Alexithymia in Adolescents with Autism Spectrum Disorder: Its Relationship to Internalising Difficulties, Sensory Modulation and Social Cognition.

The team gave 102 autistic and 102 non-autistic teens the 20-item Toronto Alexithymia Scale. They also checked anxiety, sensory quirks, face-emotion reading, and theory-of-mind stories.

Kids were 11-18 years old and matched on IQ. All ASD cases had prior ADOS and ADI-R diagnoses.

Fifty-five percent of ASD teens scored above the clinical cut-off for alexithymia. Only sixteen percent of typical teens did.

High alexithymia went hand-in-hand with more anxiety, worse sensory modulation, and poorer emotion recognition. It did not link to theory-of-mind scores.

Macenski et al. (2025) widen the lens. They show suicide risk is three times higher in Utah girls with ASD after 2012. Bosiljka’s numbers help explain why: if over half of ASD teens can’t name feelings, anxiety can spiral unseen.

Noterdaeme et al. (2002) and Zander et al. (2015) both say use ADI-R plus ADOS for clean diagnosis. Bosiljka used that exact pair, so their a large share alexithymia rate stands on solid ground.

Lee et al. (2021) found ToMI-2 factor scores shaky. Bosiljka found alexithymia correlates with emotion-labeling, not theory-of-mind. Together they warn: social-cognition tools may miss the simpler ‘I don’t know what I feel’ problem.

If a teen with ASD looks anxious or overloaded, screen for alexithymia first. A quick TAS-20 takes five minutes. When words for feelings are missing, teach emotion cards, body scans, and labeled check-ins before you run a full anxiety CBT protocol. You may cut problem behavior faster by filling the feeling-gap than by chasing the worry itself.