Common and distinct impacts of autistic traits and alexithymia on social reward

“Benjamini and Hochberg False Discovery Rate [47] was used to control for the probability of making a Type I error on multiple comparisons, and only corrected p-values are presented.”

“For example, theory of mind, the ability to represent another person’s mental states, is impaired in autism [52].”

“However, it should be noted that in the current sample, 18 participants scored 32 or higher on the AQ—an approximate threshold proposed by the original authors of the AQ for discriminating individuals with and without a clinical diagnosis of ASD ([3]; see also S2 Table).”

“Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20; [37]).”

“It has also long been recognised that individuals with ASD can vary considerably in terms of their motivation to interact with others [19].”

“[4–5]).”

“For example, there are elevated levels of anxiety and depression in both autistic (anxiety: [53]; depression: [54]) and alexithymic (anxiety: [55]), depression: [23]) populations, and anxiety and depression are both associated with atypical social reward processing (anxiety: [56]; depression: [57]).”

“[4–5]).”

“A construct that has received substantial attention in recent years is alexithymia, a subclinical condition associated with difficulties in identifying and describing one’s own emotions [20].”

“For example, there are elevated levels of anxiety and depression in both autistic (anxiety: [53]; depression: [54]) and alexithymic (anxiety: [55]), depression: [23]) populations, and anxiety and depression are both associated with atypical social reward processing (anxiety: [56]; depression: [57]).”

“Such emotion processing difficulties have been found inconsistently in individuals with ASD, and recent research indicates that once co-occuring alexithymia is taken into account, a number of apparent associations between autistic traits and affective processing deficits disappear [25,28,30].”

“This subscale measures the enjoyment of socialising, such as spending time with others and going to parties, and engagement in this type of activity is rare in individuals with ASD [41].”

“Finally, we hypothesised that the association between autistic traits and alexithymia would be positive, in line with existing research [25, 42].”

“For example, there are elevated levels of anxiety and depression in both autistic (anxiety: [53]; depression: [54]) and alexithymic (anxiety: [55]), depression: [23]) populations, and anxiety and depression are both associated with atypical social reward processing (anxiety: [56]; depression: [57]).”

“A possible explanation for the mixed findings thus far is that ASD is a heterogeneous disorder, with individuals presenting with different types and severities of difficulties under the same umbrella diagnosis [2,18].”

“There is also support for the social motivation hypothesis from neuroimaging studies: individuals with ASD have shown reduced neural activation in frontostriatal regions implicated in reward processing during social reward tasks relative to typically developing controls (reward anticipation: [10]; receipt: [11]; learn…”

“An alternative explanation could be that the reduced levels of empathy in alexithymia [30–31,51] facilitate the enjoyment of negative social potency.”

“Such emotion processing difficulties have been found inconsistently in individuals with ASD, and recent research indicates that once co-occuring alexithymia is taken into account, a number of apparent associations between autistic traits and affective processing deficits disappear [25,28,30].”

“Autistic traits have also been associated with elevated levels of loneliness [58–59], and loneliness implies a desire for interactions or relationships that goes unfulfilled.”

“In addition, endogenous opioids play a key role in the hedonic value of social (and other) experiences, but there is little support that levels are decreased in individual with ASD [16–17].”

“Recent research has demonstrated that alongside deficits in processing their own emotions, individuals with alexithymia also have difficulties with processing others’ emotions, such that these individuals have difficulty recognising others’ facial expressions [26–29] and have reduced levels of empathy [30–31].”

“Autistic traits have also been associated with elevated levels of loneliness [58–59], and loneliness implies a desire for interactions or relationships that goes unfulfilled.”

“As social cues can be difficult to interpret for individuals with high levels of alexithymia [26–28], it may be that the predictability of response that cruel behaviour elicits is rewarding for alexithymic individuals.”

“Alexithymia is reported in approximately 10% of the general population [21], but occurs at significantly elevated levels in many psychiatric conditions, including anorexia nervosa [22], depression [23] and schizophrenia [24].”

“For example, there are elevated levels of anxiety and depression in both autistic (anxiety: [53]; depression: [54]) and alexithymic (anxiety: [55]), depression: [23]) populations, and anxiety and depression are both associated with atypical social reward processing (anxiety: [56]; depression: [57]).”

“An alternative explanation could be that the reduced levels of empathy in alexithymia [30–31,51] facilitate the enjoyment of negative social potency.”

“Our analysis of the passivity and negative social potency subscales of the SRQ was also exploratory as there has been limited previous research on this topic, although one study found that adolescents with ASD did not differ from controls with regard to frequency or duration of submissive/passive behaviours towards pe…”

“Alexithymia is reported in approximately 10% of the general population [21], but occurs at significantly elevated levels in many psychiatric conditions, including anorexia nervosa [22], depression [23] and schizophrenia [24].”

“In addition, endogenous opioids play a key role in the hedonic value of social (and other) experiences, but there is little support that levels are decreased in individual with ASD [16–17].”

“[33]).”

“There is also support for the social motivation hypothesis from neuroimaging studies: individuals with ASD have shown reduced neural activation in frontostriatal regions implicated in reward processing during social reward tasks relative to typically developing controls (reward anticipation: [10]; receipt: [11]; learn…”

“For example, there are elevated levels of anxiety and depression in both autistic (anxiety: [53]; depression: [54]) and alexithymic (anxiety: [55]), depression: [23]) populations, and anxiety and depression are both associated with atypical social reward processing (anxiety: [56]; depression: [57]).”

“The negative associations observed between both autistic traits and alexithymia and enjoyment of prosocial interactions support previous evidence that both constructs are associated with less prosocial behaviour (autistic traits: [40]; alexithymia: [49]).”

“Similarly, individuals with ASD reported less pleasure from social activities when compared to controls [8–9].”

“As social cues can be difficult to interpret for individuals with high levels of alexithymia [26–28], it may be that the predictability of response that cruel behaviour elicits is rewarding for alexithymic individuals.”

“There is also support for the social motivation hypothesis from neuroimaging studies: individuals with ASD have shown reduced neural activation in frontostriatal regions implicated in reward processing during social reward tasks relative to typically developing controls (reward anticipation: [10]; receipt: [11]; learn…”

“Indeed, studies that have focused on alexithymia (but not their co-occurrence with ASD) have found that alexithymia is significantly associated with social anhedonia [34] and with lower levels of satisfaction in intimate relationships [35], suggesting that alexithymia does negatively impact the experience of social re…”

“Similarly, the negative association between autistic traits and enjoyment of sexual relationships reported here could be interpreted as a dislike of the complex rules of dating and romantic relationships associated with sex, as opposed to a lack of reward value of sex itself [62].”

“For example, there are elevated levels of anxiety and depression in both autistic (anxiety: [53]; depression: [54]) and alexithymic (anxiety: [55]), depression: [23]) populations, and anxiety and depression are both associated with atypical social reward processing (anxiety: [56]; depression: [57]).”

“For example, two reviews concluded that individuals with autism are interested in sexual relationships with others, but that they tend to have less actual sexual experiences and more problematic sexual behaviours [43–44], leaving it unclear how autistic traits might be associated with sexual reward.”

“Finally, the negative associations between both autistic traits and alexithymia and enjoyment of sexual relationships are in line with findings that individuals with ASD have fewer sexual experiences than their peers [44] and experience higher levels of physical anhedonia [9], and that alexithymia is associated with l…”

“An EEG study found that children with ASD showed reduced event-related potentials while anticipating and receiving social rewards compared with typically developing controls ([13]).”

“A possible explanation for the mixed findings thus far is that ASD is a heterogeneous disorder, with individuals presenting with different types and severities of difficulties under the same umbrella diagnosis [2,18].”

“Indeed, studies that have focused on alexithymia (but not their co-occurrence with ASD) have found that alexithymia is significantly associated with social anhedonia [34] and with lower levels of satisfaction in intimate relationships [35], suggesting that alexithymia does negatively impact the experience of social re…”

“For example, the negative association between autistic traits and enjoyment of admiration is in keeping with evidence that individuals with ASD engage in less impression management than controls (that is, they are less likely to attempt to influence others’ opinion of themselves) [38–39].”

“Social reward can be defined as the motivational (‘wanting’) and pleasurable (‘liking’) aspects of interacting with others [6], and there is evidence that these processes are impaired in individuals with ASD.”

“There is some evidence that individuals with ASD do engage in impression management when they are sufficiently motivated to do so [48].”

“For example, children with ASD score significantly lower than their peers on the Wish for Social Interaction Scale, which asks respondents how much they would like to chat with or play with people shown in a series of photographs [7].”

“Finally, the negative associations between both autistic traits and alexithymia and enjoyment of sexual relationships are in line with findings that individuals with ASD have fewer sexual experiences than their peers [44] and experience higher levels of physical anhedonia [9], and that alexithymia is associated with l…”

“Finally, the negative associations between both autistic traits and alexithymia and enjoyment of sexual relationships are in line with findings that individuals with ASD have fewer sexual experiences than their peers [44] and experience higher levels of physical anhedonia [9], and that alexithymia is associated with l…”

“In a Go/No-Go task, children with ASD responded with faster reaction times to social reward than typically developing controls [15].”

“This suggests that while social anhedonia might be present to some degree as a pediatric vulnerability marker for psychopathology, it appears to be more core to the presentation of ASD.”

“However, following recent evidence [37–39], it was also pre-”

“This is surprising given that impaired social functioning affects a number of psychiatric disorders (Bosc, 2000; De Silva et al., 2013; Foulkes et al., 2015).”

“Our present findings appear wholly consistent with a recent report by Foulkes et al. (2015), in which non-clinical adults displayed negative inverse relationships between autistic traits and reported levels of enjoyment of prosocial interactions (“sociability”) as measured by the Social Reward…”

“, 2014) and experience less enjoyment from social rewards (Foulkes et al., 2015).”

“Alexithymia also impacts social reward (Foulkes, Bird, Gökçen, McCrory, & Viding, 2015) and the ability to draw typical inferences about others’ character (Brewer, Collins, Cook, & Bird, 2015), which could underpin some of the interpersonal problems reported by alexithymic individuals.”

“, 2009), which suggests that autistic individuals desire social interactions, but these desires are not being fulfilled (Foulkes et al., 2015).”

“The adult SRQ can be used as a tool to explore the experience of social reward in individuals who display problematic or unusual social behaviour [13,14].”

“, 2007), individuals with alexithymia also derive less enjoyment from prosocial interactions (Foulkes et al., 2015).”

“There is potential for vulnerability to serious self-harm [21]–[23] or addiction [97] if rejection is received or perceived, or if they believe they are becoming a burden to others [22], [37].”

“Reducing masking or camouflaging may lead to decreased perceived rewards of social acceptance and inclusion (Foulkes et al., 2015), which, in turn, can contribute to increased social withdrawal and heightened vulnerability to autistic burnout.”

“…such compromises include traumatized or severely neglected children (Perry, 2006b; Perry, 2013; Nelson et al., 2007; Nelson et al., 2009), children with executive functioning disorder (Hinnant et al., 2013; Cottone et al., 2007), and autistic individuals (Jameel et al., 2014; Foulkes et al., 2015).”

“Other studies have demonstrated a relationship between autistic traits and social anhedonia symptoms in non-clinical adult samples (Foulkes et al., 2015; Novacek et al., 2016; Pieslinger et al., 2022).”

“This notion, known as the alexi-thymia hypothesis (Bird & Cook, 2013), suggests that alexi-thymia might underlie the poor emotion recognition abilities observed in a subgroup of individuals with ASD (Foulkes et al., 2015).”

“…behavior in psychopathology, including reduced prosocial behavior in anti-social personality disorder, social withdrawal in depression, and adjusted reciprocity in autism spectrum conditions (Aldridge-Waddon et al., 2020, 2022; Chen et al., 2022; Foulkes et al., 2015; Raihani et al., 2021).”