Executive Function’s Association with Mental Health Outcomes, Caregiver Strain, and Well-Being in Parents of Autistic Children: A Dyadic Analysis

Executive Function’s Association with Mental Health Outcomes, Caregiver Strain, and Well-Being in Parents of Autistic Children: A Dyadic Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Executive Function’s Association with Mental Health Outcomes, Caregiver Strain, and Well-Being in Parents of Autistic Children: A Dyadic Analysis Leonardo Dominguez Ortega, Meghan M. Krushena, Amanda C. Gulsrud, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8408759/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version 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. executive function parents of autistic children actor-partner interdependence model depression anxiety caregiver strain well-being Figures Figure 1 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 colleagues 17 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-being 34 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 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 Being 54 , 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 4.2.3 57 was used to calculate descriptive statistics, bivariate raw correlations, and t-tests (see Tables 1 – 3 ). The Actor-Partner Interdependence Model 45 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’s 45 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. 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 . 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 Table 2 presents descriptive statistics for parents’ EF abilities (self-inhibition and emotion regulation), caregiver strain, anxiety, depression, and well-being by parent sex. A series of paired sample t-tests and Wilcoxon signed rank tests (for variables with non-normally distributed difference scores between mothers and fathers) found that mothers reported more caregiver strain ( d = 0.182, p = 0.004), depression symptoms ( d = 0.11, p = 0.03) and anxiety symptoms ( d = 0.217, p < 0.001). Conversely, fathers reported higher self-inhibition deficits ( d = 0.294, p < 0.001). Parents did not differ in self-reported well-being or emotion regulation. These results held after Benjamini-Hochberg procedure corrections to account for FDR. The p -values of our preliminary correlations to establish interdependence fell below our alpha of 0.20, indicating interdependence amongst mothers’ and fathers’ outcomes and can be found in Table 3 . 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. Table 3 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 understudied 36 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. 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 Availability of Data & Materials 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. 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). Author Contributions 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. 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11:57:46","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":180759,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8408759/v1/c522513f8c0ce1a7af875433.html"},{"id":100399719,"identity":"180160ab-13a8-4750-8327-55252d71530e","added_by":"auto","created_at":"2026-01-16 11:57:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":182658,"visible":true,"origin":"","legend":"\u003cp\u003e1a-1d \u003cem\u003eSchematics of Actor-Partner Interdependence Models (APIMs)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8408759/v1/cb036892a698cb4b10194b42.png"},{"id":100546576,"identity":"66375520-b0b1-4f09-848a-d0809951decf","added_by":"auto","created_at":"2026-01-19 08:10:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1205720,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8408759/v1/3e7c9941-76d0-446b-a7b5-b68cfea1b6f5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Executive Function’s Association with Mental Health Outcomes, Caregiver Strain, and Well-Being in Parents of Autistic Children: A Dyadic Analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eIt 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.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e 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,\u003csup\u003e6\u003c/sup\u003e whilst marital relationships may also be negatively impacted within this context.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e 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.\u003c/p\u003e \u003cp\u003eBeyond the normative stressors of parenthood, research suggests these outcomes in parents of autistic children may stem from children\u0026rsquo;s symptom severity,\u003csup\u003e1,9\u003c/sup\u003e difficulties accessing necessary care,\u003csup\u003e10\u0026ndash;11\u003c/sup\u003e a lack of respite,\u003csup\u003e12\u0026ndash;13\u003c/sup\u003e and financial strain,\u003csup\u003e14\u003c/sup\u003e 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.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e 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.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e With many documented benefits and notable vulnerabilities for those with deficits in this domain, EF may be particularly useful to study (e.g., \u003csup\u003e17\u0026ndash;19\u003c/sup\u003e). Emotion regulation and self-inhibition, two kinds of EF skills, are of note given their relevance to parenting and role in managing stressful experiences.\u003c/p\u003e\n\u003ch3\u003eExecutive Functioning: Emotion Regulation and Self-Inhibition\u003c/h3\u003e\n\u003cp\u003eEF is a much-researched topic with noted positive associations across different contexts. A literature review by Williams and colleagues\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e 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.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e The effects of EF are not isolated to individual experiences, however, as parents\u0026rsquo; skills serve as scaffolding for children\u0026rsquo;s EF.\u003csup\u003e21\u0026ndash;22\u003c/sup\u003e 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.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAt their core, EF skills are critical tools that aid in responding to one\u0026rsquo;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,\u003csup\u003e3\u0026ndash;4\u003c/sup\u003e complex medical and educational systems,\u003csup\u003e25\u003c/sup\u003e and stigma.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e 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.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Studies in the general population have found that emotion regulation may aid depression and anxiety symptom management,\u003csup\u003e1,27\u0026ndash; 31\u003c/sup\u003e promote well-being,\u003csup\u003e32\u003c/sup\u003e and reduce caregiver strain.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Whilst emotion regulation focuses on emotion processing, self-inhibition focuses on control over one\u0026rsquo;s impulsivity and emotional urges to act.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Self-inhibition has been associated with better well-being\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e and better response to depression treatment in the general population.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Simultaneously, deficits in EF can play a critical role in blunting one\u0026rsquo;s ability to manage stress, which is particularly relevant to parents of autistic children.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e 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.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eA More Complete Perspective: The Actor-Partner Interdependence Model\u003c/h2\u003e \u003cp\u003eWhether interrogating the effects of parent characteristics on their own outcomes or their children\u0026rsquo;s outcomes, studies focused on parents of autistic children face a critical limitation common in parenting research: fathers are heavily understudied.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e One systematic review found that mothers outnumbered fathers in research participation by a factor of eight.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e Theories to explain this disparity include fathers being more inaccessible (e.g., employment restrictions, lack of time) and difficult to recruit than mothers,\u003csup\u003e38\u003c/sup\u003e fathers not being asked to participate,\u003csup\u003e39\u003c/sup\u003e and mothers often fulfilling the role of primary caregiver.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e The latter theory highlights that mothers\u0026rsquo; increased role in childrearing provides them with a perspective most relevant to inform pediatric research.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e 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.\u003c/p\u003e \u003cp\u003eAnother important and related limitation in this research is that a single parent\u0026rsquo;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.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e 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.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Additionally, various theoretical models have been proposed to explain how couples interact in the face of illness and other stressors, like a child\u0026rsquo;s autism diagnosis (e.g., the systematic transactional model, the developmental-contextual model).\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e This serves to inform consistent trends of couples influencing each other\u0026rsquo;s physical and mental health, like depression.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e Thus, a more complete assessment of the parenting dyad is needed to understand how parents influence each other, highlight fathers\u0026rsquo; unique experiences, and address these topics through germane methodologies.\u003c/p\u003e \u003cp\u003eThe Actor-Partner Interdependence Model (APIM)\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e is one such method that considers interdependence by assessing the way parents\u0026rsquo; 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.,\u003csup\u003e15,42,46\u003c/sup\u003e). 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).\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e With this approach, not only are fathers\u0026rsquo; perspectives incorporated, but a more complete analysis is executed as both dyad members are included. This model also considers dyad members\u0026rsquo; shared context by controlling for partners\u0026rsquo; predictor scores when estimating actor effects and tests for additional factors that could increase model fit by correlating residuals from each dyad member.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e Thus, the APIM, and methods like it are critical when looking to understand the complex interplay between parents\u0026rsquo; experiences.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAims \u0026 Current Study\u003c/h3\u003e\n\u003cp\u003eThe current study sought to investigate the effect of parents\u0026rsquo; EF (emotion regulation and self-inhibition) on their own and their partner\u0026rsquo;s anxiety and depression symptoms, caregiver strain, and well-being using the Actor-Partner Interdependence Model.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e 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\u0026rsquo; 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\u0026rsquo; EF would result in more anxiety and depression symptoms, caregiver strain, and poorer well-being in their partners (partner effeects).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSPARK and Research Match\u003c/h2\u003e \u003cp\u003eSimons 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\u0026rsquo;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\u0026thinsp;+\u0026thinsp;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.\u003csup\u003e47,48\u003c/sup\u003e for additional SPARK protocol information.\u003c/p\u003e \u003cp\u003eResearch 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.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eAt the time of data collection, SPARK had enrolled 106,577 probands of all ages. Our Research Match sample included \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;263 probands along with both biological parents (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;263 parent-child triads; \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;789 individuals). The current study utilized a subset of data from the parent dyads (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;263 different-sex parent dyads, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;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).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eDemographic Questionnaire\u003c/h2\u003e \u003cp\u003eInformation 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\u0026rsquo; 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.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eBarkley Deficits in Executive Functioning Scale\u003c/h3\u003e\n\u003cp\u003eThe Barkley Deficits in Executive Functioning Scale (BDEFS),\u003csup\u003e49\u003c/sup\u003e 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 (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;89 items). Items from the self-restraint (also referred to as self-inhibition; \u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;19 items) and self-regulation of emotions (also referred to as emotion regulation; \u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;13 items) subscales were selected for the current study. The self-inhibition subscale aims to measure participants\u0026rsquo; impulsivity and ability to inhibit responses, and the emotion regulation subscale focuses on respondents\u0026rsquo; ability to manage emotions. All items were answered on a 4-point Likert scale (1 = \u003cem\u003e\u0026ldquo;Never or rarely\u0026rdquo;\u003c/em\u003e to 4 = \u003cem\u003e\u0026ldquo;Very often\u0026rdquo;\u003c/em\u003e). The BDEFS had excellent internal consistency in the current sample (self-inhibition, α\u0026thinsp;=\u0026thinsp;0.93; emotion regulation, α\u0026thinsp;=\u0026thinsp;0.92), replicating psychometrics from prior studies (α\u0026thinsp;=\u0026thinsp;0.92 for the entire measure).\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e 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\u0026ndash;76 and 13\u0026ndash;52, respectively.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eGeneralized Anxiety Disorder-7\u003c/h2\u003e \u003cp\u003eThe Generalized Anxiety Disorder-7 (GAD-7)\u003csup\u003e50\u003c/sup\u003e 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 = \u003cem\u003e\u0026ldquo;Not at all\u0026rdquo;\u003c/em\u003e to 3 = \u003cem\u003e\u0026ldquo;Nearly every day\u0026rdquo;\u003c/em\u003e). The GAD-7 has been found to have strong psychometric properties, with excellent internal consistency in the current sample (α\u0026thinsp;=\u0026thinsp;0.91), similar to prior studies (Cronbach α\u0026thinsp;=\u0026thinsp;0.92),\u003csup\u003e50\u003c/sup\u003e and good test-retest reliability in the reference sample (ICC\u0026thinsp;=\u0026thinsp;0.83).\u003csup\u003e50\u003c/sup\u003e Additionally, this measure has been found to have strong evidence of criterion, construct, and factorial validity.\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e The GAD-7 yields a total sum score with possible scores ranging from 0\u0026ndash;21 with higher scores indicating greater levels of anxiety.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePatient Health Questionnaire-9\u003c/h2\u003e \u003cp\u003eThe Patient Health Questionnaire-9 (PHQ-9)\u003csup\u003e51\u003c/sup\u003e 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 = \u003cem\u003e\u0026ldquo;Not at all\u0026rdquo;\u003c/em\u003e to 3 = \u003cem\u003e\u0026ldquo;Nearly every day\u0026rdquo;\u003c/em\u003e). The PHQ-9 was found to have good internal consistency in the current sample (α\u0026thinsp;=\u0026thinsp;0.89), similar to prior studies (α\u0026thinsp;=\u0026thinsp;0.86\u0026ndash;0.89; test-retest reliability in the reference sample, 0.84).\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e It has also been found to have strong construct and criterion validity.\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e 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\u0026ndash;24 using eight items that represent the severity of respondents\u0026rsquo; 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCaregiver Strain Questionnaire\u0026ndash;Short Form\u003c/h2\u003e \u003cp\u003eInternalized caregiver strain from the previous six months was assessed using the Caregiver Strain Questionnaire-Short Form (CGSQ-SF),\u003csup\u003e52\u003c/sup\u003e an abbreviated version of the Caregiver Strain Questionnaire.\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e It consists of 10 items that query objective strain (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6 items) and subjective internalized strain (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4 items). Responses were measured using a 5-point Likert scale (1 = \u003cem\u003e\u0026ldquo;Not at all\u0026rdquo;\u003c/em\u003e to 5 = \u003cem\u003e\u0026ldquo;Very much a problem\u0026rdquo;\u003c/em\u003e). Items were prefaced with \u0026ldquo;In the past 6 months, how much of a problem was the following\u0026hellip;\u0026rdquo;. The internal consistency of the CGSQ-SF is comparable to that of the original form (α\u0026thinsp;=\u0026thinsp;0.90),\u003csup\u003e52\u003c/sup\u003e which was replicated in the current sample (α\u0026thinsp;=\u0026thinsp;0.91). Total scores were calculated by summing measure items, with higher scores indicating increased caregiver strain. Possible scores ranged from 10\u0026ndash;50.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eWellbeing Scale\u003c/h2\u003e \u003cp\u003eThe Wellbeing Scale is a modified version of Ryff\u0026rsquo;s Scales of Psychological Well Being\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e,\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e 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 = \u003cem\u003e\u0026ldquo;Strongly agree\u0026rdquo;\u003c/em\u003e to 7 = \u003cem\u003e\u0026ldquo;Strongly disagree\u0026rdquo;\u003c/em\u003e) and item scores were averaged to create a total score. The Wellbeing Scale demonstrated good internal consistency in the current sample (α\u0026thinsp;=\u0026thinsp;.86), similar to prior studies.\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e Possible scores ranged from 18 to 126 with higher scores representing greater well-being.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAnalytic Plan\u003c/h2\u003e \u003cp\u003eRStudio version 4.2.3\u003csup\u003e57\u003c/sup\u003e was used to calculate descriptive statistics, bivariate raw correlations, and t-tests (see Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The Actor-Partner Interdependence Model\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e guided our main analyses interrogating the impact of parents\u0026rsquo; EF on their own and their partner\u0026rsquo;s depression and anxiety symptoms, caregiver strain, and well-being. As specified by Cook \u0026amp; Kenny,\u003csup\u003e45\u003c/sup\u003e our first step was to establish interdependence between mothers\u0026rsquo; and fathers\u0026rsquo; corresponding variables (e.g., mothers\u0026rsquo; and fathers\u0026rsquo; well-being). Given our dyads were distinguishable (i.e., there is a meaningful difference between dyad members \u0026ndash; their biological sex) we employed a series of two-tailed Pearson\u0026rsquo;s raw correlations. We also specified a liberal alpha of 0.20 as highlighted in Cook \u0026amp; Kenny\u0026rsquo;s\u003csup\u003e45\u003c/sup\u003e work where a statistically significant finding would indicate interdependence.\u003c/p\u003e \u003cp\u003eSubsequently, APIM models were conducted using path analysis in Mplus software.\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e We assessed the effects of parents\u0026rsquo; EF skills (self-inhibition, emotion regulation) on their own and their partner\u0026rsquo;s anxiety and depression symptoms, caregiver strain, and well-being. Four models were run in total: all used parents\u0026rsquo; EF as predictors and either depression, anxiety, caregiver strain, or well-being as the outcome variables. See Figs.\u0026nbsp;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 \u003cem\u003eq\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05. Results below represent standardized coefficients and FDR corrected \u003cem\u003ep\u003c/em\u003e-values.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePreliminary Analyses\u003c/h2\u003e \u003cp\u003eMothers in our sample averaged 40.6 years old (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.01) and fathers averaged 42.9 years old (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;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\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eProband Demographic Characteristics\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at Registration (Years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.59 (3.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.95 (3.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.87 (3.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLanguage Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLonger Sentences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombines 3 Words\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUses Single Words\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Words\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive Impairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack or African American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative Hawaiian or Pacific Islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote\u003c/em\u003e: Proband demographics collected during SPARK registration, not during Research Match data collection. Data were missing for 12 probands.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epresents descriptive statistics for parents\u0026rsquo; EF abilities (self-inhibition and emotion regulation), caregiver strain, anxiety, depression, and well-being by parent sex. A series of paired sample t-tests and Wilcoxon signed rank tests (for variables with non-normally distributed difference scores between mothers and fathers) found that mothers reported more caregiver strain (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.182, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), depression symptoms (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03) and anxiety symptoms (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.217, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conversely, fathers reported higher self-inhibition deficits (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.294, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Parents did not differ in self-reported well-being or emotion regulation. These results held after Benjamini-Hochberg procedure corrections to account for FDR. The \u003cem\u003ep\u003c/em\u003e-values of our preliminary correlations to establish interdependence fell below our alpha of 0.20, indicating interdependence amongst mothers\u0026rsquo; and fathers\u0026rsquo; outcomes and can be found in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eParent Means and SDs for Variables of Interest\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-Inhibition (BDEFS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotion Regulation\u003c/p\u003e \u003cp\u003e(BDEFS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePHQ-9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCGSQ-SF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eWell-being Scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.25\u003c/p\u003e \u003cp\u003e(9.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.98\u003c/p\u003e \u003cp\u003e(8.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.08\u003c/p\u003e \u003cp\u003e(5.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.64\u003c/p\u003e \u003cp\u003e(5.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.08\u003c/p\u003e \u003cp\u003e(9.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.10\u003c/p\u003e \u003cp\u003e(0.84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFathers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.75\u003c/p\u003e \u003cp\u003e(9.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.32\u003c/p\u003e \u003cp\u003e(8.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.61\u003c/p\u003e \u003cp\u003e(5.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.73\u003c/p\u003e \u003cp\u003e(6.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.28\u003c/p\u003e \u003cp\u003e(9.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.02\u003c/p\u003e \u003cp\u003e(0.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote\u003c/em\u003e: PHQ-9 scores have a truncated range of 0\u0026ndash;24 as item 9 was excluded. Raw scores should not be compared to other studies that use the full scale.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCorrelation Matrix of Outcome Variables (Tests of Interdependence)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMothers\u0026rsquo; Anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMothers\u0026rsquo; Depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMothers\u0026rsquo; Caregiver Strain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMothers\u0026rsquo;\u003c/p\u003e \u003cp\u003eWell-being\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFathers\u0026rsquo;\u003c/p\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003er\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.12\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.05*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.14\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.19*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e = -0.11\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFathers\u0026rsquo; Depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.15\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003er\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.24\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.10\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e = -0.12\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFathers\u0026rsquo; Caregiver Strain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.17\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.18\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003er\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.54\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e = -0.12\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.13*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFathers\u0026rsquo;\u003c/p\u003e \u003cp\u003eWell-being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e = -0.11\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.03*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e = -0.20\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e = -0.11\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.02*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003er\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.22\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote\u003c/em\u003e: Bolded values represent the analyses used to determine interdependence amongst mother and father scores. *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.20\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eDepression\u003c/h2\u003e \u003cp\u003e \u003cb\u003eActor Effects.\u003c/b\u003e The model linking parents\u0026rsquo; EF skills to their depression symptoms found that mothers\u0026rsquo; increased emotion regulation deficits were associated with more depression symptoms (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.463, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.004) and fathers\u0026rsquo; increased emotion regulation deficits were associated with more depression symptoms (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.531, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.004). Neither mothers\u0026rsquo; (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.106, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.444) nor fathers\u0026rsquo; (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.079, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.557) self-inhibition skills were associated with their own depression symptoms.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePartner Effects.\u003c/b\u003e This same model revealed no significant partner effects. Neither mothers\u0026rsquo; EF skills (mothers\u0026rsquo; emotion regulation linked to fathers\u0026rsquo; depression: \u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.065, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.679; mothers\u0026rsquo; self-inhibition linked to fathers\u0026rsquo; anxiety: \u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.027, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.791) nor fathers\u0026rsquo; EF skills (fathers\u0026rsquo; emotion regulation linked to mothers\u0026rsquo; depression: \u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.086, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.471; fathers\u0026rsquo; self-inhibition linked to mothers\u0026rsquo; depression: \u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.138, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.244) were associated with their partner\u0026rsquo;s depression symptoms.\u003c/p\u003e \u003cp\u003eThe residual correlation between parents\u0026rsquo; depression symptoms was statistically significant (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.222, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting the potential benefit of including additional predictors that may explain shared variability between mother\u0026rsquo;s and father\u0026rsquo;s depression symptoms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eAnxiety\u003c/h2\u003e \u003cp\u003e \u003cb\u003eActor Effects\u003c/b\u003e. The model linking parents\u0026rsquo; EF skills to their anxiety symptoms found that mothers\u0026rsquo; increased emotion regulation deficits were associated with more anxiety symptoms (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.466, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.004), and fathers\u0026rsquo; increased emotion regulation deficits were also associated with more anxiety symptoms (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.596, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.004). In other words, parents with poorer emotion regulation skills self-reported more anxiety symptoms. However, neither fathers\u0026rsquo; (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.015 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.833) nor mothers\u0026rsquo; (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.175, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.227) self-inhibition were associated with their own anxiety symptoms.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePartner Effects\u003c/b\u003e. This same model revealed no significant partner effects. Neither mothers\u0026rsquo; EF skills (mothers\u0026rsquo; emotion regulation linked to fathers\u0026rsquo; anxiety: \u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.073, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.618; mothers\u0026rsquo; self-inhibition linked to fathers\u0026rsquo; anxiety: \u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.056, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.690) nor fathers\u0026rsquo; EF skills (fathers\u0026rsquo; emotion regulation\u0026rsquo;s linked to mothers\u0026rsquo; anxiety: \u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.132, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.117; fathers\u0026rsquo; self-inhibition\u0026rsquo;s linked to mothers\u0026rsquo; anxiety: \u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.100, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.429) was associated with their partner\u0026rsquo;s anxiety.\u003c/p\u003e \u003cp\u003eThe residual correlation between parents\u0026rsquo; anxiety symptoms was not significant (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.097, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.153), suggesting our model accounted for a significant portion of the shared variance between parents\u0026rsquo; anxiety.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eCaregiver Strain\u003c/h2\u003e \u003cp\u003e \u003cb\u003eActor Effects.\u003c/b\u003e The model linking parents\u0026rsquo; EF skills to caregiver strain found that mothers\u0026rsquo; increased emotion regulation deficits were associated with higher levels of their own caregiver strain (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.283, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.004) and that fathers\u0026rsquo; increased emotion regulation deficits were associated with higher levels of their own caregiver strain (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.269, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.007). Neither mothers\u0026rsquo; (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.033, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.786) nor fathers\u0026rsquo; (\u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.039, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.786) self-inhibition was associated with their own caregiver strain.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePartner effects.\u003c/b\u003e This same model found no significant partner effects. Neither mothers\u0026rsquo; EF skills (mothers\u0026rsquo; emotion regulation linked to father\u0026rsquo;s caregiver strain: \u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.079, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.672; mothers\u0026rsquo; self-inhibition linked to fathers\u0026rsquo; caregiver strain: \u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.111, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.480) nor fathers\u0026rsquo; EF skills (fathers\u0026rsquo; emotion regulation linked to mothers\u0026rsquo; caregiver strain: \u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.029, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.791; fathers\u0026rsquo; self-inhibition linked to mothers\u0026rsquo; caregiver strain: \u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.039, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.782) were associated with their partner\u0026rsquo;s caregiver strain.\u003c/p\u003e \u003cp\u003eThe residual correlation between parents\u0026rsquo; caregiver strain was statistically significant (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.513, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting the potential benefit of including additional predictors that may explain shared variability between mother\u0026rsquo;s and father\u0026rsquo;s caregiver strain.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eWell-being\u003c/h2\u003e \u003cp\u003e \u003cb\u003eActor effects.\u003c/b\u003e The model linking parents\u0026rsquo; EF skills to well-being found that mothers\u0026rsquo; increased emotion regulation deficits were associated with lower levels of their own well-being (\u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.447, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.004) and fathers\u0026rsquo; increased emotion regulation deficits were associated with lower levels of their own well-being (\u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.293, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004). Mothers\u0026rsquo; self-inhibition was not associated with their own well-being (\u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.061, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.672), but fathers\u0026rsquo; self-inhibition was linked to their own well-being (\u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.361, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.004) such that deficits in fathers\u0026rsquo; self-inhibition was associated with poorer well-being.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePartner effects.\u003c/b\u003e This same model found no significant partner effects. Neither mothers\u0026rsquo; EF skills (mothers\u0026rsquo; emotion regulation linked to father\u0026rsquo;s well-being: \u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.180, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.093; mothers\u0026rsquo; self-inhibition linked to fathers\u0026rsquo; well-being: \u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.045, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.697) nor fathers\u0026rsquo; EF skills (fathers\u0026rsquo; emotion regulation linked to mothers\u0026rsquo; well-being: \u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.055, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.690; fathers\u0026rsquo; self-inhibition linked to mothers\u0026rsquo; well-being: : \u003cem\u003e\u0026szlig;\u003c/em\u003e = -0.129, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.286) were associated with their partner\u0026rsquo;s well-being. Prior to correcting for FDR, mothers\u0026rsquo; emotion regulation was associated with fathers\u0026rsquo; well-being where higher deficits in mothers\u0026rsquo; emotion regulation were linked to poorer well-being in fathers (\u003cem\u003e\u0026szlig;\u003c/em\u003e = \u0026minus;\u0026thinsp;.180, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.29).\u003c/p\u003e \u003cp\u003eThe residual correlation between parents\u0026rsquo; well-being was not statistically significant (\u003cem\u003e\u0026szlig;\u003c/em\u003e = 0.068, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.053) suggesting our model accounted for a significant portion of the shared variance between parents\u0026rsquo; well-being.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study sought to investigate the association between parents\u0026rsquo; EF, as assessed by the BDEFS, and their own and their partner\u0026rsquo;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\u0026rsquo; emotion regulation was repeatedly associated with their own mental health outcomes, caregiver strain, and well-being.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e In relation to depression, emotion regulation may be particularly important given its role in processing negative experiences.\u003csup\u003e\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e Additionally, maladaptive emotion regulation processing has been associated with depression symptoms.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e 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.\u003csup\u003e\u003cspan additionalcitationids=\"CR62\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e Such findings have been extensively replicated in the general population.\u003csup\u003e27\u0026ndash;28,31\u0026minus;32,59\u003c/sup\u003e 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.\u003c/p\u003e \u003cp\u003eOur results also found that parents\u0026rsquo; 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.\u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e Whilst work has previously researched the effects of EF on caregiver strain in parents of autistic children,\u003csup\u003e19,20\u003c/sup\u003e 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.\u003c/p\u003e \u003cp\u003eAnalyses investigating the effects of EF on parents\u0026rsquo; well-being not only yielded significant emotion regulation actor effects, but also a significant association between fathers\u0026rsquo; 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.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e Similarly, self-inhibition promotes peace of mind by inhibiting reactions to unwanted or irrelevant stimuli.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e 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\u0026rsquo; self-inhibition to their well-being, but parents\u0026rsquo; 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).\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e 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\u0026rsquo;s unique effects to emerge as significant.\u003c/p\u003e \u003cp\u003eMuch 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\u0026rsquo; EF to be associated with their partner\u0026rsquo;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\u0026rsquo;s environment, emotion regulation and self-inhibition may only affect personal experiences in parenthood and not affect partners\u0026rsquo; 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.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e 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.\u003c/p\u003e \u003cp\u003eThese 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\u0026rsquo; emotion regulation, subsequently mitigating undesirable outcomes. Such supports have already been successfully implemented in other studies, resulting in reduced caregiver strain.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e 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\u0026rsquo; EF to children\u0026rsquo;s EF (e.g.,\u003csup\u003e21,22,24\u003c/sup\u003e). Despite this promising outlook, we caution against overinterpretation given the cross-sectional nature of our analyses.\u003c/p\u003e \u003cp\u003eOur 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 understudied\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e and research often include the perspective of a single caregiver (usually mothers),\u003csup\u003e40\u003c/sup\u003e these findings fill an important gap by investigating fathers\u0026rsquo; 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\u0026rsquo; 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.\u003c/p\u003e \u003cp\u003eThe 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.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Future research could benefit from investigating the moderating effects of autistic children\u0026rsquo;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\u0026rsquo;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.\u003c/p\u003e \u003cp\u003eIn conclusion, this study reaffirms the importance of EF through emotion regulation\u0026rsquo;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\u0026rsquo; 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\u0026rsquo; emotion regulation, subsequently benefitting parents\u0026rsquo; mental health, levels of stress, and overall well-being.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eExecutive 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) \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval \u0026amp; Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data \u0026amp; Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grants from SFARI (390314, AG) and the National Institutes of Health, National Center for Advancing Translational Sciences (UL1 TR001860).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: AS; Data curation: LDO, MK. \u0026amp; AS; Formal analyses: LDO, AS \u0026amp; MK; Methodology: LDO, MK \u0026amp; AS; Project administration: LDO; Software: LDO, MK \u0026amp; AS; Supervision: AS \u0026amp; AG; Validation: LDO, MK \u0026amp; AS; Visualization: LDO; Writing \u0026ndash; original draft: LDO \u0026amp; MK; Writing \u0026ndash; review \u0026amp; editing: LDO, AS, AG \u0026amp; MK; Funding acquisition \u0026ndash; AG. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThank you to the families who participated in SPARK and our Research Match Study, and the SPARK Consortium.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbbeduto L, Seltzer MM, Shattuck P, Krauss MW, Orsmond G, Murphy MM. Psychological well-being and coping in mothers of youths with autism, Down syndrome, or fragile X syndrome. Am J Ment Retard. 2004;109(3):237\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1352/0895-8017(2004)109%3C237:PWACIM%3E2.0.CO;2\u003c/span\u003e\u003cspan address=\"10.1352/0895-8017(2004)109%3C237:PWACIM%3E2.0.CO;2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiallo R, Treyvaud K, Cooklin A, Wade C. 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Support Care Cancer. 2019;27(4):1271\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00520-018-4611-5\u003c/span\u003e\u003cspan address=\"10.1007/s00520-018-4611-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-neurodevelopmental-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jndd","sideBox":"Learn more about [Journal of Neurodevelopmental Disorders](http://jneurodevdisorders.biomedcentral.com/)","snPcode":"11689","submissionUrl":"https://submission.nature.com/new-submission/11689/3","title":"Journal of Neurodevelopmental Disorders","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"executive function, parents of autistic children, actor-partner interdependence model, depression, anxiety, caregiver strain, well-being","lastPublishedDoi":"10.21203/rs.3.rs-8408759/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8408759/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eParents 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\u0026rsquo; mental health, stress, and well-being. Thus, methodologies that consider this shared context within parenting dyads is needed to appropriately address their needs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eOur 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\u0026rsquo; EF (emotion regulation and self-inhibition) and their own and their partner\u0026rsquo;s depression and anxiety symptoms, caregiver strain, and well-being. Interdependence was established using correlations given the distinguishable nature of our dyads.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBoth mothers\u0026rsquo; and fathers\u0026rsquo; 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\u0026rsquo; EF and their partner\u0026rsquo;s outcomes after false discovery rate correction.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eEmotion 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.\u003c/p\u003e","manuscriptTitle":"Executive Function’s Association with Mental Health Outcomes, Caregiver Strain, and Well-Being in Parents of Autistic Children: A Dyadic Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 08:51:04","doi":"10.21203/rs.3.rs-8408759/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-24T23:07:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-19T15:09:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-03T01:23:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95389565035583522285420167898357272053","date":"2026-01-23T09:27:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"239266114983522760831511418928056901942","date":"2026-01-11T02:31:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-09T19:07:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-29T19:35:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-26T13:16:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Neurodevelopmental Disorders","date":"2025-12-20T01:00:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-neurodevelopmental-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jndd","sideBox":"Learn more about [Journal of Neurodevelopmental Disorders](http://jneurodevdisorders.biomedcentral.com/)","snPcode":"11689","submissionUrl":"https://submission.nature.com/new-submission/11689/3","title":"Journal of Neurodevelopmental Disorders","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f2cec2ce-ab28-49cc-8e88-37d6f8285cda","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-01T22:09:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 08:51:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8408759","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8408759","identity":"rs-8408759","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}