Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Molecular Autism
Published in: Molecular Autism 1/2022

Open Access 01-12-2022 | Autism Spectrum Disorder | Research

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

Authors: Christine M. Falter-Wagner, Carola Bloch, Lana Burghof, Fritz-Georg Lehnhardt, Kai Vogeley

Published in: Molecular Autism | Issue 1/2022

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Footnotes
1
Inclusion of this case in ASD + group did neither change significance of predictors in multiple regression nor did it change the pattern of results of dominance analysis.
 
Literature
1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.
2.
Sifneos PE. The prevalence of “Alexithymic” characteristics in psychosomatic patients. Psychother Psychosom. 1973;22(2–6):255–62.PubMedCrossRef
3.
Gunzelmann T, Kupfer J, Brähler E. Alexithymia in the elderly general population. Compr Psychiatry. 2002;43(1):74–80.PubMedCrossRef
4.
Bird G, Cook R. Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism. Transl Psychiatry. 2013;3(May):1–8.
5.
Salminen JK, Saarijärvi S, Äärelä E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. J Psychosom Res. 1999;46(1):75–82.PubMedCrossRef
6.
Mattila AK, Salminen JK, Nummi T, Joukamaa M. Age is strongly associated with alexithymia in the general population. J Psychosom Res. 2006;61(5):629–35.PubMedCrossRef
7.
Franz M, Popp K, Schaefer R, Sitte W, Schneider C, Hardt J, et al. Alexithymia in the German general population. Soc Psychiatry Psychiatr Epidemiol. 2008;43(1):54–62.PubMedCrossRef
8.
9.
Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia scale-I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38(1):23–32.PubMedCrossRef
10.
Bagby RM, Taylor GJ, Parker JDA. The twenty-item Toronto Alexithymia scale-II. Convergent, discriminant, and concurrent validity. J Psychosom Res. 1994;38(1):33–40.PubMedCrossRef
11.
Bloch C, Burghof L, Lehnhardt F-G, Vogeley K, Falter-Wagner CM. Alexithymia traits outweigh autism traits in the explanation of depression in adults with autism. Sci Rep. 2021;11(1):2258.PubMedPubMedCentralCrossRef
12.
Fietz J, Valencia N, Silani G. Alexithymia and autistic traits as possible predictors for traits related to depression, anxiety, and stress: a multivariate statistical approach. J Eval Clin Pract. 2018;24(4):901–8.PubMedCrossRef
13.
Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychol Med. 2019;49(4):559–72.PubMedCrossRef
14.
Morie KP, Jackson S, Zhai ZW, Potenza MN, Dritschel B. Mood disorders in high-functioning autism: the importance of alexithymia and emotional regulation. J Autism Dev Disord. 2019;49(7):2935–45.PubMedPubMedCentralCrossRef
15.
Hemming L, Haddock G, Shaw J, Pratt D. Alexithymia and its associations with depression, suicidality, and aggression: an overview of the literature. Front Psychiatry. 2019;10(APR).
16.
Oakley BFM, Jones EJH, Crawley D, Charman T, Buitelaar J, Tillmann J, et al. Alexithymia in autism: Cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms. Psychol Med. 2020;1–13.
17.
18.
Trevisan DA, Bowering M, Birmingham E. Alexithymia, but not autism spectrum disorder, may be related to the production of emotional facial expressions. Mol Autism. 2016;7:46.PubMedPubMedCentralCrossRef
19.
Heaton P, Reichenbacher L, Sauter D, Allen R, Scott S, Hill E. Measuring the effects of alexithymia on perception of emotional vocalizations in autistic spectrum disorder and typical development. Psychol Med. 2012;42(11):2453–9.PubMedCrossRef
20.
Pisania S, Murphy J, Conway J, Millgate E, Catmure C, Bird G. The relationship between alexithymia and theory of mind: a systematic review. Neurosci Biobehav Rev. 2021;131:497–524.CrossRef
21.
Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I. The, “Reading the Mind in the Eyes” test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J child Psychol psychiatry. 2001;42(2):241–51.PubMedCrossRef
22.
Oakley BFM, Brewer R, Bird G, Catmur C. Theory of mind is not theory of emotion: a cautionary note on the reading the mind in the eyes test. J Abnorm Psychol. 2016;125(6):818–23.PubMedPubMedCentralCrossRef
23.
Rødgaard EM, Jensen K, Mottron L. An opposite pattern of cognitive performance in autistic individuals with and without alexithymia. J Abnorm Psychol. 2019;128(7):735–7.PubMedCrossRef
24.
Dziobek I, Fleck S, Kalbe E, Rogers K, Hassenstab J, Brand M, et al. Introducing MASC: a movie for the assessment of social cognition. J Autism Dev Disord. 2006;36(5):623–36.PubMedCrossRef
25.
Peñuelas-Calvo I, Sareen A, Sevilla-Llewellyn-Jones J, Fernández-Berrocal P. The, “reading the mind in the eyes” test in autism-spectrum disorders comparison with healthy controls: a systematic review and meta-analysis. J Autism Dev Disord. 2019;49(3):1048–61.PubMedCrossRef
26.
Shah P, Livingston LA, Callan MJ, Player L. Trait autism is a better predictor of empathy than alexithymia. J Autism Dev Disord. 2019;49(10):3956–64.PubMedPubMedCentralCrossRef
27.
Poquérusse J, Pastore L, Dellantonio S, Esposito G. Alexithymia and autism spectrum disorder: a complex relationship. Front Psychol. 2018;9(JUL):1–10.
28.
Nimon KF, Oswald FL. Understanding the results of multiple linear regression: beyond standardized regression coefficients. Organ Res Methods. 2013;16(4):650–74.CrossRef
29.
Budescu DV. Dominance analysis: a new approach to the problem of relative importance of predictors in multiple regression. Psychol Bull. 1993;114(3):542–51.CrossRef
30.
Demers LA, Koven NS. The relation of alexithymic traits to affective theory of mind. Am J Psychol. 2015;128(1):31–42.PubMedCrossRef
31.
Lyvers M, McCann K, Coundouris S, Edwards MS, Thorberg FA. Alexithymia in relation to alcohol use, emotion recognition, and empathy: the role of externally oriented thinking. Am J Psychol. 2018;131(1):41–51.CrossRef
32.
Lehnhardt FG, Gawronski A, Pfeiffer K, Kockler H, Schilbach L, Vogeley K. Diagnostik und Differenzialdiagnose des Asperger-Syndroms im Erwachsenenalter. Dtsch Arztebl Int. 2013;110(45):755–63.PubMedPubMedCentral
33.
Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter - Teil 1: Diagnostik - Interdisziplinäre S3-Leitlinie der DGKJP und der DGPPN sowie der beteiligten Fachgesellschaften, Berufsverbände und Patientenorganisationen Langversion. AWMF online. 2016.
34.
Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The Autism-Spectrum Quotient (AQ): evidence from asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001;31(1):5–17.PubMedCrossRef
35.
von Aster M, Neubauer A, Horn R. Wechsler Intelligenztest für Erwachsene WIE. Deutschsprachige Bearbeitung und Adaptation des WAIS-III von David Wechsler (2., korrigierte Auflage). 2006.
36.
Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I. The, “Reading the Mind in the Eyes” Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J Child Psychol Psychiatry Allied Discip. 2001;42(2):241–51.CrossRef
37.
Schroeter ML, Pawelke S, Bisenius S, Kynast J, Schuemberg K, Polyakova M, et al. A modified reading the mind in the eyes test predicts behavioral variant frontotemporal dementia better than executive function tests. Front Aging Neurosci. 2018;10(JAN):1–11.
38.
Schwartz C, Bente G, Gawronski A, Schilbach L, Vogeley K. Responses to nonverbal behaviour of dynamic virtual characters in high-functioning autism. J Autism Dev Disord. 2010;40(1):100–11.PubMedCrossRef
39.
Lehnhardt FG, Falter CM, Gawronski A, Pfeiffer K, Tepest R, Franklin J, et al. Sex-related cognitive profile in autism spectrum disorders diagnosed late in life: implications for the female autistic phenotype. J Autism Dev Disord. 2016;46(1):139–54.PubMedCrossRef
40.
Dziobek I, Rogers K, Fleck S, Hassenstab J, Gold S, Wolf OT, et al. In search of “master mindreaders”: are psychics superior in reading the language of the eyes? Brain Cogn. 2005;58(2):240–4.PubMedCrossRef
41.
Woodbury-Smith MR, Robinson J, Wheelwright S, Baron-Cohen S. Screening adults for Asperger Syndrome using the AQ: a preliminary study of its diagnostic validity in clinical practice. J Autism Dev Disord. 2005;35(3):331–5.PubMedCrossRef
42.
Parker JDA, Taylor GJ, Bagby RM. The 20-Item Toronto Alexithymia Scale: III. Reliability and factorial validity in a community population. J Psychosom Res. 2003;55(3):269–75.PubMedCrossRef
43.
Taylor GJ, Bagby RM, Parker JDA. The 20-Item Toronto Alexithymia Scale: IV. Reliability and factorial validity in different languages and cultures. J Psychosom Res. 2003;55(3):277–83.
44.
45.
46.
Zeileis A. Econometric computing with HC and HAC covariance matrix estimators. J Stat Softw. 2004;11(October):1–17.
47.
Zeileis A, Hothorn T. Diagnostic checking in regression relationships. R News. 2002;2(3):7–10.
48.
Long JS, Ervin LH. Using heteroscedasticity consistent standard errors in the linear regression model. Am Stat. 2000;54(3):217–24.
49.
Rosopa PJ, Schaffer MM, Schroeder AN. Managing heteroscedasticity in general linear models. Psychol Methods. 2013;18(3):335–51.PubMedCrossRef
50.
LeBreton JM, Ployhart RE, Ladd RT. A Monte Carlo comparison of relative importance methodologies. Organ Res Methods. 2004;7(3):258–82.CrossRef
51.
52.
Vellante M, Baron-Cohen S, Melis M, Marrone M, Petretto DR, Masala C, et al. The “reading the Mind in the Eyes” test: systematic review of psychometric properties and a validation study in Italy. Cogn Neuropsychiatry. 2013;18(4):326–54.PubMedCrossRef
53.
Rösch S, Puhlmann L, Preckel K. A cross-modal component of alexithymia and its relationship with performance in a social cognition task battery. J Affect Disord. 2022;298(2):625–33.PubMedCrossRef
54.
Milosavljevic B, Carter Leno V, Simonoff E, Baird G, Pickles A, Jones CRG, et al. Alexithymia in adolescents with autism spectrum disorder: its relationship to internalising difficulties, sensory modulation and social cognition. J Autism Dev Disord. 2016;46(4):1354–67.PubMedCrossRef
55.
Lane RD, Hsu CH, Locke DEC, Ritenbaugh C, Stonnington CM. Role of theory of mind in emotional awareness and alexithymia: implications for conceptualization and measurement. Conscious Cogn. 2015;33:398–405.PubMedCrossRef
56.
57.
Saarijärvi S, Salminen JK, Toikka T. Temporal stability of alexithymia over a five-year period in outpatients with major depression. Psychother Psychosom. 2006;75(2):107–12.PubMedCrossRef
58.
Li S, Zhang B, Guo Y, Zhang J. The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: a meta-analysis. Psychiatry Res. 2015;227(1):1–9.PubMedCrossRef
59.
Geiger A, Bente G, Lammers S, Tepest R, Roth D, Bzdok D, et al. Distinct functional roles of the mirror neuron system and the mentalizing system. Neuroimage. 2019;202: 116102.PubMedCrossRef
60.
Vogeley K. Two social brains: Neural mechanisms of intersubjectivity. Philos Trans R Soc B Biol Sci. 2017;372(1727):1–11.CrossRef
61.
Frith U, Frith CD. Development and neurophysiology of mentalizing. Philos Trans R Soc B Biol Sci. 2003;358(1431):459–73.CrossRef
62.
Vogeley K, Bussfeld P, Newen A, Herrmann S, Happé F, Falkai P, et al. Mind reading: Neural mechanisms of theory of mind and self-perspective. Neuroimage. 2001;14(1):170–81.PubMedCrossRef
63.
Alcalá-López D, Smallwood J, Jefferies E, Van Overwalle F, Vogeley K, Mars RB, et al. Computing the social brain connectome across systems and states. Cereb Cortex. 2018;28(7):2207–32.PubMedCrossRef
64.
Livingston LA, Shah P, White SJ, Happé F. Further developing the Frith-Happé animations: a quicker, more objective, and web-based test of theory of mind for autistic and neurotypical adults. Autism Res. 2021;14(9):1905–12.PubMedCrossRef
65.
Clutterbuck RA, Callan MJ, Taylor EC, Livingston LA, Shah P. Development and validation of the four-item mentalising index. Psychol Assess. 2021;33(7):629–36.PubMedCrossRef
66.
Murray K, Johnston K, Cunnane H, Kerr C, Spain D, Gillan N, et al. A new test of advanced theory of mind: the “Strange Stories Film Task” captures social processing differences in adults with autism spectrum disorders. Autism Res. 2017;10(6):1120–32.PubMedCrossRef
Metadata
Title
Autism traits outweigh alexithymia traits in the explanation of mentalising performance in adults with autism but not in adults with rejected autism diagnosis
Authors
Christine M. Falter-Wagner
Carola Bloch
Lana Burghof
Fritz-Georg Lehnhardt
Kai Vogeley
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Molecular Autism / Issue 1/2022
Electronic ISSN: 2040-2392
DOI
https://doi.org/10.1186/s13229-022-00510-9

Other articles of this Issue 1/2022

Molecular Autism 1/2022 Go to the issue

Research

Friend matters: sex differences in social language during autism diagnostic interviews

Research

Early life sleep disruption potentiates lasting sex-specific changes in behavior in genetically vulnerable Shank3 heterozygous autism model mice

Letter to the Editor

Clinical trial of insulin-like growth factor-1 in Phelan-McDermid syndrome

Research

Disruption of grin2B, an ASD-associated gene, produces social deficits in zebrafish

Research

Maternal vitamin D during pregnancy and offspring autism and autism-associated traits: a prospective cohort study

Research

Deletion of Fmr1 in parvalbumin-expressing neurons results in dysregulated translation and selective behavioral deficits associated with fragile X syndrome