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Autistic children experience more externalizing and internalizing symptoms relative to non-autistic peers. Higher quality parent-teacher relationships (PTR) may support children's adjustment. At the same time, higher levels of these mental health difficulties may create a strained relationship between parents and teachers. Therefore, the relation between PTR quality and externalizing or internalizing symptoms may be bidirectional. This study examined the longitudinal associations between PTR quality and externalizing or internalizing symptoms among 192 autistic children (91% boys, ages 4–8 years) across three assessments spanning two academic years. Eight cross-lagged panel analyses were conducted to examine how parent-rated PTR quality and teacher-rated PTR quality relate to parent-rated or teacher-rated externalizing and internalizing symptoms. Results showed that (1) parent-rated symptoms appeared to drive changes in PTR quality; this pattern was more consistently shown with parent-rated externalizing symptoms than with internalizing symptoms. (2) Teacher-rated symptoms did not drive changes in PTR quality. Finally, (3) there was no support for a relationship-driven or a reciprocal model; in other words, PTR quality did not contribute to changes in children's externalizing or internalizing symptoms over time. Higher parent-reported child symptoms appeared to predict reduced PTR quality across multiple teachers, school years, and classroom contexts. Addressing children's elevated mental health problems may take a toll on parents' and teacher's ability to collaborate effectively over time. The results demonstrate the importance of interventions targeting child internalizing and externalizing symptoms at home, which may indirectly improve PTR quality. • First study to examine the transactional effects of parent teacher relationships and mental health symptoms in autistic children. • Parent perceptions of elevated internalizing and externalizing symptoms impacted relationships between parents and teachers. • Children's elevated mental health symptoms may take a toll on parents' and teacher's ability to collaborate effectively. • Parent-teacher relationship quality did not impact changes in children's externalizing or internalizing symptoms over time. [ABSTRACT FROM AUTHOR]