Improving the measurement of alexithymia in autistic adults: a psychometric investigation and refinement of the twenty-item Toronto Alexithymia Scale.
Zachary J Williams, Katherine O Gotham
PMID 33653400WHAT IT FOUND
The 20-item Toronto Alexithymia Scale has poor structure in autistic adults.
An 8-item short form was created that is more reliable, easier to read, and fairer for comparing autistic and non-autistic people. Use the 8-item version instead of the full scale.
Key findings
01The 20-item Toronto Alexithymia Scale (TAS-20) showed poor model fit and unreliable subscales in autistic adults, driven largely by the externally oriented thinking items.
02An 8-item short form (TAS-8) was developed that demonstrated strong reliability, better fit, and no practically significant bias when comparing autistic and non-autistic respondents.
03The TAS-8 scores correlated with autism traits, depression, anxiety, and lower quality of life even after accounting for neuroticism.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study is cross-sectional, so it did not test whether the new 8-item scale is sensitive to change over time or after therapy. The autistic sample was recruited online and was not representative of the broader autistic population, having more females and higher education levels than typical clinical samples. The general population control group completed a different version of the scale (16 items), requiring the researchers to estimate missing scores, though they confirmed this did not affect the final 8-item results. The 8-item scale does not measure 'externally oriented thinking' or 'difficulty fantasizing', focusing only on identifying and describing feelings.
Declared interests
The authors declared no conflicts of interest. The study was funded by the National Institute of Mental Health, National Institute of General Medical Sciences, Nancy Lurie Marks Family Foundation, and National Institute on Deafness and Other Communication Disorders.
The easy way to misread this
Do not assume the TAS-8 measures the full theoretical construct of alexithymia. It excludes the 'externally oriented thinking' and 'difficulty fantasizing' facets, focusing only on the difficulty identifying and describing feelings.