A Network Analysis of Alexithymia, Interoception, Empathy, Self-Awareness and Psychopathological Symptoms in Young People With Autism Spectrum Disorder.

Everyone was measured once, at one point in time, so the study cannot say whether difficulty with feelings leads to anxiety and depression or the other way round. The authors acknowledge this. Every measure was a self-report questionnaire. Nothing was measured from the body or from behaviour, and the authors say behavioural measures of interoception and emotion processing should be used in future work. 208 people is small for a 10-point network. The authors note that large links in a network built from a modest sample do not clearly mean two things are related, and two of the four connection measures (closeness and betweenness) were unstable and should not be trusted. The supplementary network that split interoception into its subscales was even less stable, and the authors explicitly say those results need cautious interpretation. Everyone was in active psychiatric follow-up, aged 15 to 25, ethnic Chinese, and able to communicate in written and oral Chinese. People with IQ below 70, psychosis, recent substance use or severe uncorrected hearing or vision problems were excluded, so the findings do not describe autistic people with intellectual disability or other excluded groups. Depression and anxiety scores were mild on average and only 18% had a diagnosed anxiety disorder or depression, so the sample may not represent autistic young people with severe mood problems. There was no comparison group of autistic people without psychiatric care or of non-autistic people, so it is not known whether this pattern is specific to clinical autism. Social functioning was not included as a point in the network, so the study cannot say whether any of these traits affect day-to-day social function.

The work was supported by an HKU Seed Fund for PI Research (Basic Research) awarded to one of the authors, Simon S.Y. Lui. The funder had no role in designing the study, collecting, analysing or interpreting the data, writing the manuscript, or deciding to submit it. The authors declare no conflicts of interest. Participants were given a HK$50 coupon (about US$6.5) for taking part.

Do not read the authors' conclusion that targeting alexithymia and interoception may improve depressive and anxiety symptoms as evidence that it does. No treatment was given in this study and everyone was measured once, so it cannot show that changing how well someone names their feelings would change their mood, or which of the two comes first. The recommendation is the authors' interpretation of a cross-sectional network, not a tested intervention.