r = 0.10
p = 0.06*
|
r = -0.12
p = 0.02*
|
|
Fathers’ Caregiver Strain
|
r = 0.17
p < 0.01*
|
r = 0.18
p < 0.01*
|
r = 0.54,
p < 0.001*
|
r = -0.12
p = .13*
|
|
Fathers’
Well-being
|
r = -0.11
p = .03*
|
r = -0.20
p < 0.01*
|
r = -0.11
p = .02*
|
r = 0.22,
p < 0.001*
|
| Note: Bolded values represent the analyses used to determine interdependence amongst mother and father scores. *p < .20 | ||||
Depression
Actor Effects. The model linking parents’ EF skills to their depression symptoms found that mothers’ increased emotion regulation deficits were associated with more depression symptoms (ß = 0.463, p < .004) and fathers’ increased emotion regulation deficits were associated with more depression symptoms (ß = 0.531, p < .004). Neither mothers’ (ß = 0.106, p = 0.444) nor fathers’ (ß = 0.079, p = 0.557) self-inhibition skills were associated with their own depression symptoms.
Partner Effects. This same model revealed no significant partner effects. Neither mothers’ EF skills (mothers’ emotion regulation linked to fathers’ depression: ß = 0.065, p = 0.679; mothers’ self-inhibition linked to fathers’ anxiety: ß = 0.027, p = 0.791) nor fathers’ EF skills (fathers’ emotion regulation linked to mothers’ depression: ß = -0.086, p = 0.471; fathers’ self-inhibition linked to mothers’ depression: ß = 0.138, p = 0.244) were associated with their partner’s depression symptoms.
The residual correlation between parents’ depression symptoms was statistically significant (ß = 0.222, p < 0.001), suggesting the potential benefit of including additional predictors that may explain shared variability between mother’s and father’s depression symptoms.
Anxiety
Actor Effects. The model linking parents’ EF skills to their anxiety symptoms found that mothers’ increased emotion regulation deficits were associated with more anxiety symptoms (ß = 0.466, p < .004), and fathers’ increased emotion regulation deficits were also associated with more anxiety symptoms (ß = 0.596, p < .004). In other words, parents with poorer emotion regulation skills self-reported more anxiety symptoms. However, neither fathers’ (ß = 0.015 p = 0.833) nor mothers’ (ß = 0.175, p = 0.227) self-inhibition were associated with their own anxiety symptoms.
Partner Effects. This same model revealed no significant partner effects. Neither mothers’ EF skills (mothers’ emotion regulation linked to fathers’ anxiety: ß = 0.073, p = 0.618; mothers’ self-inhibition linked to fathers’ anxiety: ß = 0.056, p = 0.690) nor fathers’ EF skills (fathers’ emotion regulation’s linked to mothers’ anxiety: ß = -0.132, p = 0.117; fathers’ self-inhibition’s linked to mothers’ anxiety: ß = 0.100, p = 0.429) was associated with their partner’s anxiety.
The residual correlation between parents’ anxiety symptoms was not significant (ß = 0.097, p = 0.153), suggesting our model accounted for a significant portion of the shared variance between parents’ anxiety.
Caregiver Strain
Actor Effects. The model linking parents’ EF skills to caregiver strain found that mothers’ increased emotion regulation deficits were associated with higher levels of their own caregiver strain (ß = 0.283, p < .004) and that fathers’ increased emotion regulation deficits were associated with higher levels of their own caregiver strain (ß = 0.269, p = .007). Neither mothers’ (ß = 0.033, p = 0.786) nor fathers’ (ß = -0.039, p = 0.786) self-inhibition was associated with their own caregiver strain.
Partner effects. This same model found no significant partner effects. Neither mothers’ EF skills (mothers’ emotion regulation linked to father’s caregiver strain: ß = 0.079, p = 0.672; mothers’ self-inhibition linked to fathers’ caregiver strain: ß = 0.111, p = 0.480) nor fathers’ EF skills (fathers’ emotion regulation linked to mothers’ caregiver strain: ß = -0.029, p = 0.791; fathers’ self-inhibition linked to mothers’ caregiver strain: ß = -0.039, p = 0.782) were associated with their partner’s caregiver strain.
The residual correlation between parents’ caregiver strain was statistically significant (ß = 0.513, p < 0.001), suggesting the potential benefit of including additional predictors that may explain shared variability between mother’s and father’s caregiver strain.
Well-being
Actor effects. The model linking parents’ EF skills to well-being found that mothers’ increased emotion regulation deficits were associated with lower levels of their own well-being (ß = -0.447, p < .004) and fathers’ increased emotion regulation deficits were associated with lower levels of their own well-being (ß = -0.293, p = .004). Mothers’ self-inhibition was not associated with their own well-being (ß = -0.061, p = 0.672), but fathers’ self-inhibition was linked to their own well-being (ß = -0.361, p < 0.004) such that deficits in fathers’ self-inhibition was associated with poorer well-being.
Partner effects. This same model found no significant partner effects. Neither mothers’ EF skills (mothers’ emotion regulation linked to father’s well-being: ß = -0.180, p = 0.093; mothers’ self-inhibition linked to fathers’ well-being: ß = 0.045, p = 0.697) nor fathers’ EF skills (fathers’ emotion regulation linked to mothers’ well-being: ß = -0.055, p = 0.690; fathers’ self-inhibition linked to mothers’ well-being: : ß = -0.129, p = 0.286) were associated with their partner’s well-being. Prior to correcting for FDR, mothers’ emotion regulation was associated with fathers’ well-being where higher deficits in mothers’ emotion regulation were linked to poorer well-being in fathers (ß = − .180, p = 0.29).
The residual correlation between parents’ well-being was not statistically significant (ß = 0.068, p = 0.053) suggesting our model accounted for a significant portion of the shared variance between parents’ well-being.
Discussion
The present study sought to investigate the association between parents’ EF, as assessed by the BDEFS, and their own and their partner’s depression and anxiety symptoms, caregiver strain, and well-being using. We used the Actor-Partner Interdependence Model to leverage a large, U.S.-based sample of 263 different-sex dyads. Consistent with our prediction and research in the general population, parents’ emotion regulation was repeatedly associated with their own mental health outcomes, caregiver strain, and well-being.27,29–32,59 In relation to depression, emotion regulation may be particularly important given its role in processing negative experiences.59 Additionally, maladaptive emotion regulation processing has been associated with depression symptoms.26,60 Our findings extend these results to parents of autistic children as parents with higher emotion regulation deficits reported more depression symptoms. Anxiety may be related to emotion regulation in a similar way given high rates of comorbidity between depression and anxiety. Deficits in adaptive strategies, like emotion regulation, have been linked to anxiety, resulting in difficulties processing stressful events and triggering worry.61–63 Such findings have been extensively replicated in the general population.27–28,31−32,59 Our findings build off such results by identifying specific cognitive components that could be targeted given high levels of anxiety in parents of autistic children.
Our results also found that parents’ increased emotion regulation deficits were associated with higher levels of caregiver strain in themselves. Cognitive reappraisal (a mechanism of emotion regulation) has been identified as useful when processing impactful medical situations through reframing, subsequently reducing parenting stress.63 Whilst work has previously researched the effects of EF on caregiver strain in parents of autistic children,19,20 our work helps specify which facets of EF may be most fruitful to target (i.e., emotion regulation). This could aid the creation of more streamlined and focused supports for parents of autistic children.
Analyses investigating the effects of EF on parents’ well-being not only yielded significant emotion regulation actor effects, but also a significant association between fathers’ self-inhibition and their well-being. These findings are consistent with studies focused on emotion regulation and self-inhibition in the general population. Like before, emotion regulation can help with managing negative situations through reappraisal, promoting well-being.34 Similarly, self-inhibition promotes peace of mind by inhibiting reactions to unwanted or irrelevant stimuli.32 These skills appear to be particularly useful to parents of autistic children given the demands they face. Thus, a lack of actor effects linking not just mothers’ self-inhibition to their well-being, but parents’ self-inhibition to their depression and anxiety symptoms and caregiver strain is of note. We posit that, though both emotion regulation and self-inhibition may be important to our outcomes of interest, emotion regulation may be more pertinent to parents of autistic children. As facets of EF, emotion regulation and self-inhibition are not explicitly orthogonal. Rather, self-inhibition often includes mention of emotion regulation (e.g., not allowing emotional stimuli drive rash decision making).32,33 Consequently, we hypothesize the variance self-inhibition may explain in the mental health, caregiver strain, and well-being of parents may be shared with emotion regulation, allowing emotion regulation’s unique effects to emerge as significant.
Much research has linked mental health outcomes, stress, and well-being in parents. Our correlations allowed us to establish interdependence between mothers and fathers, but we did not observe parents’ EF to be associated with their partner’s outcomes. This suggests the effects of EF may not permeate across partner and only result in intra-individual consequences. As tools to deal with one’s environment, emotion regulation and self-inhibition may only affect personal experiences in parenthood and not affect partners’ experiences. This may be due to the distinct roles mothers and fathers fulfill within childrearing. As noted, mothers often take on the role of primary caregiver.41 This disparity in responsibility may be the isolating factor that separates the effects of EF, but further research is needed to understand the mechanisms behind this finding and to understand what links parent mental health and well-being.
These findings allude to several important implications. Understanding the relationship between EF and these outcomes can help identify whether targeting these skills may be useful in improving depression and anxiety symptoms, caregiver strain, and well-being in this vulnerable population. Results could aid the development of supports aimed at improving parents’ emotion regulation, subsequently mitigating undesirable outcomes. Such supports have already been successfully implemented in other studies, resulting in reduced caregiver strain.19,20 This work can serve as a natural extension by isolating emotion regulation as a crucial component within EF and by providing preliminary evidence of its viability in reducing depression and anxiety symptoms and improving well-being in parents of autistic children. The scalability and relatively inexpensive nature of these interventions is also of note and could be useful in dissemination. Another important point is that the benefits of these supports may extend to children given numerous studies linking parents’ EF to children’s EF (e.g.,21,22,24). Despite this promising outlook, we caution against overinterpretation given the cross-sectional nature of our analyses.
Our inclusion of fathers and use of dyad-level analyses in this large sample is also of note. Findings corroborate that fathers experience similar mental health, caregiver strain, and well-being outcomes as mothers in relation to emotion regulation (i.e., we did not observe sex differences across parents). Given fathers are understudied36 and research often include the perspective of a single caregiver (usually mothers),40 these findings fill an important gap by investigating fathers’ unique experiences and providing a more complete picture of parenting. Similar studies to the present are limited, particularly in parents of autistic children, allowing this research to provide important foundational information that can be built upon by future research. Finally, there were significant residual relationships within dyads’ depression and caregiver strain after accounting for EF, suggesting other factors could help create models that better fit the data. Additional environmental and/or individual traits (e.g., child autism behavior problem severity) may help explain remaining variance and could be the focus of future research.
The current study is not without limitations. An important factor to consider when assessing the mental health, caregiver strain, and well-being of parents of autistic children is the level of externalizing or problem behaviors a child exhibits. Research suggests that an autism diagnosis itself may not be the driver of parent outcomes, but rather the severity of behavioral symptoms may serve as a more reliable predictor.1 Future research could benefit from investigating the moderating effects of autistic children’s behavioral symptoms as they relate to parent EF and parent outcomes. Additionally, our study did not exclusively include cohabitating couples, which could provide better insight into the interdependence of our variables of interest. This may have impacted the lack of partner effects observed in our study given less overlap and shared parenting experiences. Lastly, our study did not explicitly investigate the mechanisms behind emotion regulation’s impact on parent outcomes. Future research that interrogates the directionality of these effects and that can help understand why emotion regulation impacts mental health outcomes, caregiver strain, and well-being in parents of autistic children is needed.
In conclusion, this study reaffirms the importance of EF through emotion regulation’s association with more anxiety and depression symptoms, higher caregiver strain, and poor well-being in parents of autistic children. Despite the interdependent nature of our data, limited partner effects were found. We hypothesized this may be due to mother and fathers’ distinct parenting roles. Our large sample size, inclusion of fathers, and analysis of the whole dyad provide important foundational work in an emerging area of research. Future research in this domain would benefit from the inclusion of child behavior symptoms in explanatory models, additional family-level factors that may impact these analysis, and longitudinal studies that could better understand the directionality and mechanisms behind these effects. For now, these findings can help inform supports to improve parents’ emotion regulation, subsequently benefitting parents’ mental health, levels of stress, and overall well-being.
List of Abbreviations
Executive function (EF)
Actor
Partner Interdependence Model (APIM)
Simons Powering Autism Research for Knowledge (SPARK)
Simons Foundation Autism Research Initiative (SFARI)
Participant Access Committee (PAC)
Barkley Deficits in Executive Functioning Scale (BDEFS)
Generalized Anxiety Disorder
7 (GAD-7)
Patient Health Questionnaire
9 (PHQ-9)
Caregiver Strain Questionnaire
Short Form (CGSQ-SF)
false discovery rate (FDR)
Declarations
Ethics Approval & Consent to Participate
Study protocols were reviewed and approved by the University of California, Los Angeles Institutional Review Board (South General Campus IRB (SGIRB): 00004474). Participants provided their written informed consent to participate in this study.
Consent for Publication
Not applicable
Clinical Trial Number
Not applicable
A
Data Availability
Data used in this study are publicly available through the Research Match mechanism of the Simons Powering Autism Research for Knowledge (SPARK) Study. For further details, please contact the corresponding author.
Competing Interests
The authors declare they have no competing interests.
A
Funding
This work was supported by grants from SFARI (390314, AG) and the National Institutes of Health, National Center for Advancing Translational Sciences (UL1 TR001860).
A
Author Contribution
Conceptualization: AS; Data curation: LDO, MK. & AS; Formal analyses: LDO, AS & MK; Methodology: LDO, MK & AS; Project administration: LDO; Software: LDO, MK & AS; Supervision: AS & AG; Validation: LDO, MK & AS; Visualization: LDO; Writing – original draft: LDO & MK; Writing – review & editing: LDO, AS, AG & MK; Funding acquisition – AG. All authors read and approved the final manuscript.
A
Acknowledgement
Thank you to the families who participated in SPARK and our Research Match Study, and the SPARK Consortium.
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