Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism

The association between personality traits and third-party moral judgment: A preregistered study

The present preregistered study investigated the relationship between personality traits and third-party moral judgment, with specific predictions about honesty-humility, emotionality, and conscientiousness. Participants (N = 405) completed the HEXACO personality questionnaire and read short narratives describing the interaction between an agent and a victim. We manipulated the intent of the agent (harmful or neutral) and the outcome for the victim (harmful or neutral) and participants judged the agent's behavior. While higher honesty-humility was associated with harsher judgment overall, higher emotionality was associated with harsher judgment of a malevolent agent, and higher conscientiousness was associated with harsher judgment of an agent who harmed intentionally. The results thus suggest that third-party moral judgment is selectively related to personality traits depending on the agent's intention.

Ventrolateral prefrontal hemodynamic responses in autism spectrum disorder with and without depression

In clinical settings, autism spectrum disorder (ASD) with comorbid depression is often difficult to diagnose, and should be considered in treatment. However, to our knowledge, no functional imaging study has examined the difference between ASD adolescents with and without comorbid depression. We aimed to compare the characteristics and prefrontal brain function of ASD with and without depression in order to identify a biological marker that can be used to detect the difference. Twenty-eight drug-naïve adolescents with ASD (14 ASD with and 14 ASD without depression) and 14 age- and gender-matched adolescents with typical development were evaluated using several variables. These included intelligence quotient, autism quotient, depression severity using the Beck Depression Inventory 2nd edition (BDI-II), and level of social functioning using the Social Adaptation Self-evaluation Scale (SASS). In addition, frontotemporal hemodynamic responses during a verbal fluency task (VFT) were measured using functional near-infrared spectroscopy (fNIRS). The ASD group, including both of the ASD with and ASD without depression groups, showed smaller hemodynamic responses than the typical development group in portions of the left dorsolateral prefrontal cortex (DLPFC), bilateral ventrolateral prefrontal cortex (VLPFC) and anterior part of the temporal cortex (aTC) during the VFT. Moreover, the smaller hemodynamic responses in the right VLPFC during the VFT in the ASD group were associated with the worse BDI-II and SASS scores. Furthermore, the ASD with depression group showed smaller hemodynamic responses in the right VLPFC during the VFT than the ASD without depression group in a direct comparison. Adolescents with ASD showed reduced activation in broad frontotemporal regions during a cognitive task compared with those with typical development. More specifically, the right VLPFC activation reflected the level of self-estimated depression and social functioning in the ASD subjects, and could be used to discriminate between ASD adolescents with and without depression.

Social-Specific Impairment of Negative Emotion Perception in Alexithymia

Alexithymia has been characterized as an impaired ability of emotion processing and regulation. The definition of alexithymia does not include a social component. However, there is some evidence that social cognition may be compromised in individuals with alexithymia. Hence, emotional impairments associated with alexithymia may extend to socially relevant information. Here, we recorded electrophysiological responses of individuals meeting the clinically relevant cutoff for alexithymia (ALEX; n = 24) and individuals without alexithymia (NonALEX; n = 23) while they viewed affective scenes that varied on the dimensions of sociality and emotional valence during a rapid serial visual presentation task. We found that ALEX exhibited lower accuracy and larger N2 than NonALEX in the perception of social negative scenes. Source reconstruction revealed that the group difference in N2 was localized at the dorsal anterior cingulate cortex. Irrespective of emotional valence, ALEX showed stronger alpha power than NonALEX in social but not non-social conditions. Our findings support the hypothesis of social processing being selectively affected by alexithymia, especially for stimuli with negative valence. Electrophysiological evidence suggests altered deployment of attentional resources in the perception of social-specific emotional information in alexithymia. This work sheds light on the neuropsychopathology of alexithymia and alexithymia-related disorders.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory

BACKGROUND

Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults.

METHODS

This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1-40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a "general alexithymia" factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample.

RESULTS

The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with "TAS" no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants.

LIMITATIONS

Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations.

CONCLUSIONS

These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia ).

Examination of professional biases about autism: how can we do better?

This paper lends a critical eye to six common assumptions/biases about autism that may influence neuropsychologists in their clinical work. These biases are based on research as well as the historical roots of the study of autism. Our goal is to encourage curiosity and reflection on these biases in order to improve neuropsychological service delivery for people on the autism spectrum. Methods: We argue that psychologists should strive to understand the function of behaviours observed with autism in order to offer helpful supports. We explore the assertions that autism is not a dichotomous or linear construct and that the use of high and low functioning descriptors are not useful nor appreciated by the autism community. We discuss the widely held beliefs that individuals on the autism spectrum lack theory of mind, empathy and social motivation. Importantly, people on the autism spectrum are telling us that the dialogue about them around theory of mind and empathy is a human rights issue. Finally, we discuss the role of standardized testing. Conclusions: Through an exploration of research literature, the writings of scholars and advocates on the autism spectrum, and personal, clinical and research experience we encourage our profession to take a leadership role in examining biases and changing the clinical and research landscape so that it better reflects respectful discourse for individuals on the autism spectrum. This is critical to reduce the stigma that continues to be associated with autism and has a negative affect on mental health and quality of life.

How to improve healthcare for autistic people: A qualitative study of the views of autistic people and clinicians

LAY ABSTRACT

Research has shown that on average, autistic people are more likely to die earlier than non-autistic people, and barriers can stop autistic people accessing healthcare. We carried out a study where we interviewed healthcare professionals (including doctors and nurses), and held discussion groups of autistic people. Our results highlighted several key points: seeing the same professional is important for autistic people and clinicians; both clinicians and autistic people think making adjustments to healthcare is important (and often possible); autistic people process information in a different way and so may need extra support in appointments; and that clinicians are often constrained by time pressures or targets.

Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting

The guidance available for tailoring mental health services for autistic people is limited and dispersed. Practitioners attempting to appropriately adapt mental healthcare and therapy provision report low confidence and inconsistency in their approach. This study contributes to the guidance by providing a shortlist of usable and priority adaptations for diagnostic and therapy services as described by multidisciplinary staff members responsible for the design and delivery of a specialist autism service in the UK. Individual freelisting interviews were conducted with 15 staff, who were asked to list the ways that they adapt their practice individually, within therapy, and collectively as a service. Salience and cultural consensus analyses demonstrated the following agreed priority service adaptations: ensuring the suitability of the service environment with consideration of sensory demands, adapting communication, knowing individual gender identity preferences and minimising client uncertainty. Detailed examples are given for flexibly adapting therapy to individual needs to inform general and specialist services. The findings require replication and evaluation.

Alexithymia Is Associated With Deficits in Visual Search for Emotional Faces in Clinical Depression

Background: The concept of alexithymia is characterized by difficulties identifying and describing one's emotions. Alexithymic individuals are impaired in the recognition of others' emotional facial expressions. Alexithymia is quite common in patients suffering from major depressive disorder. The face-in-the-crowd task is a visual search paradigm that assesses processing of multiple facial emotions. In the present eye-tracking study, the relationship between alexithymia and visual processing of facial emotions was examined in clinical depression. Materials and Methods: Gaze behavior and manual response times of 20 alexithymic and 19 non-alexithymic depressed patients were compared in a face-in-the-crowd task. Alexithymia was empirically measured via the 20-item Toronto Alexithymia-Scale. Angry, happy, and neutral facial expressions of different individuals were shown as target and distractor stimuli. Our analyses of gaze behavior focused on latency to the target face, number of distractor faces fixated before fixating the target, number of target fixations, and number of distractor faces fixated after fixating the target. Results: Alexithymic patients exhibited in general slower decision latencies compared to non-alexithymic patients in the face-in-the-crowd task. Patient groups did not differ in latency to target, number of target fixations, and number of distractors fixated prior to target fixation. However, after having looked at the target, alexithymic patients fixated more distractors than non-alexithymic patients, regardless of expression condition. Discussion: According to our results, alexithymia goes along with impairments in visual processing of multiple facial emotions in clinical depression. Alexithymia appears to be associated with delayed manual reaction times and prolonged scanning after the first target fixation in depression, but it might have no impact on the early search phase. The observed deficits could indicate difficulties in target identification and/or decision-making when processing multiple emotional facial expressions. Impairments of alexithymic depressed patients in processing emotions in crowds of faces seem not limited to a specific affective valence. In group situations, alexithymic depressed patients might be slowed in processing interindividual differences in emotional expressions compared with non-alexithymic depressed patients. This could represent a disadvantage in understanding non-verbal communication in groups.

Objective and Subjective Measurement of Alexithymia in Adults with Autism

High rates of alexithymia, a condition characterised by difficulties identifying and describing emotions, are frequently reported in both children and adults with autism spectrum disorder (ASD). However, the dilemma of measuring alexithymia via self-report has rarely been addressed. In this study, we compared objective and subjective measures of alexithymia in adults with ASD and typically developing adults. We found significantly higher levels of alexithymia in the ASD sample as measured by both self-report on the Toronto Alexithymia Scale (TAS-20) and by the observer rated Alexithymia Provoked Response Scale (APRQ). However, the two measures did not correlate with each other. We explore the different facets of the alexithymia construct that these two measures may be distinguishing.

Brief Report: Visuospatial and Spoken Language Recall in Autism: Preliminary Findings

Challenges to verbal encoding may affect the ability of autistic individuals to express their ideas. Therefore, visuospatial expression may represent a person's knowledge and skills more accurately than spoken language. To test this hypothesis, we asked seven autistic adults to linguistically retell and visuospatially reenact several animated clips. On average, visuospatial responses contained more correct elements than spoken responses. The level of intention of the three stimulus categories did not systematically affect response accuracy. Participants who produced visuospatial responses before spoken responses and those who had watched a greater number of stimuli assigned higher intentionality to shapes in the animations that were designed to elicit mentalizing. The modality used for expression may affect accuracy of responses by autistic individuals.

Alexithymic But Not Autistic Traits Impair Prosocial Behavior

Social impairments are a core feature of autism-spectrum disorders. However, there is a considerable variability in these impairments. Most autistic individuals show large impairments in social functioning but some autistic individuals show small impairments in social functioning. The variability of these impairments has been attributed to the presence or absence of alexithymia. To address this issue, we capitalized on the fact that alexithymic and autistic traits are broadly distributed in the population. This allowed us to investigate how alexithymic and autistic traits affect social functioning in healthy individuals. Healthy individuals showed impairments on a resource-allocation task that were due to alexithymic but not autistic traits. These findings suggest that alexithymic rather than autistic traits impair prosocial behavior across the autism-spectrum.

The Impact of a Novel Mimicry Task for Increasing Emotion Recognition in Adults with Autism Spectrum Disorder and Alexithymia: Protocol for a Randomized Controlled Trial

Background

Impaired facial emotion expression recognition (FEER) has typically been considered a correlate of autism spectrum disorder (ASD). Now, the alexithymia hypothesis is suggesting that this emotion processing problem is instead related to alexithymia, which frequently co-occurs with ASD. By combining predictive coding theories of ASD and simulation theories of emotion recognition, it is suggested that facial mimicry may improve the training of FEER in ASD and alexithymia.

Objective

This study aims to evaluate a novel mimicry task to improve FEER in adults with and without ASD and alexithymia. Additionally, this study will aim to determine the contributions of alexithymia and ASD to FEER ability and assess which of these 2 populations benefit from this training task.

Methods

Recruitment will primarily take place through an ASD community group with emphasis put on snowball recruiting. Included will be 64 consenting adults equally divided between participants without an ASD and participants with an ASD. Participants will be screened online using the Kessler Psychological Distress Scale (K-10; cut-off score of 22), Autism Spectrum Quotient (AQ-10), and Toronto Alexithymia Scale (TAS-20) followed by a clinical interview with a provisional psychologist at the Federation University psychology clinic. The clinical interview will include assessment of ability, anxiety, and depression as well as discussion of past ASD diagnosis and confirmatory administration of the Autism Mental Status Exam (AMSE). Following the clinical interview, the participant will complete the Bermond-Vorst Alexithymia Questionnaire (BVAQ) and then undertake a baseline assessment of FEER. Consenting participants will then be assigned using a permuted blocked randomization method into either the control task condition or the mimicry task condition. A brief measure of satisfaction of the task and a debriefing session will conclude the study.

Results

The study has Federation University Human Research Ethics Committee approval and is registered with the Australian New Zealand Clinical Trials. Participant recruitment is predicted to begin in the third quarter of 2021.

Conclusions

This study will be the first to evaluate the use of a novel facial mimicry task condition to increase FEER in adults with ASD and alexithymia. If efficacious, this task could prove useful as a cost-effective adjunct intervention that could be used at home and thus remove barriers to entry. This study will also explore the unique effectiveness of this task in people without an ASD, with an ASD, and with alexithymia.

Trial Registration

Australian New Zealand Clinical Trial Registry ACTRN12619000705189p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377455

International Registered Report Identifier (IRRID)

PRR1-10.2196/24543

Family Functioning and Multiple Sclerosis: Study Protocol of a Multicentric Italian Project

Multiple Sclerosis (MS) is a chronic inflammatory and neurodegenerative disease, which not only affects physical functioning, but is also associated with cognitive impairments and great psychological distress. The combination of those symptoms may have negative consequences on the family functioning of patients with MS, with detrimental effects on both marital relationships and parental bonding. Furthermore, the presence of individual characteristics and of an adequate social support may also contribute to the quality and endurance of family relationships. Particularly, high levels of alexithymia, a personality trait that affects the recognition of a person's own emotions, have been associated with reduced interpersonal communication skills and enhanced anxiety/depressive symptoms. Therefore, the main aim of the present study is to provide an in-depth evaluation of family functioning and related factors in patients with MS and their families. In order to reach this goal, the perceived quality of family functioning, dyadic relationships, and parental bonding will be first investigated. Secondly, the possible associations between the quality of family relationships and the presence of alexithymia, psychological distress, and perceived social support will be examined. Patients with MS and their families who will consent to take part in the study will be asked to provide sociodemographic and clinical information, and to complete a series of questionnaires, presented and uploaded on an online dedicated platform. The final sample will be made up of 300 families, consecutively recruited from the Italian medical centers involved in the project. The results of the present study will shed light on the family functioning of patients with MS, through a comprehensive assessment of the main factors that are associated with family dynamics. A holistic evaluation of those aspects can help clinicians and researchers understand family dynamics in MS population better.

Valence and arousal ratings for 11,310 simplified Chinese words

This study reports valence and arousal ratings for 11,310 simplified Chinese words, including 9774 two-character words, 949 three-character words, and 587 four-character words. These affective ratings are validated through comparisons with prior ratings of smaller word samples. All but four words included in this study are from the MEgastudy of Lexical Decision in Simplified CHinese (MELD-SCH) database. As age-of-acquisition ratings and concreteness ratings have recently become available for large portions of words in the MELD-SCH, the affective ratings not only further enrich the database as a valuable research tool, but also allow us to gain insight into a range of psycholinguistic constructs based on normative ratings of a large set of Chinese words. Cross-language comparisons of the valence ratings between Chinese words and English words appear to indicate cultural and sociopolitical influences reflected in affect representations.

Differences Between Autistic and Non-Autistic Adults in the Recognition of Anger from Facial Motion Remain after Controlling for Alexithymia

To date, studies have not established whether autistic and non-autistic individuals differ in emotion recognition from facial motion cues when matched in terms of alexithymia. Here, autistic and non-autistic adults (N = 60) matched on age, gender, non-verbal reasoning ability and alexithymia, completed an emotion recognition task, which employed dynamic point light displays of emotional facial expressions manipulated in terms of speed and spatial exaggeration. Autistic participants exhibited significantly lower accuracy for angry, but not happy or sad, facial motion with unmanipulated speed and spatial exaggeration. Autistic, and not alexithymic, traits were predictive of accuracy for angry facial motion with unmanipulated speed and spatial exaggeration. Alexithymic traits, in contrast, were predictive of the magnitude of both correct and incorrect emotion ratings.

Understanding Oneself to Understand Others: The Role of Alexithymia and Anxiety in the Relationships Between Autistic Trait Dimensions and Empathy

People on the autism spectrum may have difficulty inferring others' emotions (cognitive empathy), but may share another's emotions (affective empathy) and exhibit heightened personal distress. The present study examined independent autistic trait dimensions (social difficulties and restricted/repetitive behaviours) and the roles alexithymia and trait anxiety have in explaining this profile of empathy. Results from the general population (n = 301) revealed that pronounced social difficulties and not restricted/repetitive behaviours related to reduced cognitive and affective empathy, and heightened personal distress. However, both dimensions, through alexithymia and anxiety, indirectly influenced empathy. Surprisingly, while the dimensions indirectly improved affective empathy, pronounced social difficulties directly reduced affective empathy. This study motivates a nuanced model of empathy by including autistic trait dimensions, anxiety, and alexithymia.

Translation, Cross-Cultural Adaptation, and Validation of a Dutch Version of the Actions and Feelings Questionnaire in Autistic and Neurotypical Adults

The actions and feelings questionnaire (AFQ) provides a short, self-report measure of how well someone uses and understands visual communicative signals such as gestures. The objective of this study was to translate and cross-culturally adapt the AFQ into Dutch (AFQ-NL) and validate this new version in neurotypical and autistic populations. Translation and adaptation of the AFQ consisted of forward translation, synthesis, back translation, and expert review. In order to validate the AFQ-NL, we assessed convergent and divergent validity. We additionally assessed internal consistency using Cronbach’s alpha. Validation and reliability outcomes were all satisfactory. The AFQ-NL is a valid adaptation that can be used for both autistic and neurotypical populations in the Netherlands.

Autism and mood disorders

Individuals with autism experience substantially higher rates of mood problems compared to the general population, which contribute to reduced quality of life and increased mortality through suicide. Here, we reviewed evidence for the clinical presentation, aetiology and therapeutic approaches for mood problems in autism. We identified a lack of validated tools for accurately identifying mood problems in individuals with autism, who may present with 'atypical' features (e.g. severe irritability). Risk factors for mood problems in autism appear to be largely overlapping with those identified in the general population, including shared genetic, environmental, cognitive, physiological/neurobiological mechanisms. However, these mechanisms are exacerbated directly/indirectly by lived experiences of autism, including increased vulnerability for chronic stress - often related to social-communication difficulties(/bullying) and sensory sensitivities. Lastly, current therapeutic approaches are based on recommendations for primary mood disorders, with little reference to the neurobiological/cognitive differences associated with autism. Thus, we recommend: 1) the development and validation of (objective) tools to identify mood problems in autism and measure therapeutic efficacy; 2) an interactive approach to investigating aetiologies in large-scale longitudinal studies, integrating different levels of analysis (e.g. cognitive, neurobiological) and lived experience; 3) testing potential treatments through high-quality (e.g. sufficiently powered, blinded) clinical trials, specifically for individuals with autism.

Parent-child interaction, parental attachment styles and parental alexithymia levels of children with ASD

AIM

Given the recent findings regarding the increased evidence for the presence of the alexithymia in parents of children with autism spectrum disorder (ASD), the construct of alexithymia in parents of children with ASD and its effect on adult romantic attachment style of parents, family functioning and parent-child relationship were investigated.

METHODS

The sample included children diagnosed as having ASD, developmental delay (DD), and 27 typically developing children aged 1-5 years and their parents. The Crowell procedure, an observational and structured assessment was performed, and the quality of the parent-child relationship was assessed using the Parent-Infant Relationship-Global Assessment Scale (PIR-GAS) based on DC: 0-5. The Toronto Alexithymia Scale-20, Experiences in Close Relationships Revised, and the Family Assessment Device were administered to the parents.

RESULTS

PIR-GAS scores were lower in the ASD group compared with the scores of the other groups. Family functioning rated by fathers of children with DD was lower than in the other groups. However, there was no significant difference between the groups in terms of alexithymia levels, and parent's own attachment styles in romantic relationships.

CONCLUSIONS

ASD was found to be an independent predictor for disordered relationship between children and their parents. Appropriate family interventions focusing on enhancing social interaction and emotional development may be beneficial in the treatment of ASD.

A bottom-up model of functional outcome in schizophrenia

Schizophrenia results in poor functional outcomes owing to numerous factors. This study provides the first test of a bottom-up causal model of functional outcome in schizophrenia, using neurocognition, vocal emotional cognition, alexithymia, and negative symptoms as predictors of functional outcome. We investigated a cross-sectional sample of 135 individuals with schizophrenia and 78 controls. Using a series of structural equation modelling analyses, a single pathway was generated among scores from the MATRICS Consensus Cognitive Battery (MCCB), vocal emotion recognition test, Toronto Alexithymia Scale (TAS), Brief Negative Symptom Scale, and the Personal and Social Performance Scale. The scores for each dimension of the MCCB in the schizophrenia group were significantly lower than that in the control group. The recognition accuracy for different emotions (anger, disgust, fear, sadness, surprise, and satire, but not calm was significantly lower in the schizophrenia group than in the control group. Moreover, the scores on the three dimensions of TAS were significantly higher in the schizophrenia group than in the control group. On path analysis modelling, the proposed bottom-up causal model showed a strong fit with the data and formed a single pathway, from neurocognition to vocal emotional cognition, to alexithymia, to negative symptoms, and to poor functional outcomes. The study results strongly support the proposed bottom-up causal model of functional outcome in schizophrenia. The model could be used to better understand the causal factors related to the functional outcome, as well as for the development of intervention strategies to improve functional outcomes in schizophrenia.

Associations and interactions of the serotonin receptor genes 5-HT1A, 5-HT2A, and childhood trauma with alexithymia in two independent general-population samples

Previous studies suggested that childhood trauma and a disturbed serotonergic neurotransmission are involved in the pathogenesis of alexithymia. Specifically, genetic polymorphisms of the serotonin receptors 5-HT1A and 5-HT2A were found to be associated with alexithymia. However, it is unclear whether these factors show main or interaction effects with childhood trauma on alexithymia. Data from two independent general-population cohorts of the Study of Health in Pomerania (SHIP-Trend: N=3,706, Age: range=20-83, 51.6% female, SHIP-LEGEND: N=2,162, Age: range=20-80, 52.5% female) were used. The Toronto Alexithymia Scale-20 (TAS-20) and the Childhood Trauma Questionnaire (CTQ) were applied. Genotypes of rs6295 of 5-HT1A and rs6311 of 5-HT2A were determined. Ordinary least-squared regression models with robust standard errors were applied to investigate associations of the main and interaction effects of childhood maltreatment and the polymorphisms with alexithymia. Childhood trauma, but none of the investigated polymorphisms showed main effects on alexithymia. However, childhood trauma showed significant CTQ sum score x rs6295 interactions in male subjects in both samples such that the presence of the G-allele diminished the CTQ associated increase in the TAS-20 sum scores. Our results support a strong role of early life stress and interactions with rs6295 on alexithymic personality features at least in male subjects.

Current rodent models for the study of empathic processes

Empathy is a complex phenomenon critical for group survival and societal bonds. In addition, there is mounting evidence demonstrating empathic behaviors are dysregulated in a multitude of psychiatric disorders ranging from autism spectrum disorder, substance use disorders, and personality disorders. Therefore, understanding the underlying drive and neurobiology of empathy is paramount for improving the treatment outcomes and quality of life for individuals suffering from these psychiatric disorders. While there is a growing list of human studies, there is still much about empathy to understand, likely due to both its complexity and the inherent limitations of imaging modalities. It is therefore imperative to develop, validate, and utilize rodent models of empathic behaviors as translational tools to explore this complex topic in ways human research cannot. This review outlines some of the more prevailing theories of empathy, lists some of the psychiatric disorders with disrupted empathic processes, describes rat and mouse models of empathic behaviors currently used, and discusses ways in which these models have elucidated social, environmental, and neurobiological factors that may modulate empathy. The research tools afforded to rodent models will provide an increasingly clear translational understanding of empathic processes and consequently result in improvements in care for those diagnosed with any one of the many psychiatric disorders.

Alexithymia and Autistic Traits as Contributing Factors to Empathy Difficulties in Preadolescent Children

Recent evidence suggests that, contrary to traditional views, empathy difficulties may not be a core feature of autism; but are rather due to co-occurring alexithymia. Empathy, alexithymia and autistic traits have yet to be examined concurrently in children. Therefore, we examined the co-occurrence of empathy difficulties and alexithymia in 59 typically developing and 5 autistic children. Multiple measures (self-report, parent-report and a behavioural task) were used to evaluate empathy and to assess differences in self- and parent-reports using multiple regressions. Alexithymia was found to predict empathy significantly better than autistic traits, providing support for the alexithymia hypothesis. From a therapeutic perspective, results suggest autistic children who screen positive for elevated alexithymic traits may benefit from additional support targeting emotion identification.

Associations Between Mental Health, Interoception, Psychological Flexibility, and Self-as-Context, as Predictors for Alexithymia: A Deep Artificial Neural Network Approach

Background: Alexithymia is a personality trait which is characterized by an inability to identify and describe conscious emotions of oneself and others.

Aim: The present study aimed to determine whether various measures of mental health, interoception, psychological flexibility, and self-as-context, predicted through linear associations alexithymia as an outcome. This also included relevant mediators and non-linear predictors identified for particular sub-groups of participants through cluster analyses of an Artificial Neural Network (ANN) output.

Methodology: Two hundred and thirty participants completed an online survey which included the following questionnaires: Toronto alexithymia scale; Acceptance and Action Questionnaire 2 (AQQII); Positive and Negative Affect Scale (PANAS-SF), Depression, Anxiety, and Stress Scale 21 (DAS21); Multidimensional Assessment of Interoceptive Awareness (MAIA); and the Self-as-Context (SAC) scale. A stepwise backwards linear regression and mediation analysis were performed, as well as a cluster analysis of the non-linear ANN upper hidden layer output.

Results: Higher levels of alexithymia were associated with increased psychological inflexibility, lower positive affect scores, and lower interoception for the subscales of “not distracting” and “attention regulation.” SAC mediated the relation between emotional regulation and total alexithymia. The ANNs accounted for more of the variance than the linear regressions, and were able to identify complex and varied patterns within the participant subgroupings.

Conclusion: The findings were discussed within the context of developing a SAC processed-based therapeutic model for alexithymia, where it is suggested that alexithymia is a complex and multi-faceted condition, which requires a similarly complex, and process-based approach to accurately diagnose and treat this condition.

Deficient auditory emotion processing but intact emotional multisensory integration in alexithymia

Alexithymia has been associated with emotion recognition deficits in both auditory and visual domains. Although emotions are inherently multimodal in daily life, little is known regarding abnormalities of emotional multisensory integration (eMSI) in relation to alexithymia. Here, we employed an emotional Stroop‐like audiovisual task while recording event‐related potentials (ERPs) in individuals with high alexithymia levels (HA) and low alexithymia levels (LA). During the task, participants had to indicate whether a voice was spoken in a sad or angry prosody while ignoring the simultaneously presented static face which could be either emotionally congruent or incongruent to the human voice. We found that HA performed worse and showed higher P2 amplitudes than LA independent of emotion congruency. Furthermore, difficulties in identifying and describing feelings were positively correlated with the P2 component, and P2 correlated negatively with behavioral performance. Bayesian statistics showed no group differences in eMSI and classical integration‐related ERP components (N1 and N2). Although individuals with alexithymia indeed showed deficits in auditory emotion recognition as indexed by decreased performance and higher P2 amplitudes, the present findings suggest an intact capacity to integrate emotional information from multiple channels in alexithymia. Our work provides valuable insights into the relationship between alexithymia and neuropsychological mechanisms of emotional multisensory integration.

Our behavioral and electrophysiological data provide substantial evidence for intact emotion multisensory integration in relation to alexithymia. With high ecological validity, these findings are of particular importance given that humans are constantly exposed to competing, complex audiovisual emotional information in social interaction contexts. Our work has important implications for the psychophysiology of alexithymia and emotional processing.

Autistic traits and loneliness in autism are associated with increased tendencies to anthropomorphise

Anthropomorphism-the attribution of human qualities to non-human objects-is believed to be a natural tendency which may serve several adaptive functions. One possibility is that anthropomorphism provides an egocentric heuristic by which we can understand the world. It may also be a strategy for reducing our subjective sense of loneliness. However, not all humans exhibit the same propensity to anthropomorphise. Recent findings suggest that autistic individuals may be more likely to anthropomorphise than non-autistic individuals. In Study 1, we conducted a large-scale survey of autistic traits and dispositional anthropomorphism in the general population (n = 870). We found that individuals who reported having more autistic traits had an increased dispositional tendency to anthropomorphise non-human entities. In Study 2, we more closely examined variation in anthropomorphism tendencies in a sample of autistic adults (n = 90) to better understand what might drive increased anthropomorphism in this population. We found that those with greater anthropomorphism tendencies experienced greater levels of self-reported loneliness. We propose that increased anthropomorphism might reflect reduced opportunities for social connection for autistic people and those with more autistic traits.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation and refinement of the twenty-item Toronto Alexithymia Scale

BACKGROUND

Alexithymia, a personality trait characterized by difficulties interpreting one's own emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies a number of cognitive and emotional differences previously attributed to autism, such as difficulties in facial emotion recognition and reduced empathy. Although questionnaires such as the twenty-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have attempted to determine the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults.

METHODS

We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 verbal autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study (the Human Penguin Project). The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to further refine the scale based on local model misfit and I-DIF between the groups. Correlations between alexithymia and other clinical outcomes such as autistic traits, anxiety, and quality-of-life were used to assess the nomological validity of the revised alexithymia scale in the SPARK sample.

RESULTS

The TAS-20 did not exhibit adequate global model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an eight-item unidimensional scale (TAS-8) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that TAS-8 scores meaningfully predict autistic trait levels, anxiety and depression symptoms, and quality of life, even after controlling for trait neuroticism.

LIMITATIONS

Limitations of the current study include a sample of autistic adults that was overwhelmingly female, later-diagnosed, and well-educated; clinical and control groups drawn from different studies with variable measures; and an inability to test several other important psychometric characteristics of the TAS-8, including sensitivity to change and I-DIF across multiple administrations.

CONCLUSIONS

These results indicate the potential of the TAS-8 as a psychometrically robust tool to measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced TAS-8 latent trait scores in research applications (available at http://asdmeasures.shinyapps.io/TAS8_Score ).

Mapping alexithymia: Level of emotional awareness differentiates emotion-specific somatosensory maps

BACKGROUND

Emotions have been associated with culturally universal and distinct bodily sensation "maps". Despite this knowledge, to date few studies have explored emotion-specific topography along clinically relevant dimensions, such as alexithymia.

OBJECTIVE

We aimed to investigate emotion-specific topographies among individuals exposed to childhood maltreatment or neglect with absent (n = 51) or with probable (n = 46) alexithymia in adulthood, as defined by scores on the Toronto Alexithymia Scale (TAS-20).

PARTICIPANTS AND SETTING

Ninety eight adult participants with exposure to childhood maltreatment or neglect were recruited to complete an online survey.

METHODS

Using the well-validated emBODY tool (Nummenmaa et al., 2014), participants reported on their somatic experience of 17 emotions.

RESULTS

Random effects analyses revealed topographically distinct bodily sensation t-maps that differentiated participants who endorsed probable alexithymia from those who did not (p-FDR < .05). Consistent with our a priori hypothesis, the probable alexithymia group reported a muted, diffuse and undifferentiated pattern of emotion-specific bodily sensation, whereas the non-alexithymia group reported a more distinct and localized pattern.

CONCLUSIONS

These results suggest that difficulty identifying and labeling emotions, as observed in alexithymia, may arise, in part, from an altered perception of somatic activation. It is well-established that childhood maltreatment predicts the development of alexithymia symptoms. The preliminary findings presented here expand our working understanding of the physical markers of childhood trauma, which may be used in practice to aid detection and to monitor treatment outcomes.

Facial Expression Production and Recognition in Autism Spectrum Disorders: A Shifting Landscape

Social "difficulties" associated with ASD may be a product of neurotypical-autistic differences in emotion expression and recognition. Research suggests that neurotypical and autistic individuals exhibit expressive differences, with autistic individuals displaying less frequent expressions that are rated lower in quality by non-autistic raters. Autistic individuals have difficulties recognizing neurotypical facial expressions; neurotypical individuals have difficulties recognizing autistic expressions. However, findings are mixed. Task-related factors (e.g., intensity of stimuli) and participant characteristics (e.g., age, IQ, comorbid diagnoses) may contribute to the mixed findings. The authors conclude by highlighting important areas for future research and the clinical implications of the discussed findings.

Alexithymia is related to poor social competence in autistic and nonautistic children

Alexithymia is characterized by difficulties identifying and describing one's own emotions and the emotions of others. These challenges with understanding emotions in people with alexithymia may give rise to difficulties with social interactions. Given that alexithymia frequently co-occurs with autism spectrum disorder (ASD), and that both populations have difficulties with social interactions, it is of interest to determine whether alexithymia can help to parse some of the heterogeneity in social competence in autistic and nonautistic individuals. The caregivers of 241 children (6-14 years old), including 120 autistic, and 121 nonautistic, rated their child's social competence using the Multidimensional Social Competence Scale (MSCS), autism traits using the Autism Spectrum Quotient (AQ), and alexithymia traits using the Children's Alexithymia Measure (CAM). Regression analyses indicated that age, IQ, sex, AQ, and CAM scores accounted for 40.2% of the variance in autistic children's, and 68.2% of the variance in nonautistic children's, parent-reported social competence. Importantly, after controlling for age, IQ, sex, and AQ scores, CAM scores alone accounted for an additional 16.2% of the variance in autistic children's, and 17.4% of the variance in nonautistic children's social competence. These results indicate that higher alexithymia traits predict lower levels of social competence, suggesting that increased difficulty in identifying and describing one's own emotions and the emotions of others is associated with poorer social competence. Furthermore, CAM scores were found to partially mediate the relationship between autistic traits and social competence, suggesting that comorbid alexithymia traits may be partially responsible for poor social competence in individuals with high autistic traits. This research contributes to the understanding of the factors associated with the development of social competence and highlights alexithymia as a potential target for identification and intervention to improve social competence. LAY SUMMARY: Alexithymia is a condition where people find it hard to think and talk about their (and others') feelings. About 50% of autistic people have alexithymia. This might be why they have social and emotional difficulties. Parents answered questions about alexithymia and social difficulties their children have. Children with more alexithymia problems had poorer social skills. Thus, alexithymia may be related to social problems faced by autistic and nonautistic children.

A Contemplative Biofeedback Intervention for Adults with Autism Spectrum Disorder: Feasibility of a Community-Based Treatment

As the number of diagnosed adults living with autism spectrum disorder (ASD) continues to grow, a lack of resources and lack of available interventions exacerbate their low quality of life, including low levels of education and employment, and high levels of co-morbid anxiety and depression. Here we build upon existing research showing the effectiveness of contemplative interventions on individuals with ASD, to provide a low-cost biofeedback-enhanced training which can be implemented by non-professional staff, and may help autistic individuals grasp abstract contemplative techniques. We hypothesize that the intervention will decrease participants' anxiety and autism symptoms, and increase their self-awareness, self-determination, and empathy. Fourteen adults with ASD, residing in assisted living, were provided with 16 weekly half-hour contemplative-biofeedback sessions with non-professional trainers, in which they learned to reduce their arousal levels through combined biofeedback and contemplative techniques, and apply those to everyday life. Quantitative and qualitative data was collected pre- and post-intervention, to determine changes in participants' self-awareness, self-determination, anxiety, autism symptoms, and empathy. Participants were capable of successfully improving their physiological arousal levels on the biofeedback setup, indicating feasibility of the technique. Further, we found initial indications for reduction in autism symptoms and increased self-determination. Qualitative reports by participants and counselors revealed that participants applied the techniques in many real-life situations, and these had far-ranging effects on their emotional regulation, work and social motivation, and self-determination. The study provides proof-of-concept for a low-cost, community-based intervention which can ameliorate the lives of adults with ASD.

Alexithymia traits outweigh autism traits in the explanation of depression in adults with autism

When contemplating the alarming depression rates in adults with autism spectrum disorder (ASD), there is a need to find factors explaining heightened symptoms of depression. Beyond the impact of autism traits, markedly increased levels of alexithymia traits should be considered as a candidate for explaining why individuals with ASD report higher levels of depressive symptoms. Here, we aim to identify the extent to which autism or alexithymia traits indicate depressive symptoms in ASD and whether the pattern of association are specific to ASD. Data of a large (N = 400) representative clinical population of adults referred to autism diagnostics have been investigated and split by cases with a confirmed ASD diagnosis (N = 281) and cases with a ruled out ASD diagnosis (N = 119). Dominance analysis revealed the alexithymia factor, difficulties in identifying feelings, as the strongest predictor for depressive symptomatology in ASD, outweighing autism traits and other alexithymia factors. This pattern of prediction was not specific to ASD and was shared by clinical controls from the referral population with a ruled out ASD diagnosis. Thus, the association of alexithymia traits with depression is not unique to ASD and may constitute a general psychopathological mechanism in clinical samples.

How Closely Related Are Parent and Child Reports of Child Alexithymia?

Alexithymia is a subclinical trait involving difficulty describing and identifying emotions. It is common in a number of psychiatric conditions. Alexithymia in children is sometimes measured by parent report and sometimes by child self-report, but it is not yet known how closely related the two measures are. This is an important question both theoretically and practically, in terms of research design and clinical practice. We conducted a preliminary study to investigate this question in a sample of 6- to 11-year-old neurotypical children and their parents (N = 29 dyads). Parent and child reports were not correlated, and 93% of parents under-estimated their child’s level of alexithymia relative to the child’s self-report. Based on these results, we hypothesize that when asked to report on the child’s alexithymia, children and parents may not be reporting on the same phenomenon, and thus these two measures may not be interchangeable. These provocative findings, however, must be considered preliminary: our analyses were sufficiently powered to detect a strong relation between the two types of report had one existed, but our analyses were not sufficiently powered to distinguish between a small relation and no relation at all.

Alexithymia Is Associated with Altered Cortical Thickness Networks in the General Population

BACKGROUND

Alexithymia is a personality trait characterized by difficulties in identifying and describing emotions and associated with various psychiatric disorders. Neuroimaging studies found evidence for morphological and functional brain alterations in alexithymic subjects. However, the neurobiological mechanisms underlying alexithymia remain incompletely understood.

METHODS

We study the association of alexithymia with cortical correlation networks in a large community-dwelling sample of the Study of Health in Pomerania. Our analysis includes data of n = 2,199 individuals (49.4% females, age = 52.1 ± 13.6 years) which were divided into a low and high alexithymic group by a median split of the Toronto Alexithymia Scale. Cortical correlation networks were constructed based on the mean thicknesses of 68 regions, and differences in centralities were investigated.

RESULTS

We found a significantly increased centrality of the right paracentral lobule in the high alexithymia network after correction for multiple testing. Several other regions with motoric and sensory functions showed altered centrality on a nominally significant level.

CONCLUSIONS

Finding increased centrality of the paracentral lobule, a brain area with sensory as well as motoric features and involvement in bowel and bladder voiding, may contribute to explain the association of alexithymia with functional somatic disorders and chronic pain syndromes.

First-Hand Accounts of Interoceptive Difficulties in Autistic Adults

Interoceptive awareness refers to one's ability to detect, discriminate, and regulate internal bodily and mental processes. Interoceptive challenges in ASD remain under researched and poorly understood. In this study, we analyzed texts of adults who self-identify as autistic describing their interoceptive challenges. Many individuals described limited awareness of hunger, satiation, or thirst, which contributed to eating disordered behavior in some instances. Others described limited awareness or difficulty understanding affective arousal, pain or illness, and difficulty differentiating benign body signals from signals that represent medical concerns. Findings from this study call for increased research attention on this topic, and a need for valid and objective measures for assessing interoception in ASD.

Self-Conscious Emotion Processing in Autistic Adolescents: Over-Reliance on Learned Social Rules During Tasks with Heightened Perspective-Taking Demands May Serve as Compensatory Strategy for Less Reflexive Mentalizing

Autistic adolescents experience a secondary wave of social cognitive challenges which impact interpersonal success. We investigated self-conscious emotion (SCE) processing in autistic and neurotypical adolescents. Participants watched videos of peers acting embarrassed and proud and rated inferred and empathic SCEs. We compared intensity ratings across groups and conducted correlations with social cognitive abilities and autistic features. Autistic adolescents recognized SCEs and felt empathic SCEs; however, they made atypical emotion attributions when perspective-taking demands were high, which more strongly reflected the situational context. Atypical attributions were associated with perspective-taking difficulties and autistic feature intensity. An over-reliance on contextual cues may reflect a strict adherence to learned social rules, possibly compensating for less reflexive mentalizing, which may underlie interpersonal challenges in ASD.

New Technologies as Promising Tools for Assessing Facial Emotion Expressions Impairments in ASD: A Systematic Review

The ability to recognize and express emotions from facial expressions are essential for successful social interactions. Facial Emotion Recognition (FER) and Facial Emotion Expressions (FEEs), both of which seem to be impaired in Autism Spectrum Disorders (ASD) and contribute to socio-communicative difficulties, participate in the diagnostic criteria for ASD. Only a few studies have focused on FEEs processing and the rare behavioral studies of FEEs in ASD have yielded mixed results. Here, we review studies comparing the production of FEEs between participants with ASD and non-ASD control subjects, with a particular focus on the use of automatic facial expression analysis software. A systematic literature search in accordance with the PRISMA statement identified 20 reports published up to August 2020 concerning the use of new technologies to evaluate both spontaneous and voluntary FEEs in participants with ASD. Overall, the results highlight the importance of considering socio-demographic factors and psychiatric co-morbidities which may explain the previous inconsistent findings, particularly regarding quantitative data on spontaneous facial expressions. There is also reported evidence for an inadequacy of FEEs in individuals with ASD in relation to expected emotion, with a lower quality and coordination of facial muscular movements. Spatial and kinematic approaches to characterizing the synchrony, symmetry and complexity of facial muscle movements thus offer clues to identifying and exploring promising new diagnostic targets. These findings have allowed hypothesizing that there may be mismatches between mental representations and the production of FEEs themselves in ASD. Such considerations are in line with the Facial Feedback Hypothesis deficit in ASD as part of the Broken Mirror Theory, with the results suggesting impairments of neural sensory-motor systems involved in processing emotional information and ensuring embodied representations of emotions, which are the basis of human empathy. In conclusion, new technologies are promising tools for evaluating the production of FEEs in individuals with ASD, and controlled studies involving larger samples of patients and where possible confounding factors are considered, should be conducted in order to better understand and counter the difficulties in global emotional processing in ASD.

Alexithymia

Humans are highly adept at differentiating, regulating, and responding to their emotions. At the core of all these functions is emotional awareness: the conscious feeling states that are central to human mental life. Disrupted emotional awareness-a subclinical construct commonly referred to as alexithymia-is present in a range of psychiatric and neurological disorders and can have a deleterious impact on functional outcomes and treatment response. This chapter is a selective review of the current state of the science on alexithymia. We focus on two separate but related issues: (i) the functional deficits associated with alexithymia and what they reveal about the importance of emotional awareness for shaping normative human functioning, and (ii) the neural correlates of alexithymia and what they can inform us about the biological bases of emotional awareness. Lastly, we outline challenges and opportunities for alexithymia research, focusing on measurement issues and the potential utility of formal computational models of emotional awareness for advancing the fields of clinical and affective science.

Reduced Brain Activation in Response to Social Cognition Tasks in Autism Spectrum Disorder with and without Depression

PURPOSE

In clinical settings, diagnosing comorbid depression in individuals with autism spectrum disorder (ASD) is often difficult. Neuroimaging studies have reported reduced activation of frontal and temporal regions during emotional face recognition task (EFRT) in ASD and depression. However, to the best of our knowledge, no study has examined differences in frontotemporal activation during EFRT between ASD with and without comorbid depression. We aimed to compare the frontotemporal hemodynamic responses to the EFRT in ASD with and without depression and to find clues to help in discriminating the characteristics between them.

PATIENTS AND METHODS

In 24 drug-naïve young adults with ASD (12 with depression [ASD-Dep(+)] and 12 without depression [ASD-Dep(-)]) and 12 with typical development (TD), frontotemporal hemodynamic responses during an EFRT were measured using functional near-infrared spectroscopy (fNIRS).

RESULTS

The ASD groups showed reduced activation during EFRT than the TD group in the right ventrolateral prefrontal cortex (VLPFC). Moreover, the ASD-Dep(+) group showed reduced activation during EFRT than the ASD-Dep(-) group in the right anterior temporal cortex (aTC), and reduced activation than the TD group in the left VLPFC.

CONCLUSION

The observed results might reflect reduced regional activation in ASD and ASD with comorbid depression.

Suicidality in Adults with Autism Spectrum Disorder: The Role of Depressive Symptomatology, Alexithymia, and Antidepressants

People with autism spectrum disorder (ASD) have an increased risk of suicidality. However, the risk factors remain under-investigated. This study explored factors that increase suicidality risk in ASD. Through an online survey, 150 adults with ASD were compared to 189 control adults. Autistic traits, depressive symptomatology, alexithymia, and antidepressant intake were assessed on their contribution predicting suicidality. Among people with ASD, 63% scored above the cutoff for high suicidality risk. Increased autistic traits, depressive symptomatology, and antidepressant intake significantly predicted suicidality. Furthermore, among those with high levels of autistic traits, the risk of suicidality was increased if they also had high levels of alexithymia. These results highlight the importance of considering depression, antidepressants, and alexithymia to prevent suicidality in ASD.

A Comparative Study of Suicidality and Its Association with Emotion Regulation Impairment in Large ASD and US Census-Matched Samples

Evidence suggests increased rates of suicidality in autism spectrum disorder (ASD), but the research has rarely used comparison samples and the role of emotion dysregulation has not been considered. We compared the prevalence of parent-reported suicidality ideation and considered the role of emotion dysregulation in 330 psychiatric inpatient youth with ASD, 1169 community youth with ASD surveyed online, and 1000 youth representative of the US census. The prevalence of suicidal ideation was three and five times higher in the community and inpatient ASD samples, respectively, compared to the general US sample. In the ASD groups, greater emotion dysregulation was associated with suicidal ideation. Implications include consideration of emotion regulation as a potential mechanism and treatment target for suicidality in ASD.

Exploring the cognitive, emotional and sensory correlates of social anxiety in autistic and neurotypical adolescents

BACKGROUND

Social anxiety is common in autistic adolescents. While emerging evidence indicates the importance of several mechanisms (including intolerance of uncertainty (IU), alexithymia and sensory processing) for maintaining anxiety, limited research has explored how these factors are associated with social anxiety in autistic adolescents.

METHODS

We investigated whether IU, emotional and sensory processing are related to social anxiety in autistic and neurotypical adolescents, gathering experimental and questionnaire data from 61 autistic and 62 neurotypical 11- to 17-year-olds recruited to have similarly high levels of anxiety.

RESULTS

In autistic and neurotypical adolescents matched for social anxiety, similar significant associations were observed between social anxiety and IU, alexithymia, maladaptive emotion regulation, sensory hypersensitivity and interoceptive sensibility. Taking a dimensional approach, we found that child- and parent-reported IU, alexithymia and sensory hypersensitivity mediated the relationship between autistic traits and social anxiety symptoms in the combined group of adolescents.

CONCLUSIONS

Our findings indicate that similar correlates of social anxiety are evident in autistic and neurotypical youths experiencing social anxiety and further our understanding of mechanisms that may contribute towards social anxiety in both groups.

No preference for direct versus averted gaze in autistic adults: a reinforced preferential looking paradigm

Background

With the overarching objective to gain better insights into social attention in autistic adults, the present study addresses three outstanding issues about face processing in autism. First, do autistic adults display a preference for mouths over eyes; second, do they avoid direct gaze; third, is atypical visual exploration of faces in autism mediated by gender, social anxiety or alexithymia?

Methods

We used a novel reinforced preferential looking paradigm with a group of autistic adults (n = 43, 23 women) pairwise matched on age with neurotypical participants (n = 43, 21 women). Participants watched 28 different pairs of 5 s video recordings of a speaking person: the two videos, simultaneously displayed on the screen, were identical except that gaze was directed at the camera in one video and averted in the other. After a 680 ms transition phase, a short reinforcement animation appeared on the side that had displayed the direct gaze.

Results

None of the groups showed a preference for mouths over eyes. However, neurotypical participants fixated significantly more the stimuli with direct gaze, while no such preference emerged in autistic participants. As the experiment progressed, neurotypical participants also increasingly anticipated the appearance of the reinforcement, based on the location of the stimulus with the direct gaze, while no such anticipation emerged in autistic participants.

Limitations

Our autistic participants scored higher on the social anxiety and alexithymia questionnaires than neurotypicals. Future studies should match neurotypical and autistic participants on social anxiety and alexithymia and complement questionnaires with physiological measures of anxiety.

Conclusions

The absence of preference for direct versus averted gaze in the autistic group is probably due to difficulties in distinguishing eye gaze direction, potentially linked to a reduced spontaneous exploration or avoidance of the eye region. Social attention and preference for direct versus averted gaze correlated with alexithymia and social anxiety scores, but not gender.

Emotional self-awareness in autism: A meta-analysis of group differences and developmental effects

LAY ABSTRACT

Autistic people are thought to have difficulties with identifying and understanding their own emotions. This is referred to as emotional self-awareness. It is important to study emotional self-awareness as people who are more able to understand their own emotions, whether they are autistic or not, are more able to respond to them appropriately, as well as to identify them in other people. It has not yet been confirmed whether autistic people have difficulties with emotional self-awareness, or if any reported difficulties are actually due to the way in which emotional self-awareness is measured in autistic people. If these difficulties do exist, it is also not known when these difficulties emerge. In this research, we reviewed 47 existing studies that measured emotional self-awareness in autistic and non-autistic adults and children. We also compared studies that measured emotional self-awareness in different ways. We found that autistic adults did seem to have poorer emotional self-awareness compared to their neurotypical peers. However, this was not the case with autistic children of age 12 years and below. Instead, differences in emotional self-awareness only seemed to emerge during adolescence. Moreover, these difficulties seemed to increase with age. These results suggest that difficulties with emotional self-awareness may not be inherent in autism. Instead, they may emerge alongside the greater social and mental health difficulties that are experienced by many autistic people during adolescence. We therefore suggest that it is important to find out more about, and subsequently support, the emotional self-awareness difficulties that autistic adolescents may encounter.

Alexithymic and autistic traits: Relevance for comorbid depression and social phobia in adults with and without autism spectrum disorder

LAY ABSTRACT

Adults with autism often develop mental health problems such as depression and social phobia. The reasons for this are still unclear. Many studies found that alexithymia plays an important role in mental health problems like depression. People with alexithymia have difficulties identifying and describing their emotions. Almost every second person with autism has alexithymia. Therefore, we explored in this study whether alexithymia is linked to worse mental health in autistic people. We looked at two common diagnoses, depression and social phobia. We found that alexithymia increased symptoms of depression, while autistic traits increased symptoms of social phobia. Our results suggest that alexithymia and autistic traits can increase the risk of mental health problems. An early assessment could help prevent mental health problems and improve quality of life.

The role of the MTG in negative emotional processing in young adults with autistic-like traits: A fMRI task study

BACKGROUND

Few previous studies explored negative emotion processing in autistic-like traits people using task-based fMRI. In this study, we applied task fMRI to determine the relationship between negative emotion processing and social skill within autistic-like traits people. aimed to find which brain areas specificity play a key role in emotional processing.

METHODS

106 of Chinese individuals measured with AQ. Then applied emotion regulation task to explore the difference in brain activation and functional connectivity in individuals with autistic traits.

RESULTS

The results showed increased activation in the right middle temporal gyrus (MTG). The mediation analysis showed the right MTG mediates the relationship between autistic-like traits and negative emotion. Generalized psychophysiological interaction (gPPI) analysis also suggested that the right MTG shows significant functional connectivity with the left parahippocampal gyrus (PHG) and left precuneus cortex.

LIMITATIONS

Our sample are university students, there may have a bias in the sample compared to sub-average and have no differences between the gender, we will broaden the sample size and take the gender into account. We use two conditions as our focused theme, we want to use a more specific task to explore negative emotion in autistic-like traits people.

CONCLUSIONS

The results showed that the right MTG was an important brain region in individuals with autistic-like traits, and our study provides a wider discussion about autism brain activation and functional connectivity patterns and the use the MTG as a hallmark in individuals with autistic-like traits.

Face individual identity recognition: a potential endophenotype in autism

BACKGROUND

Face individual identity recognition skill is heritable and independent of intellectual ability. Difficulties in face individual identity recognition are present in autistic individuals and their family members and are possibly linked to oxytocin polymorphisms in families with an autistic child. While it is reported that developmental prosopagnosia (i.e., impaired face identity recognition) occurs in 2-3% of the general population, no prosopagnosia prevalence estimate is available for autism. Furthermore, an autism within-group approach has not been reported towards characterizing impaired face memory and to investigate its possible links to social and communication difficulties.

METHODS

The present study estimated the prevalence of prosopagnosia in 80 autistic adults with no intellectual disability, investigated its cognitive characteristics and links to autism symptoms' severity, personality traits, and mental state understanding from the eye region by using standardized tests and questionnaires.

RESULTS

More than one third of autistic participants showed prosopagnosia. Their face memory skill was not associated with their symptom's severity, empathy, alexithymia, or general intelligence. Face identity recognition was instead linked to mental state recognition from the eye region only in autistic individuals who had prosopagnosia, and this relationship did not depend on participants' basic face perception skills. Importantly, we found that autistic participants were not aware of their face memory skills.

LIMITATIONS

We did not test an epidemiological sample, and additional work is necessary to establish whether these results generalize to the entire autism spectrum.

CONCLUSIONS

Impaired face individual identity recognition meets the criteria to be a potential endophenotype in autism. In the future, testing for face memory could be used to stratify autistic individuals into genetically meaningful subgroups and be translatable to autism animal models.

Age-Related Effects on Social Cognition in Adults with Autism Spectrum Disorder: A Possible Protective Effect on Theory of Mind

Impaired social cognition has been suggested to underlie the social communication difficulties that define autism spectrum disorder (ASD). In typical development, social cognition may deteriorate in older age, but age effects in ASD adults have been little explored. In the present study, we compared groups of younger and older adults with and without ASD (n = 97), who completed a set of social cognition tasks assessing theory of mind (ToM), and self-report measures of empathy and alexithymia. While typically developing (TD) younger adults outperformed elderly TD and younger ASD participants, younger and older ASD adults did not differ in their ToM performance, and the elderly ASD and TD groups performed equivalently. By contrast, ASD adults reported lower empathy scores and higher levels of alexithymia symptoms compared to TD adults regardless of age. The difference between ASD and TD groups in self-reported empathy scores was no longer significant when alexithymia was covaried (with the exception of the Perspective Taking subscore). Results suggest a possible age-protective effect on ToM in the ASD group. In addition, empathy difficulties appear to be associated with alexithymia rather than ASD per se. Possible interpretations are discussed, and future directions for autism aging research are proposed. LAY SUMMARY: People with autism spectrum disorder (ASD) have difficulties with social understanding. Some age-related studies in typical development have shown a decline in social understanding in older age. We investigated whether a similar pattern is present in adults with ASD. We found that understanding what someone is thinking was not worse in older versus younger autistic adults. Also, we reported further evidence suggesting that emotional empathy difficulties were related to difficulties with understanding one's own emotions rather than with autism itself. Autism Res 2021, 14: 911-920. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

Cognitive and Social Cognitive Self-assessment in Autistic Adults

An aspect of metacognition associated with broader functional abilities in several clinical conditions, but previously unexamined in autism, is self-assessment (i.e., the ability to accurately self-evaluate one's own performance). We compared self-assessment between 37 autistic adults without intellectual disability to 39 non-autistic (NA) controls on a series of three general cognitive and three social cognitive tasks. Whereas autistic adults and NA adults did not differ in their self-assessment accuracy on general cognitive tasks, they did on social cognitive tasks, with autistic adults demonstrating lower accuracy. The direction of their inaccuracy was variable (i.e., both over and underestimation), and self-assessment was largely unrelated to their level of social functioning. Over versus underestimation may have different functional implications, and warrants future investigation.