Reduced eye fixation has been commonly reported in autistic samples but may be at least partially explained by alexithymia (i.e., difficulty understanding and describing one’s emotional state). Because anxiety is often elevated in autism, and emotion-processing differences have also been observed in anxious samples, anxiety traits may also influence emotion processing within autism. This study tested the contribution of dimensional traits of autism, anxious apprehension, and alexithymia in mediating eye fixation during face processing. Participants included 105 adults from three samples: autistic adults (AS; n = 30), adults with clinically elevated anxiety and no autism (HI-ANX; n = 29), and neurotypical adults without elevated anxiety (NT; n = 46). Experiment 1 used an emotion identification task with dynamic stimuli, while Experiment 2 used a static luminance change detection task with emotional- and neutral-expression static photos. The emotions of interest were joy, anger, and fear. Dimensional mixed-effects models showed that autism traits, but not alexithymia, predicted reduced eye fixation across both tasks. Anxious apprehension was negatively related to response time in Experiment 1 and positively related to eye fixation in Experiment 2. Attentional avoidance of negative stimuli occurred at lower levels of autism traits and higher levels of worry traits. The results highlight the contribution of autism traits to emotional processing and suggest additional effects of worry-related traits.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2.
ArmstrongT.OlatunjiB. O. (2012). Eye tracking of attention in the affective disorders: A meta-analytic review and synthesis. Clinical Psychology Review, 32, 704–723.
3.
AshwinC.WheelwrightS.Baron-CohenS. (2006). Attention bias to faces in Asperger Syndrome: A pictorial emotion Stroop study. Psychological Medicine, 36, 835–843.
4.
BagbyR. M.ParkerJ. D. A.TaylorG. J. (1994). The twenty-item Toronto Alexithymia Scale: I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32.
5.
Baron-CohenS.WheelwrightS.SkinnerR.MartinJ.ClubleyE. (2001). The Autism-Spectrum Quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31, 5–17.
6.
BerthozS.HillE. L. (2005). The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder. European Psychiatry, 20, 291–298.
7.
BirdG.CookR. (2013). Mixed emotions: The contribution of alexithymia to the emotional symptoms of autism. Translational Psychiatry, 3, e285.
8.
BirdG.PressC.RichardsonD. C. (2011). The role of alexithymia in reduced eye-fixation in autism spectrum conditions. Journal of Autism and Developmental Disorders, 41, 1556–1564.
9.
BirdG.SilaniG.BrindleyR.WhiteS.FrithU.SingerT. (2010). Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain, 133, 1515–1525.
10.
CookR.BrewerR.ShahP.BirdG. (2013). Alexithymia, not autism, predicts poor recognition of emotional facial expressions. Psychological Science, 24, 723–732.
11.
CroenL. A.ZerboO.QianY.MassoloM. L.RichS.SidneyS.KripkeC. (2015). The health status of adults on the autism spectrum. Autism, 19, 814–823.
12.
DaltonK. M.NacewiczB. M.JohnstoneT.SchaeferH. S.GernsbacherM. A.GoldsmithH. H.. . . DavidsonR. J. (2005). Gaze fixation and the neural circuitry of face processing in autism. Nature Neuroscience, 8, 519–526.
13.
DemenescuL. R.KortekaasR.den BoerJ. A.AlemanA. (2010). Impaired attribution of emotion to facial expressions in anxiety and major depression. PloS one, 5(12), e15058.
14.
DickterC. L.BurkJ. A.FleckensteinK.KozikowskiC. T. (2018). Autistic traits and social anxiety predict differential performance on social cognitive tasks in typically developing young adults. PLoS ONE, 13(3), e0195239.
15.
FujiwaraE. (2018). Looking at the eyes interferes with facial emotion recognition in alexithymia. Journal of Abnormal Psychology, 127, 571–577.
16.
GoelevenE.De RaedtR.LeymanL.VerschuereB. (2008). The Karolinska Directed Emotional Faces: A validation study. Cognition and Emotion, 22, 1094–1118.
17.
GrynbergD.ChangB.CorneilleO.MaurageP.VermeulenN.BerthozS.LuminetO. (2012). Alexithymia and the processing of emotional facial expressions (EFEs): Systematic review, unanswered questions and further perspectives. PloS one, 7(8), e42429.
18.
HarmsM. B.MartinA.WallaceG. L. (2010). Facial emotion recognition in autism spectrum disorders: A review of behavioral and neuroimaging studies. Neuropsychology Review, 20, 290–322.
19.
HillE.BerthozS.FrithU. (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.
20.
HollocksM. J.OzsivadjianA.MatthewsC. E.HowlinP.SimonoffE. (2013). The relationship between attentional bias and anxiety in children and adolescents with autism spectrum disorders. Autism Research, 6, 237–247.
21.
HorleyK.WilliamsL. M.GonsalvezC.GordonE. (2003). Social phobics do not see eye to eye: A visual scanpath study of emotional expression processing. Journal of Anxiety Disorders, 17, 33–44.
22.
IsomuraT.OgawaS.ShibasakiM.MasatakaN. (2015). Delayed disengagement of attention from snakes in children with autism. Frontiers in Psychology, 6, 241.
23.
JoshiG.WozniakJ.PettyC.MartelonM. K.FriedR.BolfekA.. . . BiedermanJ. (2013). Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: A comparative study. Journal of Autism and Developmental Disorders, 43, 1314–1325.
24.
KernsC. M.KendallP. C.BerryL.SoudersM. C.FranklinM. E.SchultzR. T.. . . HerringtonJ. (2014). Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44, 2851–2861.
25.
KliemannD.DziobekI.HatriA.SteimkeR.HeekerenH. R. (2010). Atypical reflexive gaze patterns on emotional faces in autism spectrum disorders. Journal of Neuroscience, 30, 12281–12287.
26.
KlinA.JonesW.SchultzR.VolkmarF.CohenD. (2002). Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism. Archives of General Psychiatry, 59, 809–816.
27.
LockeB. D.BuzolitzJ. S.LeiP. W.BoswellJ. F.McAleaveyA. A.SevigT. D.… HayesJ. A. (2011). Development of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62). Journal of Counseling Psychology, 58(1), 97–109.
28.
LordC.RutterM.DiLavoreP.RisiS.GothamK.BishopS. (2012). Autism diagnostic observation schedule-2nd edition (ADOS-2). Los Angeles, CA: Western Psychological Corporation.
29.
LozierL. M.VanmeterJ. W.MarshA. A. (2014). Impairments in facial affect recognition associated with autism spectrum disorders: A meta-analysis. Development and Psychopathology, 26, 933–945.
30.
LugnegårdT.HallerbäckM. U.GillbergC. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities, 32, 1910–1917.
31.
MaiselM. E.StephensonK. G.SouthM.RodgersJ.FreestonM. H.GaiggS. B. (2016). Modeling the cognitive mechanisms linking autism symptoms and anxiety in adults. Journal of Abnormal Psychology, 125, 692–703.
32.
MayT.CornishK.RinehartN. J. (2015). Mechanisms of anxiety related attentional biases in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 3339–3350.
33.
MayesS. D.CalhounS. L.AggarwalR.BakerC.MathapatiS.MolitorisS.MayesR. D. (2013). Unusual fears in children with autism. Research in Autism Spectrum Disorders, 7, 151–158.
34.
MeyerT. J.MillerM. L.MetzgerR. L.BorkovecT. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.
35.
MilosavljevicB.ShephardE.HappéF. G.JohnsonM. H.CharmanT., & BASIS Team. (2017). Anxiety and attentional bias to threat in children at increased familial risk for autism spectrum disorder. Journal of Autism and Developmental Disorders, 47, 3714–3727.
36.
MoukheiberA.RautureauG.Perez-DiazF.SoussignanR.DubalS.JouventR.PelissoloA. (2010). Gaze avoidance in social phobia: Objective measure and correlates. Behaviour Research and Therapy, 48, 147–151.
37.
NuskeH. J.VivantiG.DissanayakeC. (2013). Are emotion impairments unique to, universal, or specific in autism spectrum disorder? A comprehensive review. Cognition & Emotion, 27(6), 1042–1061.
38.
PapagiannopoulouE. A.ChittyK. M.HermensD. F.HickieI. B.LagopoulosJ. (2014). A systematic review and meta-analysis of eye-tracking studies in children with autism spectrum disorders. Social Neuroscience, 9, 610–632.
39.
PelphreyK. A.SassonN. J.ReznickJ. S.PaulG.GoldmanB. D.PivenJ. (2002). Visual scanning of faces in autism. Journal of Autism and Developmental Disorders, 32, 249–261.
40.
PflugshauptT.MosimannU. P.von WartburgR.SchmittW.NyffelerT.MüriR. M. (2005). Hypervigilance-avoidance pattern in spider phobia. Journal of Anxiety Disorders, 19, 105–116.
41.
ReiersenA. M.ToddR. D. (2008). Co-occurrence of ADHD and autism spectrum disorders: Phenomenology and treatment. Expert Review of Neurotherapeutics, 8, 657–669.
42.
SalminenJ. K.SaarijärviS.ÄäreläE.ToikkaT.KauhanenJ. (1999). Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. Journal of Psychosomatic Research, 46(1), 75–82.
43.
SifneosP. E. (1972). Short-term psychotherapy and emotional crisis. Cambridge, MA: Harvard University Press.
44.
SifneosP. E. (1973). The prevalence of “alexithymic” characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255–262.
45.
SilaniG.BirdG.BrindleyR.SingerT.FrithC.FrithU. (2008). Levels of emotional awareness and autism: An fMRI study. Social Neuroscience, 3, 97–112.
46.
SouthM.CarrA. W.StephensonK. G.MaiselM. E.CoxJ. C. (2017). Symptom overlap on the srs-2 adult self-report between adults with asd and adults with high anxiety. Autism Research, 10, 1215–1220.
47.
StevensonJ. L.HartK. R. (2017). Psychometric properties of the autism-spectrum quotient for assessing low and high levels of autistic traits in college students. Journal of Autism and Developmental Disorders, 47, 1838–1853.
48.
SucksmithE.AllisonC.Baron-CohenS.ChakrabartiB.HoekstraR. A. (2013). Empathy and emotion recognition in people with autism, first-degree relatives, and controls. Neuropsychologia, 51, 98–105.
49.
TaurinesR.SchwenckC.WesterwaldE.SachseM.SiniatchkinM.FreitagC. (2012). ADHD and autism: Differential diagnosis or overlapping traits? A selective review. ADHD Attention Deficit and Hyperactivity Disorders, 4, 115–139.
50.
TaylorG. J.BagbyR. M.ParkerJ. D. A. (1997). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. New York, NY: Cambridge University Press.
51.
TopD. N.Jr.StephensonK. G.DoxeyC. R.CrowleyM. J.KirwanC. B.SouthM. (2016). Atypical amygdala response to fear conditioning in autism spectrum disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 1, 308–315.
52.
UljarevicM.HamiltonA. (2013). Recognition of emotions in autism: A formal meta-analysis. Journal of Autism and Developmental Disorders, 43, 1517–1526.
53.
van der SchalkJ.HawkS. T.FischerA. H.DoosjeB. (2011). Moving faces, looking places: Validation of the Amsterdam Dynamic Facial Expression Set (ADFES). Emotion, 11, 907–920.
54.
WechslerD. (2011). Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II). San Antonio, TX: NCS.
55.
WieserM. J.PauliP.WeyersP.AlpersG. W.MühlbergerA. (2009). Fear of negative evaluation and the hypervigilance-avoidance hypothesis: An eye-tracking study. Journal of Neural Transmission, 116, 717–723.
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