My first professional blog attempt

Welcome All!

The objective of this blog is to advocate, educate and inform my readers by providing an 'insiders view' to the screening, assessment and interventions for adults with Asperger's Syndrome (AS). Timely articles and postings will include topics such as screening, evaluation, self-manangement techniques, specific differences, evidence-based interventions (EBI), Alternative Behavioural Analyses (ABA) and much more.

As a trained counsellor, I was recently diagnosed AS and so this blog also dares to share part of my own journey through assessment & adjustment -- and eventually seeing the issue "with new eyes"; and other salient issues that might affect those struggling to come to grips with their diagnosis (especially those diagnosed later in life, like I was).

Created as a practical and useful resource, this blog will attempt to offer its visitors essential information -- hopefully useful for informing other counsellors & mental health professionals, advocates, barristers, Special Ed instructors, and, most of all, for those NT adults with "Spectrumite" partners.

Thursday, 15 March 2012

Alexithymia, Empathy, and Autism

A friend of mine, Lee Wilkinson, wrote an article on AS and empathy -- worth reading...

An important aspect of social relatedness is the ability to empathize with the feelings of others. Empathy involves two major components: a cognitive component (e.g., theory of mind, perspective taking, or mindreading) and an affective component (emotional processing) which allows us to share the feelings of others. The affective component of sympathy involves having an appropriate emotional reaction to another person’s thoughts and feelings. When engaged in affective empathy, we vicariously experience the emotional states of others, understanding that our feelings are not ours but rather those of the other individual (Baron-Cohen, 2008).

Although affective empathizing and theory of mind (ToM) are both involved in social-emotional understanding, recent imaging studies have suggested that they involve different neural networks. For example, ToM has been primarily linked to activity of the medial prefrontal cortex, the superior temporal sulcus and the adjacent temporoparietal junction. In contrast, our ability to empathize with other people’s emotional states (such as disgust or pain) activates parts of the neuronal networks relevant for emotion processing such as somatosensory, insular and anterior cingulate cortices (Bird et al., 2010).
While autism has been shown to be associated with a deficit in ToM or perspective taking (cognitive empathy), it is much less clear to what degree individuals with ASD also experience deficits in affective empathy. In fact, it is uncertain whether the empathy deficit commonly attributed to individuals with autism is a result of the disorder itself, or if it is a consequence of a comorbid (coexisting) subclinical condition known as alexithymia. 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 (Kooiman, Spinhoven, & Trijsburg, 2002). It is especially important to note that Alexithymia does not constitute a clinical diagnosis and is best conceptualized as a dimensional personality trait that is normally distributed in the general population (estimates of 10%). However, there is evidence to suggest that it is associated with an increased risk of psychopathology. For example, several studies indicate that even in childhood, alexithymia and problems in the domain of emotion processing are positively related to internalizing problems such as depression and anxiety.

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 ASD (Hill, Berthoz, & Frith, 2004). 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 (Rieffe et al., 2011). There is also evidence to suggest that the alexithymia trait might be part of the broader autism phenotype. Together, these findings suggest that the alexithymia trait may be a significant component of the emotion processing difficulties experienced by people with ASD (Szatmari et al., 2008).
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. In a recent study, Bird et al (2010) examined whether there is a general empathic deficit associated with ASD that is not explained by alexithymia. They investigated empathic brain responses in a sample of 18 male participants with autism spectrum disorders and 18 male controls who were matched on alexithymia scores, age and IQ. Using functional magnetic resonance imaging (fMRI), the researchers measured empathic brain responses with an “empathy for pain” model in a real-life social setting that does not rely on attention to, or recognition of, facial affect cues. Confirming previous findings (Silani et al., 2008), empathic brain responses (to the suffering of others) were associated with increased activation in the left anterior insula. Moreover, the strength of this signal was predictive of the degree of alexithymia in both the autism and control groups, but did not vary as a function of group. Importantly, there was no difference in the degree of empathy between the groups after accounting for alexithymia. These results support the notion that it is not autism per se, but high levels of alexithymia (in both individuals with and without an ASD diagnosis) that are predictive of reduced empathic brain responses. Although individuals with ASD experience alexithymia at much higher rates than the general population, autism and alexithymia appear to be distinct, unrelated, and overlapping conditions in which alexithymia seems to influence affective empathy. Therefore, the empathy deficits typically observed in autism may be due to the large comorbidity between alexithymic traits and autism, rather than representing an essential feature of the social impairments in autism.
The results of this study illustrate the heterogeneity of individuals with ASD in regards to empathy deficits. Although difficulties with social relationships are common to both Alexithymia and ASD, it appears that not all individuals with ASD experience a global empathy deficit. This cautions against overgeneralizing the deficits commonly attributed to ASD to every individual on the autism spectrum. These findings also support the differentiation between cognitive empathy (ToM) and affective empathy. Previous research demonstrating ToM deficits in ASD, together with intact empathy shown by the present study, support the view that affective empathy and ToM are separate components.
Baron-Cohen, S. (2008). Autism and Asperger syndrome: The facts. New York: Oxford University Press.
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.
Hill, E., Berthoz, S., & Frith, U. (2004). Brief report: Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34, 229–235.
Kooiman, C.G., Spinhoven, P. & Trijsburg, R.W. (2002). The assessment of alexithymia: A critical review of the literature and a psychometric study of the Toronto Alexithymia Scale-20, Journal of Psychosomatic Research, 53, 1083-1090.
Rieffe, C., Oosterveld, P., Meerum Terwogt, M., Mootz, S., van Leeuwen, E., & Stockmann, L. (2011). Emotion regulation and internalizing symptoms in children with autism spectrum disorders, Autism, 15, 655-670.
Silani, G., Bird, G., Brindley, R., Singer, T., Frith, C., Frith, U. (2008). Levels of emotional awareness and autism: An fMRI study. Soc Neuroscience, 3, 97-112.
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.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.
© Lee A. Wilkinson, PhD