Received: 21 July 2020 Accepted: 21 January 2021

DOI: 10.1002/aur.2485

RESEARCH ARTICLE

Alexithymia is related to poor social competence in autistic and

nonautistic children

Nichole E. Scheerer1,2 | Troy Q. Boucher1 | Grace Iarocci1

1
Department of Psychology, Simon Fraser
University, Burnaby, British Columbia, Canada
2
The Brain and Mind Institute, Western
Interdisciplinary Research Building, University
of Western Ontario, London, Ontario, Canada
Correspondence
Nichole E. Scheerer, The Brain and Mind
Institute, Western Interdisciplinary Research
Building, University of Western Ontario, 1151
Richmond Street, London, Ontario N6A 3K7,
Canada.
Email: nikkischeerer@gmail.com
Funding information
Canada First Research Excellence Fund;
Natural Sciences and Engineering Research
Council of Canada
Abstract
Alexithymia is characterized by difficulties identifying and describing one’s own
emotions and the emotions of others. These challenges with understanding emo-
tions in people with alexithymia may give rise to difficulties with social interac-
tions. Given that alexithymia frequently co-occurs with autism spectrum disorder
(ASD), and that both populations have difficulties with social interactions, it is of
interest to determine whether alexithymia can help to parse some of the heteroge-
neity in social competence in autistic and nonautistic individuals. The caregivers
of 241 children (6–14 years old), including 120 autistic, and 121 nonautistic, rated
their child’s social competence using the Multidimensional Social Competence
Scale (MSCS), autism traits using the Autism Spectrum Quotient (AQ), and
alexithymia traits using the Children’s Alexithymia Measure (CAM). Regression
analyses indicated that age, IQ, sex, AQ, and CAM scores accounted for 40.2% of
the variance in autistic children’s, and 68.2% of the variance in nonautistic chil-
dren’s, parent-reported social competence. Importantly, after controlling for age,
IQ, sex, and AQ scores, CAM scores alone accounted for an additional 16.2% of
the variance in autistic children’s, and 17.4% of the variance in nonautistic chil-
dren’s social competence. These results indicate that higher alexithymia traits pre-
dict lower levels of social competence, suggesting that increased difficulty in
identifying and describing one’s own emotions and the emotions of others is asso-
ciated with poorer social competence. Furthermore, CAM scores were found to
partially mediate the relationship between autistic traits and social competence,
suggesting that comorbid alexithymia traits may be partially responsible for poor
social competence in individuals with high autistic traits. This research contributes
to the understanding of the factors associated with the development of social com-
petence and highlights alexithymia as a potential target for identification and
intervention to improve social competence.

Lay Summary: Alexithymia is a condition where people find it hard to think and
talk about their (and others’) feelings. About 50% of autistic people have
alexithymia. This might be why they have social and emotional difficulties. Par-
ents answered questions about alexithymia and social difficulties their children
have. Children with more alexithymia problems had poorer social skills. Thus,
alexithymia may be related to social problems faced by autistic and nonautistic
children.

KEYWORDS
alexithymia, autism, autism spectrum disorder, emotional processing, social competence

[Correction added on 26 February 2021, after first online publication: The

affiliation of Dr. Boucher and Dr. Iarocci were incorrect in the initial publication.
It has been corrected.]

© 2021 International Society for Autism Research, Wiley Periodicals LLC.

Autism Research. 2021;1–8. wileyonlinelibrary.com/journal/aur 1

2 SCHEERER ET AL.
INTRODUCTION
Alexithymia is a condition that is characterized by diffi-
culties identifying and describing one’s own emotions
and the emotions of others. Alexithymia has a high co-
occurrence with Autism Spectrum Disorder (ASD) and
other disorders such as schizophrenia and bipolar disor-
der (Bird & Cook, 2013; Ospina et al., 2019; Trevisan
et al., 2019). The compromised understanding of others’
emotions in individuals with alexithymia has been
suggested to give rise to problems with social interactions
(Poquérusse et al., 2018). Given that alexithymia fre-
quently co-occurs with ASD, and that both populations
have difficulties with social interactions, it is of interest to
determine whether alexithymia can help to parse some of
the heterogeneity in social competence seen not only in
individuals with ASD, but also those without ASD.
Alexithymia traits can be measured continuously
within the general population (Bagby et al., 1994;
Trevisan et al., 2019), with alexithymia occurring in
approximately 10% of the nonautistic population
(Berthoz et al., 2011), relative to approximately 50% of
autistic individuals (Berthoz & Hill, 2005; Kinnaird
et al., 2019). Alexithymic individuals struggle to recog-
nize and articulate their emotional experiences
(Sifneos, 1972). Alexithymic individuals are characterized
as having difficulties identifying and describing their
emotions, attributing bodily sensations to emotional
experiences, thinking symbolically, and self-reflecting on
their inner experiences (Kooiman et al., 2002; Nemiah
et al., 1976; Ospina et al., 2019; Trevisan et al., 2019).
Poor emotional awareness can contribute to difficulties
in social communication (e.g., expressing one’s emotions)
and social interaction (e.g., understanding emotional cues
from others). Emotional awareness and understanding
are essential aspects of social engagement and under-
standing (Blair et al., 2007; Van Kleef, 2009). Thus,
alexithymia may interfere with the development of social
competence. Accordingly, in both bipolar disorder
(Ospina et al., 2019) and schizophrenia (Kimhy
et al., 2012), alexithymia has been found to predict social
functioning. Given the high prevalence of alexithymia in
the autistic population, it is possible that certain emo-
tional and social difficulties experienced by some autistic
individuals may be due to co-occurring alexithymia.
Although emotional deficits are not a core diagnostic
feature of ASD, a difficulty perceiving emotions in
others, a lack of empathy, and other emotional
processing difficulties are often used as diagnostic
markers of ASD (APA, 2013; Bird & Cook, 2013;
Gaigg, 2012). However, not all autistic individuals have
these emotional processing difficulties (Kinnaird
et al., 2019). Recent studies have suggested that it is
alexithymia, not autism, that is driving these emotional
processing difficulties (Bird & Cook, 2013; Cook
et al., 2013; Trevisan et al., 2019). According to the
“alexithymia hypothesis”, individual differences in emo-
tional processing that are common, but not universal, to
autistic individuals can be explained by co-occurring
alexithymia. For example, alexithymia, rather than autis-
tic traits, was found to predict variability in emotion rec-
ognition and empathy in a sample of autistic individuals
(Bird et al., 2010; Cook et al., 2013). Thus, alexithymia
may be the root of the emotion recognition and related
challenges in a subgroup of autistic people (Foulkes
et al., 2015).
To develop effective interventions to improve the
social skills of autistic individuals, it is important to first
identify which of the many social competencies
(e.g., emotion understanding) are affected in specific
groups of autistic people. The aim of this study was to
explore whether there is a link between alexithymia and
social competence in autistic and nonautistic children,
which could account for the heterogeneity in social com-
petence observed in both autistic and nonautistic chil-
dren. Given the previously reported association between
social functioning and alexithymia in individuals with
bipolar disorder and schizophrenia (Ospina et al., 2019;
Kimhy et al., 2012, respectively), we expected that
higher scores on the children’s alexithymia measure
(CAM), indicating more alexithymia traits, would be
related to lower scores on the multidimensional social
competence scale (MSCS), indicating lower social
competence.
METHODS
Caregivers of 241 children between the ages of 6 and
14 years old participated: 120 autistic (95 boys,
Mage = 10.20; SD = 1.91), and 121 nonautistic (71 boys,
Mage = 9.50; SD = 1.73) children. Inclusion criteria for
the current study were an ASD diagnosis (ASD group
only) and Full Scale IQ > 80 assessed using the Wechsler
Abbreviated Scales of Intelligence, Second Edition
(WASI-II; Wechsler, 2011). Children with ASD and
intellectual disability should be considered as a separate
subgroup. Sample characteristics are presented in
Table 1. Caregivers rated their child’s social competence
on the Multidimensional Social Competence Scale
(MSCS; Yager & Iarocci, 2013), and alexithymia traits
on the Children’s Alexithymia Measure (CAM; Way
et al., 2010). A diagnosis of ASD in the province of Brit-
ish Columbia, Canada involves a standardized procedure
using the Autism Diagnostic Observation Schedule
(ADOS) and the Autism Diagnostic Interview-Revised
(ADI-R) conducted by a trained clinician. Confirmation
of ASD diagnosis was provided by caregivers in the form
of a clinical diagnostic report or government funding eli-
gibility report. All caregivers provided informed consent
prior to participation. This study was approved by the
Office of Research Ethics at Simon Fraser University.
SCHEERER ET AL. 3

TABLE 1 Participant characteristics

TD children (n = 121) ASD children (n = 120)

N (%) Mean (SD) N (%) Mean (SD)

Age 9.50 (1.73) 10.20 (1.91)

MSCS 287.94 (44.81) 208.07 (31.01)
CAM 7.69 (7.52) 16.71 (8.80)
AQ 15.64 (7.83) 32.41 (6.78)
WASI-II FSIQ-2 109.39 (13.60) 100.63 (18.46)
Ethnicity
Asian 53 (44) 44 (37)
Asian-Canadian 9 (7) 16 (13)
White 41 (34) 56 (47)
Other 18 (15) 4 (3)
Child’s school type
Public school 116 (96) 100 (83)
Private school 5 (4) 13 (11)
Home school 0 7 (6)
Parent marital status
Single 4 (3) 4 (3)
Married/common-law 106 (88) 97 (80)
Separated/divorced 11 (9) 19 (16)
Family income
Less than $20,000 2 (2) 3 (3)
$20,000 to $49,999 11 (9) 18 (15)
$50,000 to $79,999 33 (27) 23 (19)
$80,000 to $109,999 22 (18) 23 (19)
$110,000 to $139,999 22 (18) 23 (19)
Greater than $140,000 28 (23) 22 (18)
Prefer not to say 3 (3) 8 (7)
Abbreviations: AQ, autism quotient; CAM, children’s alexithymia measure; MSCS, Multidimensional Social Competence Scale; WASI-II FSIQ-2, Wechsler abbreviated
scales of intelligence, second edition, full scale IQ-2.

Social competence Alexithymia

The MSCS is a 77-item parent-report questionnaire
that assesses childrens’ social competence, answered
using a five-point rating scale (1 = Not True or Almost
Never True, 5 = Very True or Almost Always True).
Questions on the MSCS assess the social functioning
of the child in everyday life across seven domains:
social motivation, social inferencing, demonstrating
empathic concern, social knowledge, emotion regula-
tion, verbal conversation skills, and nonverbal sending
skills. The MSCS total score, which is the sum of
scores for all seven domains, was used as the measure
of social competence in the current study. Higher
MSCS total scores reflect better social competence of
the child. The reliability coefficients for the internal
consistency of MSCS subscales are high (range
0.84–0.90), as is the MSCS total score (0.95; Yager &
Iarocci, 2013).
The CAM is a 14-item parent-report questionnaire that
assesses childrens’ alexithymia traits using a 4-point
Likert scale (Almost Never, Sometimes, Often, and
Almost Always). Higher total scores indicate higher
levels of alexithymia. Factor analysis of the CAM shows
strong internal reliability (0.92; Way et al., 2010).
Autistic traits
The AQ is a 50-item parent-report questionnaire that
assesses autistic traits in children using a 4-point scale
(definitely agree, slightly agree, slightly disagree, and def-
initely agree). The AQ-Child (ages 4–11; Auyeung
et al., 2008) or the AQ-Adolescent (ages 12–15; Baron-
Cohen et al., 2006) were completed by parents of children
depending on the child’s age. Both versions yield a total
4 SCHEERER ET AL.
score ranging from 0 to 50 and follow a similar structure,
assessing social and nonsocial characteristics of ASD
across five domains: social skills, attention switching,
attention to details, communication skills, and imagina-
tion. Typically, a score of 32 is considered the cutoff for
significant autistic traits (Baron-Cohen et al., 2001).
Internal consistency is good for both the AQ-Child (0.97;
Auyeung et al., 2008) and the AQ-Adolescent (0.79;
Baron-Cohen et al., 2006).
Intelligence quotient (IQ)
The IQ of participants was estimated using the WASI-II.
The WASI-II provides an accurate estimate of cognitive
ability comparable to other measures of intelligence,
developed for quick administration with individuals aged
6–90 years old (Wechsler, 2011). The WASI-II Full-Scale
IQ-2 (FSIQ-2) composite scale was administered with
participants by clinical psychology graduate students and
is reported in the current study. The FSIQ-2 is composed
of scores from two subtests: Vocabulary and Matrix Rea-
soning. The reliability coefficients for the FSIQ-2 com-
posite scale is excellent (0.93) for children ages 6–16 years
old, and the interrater reliability for the subtests is high
for both Matrix Reasoning (0.99) and for Vocabu-
lary (0.95).
Statistical analyses
Independent samples t tests were conducted to investigate
group differences in age, MSCS, CAM, AQ, and IQ,
while a chi-square analysis was conducted to look for dif-
ferences in the gender distribution across groups. Next,
correlational analyses were conducted to look at the rela-
tions between MSCS, CAM, AQ, and IQ, separately for
autistic and nonautistic children. Hierarchical regressions
were conducted separately for autistic children and non-
autistic children to see whether after controlling for age,
sex, IQ, and autism characteristics, alexithymia could
account for a significant amount of variance in MSCS
scores. A three-step procedure was used whereby the first
step contained the independent variables of age, sex, and
IQ in order to control for their potential influence on
social competence. Given social competence has been
shown to vary with autistic traits (Scheerer et al., 2020),
the second step contained AQ scores to parse out the var-
iance in social competence accounted for by autistic
traits. The third step contained CAM scores to determine
how much additional variance in the dependent variable,
MSCS scores, could be accounted for by alexithymia
traits. Finally, regression-based mediation analyses were
conducted using the bootstrapping method (Hayes &
Rockwood, 2017), to examine alexithymia traits as a
potential mediator of the relationship between autistic
traits and social competence.
RESULTS
Group differences
Independent samples t tests indicated that autistic chil-
dren were significantly older than nonautistic children (t
(239) = −2.998, p = 0.003). Nonautistic children had sig-
nificantly higher MSCS (t(213.62) = 16.102, p < 0.001)
and IQ (t(218.75) = 4.190, p < 0.001) scores, while autis-
tic children had significantly higher CAM (t
(232.72) = −8.552, p < 0.001) and AQ (t(239) = −17.758,
p < 0.001) scores. Chi-square results indicate that the dis-
tribution of males and females differed across autistic
and nonautistic groups (χ 2(1) = 11.799, p = 0.001).
The goal of this study was to see if alexithymia traits
could help to parse some of the heterogeneity in social
competence in both our samples of autistic and non-
autistic children. Given we found group differences in
CAM and MSCS scores, we opted to run subsequent
analyses separately for each group in order to investigate
the relationship between alexithymia traits and social
competence within each group, without worrying about
the between group differences driving our effects. How-
ever, results of the combined analyses can be found in the
supplemental information.
ASD group
Pearson’s correlational analyses indicate that CAM scores
were significantly correlated with total MSCS (r
(119) = −0.520, p < 0.001) and AQ (r(119) = 0.271,
p = 0.003) scores. CAM scores were also significantly corre-
lated with all seven subscales of the MSCS (p < 0.05). MSCS
scores were also significantly correlated with AQ scores (r
(119) = −0.520, p < 0.001). However, IQ scores were not sig-
nificantly correlated with CAM, MSCS, or AQ scores.
Step 1 of the regression model indicated that age, sex,
and IQ did not account for significant variance in MSCS
scores (R2 = 0.017, F(3, 116) = 0.685, p = 0.563). With
the addition of AQ scores in the second step of the model
an additional 22.3% of the variance in MSCS scores was
accounted for, resulting in a significant model
(R2 = 0.241, F(4, 115) = 9.111, p < 0.001). Similarly, in
step 3 of the model CAM scores were added, accounting
for an additional 16.2% of variance in MSCS scores,
resulting in a significant model (R2 = 0.402, F
(5, 114) = 15.347, p < 0.001; see Table 2).
Given AQ scores were significantly correlated with
both MSCS and CAM scores, and CAM scores were also
correlated with MSCS scores, we conducted a mediation
analysis to determine whether social deficits in children
with high levels of autistic traits are mediated by
alexithymia traits. As Figure 1 illustrates, the standard-
ized regression coefficient between autistic traits and
alexithymia traits was statistically significant, as was the
standardized regression coefficient between alexithymia
SCHEERER ET AL. 5

TABLE 2 Hierarchical regression analysis for autistic participants

Step 1 Step 2 Step 3

Variable B β B β B β

Constant 207.500** - 277.486** - 288.349** -

IQ 0.09 0.053 0.092 0.055 −0.028 −0.017
Age −0.998 −0.061 −1.002 −0.062 −0.126 −0.008
Sex 8.302 0.109 7.511 0.099 8.24 0.108
AQ - - −2.160** −0.473 −1.627** −0.356
CAM - - - - −1.507** −0.428
R2 0.017 0.241 0.402
F 0.563 9.111** 15.347**
ΔR 2
- 0.223 0.162
ΔF - 33.810** 30.836**
Note: n = 120; **p < 0.001.

F I G U R E 1 Standardized regression coefficients for the relationship between autistic traits and social competence as mediated by alexithymia
traits. Standardized regression coefficients for the relationship between autistic traits and social competence for (a) autistic and (b) nonautistic
children. Followed by standardized regression coefficients for the mediation of the relationship between autistic traits and social competence by
alexithymia traits for (c) autistic and (d) nonautistic children

traits and social competence. The standardized indirect
effect was (0.27)(−0.42) = −0.12. We tested the signifi-
cance of this indirect effect using bootstrapping proce-
dures (Hayes, 2013). Unstandardized indirect effects were
computed for each of 10,000 bootstrapping samples. The
bootstrapped unstandardized indirect effect was −0.52
with a 95% confidence interval that ranged from −0.97 to
−0.18. Thus, the indirect effect was statistically signifi-
cant. However, given that the relationship between autis-
tic traits and social competence was reduced but still
significant with alexithymia traits added to the model,
alexithymia traits only partially mediated this
relationship.
Nonautistic group
Pearson’s correlational analyses indicate that CAM
scores were significantly correlated with total MSCS (r
(120) = −0.761, p < 0.001) and AQ (r(120) = 0.596,
p < 0.001) scores. CAM scores were also significantly
correlated with all seven subscales of the MSCS
(p < 0.05). MSCS scores were also significantly correlated
with AQ scores (r(120) = −0.694, p < 0.001). However,
IQ scores were not significantly correlated with CAM,
MSCS, or AQ scores.
Step 1 of the model indicated that age, sex, and IQ did
not account for significant variance in MSCS scores
(R2 = 0.049, F(3, 117) = 2.014, p = 0.116). With the addi-
tion of AQ scores in the second step of the model an addi-
tional 45.8% of variance in MSCS scores was accounted
for, resulting in a significant model (R2 = 0.508, F
(4, 116) = 29.864, p < 0.001). In step 3 of the model CAM
scores were added, accounting for an additional 17.4% of
variance in MSCS scores, resulting in a significant model
(R2 = 0.668, F(5, 115) = 49.330, p < 0.001; see Table 3).
Given AQ scores were significantly correlated with
both MSCS and CAM scores, and CAM scores were also
6 SCHEERER ET AL.
TABLE 3 Hierarchical regression analysis for nonautistic participants
Step 1
Variable B β
Constant 243.716** - 293.994**
IQ 0.589 0.179
Age −2.575 −0.1
Sex 10.336 0.114
AQ - -
CAM - -
R2 0.049
F 2.014
ΔR 2
- 0.458
ΔF - 108.009**
Note: n = 121; **p < 0.001.
correlated with MSCS scores, we conducted a mediation
analysis to determine whether social deficits in children
with high levels of autistic traits are mediated by
alexithymia traits. As Figure 1 illustrates, the standard-
ized regression coefficient between autistic traits and
alexithymia traits was statistically significant, as was the
standardized regression coefficient between alexithymia
traits and social competence. The standardized indirect
effect was (0.60)(−0.54) = −0.32. We tested the signifi-
cance of this indirect effect using bootstrapping proce-
dures (Hayes, 2013). Unstandardized indirect effects were
computed for each of 10,000 bootstrapping samples. The
bootstrapped unstandardized indirect effect was −1.84
with a 95% confidence interval that ranged from −2.59 to
−1.17. Thus, the indirect effect was statistically signifi-
cant. However, given the relationship between autistic
traits and social competence was reduced, but still signifi-
cant, with alexithymia traits added to the model,
alexithymia traits only partially mediated this
relationship.
DISCUSSION
The aim of this study was to explore the link between
alexithymia and social competence in autistic and non-
autistic children. The results indicate that autistic traits
accounted for significant variance in social competence
in both children with and without ASD, 22.3% and
45.8% respectively. However, scores on the childhood
alexithymia measure accounted for an additional 16.2%
and 17.4% of the variance in social competence for autis-
tic and nonautistic children, respectively, after controlling
for age, IQ, gender, and autistic traits. These results sug-
gest that over and above autistic traits, alexithymia is
related to parent reports of social competence in autistic
and nonautistic children. Notably, alexithymia was
related to total MSCS scores, as well as each domain of
the MSCS. Interestingly, alexithymia traits were also
Step 2 Step 3
B β B β
- 311.909** -
0.369 0.112 0.14 0.042
1.371 0.053 1.777 0.069
6.631 0.073 6.118 0.068
−3.975 −0.694 −2.209 −0.386
- - −3.137 −0.526
0.508 0.682
29.894** 49.330**
0.174
63.080**
found to partially mediate the relationship between autis-
tic traits and social competence, suggesting that comor-
bid alexithymia may be partially responsible for the poor
social competence observed in individuals with high
autistic traits.
Social communication difficulties are one of the diag-
nostic criteria for ASD, and this association is reflected
in the relation between autistic traits and social compe-
tence seen in our samples. However, alexithymia
accounted for additional variance in social competence,
supporting the idea that alexithymia may explain some of
the heterogeneity in social competence seen in the autistic
population. The ability to recognize and articulate one’s
emotional experiences, and the experiences of others, is
crucial for many social functions such as producing and
perceiving nonverbal signals like facial affect and tone of
voice, as well as understanding sarcasm. Many of these
functions appear to be impaired in individuals with
alexithymia. For example, Heaton et al. (2012) found
that in autistic individuals, differences in the ability to
recognize the emotion expressed by changes in vocal
affect were accounted for by alexithymia traits. If co-
occurring alexithymia makes it difficult for individuals
to produce and perceive social cues, social interactions
are likely to be confusing, uncomfortable, and ulti-
mately unsuccessful. When social interactions are per-
ceived as unsuccessful, they become less rewarding and
pleasurable (Jobe & White, 2007). Accordingly, previ-
ous studies of alexithymia in the general population
have shown that alexithymia is related to social anhedo-
nia (Prince & Berenbaum, 1993) and decreased satisfac-
tion in intimate relationships (Humphreys et al., 2009).
Furthermore, frequent social blunders are likely to lead
to social withdrawal, which then limits future opportu-
nities to practice and improve one’s social abilities
(Foulkes et al., 2015). Accordingly, a recent study has
shown that alexithymia, not autism, predicted the num-
ber of social interactions autistic adults engaged in
(Gerber et al., 2019).
SCHEERER ET AL.
Autistic individuals often have fewer social relation-
ships than nonautistic individuals (Locke et al., 2010).
However, ASD has been associated with high levels of
loneliness (Jobe & White, 2007; Whitehouse et al., 2009),
which suggests that autistic individuals desire social inter-
actions, but these desires are not being fulfilled (Foulkes
et al., 2015). The current results suggest that the poor
emotional awareness caused by co-occurring alexithymia
may contribute to the social difficulties that make for-
ming and maintaining relationships difficult for autistic
individuals. Approximately 50% of the autistic popula-
tion has been shown to also have alexithymia, thus these
individuals represent a specific subgroup in the autistic
population that may benefit from interventions targeting
emotional awareness and understanding to improve their
social success (Kinnaird et al., 2019). Given alexithymia
was also related to social competence in the nonautistic
sample, these findings suggest that emotional processing
difficulties may also contribute to social difficulties in
nonautistic children, and also represent a target for inter-
vention in nonautistic individuals with social difficulties.
However, the other core cluster of symptoms in autism
related to restricted and repetitive patterns of behavior
may create challenges that are unique to autistic individ-
uals. Additional research is necessary to determine
whether alexithymia traits influence social functioning in
a similar manner in autistic and nonautistic individuals.
The results of this study suggest a strong link between
alexithymia and social competence, yet we must acknowl-
edge a few limitations of the current study. Anxiety and
depression are both constructs that have been associated with
alexithymia and are also highly comorbid with ASD
(Foulkes et al., 2015; Kinnaird et al., 2019), thus it is possible
that anxiety and depression also play a mediating or moder-
ating role in the relations between alexithymia and social
competence. In addition, given that the results of this study
were obtained by parent report, these findings are limited by
the extent to which parents can accurately assess their child’s
emotional awareness and understanding. We also cannot
confirm the direction of influence whether emotional difficul-
ties lead to poor social competence or vice versa.
CONCLUSION
Alexithymia has been associated with a wide range of
emotional processing difficulties, including emotional
interoception (Murphy et al., 2018; Silani et al., 2008),
empathy (Bird et al., 2010), and the recognition of emo-
tion in others (Cook et al., 2013). Many of these difficul-
ties are often attributed to an ASD diagnosis, but recent
work suggests that these difficulties may actually be the
byproduct of co-morbid alexithymia (e.g., Shah
et al., 2016; but also c.f. Nicholson et al., 2018). The cur-
rent findings support this hypothesis, indicating that chil-
dren with higher alexithymia traits also have similarly
7
lower levels of social competence regardless of ASD diag-
nosis. Thus, co-occurring alexithymia may be one rea-
son for poor social competence in a subgroup of autistic
children. This research highlights emotion recognition
and understanding as an important target for identifica-
tion and intervention to improve social competence.
With this in mind, when investigating and developing
interventions for emotional processing difficulties in
autistic individuals, it is important that researchers and
clinician measure and control for co-occurring
alexithymia.
A C K N O W L E D G M EN T S
Thank you to the families who participated in this
research, and the research assistants in the Autism and
Developmental Disorders Lab at SFU who helped collect
and analyze this data. I would also like to thank Dr.
Ryan Stevenson, Dr. Fakhri Shafai, and Samantha
Schultz for comments and feedback on the manuscript
drafts. This research was supported by Nichole Scheerer’s
NSERC Postdoctoral Fellowship (PDF) held at Simon
Fraser University, as well as her BrainsCAN Postdoc-
toral Fellowship at Western University, funded by the
Canada First Research Excellence Fund (CFREF).
CONFLICT OF INTEREST
The authors have no conflicts of interest to declare,
financial or otherwise.
OR CID
Nichole E. Scheerer https://orcid.org/0000-0003-0070-
6559
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SUPPORTING INFORMATION
Additional supporting information may be found online
in the Supporting Information section at the end of this
article.
How to cite this article: Scheerer NE, Boucher TQ,
Iarocci G. Alexithymia is related to poor social
competence in autistic and nonautistic children.
Autism Research. 2021;1–8. https://doi.org/10.1002/
aur.2485