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. Author manuscript; available in PMC: 2026 Feb 21.
Published before final editing as: J Fam Psychol. 2026 Feb 19:10.1037/fam0001464. doi: 10.1037/fam0001464

Parenting Knowledge Moderates the Association Between Parent and Child Internalizing Symptoms

Claire S Tomlinson 1, Rachel Vaughn-Coaxum 1, Paul A Pilkonis 1, David J Kolko 1, Lan Yu 1, Oliver Lindhiem 1
PMCID: PMC12922502  NIHMSID: NIHMS2140605  PMID: 41712327

Abstract

Parent anxiety and depression are well-established risk factors for childhood internalizing problems. While effective parenting may buffer this relationship, the role of parenting knowledge, defined as understanding evidence-based parenting strategies, remains underexplored. Using a nationally representative sample of 1,000 parents of children aged 5–12, we examined whether parenting knowledge moderated the association between parent and child symptoms of anxiety and depression. Results indicated significant moderation effects: among parents with lower knowledge, there were strong positive associations between parent and child internalizing symptoms, whereas among those with higher knowledge, these associations were significantly weaker. Findings held even after adjusting for key demographic covariates and sensitivity analyses. These results suggest that parenting knowledge may serve as a protective factor within families experiencing psychological distress and highlight its potential as a target for prevention and early intervention efforts. This study contributes to a growing literature on cognitive protective mechanisms in parent-child mental health dynamics.

Keywords: Parent Anxiety, Parent Depression, Child Anxiety, Child Depression, Parenting Knowledge, Moderation

Family Systems and Anxiety and Depression

Anxiety and depression are the most commonly endorsed symptoms of mental health disorders in children (CDC, 2025; Lu, 2019; Racine et al., 2021) with the rate of onset of these symptoms increasing among school-age children (Kessler et al., 2012). One of the strongest risk factors for anxiety and depression symptoms in children is parent depression and anxiety (Johnco et al., 2021; Strawn & Peris, 2025). Although genetics play a significant role in the transmission of psychopathology, psychosocial and environmental factors, including parenting, also contribute to an elevated risk for these symptoms (Aitken et al., 2024).

Family systems theory (Cox & Paley, 1997; Minuchin, 1985) provides a framework for understanding this transmission. The theory posits that parents and children operate within an interdependent emotional system in which changes in one member’s functioning affect the entire family unit. Parent psychopathology, and, in particular, anxiety and depression, can disrupt this system by altering patterns of interaction, emotional communication, and regulation, thereby shaping the child’s immediate environment and emotional development. Parent anxiety and depression may undermine effective parenting practices, reducing warmth and responsiveness, increasing inconsistency, or heightening control, thereby influencing the quality of parent-child interactions and the broader emotional climate. Understanding these relationships through a systems lens highlights how parent functioning, parenting processes, and child outcomes are dynamically interconnected components of a shared regulatory system.

Parent Psychopathology and Parenting

Extensive evidence links parent depressive symptoms with lower levels of warmth, reduced responsiveness, and greater use of harsh or inconsistent discipline (Aaron et al., 2024; Cheung & Theule, 2019; Goodman et al., 2020; Ivanova et al., 2022). Longitudinal findings indicate that parent depression predicts more authoritarian parenting (Chad-Friedman et al., 2024), potentially due to fatigue, sleep disturbance, and reduced motivation (Elgar et al., 2007; Goodman et al., 2011). From a cognitive-behavioral standpoint, depressive cognitions, such as hopelessness or negative self-appraisals about one’s parenting, can impair sensitivity and consistency in parent-child interactions (Connell & Goodman, 2002; Goodman et al., 2011).

Parent anxiety has similarly been associated with hypervigilance, intolerance of uncertainty, and threat sensitivity, which may give rise to over-controlling or overprotective parenting (Ginsburg & and Schlossberg, 2002). These behaviors often reflect attempts to manage the parent’s own distress, but can inadvertently limit children’s autonomy and reinforce anxiety symptoms (McLeod et al., 2007). Both anxiety and depression are also linked to poor sleep quality and impaired stress regulation, which can further compromise calm and consistent parenting (Tikotzky et al., 2015). From a systems perspective, these patterns illustrate how parent psychological functioning interacts with parenting behaviors to influence the broader emotional climate of the family, creating feedback loops that may amplify or mitigate child psychopathology.

Although much of this research focuses on observable parenting behaviors, considerably less is known about parenting knowledge, that is, parents’ understanding of effective child-rearing strategies. Parenting knowledge is conceptually distinct from behavior; it reflects what parents know rather than what they do (Lindhiem et al., 2019). However, this knowledge likely guides behavior, particularly when parents face emotional or cognitive strain. Symptoms of anxiety or depression may interfere with the acquisition or use of accurate parenting knowledge by narrowing attention, fostering negative interpretations of parenting challenges, or reducing engagement with parenting information (Lindhiem et al., 2019). Conversely, greater knowledge of evidence-based strategies may help parents counteract maladaptive cognitions and regulate their responses more effectively, even in the context of psychological distress.

Parenting and Child Psychopathology

Building on the literature reviewed above, extensive evidence has linked parenting behaviors shaped by parent anxiety and depression to child internalizing psychopathology. Meta-analytic work consistently shows that warm, responsive, and consistent parenting is protective, whereas harsh, intrusive, or over-controlling practices confer risk for child anxiety and depression (Clayborne et al., 2021; Goodman et al., 2020; Romero-Acosta et al., 2021; Yap & Jorm, 2015). These findings underscore the family systems view that children’s emotional well-being is embedded within patterns of parent-child interaction and mutual regulation rather than existing in isolation.

However, similar to the body of work linking parent psychopathology to parenting, much of this literature has focused on parenting behaviors, with less attention paid to parenting knowledge, the cognitive foundation that informs how parents interpret and respond to their children’s behavior. Parents with greater knowledge of child development and evidence-based parenting strategies may be better equipped to recognize normative misbehavior, anticipate developmental challenges, and apply consistent, appropriate responses (Lindhiem et al., 2019). In this way, parenting knowledge may shape how parents enact their behaviors and how effectively they regulate emotional exchanges within the family system. Moreover, for parents experiencing anxiety or depression, such knowledge may serve as a stabilizing resource, helping to counteract maladaptive cognitive biases and reduce the likelihood that distress translates into negative parenting behaviors or heightened child psychopathology.

Parenting Knowledge as a Buffer for Child Psychopathology

Parent psychopathology influences parenting behaviors, which in turn are associated with child psychopathology, though few studies have examined these concepts using a moderation model. Parent psychopathology has been linked to less affirming and more hostile parenting behaviors, which in turn predict both child externalizing (Bellina et al., 2020) and internalizing symptoms (Hanetz-Gamliel & Dollberg, 2022). Certain parenting behaviors, such as psychological control and rejection, may also intensify the link between parent depression and child internalizing symptoms (Aunola et al., 2015; Zalewski et al., 2017).

Importantly, as discussed above, observed or self-reported parenting behaviors may differ significantly from parent knowledge of effective and evidence-based parenting practices. The role of parent knowledge of effective parenting practices has been largely unexplored in the relationship between parent and child psychopathology as there is little research due to the lack, until recently, of well-validated measures of parenting knowledge (Lindhiem et al., 2019, 2025). The development of such measures now provides an opportunity to expand our understanding of how cognitive components of parenting, such as what parents know and understand about child development and effective behavior management, may influence intergenerational transmission of psychopathology.

There are several reasons why examining parenting knowledge, rather than behavior alone, represents a valuable contribution. Parenting behaviors are often complex, multi-faceted, and situationally influenced, making them difficult to assess and categorize reliably. In contrast, parenting knowledge, when measured with psychometrically sound instruments, can provide a more consistent and accessible index of parenting competence. Moreover, parenting knowledge may serve as a key cognitive mechanism through which parents manage their own emotional and behavioral responses. For parents experiencing depression or anxiety, conditions often characterized by cognitive distortions, low self-efficacy, and emotion (American Psychiatric Association, 2013), greater understanding of effective parenting strategies may help reframe negative thoughts about their child’s behavior, reduce self-blame, and promote more adaptive coping. In this way, parenting knowledge may function similarly to cognitive-behavioral processes taught in therapy: identifying and challenging maladaptive thoughts, enhancing problem-solving skills, and supporting behavioral consistency even in the face of distress (Dix & Meunier, 2009). Within the broader family system, such cognitive scaffolding may help parents respond more calmly and predictably, fostering a more regulated family environment and reducing the likelihood that symptoms are transmitted across generations.

Method

Current Study

The current study evaluated parenting knowledge as a moderator between parent depression and anxiety symptoms, and parent reports of child symptoms. Given that the association between parent to child transmission of psychopathology is stronger than child to parent psychopathology (Xerxa et al., 2021), both through genetic risk transmission and environmental influences (Goodman et al., 2011; Van Loon et al., 2014), we chose to evaluate knowledge as a moderator between parent and child symptoms unidirectionally.

Overview

The study was approved by the Institutional Review Board at the University of Pittsburgh, which waived written informed consent due to the survey nature of the study. All study measures were administered to a national sample of parents/guardians of children aged 5–12 as part of a larger study (Lindhiem et al., 2025). The sample was collected in February 2024.

Transparency and Openness

We report how we determined our sample size, all data exclusions, all manipulations, and all measures in the study, and we follow JARS (Appelbaum et al., 2018). All data, analysis code, and research materials are available upon request. Data were analyzed using R, version 4.0.0 (R Core Team, 2020) and the package ggplot, version 3.2.1 (Wickham, 2016). This study’s design and its analysis were not pre-registered.

Participants

The dataset was generated from a national sample of biological parents or legal guardians of children aged 5–12 (N = 1,000, 56.7% female, 76.2% white, average parent age = 40.0, average child age = 8.8 years). The sample was selected to be representative of parents of school-aged children in the United States on key demographic variables including age, gender, race, and education. Parents were asked to report on the mental health symptoms of their child, or, in the case of multiple children in the age range, the child with the most recent birthday, along with their parenting knowledge and their own symptoms of anxiety and depression. Parent and child demographic data are summarized in Table 1.

Table 1.

Child and Parent Demographic Information (N=1,000)

Parent/Guardian Age M = 40.0; SD = 7.4
Parent/Guardian Gender
 Female 56.7%
 Male 42.5%
 Nonbinary or gender non-confirming 0.5%
 Prefer not to say 0.3%
Child Age M = 8.8; SD = 2.2
Child Gender
 Female 45.5%
 Male 54.0%
 Nonbinary or gender non-confirming 0.2%
 Prefer not to say 0.3%
Parent/Guardian Race
 White 76.2%
 Black or African American 13.6%
 Asian 4.8%
 American Indian or Alaska Native 3.7%
 Native Hawaiian or Pacific Islander 0.6%
 Some other race 5.0%
Parent/Guardian Ethnicity
 Hispanic, Latino, or Spanish Origin 17.9%
Parent/Guardian Education
 High school or lower 29.6%
 Some college or higher 70.4%
Annual Household Income
 Less than $30,000 12.3%
 $30,000 – $49,999 11.7%
 $50,000 – $74,999 17.8%
 $75,000 – $99,999 18.6%
 $100,000 and above 34.4%
 Prefer not to say 5.2%
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Procedures

Over two million US residents participate in YouGov panels and have been recruited through web advertising, permission-based email campaigns, partner contacts, random digit dialing, and postal mail. YouGov surveyed 1,102 parents of children ages 5–12, who were then used to create the final sample of 1,000. The eligibility rate for the survey was 66.7% and the response rate was 57.8%. The sampling frame was constructed by mirroring stratified sampling from a parents-only subset of the 2020 American Community Survey (ACS) sample. The YouGov matched cases were weighted to the sampling frame using propensity scores. The propensity score function included age, gender, race/ethnicity, years of education, marital status, employment status, and region. The YouGov matched cases and the ACS subsample were combined, and a logistic regression was estimated for inclusion in the frame. The propensity scores were grouped into deciles, and post-stratified according to these deciles. Participants were compensated with a $25 gift card for completing the full survey.

Measures

Parent Anxiety: Generalized Anxiety Disorder-7

The GAD-7 is a seven-item self-report screening measure for assessing the severity of generalized anxiety disorder symptoms. Parents were asked to rate symptoms experienced during the prior three months. Items are scaled from not at all to nearly every day; example item: “Feeling nervous, anxious, or on edge.” Scores range from 0–21, with 10 or higher indicating clinically significant symptoms in the moderate (10–14) to severe (15+) range. The measure has excellent internal consistency (Cronbach’s α of 0.92), with strong test-retest reliability, and evidence for convergent validity (Spitzer et al., 2006).

Parent Depression: Patient Health Questionnaire-8

The PHQ-8 is an eight-item self-report measure assessing depressive symptoms during the prior three months. Items are scaled from not at all to nearly every day; example item: “Little interest or pleasure in doing things.” Scores range from 0–24, with 10 or higher falling within the clinical range of moderate (10–14) to severe (15+) symptoms. The measure has a Cronbach’s α of 0.82 and has satisfactory construct validity (Pressler et al., 2011).

Child Anxiety: Screen for Child Anxiety Related Disorders (SCARED) Parent Report

The SCARED is a 41-item parent-report measure of child anxiety symptoms, including generalized anxiety, separation anxiety, social phobia, panic disorder, and school phobia. Parents were asked about symptoms during the prior three months. Items are scaled from 0 = not true or hardly ever true to 2 = very or often true; example item: “My child worries about going to school.” Total scores range from 0–82. The internal consistency of the SCARED is good with Cronbach’s alphas ranging from .74 to .93. The measure has strong convergent and divergent validity (Birmaher et al., 1997; Sequeira et al., 2020). Tests of criterion validity suggest a cut-off score of 25 for optimal prediction of symptoms consistent with an anxiety disorder (Birmaher et al., 1997).

Child Depression: Mood and Feelings Questionnaire (MFQ) Parent Report

The MFQ is a 34-item parent-report measure of depressive symptoms in children (Costello & Angold, 1988). Parents rated how often their child experienced each symptom during the prior three months. Items are scaled from 0 = not true to 2 = true; example item: “My child felt miserable or unhappy.” Scores range from 0–68, with higher scores indicating greater depressive symptom severity. The measure has very high internal consistency (Cronbach’s alpha = .94) and strong construct validity. Tests of criterion validity suggest 25 as a cut-off score for optimal prediction of symptoms consistent with a depressive disorder (Kent et al., 1997).

Parenting Knowledge: Knowledge of Effective Parenting Test - Internalizing (KEPT - I)

The KEPT-I (Lindhiem et al., 2025) is a 22-item measure of parent knowledge of effective parenting strategies. The measure was developed as a potential treatment target for evidence-based psychosocial treatments of childhood internalizing disorders. The KEPT–I evaluates knowledge of exposure principles, relaxation, warmth, involvement, behavioral activation, reduction of criticism, and cognitive reframing. Items are scored 0 (incorrect) or 1 (correct); example items: “Justin (age 7) is afraid to go into the ocean. What is the best way to help him?” and “Nyla (age 7) loves music and you notice she has been feeling ‘on edge’ recently. What is one way to help her relax?” Scores range from 0–22, with higher scores reflecting greater knowledge of effective parenting strategies. The measure has good internal consistency (Cronbach’s alpha = .82). The measure also demonstrated convergent validity with other measures of parenting knowledge and parenting related constructs (e.g., child behavior, child psychopathology).

Statistical Analyses

Linear regression models were used to evaluate whether parenting knowledge moderated the association between parent internalizing symptoms (anxiety and depression) and child internalizing symptoms (anxiety and depression). Predictor, moderator, and outcome variables were standardized (z-scored) to facilitate interpretation of regression coefficients. Separate models were estimated for each outcome (child anxiety and child depression), with corresponding parent symptom measures entered as predictors. Parenting knowledge was entered as a moderator. Interaction terms were computed by multiplying the standardized parent internalizing symptom variable with the standardized parenting knowledge variable. Each model included the main effects of parent symptoms and parenting knowledge, as well as their interaction. Standardized regression coefficients, confidence intervals, standard errors, and p-values were computed. Missing data were minimal (<0.05%) and were handled through listwise deletion.

To probe significant interactions, parenting knowledge was dichotomized at the sample median into high and low knowledge groups. Interactions were further evaluated using simple slopes analysis with the interactions package in R, which evaluated the strength and direction of the relationship between parent and child symptoms at low and high levels of parenting knowledge. Effect sizes were evaluated using both total model R2 values and partial R2 values to estimate the unique variance explained by interaction terms. Partial R2 values were computed via nested model comparisons using the anova function, by comparing models with and without the interaction term. Partial R2 values were converted to f2 to allow for interpretation according to the effect size benchmarks indicated by Cohen (Cohen, 1988) as small (.02), medium (.15), and large (.35).

To evaluate the robustness of the observed moderation effects and to rule out the influence of potential third variable confounds, we conducted secondary analyses. In these models, we included several relevant demographic covariates: parent gender, parent age, parent income, and parent education. These covariates were selected based on existing literature linking them to the primary variables of interest (Bornstein et al., 2022; McLean et al., 2011; Salk et al., 2017; Shahbazi et al., 2022). These covariates were entered simultaneously within each model. The purpose of these analyses was to determine whether the interaction between parent psychopathology and parenting knowledge remained statistically significant after adjusting for potential demographic influences. Interaction terms were considered robust if they remained significant at p < .05 in these adjusted models.

In addition, we conducted sensitivity analyses to evaluate whether the observed moderation effects were specific to the parent psychopathology variable evaluated (i.e., parent anxiety or parent depression) rather than reflecting the general relationship between internalizing symptoms. To do so, each model included the alternate dimension of parent psychopathology as an additional covariate (e.g., parent depression was added as a covariate in models predicting child anxiety). This approach allowed us to examine whether the interaction between the parent symptom of interest and parenting knowledge predicted child outcomes above and beyond shared variance with the other parent symptom.

Results

Descriptive Results

See Table 2 for descriptive statistics for all measures. On average, parents reported low levels of anxiety and depression, and, for their children, reported below threshold levels of anxiety and depression. However, approximately a fifth of parents reported symptoms above the clinical threshold for anxiety (15.0%) and depression (18.1%). Nearly a quarter of parents (23.6%) indicated that their child experienced anxiety symptoms above the cutoff, while just under ten percent (9.6%) of parents indicated that their child experienced depression symptoms above the clinical cutoff. Across the sample, parents reported average knowledge levels about parenting. Examination of skewness and kurtosis indicated that all variables were approximately normally distributed. Most measures showed mild positive skew consistent with low symptom levels, and values were within acceptable limits for parametric analyses (|skew| < 3, |kurtosis| < 8; Kline, 2023).

Table 2.

Descriptive Statistics of Measures

Measure M SD N
Patient Health Questionnaire-8 4.53 5.35 1,000
Mood and Feelings Questionnaire 7.31 10.54 999
Generalized Anxiety Disorder-7 4.10 4.93 1,000
Screen for Child Anxiety Related Disorders 17.48 14.31 997
Knowledge of Effective Parenting Test-Internalizing Score 15.29 4.46 1,000
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See Table 3 for a correlation matrix of all variables of interest and demographic covariates. Parent age was weakly correlated with all variables of interest, and parent gender was moderately correlated with parenting knowledge. Anxiety and depression scores were strongly correlated in both adults and children, which is the usual finding (Hirshfeld-Becker et al., 2008; Micco et al., 2009)

Table 3.

Correlation Matrix of Demographic and Model Variables

1 2 3 4 5 6 7 8 9
1. Parent Age -- .15** .18** .13** −.13** −.11** −.14** −.14** .16**
2. †Gender -- .10** .15** .00 .10** −.02 .05 −.28**
3. †Education (no college vs. some college) -- .42** −.07* 0.04 −0.05 −.02 .04
4. †Income (above and below mean) -- −.08* .07* −0.05 −0.03 −.06
5. Patient Health Questionnaire-8 Total -- .58** .82** .56** −.11**
6. Mood and Feelings Questionnaire Total -- .52** .78** −.34**
7. Generalized Anxiety Disorder-7 Total -- .52** −.08*
8. Screen for Child Anxiety Related Emotional Disorders Total -- −.27**
9. Knowledge of Effective Parenting Test-Internalizing Score --
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Note.

*

Correlation is significant at the 0.05 level (2-tailed);

**

Correlation is significant at the 0.01 level (2-tailed).

†

Indicates point-biserial correlation (dichotomous variables)

Depression

The linear regression model (i.e., child depression symptoms as predicted by parent depression symptoms, moderated by parenting knowledge) was significant, R2 = .50, F (3, 995) = 331.70, p < .001. The interaction between standardized values of parent depression and parenting knowledge was also significant, β = −0.28, SE = 0.02, t = −13.31, p < .001, documenting that the strength of the relationship between parent and child depression varied by level of parenting knowledge (see Table 4).

Table 4.

Interactive Regression Models Predicting Child Psychopathology, from Parent Psychopathology and Parent Knowledge

Outcome Variable Estimate 95% Confidence Interval SE t-value p-value
LL UL
Child Depression Parent Depression 0.49 0.45 0.54 0.02 21.38 <.001
Parent Knowledge −0.23 −0.27 −0.18 0.02 −10.00 <.001
Parent Depression × Parent Knowledge −0.28 −0.32 −0.24 0.02 −13.31 <.001
Child Anxiety Parent Anxiety 0.47 0.42 0.52 0.03 18.44 <.001
Parent Knowledge −0.20 −0.25 −0.15 0.03 −7.91 <.001
Parent Anxiety × Parent Knowledge −0.20 −0.25 −0.15 0.02 −8.41 <.001
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Note. All variables z-scored. LL=lower limit; UL=upper limit; SE = standard error.

Simple slopes analyses, using the dichotomized values of parenting knowledge, were conducted to further examine the interaction. When parenting knowledge was low, parent depression was strongly and positively associated with child depression (β = 0.79, SE = 0.03, t = 25.04, p < .001). When parenting knowledge was high, this association remained significant but was substantially weaker (β = 0.25, SE = 0.04, t = 6.67, p < .001). The interaction term explained a unique 15% of the variance in child depression symptoms (partial R2 = .15, f2 = .18). These results illustrate that parenting knowledge significantly buffers the strength of association between parent child depression symptoms. See Figure 1 for a visualization of the interaction, using non-standardized scores.

Figure 1.

Figure 1

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Parent Knowledge Moderates the Relationship Between Parent and Child Depression. Child depression scores are plotted on the y-axis and parent depression scores on the x-axis; both axes represent observed (non-standardized) scores from the respective measures. *** indicates a statistically significant simple slope at p < .001.

Anxiety

The linear regression model (i.e., child anxiety as predicted by parent anxiety, moderated by parenting knowledge) was significant, R2 = .37, F (3, 993) = 197.50, p < .001. The interaction between standardized values of parent anxiety and parenting knowledge was statistically significant, β = −0.20, SE = 0.02, t = −8.41, p < .001, indicating that the association between parent and child anxiety differed as a function of parenting knowledge (see Table 4).

Simple slopes analyses, using the dichotomized values of parenting knowledge, revealed that at low levels of parenting knowledge, parent anxiety was strongly and positively associated with child anxiety (standardized β = 0.65, SE = 0.03, t = 18.74, p < .001). At high levels of parenting knowledge, this association remained significant but was weaker (β = 0.33, SE = 0.04, t = 8.04, p < .001). These results indicate that parenting knowledge buffered the strength of the association between parent and child anxiety. The interaction term accounted for a partial R2 of .06 (f2 = .06). See Figure 2 for a visualization of the interaction, using non-standardized scores.

Figure 2.

Figure 2

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Parent Knowledge Moderates the Relationship Between Parent and Child Anxiety. Child anxiety scores are plotted on the y-axis and parent anxiety scores on the x-axis; both axes represent observed (non-standardized) scores from the respective measures. *** indicates a statistically significant simple slope at p < .001.

Covariate Analyses

We entered several covariates (parent gender, parent age, parent income, and parent education) into each model to evaluate the strength of the interaction when accounting for additional third variables. Regarding the depression findings, when all four covariates were entered alongside the interaction, the R2 value was attenuated slightly (.48 vs. .50) compared to the main analysis. The partial R2 value for the interaction term also decreased slightly with the inclusion of the covariates (.14 vs. .15). Regarding the anxiety findings, when all four covariates were entered alongside the interaction, the R2 value was also attenuated slightly (.36 vs. .37), similar to the depression findings. However, the partial R2 for the interaction term remained the same (.06). These results support the robustness of the main findings, documenting that demographic confounds did not have a significant impact on the moderator effects.

Sensitivity Analyses

To further evaluate the specificity of these effects, sensitivity analyses were conducted in which the alternate dimension of parent psychopathology was included as a covariate (e.g., parent depression was added to models predicting child anxiety). Across all models, the interaction between parent psychopathology and parenting knowledge remained statistically significant (ps < .05), indicating that the moderating effects of parenting knowledge were robust to adjustment for co-occurring parent internalizing symptoms.

Discussion

Findings from the current study indicated that parenting knowledge served as a moderator between parent and child anxiety and depression symptoms, with a moderate effect size, even when controlling for covariates of theoretical relevance, and following sensitivity analyses. Specifically, among parents with lower levels of knowledge, there was a strong positive relationship between parent anxiety and depression and child anxiety and depression. However, among parents with higher levels of knowledge, the relationship was significantly attenuated. In sum, parenting knowledge appears to buffer the relationship between parent and child internalizing symptoms. Effect sizes were larger when evaluating the role of parent and child depression symptoms compared to the role of parent and child anxiety symptoms.

These findings are consistent with prior literature highlighting the protective role of positive parenting strategies in mitigating the effects of parent psychopathology on child outcomes (Clayborne et al., 2021; Romero-Acosta et al., 2021; Yap & Jorm, 2015). Several theoretical arguments may explain these observed findings. From a family systems perspective, parents and children operate within an interdependent system in which disruptions in parent emotional or cognitive functioning can influence patterns of interaction and the child’s emotional environment (Cox & Paley, 1997; Dunst, 2023; Minuchin, 1985). Within this context, parenting knowledge may provide a cognitive scaffold that helps parents interpret and respond to their children’s behavior more adaptively, even when parents are experiencing psychological distress.

From a cognitive-behavioral perspective, greater knowledge of evidence-based parenting practices may help parents reframe maladaptive cognitive patterns common in anxiety and depression, such as catastrophizing or negative interpretation biases, grounding their reactions in developmentally appropriate expectations (Lee et al., 2016). Knowledge may support more intentional and reflective caregiving, enhancing parents’ ability to pause, assess the situation, and choose responses informed by best practices rather than automatic, distress-driven reactions. For parents with high levels of depressive or anxiety symptoms, knowledge may not guarantee behavioral implementation but can still mitigate negative effects by promoting reflection, problem-solving, and emotion regulation (American Psychiatric Association, 2013; Dix & Meunier, 2009). Within the broader family system, such cognitive scaffolding may help parents respond more calmly and predictably, fostering a more regulated environment and reducing the likelihood that symptoms are transmitted across generations.

Moderator Strength Across Predictors

We also observed that the effect size of parenting knowledge was larger in models involving parent depression compared to parent anxiety. One possible explanation is that depression, characterized by disengagement and low motivation, may more directly impair parenting behavior (American Psychiatric Association, 2013; Goodman et al., 2011; Lovejoy et al., 2000). In contrast, anxiety is often associated with worry and overcontrol, which can lead to intrusive but still engaged parenting styles (McLeod et al., 2007). These behaviors may be less easily altered by knowledge alone, particularly if they are negatively reinforced by lessening perceptions of risk and diminishing worry. Alternatively, our findings may be impacted by the measurement instruments we used to assess parent depression and anxiety. While the measure for parent depression, the PHQ-8, has several items related to daily functioning and interpersonal withdrawal, which may map onto parenting behaviors, the measure for parent anxiety, the GAD-7, focuses on internal worry and physiological symptoms, which may not be associated as clearly with observable parenting behaviors (Pressler et al., 2011; Spitzer et al., 2006).

Research and Clinical Implications

Parenting knowledge can be assessed efficiently and reliably using brief, standardized tools (Lindhiem et al., 2019, 2025). These characteristics make it suitable for use in both research and clinical settings, particularly for developing assessment batteries that can inform treatment planning. For example, clinicians and researchers may use knowledge assessments to triage families into varying levels of parenting support, identify those who may benefit most from psychoeducational components, or supplement behavioral interventions with cognitive scaffolding.

Further, existing evidence suggests that parents with elevated internalizing symptoms often derive reduced benefit from traditional parent management training (Chronis et al., 2006; Kazdin, 2003). For these parents, symptoms such as fatigue, concentration difficulties, and low self-efficacy may interfere with their ability to absorb, understand, and implement complex behavioral techniques (Dix & Meunier, 2009; Goodman & Gotlib, 1999). Increasing parenting knowledge may serve as a lower burden treatment target that helps parents gain foundational understanding and confidence that then paves the way for implementation of behavioral components. Improving a parents’ understanding of effective parenting practices may equip parents with cognitive tools needed to navigate parenting challenges, even in the context of their own psychological distress. Additionally, knowledge may also function as a protective cognitive scaffold, promoting better interpretation of child behavior, and more regulated parenting responses.

Strengths and Limitations

While the current study had several strengths, including a large, nationally representative dataset and the use of well-validated measures, it is important to note two limitations. First, the study was cross-sectional in design, which limits our ability to draw conclusions about temporal or causal processes. However, this concern may be partially mitigated by the nature of the moderator variable. Parent knowledge of evidence-based parenting strategies is generally considered a relatively stable cognitive construct, not subject to short-term fluctuations (Bornstein et al., 2022). Second, we relied on a single informant, parents, for both predictor and outcome measures, including symptoms of anxiety and depression in both parents and children. Our methodology choice was grounded in developmental research indicating that parents are the most reliable reporters of internalizing symptoms in school-aged children, particularly for behaviors that may not be externally visible to teachers or peers (De Los Reyes & Kazdin, 2005). Although parents with elevated psychopathology may overestimate child symptoms (Najman et al., 2000), the consistency of our findings across multiple models and outcomes suggests that reporting bias alone is unlikely to account for the observed effects.

Conclusions

The current study provides evidence of the moderating role of parenting knowledge in the context of parent and child psychopathology. By highlighting the role of parenting knowledge, this study offers new directions for both research and intervention, emphasizing the role such knowledge may serve in improving child mental health outcomes. Future research should investigate the role of parenting knowledge using methodologically rigorous designs to elucidate how it can be used most effectively as a component of both assessment and intervention.

Funding Statement:

This study was supported by a grant to the last author from National Institute of Health / Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD108140).

Footnotes

Ethical Considerations: The Institutional Review Board (IRB) at the University of Pittsburgh reviewed and approved the study (Study number: STUDY23100020), approval date: 10/20/2023). Written informed consent was waived due to the nature of the data used for this study (i.e., survey-based).

Declaration of Conflicting Interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Availability of Data and Materials:

Data for the current study may be accessed by contacting the corresponding author.

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This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data for the current study may be accessed by contacting the corresponding author.

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