Alexithymia in Adolescents with Autism Spectrum Disorder: Its Relationship to Internalising Difficulties, Sensory Modulation and Social Cognition
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Alexithymia is a personality trait frequently found in adults with autism spectrum disorder (ASD), and has been linked to impairments in emotion recognition and empathy. The presentation of alexithymia within ASD at younger ages remains unexplored, and was examined in the present study. Alexithymia rates were significantly elevated in ASD (55%; 31/56 scoring above cut-off) versus non-ASD adolescents (16%; 5/32 scoring above cut-off). Within individuals with ASD, alexithymia was associated with increased self-reported anxiety, parent-reported emotional difficulties, self-reported sensory processing atypicalities, and poorer emotion recognition, but was not associated with theory of mind ability. Overall, our results suggest that alexithymia is highly prevalent, and has selective cognitive correlates in young people with ASD.
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Anxiety in autism is commonly linked to sensory processing differences and elevated levels of alexithymia.
“This may be particularly effective in the context of autism where anxiety is commonly linked to sensory processing differences and elevated levels of alexithymia (ALX; see Vorst & Bermond, 2001), which is characterised by difficulties in identifying and describing one’s own emotions (Maisel et al., 2016; Milosavljevic et al., 2016; Nicholson et al., 2019).”
From Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. (2020) · cites this paper as Milosavljevic et al., 2016
In ‘The association of co-occurring alexithymia with emotional difficulties’ (page not specified), the paper reports significantly higher trait anxiety in autistic adolescents with alexithymia than in those without it. Its sensory-processing sections describe sensory differences in autism and alexithymia, but do not establish that anxiety in autism is commonly linked to those differences. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMost research contradicts the Moriguchi finding across a number of ToM tasks, including the Strange Stories Test and the false-belief task.
“However, most research contradicts this finding across a number of ToM tasks, including the Strange Stories Test and the false-belief task (Lane, Hsu, Locke, Ritenbaugh, & Stonnington, 2015; Milosavljevic et al., 2016).”
From ‘Theory of Mind’ is not Theory of Emotion: a cautionary note on the reading the Mind in the Eyes test (2016) · cites this paper as Milosavljevic et al., 2016
The Theory of mind section describes the Strange Stories and first- and second-order false-belief tasks, and Table 4 shows similar scores for adolescents with ASD with and without alexithymia. The role of alexithymia in social processing states that the study found no association between alexithymia and theory-of-mind ability in this group. But the Alexithymia and Social Cognition section calls the broader evidence “equivocal,” so this paper does not support the claim that most research contradicts Moriguchi. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThere is consistent evidence for a link between alexithymia and anxiety in both autistic and non-autistic individuals.
“there is consistent evidence for a link between ALX and anxiety in both autistic as well as non-autistic individuals (Milosavljevic et al., 2016; Oakley et al., 2020).”
From Examining a model of anxiety in autistic adults (2024) · cites this paper as Milosavljevic et al., 2016
A growing literature has highlighted the importance of diagnosing comorbid alexithymia, which may explain some socioemotional and communicative deficits of autism and be worthy of targeted intervention.
“A growing literature has highlighted the importance of diagnosing comorbid alexithymia, which may explain some of the socioemotional and communicative deficits of autism and be worthy of targeted intervention [78–83].”
From A 'choice', an 'addiction', a way 'out of the lost': Exploring self-injury in autistic people without intellectual disability (2019) · cites this paper as [79]
Alexithymia is implicated in depression and anxiety in autistic youth.
“Alexithymia is implicated in a range of mental health difficulties in autistic youth, including depression and anxiety (Milosavljevic et al., 2016; Oakley et al., 2022).”
From Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation. (2025) · cites this paper as Milosavljevic et al., 2016
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Alexithymia mediates the relationship between interoceptive sensibility and anxiety
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Interoceptive impairments do not lie at the heart of autism or alexithymia
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Alexithymia is associated with emotion dysregulation in young people with autism spectrum disorder
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Alexithymia in autism spectrum disorder
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“…to around 10% in the general population, about 50% of autistic individuals report high levels of ALX (Kinnaird et al., 2019), and there is consistent evidence for a link between ALX and anxiety in both autistic as well as non-autistic individuals (Milosavljevic et al., 2016; Oakley et al., 2020).”
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Commentary: Alexithymia, not autism, is associated with impaired interoception
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- Authors
- Milosavljevic, B., Carter Leno, V., Simonoff, E., Baird, G., Pickles, A., Jones, C. R. G., Erskine, C., Charman, T., & Happé, F.
- Affiliations
- King's College London (GB)
- Guy's Hospital (GB)
- Cardiff University (GB)
- Ecorys (United Kingdom) (GB)
- Corresponding author
- Milosavljevic, Bosiljka
- Simonoff, Emily
- Baird, Gillian
- Pickles, Andrew
- Jones, Catherine R. G.
- Erskine, Catherine
- Charman, Tony
- ORCID
- Venue
- Journal of Autism and Developmental Disorders
- Published
- 2015-12-11
- Volume
- 46
- Issue
- 4
- Pages
- 1354-1367
- ISSN
- 0162-3257 (ISSN-L)
- 1573-3432
- OpenAlex
- W2192012856
- Cited by
- 170
- References
- 92
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 12 · 2023: 17 · 2022: 22 · 2021: 27 · 2020: 19 · 2019: 16 · 2018: 10 · 2017: 10 · 2016: 7
- FWCI
- 5.42
- Type
- journal article
- Language
- en
- Open access
- green
- qmro.qmul.ac.uk
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Autism and Developmental Disorders (publishedVersion)
- PubMed (publishedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- BIROn (Birkbeck, University of London) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- Medical Research Council (G0400065)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- alexithymia, autism spectrum disorder, adolescents, internalizing problems, anxiety, sensory processing, sensory modulation, emotion recognition, social cognition, theory of mind, empathy, emotional problems
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Affective Symptoms, Anxiety, Emotions, England, Female, Humans, Internal-External Control, Male, Parents, Sensation Disorders, Social Behavior, Prevalence, Case-Control Studies, Theory of Mind, Self Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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