Characterizing the Nature of Alexithymia in Autistic Adults: Validation of the Perth Alexithymia Questionnaire
Bibliographic record
Abstract
Background: Alexithymia—a trait characterized by difficulties in emotion processing—is of high interest in the autism field. However, the lack of validated alexithymia measures for autistic individuals limits progress. This study aimed to address this gap by examining the psychometric properties of the Perth Alexithymia Questionnaire (PAQ) across autistic and non-autistic samples. Using the PAQ, we investigated how alexithymia manifests in autistic individuals and its links with poor mental health outcomes (anxiety). Methods: Autistic individuals (who reported having a diagnosis from a health professional; n = 244) and non-autistic individuals ( n = 383; age range: 16–62 years) completed the PAQ and a trait anxiety questionnaire online. We conducted confirmatory factor analysis, item response theory (IRT), and moderated nonlinear factor analyses to investigate the psychometric properties of the PAQ and alexithymia differences between autistic and non-autistic individuals. Regression analyses investigated the relationships between alexithymia and anxiety and whether these relationships differ for autistic or non-autistic populations. Results: As operationalized by the PAQ, alexithymia manifested similarly in autistic and non-autistic individuals, comprising a general alexithymia factor and five subfactors: positively and negatively valenced difficulties identifying feelings, positively and negatively valenced difficulties describing feelings, and externally oriented thinking. All factors exhibited good to excellent classical test theory and IRT-derived reliability. The PAQ did not meaningfully bias scores for autistic individuals, who reported greater alexithymia across all its components. Alexithymia predicted greater anxiety, with nuances regarding externally oriented thinking particularly for autistic individuals. Conclusions: For the first time, our study illustrates that all facets of alexithymia can be validly and comprehensively assessed in autistic populations. As measured via the PAQ, alexithymia manifests similarly across autistic and non-autistic individuals, and on average, autistic individuals have greater challenges across all aspects of alexithymia. The PAQ, therefore, represents a critical assessment advancement for the field, providing a foundation for future work on alexithymia and autism.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".