Alexithymia, Executive Function and Mind-Reading in Children with and without Autism Spectrum Disorders

Background:  Alexithymia refers to a pronounced difficulty in identifying and describing one’s own emotions, and is associated with an externally oriented focus of thinking. Alexithymia is known to be much more common in adults with autism spectrum disorders (ASD) compared to the typically-developing adult population. However, we know very little about alexithymia in young children with ASD and advancing our understanding of this topic may be of critical clinical and translation importance.

Objectives:   To investigate alexithymia and it’s relationship with autistic traits, executive functioning (EF) and mind-reading in children with and without ASD.

Methods:   The sample consisted of 57 school- aged children (7-12 years) both with (n= 25) and without (n=32) Autism Spectrum disorder (ASD). Both self and parent- report questionnaires were chosen to assess alexithymia. Autistic traits and communication difficulties were measured using parent-report measures. EF was measured using  the Delis- Kaplan Executive Function System and mind-reading was measured using the children’s Reading the Mind in the Eyes test.

Results:   We found that alexithymia is substantially elevated in ASD on both self- (ASD mean=21.667, SD=5.87; TD mean=16.5, SD=5.38; t=2.40, p=0.009, Cohen’s d=0.94) and parent-report (ASD mean=19.70, SD=10.20; TD mean=5.71, SD=6.24; t=4.74, p<0.0001, Cohen’s d=1.74) measures. Despite both measures being sensitive to on-average group differentiation, we found no evidence of correlation between such measures, indicating that children and their parents may be using different sources of information. Parent-rated alexithymia was also associated with increasing levels of autistic traits when corrected for multiple comparisons (i.e. p<0.0025). A discrepancy between self and other alexithymia ratings were also associated with autistic traits, but only in ASD (SRS r=-0.54, p=0.01; AQ r=-0.42, p=0.06).  Mind-reading significantly predicted higher scores on both self (F (3,43) = 6.16, p < .001) and parent-report alexithymia measures (F (4,44) = 16.19 p < .001). No relationship between EF and alexithymia were observed.

Conclusions:   These results suggest that assessing alexithymia in ASD at younger ages may be important in identifying subgroups that have particular difficulties in the domain of emotion processing. This may aid our ability to deconstruct some of the heterogeneity in ASD and may be useful in developing tailored interventions for children with ASD.