The Role of Alexithymia in Emotional Reactivity and Emotion Regulation in Children with Autism Spectrum Disorder

Background: Emotional disturbances, including emotional reactivity and regulation difficulties, are common among children with autism spectrum disorder (ASD) and pose risk factors to other problematic behaviors. In addition, alexithymia has a high prevalence among individuals with ASD and has been considered to be more relevant in the development of emotional problems than ASD symptoms themselves.

Objectives:  The present study aimed to examine the effect of alexithymia on emotional reactivity and regulation difficulties in children with ASD compared to typically developing (TD) children.

Methods:  Thirty-seven children previously diagnosed with ASD (5 female) and 41 TD children (9 female) and their parents participated in the study. Children were aged 3 to 13 years old. A multi-method assessment of children’s emotional reactivity and emotion regulation measures including parent-reports (Emotion Regulation Checklist; Shields & Cicchetti, 1997), behavioral observations (frequency of facial expressions’ valence; use of emotion regulation strategies), and physiological measures (percentage of change in heart rate; respiratory sinus arrhythmia) were used together with a parent-report of children’s alexithymia (adaptation of the Alexithymia Questionnaire for Children; Rieffe et al., 2006). The study took place in one visit during which parents were requested to fill out questionnaires and then an electrocardiogram measurement of the child took place at rest and during a frustration eliciting situation (Attractive Toy Removal; Goldsmith & Rothbart, 1999). The study was reviewed and approved by an ethics review panel.

Results:  Children with ASD had a significantly higher alexithymia score than TD children [t(76)=4.98, p<.001, d=1.13]. Compared to TD children, children with ASD had more difficulties in all indicators of emotional reactivity even after controlling for alexithymia: parents of children with ASD reported higher lability/negativity in their children compared to parents of TD children [F(1,75)=11.93, p<.01, =.14], children with ASD expressed more negative emotions than TD children [F(1,75)=15.66, p<.001, =.17], and the absolute percentage of HR change in children with ASD was higher than in TD children [F(1,70)=6.26, p<.05, =.08]. Similarly, children with ASD had more difficulties in all indicators of emotion regulation even after controlling for alexithymia: parents of children with ASD reported lower emotion regulation ability than parents of TD children [F(1,75)=5.49, p<.05, =.07], children with ASD used less adaptive emotion regulation strategies than TD children [F(1,75)=16.13, p<.001, =.18], and resting respiratory sinus arrhythmia was lower in children with ASD than in TD children [F(1,72)=4.39, p<.05, =.06]. Hierarchical regression models indicated that alexithymia contributed significantly to the explanation of certain aspects of emotional reactivity, but did not contribute further to explain emotion regulation difficulties.

Conclusions:  Our results show that children with ASD, compared to TD children, have more negative emotional reactivity, more difficulties in emotion regulation, and increased levels of alexithymia. Moreover, alexithymia plays an important role in the explanation of emotional reactivity but does not seem to contribute to difficulties regulating emotions. Therefore, these findings suggest that interventions targeting emotional reactivity would benefit from integrating alexithymia, and that interventions specifically targeting emotion regulation could help alleviate emotional disturbances in ASD.