Purpose <p>Parents of children on the autism spectrum experience elevated psychological distress, which can impact both their well-being and child outcomes. While prior research has focused primarily on child-related contributors to parental mental health, parent-specific factors remain underexplored. This study addresses this gap by examining a range of psychiatric concerns in parents of children on the autism spectrum, considering both child and parent-related factors.</p> Methods <p>Participants were drawn from a Korean genetic cohort study on autism multiplex families. Parental mental health was assessed using the Korean-Symptom Checklist 95 (K-SCL95), and measures of autistic traits were collected. Parents with T-scores greater than 70 on the K-SCL95 subdomains were considered to have clinical concern. An exploratory factor analysis (EFA) was conducted to better understand the dimensions of parental mental health. Univariate linear regressions were performed for both child- and parent-related variables, with significant factors subsequently included in multivariate linear regression analyses.</p> Results <p>Among 464 parents, 29.09% had a T-score above 70 on the K-SCL95 subdomain. EFA identified two factors in fathers (“High Sensitivity-Dysregulation” and “Depressive Domain”), and two dimensions in mothers (“High Sensitivity” and “Depressive-Dysregulation”). Parental difficulties in pragmatic language measured by the Broad Autism Phenotype Questionnaire were consistently associated with the mental health dimensions. Child-related factors were largely attenuated after adjustment, although child externalizing behaviors remained positively associated with paternal mental health domains.</p> Conclusions <p>Findings highlight the need for targeted mental health support for parents of children on the spectrum, particularly those with autistic traits, to enhance caregiver well-being.</p>