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

Dialectical Behavior Therapy in Autism

PURPOSE OF REVIEW

Recent research indicates that Dialectical Behavior Therapy (DBT) is feasible, acceptable, and effective for autistic adults. This review aims to provide conceptual arguments and empirical evidence to support DBT as a relevant therapeutic alternative for autistic individuals experiencing emotion dysregulation (ED).

RECENT FINDINGS

ED is frequent in autism whereby it is associated with severe mental health challenges. However, appropriate therapeutic options are limited. Currently, DBT has amassed the most evidence for treatment of ED across a range of clinical conditions, although it was originally developed for borderline personality disorder (BPD). In the context of autism, there is evidence supporting the efficacy of DBT for ED, life-threatening behaviors and depression, but adaptations are likely to improve its dissemination and acceptability. While similar biosocial factors seem to be involved in ED in BPD and autism, alexithymia is prominent in autism and autistic features such as sensory sensitivity and social overload also contribute to ED in autistic adults.

CONCLUSION

Given the significant impact of ED on the well-being of autistic adults, there is an urgent need to enhance our understanding of the mechanisms involved in ED in autism and the adaptations likely to improve the acceptability and dissemination of DBT for autistic people.

A non-systematic overview review of self-focused emotion regulation in autistic individuals through the lens of the extended process model

Difficulties regulating emotions have been coined as inherent to autism, possibly even presenting a core difficulty of autism. While several models of emotion regulation have been proposed in the past, in this targeted review article, we aim to map emotion regulation difficulties in autistic individuals within the framework of the extended process model of emotion regulation. This model can be considered the most comprehensive one currently incorporating not only different emotion regulation strategy groups but also different stages and processes involved in successful self-focused emotion regulation. Within this model, we will identify areas and domains as specifically impacted by autistic individuals. We will also outline gaps in the literature and provide suggestions for future research that can help deepen our understanding of the emotion regulation processes of autistic individuals. The ultimate goal is to develop specific support programs that address specific emotion regulation mechanisms, providing a much more individualized support approach.Lay abstractWhat do we already know about emotion regulation in autism?We know that many autistic children, youth, and adults experience difficulties regulating emotions. Existing research has focused mainly on the differences in emotion regulation capabilities between autistic and non-autistic individuals, the relationships between autistic traits and emotion regulation, and how emotion regulation relates to other outcomes, such as social skills and mental health.What does this paper add?We want to take a new approach to review the existing emotion regulation research through the lens of a specific theoretical model: the extended process model of emotion regulation. Professor James Gross developed this model. It consists of four emotion regulation phases: identification, selection, implementation, and monitoring.Our review revealed specific areas within these emotion regulation phases that could significantly impact the emotion regulation experiences of autistic individuals. We also outline the gaps in the research and propose avenues for future investigation.Implications for practiceBy deepening our understanding of emotion regulation in autistic individuals through the proposed future research, researchers and clinicians can pave the way for the development of tailored support programs. These programs will directly target specific emotion regulation mechanisms, offering a much-needed individualized support approach.

Autistic traits, alexithymia, and emotion recognition of human and anime faces

Individuals on the autism spectrum or with elevated autistic traits have shown difficulty in recognizing people's facial emotions. They also tend to gravitate toward anime, a highly visual medium featuring animated characters whose facial emotions may be easier to distinguish. Because autistic traits overlap with alexithymia, or difficulty in identifying and describing feelings, alexithymia might explain the association between elevated autistic traits and difficulty with facial emotion recognition. The present study used a computerized task to first examine whether elevated autistic traits in a community sample of 247 adults were associated with less accurate emotion recognition of human but not anime faces. Results showed that individuals higher in autistic traits performed significantly worse on the human facial emotion recognition task, but no better or worse on the anime version. After controlling for alexithymia and other potentially confounding variables, autistic traits were no longer associated with performance on the facial emotion recognition tasks. However, alexithymia remained a significant predictor and fully mediated the relationship between autistic traits and emotion recognition of both human and anime faces. Findings suggest that interventions designed to help individuals on the autism spectrum with facial emotion recognition might benefit from targeting alexithymia and employing anime characters.

Neural Correlates of Alexithymia Based on Electroencephalogram (EEG)-A Mechanistic Review

Introduction: Alexithymia is a multidimensional construct characterized by difficulties in identifying and describing emotions, distinguishing emotional states from bodily sensations, and an externally oriented thinking style. Although the prevalence in the general population is around 10%, it is significantly higher in clinical groups, including those with autism spectrum disorders, depression, anxiety, and neurological conditions. Neuroimaging research, especially using magnetic resonance imaging, has documented structural and functional alterations in alexithymia; however, electroencephalography (EEG)-an older yet temporally precise method-remains less comprehensively explored. This mechanistic review aims to synthesize EEG-based evidence of the neural correlates of alexithymia and to propose potential neurophysiological mechanisms underpinning its affective and cognitive dimensions. Methods: A thorough literature search was conducted in December 2024 across PubMed/Medline, ResearchGate, Google Scholar, and Cochrane using combined keywords ("EEG", "QEEG", "electroencephalography", "alexithymia") to identify English-language clinical trials or case studies published from January 1980 to December 2024. Two reviewers independently screened the titles and abstracts, followed by a full-text review. Studies were included if they specifically examined EEG activity in participants with alexithymia. Of the 1021 initial records, eight studies fulfilled the inclusion criteria. Results: Across the reviewed studies, individuals with alexithymia consistently demonstrated right-hemisphere dominance in EEG power and connectivity, particularly in the theta and alpha bands, during both neutral and emotion-eliciting tasks. Many exhibited reduced interhemispheric coherence and disrupted connectivity in the frontal and parietal regions, potentially contributing to difficulties in cognitive processing and emotion labeling. Some studies have also reported diminished gamma band activity and phase synchrony in response to negative stimuli, suggesting impaired higher-order integration of emotional information. Crucially, subjective reports (e.g., valence ratings) often do not differ between alexithymic and non-alexithymic groups, highlighting that EEG measures may capture subtle emotional processing deficits not reflected in self-reports. Conclusions: EEG findings emphasize that alexithymia involves specific disruptions in cortical activation and network-level coordination, rather than merely the absence of emotional experiences. Right-hemisphere over-reliance, reduced interhemispheric transfer, and atypical oscillatory patterns in the alpha, theta, and gamma bands appear to be central to the condition's pathophysiology. Understanding these neural signatures offers avenues for future research-particularly intervention studies that test whether modulating these EEG patterns can improve emotional awareness and expression. These insights underscore the potential clinical utility of EEG as a sensitive tool for detecting and tracking alexithymic traits in both research and therapeutic contexts.

Alexithymia may explain the genetic relationship between autism and sensory sensitivity

Sensory symptoms are highly prevalent amongst autistic individuals and are now considered in the diagnostic criteria. Whilst evidence suggests a genetic relationship between autism and sensory symptoms, sensory symptoms are neither universal within autism nor unique to autism. One explanation for the heterogeneity within autism and commonality across conditions with respect to sensory symptoms, is that it is alexithymia (a condition associated with difficulties identifying and describing one's own emotions) that has a genetic relationship with sensory symptoms, and that alexithymia commonly co-occurs with autism and with several other conditions. Using parent-reports of symptoms in a sample of adolescent twins, we sought to examine the genetic association between autism, alexithymia and sensory symptoms. Results showed that the genetic correlation between autism and sensory symptoms was not significant after controlling for alexithymia. In contrast, after controlling for variance in alexithymia explained by autism, the genetic correlation between alexithymia and sensory symptoms was significant (and the proportion of variance explained by genetic factors remained consistent after controlling for autism). These results suggest that 1) alexithymia and sensory symptoms share aetiology that is not accounted for by their association with autism and 2) that the genetic association between sensory symptoms and autism may be, in part or wholly, a product of alexithymia. Future research should seek to examine the contribution of alexithymia to sensory symptoms across other conditions.

Metacognition facilitates theory of mind through optimal weighting of trait inferences

The ability to represent and infer accurately others' mental states, known as Theory of Mind (ToM), has been theorised to be associated with metacognitive ability. Here, we considered the role of metacognition in mental state inference through the lens of a recent theoretical approach to explaining ToM, the 'Mind-space' framework. The Mind-space framework posits that trait inference, representation of the qualities of the mind giving rise to the mental state, is important in forming accurate mental state inferences. We tested a potential role for metacognition in facilitating optimal weighting of trait inferences, as well as several theoretical predictions regarding factors associated with the accuracy of trait inference and confidence in those trait inferences. Participants completed a judgement-of-confidence task in the trait inference domain alongside the Interview Task, a recently-developed task for assessing the accuracy of trait and mental state inferences. A simple relationship in which increased metacognitive sensitivity is associated with increased accuracy of mental states inferences was not found. However, when predicting trial-level performance, confidence in trait inference was shown to modulate the effect of trait inference accuracy on mental state inference accuracy. This effect was greater in magnitude with lower metacognitive sensitivity, i.e., when confidence is more likely to be misplaced. Furthermore, participants' trait inference ability was associated with the accuracy of their understanding of the average mind. In addition, the accuracy of specific trait inferences was predicted by the participant's similarity to the target, but this similarity benefit was reduced in participants whose self-perception was inaccurate. Reported confidence in a given trait inference was also predicted by participant-target similarity, such that participants showed greater overconfidence in judgements made about similar targets. This overconfidence effect was larger when self-perception was more erroneous. Results support several theoretical claims made by the Mind-space theory, and further elucidate the processes underlying accurate mental state inference.

Perceived changes in mental health and social engagement attributed to a single psychedelic experience in autistic adults: results from an online survey

RATIONALE

Anecdotal reports suggest that psychedelic drugs can improve psychological wellbeing and social engagement in autistic people. However, there are few contemporary studies on this topic.

OBJECTIVES

To examine autistic participants' experiences with psychedelic drugs and the extent to which they attributed changes in mental health and social engagement to their most 'impactful' psychedelic experience. We also explored associations between these changes and mechanistically important variables (e.g., aspects of the acute psychedelic experience and changes in 'psychological flexibility').

METHODS

Self-selecting autistic participants (n = 233) with high autism quotient scores completed an online survey relating to their most impactful psychedelic experience. Questionnaires assessed the acute psychedelic experience and perceived psychedelic-induced changes in distress, social engagement and psychological flexibility, among other relevant variables.

RESULTS

The majority of participants attributed reductions in psychological distress (82%) and social anxiety (78%) and increases in social engagement (70%) to their most 'impactful' psychedelic experience. A substantial minority (20%) also reported undesirable effects such as increases in anxiety with some describing their psychedelic experience as among the most negatively impactful experiences of their lives. The only substantial predictor of reductions in psychological distress was increased psychological flexibility.

CONCLUSION

Autistic people attributed changes in mental health and social engagement to a single highly impactful psychedelic experience. The results and their implications are discussed with caution considering the use of a non-experimental design and biased sampling.

The Alexithymia Hypothesis of Autism Revisited: Alexithymia Modulates Social Brain Activity During Facial Affect Recognition in Autistic Adults

BACKGROUND

Both autism spectrum disorder (ASD) and alexithymia are linked to difficulties in facial affect recognition (FAR) together with differences in social brain activity. According to the alexithymia hypothesis, difficulties in emotion processing in ASD can be attributed to increased levels of co-occurring alexithymia. Despite substantial evidence supporting the hypothesis at the behavioral level, the effects of co-occurring alexithymia on brain function during FAR remain unexplored.

METHODS

Data from 120 participants (60 ASD, 60 control) who completed an FAR task were analyzed using functional magnetic resonance imaging and behavioral measures. The task included both explicit and implicit measures of FAR. Autistic participants were further categorized based on their alexithymia status. Group differences in FAR performance and associated brain activation were investigated.

RESULTS

Autistic participants showed lower FAR performance than control participants, regardless of alexithymia status. Imaging revealed 3 cortical clusters with reduced activation in participants with alexithymia compared with ASD participants without alexithymia during explicit FAR, including the left inferior parietal gyrus, cuneus, and middle temporal gyrus. During implicit FAR, ASD participants with alexithymia showed 3 cortical clusters of increased activation, including the left precentral gyrus, right precuneus, and temporoparietal junction.

CONCLUSIONS

Our study shows an unexpected dissociation between behavior and brain response: While ASD affects FAR performance, only co-occurring alexithymia modulates corresponding social brain activations. Although not supporting the alexithymia hypothesis on the behavioral level, the study highlights the complex relationship between ASD and co-occurring alexithymia, emphasizing the significance of co-occurring conditions in understanding emotion processing in ASD.

Alexithymia does not explain facial expression recognition difficulties across the dark triad spectrum

The dark triad encompasses socially aversive personality traits-narcissism, psychopathy, and Machiavellianism-and has been shown to be associated with expression recognition difficulties. Alexithymia has been shown to be associated with the dark triad, and recent evidence has suggested that co-occurring alexithymia may explain facial expression recognition difficulties found in the autism spectrum. Here, I tested this alexithymia hypothesis for individuals on the dark triad spectrum. Using an individual difference approach, I assessed whether trait alexithymia was able to predict unique variance in facial expression discrimination ability and facial expression labelling ability above and beyond an individual's level of dark triad traits. Results showed that autistic traits, alexithymic traits, and dark triad traits all correlated with expression recognition ability. However, linear regression models showed that an individual's level of dark triad traits, their level of autistic traits, and a brief measure of general cognitive ability each predicted unique variance in facial expression discrimination and facial expression labelling ability, but an individual's level of alexithymic traits predicted no additional unique variance. Results suggest that dark triad and autistic traits each contribute to expression recognition ability in unique ways alongside general cognitive ability.

Inner experiences, mental health, and well-being in autistic and non-autistic adults

The nature of autistic adults' everyday inner experiences has been largely unstudied. The purpose of this study was to examine patterns of inner experiences and how they relate to mental health and wellness among autistic and non-autistic adults. Autistic (n = 303) and non-autistic (n = 289) adults (ages 21-82) completed online surveys assessing their anxiety, depression, happiness, life satisfaction, and inner thinking patterns, (inner speaking [i.e., verbal thinking], inner seeing [i.e., visual thinking], unsymbolized thinking, feelings, sensory awareness, self-talk). Group differences in inner thinking were examined using Mann-Whitney U and chi-square tests. Correlations and multiple linear regressions examined associations between inner experiences, mental health, and well-being. Autistic adults had greater use of inner speaking and sensory awareness, compared to non-autistic adults. The most common primary mode of inner experience for both groups was inner speaking, while fewer autistic adults reported that experiencing thoughts as feelings was their primary modality. Autistic adults reported greater use of self-talk for social assessment, self-criticism, and self-management purposes, compared to non-autistic adults. Experiencing thoughts as inner speech and as feelings were associated with anxiety in both groups. Using self-talk for social assessment and self-criticism purposes was correlated with anxiety and depression in both groups, while using self-talk for self-management was associated with depression and anxiety only among autistic adults. The results suggest that autistic and non-autistic adults have similarities in overall patterns of inner thinking, yet autistic adults may be more likely to engage in self-talk as a strategy to manage challenging day-to-day experiences.

Autistic adults exhibit a typical search advantage for facing dyads

Recent findings obtained with non-autistic participants indicate that pairs of facing individuals (face-to-face dyadic targets) are found faster than pairs of non-facing individuals (back-to-back dyadic targets) when hidden among distractor pairings (e.g., pairs of individuals arranged face-to-back) in visual search displays. These results suggest that facing dyads may compete for observers' attention more effectively than non-facing dyads. In principle, such an advantage might aid the detection of social interactions and facilitate social learning. Autistic individuals are known to exhibit differences in visual processing that impede their perception of other individuals. At present, however, little is known about multi-actor visual processing in autism. Here, we sought to determine whether autistic individuals show a typical search advantage for facing dyads. In an online study, autistic and non-autistic participants were tasked with finding target dyads (pairs of faces arranged face-to-face or back-to-back) embedded among distractor dyads (pairs of faces arranged face-to-back). Relative to the non-autistic controls, the autistic participants took slightly longer to locate target dyads. However, a clear and comparable search advantage for facing dyads was seen in both participant groups. This preliminary evidence suggests that multi-actor processing of autistic participants exhibits typical sensitivity to dyadic arrangement.

Alexithymia, Inner Thinking Patterns, and Perceptions of Mental Health Therapy Strategies Among Autistic Adults

PURPOSE

Autistic adults are at high risk for mental health challenges, yet there has been limited research on mental health interventions for this population. Individual differences in how thoughts and emotions are perceived may directly relate to the success of specific therapy strategies. This study examined whether alexithymia and inner thinking patterns relate to helpfulness and ease of use of mental health therapy strategies among autistic adults.

METHOD

Participants (n = 269 autistic adults, ages 21-77) completed questionnaires assessing alexithymia, inner thinking patterns (i.e., self-talk, verbal thinking, visual thinking), and experiences with mental health therapy strategies. Ordinal logistic regressions were used to examine associations between alexithymia, inner thinking, and perceived helpfulness and ease of use of therapy strategies.

RESULTS

Autistic adults with greater alexithymia found cognitive strategies more difficult to use, while those with greater frequency of self-talk found them easier to use. By contrast, autistic adults with greater visual thinking found guided imagery strategies easier to use. There were no associations between alexithymia or inner thinking and perceived helpfulness or ease of use of behavioral strategies (exposure, behavioral activation), mind-body relaxation strategies (deep breathing, progressive muscle relaxation), or mindfulness meditation.

CONCLUSIONS

The findings suggest that some mental health strategies may be more difficult to implement for some autistic adults, depending on individual thinking profiles. However, alexithymia and inner thinking patterns were unrelated to the perceived helpfulness of mental health strategies. Overall, this highlights the importance of providing individualized supports and accommodations to optimize mental health therapy for autistic adults.

Poor face recognition predicts social anxiety in autism: A short report

LAY ABSTRACT

Research has shown that some autistic people have severe difficulties in recognising other people's faces. However, little is understood about how these difficulties impact the daily life and the mental well-being of autistic people. In this study, we asked 60 autistic adults with varying degrees of face recognition ability to complete two tests of face recognition, a questionnaire about social anxiety and a bespoke survey which asked participants about their experiences of face recognition and social interaction. We found that participants who had poor face recognition reported experiencing higher levels of social anxiety compared to those with average or better face recognition skills. More than half felt that their face recognition difficulties affected their social interactions, and over a third believed it hindered their ability to make friends. These findings suggest that face recognition difficulties may contribute to social anxiety among autistic individuals.

An Analysis of the Time Required for the Diagnosis of ASD and the Factors Influencing Its Duration in a Sample of the Pediatric Population from Poland

Background/Objectives: Early diagnosis of autism spectrum disorder (ASD) is a very important factor for improving the quality of life of people on the spectrum, but it still remains a major problem in Europe, especially concerning girls. In this study, we tried to answer the question of what factors affect the age of diagnosis in Poland. Additionally, we tried to establish the time between the first visit to the mental health center (MHC) and the diagnosis in this population, and what factors affect its length. Methods: 77 children were randomly recruited among the patients who came to local MHC at the Child and Family Health Centre in Sosnowiec. All participants were tested using the ADOS-2 protocol. In addition, the study used the TAS-20 test and BDI. Results: The mean age of the first enrollment in the MHC was 9.09 years for girls and 6.42 for the boys. The time needed to obtain a diagnosis from the first visit was consecutively 2.90 years and 4.29 years, but the difference was not statistically significant (p > 0.05). Obtaining a different psychiatric diagnosis did not affect the average time to diagnosis and the age of diagnosis. Conclusions: The results of the study indicate that the diagnosis of ASD is still a significant problem both in Poland and in the world. Obtaining an accurate diagnosis requires significant time, and it frequently involves consulting multiple specialists. The diagnostic process should be flexible, and the specialist should always take into account the axial symptoms but remain aware that the "overdiagnosis" of ASD can also have harmful consequences for the child.

Attentional Processing of Unpleasant Stimuli in Alexithymia

Alexithymia is a multi-faceted personality trait defined by difficulties in identifying and describing emotions and is considered a risk factor for multiple psychiatric disorders. Current alexithymia research debates the type of attention bias involved in the processing of negative emotional information, especially in anxiety-evoking situations that are frequently associated with stress states. Relatedly, this study aims to examine the role of emotional influence on the attentional processing of Taiwanese alexithymic individuals. Using the Chinese version of the Toronto Alexithymia Scale-20 (TAS-20), individuals with high alexithymia (HA: TAS > 60, n = 26; Mage = 23.36) and individuals with low alexithymia (LA: TAS < 39, n = 26; Mage = 25.76) were recruited. Participants performed an emotional counting Stroop task preceded by anxiety-evoking (threatening and aversive pictures) or neutral pictures. Reaction times (RTs) of the emotional Stroop task were compared between HA and LA groups. Our results demonstrate that compared to individuals with LA, individuals with HA show early avoidance tendency (i.e., allocate less attentional resources to anxiety-evoking stimuli), and that negative affect therefore does not interfere with subsequent attention processing during the Stroop task, resulting in faster RT for unpleasant stimuli (Mthreatening = 683.87, Maversive = 685.87) than neutral stimuli (Mneutral = 695.64) (ps < .05). In addition, the attentional bias toward specific types of negative emotion was not differentiated in individuals with HA (p < .05), suggesting that alexithymic individuals' emotion schemas may be underdeveloped in terms of ability to specify exact emotions. This study provides evidence regarding early sensitization to negative stimuli during information processing, consistent with the notion that alexithymia is related to avoidant emotion regulation processes.

Exploring Emotion Control and Alexithymia in Autistic Adults: An Ecological Momentary Assessment Study

Difficulties in controlling emotions - a proxy for emotion dysregulation (ED)-and difficulties in expressing feelings in words-'absence of emotion labelling' or alexithymia-co-exist in autism and contribute to elevated levels of impulsive and suicidal behaviour. To date, studies linking the two phenomena have relied on retrospective self-reported measures, lacking support for generalizability to real-life situations. The present study investigated in vivo emotion labelling and its impact on emotion control in 29 autistic adults without intellectual disability (ASC) and 28 neurotypical (NT) individuals of similar age, sex, and educational level. Participants were trained in an Ecological Momentary Assessment (EMA) to label their emotions, the arousal dimension, and their emotion control via smartphone over a one-week period. Findings showed that the ASC group experienced more instances of 'having an emotion that I cannot name' and, when they were able to label their emotions, they reported higher rates of negative and conflicting (simultaneously positive and negative) emotions. In both groups, the absence of emotion labelling, and intense negative emotions were associated with impaired emotion control. However, the association between lack of emotional awareness-'I have no emotion'-and impaired emotion control was only evident in ASC individuals. Our study highlights a nuanced facet of emotional processing in the ASC population. Further research is needed to gain a deeper understanding of the complex relationship between ED and alexithymia in autism.

Autistic traits and perspective taking in youths with anorexia nervosa: an exploratory clinical and eye tracking study

BACKGROUND

Despite their apparent dissimilarity, Anorexia Nervosa (AN) and Autism Spectrum Disorder (ASD) share many features, especially in terms of social and emotional difficulties. In recent years, empathic abilities in AN have been frequently assessed using self-report measures. Otherwise, the director task (DT) has been used to investigate the ability to take the visual perspective of another individual in a communicative context, using eye-tracking technology. The aim of the current study was to test the presence of autism-relevant features in AN, through: (i) comparing self-reported autistic traits and empathic abilities in a group of young inpatients with AN and age/gender matched healthy controls (HC); (ii) comparing performance on the director paradigm.

METHODS

The participants were females in the age-range between 11 and 18 years: 24 with AN and 23 HC. Autistic traits, empathic abilities, and severity of the eating disorder were respectively measured using: the Autism Quotient (AQ), the Interpersonal Reactivity Index (IRI), and the Eating Disorder Inventory-3 (EDI-3). Both groups performed a computerized task in which a director instructed them to move objects placed on a set of shelves using a mouse, while their eye gaze was tracked. A total of 36 shelf configurations, divided into three categories (with dimensional distractor - with spatial distractor - control), were created.

RESULTS

Subjects with AN showed higher autistic traits than HC. Eye-tracking data revealed that subjects with AN took longer to decide which object to select and where to move it, both in distractor-trials and in control-trials. In the AN group, we found a significant negative correlation between the total score of the AQ and the number of fixations to the irrelevant object in the dimensional control condition -in which the subjects were asked to focus on dimensional aspects of the object (large-small)-.

CONCLUSIONS

Autistic traits were over-represented in a group of young inpatients with AN. Through the use of eye-tracking technology, this exploratory study documented some differences between AN inpatients and HC in their online processes during the perspective taking tasks, which could be considered a target of tailored intervention. A larger sample of patients is needed to confirm these preliminary findings.

Influences of heart rate feedback and autistic traits on affective mindreading

Although mindreading is an important prerequisite for successful social interactions, the underlying mechanisms are still matter of debate. It is unclear, for example, if inferring others' and own mental states are distinct processes or are based on a common mechanism. Using an affect-induction experimental set-up with an acoustic heart rate feedback that addresses affective mindreading in self and others, we investigated if non-autistic study participants relied on similar information for self- and other-directed mindreading. We assumed that due to altered mindreading capacities in autism, mainly individuals with low autistic traits would focus on additional sensory cues, such as heart rate, to infer their own and their gambling partner's affective states. Our analyses showed that the interpretation of a heart rate signal differed in self- and other-directed mindreading trials. This effect was modulated by autistic traits suggesting that individuals with higher autistic traits might not have interpreted the heart rate feedback for gambling partner ratings and differentiated less between self- and other-directed mindreading trials. We discuss these results in the context of a common mechanism underlying self- and other-directed mindreading and hypothesize that the weighting of internal and external sensory information might contribute to how we make sense of our and others' mental states.

No association between alexithymia and emotion recognition or theory of mind in a sample of adolescents enhanced for autistic traits

LAY ABSTRACT

Alexithymia is a sub-clinical condition characterised by difficulties identifying and describing one's own emotions, which is found in many, but not all autistic people. The alexithymia hypothesis suggests that certain aspects of socio-cognitive functioning typically attributed to autism, namely difficulties in emotion recognition, might be better explained by often co-occurring alexithymia. It is important to understand what is specific to autism and what is due to other co-occurring characteristics to develop appropriate support for autistic people. However, most research on this topic has been conducted in adults, which limits our knowledge about the relevance of this theory to younger autistic populations. This study tested whether difficulties in emotion recognition and theory of mind traditionally associated with autism might be better explained by alexithymia in a sample of adolescents with and without a diagnosis of autism. Results found that difficulties in emotion recognition and theory of mind were both associated with autistic traits, and this was not accounted for by individual differences in levels of alexithymia. This research suggests that more work is needed to understand the applicability of the alexithymia hypothesis in younger populations, but that at least in adolescents and when using parent-report measures, alexithymia may not account for emotion recognition or theory of mind difficulties associated with autistic traits.

Autistic adults have insight into their relative face recognition ability

The PI20 is a self-report questionnaire that assesses the presence of lifelong face recognition difficulties. The items on this scale ask respondents to assess their face recognition ability relative to the rest of the population, either explicitly or implicitly. Recent reports suggest that the PI20 scores of autistic participants exhibit little or no correlation with their performance on the Cambridge Face Memory Test-a key measure of face recognition ability. These reports are suggestive of a meta-cognitive deficit whereby autistic individuals are unable to infer whether their face recognition is impaired relative to the wider population. In the present study, however, we observed significant correlations between the PI20 scores of 77 autistic adults and their performance on two variants of the Cambridge Face Memory Test. These findings indicate that autistic individuals can infer whether their face recognition ability is impaired. Consistent with previous research, we observed a wide spread of face recognition abilities within our autistic sample. While some individuals approached ceiling levels of performance, others met the prevailing diagnostic criteria for developmental prosopagnosia. This variability showed little or no association with non-verbal intelligence, autism severity, or the presence of co-occurring alexithymia or ADHD.

Herpertz S, Fuchs T. Emotion recognition in autism spectrum condition during the COVID-19 pandemic

LAY ABSTRACT

In the COVID-19 pandemic, wearing face masks became mandatory to prevent the spread of the virus. However, they restrict the ability to recognize emotions to the upper part of the face. Since individuals with autism spectrum condition often tend to look at the lower half of the face, they may be particularly restricted in emotion recognition by people wearing masks, since they are now forced to look at the upper half of the face. The current study compared the recognition of facially expressed emotions between individuals with and without autism spectrum condition. Each photo was shown in three types, once uncovered, once with face mask, and once with sunglasses. Our results revealed a reduction in accuracy of individuals with autism spectrum condition at recognizing emotions in all three stimulus types and exhibited more difficulties distinguishing anger, fear, pride, and embarrassment. During the emotion recognition task, there was no difference in which facial areas the groups looked at. We did not find evidence that the disadvantages of individuals with autism spectrum condition in emotion recognition were due to looking at different areas of the face.

Social Anxiety Symptoms Predict Poorer Facial Emotion Recognition in Autistic Male Adolescents and Young Adults Without Intellectual Disability

Utilizing a novel computerized task, we aimed to examine whether social anxiety symptoms would be related to individual differences in facial emotion recognition (FER) in a sample of autistic male adolescents and young adults without intellectual disability. Results indicated that social anxiety and IQ predicted poorer FER, irrespective of specific emotion type. When probing specific effects within emotion and condition types, social anxiety impacted surprise and disgust FER during a truncated viewing condition and not full viewing condition. Collectively, results suggest that social anxiety in autism may play a larger role in FER than previously thought. Future work should consider the role of social anxiety within autism as a factor that may meaningfully relate to FER assessment and intervention.

Autistic adults exhibit typical sensitivity to changes in interpersonal distance

The visual processing differences seen in autism often impede individuals' visual perception of the social world. In particular, many autistic people exhibit poor face recognition. Here, we sought to determine whether autistic adults also show impaired perception of dyadic social interactions-a class of stimulus thought to engage face-like visual processing. Our focus was the perception of interpersonal distance. Participants completed distance change detection tasks, in which they had to make perceptual decisions about the distance between two actors. On half of the trials, participants judged whether the actors moved closer together; on the other half, whether they moved further apart. In a nonsocial control task, participants made similar judgments about two grandfather clocks. We also assessed participants' face recognition ability using standardized measures. The autistic and nonautistic observers showed similar levels of perceptual sensitivity to changes in interpersonal distance when viewing social interactions. As expected, however, the autistic observers showed clear signs of impaired face recognition. Despite putative similarities between the visual processing of faces and dyadic social interactions, our results suggest that these two facets of social vision may dissociate.

Disentangling the relationship between sensory processing, alexithymia and broad autism spectrum: A study in parents' of children with autism spectrum disorders and sensory processing disorders

BACKGROUND

Autistic features and sensory processing difficulties and their phenotypic co-expression with alexithymia share a transdiagnostic vulnerability. In this work, we explored whether the current concept of broad autism phenotype rather translates altered sensory processing (non-specific to autism), meaning that the characteristics of altered sensory processing should be overexpressed among individuals with heightened vulnerability to sensory processing atypicalities (parents of children with sensorial processing disorder, or SPD parents) and individuals with heightened vulnerability to autistic traits (parents of children with autism spectrum disorders, or ASD parents). In addition, the association between altered sensory processing and alexithymia was inspected.

METHOD

The Adolescent/Adult Sensory Profile, Autism Spectrum Quotient, and Toronto Alexithymia Scale were completed by 31 parents of children with ASD, 32 parents of children with SPD, and 52 parents of typically developed (TD) children.

RESULTS

Extreme sensory patterns were overexpressed both in parents of children with SPD and parents of children with ASD when compared to parents of TD children. In addition, extreme sensory patterns were significantly associated with alexithymia scores. Specifically, sensory avoidance, low registration, and sensory sensitivity were positively correlated with alexithymia. No significant differences were found regarding the proportion of autistic traits and alexithymia between ASD and SPD groups of parents.

CONCLUSIONS

These results challenge the specificity of broad autism phenotype and suggest a neurodevelopmental atypicity with roots in altered sensory and emotional processing.

Individuals with high levels of autistic traits exhibit impaired cognitive but not affective theory of mind and empathy

Theory of mind (ToM) and empathy are considered key components of social cognition that are often impaired in individuals with autism spectrum disorders (ASD). However, it remains unclear whether individuals with high levels of autistic traits exhibit similar impairments in these two functions. This study examined the affective and cognitive domains of ToM and empathy in individuals with high levels of autistic traits. We recruited 84 participants with high levels and 78 participants with low levels of autistic traits to complete a set of self-reported checklists and performance-based tasks capturing affective and cognitive components of ToM and empathy. The results showed that participants with high levels of autistic traits exhibited significant impairments in cognitive but not in affective ToM and empathy compared with their counterparts with low levels of autistic traits. We also found that empathy impairments in people with high levels of autistic traits were confounded by alexithymia and depressive traits.

Autistic Traits and Aggressive Behavior in Chinese College Students: A Serial Mediation Model and the Gender Difference

Background

The existence of aggressive behavior in autism spectrum disorders (ASD) raises questions about whether cognitive and emotional factors in social information processing play a role between autistic traits (ATs) and aggressive behavior in the general population, especially in the context of Chinese culture. Moreover, given a possible gender difference in these variables, the study aimed to examine the effect of ATs on aggressive behavior, and the potential mediating role of hostile attribution bias and alexithymia on this association, as well as gender difference.

Methods

850 Chinese college students participated in the assessment, including their ATs, hostile attribution bias, alexithymia, and aggressive behavior. Pearson correlation, mediation effects analyses, and multiple-group comparison were conducted.

Results

The results indicated that ATs indirectly predicted increased aggressive behavior through attribution bias and alexithymia. Gender difference in mediating effects was revealed: ATs indirectly predicted increased aggressive behavior through the serial mediating effect only in males.

Conclusion

Hostile attribution bias and alexithymia completely mediated the association between ATs and aggressive behavior, which contained the separate mediating effects of (a) hostile attribution bias and (b) alexithymia and the serial mediating effect of (c) hostile attribution bias and alexithymia. Gender differences in mediating effects were found only in the serial mediating effect, which was significant in males but not in females. The findings revealed the internal mechanism of ATs affecting aggressive behavior and gender difference, which have implications for the intervention of aggressive behavior of individuals with autism and those with high levels of ATs.

Deployment of attention to facial expressions varies as a function of emotional quality-but not in alexithymic individuals

Background

Alexithymia is a risk factor for emotional disorders and is characterized by differences in automatic and controlled emotion processing. The multi-stimulus free-viewing task has been used to detect increased negative and reduced positive attentional biases in depression and anxiety. In the present eye-tracking study, we examined whether lexical emotional priming directs attention toward emotion-congruent facial expressions and whether alexithymia is related to impairments in lexical priming and spontaneous attention deployment during multiple face perception.

Materials and methods

A free-viewing task with happy, fearful, angry, and neutral faces shown simultaneously was administered to 32 alexithymic and 46 non-alexithymic individuals along with measures of negative affect and intelligence. Face presentation was preceded by masked emotion words. Indices of initial orienting and maintenance of attention were analyzed as a function of prime or target category and study group.

Results

Time to first fixation was not affected by prime category or study group. Analysis of fixation duration yielded a three-way interaction. Alexithymic individuals exhibited no prime or target category effect, whereas non-alexithymic individuals showed a main effect of target condition, fixating happy faces longer than neutral and angry faces and fearful faces longer than angry faces.

Discussion

Our results show evidence of attentional biases for positive and fearful social information in non-alexithymic individuals, but not in alexithymic individuals. The lack of spontaneous attentional preference for these social stimuli in alexithymia might contribute to a vulnerability for developing emotional disorders. Our data also suggest that briefly presented emotion words may not facilitate gaze orientation toward emotion-congruent stimuli.

Relationship of autistic traits and the severity of fear of the COVID-19 pandemic in the general population

Background

The aim of the study was to investigate the level of fear of the COVID-19 pandemic and to detect a possible correlation between the autistic traits and the level of fear and to learn about other factors that may affect the level of fear.

Methods

The study utilised a questionnaire and was conducted online in the period from 16.02.2021 to 11.06.2021. The test group consisted of 214 respondents with an average age of 23.78 years (95%CI: 22.48 - 25.08; max: 61, min: 14) from the general population. The study used The Autism-Spectrum Quotient (AQ) questionnaire to assess the degree of autistic traits in the general population and The Fear of COVID-19 Scale, which was used to assess the level of fear of COVID-19.

Results

Among the respondents, 9 people scored ≥32 on the AQ test and were considered to have a high degree of autistic traits. In multiple regression (R2 = 0.1, p<0.0001), a positive relationship between the severity of fear of COVID-19 and the autistic traits (p=0.01) and age (p<0.001) was obtained. Additionally, a second multiple regression (R2 = 0.1, p<0.000001) including the subscales of AQ was performed and a positive relationship between the severity of fear of COVID-19 and the difficulties in attention switching (p=0.0004) and age (p=0.00001) was obtained.

Conclusion

People with higher autistic traits present greater fear of the COVID-19 pandemic. We suggest that it might be caused by cognitive stiffness and disorders in emotions regulation, according to the literature. The elderly also present higher levels of fear. The other variables did not affect the level of fear of the COVID-19 pandemic.

The association between childhood trauma and emotion recognition is reduced or eliminated when controlling for alexithymia and psychopathy traits

Emotion recognition shows large inter-individual variability, and is substantially affected by childhood trauma as well as modality, emotion portrayed, and intensity. While research suggests childhood trauma influences emotion recognition, it is unclear whether this effect is consistent when controlling for interrelated individual differences. Further, the universality of the effects has not been explored, most studies have not examined differing modalities or intensities. This study examined childhood trauma's association with accuracy, when controlling for alexithymia and psychopathy traits, and if this varied across modality, emotion portrayed, and intensity. An adult sample (N = 122) completed childhood trauma, alexithymia, and psychopathy questionnaires and three emotion tasks: faces, voices, audio-visual. When investigating childhood trauma alone, there was a significant association with poorer accuracy when exploring modality, emotion portrayed, and intensity. When controlling for alexithymia and psychopathy, childhood trauma remained significant when exploring emotion portrayed, however, it was no longer significant when exploring modality and intensity. In fact, alexithymia was significant when exploring intensity. The effect sizes overall were small. Our findings suggest the importance of controlling for interrelated individual differences. Future research should explore more sensitive measures of emotion recognition, such as intensity ratings and sensitivity to intensity, to see if these follow accuracy findings.

Development of Moral Judgments in Impersonal and Personal Dilemmas in Autistic Spectrum Disorders from Childhood to Late Adolescence

A potential underlying mechanism associated with the difficulties in social interactions in Autistic Spectrum Disorders (ASD) concerns the abnormal development of moral reasoning. The present study examined utilitarian and deontological judgments in impersonal and personal moral dilemmas, comparing 66 individuals with ASD and 61 typically developing (TD) individuals between 6 and 18 years. Utilitarian judgments decreased with age. This decline was much more gradual for personal dilemmas in the ASD than in the TD group. ASD individuals rated utilitarian judgments as more appropriate but felt less calm, consistent with the Empathy Imbalance hypothesis. Utilitarian judgments were associated with social interaction difficulties in ASD. These findings identify possible social therapeutic targets for more efficient coping strategies in individuals with ASD.

The suitability and acceptability of a co-designed prototype psychoeducational activity book for autistic children aged five-eleven years

Background and aims

Evidence suggests that autistic children and young people (CAYP) can benefit from age-appropriate psychoeducation. Co-design is a methodology that iteratively involves end users and stakeholders in producing an intervention which may increase engagement and impact. Few age-appropriate co-designed psychoeducation resources for autistic CAYP exist. Therefore, a paper-based resource was co-designed for autistic CAYP who attend mainstream primary education. The resource aims to educate CAYP about their autism and provide strategies to support them to live well with their autism.

Methods

This paper describes the evaluation of the prototype resource through online workshops with 12 families and input from four specialist clinicians. The suitability and acceptability of the resource was explored, and sketch notes were taken for respondent validity and engagement purposes.

Results

A reflexive thematic analysis identified six themes and two subthemes: (1) content appropriateness (subtheme: strategies and unpredictability); (2) relating to content, (3) feelings and emotions, (4) terminology (subtheme: literal thinking); (5) positivity, and (6) communication aid. Suggested improvements were also identified. Results suggest the resource is suitable and acceptable.

Conclusions

Future intervention development research may consider individual differences of autistic CAYP and the co-design of resources for other age groups of neurodiverse populations.

Multimodal investigations of emotional face processing and social trait judgment of faces

Faces are among the most important visual stimuli that humans perceive in everyday life. While extensive literature has examined emotional processing and social evaluations of faces, most studies have examined either topic using unimodal approaches. In this review, we promote the use of multimodal cognitive neuroscience approaches to study these processes, using two lines of research as examples: ambiguity in facial expressions of emotion and social trait judgment of faces. In the first set of studies, we identified an event-related potential that signals emotion ambiguity using electroencephalography and we found convergent neural responses to emotion ambiguity using functional neuroimaging and single-neuron recordings. In the second set of studies, we discuss how different neuroimaging and personality-dimensional approaches together provide new insights into social trait judgments of faces. In both sets of studies, we provide an in-depth comparison between neurotypicals and people with autism spectrum disorder. We offer a computational account for the behavioral and neural markers of the different facial processing between the two groups. Finally, we suggest new practices for studying the emotional processing and social evaluations of faces. All data discussed in the case studies of this review are publicly available.

Alexithymia in Adult Autism Clinic Service-Users: Relationships with Sensory Processing Differences and Mental Health

Mental health difficulties commonly co-occur with autism, especially in autistic people accessing clinic services, impacting substantially on quality-of-life. Alexithymia (difficulty describing/identifying feelings) and sensory processing differences are prevalent traits in autism that have been associated with depression/anxiety in autistic community samples. However, it is important to better understand interrelationships between these traits in clinical populations to improve identification of service-user needs. In this study, 190 autistic adults (65.3% male), seen in a tertiary autism clinic, completed self-report measures of alexithymia (20-item Toronto Alexithymia Scale), sensory processing differences (Adolescent/Adult Sensory Profile) and depression/anxiety (Hospital Anxiety and Depression Scale). Multiple linear regression models and mediation analyses were used to examine associations between alexithymia, sensory processing differences, and depression/anxiety severity. Across the sample, 66.3% of individuals (N = 126) were classified as alexithymic (score ≥ 61). Total alexithymia and difficulty describing/identifying feelings were significantly associated with depression severity (β = 0.30-0.38, highest p < 0.002), and difficulty identifying feelings was significantly associated with anxiety severity (β = 0.36, p < 0.001). Sensory processing differences were also significantly associated with depression severity (β = 0.29, p = 0.002) and anxiety severity across all models (β = 0.34-0.48, highest p < 0.001) Finally, difficulty describing/identifying feelings partially mediated the relationships between sensory processing differences and both depression/anxiety severity. Overall, these results highlight that interventions adapted for and targeting emotional awareness and sensory-related uncertainty may improve mental health outcomes in autistic service-users.

Recognition of facial expressions in autism: Effects of face masks and alexithymia

It is often assumed that the recognition of facial expressions is impaired in autism. However, recent evidence suggests that reports of expression recognition difficulties in autistic participants may be attributable to co-occurring alexithymia-a trait associated with difficulties interpreting interoceptive and emotional states-not autism per se. Due to problems fixating on the eye-region, autistic individuals may be more reliant on information from the mouth region when judging facial expressions. As such, it may be easier to detect expression recognition deficits attributable to autism, not alexithymia, when participants are forced to base expression judgements on the eye-region alone. To test this possibility, we compared the ability of autistic participants (with and without high levels of alexithymia) and non-autistic controls to categorise facial expressions (a) when the whole face was visible, and (b) when the lower portion of the face was covered with a surgical mask. High-alexithymic autistic participants showed clear evidence of expression recognition difficulties: they correctly categorised fewer expressions than non-autistic controls. In contrast, low-alexithymic autistic participants were unimpaired relative to non-autistic controls. The same pattern of results was seen when judging masked and unmasked expression stimuli. In sum, we find no evidence for an expression recognition deficit attributable to autism, in the absence of high levels of co-occurring alexithymia, either when participants judge whole-face stimuli or just the eye-region. These findings underscore the influence of co-occurring alexithymia on expression recognition in autism.

What is the relationship between alexithymia and experiential avoidance? A latent analysis using three alexithymia questionnaires

Alexithymia is a clinically relevant personality trait characterized by poor emotional awareness and associated with several psychological and physical health concerns. Individuals with high alexithymia tend to engage in experiential avoidance and this may mediate psychological distress. However, little is known about what specific processes of experiential avoidance are involved, and the nature of the relation between alexithymia, experiential avoidance, and psychological distress remains unclear at a latent construct level. To examine this relationship at the latent construct level, a representative sample of 693 U.S. adults completed alexithymia (TAS-20, BVAQ, PAQ), general distress (DASS-21), multi-dimensional experiential avoidance (MEAQ), and general health (PROMIS-G-10) questionnaires. Structural equation modeling revealed that alexithymia significantly predicted experiential avoidance (β = 0.966, t = 82.383, p < .01), experiential avoidance significantly predicted general distress (β = 0.810, t = 2.017, p < .05), and experiential avoidance fully mediated the relationship between alexithymia and general distress (βindirect = -0.159, t = -0.398, p > .05). Correlations between alexithymia and experiential avoidance subfactors revealed a strong relationship to the repression and denial subfactor. Experiential avoidance is a promising target for clinical interventions, though longitudinal research is necessary to elucidate how the relationship between alexithymia and experiential avoidance unfolds over time.

Brief Report: Alexithymia Trait Severity, Not Autistic Trait Severity, Relates to Caregiver Reactions to Autistic Children's Negative Emotions

Alexithymia impacts an individual's ability to recognize and understand emotions and frequently co-occurs with autism. This study investigated the relationship between children's alexithymia, autistic traits, and caregiver reactions to their child's negative emotions. Caregivers of 54 autistic and 51 non-autistic children between the ages of 7 and 12 years rated their child's alexithymia and autistic trait severity and their reactions to their child's negative emotions. Caregivers of autistic children reported greater supportive reactions and fewer restrictive/controlling reactions to their child's negative emotions when their child had more alexithymia traits. This study extends previous research by demonstrating that caregivers of autistic children with co-occurring alexithymia traits represent a specific subgroup of caregivers that respond more positively to their child's negative emotions.

The prevalence of self-harm and mental disorders among individuals with intellectual disabilities

OBJECTIVE

Mental health disorders are prevalent among individuals with intellectual disabilities (ID). However, there is a lack of research on the impact of concomitant autism spectrum disorders (ASD) or attention deficit hyperactivity disorder (ADHD) on the mental health within this population. We aimed to investigate the prevalence of mental health disorders and registered healthcare visits due to self-harm among individuals with ID.

METHOD

We used administrative data for all healthcare with at least one recorded diagnosis of mental health disorder or self-harm during 2007-2017 among people with a diagnosis of Down syndrome (DS; n = 1298) and with ID without DS (IDnonDS; n = 10,671) using the rest of the population in Stockholm Region (n = 2,048,488) for comparison.

RESULTS

The highest odds ratios for a mental health disorder were present in females with IDnonDS (9.01) followed by males with IDnonDS (8.50), compared to the general population. The ORs for self-harm among individuals with IDnonDS were high (8.00 for females and 6.60 for males). There were no registered cases of self-harm among individuals with DS. The prevalence of an anxiety or affective disorder was higher among individuals with ID including DS with concomitant ASD or ADHD. Neighbourhood socio-economic status was associated with a lower occurrence of mental health disorders and self-harm in wealthier areas for all outcomes and for all groups.

CONCLUSIONS

Self-harm and psychiatric comorbidities were common among individuals with ID without DS with an attenuated difference among those with concomitant ASD or ADHD, which calls for attention.

Atypical emotion sharing in individuals with mirror sensory synaesthesia

Being able to empathise with others is a crucial ability in everyday life. However, this does not usually entail feeling the pain of others in our own bodies. For individuals with mirror-sensory synaesthesia (MSS), however, this form of empathic embodiment is a common feature. Our study investigates the empathic ability of adults who experience MSS using a video-based empathy task. We found that MSS participants did not differ from controls on emotion identification and affective empathy; however, they showed higher affect sharing (degree to which their affect matches what they attribute to others) than controls. This finding indicates difficulties with self-other distinction, which our data shows results in fewer signs of prosocial behaviour. Our findings are in line with the self-other control theory of MSS and highlight how the use of appropriate empathy measures can contribute to our understanding of this important socio-affective ability, both in typical and atypical populations.

The Inter-Relationship of Emotion Regulation, Self-Compassion, and Mental Health in Autistic Adults

Background

Emotion regulation is one of the key factors that influence mental health outcomes in autistic and nonautistic populations. Recent research has also identified self-compassion as a negative correlate of depression and positive correlate of psychological well-being in autistic adults. Empirical evidence from the general population supports the notion that being kind and compassionate toward oneself during stressful and difficult moments can help with one's ability to regulate negative emotions, which then has flow-on effects on mental health outcomes. However, the inter-relationship between self-compassion, emotion regulation, and mental health has not been examined in autistic samples. Therefore, the aim of this study was to determine if emotion regulation mediates the relationship between self-compassion and anxiety or depression in a sample of autistic adults.

Methods

Participants were 153 adults (meanage = 35.70, standard deviationage = 12.62) who had either self-reported a clinical diagnosis of autism spectrum disorder or self-identified as autistic. They completed an online survey capturing self-compassion, emotion regulation, anxiety, and depression. We hypothesized that emotion regulation would mediate the relationship between self-compassion and anxiety or depression, and self-compassion would not mediate the relationship between emotion regulation and anxiety or depression.

Results

As predicted, only emotion regulation mediated the relationship between self-compassion and mental health outcomes. Self-compassion did not mediate the relationship between emotion regulation and mental health outcomes.

Conclusion

This study provides preliminary evidence for the role that self-compassion plays in improving emotion regulation and mental health in autistic adults. If this mechanism of emotion regulation mediating the relationship between self-compassion and mental health is consistently found in future studies, then it would be helpful for future research to examine the clinical benefits of including a self-compassion component in emotion regulation interventions to improve mental health outcomes of autistic adults.

Relationships between Affect Recognition, Empathy, Alexithymia, and Co-Occurring Conditions in Autism

Prior studies show differences in empathy and affect-recognition ability between those with autism spectrum disorder (ASD) and typically developing (TD) individuals. Autistic individuals also exhibit increased behavioral, gastrointestinal, and sleep issues. In the current study, we explored the differences in empathy and affect recognition between the ASD and TD groups; and we investigated their associations with conditions co-occurring in ASD. A total of 54 TD and 56 ASD children (8-17 years) were included. As compared to the TD group, the ASD group showed lower scores for affect recognition and perspective taking (PT) and higher scores for personal distress (PD). Interestingly, results from hierarchical linear regressions suggested that disparities in the PD and PT between the groups were primarily attributable to attenuated levels of alexithymia, rather than being mediated by the presence of an autism diagnosis. Differences in affect-recognition ability, however, were mediated by both an autism diagnosis and alexithymia. We also found significant correlations between empathy and affect recognition and measures of related conditions common in ASD. Alexithymia, hence, contributes to difficulties in empathy while both alexithymia and autism are associated with affect-recognition ability in ASD. Additionally, the association between affect recognition and empathic ability with co-occurring conditions in ASD needs to be considered during assessments and interventions.

Empathy and behavior in children affected by autism spectrum disorders

BACKGROUND

Many studies have already shown that individuals suffering from autism spectrum disorders (ASD) present low levels of empathy: in fact, reduced emotional reciprocity is considered a clinically significant indicator of autistic functioning. We decided to investigate the role of empathy in determining pathological behaviors in children affected by ASD considering parents' point of view; and to evaluate the presence of differences between mothers and fathers' perception of their child's empathy and behaviors.

METHODS

We compared empathy levels in a sample of 58 patients with ASD as reported by a parent-filled questionnaire with the results of a global evaluation conducted by means of play observations, clinician-rated scales, a semistructured interview with both caregivers and parent-filled questionnaires.

RESULTS

The majority of ASD patients have low levels of empathy according to both parents' points of view; noteworthy, mothers and fathers are highly concordant in this respect. Children's levels of empathy negatively correlate with many behavioral problems, both internalizing and externalizing. Furthermore, we found that mothers tend to perceive more internalizing problems, while fathers are more willing to notice externalizing ones.

CONCLUSIONS

Involving both caregivers in children's diagnostic assessment could deepen patient's evaluation and finally the therapeutic results. Mothers and fathers seem to be highly consistent in describing the psychological characteristics of their child, but not in respect to symptoms.

Autistic adults exhibit highly precise representations of others' emotions but a reduced influence of emotion representations on emotion recognition accuracy

To date, studies have not yet established the mechanisms underpinning differences in autistic and non-autistic emotion recognition. The current study first investigated whether autistic and non-autistic adults differed in terms of the precision and/or differentiation of their visual emotion representations and their general matching abilities, and second, explored whether differences therein were related to challenges in accurately recognizing emotional expressions. To fulfil these aims, 45 autistic and 45 non-autistic individuals completed three tasks employing dynamic point light displays of emotional facial expressions. We identified that autistic individuals had more precise visual emotion representations than their non-autistic counterparts, however, this did not confer any benefit for their emotion recognition. Whilst for non-autistic people, non-verbal reasoning and the interaction between precision of emotion representations and matching ability predicted emotion recognition, no variables contributed to autistic emotion recognition. These findings raise the possibility that autistic individuals are less guided by their emotion representations, thus lending support to Bayesian accounts of autism.

Alexithymia modulates the attitudes towards odors but not the olfactory abilities or the affective reactions to odors

Although emotion and olfaction are closely linked, only a few studies have investigated olfactory processing in alexithymia, a condition characterized by altered emotional processing. These results do not allow comprehensive conclusions on whether individuals with alexithymia present lower olfactory abilities or only altered affective reactions and awareness of odors. Three pre-registered experiments were conducted to clarify this relation. We assessed olfactory functions, the affective qualities of odors, the awareness of odors, the attitudes towards them, and the ability to form olfactory images in the mind. Bayesian statistics were used to assess differences between low, medium and high alexithymia groups, and Linear Mixed Models (LMMs) were applied to investigate the modulation of the affective and cognitive components of alexithymia. We observed that individuals with a high level of alexithymia presented the same olfactory abilities, and did not show differences in their rating of odors compared to individuals with low alexithymia levels, while they reported lower levels of social and common odor awareness and a more indifferent attitude towards odors. Olfactory imagery was not affected by alexithymia level, and the affective and cognitive components of alexithymia, when considered separately, modulated olfactory perception differently. Learning more about olfactory perception in individuals with alexithymia leads to a better understanding of how alexithymia impacts the perception of hedonic stimuli coming from different sensory modalities. Our results imply that treatment goals for alexithymia should be the enhancement of the conscious perception of odors, supporting the use of mindfulness-based protocols in the alexithymia treatment.

The role of anxiety and depression in suicidal thoughts for autistic and non-autistic people: A theory-driven network analysis

BACKGROUND

Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non-autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non-autistic adults.

METHODS

Participants (autistic adults n = 463, 61% female; non-autistic n = 342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non-autistic adults.

RESULTS

Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non-autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults.

CONCLUSION

Autistic people experience more life stressors than non-autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs.

Brief Report: An Exploration of Alexithymia in Autistic and Nonautistic Transgender Adults

Background

Research has shown that many autistic people have alexithymia, a psychological trait characterized by difficulties in identifying and describing emotions. It is also now clear that there is a high rate of autism among transgender people, but we know little about the intersection of autism and gender diversity or about the clinical features of autistic transgender individuals.

Methods

Seventy-eight nonautistic transgender, 56 autistic transgender, 106 nonautistic cisgender, and 107 autistic cisgender adults completed the Toronto Alexithymia Scale-20 and the Autism-spectrum Quotient as part of an online study. We also used the General Alexithymia Factor Score-8 as an additional alexithymia score.

Results

We found that nonautistic transgender participants reported significantly higher mean levels of alexithymia than nonautistic cisgender participants, and that there was a significant overrepresentation of individuals in this group who met the clinical cutoff for alexithymia. The difference in alexithymia between autistic cisgender and autistic transgender participants was nonsignificant, with >50% of each group scoring above the clinical cutoff point. Of note, when we used the General Alexithymia Factor Score-8, the difference between autistic transgender participants and autistic cisgender participants was significant, with autistic transgender participants reporting higher mean levels of alexithymia.

Conclusion

Results suggest that nonautistic transgender individuals might be more prone to experience alexithymia (including at clinically significant levels) than nonautistic cisgender people. When autism occurs in transgender people, the average level and clinical rate of alexithymia is higher than among nonautistic transgender people and potentially higher than among autistic cisgender people. Our findings are in keeping with evidence of a subgroup of transgender people with "subclinical autism" and inconsistent with the notion that autism among transgender and gender diverse people is a "phenomimic" of autism. Lastly, our study highlights the potential importance of screening autistic and nonautistic transgender people for alexithymia.

Inferential Emotion Tracking reveals impaired context-based emotion processing in individuals with high Autism Quotient scores

Emotion perception is essential for successful social interactions and maintaining long-term relationships with friends and family. Individuals with autism spectrum disorder (ASD) experience social communication deficits and have reported difficulties in facial expression recognition. However, emotion recognition depends on more than just processing face expression; context is critically important to correctly infer the emotions of others. Whether context-based emotion processing is impacted in those with Autism remains unclear. Here, we used a recently developed context-based emotion perception task, called Inferential Emotion Tracking (IET), and investigated whether individuals who scored high on the Autism Spectrum Quotient (AQ) had deficits in context-based emotion perception. Using 34 videos (including Hollywood movies, home videos, and documentaries), we tested 102 participants as they continuously tracked the affect (valence and arousal) of a blurred-out, invisible character. We found that individual differences in Autism Quotient scores were more strongly correlated with IET task accuracy than they are with traditional face emotion perception tasks. This correlation remained significant even when controlling for potential covarying factors, general intelligence, and performance on traditional face perception tasks. These findings suggest that individuals with ASD may have impaired perception of contextual information, it reveals the importance of developing ecologically relevant emotion perception tasks in order to better assess and treat ASD, and it provides a new direction for further research on context-based emotion perception deficits in ASD.

Polymorphisms in Oxytocin and Vasopressin Receptor Genes as a Factor Shaping the Clinical Picture and the Risk of ASD in Males

Autism spectrum disorders (ASD) are a heterogeneous group of disorders affecting virtually every population, regardless of their ethnic or socioeconomic background. Their pathogenesis is multifactorial, based on interactions between genetic and environmental factors. The key symptom of ASD are deficits in social communication, which are the basis of many difficulties in everyday functioning. The aim of the presented study was to analyze the clinical picture of social cognition deficits in boys with autism spectrum disorders and to relate its elements with the frequency of alleles of selected polymorphisms within the oxytocin receptor (OXTR) and vasopressin receptor 1A (AVPR1A) genes. The study included 58 boys with IQ > 90, who were divided into two groups based on a confirmed or excluded ASD diagnosis based on the DSM-5 and ICD-10 criteria and then using the ADOS-2 protocol. The results indicated that polymorphism rs10877969 (T) within the AVPR1a gene was the only one to show a statistically significant association with a higher risk of autism spectrum disorders and has an impact on clinical presentation in the ADOS-2 study, primarily in terms of the social affect subscale. Polymorphisms in the OXTR gene showed no significant association with ASD risk and severity of autistic traits in the ADOS-2 study. In the group of people with ASD and those who are neurotypical, the rs53572 (A) genotype in the OXTR gene significantly increased the severity of the clinical picture of social cognition disorders in reading mind in the eyes test (RMiE) and empathy quotient (EQ) studies.

Emotional Dysfunction and Interoceptive Challenges in Adults with Autism Spectrum Disorders

People with autism spectrum disorder (ASD) frequently show impaired sensory processing in different senses, including the interoceptive system. Recent findings suggest that interoception is a fundamental component of emotional experience and that impaired interoception is associated with alexithymia. This study aims to explore the association and interrelation between interoceptive confusion, alexithymia, and the capacity for emotional regulation among a sample of 33 adults with ASD compared to a control group of 35 adults with neurotypical development and its mutual impact. The participants answered a series of questionnaires addressing these three variables. The results showed (1) significant differences between the groups in all dimensions, with dysfunctional emotional regulation, impaired interoception, and alexithymia in the ASD group, (2) significant correlations between interoceptive confusion, emotional clarity, and alexithymia in the ASD group but only positive correlations between interoceptive confusion and alexithymia in the CG, and (3) that emotional clarity, alexithymia, and autism explain 61% of the variance in interoceptive confusion. These results are in line with previous studies and suggest that training interoceptive ability may enhance emotional clarity and reduce alexithymia among those diagnosed with ASD, with significant implications in the planning of treatment.

Relationships between alexithymia, interoception, and emotional empathy in autism spectrum disorder

LAY ABSTRACT

Empathy, the ability to understand and share the emotions of others, is a necessary skill for social functioning and can be categorized into cognitive and emotional empathy. There is evidence to suggest that individuals with autism spectrum disorder have difficulties with cognitive empathy, the ability to imagine how another person is thinking or feeling. However, it is unclear if individuals with autism spectrum disorder struggle with emotional empathy, the ability to share and feel emotions others are experiencing. Self-report and interview data were collected to explore the relationships between interoception (individuals' self-reported awareness of sensation from their body such as thirst, heartbeat, etc.), alexithymia (an individual's ability to describe and distinguish between their own emotions), and emotional empathy in 35 youth with autism spectrum disorder and 40 typically developing youth. Greater personal distress to others' emotions and greater difficulty describing and recognizing self-emotions were associated with reporting fewer physical sensations in the body when experiencing emotion in the autism spectrum disorder group. The results of this study suggest that while autism spectrum disorder youth with concomitant alexithymia may experience emotional empathy differently, it should not be characterized as an absence of a capacity for emotional empathy.

Depression mediates the relationship between alexithymia and obesity in the Northern Finland Birth Cohort 1966 (NFBC1966)

BACKGROUND

The fact that a complex relationship exists between alexithymia and body mass index (BMI) is well established, but the underlying mechanisms remain poorly understood. Here, we explore the relationship between alexithymia and depressive symptoms in relation to adiposity measures, including the direct and indirect effect of alexithymia and depressive symptoms on obesity over a 15-year time-period, in the Northern Finland Birth Cohort 1966 (NFBC1966).

METHODS

The study included individuals from the Northern Finland Birth Cohort 1966 (NFBC1966) who had available data for adiposity measures (body mass index and waist-to-hip ratio), alexithymia (measured by the 20-Item Toronto Alexithymia Scale: TAS-20), depressive symptoms (measured by the 13-item depression subscale of Hopkins Symptom Checklist: HSCL-13) at age of 31 years (n = 4773) and 46 years (n = 4431). Pearson's (r) correlation, and multiple linear regression were used to investigate the relationships between alexithymia, depressive symptoms, and adiposity measures. The potential mediating role of depressive symptoms was examined via Hayes' procedure (PROCESS).

RESULTS

Positive correlations were confirmed between adiposity measures (BMI and WHR) and the TAS-20 score (and its subscale), but not between obesity and HSCL-13 score. The strongest correlation was between the DIF (difficulty identifying feelings) subscale of the TAS-20 and HSCL-13 at both time points (31 y: r₍₃₀₁₃₎ = 0.41, p < 0.01, 46 y: r₍₃₀₁₃₎ = 0.43, p < 0.01). Depressive symptoms completely (z = 2.55 (±0.00003), p = 0.01) and partly (z = 2.16 (±0.0001), p = 0.03) mediated the alexithymia-obesity relationship over the 15-year time-period.

LIMITATIONS

Other psychological and environmental factors such as interoception, dietary intake and physical activities may also play a role as a potential mediating factor in alexithymia-obesity relationship.

CONCLUSIONS

Our findings provide additional insights of theoretical framework of depressive symptoms mediation effect in the relationship between alexithymia and obesity. Alexithymia and depression should, therefore, be considered in the design of future clinical obesity research.