Skip to main content

Alexithymia is Associated with Emotion Dysregulation in Young People with Autism Spectrum Disorder

Abstract

Evidence suggests young people with autism spectrum disorder (ASD) have lower levels of emotion regulation than typically developing peers and struggle to modulate the frequency and intensity of their emotions. It may be that these emotion regulation difficulties are a result of co-occurring alexithymia rather than being a core symptom of ASD. We explored the associations between alexithymia and emotion regulation in 43 young people with ASD, aged 10 – 18 years, through self and parent report questionnaires. Parents completed questionnaires measuring the young person’s emotion regulation skills and ASD symptom severity. The young people completed measures of emotion regulation and alexithymia. Correlational analysis and linear regression were used to investigate the relationships between ASD severity, alexithymia and emotion regulation. As predicted, high levels of alexithymia and high level of emotion dysregulation were reported by the young people. Parents also scored the young people as being high on emotion dysregulation. We found statistically significant correlations between alexithymia and emotion regulation, as reported by young people themselves, with some large effect sizes. Parental report of emotion regulation did not correlate with the measure of alexithymia. The source of discrepancies between parent and adolescent perceptions of emotion regulation and emotion recognition are discussed. These results highlighted the key role emotion regulation difficulties play in the lives of young people with ASD and the association with alexithymia. High levels of alexithymia are likely to impinge on the selection of appropriate emotion regulation strategies. The clinical implications for treatment are discussed.

This is a preview of subscription content, access via your institution.

Fig. 1

Availability of Data and Material

Participants were not asked for permission to share their data explicitly in the consent form. However, a synthetic version of the data could be generated using R packages such as synthpop (Nowok et al., 2016) if this would be helpful.

References

  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). American Psychiatric Association.

  2. Bagby, R. M., Taylor, G. J., & Parker, J. D. (1994). The twenty-item Toronto Alexithymia Scale—II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38(1), 33–40

  3. Bauminger, N., Shulman, C., & Agam, G. (2004). The Link Between Perceptions of Self and of Social Relationships in High-Functioning Children with Autism. Journal of Developmental and Physical Disabilities, 16(2), 193–214. https://doi.org/10.1023/B:JODD.0000026616.24896.c8

    Article  Google Scholar 

  4. Berkovits, L., Eisenhower, A., & Blacher, J. (2017). Emotion Regulation in Young Children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 47(1), 68–79. https://doi.org/10.1007/s10803-016-2922-2

    Article  PubMed  Google Scholar 

  5. Bird, G., & Cook, R. (2013). Mixed emotions: The contribution of alexithymia to the emotional symptoms of autism. Translational Psychiatry, 3(7), e285–e285. https://doi.org/10.1038/tp.2013.61

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bird, G., Silani, G., Brindley, R., White, S., Frith, U., & Singer, T. (2010). Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain, 133(5), 1515–1525

    Article  Google Scholar 

  7. Brewer, R., Biotti, F., Catmur, C., Press, C., Happé, F., Cook, R., & Bird, G. (2016). Can Neurotypical Individuals Read Autistic Facial Expressions? Atypical Production of Emotional Facial Expressions in Autism Spectrum Disorders. Autism Research, 9(2), 262–271. https://doi.org/10.1002/aur.1508

    Article  PubMed  Google Scholar 

  8. Bunford, N., Evans, S. W., & Langberg, J. M. (2014). Emotion Dysregulation Is Associated With Social Impairment Among Young Adolescents With ADHD. Journal of Attention Disorders, 22(1), 66–82. https://doi.org/10.1177/1087054714527793

    Article  PubMed  Google Scholar 

  9. Capps, L., Kasari, C., Yirmiya, N., & Sigman, M. (1993). Parental perception of emotional expressiveness in children with autism. Journal of Consulting and Clinical Psychology, 61(3), 475–484. https://doi.org/10.1037/0022-006X.61.3.475

    Article  PubMed  Google Scholar 

  10. Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 19(2), 133–148. https://doi.org/10.1177/1362361313517762

    Article  PubMed  Google Scholar 

  11. Cohen, J. (1988). Statistical statistical power analysis for the behavioral sciences. Laurence Erlbaum

  12. Craparo, G., Faraci, P., & Gori, A. (2015). Psychometric Properties of the 20-Item Toronto Alexithymia Scale in a Group of Italian Younger Adolescents. Psychiatry Investigation, 12(4), 500. https://doi.org/10.4306/pi.2015.12.4.500

    Article  PubMed  PubMed Central  Google Scholar 

  13. Davies, B. E., Frude, N., Jenkins, R., Hill, C., & Harding, C. (2015). A study examining the relationship between alexithymia and challenging behaviour in adults with intellectual disability: Alexithymia and challenging behaviour. Journal of Intellectual Disability Research, 59(11), 1022–1032. https://doi.org/10.1111/jir.12186

    Article  PubMed  Google Scholar 

  14. De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A. G., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141(4), 858–900. https://doi.org/10.1037/a0038498

    Article  PubMed  PubMed Central  Google Scholar 

  15. De Los Reyes, A., Ohannessian, C. M., & Laird, R. D. (2016). Developmental Changes in Discrepancies Between Adolescents’ and Their Mothers’ Views of Family Communication. Journal of Child and Family Studies, 25(3), 790–797. https://doi.org/10.1007/s10826-015-0275-7

    Article  PubMed  Google Scholar 

  16. De Los Reyes, A., Youngstrom, E. A., Pabón, S. C., Youngstrom, J. K., Feeny, N. C., & Findling, R. L. (2011). Internal Consistency and Associated Characteristics of Informant Discrepancies in Clinic Referred Youths Age 11 to 17 Years. Journal of Clinical Child & Adolescent Psychology, 40(1), 36–53. https://doi.org/10.1080/15374416.2011.533402

    Article  Google Scholar 

  17. Demurie, E., De Corel, M., & Roeyers, H. (2011). Empathic accuracy in adolescents with autism spectrum disorders and adolescents with attention-deficit/hyperactivity disorder. Research in Autism Spectrum Disorders, 5(1), 126–134. https://doi.org/10.1016/j.rasd.2010.03.002

    Article  Google Scholar 

  18. Dirks, M. A., Reyes, A. D. L., Briggs-Gowan, M., Cella, D., & Wakschlag, L. S. (2012). Embracing not Erasing Contextual Variability in Children’s Behavior: Theory and Utility in the Selection and Use of Methods and Informants in Developmental Psychopathology. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 53(5), 558–574. https://doi.org/10.1111/j.1469-7610.2012.02537.x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dixon, W. J., & Tukey, J. W. (1968). Approximate Behavior of the Distribution of Winsorized t (Trimming/Winsorization 2). Technometrics, 10(1), 83. https://doi.org/10.2307/1266226.

    Article  Google Scholar 

  20. Dyck, M. J., Piek, J. P., Hay, D. A., & Hallmayer, J. F. (2007). The Relationship Between Symptoms and Abilities in Autism. Journal of Developmental and Physical Disabilities, 19(3), 251–261. https://doi.org/10.1007/s10882-007-9055-7

    Article  Google Scholar 

  21. Edey, R., Cook, J., Brewer, R., Johnson, M. H., Bird, G., & Press, C. (2016). Interaction takes two: Typical adults exhibit mind-blindness towards those with autism spectrum disorder. Journal of Abnormal Psychology, 125(7), 879–885. https://doi.org/10.1037/abn0000199

    Article  PubMed  Google Scholar 

  22. Fitzgerald, M., & Bellgrove, M. A. (2006). The overlap between alexithymia and Asperger’s syndrome. Journal of Autism and Developmental Disorders, 36(4), 573–576. https://doi.org/10.1007/s10803-006-0096-z

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fogleman, N. D., Slaughter, K. E., Rosen, P. J., Leaberry, K. D., & Walerius, D. M. (2019). Emotion regulation accounts for the relation between ADHD and peer victimization. Journal of Child and Family Studies, 28(9), 2429–2442. https://doi.org/10.1007/s10826-018-1297-8

    Article  Google Scholar 

  24. Fraser, G., Wilson, M. S., Garisch, J. A., Robinson, K., Brocklesby, M., Kingi, T., O’Connell, A., & Russell, L. (2018). Non-Suicidal Self-Injury, Sexuality Concerns, and Emotion Regulation among Sexually Diverse Adolescents: A Multiple Mediation Analysis. Archives of Suicide Research, 22(3), 432–452. https://doi.org/10.1080/13811118.2017.1358224

    Article  PubMed  Google Scholar 

  25. Gaigg, S. B., Cornell, A. S., & Bird, G. (2018). The psychophysiological mechanisms of alexithymia in autism spectrum disorder. Autism, 22(2), 227–231. https://doi.org/10.1177/1362361316667062

    Article  PubMed  Google Scholar 

  26. Goldstein, S., & Naglieri, J. A. (2010). Autism Spectrum Rating Scales: ASRS. Multi-Health Systems

  27. Gross, J. J. (1998). The Emerging Field of Emotion Regulation: An Integrative Review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271

    Article  Google Scholar 

  28. Hill, E., Berthoz, S., & Frith, U. (2004). Cognitive Processing of Own Emotions in Individuals with Autistic Spectrum Disorder and in Their Relatives. Journal of Autism and Developmental Disorders, 34(2), 229–235. https://doi.org/10.1023/B:JADD.0000022613.41399.14

    Article  PubMed  Google Scholar 

  29. Hillier, A. J., Fish, T., Siegel, J. H., & Beversdorf, D. Q. (2011). Social and Vocational Skills Training Reduces Self-reported Anxiety and Depression Among Young Adults on the Autism Spectrum. Journal of Developmental and Physical Disabilities, 23(3), 267–276. https://doi.org/10.1007/s10882-011-9226-4

    Article  Google Scholar 

  30. Hurrell, K. E., Hudson, J. L., & Schniering, C. A. (2015). Parental reactions to children’s negative emotions: Relationships with emotion regulation in children with an anxiety disorder. Journal of Anxiety Disorders, 29, 72–82. https://doi.org/10.1016/j.janxdis.2014.10.008

    Article  PubMed  Google Scholar 

  31. Jahromi, L. B., Bryce, C. I., & Swanson, J. (2013). The importance of self-regulation for the school and peer engagement of children with high-functioning autism. Research in Autism Spectrum Disorders, 7(2), 235–246. https://doi.org/10.1016/j.rasd.2012.08.012

    Article  Google Scholar 

  32. Jahromi, L. B., Meek, S. E., & Ober-Reynolds, S. (2012). Emotion regulation in the context of frustration in children with high functioning autism and their typical peers. Journal of Child Psychology and Psychiatry, 53(12), 1250–1258. https://doi.org/10.1111/j.1469-7610.2012.02560.x

    Article  PubMed  Google Scholar 

  33. Kim, S., Holloway, S. D., Bempechat, J., & Li, J. (2018). Explaining Adolescents’ Affect: A Time-Use Study of Opportunities for Support and Autonomy across Interpersonal Contexts. Journal of Child and Family Studies, 27(8), 2384–2393. https://doi.org/10.1007/s10826-018-1092-6

    Article  Google Scholar 

  34. Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry, 55, 80–89. https://doi.org/10.1016/j.eurpsy.2018.09.004

    Article  PubMed  PubMed Central  Google Scholar 

  35. Knickmeyer, R. C., Wheelwright, S., & Baron-Cohen, S. B. (2008). Sex-typical Play: Masculinization/Defeminization in Girls with an Autism Spectrum Condition. Journal of Autism and Developmental Disorders, 38(6), 1028–1035. https://doi.org/10.1007/s10803-007-0475-0

    Article  PubMed  Google Scholar 

  36. Kraemer, H. C., Measelle, J. R., Ablow, J. C., Essex, M. J., Boyce, W. T., & Kupfer, D. J. (2003). A New Approach to Integrating Data From Multiple Informants in Psychiatric Assessment and Research: Mixing and Matching Contexts and Perspectives. American Journal of Psychiatry, 160(9), 1566–1577. https://doi.org/10.1176/appi.ajp.160.9.1566

    Article  Google Scholar 

  37. Lieneman, C. C., Girard, E. I., Quetsch, L. B., & McNeil, C. B. (2019). Emotion Regulation and Attrition in Parent-Child Interaction Therapy. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-019-01674-4

    Article  Google Scholar 

  38. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., Pickles, A., & Rutter, M. (2000). The Autism Diagnostic Observation Schedule—Generic: A Standard Measure of Social and Communication Deficits Associated with the Spectrum of Autism. Journal of Autism and Developmental Disorders, 30(3), 205–223. https://doi.org/10.1023/A:1005592401947

    Article  PubMed  Google Scholar 

  39. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685. https://doi.org/10.1007/BF02172145

    Article  PubMed  Google Scholar 

  40. MacDermott, S. T., Gullone, E., Allen, J. S., King, N. J., & Tonge, B. (2010). The Emotion Regulation Index for Children and Adolescents (ERICA): A Psychometric Investigation. Journal of Psychopathology and Behavioral Assessment, 32(3), 301–314. https://doi.org/10.1007/s10862-009-9154-0

    Article  Google Scholar 

  41. Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. W. (2013). The Role of Emotion Regulation in Autism Spectrum Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679–688. https://doi.org/10.1016/j.jaac.2013.05.006

    Article  Google Scholar 

  42. Milosavljevic, B., Carter Leno, V., Simonoff, E., Baird, G., Pickles, A., Jones, C. R. G., Erskine, C., Charman, T., & Happé, F. (2016). Alexithymia in Adolescents with Autism Spectrum Disorder: Its Relationship to Internalising Difficulties, Sensory Modulation and Social Cognition. Journal of Autism and Developmental Disorders, 46(4), 1354–1367. https://doi.org/10.1007/s10803-015-2670-8

    Article  PubMed  Google Scholar 

  43. Nowok, B., Raab, G. M., & Dibben, C. (2016). synthpop: Bespoke Creation of Synthetic Data in R. Journal of Statistical Software, 74(11).

  44. Rieffe, C., Oosterveld, P., & Terwogt, M. M. (2006). An alexithymia questionnaire for children: Factorial and concurrent validation results. Personality and Individual Differences, 40(1), 123–133. https://doi.org/10.1016/j.paid.2005.05.013

    Article  Google Scholar 

  45. Rieffe, C., Oosterveld, P., Terwogt, M. M., Mootz, S., van Leeuwen, E., & Stockmann, L. (2011). Emotion regulation and internalizing symptoms in children with autism spectrum disorders. Autism, 15(6), 655–670. https://doi.org/10.1177/1362361310366571

    Article  PubMed  Google Scholar 

  46. Samson, A. C., Hardan, A. Y., Podell, R. W., Phillips, J. M., & Gross, J. J. (2015). Emotion Regulation in Children and Adolescents With Autism Spectrum Disorder. Autism Research, 8(1), 9–18. https://doi.org/10.1002/aur.1387

    Article  PubMed  Google Scholar 

  47. Samson, A. C., Huber, O., & Gross, J. J. (2012). Emotion regulation in Asperger’s syndrome and high-functioning autism. Emotion, 12(4), 659–665. https://doi.org/10.1037/a0027975

    Article  PubMed  Google Scholar 

  48. Samson, A. C., Phillips, J. M., Parker, K. J., Shah, S., Gross, J. J., & Hardan, A. Y. (2014). Emotion Dysregulation and the Core Features of Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 44(7), 1766–1772. https://doi.org/10.1007/s10803-013-2022-5

    Article  PubMed  Google Scholar 

  49. Shah, P., Hall, R., Catmur, C., & Bird, G. (2016). Alexithymia, not autism, is associated with impaired interoception. Cortex, 81, 215–220. https://doi.org/10.1016/j.cortex.2016.03.021

    Article  PubMed  PubMed Central  Google Scholar 

  50. Shaw, Z. A., & Starr, L. R. (2019). Intergenerational Transmission of Emotion Dysregulation: The Role of Authoritarian Parenting Style and Family Chronic Stress. Journal of Child and Family Studies, 28(12), 3508–3518. https://doi.org/10.1007/s10826-019-01534-1

    Article  Google Scholar 

  51. Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Developmental Psychology, 33(6), 906–916. https://doi.org/10.1037/0012-1649.33.6.906

    Article  PubMed  Google Scholar 

  52. Sifneos, P. E. (1973). The Prevalence of ‘Alexithymic’ Characteristics in Psychosomatic Patients. Psychotherapy and Psychosomatics, 22(2–6), 255–262. https://doi.org/10.1159/000286529

  53. Sinclair, M., O’Toole, J., Malawaraarachchi, M., & Leder, K. (2012). Comparison of response rates and cost-effectiveness for a community-based survey: Postal, internet and telephone modes with generic or personalised recruitment approaches. BMC Medical Research Methodology, 12(1), 132. https://doi.org/10.1186/1471-2288-12-132

    Article  PubMed  PubMed Central  Google Scholar 

  54. Stasiewicz, P. R., Bradizza, C. M., Gudleski, G. D., Coffey, S. F., Schlauch, R. C., Bailey, S. T., Bole, C. W., & Gulliver, S. B. (2012). The relationship of alexithymia to emotional dysregulation within an alcohol dependent treatment sample. Addictive Behaviors, 37(4), 469–476. https://doi.org/10.1016/j.addbeh.2011.12.011

    Article  PubMed  Google Scholar 

  55. Tajik-Parvinchi, D. J., Farmus, L., Cribbie, R., Albaum, C., & Weiss, J. A. (2020) Clinical and parental predictors of emotion regulation following cognitive behaviour therapy in children with autism Autism 136236132090917. https://doi.org/10.1177/1362361320909178

  56. Team, R. C. (2017). R: A language and environment for statistical computing. http://www.R-project.org/

  57. Trevisan, D. A., Bowering, M., & Birmingham, E. (2016). Alexithymia, but not autism spectrum disorder, may be related to the production of emotional facial expressions. Molecular Autism, 7(1), 46. https://doi.org/10.1186/s13229-016-0108-6

    Article  PubMed  PubMed Central  Google Scholar 

  58. Ueda, M. M., Ding, Y., Blumberg, F., Zhang, C., Yu, Q., & Lantier, K. (2020). Maternal Parenting Style in Relation to Parenting Stress and Behavioral Outcomes in Japanese Children with and without Autism. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-020-09727-z

    Article  Google Scholar 

  59. Verissimo, R., Mota-Cardoso, R., & Taylor, G. (1998). Relationships between Alexithymia, Emotional Control, and Quality of Life in Patients with Inflammatory Bowel Disease. Psychotherapy and Psychosomatics, 67(2), 75–80. https://doi.org/10.1159/000012263

    Article  PubMed  Google Scholar 

  60. Vorst, H. C. M., & Bermond, B. (2001). Validity and reliability of the Bermond-Vorst Alexithymia Questionnaire. Personality and Individual Differences, 30(3), 413–434. https://doi.org/10.1016/S0191-8869(00)00033-7

    Article  Google Scholar 

  61. Waller, E., & Scheidt, C. E. (2004). Somatoform disorders as disorders of affect regulation. Journal of Psychosomatic Research, 57(3), 239–247. https://doi.org/10.1016/S0022-3999(03)00613-5

    Article  PubMed  Google Scholar 

  62. Weiss, J. A., Thomson, K., & Chan, L. (2014). A Systematic Literature Review of Emotion Regulation Measurement in Individuals With Autism Spectrum Disorder: Emotion regulation measurement in individuals with ASD. Autism Research, 7(6), 629–648. https://doi.org/10.1002/aur.1426

    Article  PubMed  Google Scholar 

  63. Whiteley, P. (2010) Gender Ratios in Autism, Asperger Syndrome and Autism Spectrum Disorder Autism Insights 17 https://doi.org/10.4137/AUI.S3938

  64. Wing, L., Leekam, S. R., Libby, S. J., Gould, J., & Larcombe, M. (2002). The Diagnostic Interview for Social and Communication Disorders: Background, inter-rater reliability and clinical use. Journal of Child Psychology and Psychiatry, 43(3), 307–325. https://doi.org/10.1111/1469-7610.00023

    Article  PubMed  Google Scholar 

  65. Zlomke, K. R., Bauman, S., & Edwards, G. S. (2019). An Exploratory Study of the Utility of the Dyadic Parent-Child Interaction Coding System for Children with Autism Spectrum Disorder. Journal of Developmental and Physical Disabilities, 31(4), 501–518. https://doi.org/10.1007/s10882-018-9648-3

    Article  Google Scholar 

Download references

Acknowledgements

This project formed part of Emer Gormley’s MA in Applied Psychology (Mental Health). An earlier draft was displayed as a poster presentation at The PSI Early Graduate Group Conference (Sept 2018).

Funding

This research was carried out without financial support.

Author information

Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Emer Gormley. Analysis was performed by Emer Gormley, Christian Ryan and Chris McCusker. The manuscript was written Emer Gormley, Christian Ryan and Chris McCusker. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Christian Ryan.

Ethics declarations

Ethics Approval

The study was approved by the university ethics committee and the ethics committee of the community disability service. All procedures performed were in accordance with the 1964 Helsinki declaration and its later amendments.

Informed Consent

All participants provided full written informed consent before participation in the study.

Conflict of Interest

The author declares there is no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gormley, E., Ryan, C. & McCusker, C. Alexithymia is Associated with Emotion Dysregulation in Young People with Autism Spectrum Disorder. J Dev Phys Disabil (2021). https://doi.org/10.1007/s10882-021-09795-9

Download citation

Keywords

  • Adolescence
  • Alexithymia
  • Autism Spectrum Disorder
  • Emotion regulation
  • Multiple Informants