Cross-cultural associations between behavioural, emotional, and cognitive differences in autistic children and parental wellbeing: evidence from five countries.

Introduction: Parental quality of life (QoL) and stress are strongly linked to behavioural, emotional, and cognitive differences in autistic children. However, these relationships have rarely been examined with a cross-cultural lens, despite the potential influence of sociocultural contexts on assessment and interpretation. To address this knowledge gap, this study employed multinational data to investigate the cross-cultural associations between emotional/behavioural and cognitive/adaptive differences in autistic children and parental wellbeing. Methods: Data were obtained from 219 autistic children aged up to 18 years across five countries (Australia, Singapore, Hungary, Romania, and the United Kingdom). Standardised instruments were used to assess four key domains of parental QoL, parental stress, child's behavioural/emotional difficulties, and adaptive/cognitive differences. Since different standardised instruments were used across countries, all measures were dichotomised according to established clinical cut-offs for each instrument. Multivariable logistic regression models were used to examine associations between children's autistic difficulties and parental wellbeing accounting for country- and measure-level variations. Results: Across countries, children experiencing higher emotional/behavioural difficulties were significantly associated with lower parental QoL (QoLA Part A: AOR = 0.36, 95% CI 0.11-0.97) and twice higher odds of parental stress (AOR = 2.11, 95% CI 1.08-4.54). However, the association between cognitive/adaptive difficulties and parental QoL and parental stress did not reach statistical significance. Additionally, there were no evidence of country- or measure-level heterogeneity for parental wellbeing outcomes (ICC = 0.00), indicating consistent associations across cultural contexts and assessment tools. Discussion: Emotional and behavioural difficulties in autistic children are significantly associated with poorer parental quality of life and increased stress across diverse cultures, suggesting that the challenges faced by parents are largely universal. These findings highlight the importance of early identification and family-centred, culturally responsive supports to improve wellbeing for both autistic children and their parents.