Levels of emotional awareness and autism: an fMRI study

Autism is associated with an inability to identify and distinguish one's own feelings. We assessed this inability using alexithymia and empathy questionnaires, and used fMRI to investigate brain activity while introspecting on emotion. Individuals with high functioning autism/Asperger syndrome (HFA/AS) were compared with matched controls. Participants rated stimuli from the International Affective Picture System twice, once according to the degree of un/pleasantness that the pictures induced, and once according to their color balance. The groups differed significantly on both alexithymia and empathy questionnaires. Alexithymia and lack of empathy were correlated, indicating a link between understanding one's own and others' emotions. For both groups a strong relationship between questionnaire scores and brain activity was found in the anterior insula (AI), when participants were required to assess their feelings to unpleasant pictures. Regardless of self-reported degree of emotional awareness, individuals with HFA/AS differed from controls when required to introspect on their feelings by showing reduced activation in self-reflection/mentalizing regions. Thus, we conclude that difficulties in emotional awareness are related to hypoactivity in AI in both individuals with HFA/AS and controls, and that the particular difficulties in emotional awareness in individuals with HFA/AS are not related to their impairments in self-reflection/mentalizing.     

Selective impairment of cognitive empathy for moral judgment in adults with high functioning autism

Faced with a moral dilemma, conflict arises between a cognitive controlled response aimed at maximizing welfare, i.e. the utilitarian judgment, and an emotional aversion to harm, i.e. the deontological judgment. In the present study, we investigated moral judgment in adult individuals with high functioning autism/Asperger syndrome (HFA/AS), a clinical population characterized by impairments in prosocial emotions and social cognition. In Experiment 1, we compared the response patterns of HFA/AS participants and neurotypical controls to moral dilemmas with low and high emotional saliency. We found that HFA/AS participants more frequently delivered the utilitarian judgment. Their perception of appropriateness of moral transgression was similar to that of controls, but HFA/AS participants reported decreased levels of emotional reaction to the dilemma. In Experiment 2, we explored the way in which demographic, clinical and social cognition variables including emotional and cognitive aspects of empathy and theory of mind influenced moral judgment. We found that utilitarian HFA/AS participants showed a decreased ability to infer other people’s thoughts and to understand their intentions, as measured both by performance on neuropsychological tests and through dispositional measures. We conclude that greater prevalence of utilitarianism in HFA/AS is associated with difficulties in specific aspects of social cognition.     

Le changement psychologique d’hommes auteurs de violences conjugales après leur thérapie en groupe de responsabilisation

ObjectivesThe aim of our research was to examine the association between impulsivity, alexithymia and depression and the perpetration of physical and psychological intimate partner violence. We focused on these particular psychological characteristics in order to understand this phenomenon and its prevention and/or treatment. Our initial study of fifty-six male perpetrators showed domestic violence was associated with a high level of alexithymia and depression. Analyses showed they reported more depressive feelings, and more difficulties to express their emotions than did general population. To determine if reductions were noted about these psychological characteristics at the end of intervention program, the present study examined longitudinal data.Patients and methodsTwenty-four male offenders (voluntary or judicialized) were surveyed using self-report questionnaires and structured clinical interview to collect sociodemographic data and to assess specific psychological variables, namely emotional distress (Beck Depression Inventory), impulsive behavior (Barratt Impulsivity Scale 11) and alexithymia (Toronto Alexithymia Scale 20), the inability to experience and express subjective emotions. These men were examined before the start of therapeutic program (T1) and at the end of it (T2), after 42 hours of psychological support.ResultsFindings showed both alexithymia and depression were reduced after therapeutic management. Analyses showed male intimate partner violence offenders reported less difficulty to express their emotions and less depressive feelings at the end of their intervention program. However, we only observe a significant result for alexithymia and its dimension “difficulties identifying feelings”. Impulsivity, on the other side, remains unchanged between the two evaluation times for all participants after the therapeutic program.ConclusionOur findings suggested a strong link between alexithymia and domestic violence and showed the positive effect of specific therapeutic interventions on alexithymia and depression. We pointed out the fact that with the decrease of alexithymia, participants may have a better awareness of themselves and of their behavior. In conclusion, it is encouraging to note that specific treatment programs increase awareness about the problem of intimate partner violence.     

The Empathy Quotient: An Investigation of Adults with Asperger Syndrome or High Functioning Autism, and Normal Sex Differences

Empathy is an essential part of normal social functioning, yet there are precious few instruments for measuring individual differences in this domain. In this article we review psychological theories of empathy and its measurement. Previous instruments that purport to measure this have not always focused purely on empathy. We report a new self-report questionnaire, the Empathy Quotient (EQ), for use with adults of normal intelligence. It contains 40 empathy items and 20 filler/control items. On each empathy item a person can score 2, 1, or 0, so the EQ has a maximum score of 80 and a minimum of zero. In Study 1 we employed the EQ with n = 90 adults (65 males, 25 females) with Asperger Syndrome (AS) or high-functioning autism (HFA), who are reported clinically to have difficulties in empathy. The adults with AS/HFA scored significantly lower on the EQ than n = 90 (65 males, 25 females) age-matched controls. Of the adults with AS/HFA, 81% scored equal to or fewer than 30 points out of 80, compared with only 12% of controls. In Study 2 we carried out a study of n = 197 adults from a general population, to test for previously reported sex differences (female superiority) in empathy. This confirmed that women scored significantly higher than men. The EQ reveals both a sex difference in empathy in the general population and an empathy deficit in AS/HFA.     

Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism

It is widely accepted that autism is associated with disordered emotion processing and, in particular, with deficits of emotional reciprocity such as impaired emotion recognition and reduced empathy. However, a close examination of the literature reveals wide heterogeneity within the autistic population with respect to emotional competence. Here we argue that, where observed, emotional impairments are due to alexithymia—a condition that frequently co-occurs with autism—rather than a feature of autism per se. Alexithymia is a condition characterized by a reduced ability to identify and describe one''s own emotion, but which results in reduced empathy and an impaired ability to recognize the emotions of others. We briefly review studies of emotion processing in alexithymia, and in autism, before describing a recent series of studies directly testing this ‘alexithymia hypothesis''. If found to be correct, the alexithymia hypothesis has wide-reaching implications for the study of autism, and how we might best support subgroups of autistic individuals with, and without, accompanying alexithymia. Finally, we note the presence of elevated rates of alexithymia, and inconsistent reports of emotional impairments, in eating disorders, schizophrenia, substance abuse, Parkinson''s Disease, multiple sclerosis and anxiety disorders. We speculate that examining the contribution of alexithymia to the emotional symptoms of these disorders may bear fruit in the same way that it is starting to do in autism.     

Alexithymia, Emotional Awareness and Perceived Dysfunctional Parental Behaviors in Heroin Dependents

The aim of this study was to analyse alexithymia and deficits in emotional awareness, in heroin addicts, and their relationship with perceptions of early parental interactions. The sample included 99 opiate dependent outpatients and 43 healthy controls. Assessment was performed using the Toronto Alexithymia Scale, the Levels of Emotional Awareness Scale, the Inventory for Assessing Memories of Parental Rearing Behavior, the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale. Findings suggest parental representations, which were mostly characterized by emotional unavailability and a rejection interaction pattern, significantly related to alexithymia. Emotional awareness was associated with the number of years of drug use and methadone level. Negative affect was associated with alexithymia but not to emotional awareness. Regression analyses emphasized the influence of perceived dysfunctional parenting behaviors in alexithymia and difficulties in identifying feelings, particularly an interaction with paternal rejection, moderated by self-reported anxiety. These results are discussed addressing comprehensive issues of emotion regulation and treatment strategies in heroin dependence.     

Dissociation of Cognitive and Emotional Empathy in Adults with Asperger Syndrome Using the Multifaceted Empathy Test (MET)

Empathy is a multidimensional construct consisting of cognitive (inferring mental states) and emotional (empathic concern) components. Despite a paucity of research, individuals on the autism spectrum are generally believed to lack empathy. In the current study we used a new, photo-based measure, the Multifaceted Empathy Test (MET), to assess empathy multidimensionally in a group of 17 individuals with Asperger syndrome (AS) and 18 well-matched controls. Results suggested that while individuals with AS are impaired in cognitive empathy, they do not differ from controls in emotional empathy. Level of general emotional arousability and socially desirable answer tendencies did not differ between groups. Internal consistency of the MET’s scales ranged from .71 to .92, and convergent and divergent validity were highly satisfactory.     

Validity of the BVAQ: a study in eating disorder patients and controls

Alexithymia core features are the difficulties in identifying and describing feelings; the difficulties in distinguishing feelings from the bodily sensations of emotional arousal; an impaired symbolization, as evidenced by a paucity of fantasies and other imaginative activity; and a tendency to focus on external events rather than inner experience. Several measures of alexithymia have been developed, including interviewer-rated questionnaires and self-report questionnaires. Among the self-report questionnaires, the 20-item Toronto Alexithymia scale (TAS-20) is the most commonly used, but it fails to measure all the core features of alexithymia. A recently developed instrument, the Bermond-Vorst Alexithymia Questionnaire (BVAQ), allows the measurement of the alexithymia core features, as well as an additional one. It appeared to present good psychometric properties, notably the abbreviated BVAQ-form B. The results of recent studies comparing the psychometric properties of the TAS-20 and the BVAQ have recommended the BVAQ over the TAS-20. However, this questionnaire needed further validation. OBJECTIVES: Thus, the aim of the present study was to determine the convergent, discriminant and concurrent validity of the Bermond-Vorst Alexithymia Questionnaire -- form B (BVAQ-B) in a clinical sample of 59 eating disorder patients, as well as in 191 controls. The TAS-20 constituted the gold standard for the assessment of the BVAQ-B' convergent validity. To compare the concurrent validity of the BVAQ-B and the TAS-20, participants also completed several self-reports investigating different dimensions of emotion regulation capacities: the 13-item Beck Depression Inventory (BDI), the Spielberger State and Trait Anxiety Inventory (STAI-form Y), as well as the Chapman and Chapman Physical and Social Anhedonia Scales (PAS and SAS). One way analyses of variance were used for mean scores comparisons. Convergent validity was determined using Pearson coefficients of correlation. RESULTS: Results of the analyses suggested the BVAQ-B has a satisfying convergent and discriminant validity. This was observed in both the clinical and control samples. Moreover, the comparison of the convergent validity of the BVAQ-B and the TAS-20 revealed several differences between these two alexithymia self-report questionnaires. The BVAQ-B appeared less sensitive to the subjective emotional state of the participants than the TAS-20. Whereas it was argued the TAS-20 overlaps with other emotional state scores, the BVAQ-B would allow to measure alexithymia more specifically. In addition, the present results allowed to further determine the relations between alexithymia and other dimensions of emotion regulation capacities. The analyses confirmed that alexithymia is linked to other emotion regulation dimensions such as depression and anxiety. Moreover, alexithymia was associated with physical and social anhedonia, two dimensions that received less interest in the alexithymia literature to date. This study also showed that control and clinical sample have different emotion regulation capacities. Eating disorder patients were not only more alexithymic and more depressed, but also more anxious and more anhedonic than the controls. Finally, this study revealed that alexithymia differs whether the alexithymic individuals are patients or controls. Healthy alexithymic individuals (ie, individuals categorized as alexithymic in the control group) seemed characterised by a selective deficit of emotional cognition, with sparing of emotional experience (Bermond's type II alexithymia). Alexithymics individuals of the eating -disorder group seemed particularly unabled to experience affect. This pattern could correspond to Bermond's type I alexithymia, which is characterised by the absence of emotional experience and, consequently, by the absence of the cognition accompanying the emotion. In summary, results of the present study add to the literature debating on whether alexithymia is similar in different types of population.     

Gender differences in the association between alexithymia and emotional eating in obese individuals

OBJECTIVE: Women have been reported to use more emotion-regulation strategies than do men and to have more abilities to regulate their emotions in a different way. The aim of the present study was to examine gender differences in the relationships of alexithymia, negative mood, and the combination of alexithymia and negative mood with emotional eating in obese persons. METHODS: Four hundred thirteen obese individuals [343 females and 70 males, aged 18-60 years, mean=43.6 years, body mass index (BMI)=38.4+/-6.6 kg/m2] completed self-report questionnaires, including the Symptom Checklist-90 (SCL-90) questionnaire, the Dutch Eating Behavior Questionnaire (DEBQ), and the Toronto Alexithymia Scale (TAS). RESULTS: Hierarchical regression analysis showed a significant interaction between gender and alexithymia. More difficulty in identifying or describing feelings was specifically associated with more emotional eating in men. CONCLUSION: These findings suggest that alexithymia is more strongly involved in emotional eating of obese men than women. This offers indications for designing gender-specific treatments for emotional eating among obese persons.     

Superior nonverbal intelligence in children with high-functioning autism or Asperger's syndrome

Some early studies showed discordance in cognitive strengths and weaknesses in individuals with high-functioning autism (HFA) or Asperger's syndrome (AS). The present study administered the French version of Colored Raven's Progressive Matrices in 14 children with HFA/AS and in 26 chronological age matched peers with typical development. We found a trend of superior nonverbal performance in Raven's Test in our HFA/AS participants compared to controls, and this “superiority” achieved statistical significance in the HFA/AS subgroup with a FIQ ≥ 90. Superior fluid intelligence seemed to exist in individuals both with HFA and with AS. A complementary use of both the Raven's Test and the Wechsler Intelligence Scales seems to be important for exploring the domain-specific as well as multidimensional profiles in individuals with autism.     

Differential neural activity and connectivity for processing one's own face: A preliminary report

The experience of self is unique and pivotal to clinically relevant cognitive and emotional functions. However, well-controlled data on specialized brain regions and functional networks underlying the experience of self remain limited. This functional magnetic resonance imaging study investigated neural activity and connectivity specific to processing one's own face in healthy women by examining neural responses to the pictures of the subjects' own faces in contrast to faces of their own mothers, female friends and strangers during passive viewing, emotional and self-relevance evaluations. The processing of one's own face in comparison to processing of familiar faces revealed significant activity in right anterior insula (AI) and left inferior parietal lobule (IPL), and less activity in right posterior cingulate/precuneus (PCC/PCu) across all tasks. Further, the seed-based correlation analysis of right AI, and left IPL, showed differential functional networks in self and familiar faces contrasts. There were no differences in valence and saliency ratings between self and familiar others. Our preliminary results suggest that the self-experience cued by self-face is processed predominantly by brain regions and related networks that link interoceptive feelings and sense of body ownership to self-awareness and less by regions of higher order functioning such as autobiographical memories.     

Altered brain activity during emotional empathy in somatoform disorder

Somatoform disorder patients suffer from impaired emotion recognition and other emotional deficits. Emotional empathy refers to the understanding and sharing of emotions of others in social contexts. It is likely that the emotional deficits of somatoform disorder patients are linked to disturbed empathic abilities; however, little is known so far about empathic deficits of somatoform patients and the underlying neural mechanisms. We used fMRI and an empathy paradigm to investigate 20 somatoform disorder patients and 20 healthy controls. The empathy paradigm contained facial pictures expressing anger, joy, disgust, and a neutral emotional state; a control condition contained unrecognizable stimuli. In addition, questionnaires testing for somatization, alexithymia, depression, empathy, and emotion recognition were applied. Behavioral results confirmed impaired emotion recognition in somatoform disorder and indicated a rather distinct pattern of empathic deficits of somatoform patients with specific difficulties in “empathic distress.” In addition, somatoform patients revealed brain areas with diminished activity in the contrasts “all emotions”–“control,” “anger”–“control,” and “joy”–“control,” whereas we did not find brain areas with altered activity in the contrasts “disgust”–“control” and “neutral”–“control.” Significant clusters with less activity in somatoform patients included the bilateral parahippocampal gyrus, the left amygdala, the left postcentral gyrus, the left superior temporal gyrus, the left posterior insula, and the bilateral cerebellum. These findings indicate that disturbed emotional empathy of somatoform disorder patients is linked to impaired emotion recognition and abnormal activity of brain regions responsible for emotional evaluation, emotional memory, and emotion generation. Hum Brain Mapp, 2012. © 2011 Wiley Periodicals, Inc.     

Why don’t you feel how I feel? Insight into the absence of empathy after severe Traumatic Brain Injury

Although the existence of empathy deficits in people with traumatic brain injury (TBI) is generally well accepted, it has been a topic of limited investigation. The current study examined the relationship between self-reported emotional and cognitive empathy and psychophysiological responding to emotionally evocative pictures in 20 patients with severe TBI and 22 control participants. Eighteen pictures with alternating pleasant, unpleasant and neutral content selected from the International Affective Picture System (IAPS) were presented whilst facial muscle responses, skin conductance, and valence and arousal ratings were measured. Self-reported emotional and cognitive empathy questionnaires were also administered. In comparison to control participants, those in the TBI group displayed a reduction in the ability to empathize both emotionally and cognitively, and evidence that these two aspects of empathy may be interconnected was established. Further, TBI participants showed reduced facial responding to unpleasant pictures, while also rating them as less unpleasant and arousing than controls. In addition, they exhibited lowered autonomic arousal to all pictures, regardless of affective valence. Interestingly, hypoarousal to pleasant pictures in particular was found to be related to the absence of empathy observed after TBI, and is consistent with the view that impaired emotional responsivity is associated with impairment to the empathy network. The results represent a further step towards understanding what processes shape empathy.     

Déficits émotionnels chez des patients polytoxicomanes

Researches on troubles of emotional control in addictions have mainly focused their attention on alexithymia concept, defined by Sifneos in 1972. It was first characterized by a lack of words to express emotion (a: absence of; lexi: words; thymia: emotions, affects). Alexithymia's characteristics were described in patients with addictive behaviors by Wurmser in 1974 and Krystal in 1979. Since, many studies have shown there was a higher level of alexithymia in patients with addictive behaviour (alcoholism, drug addiction), when compared with normal controls. A recent large multicenter study (Jeammet, Corcos, Flamment, 2003) highlighted this assessment: 43,5% in drug addicts [N =124], 24,6% in normal controls [N =126]. Some authors think that alexithymia would be a risk factor for substances abuse, the patient using these ones in order to compensate a deficit in the ability to regulate and adjust one's emotions (primary or feature alexithymia). For others, alexithymia would develop following anxiety created by a somatic disease or a physical or psychological important trauma (secondary or state alexithymia). For Lane and Schwartz, alexithymia is linked to a deficit of emotional awareness. In 1987, the authors present a cognitive-developmental theory of emotional awareness that creates a bridge between normal and abnormal emotional states. Their primary thesis is that emotional awareness is a type of cognitive processing which undergoes five levels of structural transformation along a cognitive-developmental sequence derived from an integration of the theories of Piaget and Werner. The five levels of structural transformation are awareness of 1) bodily sensations; 2) the body in action; 3) individual feelings; 4) blends of feelings; and 5) blends of blends of feelings. The level of emotional awareness that an individual has reached can be assessed by the Levels of Emotional Awareness Scale (LEAS) which is an instrument presenting standardized emotion-evoking situations, asking the person how he or she would feel in each situation, and assigning a score to the responses based on the structural characteristics of the levels. The main objective of this research was to study the emotional treatment in 13 patients with multiple addictive behaviors according to DSM-IV criteria (drug addiction + alcoholism + smoking) and with a substitution treatment (methadone, Subutex^®). Those subjects were aged between 23 and 42 years. Our hypothesis was that subjects would present deficits in perception and regulation of emotions (alexithymia and low level of emotional awareness). Four rating scales were used to assess the emotional semiology and the possible presence of depression and/or anxiety: the Hamilton depression scale, 17 items version; the Tyrer's brief scale for anxiety; the Jouvent's rating scale of depressive mood and the Abrams-Taylor's scale of emotional blunting. Alexithymia was evaluated with the Toronto Alexithymia Scale, 20 items version (TAS-20), and the emotional awareness with the Levels of Emotional Awareness Scale (LEAS). Our results showed levels of alexithymia generally important. The prevalence of alexithymia in patients with addictive behaviors was 69% with a mean score to this scale of 57,8 ±11,5, which is above observed mean in the general population (46,2 ±10,52). The mean score to the LEAS was 49,6 ±6,5 and less than the one observed in patients with a depressive mood and normal controls by Berthoz in 2000, and same results were observed for scores « subject » and « other ». For eight patients, the total scores were between 51 and 59, showing a low level of emotional awareness corresponding to the second one, the sensorimotor enactive, in Lane and Schwartz's model. There was no significant correlation between intensity of depressive mood and anxiety (Hamilton's scale and Tyrer's scale) and the different scores of LEAS and TAS-20. On the other hand, there was a negative significant correlation between the score « subject » of LEAS and the intensity of emotional blunting assessed by the Abrams-Taylor's scale (R = -0.589, P <05). Furthermore, there was a tendency for significant correlation between the total score of LEAS and the intensity of emotional blunting (R =-0.543, P <0.10). The total score of TAS-20 was not related to the total score of LEAS. However, there was a positive significant correlation between the mean score of TAS-20 and the score « other » of LEAS (R =0.570, P <0.05). No significant correlation was observed between the three components of alexithymia and the different scores of LEAS. This study has shown troubles in emotions's treatment in a sample of patients with addictive behaviors. Levels of alexithymia were generally important (TAS-20), showing in these patients difficulties to identify and distinguish between feelings and bodily sensations, to describe feelings and presenting an externally-oriented thinking. Furthermore, subjects have a low level of emotional awareness, corresponding to the sensorimotor enactive level. At this level, emotion may be experienced as both a bodily sensation and an action tendency. Curiously, alexithymia is not related to LEAS scores: this may reflect different levels of emotional appraisal processes and consciousness in the two different instruments. However, the emotional deficit, when it is hetero-appraised by the clinician (Abrams-Taylor Scale), is related to weakness in the LEAS scores, in particular concerning awareness of one's own emotions.     

Differential activation of the amygdala and the 'social brain' during fearful face-processing in Asperger Syndrome

Impaired social cognition is a core feature of autism. There is much evidence showing people with autism use a different cognitive style than controls for face-processing. We tested if people with autism would show differential activation of social brain areas during a face-processing task. Thirteen adults with high-functioning autism or Asperger Syndrome (HFA/AS) and 13 matched controls. We used fMRI to investigate 'social brain' activity during perception of fearful faces. We employed stimuli known to reliably activate the amygdala and other social brain areas, and ROI analyses to investigate brain areas responding to facial threat as well as those showing a linear response to varying threat intensities. We predicted: (1) the HFA/AS group would show differential activation (as opposed to merely deficits) of the social brain compared to controls and (2) that social brain areas would respond to varied intensity of fear in the control group, but not the HFA/AS group. Both predictions were confirmed. The controls showed greater activation in the left amygdala and left orbito-frontal cortex, while the HFA/AS group showed greater activation in the anterior cingulate gyrus and superior temporal cortex. The control group also showed varying responses in social brain areas to varying intensities of fearful expression, including differential activations in the left and right amygdala. This response in the social brain was absent in the HFA/AS group. HFA/AS are associated with different patterns of activation of social brain areas during fearful emotion processing, and the absence in the HFA/AS brain of a response to varying emotional intensity.     

Mentalizing about emotion and its relationship to empathy

Mentalizing involves the ability to predict someone else''s behavior based on their belief state. More advanced mentalizing skills involve integrating knowledge about beliefs with knowledge about the emotional impact of those beliefs. Recent research indicates that advanced mentalizing skills may be related to the capacity to empathize with others. However, it is not clear what aspect of mentalizing is most related to empathy. In this study, we used a novel, advanced mentalizing task to identify neural mechanisms involved in predicting a future emotional response based on a belief state. Subjects viewed social scenes in which one character had a False Belief and one character had a True Belief. In the primary condition, subjects were asked to predict what emotion the False Belief Character would feel if they had a full understanding about the situation. We found that neural regions related to both mentalizing and emotion were involved when predicting a future emotional response, including the superior temporal sulcus, medial prefrontal cortex, temporal poles, somatosensory related cortices (SRC), inferior frontal gyrus and thalamus. In addition, greater neural activity in primarily emotion-related regions, including right SRC and bilateral thalamus, when predicting emotional response was significantly correlated with more self-reported empathy. The findings suggest that predicting emotional response involves generating and using internal affective representations and that greater use of these affective representations when trying to understand the emotional experience of others is related to more empathy.     

Social Competence Intervention for Elementary Students with Aspergers Syndrome and High Functioning Autism

Despite frequent reports of academic success, individuals with high functioning autism or Aspergers Syndrome (HFA/AS) often manifest deficits in social abilities. These deficits can lead to daily difficulties, and negative long-term outcomes. Deficits in social competency are evident in this population from an early age, as children with HFA/AS present unique challenges relating to peers, interpreting complex contextual cues, and transitioning across settings. A paucity of social interventions exist that target elementary-age children with HFA/AS and their combination of core social competence deficit areas: theory of mind (ToM), emotional recognition, and executive functioning. The current study expanded on the Social Competence Intervention (for adolescents; SCI-A), as detailed in Stichter et al. (J Autism Dev Disorders 40:1067–1079, 2010), by adjusting the curriculum to meet the needs of an elementary population. Results indicate significant improvements on direct assessments measuring theory of mind and problem solving, and parent perceptions of overall social abilities and executive functioning for 20 students, aged 6-10, with HFA/AS. The elementary SCI program appears promising, however, additional replications are necessary including expansion to school settings.     

Alexithymia in long-term survivors of childhood cancer

Objective: To investigate the incidence of alexithymia (difficulties in describing or recognizing one's own emotions, a limited fantasy life, and general constriction in the affective life) in a group of childhood cancer survivors and to explore medical determinants which predict alexithymia. Methods: Five years after completing therapy, 72 participants were asked to complete the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Results: Male cancer survivors scored significantly lower on overall alexithymia compared to healthy males. They also showed higher ability to fantasize, a higher emotional arousal, and were better able to verbalize their emotional reactions. The female survivors did not show differences compared to the normal female population. No medical determinant was associated with alexithymia. Conclusions: Stress due to childhood cancer does not affect the alexithymia scores of females. However, male cancer survivors score less alexithymic than age matched controls.     

Brief Report: Cognitive Flexibility and Focused Attention in Children and Adolescents with Asperger Syndrome or High-Functioning Autism as Measured on the Computerized Version of the Wisconsin Card Sorting Test

The aim of the present study was to assess mental flexibility and set maintenance of a group of individuals with Asperger syndrome (AS) or high-functioning autism (HFA) (N = 13; mean age 16,4), as compared with a matched group of typically developing children and adolescents (N = 13; mean age 15,6) on the computerized version of the Wisconsin Card Sorting Test (WCST). The participants in the AS/HFA group performed less well than the controls on all categories of the WCST, but the differences did not reach conventional statistical significance on most categories of the WCST. On the category failure to maintain set, however, the AS/HFA participants performed significantly less well than the controls, suggesting a deficit of focused attention.