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No Evidence for an Opposite Pattern of Cognitive Performance in Autistic Individuals with and without Alexithymia: a response to Rødgaard et al.

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Abstract

Rødgaard and colleagues confirmed our finding of a negative relationship between performance on the Reading the Mind in the Eyes Test and alexithymia, regardless of autism diagnosis. In their analysis of our cognitive Theory of Mind data, however, they did not control for autistic traits, which covary with alexithymia. Here we demonstrate that when autistic traits are controlled for, there is no significant association between alexithymia and cognitive theory of mind performance in participants with autism.
RESPONSE: COGNITION IN AUTISTIC INDIVIDUALS WITH AND WITHOUT
ALEXITHYMIA
No Evidence for an Opposite Pattern of Cognitive Performance in Autistic Individuals with
and without Alexithymia: a response to Rødgaard et al.
Bethany F. M. Oakley
King’s College London
Rebecca Brewer
Royal Holloway, University of London
Geoffrey Bird
University of Oxford
Caroline Catmur
King’s College London
Author Note
Bethany F. M. Oakley, Department of Forensic and Neurodevelopmental Science,
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK.
Rebecca Brewer, Department of Psychology, Royal Holloway, University of London,
UK.
Geoffrey Bird, Department of Experimental Psychology, University of Oxford, UK
and MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, UK
Caroline Catmur, Department of Psychology, Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, UK
RESPONSE: COGNITION IN AUTISTIC INDIVIDUALS WITH AND WITHOUT
ALEXITHYMIA
Correspondence concerning this article should be addressed to Caroline Catmur,
Department of Psychology, King’s College London, London SE1 1UL, UK,
caroline.catmur@kcl.ac.uk
RESPONSE: COGNITION IN AUTISTIC INDIVIDUALS WITH AND WITHOUT
ALEXITHYMIA
Abstract
Rødgaard and colleagues confirmed our finding of a negative relationship between
performance on the Reading the Mind in the Eyes Test and alexithymia, regardless of autism
diagnosis. In their analysis of our cognitive Theory of Mind data, however, they did not
control for autistic traits, which covary with alexithymia. Here we demonstrate that when
autistic traits are controlled for, there is no significant association between alexithymia and
cognitive theory of mind performance in participants with autism.
Keywords: autism spectrum disorder, alexithymia, emotion recognition, social
cognition, theory of mind
RESPONSE: COGNITION IN AUTISTIC INDIVIDUALS WITH AND WITHOUT
ALEXITHYMIA
General Scientific Summary
We analyse the performance of individuals with autism on a cognitive theory of mind
task. A previous commentary article suggested that these individuals’ performance varies
according to their level of alexithymia. Here we show that it is important to control for levels
of autism traits in such analyses, and that when this is done, there is no association between
alexithymia and cognitive theory of mind performance in participants with autism.
RESPONSE: COGNITION IN AUTISTIC INDIVIDUALS WITH AND WITHOUT
ALEXITHYMIA
No Evidence for an Opposite Pattern of Cognitive Performance in Autistic Individuals with
and without Alexithymia: a response to Rødgaard et al.
The primary aim of our original paper (Oakley, Brewer, Bird & Catmur, 2016) was to
determine whether the Reading the Mind in the Eyes Test (RMET; Baron-Cohen,
Wheelwright, Hill, Raste & Plumb, 2001) is a valid measure of theory of mind (ToM), or
whether performance on the task instead relies on emotion recognition ability. We predicted
that, if the RMET indexes ToM, then autistic traits should predict task performance.
However, if the RMET indexes emotion recognition, then alexithymia, and not autistic traits,
should predict performance. We are pleased to note that Rødgaard, Jensen and Mottron
(2019) confirmed a significant negative relationship between RMET performance and
alexithymia, regardless of autism diagnosis, validating our original findings.
In addition to the RMET, our original paper reported analyses for another ToM task -
the Movie for the Assessment of Social Cognition (MASC; Dziobek et al., 2006). We
included this control task since, unlike the RMET, it does not rely exclusively on facial
emotion recognition. In their commentary, Rødgaard et al. (2019) argue that their finding of
an association between performance on cognitive items from the MASC and alexithymia is
contrary to our original results and modifies the interpretation of our data. However, no
reference has been made to the results from our hierarchical regression models, reported in
Supplementary Table 2 of Oakley et al. (2016). Here, we showed that dimensional (i.e. not
reliant on an autism diagnosis) autistic traits were significantly and negatively related to
MASC-Cognitive performance, after controlling for alexithymia and gender. In this model,
alexithymia was not significantly related to MASC-Cognitive performance, however gender
was. Rødgaard et al. do not seem to have accounted for dimensional autistic traits nor gender
in their analyses. Controlling for such factors is essential if one wishes to conclude that
alexithymia, specifically, is associated with Cognitive ToM. Although the autism and control
RESPONSE: COGNITION IN AUTISTIC INDIVIDUALS WITH AND WITHOUT
ALEXITHYMIA
groups were matched according to alexithymia traits, the association between autistic and
alexithymia traits (Hill, Berthoz & Frith, 2004) makes it essential to control for one when
investigating the effect of the other. The analyses in the commentary are therefore
insufficiently comparable to argue that they are contrary to our original results. Indeed,
within the autism group, the data do not indicate a significant association between
alexithymia and MASC-Cognitive performance, after controlling for gender and autistic traits
(β=.45, p=.10), contrary to the authors’ suggestion.
In addition, the commentary states that ‘autistic individuals with and without
alexithymia seem to present with distinct profiles of difficulties in ToM abilities.’ While an
interesting line of enquiry, we believe that this is an overstatement of the interpretations that
can be drawn from the reported analyses. This is because the analyses reported in the
commentary do not assess autism subgroups with and without alexithymia. Rather, they
report the continuous correlation between MASC-Cognitive performance and alexithymia
within autism and control groups, respectively. When the analysis above (i.e. controlling for
gender and autistic traits) is repeated using alexithymia severity subgroup as a predictor,
alexithymia subgroup membership does not predict MASC-Cognitive performance (β=.47,
p=.09).
RESPONSE: COGNITION IN AUTISTIC INDIVIDUALS WITH AND WITHOUT
ALEXITHYMIA
References
Baron-Cohen S., Wheelwright S., Hill J., Raste Y., & Plumb I. (2001). The “Reading the
Mind in the Eyes” Test revised version: A study with normal adults, and adults with
Asperger syndrome or high-functioning autism. Journal of Child Psychology and
Psychiatry, 42, 241–251. 10.1111/1469-7610.00715
Dziobek I., Fleck S., Kalbe E., Rogers K., Hassenstab J., Brand M., et al. Convit A.
(2006). Introducing MASC: A Movie for the Assessment of Social Cognition. Journal
of Autism and Developmental Disorders, 36, 623–636. 10.1007/s10803-006-0107-0
Hill, E., Berthoz, S., & Frith, U. (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.
Oakley, B., Brewer, R., Bird, G., & Catmur, C. (2016). Theory of Mind Is Not Theory of
Emotion: A Cautionary Note on the Reading the Mind in the Eyes Test. Journal of
Abnormal Psychology, 125(6), 818-823. 10.1037/abn0000182
Rødgaard, E.-M., Jensen, K., & Mottron, L. (2019). An Opposite Pattern of Cognitive
Performance in Autistic Individuals with and without Alexithymia. Journal of
Abnormal Psychology.
Preprint
Full-text available
In our commentary article ”An opposite pattern of cognitive performance in autistic individuals with and without alexithymia” (Rødgaard et al. 2019), we examined data from a paper by Oakley et al. (2016), and reported what we believe to be an interesting correlation between alexithymia traits and cognitive theory of mind in individuals with autism. In the response to our commentary, Oakley and colleages (2019) dismiss our findings through several arguments that we find to be flawed. In the following we will respond to these arguments and explain why we find their interpretation of their statistical analyses to be problematic and why we thus disagree with their categorical rejection of our conclusions.
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