Alexithymia and Emotion Recognition in Autism

Alexithymia is characterized by difficulties in identifying, describing, and processing one's own feelings, often marked by a lack of understanding of the feelings of others, and difficulty distinguishing between feelings and the bodily sensations of emotional arousal. Alexithymia is not a formal clinical diagnosis and is best conceptualized as a dimensional personality trait that is normally distributed in the general population (with estimates of 10%) and varies in severity from person to person. However, there is evidence to suggest that it is associated with an increased risk for mental health problems. For example, several studies indicate that even in childhood, alexithymia and difficulties in the domain of emotion processing are positively related to internalizing problems such as anxiety and depression.

Research indicates that alexithymia overlaps with autism spectrum disorder (ASD). Although alexithymia is not a core feature of autism, recent studies have found varying degrees of this trait in 50 to 85% of individuals with autism ASD. The alexithymia trait appears to have the following properties: (a) it is more common in individuals with ASD than in the general population (b) it is more common in parents of individuals with ASD than in parents of individuals with another developmental disabilities, (c) it is stable over time in ASD, and (d) problems in the domain of emotion awareness are positively related to depression, anxiety, somatic complaints, worry and rumination. There is also evidence to indicate that the alexithymia trait might be part of the broader autism phenotype and a significant component of the emotion processing difficulties observed in ASD. It is uncertain whether the problem of emotion recognition commonly attributed to individuals on the autism spectrum is a result of the disorder itself, or if it is due to the large co-occurrence (comorbidity) between alexithymia and autism.

Given the apparent association between alexithymia and autism, it’s especially important to investigate the relative contribution of this dimensional trait to the impairment in social functioning experienced by individuals with ASD. An important question for future research relates to the prevalence of high levels of alexithymia in ASD compared to neurotypical individuals and how to explain the high co-occurrence (comorbidity) between alexithymia and ASD. Is alexithymia a neuroanatomical structural consequence or is the result of a neurobiological impairment, or is it a distinctive personality trait of individuals with ASD? Does the level of alexithymia predict symptom severity in ASD? Although not a diagnostic feature of autism, would alexithymia be a useful diagnostic marker for ASD? Because alexithymia is associated with increased risk of mental health problems (i.e., anxiety and depression), should a measure of alexithymia be included in an assessment battery for ASD? As with most autism research, there are more questions than answers.

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

Szatmari, P., Georgiades, S., Duku, E., Zwaigenbaum, L., Goldberg, J., & Bennett, T. (2008). Alexithymia in Parents of Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 38, 1859-1865.

Lee A. Wilkinson, PhD, NCSP is the is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools. He is also editor of a best-selling text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Healthcare Providers Unprepared to Treat adults with Autism

Healthcare Providers Unprepared to Treat Autistic Adults 

It is estimated that nearly a half million youth with autism will enter adulthood over the next decade. As children with autism become adults their primary medical care will move from pediatrics to adult medicine. A survey by the Autism Research Program at Kaiser Permanente Northern California found that many healthcare providers are ill prepared to treat adults on the autism spectrum. The findings were reported at the International Meeting for Autism Research in Salt Lake City, Utah.

Researchers polled providers of adult primary care, mental health, and obstetrics and gynecology services through the insurer’s network. Practitioners were asked about their ability to recognize autism, their knowledge of the disorder, their comfort level in treating those with the condition and their need for training and resources.

Of 922 providers surveyed, 77 percent rated their ability to treat patients on the spectrum as poor or fair. While more that 90 percent of the providers said they would investigate the possibility of autism in patients with limited eye contact, most under-reported the number of people on the autism spectrum who were actually under their care. In addition, only 13 percent of providers indicated that they had adequate tools or referral resources to appropriately accommodate those with autism.

To better understand the providers’ responses, follow-up interviews were conducted with nine primary care physicians. The researchers found that the majority had received limited or no autism training in medical school or during their residencies. All of the providers indicated a need for more education and improvements in the transition from pediatric care providers to adult medicine for those on the autism spectrum.

The preparation of healthcare providers is a pressing issue as an increasing number of individuals with autism are expected to enter adulthood in the coming years. Further research is urgently needed to study the transition from pediatric to adult healthcare and identify strategies that will lead to better medical care for adults on the autism spectrum.

Lee A. Wilkinson, PhD, NCSP is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a best-selling text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Video Game Use and Problem Behaviors in Autism

Video Game Use and Problem Behaviors in Autism

Children with autism spectrum disorder (ASD) often have strong preferences for screen-based media, particularly video games. Although a large body of research has demonstrated a clear effect of both video game content and genre on behavior problems among typically developing children and adolescents, the relationship between these variables has not been previously examined among children with ASD.  This study examined the relationships between aspects of video game use and problem behaviors among a sample of 169 boys (ages 8–18) with ASD. Parents reported on their children's behavioral functioning and video game habits and preferences, including the average number of hours spent playing video games per day, preferred game types (genres), and problematic (e.g., addictive) video game play patterns.  

                        

                                                                              Results

The results indicated that amount of game play alone (an average of 2.4 hours a day) was not associated with problem behaviors. Rather, the most reliable predictors of problem behaviors, even when controlling for age and amount of time spent playing video games, were video game genre and problematic, or addictive, qualities of play. Specifically, significant positive relationships were found between problematic video games use and both inattention and oppositional symptoms. Boys who played Role-Playing (genre) games had higher levels of both problematic game use and oppositional behavior. Interestingly, however, hyperactivity was not significantly associated with either problematic video game use or video game genre. Lastly, educational and sports games predicted less oppositional behavior. 

The results of this study are consistent, in part, with findings from the general population. For example, the significant association between problematic video game play, inattention, and oppositional behavior reported in the study is similar to those reported in adolescents and adults without ASD. The finding that Role-Playing games were highly associated with problematic video game play and externalizing problem behavior is also consistent with previous research among individuals without ASD

Implications

This study underlines the clinical importance of examining video game use patterns among children with ASD, and points to a need for future experimental and longitudinal research in this area. For example, Role-Playing games may contribute to an even greater potential for problematic game use patterns among children with ASD, given their particular game-design features. Since children with ASD tend to engage in restricted and repetitive behaviors (RRBs), they might be at higher risk for developing addictive game play patterns. Preoccupation with video games and trouble disengaging from them may serve as antecedents for disruptive behavior, as has been anecdotally reported among other children. It appears that for children with ASD, the potential for preoccupation represents a key game play quality that relates closely with the occurrence of problem behaviors. Future research in this area is critical in order to inform video game use recommendations for both parents and clinicians. As emerging research investigates the effectiveness of video-game based interventions for improving functional outcomes, it will be equally important to understand the mechanisms and nature of problematic aspects of game play among children with ASD.

Mazurek, M.O. & Engelhardt, C.R. (2013). Video game use and problem behaviors in boys with autism spectrum disorders. Research in Autism Spectrum Disorders, 7, 316-324.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)