Cited by 126Autism Spectrum Disorder ResearchPsychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Alexithymia in autism: cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms

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Oakley, Bethany F. M., Jones, Emily J. H., Crawley, Daisy, Charman, Tony, Buitelaar, Jan, Tillmann, Julian, Murphy, Declan G., Loth, Eva +1 more·2022·Psychological Medicine

Abstract

Background: Alexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social–emotional and mental health problems in the general population. Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. Nevertheless, the role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood. Methods: In total, 337 adolescents and adults (autism N = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. A total of 135 individuals (autism N = 76) were followed up 12–24 months later. We used regression models to establish cross-sectional and longitudinal associations between alexithymia, social-communication difficulties, anxiety and depression symptoms. Results: Autistic individuals reported significantly higher alexithymia than comparison individuals ( p < 0.001, r effect size = 0.48), with 47.3% of autistic females and 21.0% of autistic males meeting cut-off for clinically relevant alexithymia (score ⩾61). Difficulties in describing feelings were particularly associated with current self-reported social-communication difficulties [ p < 0.001, β = 0.57, 95% confidence interval (CI) 0.44–0.67] and predicted later social-communication difficulties ( p = 0.02, β = 0.43, 95% CI 0.07–0.82). Difficulties in identifying feelings were particularly associated with current anxiety symptom severity ( p < 0.001, β = 0.54, 95% CI 0.41–0.77) and predicted later anxiety ( p = 0.01; β = 0.31, 95% CI 0.08–0.62). Conclusions: Our findings suggest that difficulties in identifying v . describing emotion are associated with differential clinical outcomes in autism. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits.

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Research works printed but not linked: 4

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual – 5th edition. Arlington, VA: American Psychiatric Association Publishing.
  2. Beck, A., Beck, J., Jolly, J., & Steer, R. (2005). Beck youth InventoriesTM – second edition for children and adolescents (BYI-II). Torrance, CA: Western Psychological Services.
  3. Constantino, & Gruber. (2012). Social responsiveness scale, second edition (SRS-2). Torrance, CA: Western Psychological Services.
  4. National Institute of Health and Care Excellence. (2013). Autism spectrum disorder in under 19s: support and management. Retrieved from https://www.nice.org.uk/guidance/cg170 34283415

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Authors
Oakley, B. F. M., Jones, E. J. H., Crawley, D., Charman, T., Buitelaar, J., Tillmann, J., Murphy, D. G., Loth, E., & The EU-AIMS LEAP Group
Affiliations
  • King's College London (GB)
  • Birkbeck, University of London (GB)
  • Radboud University Nijmegen (NL)
  • University of Vienna (AT)
Corresponding author
Oakley, Bethany F. M.
Venue
Psychological Medicine
Published
2020-10-08
Volume
52
Issue
8
Pages
1458-1470
ISSN
  • 0033-2917 (ISSN-L)
  • 1469-8978
OpenAlex
W3091896502
Cited by
126
References
79
Citations by year
2026: 23 · 2025: 20 · 2024: 26 · 2023: 34 · 2022: 13 · 2021: 10
FWCI
7.65
Type
journal article
Language
en
Open access
Locations
  • Psychological Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • BIROn (Birkbeck, University of London) (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
Funders
  • Autism Speaks (777394, 115300)
  • Brandeis University
  • European Federation of Pharmaceutical Industries and Associations (777394, AIMS-2-TRIALS)
  • National Institute for Health and Care Research
  • European Commission (2007–2013, HORIZON2020, 115300, 777394)
  • Innovative Medicines Initiative (AIMS-2- TRIALS, 115300, 777394)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
alexithymia, autism spectrum disorder, social communication deficits, anxiety symptoms, depressive symptoms, emotional awareness, longitudinal prediction, adolescents and adults with autism, sex differences
MeSH terms
Adolescent, Adult, Affective Symptoms, Anxiety, Autistic Disorder, Communication, Cross-Sectional Studies, Depression, Female, Humans, Male

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