Alexithymia, but not autism spectrum disorder, may be related to the production of emotional facial expressions

No association between alexithymia and emotion recognition or theory of mind in a sample of adolescents enhanced for autistic traits

LAY ABSTRACT

Alexithymia is a sub-clinical condition characterised by difficulties identifying and describing one's own emotions, which is found in many, but not all autistic people. The alexithymia hypothesis suggests that certain aspects of socio-cognitive functioning typically attributed to autism, namely difficulties in emotion recognition, might be better explained by often co-occurring alexithymia. It is important to understand what is specific to autism and what is due to other co-occurring characteristics to develop appropriate support for autistic people. However, most research on this topic has been conducted in adults, which limits our knowledge about the relevance of this theory to younger autistic populations. This study tested whether difficulties in emotion recognition and theory of mind traditionally associated with autism might be better explained by alexithymia in a sample of adolescents with and without a diagnosis of autism. Results found that difficulties in emotion recognition and theory of mind were both associated with autistic traits, and this was not accounted for by individual differences in levels of alexithymia. This research suggests that more work is needed to understand the applicability of the alexithymia hypothesis in younger populations, but that at least in adolescents and when using parent-report measures, alexithymia may not account for emotion recognition or theory of mind difficulties associated with autistic traits.

Being facially expressive is socially advantageous

Individuals vary in how they move their faces in everyday social interactions. In a first large-scale study, we measured variation in dynamic facial behaviour during social interaction and examined dyadic outcomes and impression formation. In Study 1, we recorded semi-structured video calls with 52 participants interacting with a confederate across various everyday contexts. Video clips were rated by 176 independent participants. In Study 2, we examined video calls of 1315 participants engaging in unstructured video-call interactions. Facial expressivity indices were extracted using automated Facial Action Coding Scheme analysis and measures of personality and partner impressions were obtained by self-report. Facial expressivity varied considerably across participants, but little across contexts, social partners or time. In Study 1, more facially expressive participants were more well-liked, agreeable, and successful at negotiating (if also more agreeable). Participants who were more facially competent, readable, and perceived as readable were also more well-liked. In Study 2, we replicated the findings that facial expressivity was associated with agreeableness and liking by their social partner, and additionally found it to be associated with extraversion and neuroticism. Findings suggest that facial behaviour is a stable individual difference that proffers social advantages, pointing towards an affiliative, adaptive function.

Alexithymia and negative emotions among nursing students: a moderated mediation model

Nursing students, who comprise a high percentage of China's college students, experience many psychological problems; however, few studies explored the mechanisms underlying these problems. This cross-sectional study explored the relationships and mechanisms of depression, anxiety, stress, and narrative disorders in senior nursing students. Questionnaires were administered to 380 senior nursing students in Hubei Province using the Sociodemographic Questionnaire, Toronto Alexithymia-20 Scale, Perceived Social Support Scale, 10-Item Connor-Davidson Resilience Scale, and Depression-Anxiety-Stress Scale. After controlling for sociodemographic variables, Hayes' PROCESS macros were used to test how psychological resilience moderates the relationships among narrative disorders, negative affect, and perceived social support. Bootstrap confidence intervals tested for indirect effects. Correlation analyses revealed that alexithymia was correlated significantly positively with depression-anxiety-stress (r = 0.57, 0.56, and 0.58, resp.) and significantly negatively with perceived social support (r = 0-0.46). Psychological resilience was correlated significantly negatively with alexithymia (r=-0.39) and depression-anxiety-stress (r=-0.31, -0.30, and-0.32, resp.) but significantly positively with perceived social support(r = 0.50). Perceived social support was correlated significantly negatively with depression-anxiety-stress (r=-0.33, -0.34, and - 0.42 resp.). Stress was correlated significantly positively with anxiety and depression (r = 0.81 and 0.77, resp.). Psychological resilience was a partial mediator between depression and dysphoria (β=-0.08, p < 0.05). Dysphoria directly predicted anxiety (β = 0.31) and stress (β = 0.37); moreover,alexithymia predicted depression not only directly but also through the mediating effect of psychological resilience. Therefore, educators and clinical administrators must promote and recognise negative emotions among nursing students to help ensure the nursing workforce's stability.

Toward the detection of reduced emotion expression intensity: an autism sibling study

INTRODUCTION

Expressing emotions through spontaneous facial expression is an important nonverbal social communication skill. In our study, we aimed to demonstrate that both children with autism spectrum disorder (ASD) and the non-ASD siblings of children with ASD have deficits in this skill.

METHOD

In this study, we analyzed the six core facial emotion expressions of three distinct groups of children - those diagnosed with ASD (n = 60), non-ASD siblings (n = 60), and typically developed children (n = 60). To analyze facial expressions, we employed a computer vision program that uses machine learning algorithms to detect facial features and conducted an evidence-based task that involved assessing participants' ability to recognize facial emotion expressions.

RESULTS

Deficits in spontaneous emotion expression were shown in the children with ASD and in non-ASD siblings when compared with typically developed children. Interestingly, it was determined that these deficits were not related to the severity of the autism symptoms in the ASD group.

CONCLUSIONS

The results of the study suggest that computer-based automated analysis of facial expressions with contextual social scenes task holds potential for measuring limitations in the ability to express emotions, and they supplement the traditional clinical assessment of social phenotypical behavior deficits. This applies both to children with ASD and especially, to the non-ASD siblings of children with ASD. This study adds a novel approach to previous literature examining the emotion expression skills.

Social cognition in chronic migraine with medication overuse: a cross-sectional study on different aspects of mentalization and social relationships

BACKGROUND

Social cognition refers to all mental operations to decipher information needed in social interactions. Here we aimed to outline the socio-cognitive profile of Chronic Migraine with Medication Overuse (CM + MO), given they are recognized to be at risk of socio-cognitive difficulties. Given the multidimensionality of this construct, we considered: (1) socio-cognitive abilities, (2) socio-cognitive beliefs, (3) alexithymia and autism traits, and (4) social relationships.

METHODS

Seventy-one patients suffering from CM + MO, 61 from episodic migraine (EM), and 80 healthy controls (HC) were assessed with a comprehensive battery: (1) the Faux Pas test (FP), the Strange Stories task (SS), the Reading Mind in the Eyes test (RMET), (2) the Tromsø Social Intelligence Scale, (3) the Toronto Alexithymia Scale, the Autism Spectrum Quotient, (4) the Lubben Social Network Scale, the Friendship Scale.

RESULTS

CM + MO: (1) performed similar to EM but worse than HC in the FP and SS, while they were worse than EM and HC in the RMET; (2) were similar to EM and HC in social intelligence; (3) had more alexithymic/autistic traits than EM and HC; (4) reported higher levels of contact with their family members but felt little support from the people around them than HC.

CONCLUSIONS

CM + MO results characterized by a profile of compromised socio-cognitive abilities that affects different dimensions. These findings may have a relevant role in multiple fields related to chronic headache: from the assessment to the management.

Training and Profiling a Pediatric Facial Expression Classifier for Children on Mobile Devices: Machine Learning Study

BACKGROUND

Implementing automated facial expression recognition on mobile devices could provide an accessible diagnostic and therapeutic tool for those who struggle to recognize facial expressions, including children with developmental behavioral conditions such as autism. Despite recent advances in facial expression classifiers for children, existing models are too computationally expensive for smartphone use.

OBJECTIVE

We explored several state-of-the-art facial expression classifiers designed for mobile devices, used posttraining optimization techniques for both classification performance and efficiency on a Motorola Moto G6 phone, evaluated the importance of training our classifiers on children versus adults, and evaluated the models' performance against different ethnic groups.

METHODS

We collected images from 12 public data sets and used video frames crowdsourced from the GuessWhat app to train our classifiers. All images were annotated for 7 expressions: neutral, fear, happiness, sadness, surprise, anger, and disgust. We tested 3 copies for each of 5 different convolutional neural network architectures: MobileNetV3-Small 1.0x, MobileNetV2 1.0x, EfficientNetB0, MobileNetV3-Large 1.0x, and NASNetMobile. We trained the first copy on images of children, second copy on images of adults, and third copy on all data sets. We evaluated each model against the entire Child Affective Facial Expression (CAFE) set and by ethnicity. We performed weight pruning, weight clustering, and quantize-aware training when possible and profiled each model's performance on the Moto G6.

RESULTS

Our best model, a MobileNetV3-Large network pretrained on ImageNet, achieved 65.78% accuracy and 65.31% F1-score on the CAFE and a 90-millisecond inference latency on a Moto G6 phone when trained on all data. This accuracy is only 1.12% lower than the current state of the art for CAFE, a model with 13.91x more parameters that was unable to run on the Moto G6 due to its size, even when fully optimized. When trained solely on children, this model achieved 60.57% accuracy and 60.29% F1-score. When trained only on adults, the model received 53.36% accuracy and 53.10% F1-score. Although the MobileNetV3-Large trained on all data sets achieved nearly a 60% F1-score across all ethnicities, the data sets for South Asian and African American children achieved lower accuracy (as much as 11.56%) and F1-score (as much as 11.25%) than other groups.

CONCLUSIONS

With specialized design and optimization techniques, facial expression classifiers can become lightweight enough to run on mobile devices and achieve state-of-the-art performance. There is potentially a "data shift" phenomenon between facial expressions of children compared with adults; our classifiers performed much better when trained on children. Certain underrepresented ethnic groups (e.g., South Asian and African American) also perform significantly worse than groups such as European Caucasian despite similar data quality. Our models can be integrated into mobile health therapies to help diagnose autism spectrum disorder and provide targeted therapeutic treatment to children.

Effects of DBT-based interventions on alexithymia: a systematic review

While dialectical behavior therapy (DBT) appears effective for some psychiatric conditions commonly associated with alexithymia, it is unclear whether DBT improves difficulties experienced by alexithymic individuals. This review investigated the current evidence on the effectiveness of DBT-based interventions in improving alexithymia. A qualitative synthesis of studies that investigated the efficacy of DBT on self-reported alexithymia was performed, identifying eligible studies using EBSCO/Essentials, Google Scholar, PubMed, Web of Science, and PsychINFO databases. Eight studies were identified. Overall, the results were inconclusive due to the heterogeneity of the studies but suggest that DBT-based interventions may be associated with self-reported decreases in alexithymia and increases in the ability to identify emotional states. The literature is limited by significant methodological problems, such as the low number of controlled trials, small samples, and high variability between DBT programs, which increases the risk of bias across study outcomes. More research is needed to reach conclusions regarding the effectiveness of DBT in improving alexithymia. Future studies should conduct randomized controlled trial designs (primarily with active treatment control conditions), greater standardization of DBT-based interventions, and a more in-depth examination of the level of participant involvement in long-term DBT-based interventions may help to understand whether DBT improves alexithymia difficulties.

Autism traits dimensionality and multivariate relationship with alexithymia and anxiety in the general population

BACKGROUND

Autism is characterized by social and non-social alterations observed beyond the clinical diagnosis. Research analyzing the expression of autism traits in the general population helps to unravel the relationship between autism dimensions and other associated variables, such as alexithymia and anxiety. The Autism-Spectrum Quotient (AQ) was developed to assess autism traits in the general population; however, inconsistent results regarding its dimensionality have emerged.

AIMS

This study aimed to extend evidence about the AQ measurement model, and explore the multivariate relationship between autism traits, alexithymia, and trait anxiety.

METHODS

292 adults of the general population were recruited. An Exploratory Factor Analysis and Confirmatory Factor Analysis were performed to assess the factorial structure of AQ. A path analysis was carried out to explore the relationship between autism traits, alexithymia, and trait anxiety.

RESULTS

The results supported a three-factor model of AQ. The path analysis model showed evidence of a significant role of alexithymia as a mediator of the relationship between autism traits and anxiety.

CONCLUSIONS AND IMPLICATIONS

The present study provides empirical support for a three-factor model of AQ in the general population. The association between autism traits, alexithymia, and anxiety dimensions highlights the multidimensional nature of these variables and the need to account for their distinct impact on autism-related variables.

Autism traits outweigh alexithymia traits in the explanation of mentalising performance in adults with autism but not in adults with rejected autism diagnosis

Background

Pronounced alexithymia traits have been found in autism spectrum disorder (ASD) and recent research has been carving out the impact alexithymia traits might have on mentalising deficits associated with ASD.

Method

In this cross-sectional study, a large representative referral population for diagnostic examination for possible ASD (n = 400) was screened for clinical alexithymia with a German version of the Reading the Mind in the Eyes test (RME). In contrast to previous attempts to carve out the impact of alexithymia traits on mentalising deficits though, we employed dominance analysis to account for the correlation between predictors. The relative relationship between alexithymia traits and autism traits with RME performance was investigated in the group of individuals with confirmed ASD diagnosis (N = 281) and compared to the clinical referral sample in which ASD was ruled out (N = 119).

Results

Dominance analysis revealed autism traits to be the strongest predictor for reduced mentalising skills in the ASD sample, whereas alexithymia contributed significantly less. In the sample of individuals with ruled out diagnosis, autism traits were the strongest predictor, but alexithymia traits were in sum equally associated to mentalising, with the External-Oriented Thinking subscale as an important predictor of this association.

Limitations

It needs to be considered that the cross-sectional study design does not allow for causal inference. Furthermore, mentalising is a highly facetted capacity and measurements need to reduce this complexity into simple quantities which limits the generalizability of results.

Discussion

While alexithymia traits should be considered for their mental health importance, they do not dominate the explanation of reduced mentalising skills in individuals with ASD, but they might do to a larger degree in individuals with ruled out ASD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13229-022-00510-9.

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

BACKGROUND

Alexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social-emotional and mental health problems in the general population. Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. Nevertheless, the role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood.

METHODS

In total, 337 adolescents and adults (autism N = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. A total of 135 individuals (autism N = 76) were followed up 12-24 months later. We used regression models to establish cross-sectional and longitudinal associations between alexithymia, social-communication difficulties, anxiety and depression symptoms.

RESULTS

Autistic individuals reported significantly higher alexithymia than comparison individuals (p < 0.001, r effect size = 0.48), with 47.3% of autistic females and 21.0% of autistic males meeting cut-off for clinically relevant alexithymia (score ⩾61). Difficulties in describing feelings were particularly associated with current self-reported social-communication difficulties [p < 0.001, β = 0.57, 95% confidence interval (CI) 0.44-0.67] and predicted later social-communication difficulties (p = 0.02, β = 0.43, 95% CI 0.07-0.82). Difficulties in identifying feelings were particularly associated with current anxiety symptom severity (p < 0.001, β = 0.54, 95% CI 0.41-0.77) and predicted later anxiety (p = 0.01; β = 0.31, 95% CI 0.08-0.62).

CONCLUSIONS

Our findings suggest that difficulties in identifying v. describing emotion are associated with differential clinical outcomes in autism. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits.

Are Autistic and Alexithymic Traits Distinct? A Factor-Analytic and Network Approach

Despite the heterogeneity in autism, socioemotional difficulties are often framed as universal. Increasing evidence, however, suggests that socioemotional difficulties may be explained by alexithymia, a distinct yet frequently co-occurring condition. If, as some propose, autistic traits are responsible for socioemotional impairments, then alexithymia may itself be a symptom of autism. We aimed to determine whether alexithymia should be considered a product of autism or regarded as a separate condition. Using factor-analytic and network approaches, we provide evidence that alexithymic and autistic traits are distinct. We argue that: (1) models of socioemotional processing in autism should conceptualise difficulties as intrinsic to alexithymia; and (2) assessment of alexithymia is crucial for diagnosis and personalised interventions.

Alexithymic and autistic traits in children and adolescents: A systematic review of the current state of knowledge

LAY ABSTRACT

In this study, we aim to explore the ability of autistic children to process emotions and respond to a range of feelings in relation to a triad of difficulties known as alexithymia, namely children's difficulties to recognize, describe, and distinguish emotions. Alexithymia is common in autistic adults but we know very little about children. To understand this condition better, within a large group of studies, first we study the extent to which alexithymia difficulties are present in autistic children. In reviewing the literature, we also present the assessment measures implemented in each study, their limitations, and potential effects on our understanding of findings. This knowledge will help us understand the extent to which alexithymia is present in autistic children and how it may be related to their emotional difficulties. Also, it will allow us to further detect challenges early on in children's lives so that we recommend interventions that teach autistic children how to recognize, describe, and distinguish emotions in themselves and in others. Such interventions may include family members of autistic children to assist interactions with their child. Supporting children from an early age will help them develop skills that will ready them for school and life and it will enhance their ability to build supportive relationships and meet their fullest potential.

Moral Foundations Theory Among Autistic and Neurotypical Children

Morality can help guide behavior and facilitate relationships. Although moral judgments by autistic people are similar to neurotypical individuals, many researchers argue that subtle differences signify deficits in autistic individuals. Moral foundation theory describes moral judgments in terms of differences rather than deficits. The current research, aimed at assessing autistic individuals' moral inclinations using Haidt's framework, was co-designed with autistic community members. Our aim was to describe autistic moral thinking from a strengths-based perspective while acknowledging differences that may pose interpersonal challenges among autistic youth. We assessed 25 autistic and 23 neurotypical children's moral judgments using the Moral Foundations Questionnaire for Kids. We used semi-structured interviews and qualitative analysis with a subset of participants to describe children's moral reasoning. Analyses suggested that autistic and neurotypical children make similar judgments about moral transgressions across all five moral foundations. General linear mixed modeling showed that the greatest predictor of recommending punishment was how bad children deemed moral transgressions to be. We also found a trend that autistic children were more likely to recommend punishment for harmless norms violations than were neurotypical children. Future research could use longitudinal methods to understand the development of moral judgments among autistic and neurotypical children.

Atypical interoception as a common risk factor for psychopathology: A review

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

Alexithymia and Autistic Traits: Associations With Social and Emotional Challenges Among College Students

Background: Alexithymia is a multifaceted personality construct defined by marked difficulties in identifying and describing feelings and in externally oriented thinking. Given its intrinsic role in social-emotional processing, alexithymia is now recognized as a trans-diagnostic trait in a range of neurodevelopmental disorders, including autism. Research has pinpointed to the co-occurrence of autism with characteristics typical of alexithymic normative samples, such as social-communication difficulties and decreased emotion regulation abilities. Nonetheless, the role of individual facets of alexithymia in predicting challenges in social communication functioning is still understudied. Methods: In total, 275 young adults completed the Toronto Alexithymia Scale, the Autism Spectrum Quotient (short form), the Interpersonal Competence Questionnaire, and the Difficulties in Emotion Regulation Scale self-reported questionnaires for assessing alexithymic and autistic traits, social-communication abilities, and emotion regulation difficulties. We used regression models to establish cross-sectional associations between autism, alexithymia, and social-emotional difficulties. Also, we ran a parallel mediation analysis to determine whether the relationship between autistic traits and emotion regulations challenges are mediated by Alexithymia facets. Results: Analysis showed a significant positive association between autistic traits and alexithymic traits and between autistic traits and emotion regulation difficulties while, as expected, autistic traits were negatively correlated with social skills. A significant relationship was found among the participants' levels of alexithymia and their interpersonal skills with two of three alexithymic subscales significantly contributing to the model. Similarly, a significant relationship was found among alexithymia subscales and emotion regulation difficulties with all three alexithymia subscales being statistically significant. Finally, analysis on two mediator models indicated a significant effect of autistic traits on social skills mediated by alexithymic traits as well as a significant indirect effect of autistic traits on emotion regulation difficulties mediated by alexithymic traits. Conclusion: The results of this study provide evidence of the influence of different alexithymic facets on the relationship between autistic traits and social-emotional challenges in young adults. Longitudinal studies may explore further alexithymia and its associations with social-emotional difficulties in autism as well as the potential implications of these findings in intervention and treatment programs.

Missing the forest for the trees? A high rate of motor and language impairments in Disruptive Mood Dysregulation Disorder in a chart review of inpatient adolescents

Youths with severe and persistent irritability have a particularly high rate of school failures and learning difficulties. The aim of this study was to determine whether inpatient adolescents with Disruptive Mood Dysregulation Disorder (DMDD) have more motor and/or language impairments compared to patients with other psychiatric disorders. A retrospective chart review of all consecutive cases admitted in two adolescent inpatient units between January 2017 and December 2018 was conducted (N = 191). All patients received multi-disciplinary clinical and developmental assessments. For a subtest of subjects, additional standardized tests were used to document motor and language impairments. In this clinical chart 53 adolescents with a DMDD (mean age 13.6 ± 1.5, min 12, max 16, 70% males) were compared to patients with a major depressive disorder (MDD, n = 64, mean age 15.3 ± 1.6, 52% males) and patients with a non-mood disorder (NMD, n = 61, mean age 14.4 ± 1.55, 59% males). Among inpatients with DMDD, 71% had an associated motor and/or language disorder, with combined forms in around two-thirds of cases. Compared to youths with MDD, participants with DMDD were more likely to have an associated developmental coordination disorder (67% vs. 22%, OR = 4.7) and a written language disorder (35% vs. 10%, OR = 4.6). While 31% of inpatients with DMDD had an associated communication/oral language disorder, this rate was not statistically different from those observed in the MDD group (11%, OR = 3.2). The frequencies of motor and language impairments were not statistically different between participants in the DMDD group and in the NMD group. The high rate of motor and written language disorders found in DMDD patients may partly account for their academic difficulties. Such finding, if confirmed, supports systematic screening of motor and written language impairments in youths with chronic irritability and suggests remediation potential.

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 ).

Objective and Subjective Measurement of Alexithymia in Adults with Autism

High rates of alexithymia, a condition characterised by difficulties identifying and describing emotions, are frequently reported in both children and adults with autism spectrum disorder (ASD). However, the dilemma of measuring alexithymia via self-report has rarely been addressed. In this study, we compared objective and subjective measures of alexithymia in adults with ASD and typically developing adults. We found significantly higher levels of alexithymia in the ASD sample as measured by both self-report on the Toronto Alexithymia Scale (TAS-20) and by the observer rated Alexithymia Provoked Response Scale (APRQ). However, the two measures did not correlate with each other. We explore the different facets of the alexithymia construct that these two measures may be distinguishing.

Is cognitive inflexibility a missing link? The role of cognitive inflexibility, alexithymia and intolerance of uncertainty in externalising and internalising behaviours in young people with autism spectrum disorder

BACKGROUND

Internalising (anxiety and low mood) and externalising (aggressive or outburst behaviours, and irritability) difficulties are very common in autism spectrum disorder (ASD) across the life span, relatively stable over time and often associated with poorer quality of life. Understanding the cognitive mechanisms underlying internalising and externalising difficulties in ASD is essential for developing targeted supports and interventions. In the present study, we investigated established and less-researched cognitive factors hypothesised to contribute to internalising and/or externalising difficulties in ASD, namely cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia. Based on previous models and clinical experience, we hypothesised that IU would lead to internalising symptoms, with alexithymia contributing to this pathway, and that CI would have a direct effect on externalising behaviours and may indirectly contribute to internalising symptoms via increasing IU.

METHODS

Our sample consisted of 95 5- to 18-year-olds presenting to a specialist neurodevelopmental clinic and receiving a diagnosis of ASD. Parents/caregivers completed questionnaires assessing ASD symptomatology, internalising and externalising difficulties, CI, IU and alexithymia. Structural equation modelling was used to examine the hypothesised pathways and relationships between the main variables of interest.

RESULTS

Cognitive Inflexibility played a significant direct role in the pathway from ASD symptoms to externalising symptoms in ASD, and indirect role via IU in the pathway to internalising problems. Relationships between alexithymia and both internalising and externalising symptoms were weaker, with alexithymia predicting internalising difficulties via IU only.

CONCLUSIONS

The finding of a direct pathway from CI to externalising behaviours is novel, as is the indirect role of CI in internalising symptomatology. Of the three cognitive mechanisms examined, only CI significantly predicted externalising symptoms. Possible implications for interventions and supports targeting these cognitive processes in ASD are discussed.

Alexithymia explains atypical spatiotemporal dynamics of eye gaze in autism

Recognition of emotional facial expressions is considered to be atypical in autism. This difficulty is thought to be due to the way that facial expressions are visually explored. Evidence for atypical visual exploration of emotional faces in autism is, however, equivocal. We propose that, where observed, atypical visual exploration of emotional facial expressions is due to alexithymia, a distinct but frequently co-occurring condition. In this eye-tracking study we tested the alexithymia hypothesis using a number of recent methodological advances to study eye gaze during several emotion processing tasks (emotion recognition, intensity judgements, free gaze), in 25 adults with, and 45 without, autism. A multilevel polynomial modelling strategy was used to describe the spatiotemporal dynamics of eye gaze to emotional facial expressions. Converging evidence from traditional and novel analysis methods revealed that atypical gaze to the eyes is best predicted by alexithymia in both autistic and non-autistic individuals. Information theoretic analyses also revealed differential effects of task on gaze patterns as a function of alexithymia, but not autism. These findings highlight factors underlying atypical emotion processing in autistic individuals, with wide-ranging implications for emotion research.

Imitation and recognition of facial emotions in autism: a computer vision approach

Background

Imitation of facial expressions plays an important role in social functioning. However, little is known about the quality of facial imitation in individuals with autism and its relationship with defining difficulties in emotion recognition.

Methods

We investigated imitation and recognition of facial expressions in 37 individuals with autism spectrum conditions and 43 neurotypical controls. Using a novel computer-based face analysis, we measured instructed imitation of facial emotional expressions and related it to emotion recognition abilities.

Results

Individuals with autism imitated facial expressions if instructed to do so, but their imitation was both slower and less precise than that of neurotypical individuals. In both groups, a more precise imitation scaled positively with participants’ accuracy of emotion recognition.

Limitations

Given the study’s focus on adults with autism without intellectual impairment, it is unclear whether the results generalize to children with autism or individuals with intellectual disability. Further, the new automated facial analysis, despite being less intrusive than electromyography, might be less sensitive.

Conclusions

Group differences in emotion recognition, imitation and their interrelationships highlight potential for treatment of social interaction problems in individuals with autism.

Skin Conductance as an Index of Alexithymic Traits in the General Population

Alexithymia concerns a difficulty identifying and communicating one’s own emotions, and a tendency towards externally-oriented thinking. Recent work argues that such alexithymic traits are due to altered arousal response and poor subjective awareness of “objective” arousal responses. Although there are individual differences within the general population in identifying and describing emotions, extant research has focused on highly alexithymic individuals. Here we investigated whether mean arousal and concordance between subjective and objective arousal underpin individual differences in alexithymic traits in a general population sample. Participants rated subjective arousal responses to 60 images from the International Affective Picture System whilst their skin conductance was recorded. The Autism Quotient was employed to control for autistic traits in the general population. Analysis using linear models demonstrated that mean arousal significantly predicted Toronto Alexithymia Scale scores above and beyond autistic traits, but concordance scores did not. This indicates that, whilst objective arousal is a useful predictor in populations that are both above and below the cut-off values for alexithymia, concordance scores between objective and subjective arousal do not predict variation in alexithymic traits in the general population.

Alexithymia and Autistic Traits as Contributing Factors to Empathy Difficulties in Preadolescent Children

Recent evidence suggests that, contrary to traditional views, empathy difficulties may not be a core feature of autism; but are rather due to co-occurring alexithymia. Empathy, alexithymia and autistic traits have yet to be examined concurrently in children. Therefore, we examined the co-occurrence of empathy difficulties and alexithymia in 59 typically developing and 5 autistic children. Multiple measures (self-report, parent-report and a behavioural task) were used to evaluate empathy and to assess differences in self- and parent-reports using multiple regressions. Alexithymia was found to predict empathy significantly better than autistic traits, providing support for the alexithymia hypothesis. From a therapeutic perspective, results suggest autistic children who screen positive for elevated alexithymic traits may benefit from additional support targeting emotion identification.

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 ).

Facial Expression Production and Recognition in Autism Spectrum Disorders: A Shifting Landscape

Social "difficulties" associated with ASD may be a product of neurotypical-autistic differences in emotion expression and recognition. Research suggests that neurotypical and autistic individuals exhibit expressive differences, with autistic individuals displaying less frequent expressions that are rated lower in quality by non-autistic raters. Autistic individuals have difficulties recognizing neurotypical facial expressions; neurotypical individuals have difficulties recognizing autistic expressions. However, findings are mixed. Task-related factors (e.g., intensity of stimuli) and participant characteristics (e.g., age, IQ, comorbid diagnoses) may contribute to the mixed findings. The authors conclude by highlighting important areas for future research and the clinical implications of the discussed findings.

Digital Behavioral Phenotyping Detects Atypical Pattern of Facial Expression in Toddlers with Autism

Commonly used screening tools for autism spectrum disorder (ASD) generally rely on subjective caregiver questionnaires. While behavioral observation is more objective, it is also expensive, time-consuming, and requires significant expertise to perform. As such, there remains a critical need to develop feasible, scalable, and reliable tools that can characterize ASD risk behaviors. This study assessed the utility of a tablet-based behavioral assessment for eliciting and detecting one type of risk behavior, namely, patterns of facial expression, in 104 toddlers (ASD N = 22) and evaluated whether such patterns differentiated toddlers with and without ASD. The assessment consisted of the child sitting on his/her caregiver's lap and watching brief movies shown on a smart tablet while the embedded camera recorded the child's facial expressions. Computer vision analysis (CVA) automatically detected and tracked facial landmarks, which were used to estimate head position and facial expressions (Positive, Neutral, All Other). Using CVA, specific points throughout the movies were identified that reliably differentiate between children with and without ASD based on their patterns of facial movement and expressions (area under the curves for individual movies ranging from 0.62 to 0.73). During these instances, children with ASD more frequently displayed Neutral expressions compared to children without ASD, who had more All Other expressions. The frequency of All Other expressions was driven by non-ASD children more often displaying raised eyebrows and an open mouth, characteristic of engagement/interest. Preliminary results suggest computational coding of facial movements and expressions via a tablet-based assessment can detect differences in affective expression, one of the early, core features of ASD. LAY SUMMARY: This study tested the use of a tablet in the behavioral assessment of young children with autism. Children watched a series of developmentally appropriate movies and their facial expressions were recorded using the camera embedded in the tablet. Results suggest that computational assessments of facial expressions may be useful in early detection of symptoms of autism.

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.

First-Hand Accounts of Interoceptive Difficulties in Autistic Adults

Interoceptive awareness refers to one's ability to detect, discriminate, and regulate internal bodily and mental processes. Interoceptive challenges in ASD remain under researched and poorly understood. In this study, we analyzed texts of adults who self-identify as autistic describing their interoceptive challenges. Many individuals described limited awareness of hunger, satiation, or thirst, which contributed to eating disordered behavior in some instances. Others described limited awareness or difficulty understanding affective arousal, pain or illness, and difficulty differentiating benign body signals from signals that represent medical concerns. Findings from this study call for increased research attention on this topic, and a need for valid and objective measures for assessing interoception in ASD.

Frontotemporal Dementia: A Window to Alexithymia

Alexithymia is pervasive among psychiatric patients, but its neurobiological mechanism is unclear. Patients with alexithymia cannot "read emotions," a process involving interoception, or the perception of the body's internal state, primarily in the insulae. The frontotemporal dementias are also associated with inability to correctly read emotions; hence, these dementias can provide a window into the mechanism of alexithymia. Patients with behavioral variant frontotemporal dementia (bvFTD) have a weak emotional signal with impaired emotional recognition, hypoemotionality, and decreased physiological arousal. bvFTD affects the insulae, and the weak emotional signal facilitates impaired interoceptive accuracy, resulting in an overreliance on cognitive appraisal rather than on internal sensations. In contrast, patients with semantic dementia, another frontotemporal dementia syndrome, can have intact interoception, but they have disturbed cognitive appraisal of the meaning of their bodily sensations. This "alexisomia" in semantic dementia can lead to misinterpreted somatic symptoms. Together, the findings in alexithymic patients and frontotemporal dementia syndromes support the model of impaired interoceptive accuracy as the mechanism of alexithymia, possibly from dysfunction in the insulae.

New Technologies as Promising Tools for Assessing Facial Emotion Expressions Impairments in ASD: A Systematic Review

The ability to recognize and express emotions from facial expressions are essential for successful social interactions. Facial Emotion Recognition (FER) and Facial Emotion Expressions (FEEs), both of which seem to be impaired in Autism Spectrum Disorders (ASD) and contribute to socio-communicative difficulties, participate in the diagnostic criteria for ASD. Only a few studies have focused on FEEs processing and the rare behavioral studies of FEEs in ASD have yielded mixed results. Here, we review studies comparing the production of FEEs between participants with ASD and non-ASD control subjects, with a particular focus on the use of automatic facial expression analysis software. A systematic literature search in accordance with the PRISMA statement identified 20 reports published up to August 2020 concerning the use of new technologies to evaluate both spontaneous and voluntary FEEs in participants with ASD. Overall, the results highlight the importance of considering socio-demographic factors and psychiatric co-morbidities which may explain the previous inconsistent findings, particularly regarding quantitative data on spontaneous facial expressions. There is also reported evidence for an inadequacy of FEEs in individuals with ASD in relation to expected emotion, with a lower quality and coordination of facial muscular movements. Spatial and kinematic approaches to characterizing the synchrony, symmetry and complexity of facial muscle movements thus offer clues to identifying and exploring promising new diagnostic targets. These findings have allowed hypothesizing that there may be mismatches between mental representations and the production of FEEs themselves in ASD. Such considerations are in line with the Facial Feedback Hypothesis deficit in ASD as part of the Broken Mirror Theory, with the results suggesting impairments of neural sensory-motor systems involved in processing emotional information and ensuring embodied representations of emotions, which are the basis of human empathy. In conclusion, new technologies are promising tools for evaluating the production of FEEs in individuals with ASD, and controlled studies involving larger samples of patients and where possible confounding factors are considered, should be conducted in order to better understand and counter the difficulties in global emotional processing in ASD.

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.

Alexithymic and autistic traits: Relevance for comorbid depression and social phobia in adults with and without autism spectrum disorder

LAY ABSTRACT

Adults with autism often develop mental health problems such as depression and social phobia. The reasons for this are still unclear. Many studies found that alexithymia plays an important role in mental health problems like depression. People with alexithymia have difficulties identifying and describing their emotions. Almost every second person with autism has alexithymia. Therefore, we explored in this study whether alexithymia is linked to worse mental health in autistic people. We looked at two common diagnoses, depression and social phobia. We found that alexithymia increased symptoms of depression, while autistic traits increased symptoms of social phobia. Our results suggest that alexithymia and autistic traits can increase the risk of mental health problems. An early assessment could help prevent mental health problems and improve quality of life.

Facial Expression Production and Recognition in Autism Spectrum Disorders: A Shifting Landscape

Social "difficulties" associated with ASD may be a product of neurotypical-autistic differences in emotion expression and recognition. Research suggests that neurotypical and autistic individuals exhibit expressive differences, with autistic individuals displaying less frequent expressions that are rated lower in quality by non-autistic raters. Autistic individuals have difficulties recognizing neurotypical facial expressions; neurotypical individuals have difficulties recognizing autistic expressions. However, findings are mixed. Task-related factors (e.g., intensity of stimuli) and participant characteristics (e.g., age, IQ, comorbid diagnoses) may contribute to the mixed findings. The authors conclude by highlighting important areas for future research and the clinical implications of the discussed findings.

A preliminary evaluation of still face images by deep learning: A potential screening test for childhood developmental disabilities

Most developmental disorders are defined by their clinical symptoms and many disorders share common features. The main objective of this research is to evaluate still facial images as a potential screening test for childhood developmental disabilities, which is free of any biases of subjective judgments of human observers. Via supervised machine learning, a classifier of convolution neural network (CNN) was built by using 908 facial images, half of those were photos of children labeled with "autism", which may include some developmental disorders with autism-like features. Then face images were generated for two categories of photos. Above all, the most important discovery of this research is that face images labeled "autism" and normal controls populate two quite distinctive manifolds. Different pattern was found to be distributed in the eyes and mouth in the generated photos for two categories of faces by deep learning. It is showed that supervised machine learning can obtain facial features, which could possibly be applicable to improve early screening for childhood developmental disabilities by facial expression. A simple computer-based screening test of still face images may prove to be a useful adjunct in many clinical settings.

Automated recognition of spontaneous facial expression in individuals with autism spectrum disorder: parsing response variability

BACKGROUND

Reduction or differences in facial expression are a core diagnostic feature of autism spectrum disorder (ASD), yet evidence regarding the extent of this discrepancy is limited and inconsistent. Use of automated facial expression detection technology enables accurate and efficient tracking of facial expressions that has potential to identify individual response differences.

METHODS

Children and adults with ASD (N = 124) and typically developing (TD, N = 41) were shown short clips of "funny videos." Using automated facial analysis software, we investigated differences between ASD and TD groups and within the ASD group in evidence of facial action unit (AU) activation related to the expression of positive facial expression, in particular, a smile.

RESULTS

Individuals with ASD on average showed less evidence of facial AUs (AU12, AU6) relating to positive facial expression, compared to the TD group (p < .05, r = - 0.17). Using Gaussian mixture model for clustering, we identified two distinct distributions within the ASD group, which were then compared to the TD group. One subgroup (n = 35), termed "over-responsive," expressed more intense positive facial expressions in response to the videos than the TD group (p < .001, r = 0.31). The second subgroup (n = 89), ("under-responsive"), displayed fewer, less intense positive facial expressions in response to videos than the TD group (p < .001; r = - 0.36). The over-responsive subgroup differed from the under-responsive subgroup in age and caregiver-reported impulsivity (p < .05, r = 0.21). Reduced expression in the under-responsive, but not the over-responsive group, was related to caregiver-reported social withdrawal (p < .01, r = - 0.3).

LIMITATIONS

This exploratory study does not account for multiple comparisons, and future work will have to ascertain the strength and reproducibility of all results. Reduced displays of positive facial expressions do not mean individuals with ASD do not experience positive emotions.

CONCLUSIONS

Individuals with ASD differed from the TD group in their facial expressions of positive emotion in response to "funny videos." Identification of subgroups based on response may help in parsing heterogeneity in ASD and enable targeting of treatment based on subtypes.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02299700. Registration date: November 24, 2014.

Assessing the Effectiveness of Automated Emotion Recognition in Adults and Children for Clinical Investigation

Recent success stories in automated object or face recognition, partly fuelled by deep learning artificial neural network (ANN) architectures, have led to the advancement of biometric research platforms and, to some extent, the resurrection of Artificial Intelligence (AI). In line with this general trend, inter-disciplinary approaches have been taken to automate the recognition of emotions in adults or children for the benefit of various applications, such as identification of children's emotions prior to a clinical investigation. Within this context, it turns out that automating emotion recognition is far from being straightforward, with several challenges arising for both science (e.g., methodology underpinned by psychology) and technology (e.g., the iMotions biometric research platform). In this paper, we present a methodology and experiment and some interesting findings, which raise the following research questions for the recognition of emotions and attention in humans: (a) the adequacy of well-established techniques such as the International Affective Picture System (IAPS), (b) the adequacy of state-of-the-art biometric research platforms, (c) the extent to which emotional responses may be different in children and adults. Our findings and first attempts to answer some of these research questions are based on a mixed sample of adults and children who took part in the experiment, resulting in a statistical analysis of numerous variables. These are related to both automatically and interactively captured responses of participants to a sample of IAPS pictures.

Identifying Psychological Symptoms Based on Facial Movements

Background: Many methods have been proposed to automatically identify the presence of mental illness, but these have mostly focused on one specific mental illness. In some non-professional scenarios, it would be more helpful to understand an individual's mental health status from all perspectives. Methods: We recruited 100 participants. Their multi-dimensional psychological symptoms of mental health were evaluated using the Symptom Checklist 90 (SCL-90) and their facial movements under neutral stimulation were recorded using Microsoft Kinect. We extracted the time-series characteristics of the key points as the input, and the subscale scores of the SCL-90 as the output to build facial prediction models. Finally, the convergent validity, discriminant validity, criterion validity, and the split-half reliability were respectively assessed using a multitrait-multimethod matrix and correlation coefficients. Results: The correlation coefficients between the predicted values and actual scores were 0.26 and 0.42 (P < 0.01), which indicated good criterion validity. All models except depression had high convergent validity but low discriminant validity. Results also indicated good levels of split-half reliability for each model [from 0.516 (hostility) to 0.817 (interpersonal sensitivity)] (P < 0.001). Conclusion: The validity and reliability of facial prediction models were confirmed for the measurement of mental health based on the SCL-90. Our research demonstrated that fine-grained aspects of mental health can be identified from the face, and provided a feasible evaluation method for multi-dimensional prediction models.

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.

A 'choice', an 'addiction', a way 'out of the lost': exploring self-injury in autistic people without intellectual disability

Background

Non-suicidal self-injury (NSSI) describes a phenomenon where individuals inflict deliberate pain and tissue damage to their bodies. Self-injurious behaviour is especially prevalent across the autism spectrum, but little is understood about the features and functions of self-injury for autistic individuals without intellectual disability, or about the risk factors that might be valuable for clinical usage in this group.

Methods

One hundred and three autistic adults who responded to an online advertisement were classified as current, historic or non-self-harmers in accordance with responses to the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT). Multinomial regression aimed to predict categorisation of participants in accordance with scores on tests of autistic traits, alexithymia, depression, anxiety, mentalising and sensory sensitivity. Linear regression examined relationships between these predictors and the range, frequency, lifetime occurrence and functional purposes of NSSI. Qualitative analysis explored the therapeutic interventions that participants had found helpful, and what they wished people understood about self-injury.

Results

Current, historic and non-self-harming participants did not differ in age, age at diagnosis, male-to-female ratio, level of employment or education (the majority qualified to at least degree level). The most common function of NSSI was the regulation of low-energy affective states (depression, dissociation), followed by the regulation of high-energy states such as anger and anxiety. Alexithymia significantly predicted the categorisation of participants as current, historic or non-self-harmers, and predicted use of NSSI for regulating high-energy states and communicating distress to others. Depression, anxiety and sensory-sensitivity also differentiated participant groups, and sensory differences also predicted the range of bodily areas targeted, lifetime incidence and frequency of NSSI. Sensory differences, difficulty expressing and identifying emotions also emerged as problematic in the qualitative analysis, where participants expressed the need for compassion, patience, non-judgement and the need to recognise diversity between self-harmers, with some participants perceiving NSSI as a practical, non-problematic coping strategy.

Conclusions

Alexithymia, depression, anxiety and sensory differences may place some autistic individuals at especial risk of self-injury. Investigating the involvement of these variables and their utility for identification and treatment is of high importance, and the voices of participants offer guidance to practitioners confronted with NSSI in their autistic clients.

Alterations in facial expressivity in youth at clinical high-risk for psychosis

Negative symptoms, such as blunted facial affect, are core features of psychotic disorders that predict poor functional outcome. However, it is unknown whether these impairments occur prior to the onset of psychosis. Understanding this phenomenon in the psychosis risk period has significant relevance for elucidating pathogenic processes, as well as potential for informing a viable new behavioral marker for broader social dysfunction and clinical course. The current study sought to determine the nature of facial expression deficits among individuals at clinical high-risk (CHR) for developing psychosis using a comprehensive approach, incorporating clinical interview ratings and automated facial expression coding analysis. A total of 42 CHR and 42 control participants completed clinical interviews and digitally taped segments were submitted into an automated, computerized tool to assess for 7 facial expressions (joy, anger, surprise, fear, contempt, disgust, sadness). Furthermore, relationships between facial expressions and social functioning and available scores on a psychosis conversion risk calculator from a total of 78 participants (39 CHR and 39 controls) were examined. Relationships between measures were also investigated (data was available for the Prodromal Inventory of Negative Symptoms among 33 CHR and 25 controls). Findings from clinical interview indicated that the CHR group exhibited elevated blunting. Furthermore, automated analyses showed that the CHR group displayed blunting in expressions of joy but surprisingly, increased anger facial expressions. Lastly, irregularities in facial expressions were related to decreased social functioning and increased psychosis conversion risk calculator scores, signaling heightened likelihood of conversion to psychosis. These findings suggest that alterations in facial expressivity occur early in the pathogenesis of psychosis and provide evidence for the efficacy of higher resolution measures of facial expressivity in psychosis research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Automatic Recognition of Posed Facial Expression of Emotion in Individuals with Autism Spectrum Disorder

Facial expression is impaired in autism spectrum disorder (ASD), but rarely systematically studied. We focus on the ability of individuals with ASD to produce facial expressions of emotions in response to a verbal prompt. We used the Janssen Autism Knowledge Engine (JAKE^®), including automated facial expression analysis software (FACET) to measure facial expressions in individuals with ASD (n = 144) and a typically developing (TD) comparison group (n = 41). Differences in ability to produce facial expressions were observed between ASD and TD groups, demonstrated by activation of facial action units (happy, scared, surprised, disgusted, but not angry or sad). Activation of facial action units correlated with parent-reported social communication skills. This approach has potential for diagnostic and response to intervention measures.Trial Registration NCT02299700.

Nonverbal Communication

The field of nonverbal communication (NVC) has a long history involving many cue modalities, including face, voice, body, touch, and interpersonal space; different levels of analysis, including normative, group, and individual differences; and many substantive themes that cross from psychology into other disciplines. In this review, we focus on NVC as it pertains to individuals and social interaction. We concentrate specifically on ( a) the meanings and correlates of cues that are enacted (sent) by encoders and ( b) the perception of nonverbal cues and the accuracy of such perception. Frameworks are presented for conceptualizing and understanding the process of sending and receiving nonverbal cues. Measurement issues are discussed, and theoretical issues and new developments are covered briefly. Although our review is primarily oriented within social and personality psychology, the interdisciplinary nature of NVC is evident in the growing body of research on NVC across many areas of scientific inquiry.

Signing with the Face: Emotional Expression in Narrative Production in Deaf Children with Autism Spectrum Disorder

This study examined facial expressions produced during a British Sign Language (BSL) narrative task (Herman et al., International Journal of Language and Communication Disorders 49(3):343-353, 2014) by typically developing deaf children and deaf children with autism spectrum disorder. The children produced BSL versions of a video story in which two children are seen to enact a language-free scenario where one tricks the other. This task encourages elicitation of facial acts signalling intention and emotion, since the protagonists showed a range of such expressions during the events portrayed. Results showed that typically developing deaf children produced facial expressions which closely aligned with native adult signers' BSL narrative versions of the task. Children with ASD produced fewer targeted expressions and showed qualitative differences in the facial actions that they produced.

Alexithymia explains increased empathic personal distress in individuals with and without eating disorders

It is often assumed that empathy impairments are common in individuals with eating disorders (EDs), but empirical work has been limited and produced mixed results, making the clinical features and treatment needs of this population difficult to determine. Alexithymia, characterised by difficulties identifying and describing one’s own emotions, frequently co-occurs with EDs and is associated with atypical recognition of, and empathy for, others’ emotions. This study used an existing empathy for pain paradigm to determine whether atypical empathy in EDs stems from co-occurring alexithymia, rather than EDs per se. Empathy (specifically personal distress in response to others’ pain) was assessed in individuals with EDs ( N = 21) and an alexithymia-matched control group ( N = 22). Participants were simultaneously members of a high alexithymia ( N = 16) or low alexithymia ( N = 27) group, allowing the independent contributions of alexithymia and EDs to be determined. Participants judged the laterality of hands and feet in painful and non-painful situations, and the degree of empathic interference on response times was measured. Results indicated that observation of painful stimuli affected task performance in those with high levels of alexithymia more than those with low levels, but no effect of ED diagnosis was observed. These findings suggest that co-occurring alexithymia explains increased empathic personal distress in ED populations. Atypical empathy may therefore not be a core feature of EDs, and interventions aimed at improving empathy-related social functioning may only be necessary for patients who also have alexithymia. These findings emphasise the importance of determining the influence of co-occurring alexithymia when assessing empathy in clinical populations.

Alexithymia and Autism Spectrum Disorder: A Complex Relationship

Alexithymia is a personality construct characterized by altered emotional awareness which has been gaining diagnostic prevalence in a range of neuropsychiatric disorders, with notably high rates of overlap with autism spectrum disorder (ASD). However, the nature of its role in ASD symptomatology remains elusive. Here, we distill research at the intersection of alexithymia and ASD. After a brief synopsis of the studies that plaid a pioneering role in the identification of the overlapping fields between alexithymia and ASD, we comb the literature for evidence of its overlap with ASD in terms of prevalence, etiology, and behaviors. Through a formalized framework of the process of emotional interpretation and expression, we explore evidence for where and how deficits arise in this complex network of events. We portray how these relate to the dynamic interplay between alexithymic and autistic traits and find emerging evidence that alexithymia is both a cause and consequence of autistic behaviors. We end with a strategic proposal for future research and interventions to dampen the impacts of alexithymia in ASD.

I Think We're Alone Now: Solitary Social Behaviors in Adolescents with Autism Spectrum Disorder

Research into emotional responsiveness in Autism Spectrum Disorder (ASD) has yielded mixed findings. Some studies report uniform, flat and emotionless expressions in ASD; others describe highly variable expressions that are as or even more intense than those of typically developing (TD) individuals. Variability in findings is likely due to differences in study design: some studies have examined posed (i.e., not spontaneous expressions) and others have examined spontaneous expressions in social contexts, during which individuals with ASD-by nature of the disorder-are likely to behave differently than their TD peers. To determine whether (and how) spontaneous facial expressions and other emotional responses are different from TD individuals, we video-recorded the spontaneous responses of children and adolescents with and without ASD (between the ages of 10 and 17 years) as they watched emotionally evocative videos in a non-social context. Researchers coded facial expressions for intensity, and noted the presence of laughter and other responsive vocalizations. Adolescents with ASD displayed more intense, frequent and varied spontaneous facial expressions than their TD peers. They also produced significantly more emotional vocalizations, including laughter. Individuals with ASD may display their emotions more frequently and more intensely than TD individuals when they are unencumbered by social pressure. Differences in the interpretation of the social setting and/or understanding of emotional display rules may also contribute to differences in emotional behaviors between groups.