Suicidality in adults with autism spectrum disorder: The role of depression and alexithymia.

Scientific Conference (2019)

Background: Individuals with autism spectrum disorder (ASD) have a higher risk of depression and suicidality than individuals without ASD. Alexithymia, a personality construct characterized by a lack of ... [more ▼]

Background: Individuals with autism spectrum disorder (ASD) have a higher risk of depression and suicidality than individuals without ASD. Alexithymia, a personality construct characterized by a lack of emotional awareness, that is highly linked to depression, is also more prevalent among people with ASD than in the general population. Few studies have so far examined the increased risk of suicidality in people with ASD and none have looked into how alexithymia could be a significant risk factor for suicidality in ASD. Objectives: The aim of the present study is to explore more closely the relationship between alexithymia, depression, and suicidality in ASD. It is hypothesized that there are higher rates of depression, suicidality, and alexithymia in people with ASD compared to neurotypical adults. Because the risk of suicidality can be explained by high levels of depression and alexithymia in the general population, this is also hypothesized for the group of people with ASD. Methods: In the present study, 53 adults diagnosed with ASD and a control group of 132 adults without ASD were compared on their self-reported scores on autistic traits (AQ-short), depression (CES-D), suicidality (SBQ-R), and alexithymia (TAS-20). Participants were aged between 18 and 60 years. The ASD group was significantly older (M = 33.75; SD = 11.02) than the control group (M = 29.08; SD = 8.74), t(183) = -3.04, p < .01 and there were significantly more men than women in the ASD group (21 men, 31 women, 1 other) than in the control group (31 men, 101 women), χ2(2) = 7.72, p < .05. Results: The results revealed that the ASD group had significantly higher levels of autistic traits [F(1, 181) = 394.61, p < .001, ɳp2 = .69], depression [F(1, 181) = 51.86, p < .001, ɳp2 = .22], suicidality [F(1, 181) = 71.51, p < .001, ɳp2 = .28], and alexithymia [F(1,181) = 143.44, p < .001, ɳp2 = .44] than the control group. A hierarchical linear regression analysis including age, gender, autistic traits, depressive symptomatology, and alexithymia also revealed that the severity of autistic traits and depressive symptomatology were significant predictors of suicidality (autistic traits: β = 1.24, p <.001; depression: β = 1.30, p <.001). Furthermore, alexithymia played a moderating role in the relation between autistic traits and suicidality: a significant relation was found between autistic traits and suicidality on participants with high levels of alexithymia [b = 1.61, SE = 0.31, p < .001], but autistic traits were not related to suicidality on participants with low levels of alexithymia [b = -0.54, SE = .45, p = .24]. Conclusions: The present results show that individuals with ASD are vulnerable to suicidal ideation and that the severity of autistic traits, depression, and alexithymia are important factors in the occurrence of suicidal ideation in ASD. Because of the high risk of suicidality in ASD, interventions that take into consideration depression, and particularly alexithymia, could potentially benefit people with ASD. [less ▲]

The role of alexithymia in parent-child interaction and in the emotional ability of children with autism spectrum disorder

in Autism Research (2019)

Children with autism spectrum disorder (ASD) have more emotional difficulties than typically developing (TD) children. Of all the factors that impact children’s emotional development, parents, and the way ... [more ▼]

Children with autism spectrum disorder (ASD) have more emotional difficulties than typically developing (TD) children. Of all the factors that impact children’s emotional development, parents, and the way they interact with their children, are of crucial importance. The present study compared the amount of parent-child interactions among 35 dyads of parents and their children with ASD and 41 dyads of parents and their TD children, aged between 3 and 13 years, during a frustration-eliciting situation. We further examined whether children’s alexithymia is linked to parent-child interactions and whether parent-child interactions are linked to children’s emotional difficulties. We found that parents of children with ASD interacted significantly less with their children than parents of TD children. This reduced interaction was better explained by children’s alexithymia than by children’s ASD diagnosis. Finally, parent-child interaction mediated the relationship between children’s ASD diagnosis and children’s emotion regulation ability, as well as some aspects of children’s emotional reactivity but only if not accounting for children’s alexithymia levels. Our results demonstrate the determinant role children’s alexithymia plays on parent-child interactions and on how these interactions are linked to children’s difficulties in emotion regulation and emotional reactivity. Results are discussed in light of how parent-child interactions and the emotional ability of children with ASD can be improved by targeting children’s alexithymia. [less ▲]

Luxembourg and Autism

in Volkmar, Fred (Ed.) Encyclopedia of Autism Spectrum Disorders (2018)

More Attention and Less Repetitive and Stereotyped Behaviors using a Robot with Children with Autism

in 27th IEEE International Symposium on Robot and Human Interactive Communication, RO-MAN 2018, Nanjing, China, August 27-31, 2018 (2018)

The aim of the present study was to assess the usefulness of QTrobot, a socially assistive robot, in interventions with children with autism spectrum disorder (ASD) by assessing children's attention ... [more ▼]

The aim of the present study was to assess the usefulness of QTrobot, a socially assistive robot, in interventions with children with autism spectrum disorder (ASD) by assessing children's attention, imitation, and presence of repetitive and stereotyped behaviors. Fifteen children diagnosed with ASD, aged from 4 to 14 years participated in two short interactions, one with a person and one with the robot. Statistical analyses revealed that children directed more attention towards the robot than towards the person, imitated the robot as much as the person, and engaged in fewer repetitive or stereotyped behaviors with the robot than with the person. These results support previous research demonstrating the usefulness of robots in short interactions with children with ASD and provide new evidence to the usefulness of robots in reducing repetitive and stereotyped behaviors in children with ASD, which can affect children's learning. [less ▲]

The link between focused attention and emotion regulation ability in children with ASD.

Scientific Conference (2018)

Background: Empirical studies have frequently highlighted the importance of attentional mechanisms in the emotion regulation of people with autism spectrum disorder (ASD). For instance, people with ASD ... [more ▼]

Background: Empirical studies have frequently highlighted the importance of attentional mechanisms in the emotion regulation of people with autism spectrum disorder (ASD). For instance, people with ASD present distinct gaze patterns when looking at emotional stimuli. However, far less research has focused on the link between general attentional capacity and the ability to regulate emotions in people with ASD. In the typically developing (TD) literature it is shown that children’s focused and sustained attention to non-emotional stimuli is related to a better regulation of negative emotions. Therefore, studying this link in ASD can help understand emotional difficulties in children with ASD. Objectives: The present study aims to analyse the link between sustained attention to non-emotional stimuli and the use of emotion regulation strategies during a frustration-eliciting situation in children with ASD. Methods: Thirty-seven children previously diagnosed with ASD (5 female) and 41 TD children (9 female) aged 3 to 13 years old participated in the study. Children first took part in a sustained attention task in which they watched a 3-minute slide presentation of 15 pictures of landscapes, animals, and humans. Then, children took part in a frustration-eliciting situation during which they were presented with attractive toys. After 15 seconds playing with the toys those were removed and placed behind a transparent barrier. Both tasks were videotaped and children’s behaviors were coded by two independent observers. In the sustained attention task children were coded regarding the intensity of facial interest (0=not interested, 1=interested, 2=very interested) and the total amount of time in seconds looking at the slide presentation (maximum = 180 seconds). In the frustration-eliciting situation children’s behaviors were coded into 12 categories and then grouped into 3 emotion regulation strategies: disruptive behavior (physical objection, crying/venting, defending, infraction, and verbal objection), passive tolerance (staring, doing nothing, self-distraction, and parent/researcher), and active self-regulation (directing situation, alternating activity, and complying). Results: Regarding attention, children with ASD displayed less interest in the slide presentation [t(70)=4.118, p<.001, d=0.96] and watched the presentation for less time [t(43)=5.492, p<.001, d=1.33] than TD children. Regarding the use of emotion regulation strategies, a significant effect of group was found [Λ=.71, F(3,74)=10.26, p<.001, η_p^2=.29]. Separate univariate ANOVAs revealed that children with ASD used more disruptive behaviors [F(1,76)=25.24, p<.001, η_p^2=.25] and less passive tolerance behaviors [F(1,76)=11.35, p<.01, η_p^2=.13] than TD children but did not differ regarding active self-regulation behaviors [F(1,76)=2.03, p=.16, η_p^2=.03]. Regression analyses revealed that children’s total duration of look but not the interest during the attention task significantly predicted children’s use of disruptive behavior (β=-1.12, p<.01) and passive tolerance (β=1.26, p<.01) above and beyond ASD diagnosis. Conclusions: Our results show a significant association between children’s capacity for sustained attention and their use of less disruptive behaviors and more passive tolerance behaviors as emotion regulation strategies. However, mutual influences between sustained attention and emotion regulation can occur and should be taken into consideration when interpreting the results. The present results offer new perspectives on intervention programs for children with ASD with emotional difficulties. [less ▲]

Socially assistive robots for teaching emotional abilities to children with autism spectrum disorder

Scientific Conference (2017, March)

Socially assistive robots, when used in a way that takes into consideration children’s needs and developmental characteristics, can be useful tools to enable children’s development. More specifically, due ... [more ▼]

Socially assistive robots, when used in a way that takes into consideration children’s needs and developmental characteristics, can be useful tools to enable children’s development. More specifically, due to their characteristics (predictability, simplicity, and repetition) robots can be especially helpful to teach emotional abilities to children with autism spectrum disorder (ASD). Previous research has provided preliminary evidence that robots can help children improve in some domains such as joint attention and imitation. However, no studies have examined how robots can be integrated in intervention protocols targeting the acquisition of emotional abilities in children with ASD. This paper presents a work in progress on an emotional ability training developed for children with ASD using the QT socially assistive robot. This training aims to test whether children with ASD can benefit from a robot-mediated training to improve emotional ability. [less ▲]

The role of parents in children’s emotional ability.

Scientific Conference (2017)

Understanding the processes that lead to different emotional responses in children is important for prevention and intervention programs aimed at improving developmental outcomes. Among the many factors ... [more ▼]

Understanding the processes that lead to different emotional responses in children is important for prevention and intervention programs aimed at improving developmental outcomes. Among the many factors that can influence children’s emotional reactivity and emotion regulation, parents and the way they interact with their children can impact children’s emotional responses. Even though the influence of parents in children’s emotional responses has been extensively studied during infancy and toddlerhood, the way parents interact with their preschool and school-aged children during upsetting moments has received little attention. The present study aimed at examining the effects of parental presence and parental interaction during a frustration-eliciting situation on preschoolers’ and school-aged children’s emotional reactivity and emotion regulation. More specifically, it aimed at examining whether parents’ presence during a frustration-eliciting situation (attractive toy removal) influences children’s emotional reactivity and emotion regulation. Moreover, whether children whose parents interact with them differ in emotional reactivity and emotion regulation from those whose parents do not interact with them. A convenience sample of 66 children (19 girls) together with one of their parents participated in the study. Children were aged between 3 and 13 years (Mage=8.65; SDage=2.32) and parents were aged between 26 to 53 years (Mage=40.38; SDage=5.22). For 41 children, parents were present during the frustration-eliciting situation. For the remaining 25 children, parents were absent. Children and parents who were present were videotaped during the situation. Parents’ interaction with their children, children’s emotional reactivity, and children’s emotion regulation during the situation were coded by 2 independent observers. Ethical approval as well as parents’ and children’s informed consent was obtained before conducting the study. It was found that children whose parents were present, compared to children whose parents were absent, expressed more positive emotions [t(63)=3.19, p<.01, r=.37] and less neutral emotions [t(64)=2.92, p<.01, r=.34], but did not differ in the amount of negative emotions [t(64)=0.28, p=.78, r=.03], or in the use of adaptive emotion regulation strategies [t(64)=0.99, p=.33, r=.12]. Regarding parents’ interaction, it was found that children of parents who interacted with them, compared to children of parents who did not interact with them, expressed less neutral emotions [t(39)=2.80, p<.01, r=.41], expressed more positive [t(39)=2.01, p=.05, r=.31] and more negative emotions [t(33)=2.30, p<.05, r=.37], and used more emotion regulation strategies [t(39)=2.55, p<.05, r=.38]. These results show that parents’ presence can have an influence in preschoolers’ and school-aged children’s positive reactivity but not in children’s negative reactivity or in the use of adaptive emotion regulation strategies. Furthermore, when present, parents’ interaction with their children is related to children’s lower neutrality, and to higher positive and negative reactivity. It is also related to children’s use of more adaptive emotion regulation strategies. These results suggest that, either because parents interact more with reactive children, or because children are more expressive with interactive parents, parents’ interaction is related to children’s reactivity and better regulation. Including parents in interventions and providing parents with training on emotional support for their children may be beneficial for improving developmental outcomes in children with emotional difficulties. [less ▲]

Expressive incoherence and alexithymia in autism spectrum disorder

in Journal of Autism and Developmental Disorders (2017)

Expressive incoherence can be implicated in socio-emotional communicative problems in autism spectrum disorder (ASD). The present study examined expressive incoherence in 37 children with ASD and 41 ... [more ▼]

Expressive incoherence can be implicated in socio-emotional communicative problems in autism spectrum disorder (ASD). The present study examined expressive incoherence in 37 children with ASD and 41 typically developing (TD) children aged 3–13 years old during a frustration task. The role of alexithymia in expressive incoherence was also assessed. Compared to TD children, children with ASD had higher expressive incoherence, such as more neutral and positive emotion expressions during negative behaviors, but not in the expression of negative emotions during positive behaviors. Further analyses revealed that alexithymia moderated the expressions of positive emotions during negative behaviors. These results suggest that children with ASD may benefit from interventions targeting alexithymia to increase emotional coherence, which may improve socio-emotional communication. [less ▲]

Difficultés émotionnelles chez les parents et ses enfants atteints d’un trouble du spectre autistique

Scientific Conference (2016, May 20)

Emotional reactivity and emotion regulation in children with autism spectrum disorder.

Doctoral thesis (2016)

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and social interaction, as well as restricted and repetitive patterns of behaviors and ... [more ▼]

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and social interaction, as well as restricted and repetitive patterns of behaviors and interests. Additionally, children with ASD often present internalizing and externalizing problems such as anxiety, depression, and conduct problems. These problems can hinder children’s social competence and development and may have repercussions into adolescence and adulthood. It is believed that internalizing and externalizing problems originate from children’s emotional difficulties such as difficulties in emotional reactivity and emotion regulation. The aim of the present thesis was therefore to examine the role of emotional reactivity and emotion regulation in children with ASD. Emotional difficulties in children with ASD may be due to several factors: ASD’s core symptoms, children’s other characteristics such as alexithymia, and parents’ characteristics. The relation between these factors to emotional difficulties in children with ASD have been integrated into a model of the emotional reactivity and emotion regulation difficulties in children with ASD. Based on the model’s assumptions different hypotheses were formulated for the present thesis: (a) ASD’s core symptoms contribute to children’s emotional difficulties by increasing emotional reactivity, decreasing emotion regulation, and increasing emotional incoherence; (b) children’s alexithymia also contributes to children’s emotional difficulties by increasing them; (c) ASD’s core symptoms are related to parents’ characteristics by decreasing parents’ emotion regulation capacity, increasing parents’ stress reaction, and decreasing parents’ frequency of interaction with their children; (d) difficulties in emotional reactivity and emotion regulation in children together with alexithymia are also related to parents’ characteristics; (e) in turn, parents’ frequency of interaction with the child also contributes to children’s difficulties in emotional reactivity and emotion regulation. Applying a multimethod approach where parents-reports, parents’ self-reports, observations, and physiological indicators were used, 37 children with ASD and 66 typically developing (TD) children and their parents were assessed. It was found that: (a) children with ASD had more emotional reactivity, less emotion regulation ability, and more emotional incoherence than TD children; (b) children’s alexithymia contributed more than ASD diagnosis to the explanation of some aspects of emotional reactivity and emotional incoherence but not of emotion regulation; (c) parents of children with ASD had more emotion regulation difficulties, more stress, and interacted less frequently with their children than parents of TD children; (d) parents’ perceptions of children’s difficulties contributed more to parents’ emotion regulation capacity and as much to parents’ stress as ASD diagnosis; moreover, children’s alexithymia also contributed more to parents’ frequency of interaction with their children than ASD diagnosis; and (e) parents’ frequency of interaction with their children contributed to more positive and negative emotional expressions and to the use of better emotion regulation strategies in children. The present findings highlight the complexity of emotional difficulties in children with ASD by suggesting that difficulties in emotional reactivity and emotion regulation are reflected at the subjective, observational, and physiological levels. Furthermore, these difficulties are influenced by different factors: children’s ASD characteristics, children’s other characteristics such as alexithymia, and parents’ characteristics. Given the relevance of emotional difficulties to internalizing and externalizing problems in children with ASD it is important that interventions include a multicomponent approach to emotional difficulties in ASD. Furthermore, interventions would benefit from integrating children’s alexithymia and parents’ characteristics such as their difficulties with emotion regulation and stress to help alleviate emotional difficulties in children with ASD. Finally, parents’ trainings on learning strategies to deal with their children’s emotional reactivity might prove beneficial both for parents and for children. [less ▲]