Investigating emotional impairments in adults with autism spectrum disorders and the broader autism phenotype

The effect of reappraisal on the emotional regulation of shame in young adults with ASD and typical peers

Young adults with ASD experience shame in social interactions, and if poorly mishandled, it may interfere with their attempts to participate in their social environment. One strategy to reduce shame is cognitive reappraisal, yet the efficacy of this strategy was not examined in ASD. Here, we investigated the effect of reappraisal in reducing feelings of shame in ASD and the thematic contents used. Young adults with high-functioning ASD and typical participants were shown shame-arousing pictures. They imagined themselves as the primary character in each scenario and rated their feelings of shame. Then, they were trained to reappraise shame-arousing pictures less negatively. Finally, they viewed other shame-arousing photos, reappraised them, stated aloud their new interpretations, and rated their feelings. We found lower shame ratings in participants with ASD than in typical participants. In addition, we found a similar reduction in shame ratings after reappraising these pictures in both groups. Qualitative analysis revealed that participants with ASD used fewer positive narratives and more neutral and unrealistic descriptions than their typical peers. These findings highlight shame-regulation abilities in individuals with ASD while pointing to their unique narratives. We recommend that clinical interventions in ASD emphasize generating positive reappraisals of social situations.

Alexithymia as a mediator of the associations between child maltreatment and internalizing and externalizing behaviors in adolescence

Child maltreatment is a global concern that profoundly affects individuals throughout their lives. This study investigated the relationships between various forms of child maltreatment and behavior problems involving internalization and externalization during adolescence. Data obtained from a diverse sample of 1802 Canadians aged 14-18 years was used to examine the mediating role of alexithymia-a difficulty in recognizing and expressing emotions-in these associations. Results indicated that adolescents who experienced sexual abuse, emotional abuse, and exposure to intimate partner violence (IPV) in their childhood exhibited higher levels of alexithymia, which was correlated with elevated levels of both internalizing and externalizing problems. Physical abuse and parental neglect were only associated with externalizing problems. Gender differences also emerged, with gender-diverse adolescents reporting a higher prevalence of maltreatment, alexithymia, and behavior problems compared with their peers. However, alexithymia's mediating role was consistent across genders. Overall, this study highlights the intricate relationships between child maltreatment, alexithymia, and adolescent behavior problems. The findings of this study how different forms of child maltreatment significantly shape behavioral outcomes and indicate the importance of interventions in enhancing emotional awareness and expression in adolescents with a childhood history of maltreatment.

Social Anhedonia Accounts for Greater Variance in Internalizing Symptoms than Autism Symptoms in Autistic and Non-Autistic Youth

PURPOSE

Social anhedonia is a transdiagnostic trait that reflects reduced pleasure from social interaction. It has historically been associated with autism, however, very few studies have directly examined behavioral symptoms of social anhedonia in autistic youth. We investigated rates of social anhedonia in autistic compared to non-autistic youth and the relative contributions of autism and social anhedonia symptoms to co-occurring mental health.

METHODS

Participants were 290 youth (Mage=13.75, Nautistic=155) ranging in age from 8 to 18. Youth completed a cognitive assessment and a diagnostic interview. Their caregiver completed questionnaires regarding symptoms of autism and co-occurring psychiatric conditions.

RESULTS

Autistic youth were more likely to meet criteria for social anhedonia than non-autistic youth. There was a significant positive relationship between age and social anhedonia symptom severity, but there was no association between sex and social anhedonia. Dominance analysis revealed that social anhedonia symptom severity had the strongest association with symptoms of depression and social anxiety, while symptoms of ADHD, generalized anxiety, and separation anxiety were most strongly associated with autism symptom severity.

CONCLUSION

This was the first study to tease out the relative importance of social anhedonia and autism symptoms in understanding psychiatric symptoms in autistic youth. Findings revealed higher rates of social anhedonia in autistic youth. Our results indicate that social anhedonia is an important transdiagnostic trait that plays a unique role in understanding co-occurring depression and social anxiety in autistic youth. Future research should utilize longitudinal data to test the transactional relationships between social anhedonia and internalizing symptoms over time.

Autistic traits distribution in different psychiatric conditions: A cluster analysis on the basis of the Adult Autism Subthreshold Spectrum (AdAS Spectrum) questionnaire

Increasing interest is being paid on full-threshold and sub-threshold autism spectrum conditions among adults. Sub-threshold autistic traits (AT) seem to be distributed in a continuum from the clinical to the general population, being particularly higher among subjects with other psychiatric disorders. The aim of the present study was to evaluate the distribution of AT in a sample of subjects with different psychiatric conditions by means of a cluster analysis on the basis of the score reported to the AdAS Spectrum instrument. A total of 738 subjects recruited by seven Italian Universities were divided in 5 groups depending on the clinical diagnosis: Autism spectrum disorder (ASD), subthreshold ASD symptoms (partial ASD), Bipolar disorder (BD), Feeding and eating disorders (FED), and controls (CTLs). All subjects were assessed with the AdAS Spectrum. The cluster analysis identified 3 clusters: the high, medium and low autism clusters. The Restricted interests and rumination domain reported the highest influence in forming the clusters. The high, medium and low autism clusters were respectively more represented in the ASD, partial ASD and CTL groups. The clusters were represented intermediately in the FED and BD groups, confirming the presence of intermediate levels of AT in these clinical populations.

Contributions of face processing, social anhedonia and mentalizing to the expression of social autistic-like traits

Introduction

Quantitative autistic-like traits (QATs) are a constellation of traits that mirror those of clinical autism and are thought to share the same mechanisms as the condition. There is great interest in identifying the genetic and neurobiological basis of QATs, but progress is hindered by the composite nature of these clinically based constructs. Social QATs are defined according to the diagnostic criteria for autism, comprising multiple potential neural mechanisms that may contribute to varying degrees. The objective of this study was to decompose social QATs into more specific constructs, in line with the Research Domain Criteria (RDoC). We chose constructs with trait-like properties and known or suggested significance for autistic social function: (1) social anhedonia, (2) prosopagnosia (face blindness), and (3) mentalizing (attributing mental states to images of eyes). We hypothesized that these constructs may all contribute to observed variance in social QATs.

Methods

We recruited 148 adults with a broad range of QATs (mean age 37.9 years, range 18-69; 50% female; 5.4% autistic) to an experimental behavioral study conducted online. We estimated social QATs using the social factor of the Comprehensive Autistic Traits Inventory. We used the Oxford Face Matching Task and the Reading the Mind in the Eyes Test to measure face matching ability and mentalizing, respectively. Social anhedonia traits were measured with the Anticipatory and Consummatory Interpersonal Pleasure Scale, and prosopagnosic traits with the 20-item Prosopagnosia Index. A combination of frequentist and Bayesian statistics was used to test the social constructs as predictors of social QATs.

Results

We found that social anhedonic traits, prosopagnosic traits, and face matching performance were likely predictors of social QATs, whereas mentalizing showed limited contribution.

Conclusion

The findings support prosopagnosic and anhedonic traits, but not mentalizing deficits, as dimensional predictors of individual differences in social function across the autistic spectrum. Further, the study strongly suggests that social reward systems and face processing networks play significant and independent roles in autistic-like social function.

Eating disorders and autism spectrum: links and risks

In the last decades, increasing attention has been provided to socio-cultural and neurobiological factors involved in the psychopathology of feeding and eating disorders (FED), encouraging a multifactorial approach. In this framework, several authors stressed an association between FED and other kinds of psychiatric disorders from both a psychopathological and a neurobiological point of view. In particular, many promising contributions are focusing on the possible link between FED and autism spectrum disorder (ASD). Growing interest about this association rose from the frequently reported evidence of ASD-like traits amongst FED patients and abnormal eating behaviors amongst patients with ASD. This narrative review overview aims to summarize the most relevant findings about the overlap between different kinds of FED and the autism spectrum, taking into account the most recent hypotheses about the psychopathology of both these conditions. While most of the studies focused on anorexia nervosa, both ASD and autistic traits seem to be detectable also in other kinds of FED. In addition, the recently increased interest toward a dimensional approach to psychopathology led to progressively broadening the concept of ASD, focusing on its subthreshold and gender-specific manifestations and on its link with other psychiatric conditions, including FED. Globally the studies summarized here provide further support to theoretical models featuring a neurodevelopmental approach for mental disorders. In particular, FED have been conceptualized as a possible psychopathological trajectory of a neurodevelopmental alteration, toward which female gender would act as one of many predisposing factors.

The Transdiagnostic Nature of Social Anhedonia: Historical and Current Perspectives

In this chapter, we trace the historical roots of the social anhedonia (SoA) construct to current conceptualizations. We first describe the aspects of SoA that distinguish it from anhedonia in general. We summarize evidence that SoA is a transdiagnostic symptom and risk factor. Although several forms of psychopathology are associated with elevated rates of self-reported SoA, one unresolved issue is whether the processes and mechanisms underlying SoA in one disorder are the same as the processes and mechanisms underlying SoA seen in another disorder. We assert that there may be different causal factors underlying SoA across disorders. Considering both the principles of equifinality and multifinality, we offer an integrative model for social reward processing. This conceptualization considers roles for the following: attention; social cognition, including, but not limited to, social skills; reward learning and valuation; working memory; anticipation, prediction, and remembering; and motivation and effort. We conclude that SoA may be caused by multiple underlying impairments, all of which may serve as targets for intervention. This conceptualization is provided as an impetus for further research in the area.

Validation of the Italian version of the Camouflaging Autistic Traits Questionnaire (CAT-Q) in a University population

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is an instrument recently developed and validated in English for measuring social camouflaging. While increasing research is focusing on camouflaging behaviours often used for masking autistic traits in social contexts, the CAT-Q remains the only self-report instrument in this field. We aimed to validate the Italian version of the CAT-Q, further testing its validity and reliability in a large Italian University population (N = 2439). We employed the Adult Autism Subthreshold Spectrum (AdAS Spectrum) for assessing autism spectrum conditions. The CAT-Q demonstrated excellent internal consistency and test-retest reliability, as well as strong correlations with the AdAS Spectrum. Our results confirm that the CAT-Q is a valuable instrument for evaluating social camouflaging.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory

BACKGROUND

Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults.

METHODS

This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1-40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a "general alexithymia" factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample.

RESULTS

The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with "TAS" no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants.

LIMITATIONS

Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations.

CONCLUSIONS

These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia ).

Alexithymic But Not Autistic Traits Impair Prosocial Behavior

Social impairments are a core feature of autism-spectrum disorders. However, there is a considerable variability in these impairments. Most autistic individuals show large impairments in social functioning but some autistic individuals show small impairments in social functioning. The variability of these impairments has been attributed to the presence or absence of alexithymia. To address this issue, we capitalized on the fact that alexithymic and autistic traits are broadly distributed in the population. This allowed us to investigate how alexithymic and autistic traits affect social functioning in healthy individuals. Healthy individuals showed impairments on a resource-allocation task that were due to alexithymic but not autistic traits. These findings suggest that alexithymic rather than autistic traits impair prosocial behavior across the autism-spectrum.

An evaluation of alexithymia subtypes using latent profile analysis

Four subtypes of the alexithymia construct have been proposed based on different response patterns to the Cognitive and Affective dimensions of the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Previous studies investigating whether alexithymia subtypes can be statistically estimated have not found complete support for these specific subtypes. These previous studies, however, contained several methodological limitations such as relatively small sample sizes, and considerations of only a limited number of proposed subtypes. In the current investigation, we examined whether the four proposed subtypes could be statistically detected in a large sample of undergraduate students (N = 612) who completed the BVAQ, using latent profile analysis (LPA). Based on observed responses to the five BVAQ subscales, consistent with previous studies, our results did not find support for the four proposed alexithymia subtypes. Rather, our results suggested LPA solutions that correspond to individuals with various degrees of alexithymia 'severity'. Although further studies are needed, especially with clinical samples, these results question the idea of four alexithymia subtypes and suggest that the implementation of these subtypes into various research studies may be a premature endeavour.

Validation strategies for subtypes in psychiatry: A systematic review of research on autism spectrum disorder

Heterogeneity within autism spectrum disorder (ASD) is recognized as a challenge to both biological and psychological research, as well as clinical practice. To reduce unexplained heterogeneity, subtyping techniques are often used to establish more homogeneous subtypes based on metrics of similarity and dissimilarity between people. We review the ASD literature to create a systematic overview of the subtyping procedures and subtype validation techniques that are used in this field. We conducted a systematic review of 156 articles (2001-June 2020) that subtyped participants (range N of studies = 17-20,658), of which some or all had an ASD diagnosis. We found a large diversity in (parametric and non-parametric) methods and (biological, psychological, demographic) variables used to establish subtypes. The majority of studies validated their subtype results using variables that were measured concurrently, but were not included in the subtyping procedure. Other investigations into subtypes' validity were rarer. In order to advance clinical research and the theoretical and clinical usefulness of identified subtypes, we propose a structured approach and present the SUbtyping VAlidation Checklist (SUVAC), a checklist for validating subtyping results.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation and refinement of the twenty-item Toronto Alexithymia Scale

BACKGROUND

Alexithymia, a personality trait characterized by difficulties interpreting one's own emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies a number of cognitive and emotional differences previously attributed to autism, such as difficulties in facial emotion recognition and reduced empathy. Although questionnaires such as the twenty-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have attempted to determine the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults.

METHODS

We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 verbal autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study (the Human Penguin Project). The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to further refine the scale based on local model misfit and I-DIF between the groups. Correlations between alexithymia and other clinical outcomes such as autistic traits, anxiety, and quality-of-life were used to assess the nomological validity of the revised alexithymia scale in the SPARK sample.

RESULTS

The TAS-20 did not exhibit adequate global model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an eight-item unidimensional scale (TAS-8) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that TAS-8 scores meaningfully predict autistic trait levels, anxiety and depression symptoms, and quality of life, even after controlling for trait neuroticism.

LIMITATIONS

Limitations of the current study include a sample of autistic adults that was overwhelmingly female, later-diagnosed, and well-educated; clinical and control groups drawn from different studies with variable measures; and an inability to test several other important psychometric characteristics of the TAS-8, including sensitivity to change and I-DIF across multiple administrations.

CONCLUSIONS

These results indicate the potential of the TAS-8 as a psychometrically robust tool to measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced TAS-8 latent trait scores in research applications (available at http://asdmeasures.shinyapps.io/TAS8_Score ).

How Closely Related Are Parent and Child Reports of Child Alexithymia?

Alexithymia is a subclinical trait involving difficulty describing and identifying emotions. It is common in a number of psychiatric conditions. Alexithymia in children is sometimes measured by parent report and sometimes by child self-report, but it is not yet known how closely related the two measures are. This is an important question both theoretically and practically, in terms of research design and clinical practice. We conducted a preliminary study to investigate this question in a sample of 6- to 11-year-old neurotypical children and their parents (N = 29 dyads). Parent and child reports were not correlated, and 93% of parents under-estimated their child’s level of alexithymia relative to the child’s self-report. Based on these results, we hypothesize that when asked to report on the child’s alexithymia, children and parents may not be reporting on the same phenomenon, and thus these two measures may not be interchangeable. These provocative findings, however, must be considered preliminary: our analyses were sufficiently powered to detect a strong relation between the two types of report had one existed, but our analyses were not sufficiently powered to distinguish between a small relation and no relation at all.

Defining the Optimal Threshold Scores for Adult Autism Subthreshold Spectrum (AdAS Spectrum) in Clinical and General Population

Background:

The Adult Autism Subthreshold Spectrum (AdAS Spectrum) is a recently developed instrument tailored to assess the broad range of full-threshold as well as sub-threshold manifestations related to the autism spectrum. Although it has proved to be a valuable instrument for quantitative assessment of autistic symptoms, the AdAS Spectrum still lacks validated diagnostic thresholds.

Objective:

The aim of this study was to define the best cut-off scores of the AdAS Spectrum for determining the presence of subthreshold autistic traits as well as a clinically significant autism spectrum disorder (ASD).

Methods:

Our sample was composed of 39 patients with full-blown ASD, 73 subjects with autistic traits, and 150 healthy controls. Subjects were evaluated by trained psychiatrists, who performed a clinical diagnosis according to DSM-5 and then assessed with the AdAS Spectrum and the Autism Spectrum Quotient.

Results:

Our results showed that the most discriminant cut-off scores were 70 for identifying subjects with full-blown ASD, and 43 for determining the presence of significant autistic traits.

Conclusion:

The threshold values proposed here showed satisfying levels of specificity and sensibility, as well as a good agreement with the diagnosis according to DSM-5 criteria, confirming the validity of the AdAS Spectrum as a psychometric tool for measuring ASD-related conditions in the clinical and general population.

Discrepancies between explicit and implicit evaluation of aesthetic perception ability in individuals with autism: a potential way to improve social functioning

Background

The capacity to evaluate beauty plays a crucial role in social behaviour and social relationships. It is known that some characteristics of beauty are important social cues that can induce stereotypes or promote different behavioural expectations. Another crucial capacity for success in social interactions is empathy, i.e. the ability to understand and share others’ mental and emotional states. Individuals with Autism Spectrum Disorder (ASD) have an impairment of empathic ability. We showed in a previous study that empathy and aesthetic perception abilities closely related. Indeed, beauty can affect different aspects of empathic behaviour, and empathy can mediate the aesthetic perception in typically developing (TD) individuals. Thus, this study evaluates the ability of aesthetic perception in ASD individuals compared to TD individuals, using the Golden Beauty behavioural task adapted for eye-tracking in order to acquire both explicit and implicit evidences. In both groups, the relationship between empathic and aesthetic perception abilities was also evaluated.

Methods

Ten ASD individuals (age ± SD:20.7 ± 4.64) and ten TD individuals (age ± SD:20.17 ± 0.98) participated in the study. Participants underwent empathy tasks and then the Golden Beauty task. To assess differences in the participants’ performance, we carried out a repeated measures general linear model.

Results

At the explicit level, our behavioural results show an impairment in aesthetic perception ability in ASD individuals. This inability could have relevance for their ability to experience pleasure during social interactions. However, at the implicit level (eye-tracking results), ASD individuals conserved a good ability to feel aesthetic pleasure during the Golden Beauty task, thus indicating a discrepancy between the explicit and implicit evaluation of the beauty task. Finally, beauty perception appears to be linked to empathy when neither of these capacities is compromised, as demonstrated in the TD group. In contrast, this link is missed in ASD individuals.

Conclusion

Overall, our results clearly show that individuals with autism are not completely blind to aesthetic pleasure: in fact, they retain an implicit ability to experience beauty. These findings could pave the way for the development of new protocols to rehabilitate ASD social functioning, exploiting their conserved implicit aesthetic perception.

Exploring the cognitive, emotional and sensory correlates of social anxiety in autistic and neurotypical adolescents

BACKGROUND

Social anxiety is common in autistic adolescents. While emerging evidence indicates the importance of several mechanisms (including intolerance of uncertainty (IU), alexithymia and sensory processing) for maintaining anxiety, limited research has explored how these factors are associated with social anxiety in autistic adolescents.

METHODS

We investigated whether IU, emotional and sensory processing are related to social anxiety in autistic and neurotypical adolescents, gathering experimental and questionnaire data from 61 autistic and 62 neurotypical 11- to 17-year-olds recruited to have similarly high levels of anxiety.

RESULTS

In autistic and neurotypical adolescents matched for social anxiety, similar significant associations were observed between social anxiety and IU, alexithymia, maladaptive emotion regulation, sensory hypersensitivity and interoceptive sensibility. Taking a dimensional approach, we found that child- and parent-reported IU, alexithymia and sensory hypersensitivity mediated the relationship between autistic traits and social anxiety symptoms in the combined group of adolescents.

CONCLUSIONS

Our findings indicate that similar correlates of social anxiety are evident in autistic and neurotypical youths experiencing social anxiety and further our understanding of mechanisms that may contribute towards social anxiety in both groups.

Emotional self-awareness in autism: A meta-analysis of group differences and developmental effects

LAY ABSTRACT

Autistic people are thought to have difficulties with identifying and understanding their own emotions. This is referred to as emotional self-awareness. It is important to study emotional self-awareness as people who are more able to understand their own emotions, whether they are autistic or not, are more able to respond to them appropriately, as well as to identify them in other people. It has not yet been confirmed whether autistic people have difficulties with emotional self-awareness, or if any reported difficulties are actually due to the way in which emotional self-awareness is measured in autistic people. If these difficulties do exist, it is also not known when these difficulties emerge. In this research, we reviewed 47 existing studies that measured emotional self-awareness in autistic and non-autistic adults and children. We also compared studies that measured emotional self-awareness in different ways. We found that autistic adults did seem to have poorer emotional self-awareness compared to their neurotypical peers. However, this was not the case with autistic children of age 12 years and below. Instead, differences in emotional self-awareness only seemed to emerge during adolescence. Moreover, these difficulties seemed to increase with age. These results suggest that difficulties with emotional self-awareness may not be inherent in autism. Instead, they may emerge alongside the greater social and mental health difficulties that are experienced by many autistic people during adolescence. We therefore suggest that it is important to find out more about, and subsequently support, the emotional self-awareness difficulties that autistic adolescents may encounter.

Do early-life eating habits predict later autistic traits? Results from a population-based study

Eating problems are common among children with Autism Spectrum Disorder (ASD), but it is unknown to what extent infant eating behavior is associated with later autistic traits. As eating behavior is currently not included in ASD screening instruments, it is important to evaluate whether infant eating behavior predicts later autistic traits and might therefore be used to enhance the early detection of ASD. We investigated the association of breastfeeding and eating behavior during infancy with later autistic traits in the population-based Generation R cohort. We included 3546 mother-child dyads with maternal reports on feeding and eating at age two months and autistic traits at six years. Eating behavior was assessed with seven items on specific eating habits and the Social Responsiveness Scale was used to evaluate autistic traits. Covariates included child sex, and maternal psychopathology and autistic traits. Linear regression analyses showed that being formula fed at two months was associated with a higher autistic trait score at six years (adjusted B = 0.07; 95% CI: 0.00-0.14). Children who were drinking only small quantities (adjusted B = 0.17, 95% CI: 0.04-0.30) and were hungry/not satisfied (adjusted B = 0.23, 95% CI: 0.08-0.39) at age two months also had a higher autistic traits score at age six years. We found no interactions with sex or breastfeeding. This study shows that eating behavior during infancy is related with autistic traits in childhood. Although the associations were fairly small, these findings suggest that early-life eating problems might be relevant for early detection of ASD and a potential addition to ASD-specific screening instruments.

Alexithymia Profile in Relation to Negative Affect in Parents of Autistic and Typically Developing Young Children

In our study, we explored the construct of alexithymia in parents of children with and without ASD using a multi-method approach based on self-rated and external rater assessment. We also assessed the level of self-report measures of negative affect states such as trait anxiety and depression, and investigated the correlation between the alexithymia construct, trait anxiety, and depression within the broader autism phenotype (BAP). A total sample of 100 parents (25 mothers and 25 fathers in each group) were administered the TAS-20 and the TSIA to measure self-reported and observer-rated alexithymia traits, as well as self-report measures of anxiety and depression. Study results showed that the TSIA but not the TAS-20 was able to detect significant group differences in alexithymia traits among parents of children with and without ASD, with parents of ASD children displaying significantly higher levels of alexithymia. Furthermore, differently from the TAS-20, no significant correlations between the TSIA and measures of anxiety and depression were detected. Taken together, our results suggest the importance of using multi-method approaches to control for potential measurement bias and to detect psychological constructs such as alexithymia in subclinical samples such as parents of children with ASD.

Predictors of performance on the Reading the Mind in the Eyes Test

We explored factors associated with performance on the Reading the Mind in the Eyes Test (RMET). 180 undergraduate students completed the human RMET requiring forced-choice mental state judgment; a control human Age Eyes Test (AET) requiring age judgment; a Cat Eyes Test (CET) requiring mental state judgment; and measures of executive function, empathy and psychopathology. Versions of the CET and AET were created that matched the RMET for difficulty (accuracy 71%). RMET and CET performance were strongly correlated after accounting for AET performance. Working memory, schizotypal personality and empathy predicted RMET accuracy but not CET scores. Liking dogs predicted higher accuracy on all eyes tasks, whereas liking cats predicted greater mentalizing but reduced emotional expression. Importantly, we replicated our core findings relating to accuracy and correlations between the CET and RMET in a second sample of 228 students. In conclusion, people can apply similar skills when interpreting cat and human expressions. As RMET and CET performance were found to be differentially affected by executive function and psychopathology, the use of social cognitive measures featuring non-human animals may be of particular use in future clinical research.

Social endophenotypes in autism spectrum disorder: A scoping review

Endophenotypes are measurable markers of genetic vulnerability to current or future disorder. Autism spectrum disorder (ASD) is well-suited to be examined within an endophenotype framework given past and current emphases on the broader autism phenotype and early detection. We conducted a scoping review to identify potential socially-related endophenotypes of ASD. We focused on paradigms related to sociality (e.g., theory of mind (TOM), social attention), which comprise most of this literature. We integrated findings from traditional behavioral paradigms with brain-based measures (e.g., electroencephalography, functional magnetic resonance imaging). Broadly, infant research regarding social attention and responsivity (Research Domain Criteria (RDoC) domain of affiliation) and attention to faces and voices (social communication) finds consistent abnormality in vulnerable infant siblings. Several additional paradigms that have shown differences in vulnerable infants and young children include animacy perception tasks (perception and understanding of others), measures of recognition and response to familiar faces (attachment), and joint attention and false-belief tasks (understanding mental states). Research areas such as alexithymia (the perception and understanding of self), empathic responding, and vocal prosody may hold interest; however, challenges in measurement across populations and age ranges is a limiting factor. Future work should address sex differences and age dependencies, specificity to ASD, and heterogeneous genetic pathways to disorder within samples individuals with ASD and relatives.

The effect of dialectical behaviour therapy in autism spectrum patients with suicidality and/ or self-destructive behaviour (DIASS): study protocol for a multicentre randomised controlled trial

BACKGROUND

Many persons with autism spectrum disorder (ASD) are treated in long-term specialised care. In this population, suicidal behaviour troubles patients, families, and specialists in the field because it is difficult to treat. At present, there is no documented effective therapy for suicidal behaviour in ASD (Autism Research 7:507-521, 2014; Crisis 35:301-309, 2014). Dialectical Behaviour Therapy (DBT) is an efficacious treatment programme for chronically suicidal and/or self-harm behaviour in patients with Borderline Personality Disorder (J Psychiatry 166:1365-1374, 2014; Linehan MM. Cognitive behavioural therapy of borderline personality disorder. 1993). This study will evaluate the efficacy of DBT in persons with ASD and suicidal/ self- destructive behaviour in a multicentre randomised controlled clinical trial.

METHOD

One hundred twenty-eight persons with autism and suicidal and/or self-harming behaviour will be recruited from specialised mental healthcare services and randomised into two conditions: 1) the DBT condition in which the participants have weekly individual cognitive behavioural therapy sessions and a 2.5 h skills training group session twice per week during 6 months, and 2) the treatment as usual condition which consists of weekly individual therapy sessions of 30-45 min with a psychotherapist or social worker. Assessments will take place at baseline, at post-treatment (6 months), and after a follow-up period of 12 months. The mediators will also be assessed at 3 months. The primary outcome is the level of suicidal ideation and behaviour. The secondary outcomes are anxiety and social performance, depression, core symptoms of ASD, quality of life, and cost-utility. Emotion regulation and therapeutic alliance are hypothesised to mediate the effects on the primary outcome.

DISCUSSION

The results from this study will provide an evaluation of the efficacy of DBT treatment in persons with ASD on suicidal and self-harming behaviour. The study is conducted in routine mental health services which enhances the generalisability of the study results to clinical practice.

TRIAL REGISTRATION

ISRCTN96632579. Registered 1 May 2019. Retrospectively registered.

What are Replicable Aspects of the Broader Autism Phenotype among College Students?

Are people with heightened autistic traits less likely to help other people? Recent research suggests that heightened autistic traits are associated with reduced self-reported prosocial behavior among college students. However, the growing literature examining sub-clinical traits associated with autism, or the Broader Autism Phenotype (BAP), among college students has invested insufficient attention in replication of findings, potential interrelationships between constructs, or the degree to which social desirability bias may contribute to findings. To identify replicable aspects of the BAP, we administered a battery of measures to 391 undergraduate students. Replicating prior work, findings suggested that self-reported difficulties understanding the self and others (but not less feeling for others) and sensory atypicalities are core aspects of the BAP. Reduced social desirability bias was also associated with the BAP. Prior associations between reduced prosocial tendencies and the BAP were not replicated. Findings highlight the importance of assessing multiple potential aspects of the BAP, particularly reduced susceptibility to the social desirability bias, when using self-report measures.

Theory of mind performance in younger and older adults with elevated autistic traits

Little is known about the impact of aging with Autism Spectrum Disorder on theory of mind (ToM). While ToM difficulties appear to abate with age in older autistic populations, this has yet to be explored in the Broad Autism Phenotype (BAP). The current study examined ToM performance among younger (n = 49, aged 18-46) and older adults (n = 47, aged 60-91) who were classified as on the BAP (younger n = 18; older n = 21) or not (younger n = 31; older n = 26) using the BAP Questionnaire. ToM was assessed using the ecologically valid Strange Stories Film Task (SSFT) and the dynamic Happé-Frith Triangle Animations task (TA). A 2 × 2 analysis of variance examined the effects of autistic traits (BAP vs. non-BAP) and age (young vs. old). For both SSFT and TA, results showed autistic trait main effects on task performance (non-BAP > BAP). Age main effects were observed for some but not all metrics on TA (younger better than older), with no differences in SSFT. An interaction of autistic traits and age was observed in TA Intentionality, with younger non-BAP and younger BAP performing similarly but older non-BAP performing better than older BAP. Results show that younger and older adults with elevated autistic traits show poorer ToM performance. Despite ToM difficulties being common in later life in the general population, this effect was not observed when using a ToM task designed to reflect real-world scenarios. However, results suggest that autistic traits and age could interact to increase risk for poor ToM performance in older adults who endorse elevated autistic traits. Autism Res 2020, 13: 751-762. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The behaviors and characteristics commonly found in autism spectrum disorders have been linked to differences in understanding social situations. Similar difficulties have also been found in older age. We assessed social understanding in younger and older adults from the general population. Both younger and older adults who report more autism-like characteristics experience more difficulties with social understanding. However, few differences were found between younger and older adults.

The Role of Language in Alexithymia: Moving Towards a Multiroute Model of Alexithymia

Alexithymia is characterized by difficulty identifying and describing one’s own emotion. Identifying and describing one’s emotion involves several cognitive processes, so alexithymia may result from a number of impairments. Here we propose the alexithymia language hypothesis—the hypothesis that language impairment can give rise to alexithymia—and critically review relevant evidence from healthy populations, developmental disorders, adult-onset illness, and acquired brain injury. We conclude that the available evidence is supportive of the alexithymia–language hypothesis, and therefore that language impairment may represent one of multiple routes to alexithymia. Where evidence is lacking, we outline which approaches will be useful in testing this hypothesis.

Association Between Breastfeeding Initiation and Duration and Autism Spectrum Disorder in Preschool Children Enrolled in the Study to Explore Early Development

Studies report inconsistent findings on the relationship between ASD and breastfeeding. We explored associations between ASD and breastfeeding initiation (yes/no) and duration (months categorized in tertiles) in the Study to Explore Early Development, a community-based case-control study in six sites in the Unites States. We adjusted for various child and mother demographic and pregnancy factors. Breastfeeding initiation was reported in 85.7% of mothers of children with ASD and 90.6% of mothers of controls. After adjustment, we found no significant difference in breastfeeding initiation (adjusted odds-ratio [aOR]: 0.88 and 95% confidence interval (CI) 0.60-1.28). However, mothers of children with ASD were less likely to report duration of breastfeeding in the high (≥12 months) versus low tertile (<6 months) (aOR and 95% CI: 0.61 [0.45-0.84]) or the middle (6-<12 months) versus low tertile (0.72: 0.54-0.98). The association of ASD and breastfeeding duration was slightly attenuated when the presence of the broader autism phenotype (BAP) in the mother was accounted for, but still remained for the highest tertile. This association does not appear to be totally explained by maternal BAP. We were unable to distinguish whether the difference in duration was due to difficulties breastfeeding children who later develop ASD, other factors not adjusted in our study, or greater ASD risk resulting from shorter breastfeeding duration. Longitudinal studies that compare reasons why mothers stop breastfeeding between ASD and controls and establish a temporal relation between ASD and breastfeeding are needed. Future studies should also evaluate interactions between ASD risk genes and breastfeeding. Autism Research 2019, 12: 816-829. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In this study, we compared breastfeeding practices between mothers of children with and without autism spectrum disorder (ASD). We found that the percentage of mothers who started breastfeeding was similar between the two groups, but mothers of children with ASD breastfed for a shorter amount of time compared to mothers of children without ASD. Future studies are needed to evaluate the reasons why the duration of breastfeeding was shorter for mothers of children with ASD compared to those without ASD.

A Transdiagnostic Perspective on Social Anhedonia

Humans are highly social beings, yet people with social anhedonia experience reduced interest in or reward from social situations. Social anhedonia is a key facet of schizotypal personality, an important symptom of schizophrenia, and increasingly recognized as an important feature in a range of other psychological disorders. However, to date, there has been little examination of the similarities and differences in social anhedonia across diagnostic borders. Here, our goal was to conduct a selective review of social anhedonia in different psychological and life course contexts, including the psychosis continuum, depressive disorder, posttraumatic stress disorder, eating disorders, and autism spectrum disorders, along with developmental and neurobiological factors. Current evidence suggests that the nature and expression of social anhedonia vary across psychological disorders with some groups showing deficient learning about, enjoyment from, and anticipation of the pleasurable aspects of social interactions, while for others, some of these components appear to remain intact. However, study designs and methodologies are diverse, the roles of developmental and neurobiological factors are not routinely considered, and direct comparisons between diagnostic groups are rare-which prevents a more nuanced understanding of the underlying mechanisms involved. Future studies, parsing the wanting, liking, and learning components of social reward, will help to fill gaps in the current knowledge base. Consistent across disorders is diminished pleasure from social situations, subsequent withdrawal, and poorer social functioning in those who express social anhedonia. Nonetheless, feelings of loneliness often remain, which suggests the need for social connection is not entirely absent. Adolescence is a particularly important period of social and neural development and may provide a valuable window on the developmental origins of social anhedonia. Adaptive social functioning is key to recovery from mental health disorders; therefore, understanding the intricacies of social anhedonia will help to inform treatment and prevention strategies for a range of diagnostic categories.

Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis

Adults with autism spectrum disorder (ASD) are thought to be at disproportionate risk of developing mental health comorbidities, with anxiety and depression being considered most prominent amongst these. Yet, no systematic review has been carried out to date to examine rates of both anxiety and depression focusing specifically on adults with ASD. This systematic review and meta-analysis examined the rates of anxiety and depression in adults with ASD and the impact of factors such as assessment methods and presence of comorbid intellectual disability (ID) diagnosis on estimated prevalence rates. Electronic database searches for studies published between January 2000 and September 2017 identified a total of 35 studies, including 30 studies measuring anxiety (n = 26 070; mean age = 30.9, s.d. = 6.2 years) and 29 studies measuring depression (n = 26 117; mean age = 31.1, s.d. = 6.8 years). The pooled estimation of current and lifetime prevalence for adults with ASD were 27% and 42% for any anxiety disorder, and 23% and 37% for depressive disorder. Further analyses revealed that the use of questionnaire measures and the presence of ID may significantly influence estimates of prevalence. The current literature suffers from a high degree of heterogeneity in study method and an overreliance on clinical samples. These results highlight the importance of community-based studies and the identification and inclusion of well-characterized samples to reduce heterogeneity and bias in estimates of prevalence for comorbidity in adults with ASD and other populations with complex psychiatric presentations.

Investigating alexithymia in autism: A systematic review and meta-analysis

BACKGROUND

New research suggests that, rather than representing a core feature of autism spectrum disorder (ASD), emotional processing difficulties reflect co-occurring alexithymia. Autistic individuals with alexithymia could therefore represent a specific subgroup of autism who may benefit from tailored interventions. The aim of this systematic review and meta-analysis was to explore the nature and prevalence of alexithymia in autism using the Toronto Alexithymia Scale (TAS).

METHODS

Online scientific databases were searched systematically for studies on ASD popu lations using the TAS. Meta-analyses were performed to evaluate differences in scores between the ASD and neurotypical groups, and to determine the prevalence of alexithymia in these populations.

RESULTS

15 articles comparing autistic and neurotypical (NT) groups were identified. Autistic people scored significantly higher on all scores compared to the NT group. There was also a higher prevalence of alexithymia in the ASD group (49.93% compared to 4.89%), with a significantly increased risk of alexithymia in autistic participants.

CONCLUSIONS

This review highlights that alexithymia is common, rather than universal, in ASD, supporting a growing body of evidence that co-occurring autism and alexithymia represents a specific subgroup in the ASD population that may have specific clinical needs. More research is needed to understand the nature and implications of co-occurring ASD and alexithymia.

Broader autism phenotype in parents of children with autism: a systematic review of percentage estimates

The broader autism phenotype (BAP) is a collection of sub-diagnostic autistic traits more common in families of individuals with autism spectrum disorder (ASD) than in the general population. BAP is a latent construct that can be defined using different domains, measured using multiple instruments, and reported using different techniques. Therefore, estimates of BAP may vary greatly across studies. Our objective was to systematically review studies that reported occurrence of BAP in parents of children with ASD in order to quantify and describe heterogeneity in estimates. We systematically searched PubMed and Scopus using PRISMA guidelines for studies quantifying percentage of parents of children with ASD who had BAP We identified 41 studies that measured BAP in parents of children with ASD. These studies used eight different instruments, four different forms of data collection, and had a wide range of sample sizes (N=4 to N=3299). Percentage with BAP ranged from 2.6% to 80%. BAP was more prevalent in fathers than mothers. Parental BAP may be an important tool for parsing heterogeneity in ASD etiology and for developing parent-mediated ASD interventions. However, the variety in measurement instruments and variability in study samples limits our ability to synthesize estimates. To improve measurement of BAP and increase consistency across studies, universal methods should be accepted and adopted across studies. A more consistent approach to BAP measurement may enable efficient etiologic research that can be meta-analyzed and may allow for a larger evidence base that can be used to account for BAP when developing parent-mediated interventions.

Language and alexithymia: Evidence for the role of the inferior frontal gyrus in acquired alexithymia

The clinical relevance of alexithymia, a condition associated with difficulties identifying and describing one's own emotion, is becoming ever more apparent. Increased rates of alexithymia are observed in multiple psychiatric conditions, and also in neurological conditions resulting from both organic and traumatic brain injury. The presence of alexithymia in these conditions predicts poorer regulation of one's emotions, decreased treatment response, and increased burden on carers. While clinically important, the aetiology of alexithymia is still a matter of debate, with several authors arguing for multiple 'routes' to impaired understanding of one's own emotions, which may or may not result in distinct subtypes of alexithymia. While previous studies support the role of impaired interoception (perceiving bodily states) in the development of alexithymia, the current study assessed whether acquired language impairment following traumatic brain injury, and damage to language regions, may also be associated with an increased risk of alexithymia. Within a sample of 129 participants with penetrating brain injury and 33 healthy controls, neuropsychological testing revealed that deficits in a non-emotional language task, object naming, were associated with alexithymia, specifically with difficulty identifying one's own emotions. Both region-of-interest and whole-brain lesion analyses revealed that damage to language regions in the inferior frontal gyrus was associated with the presence of both this language impairment and alexithymia. These results are consistent with a framework for acquired alexithymia that incorporates both interoceptive and language processes, and support the idea that brain injury may result in alexithymia via impairment in any one of a number of more basic processes.

‘Something needs to change’: Mental health experiences of young autistic adults in England

There is a high incidence and prevalence of mental health problems among young people, with several barriers to help-seeking noted in this group. High rates of mental health problems have also been reported in children and adults on the autism spectrum. Taken together, young autistic people may be a particularly vulnerable group when it comes to mental health. Yet, there has been remarkably little work on the mental health needs and experiences of young autistic adults (16–25 years). Adopting a community-based participatory research (CBPR) approach – in which academic researchers and young autistic adults collaborated in an equitable research partnership – we explored young autistic people’s experiences of mental health problems and their perspectives on the support they sought, if any, for these problems. A total of 130 young autistic adults took part in the research: 109 completed an online survey and 21 took part in detailed interviews. The results highlight how young autistic people find it difficult to evaluate their mental health, experience high levels of stigma and often face severe obstacles when trying to access mental health support. The findings also demonstrate how listening to – and learning from – young autistic people is crucial in ensuring that their mental health needs are met.

The Broader Autism Phenotype in Mothers is Associated with Increased Discordance Between Maternal-Reported and Clinician-Observed Instruments that Measure Child Autism Spectrum Disorder

Autism spectrum disorder (ASD) diagnosis relies on parent-reported and clinician-observed instruments. Sometimes, results between these instruments disagree. The broader autism phenotype (BAP) in parent-reporters may be associated with discordance. Study to Explore Early Development data (N = 712) were used to address whether mothers with BAP and children with ASD or non-ASD developmental disabilities were more likely than mothers without BAP to 'over-' or 'under-report' child ASD on ASD screeners or interviews compared with clinician observation or overall impression. Maternal BAP was associated with a child meeting thresholds on a maternal-reported screener or maternal interview when clinician ASD instruments or impressions did not (risk ratios: 1.30 to 2.85). Evidence suggests acknowledging and accounting for reporting discordances may be important when diagnosing ASD.

Investigating the Evidence of Behavioral, Cognitive, and Psychiatric Endophenotypes in Autism: A Systematic Review

Substantial evidence indicates that parents of autistic individuals often display milder forms of autistic traits referred to as the broader autism phenotype (BAP). To determine if discrete endophenotypes of autism can be identified, we reviewed the literature to assess the evidence of behavioral, cognitive, and psychiatric profiles of the BAP. A systematic review was conducted using EMBASE, MEDLINE, PsycINFO, PsycEXTRA, and Global Health. Sixty papers met our inclusion criteria and results are discussed according to the proportion of studies that yield significant deficits per domain. The behavioral, cognitive, and psychiatric endophenotypes in parents of autistic probands are still not clarified; however, evidence suggests mild social/communication deficits, rigid/aloof personality traits, and pragmatic language difficulties as the most useful sociobehavioral candidate endophenotype traits. The existence of deficits in the cognitive domain does suggest familial vulnerability for autism. Furthermore, increased depressed mood and anxiety can also be useful markers; however, findings should be interpreted with caution because of the small number of studies in such heterogeneously broad domains and several methodological limitations.

Understanding Behavioural Rigidity in Autism Spectrum Conditions: The Role of Intentional Control

Although behavioural rigidity belongs to the core symptoms of autism spectrum conditions, little is known about its underlying cognitive mechanisms. The current study investigated the role of intentional control mechanisms in behavioural rigidity in autism. Autistic individuals and their matched controls were instructed to repeatedly choose between two simple cognitive tasks and to respond accordingly to the subsequently presented stimulus. Results showed that autistic participants chose to repeat tasks more often than their controls and when choosing to switch, they demonstrated larger performance costs. These findings illustrate that when required to make their own choices, autistic people demonstrate rigidity at different performance levels, suggesting that intentional control mechanisms might be important for a better understanding of behavioural rigidity in autism.

Alexithymia in Adolescents with Autism Spectrum Disorder: Its Relationship to Internalising Difficulties, Sensory Modulation and Social Cognition

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.

Mimetic desire in autism spectrum disorder

Mimetic desire (MD), the spontaneous propensity to pursue goals that others pursue, is a case of social influence that is believed to shape preferences. Autism spectrum disorder (ASD) is defined by both atypical interests and altered social interaction. We investigated whether MD is lower in adults with ASD compared to typically developed adults and whether MD correlates with social anhedonia and social judgment, two aspects of atypical social functioning in autism. Contrary to our hypotheses, MD was similarly present in both ASD and control groups. Anhedonia and social judgment differed between the ASD and control groups but did not correlate with MD. These results extend previous findings by suggesting that basic mechanisms of social influence are preserved in autism. The finding of intact MD in ASD stands against the intuitive idea that atypical interests stem from reduced social influence and indirectly favors the possibility that special interests might be selected for their intrinsic properties.

From Asperger's Autistischen Psychopathen to DSM-5 Autism Spectrum Disorder and Beyond: A Subthreshold Autism Spectrum Model

Growing interest has recently been devoted to partial forms of autism, lying at the diagnostic boundaries of those conditions previously diagnosed as Asperger's Disorder. This latter includes an important retrieval of the European classical psychopathological concepts of adult autism to which Hans Asperger referred in his work. Based on the review of Asperger's Autistische Psychopathie, from first descriptions through the DSM-IV Asperger's Disorder and up to the recent DSM-5 Autism Spectrum Disorder, the paper aims to propose a Subthreshold Autism Spectrum Model that encompasses not only threshold-level manifestations but also mild/atypical symptoms, gender-specific features, behavioral manifestations and personality traits associated with Autism Spectrum Disorder. This model includes, but is not limited to, the so-called broad autism phenotype spanning across the general population that does not fully meet Autism Spectrum Disorder criteria. From this perspective, we propose a subthreshold autism as a unique psychological/behavioral model for research that could help to understand the neurodevelopmental trajectories leading from autistic traits to a broad range of mental disorders.

Depression in Adolescents with ASD: A Pilot RCT of a Group Intervention

Depression is a potentially life threatening affective disorder that is highly prevalent in individuals with autism spectrum disorders (ASD). This study aimed to evaluate the feasibility, acceptability and preliminary efficacy of a cognitive behavioural intervention for depression in adolescents with ASD. Participants were randomly assigned to the intervention group, or wait-list control group. Although recruitment was extremely difficult, attendance was favourable and attrition was low, and participants reported being satisfied with the programme. No significant treatment effect was revealed on the Beck Depression Inventory or Emotion Regulation Questionnaire. However despite the small sample size (n = 20), there was a trending treatment effect measured by the Depression Anxiety Stress Scale: Depression Subscale. Limitations and areas of future research are discussed.

Social Anhedonia Is Not Just Extreme Introversion: Empirical Evidence of Distinct Constructs

Social anhedonia and introversion, two closely related constructs associated with decreased positive emotions and decreased sociability, are common in schizophrenia-spectrum personality disorders. In light of a myriad of mixed findings regarding positive emotionality in anhedonia, there has been a call to reconceptualize "anhedonia." To clarify the nature of social anhedonia, we used confirmatory factor analysis to investigate the relationship between social anhedonia and introversion. Findings were consistent with the conceptualization of social anhedonia as a separate construct from introversion-the best fitting model was one in which social anhedonia and introversion measures loaded separately. Also consistent with the conceptualization of social anhedonia as separate, we found evidence that it was associated with aspects of alexithymia above and beyond any relationship with introversion. Overall, these results have implications for the understanding of social anhedonia and for the use of it as a discriminating factor between personality disorders characterized by introversion.

Hedonic Capacity in the Broader Autism Phenotype: Should Social Anhedonia Be Considered a Characteristic Feature?

Impairments in social motivational processes may partially explain the differences in social interaction seen among individuals with autism spectrum disorder (ASD). The social motivation hypothesis would predict an association between reduced hedonic capacity and ASD. However, to date, findings have been mixed regarding hedonic deficits among individuals with ASD; adults report lower levels of both social and physical pleasure whereas adolescents only report experiencing lower social pleasure. Moreover, very few studies examining the association between anhedonia and autistic traits have used measures of hedonic response or taken temporal aspects of pleasure into account. The present study examined associations between autistic traits and the experience of pleasure using a non-clinical sample of young adults to further clarify the nature of hedonic deficits in the broader autism phenotype (BAP). Results revealed that autistic traits were negatively associated with both the experience of social pleasure as well as general pleasure, although the association was stronger for social pleasure. Regression analyses revealed that reduced social pleasure was a better predictor of autistic traits than general pleasure. Together these findings suggest that reduced social hedonic capacity is associated with autistic traits in the general population and should be included in conceptualizations of the BAP.