This article details our recent research on the impact and underpinnings of commonly co-occurring mental health features in autism (e.g., anxiety, depression), carried out as part of the Longitudinal European Autism Project (LEAP). The LEAP study started in 2013 and includes over 700 autistic and non-autistic males and females aged 6-30-years, with and without mild intellectual disability, across seven European countries.
We wanted to better understand possible predictors of mental health in autism – including difficulties identifying and describing emotions (also called ‘alexithymia’). We focused on this research area because at least 30-50% of autistic people report experiencing anxiety and/ or depression symptoms; and developing more effective interventions for managing mental health has been declared a research priority by the autism community. We also know from our previous work that mental health has a notable impact on the quality of life of autistic people, from childhood to adulthood (you can find out more about this work here).
In our study, 179 autistic and 158 non-autistic adolescents and adults (110 female) completed self-report questionnaires on difficulties identifying and describing emotions, social-communication difficulties and anxiety and depression symptoms. 76 autistic and 59 non-autistic participants were followed up on the same measures again around 12-24-months later.
What did we find?
- Our first finding was that autistic participants self-reported significantly higher difficulties identifying and describing emotions (or, ‘alexithymia’) than comparison participants without an autism diagnosis. Autistic females were over-represented in the group scoring highest for alexithymia, with 47.3% of autistic females vs. 21.0% of autistic males reporting ‘high’ levels of alexithymia. Participants tended to have similar alexithymia scores over the 12-24-month study period, suggesting that this trait is reasonably stable over time.
- We also found that difficulties describing feelings were particularly related to current and later self-reported social-communication difficulties.
- Last, difficulties identifying feelings were related to current anxiety symptom severity and predicted anxiety symptoms 12-24-months later.
Overall, our findings suggest that difficulties in identifying feelings are significantly related to anxiety severity for at least some autistic people – and possibly for autistic girls and women in particular. Therefore, autism adapted mental health interventions that include emotion awareness and mindfulness strategies require further investigation, with the ultimate goal of improving long-term mental health and quality of life outcomes for autistic people.
The next steps for this research are to try to better understand why difficulty identifying emotion is linked to anxiety – e.g., possibly through emotion regulation processes. We also want to understand the extent to which our findings extend to younger age groups and those who may find self-report questionnaires more difficult to complete – for example, those with intellectual disability.
If you would like to, you can read more about the research summarised in this article here.
