Peer-reviewed article

The presence and impact of Autistic child comorbid conditions and their relationship to parent well-being

Daniel Shepherd, Sonja Goedeke, Jason Landon · 7 Jan 2026

Abstract

The diagnosis of Autism Spectrum Disorder is rising globally, and as a long-life condition associated with high support needs, parents of Autistic children experience greater parenting stress and lower quality of life than parents raising typically developing children. However, while research has investigated the relationship between the severity of child autism symptoms and parenting stress, studies into comorbid conditions that likewise impair child function are not as common and often focus on a small subset of conditions. The aim of the current study was to estimate the frequency of the five most common comorbidities reported in the autism literature (Anxiety, ADHD, Intellectual Disability, Gastrointestinal Issues, Sleep Disorder) and relate them to parenting stress and health-related quality of life (HRQOL). Using an internet-based survey, parent reports of their Autistic child’s comorbid conditions and the impact these have on their child’s function, parenting stress, and parental HRQOL were obtained from 453 parents residing in New Zealand. A global measure of parenting stress was obtained using the 18-item Parenting Stress Scale, while HRQOL ratings were obtained using the 36-Item Short Form Survey (SF-36). While many parents indicated the presence of comorbid conditions in their Autistic child, a substantial proportion were not formally diagnosed. A Linear Mixed-Effects Model indicated that child anxiety, Intellectual Disability, and ADHD had the greatest impact on both child and parent, however, subsequent multivariate analyses clarified that sleep disorder and Gastrointestinal Issues had the largest effect on parental stress and HRQOL, followed by ADHD. This result was robust irrespective of whether parents were asked if the comorbidity was present (vs. absent), diagnosed (vs. undiagnosed), or when related to child (i.e., functional) and parent (i.e., stress) impact. Evidence that child sleep disorder, Gastrointestinal Issues, and ADHD are most detrimental to parental well-being indicate that interventions targeting these comorbidities should be prioritised. Coupled with increased child function as a direct result of intervention, better parental outcomes should increase child well-being and family quality of life, indicating that future research into the diagnostic barriers associated with comorbid conditions would be useful. • Autism can co-occur with a number of comorbid conditions, though for a multitude of reasons these may go undiagnosed. • This study found that anxiety, ADHD, and sleep dysfunction were the most commonly represented comorbidities. • The greater the impact on child function, the more a comorbid condition contributes to parent stress. • Sleep and gastrointestinal disorders, followed by ADHD, had the greatest impact on child function and parenting stress.