Alexithymia and Atypical Facial Expressions in Individuals with Autism Spectrum Disorders by Dominic Trevisan M.A., Simon Fraser University, 2014 B.A., Humboldt State University, 2011 Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in the Educational Psychology Program Faculty of Education © Dominic Trevisan 2018 SIMON FRASER UNIVERSITY Summer 2018 Copyright in this work rests with the author. Please ensure that any reproduction or re-use is done in accordance with the relevant national copyright legislation. Approval Name: Dominic Trevisan Degree: Doctor of Philosophy Title: Alexithymia and Atypical Facial Expressions in Individuals with Autism Spectrum Disorders Examining Committee: Chair: Margaret MacDonald Associate Professor Elina Birmingham Senior Supervisor Associate Professor Maureen Hoskyn Supervisor Associate Professor Grace Iarocci Supervisor Professor Tanya Broesch Internal Examiner Assistant Professor Department of Psychology James Parker External Examiner Professor Department of Psychology Trent University Date Defended/Approved: June 8, 2018 ii Ethics Statement iii Abstract This dissertation research sought to determine in what ways, and in what contexts, emotional facial expressions are atypical in the Autism Spectrum Disorder (ASD) population, and to investigate the specific role that alexithymia—a condition characterized by difficulties identifying and describing one’s feelings—may relate to facial expression production abilities in individuals with and without ASD. Results of a meta-analysis showed that on average, individuals with ASD display facial expressions less frequently and are less likely to share facial expressions with others in naturalistic settings or automatically mimic the expressions of real faces or face stimuli in comparison to non-ASD comparison groups. Their facial expressions are rated as more awkward or unusual in appearance, sometimes making it difficult for observers to identify what emotion is being expressed. However, across studies, participants with ASD do not express emotions less intensely, nor do they respond more slowly to emotion-eliciting stimuli. Age, intellectual functioning of ASD participants, and methodological features of the study, significantly moderated the strength of effect sizes. A second study examined spontaneous facial production in response to emotionally arousing videos in children with and without ASD. Results showed that alexithymia, but not ASD traits, was negatively correlated with spontaneous production of negative facial expressions. A similar pattern of results was found in a third study, such that alexithymia and depression were associated with less spontaneous emotional expression during tasks that required typically developing undergraduates to watch emotional video clips or tell emotional stories about their personal lives. In a separate task in which participants were instructed to pose emotional facial expressions, it was hypothesized that reduced voluntary expression accuracy would be more strongly related to ASD traits than alexithymia or depression, although support for this prediction was mixed. Results provide partial support for the suggestion that reduced spontaneous expression and reduced voluntary expression accuracy have distinct correlates. I argue that the alexithymia construct deserves significantly more research and clinical attention within the ASD population. Keywords: Alexithymia; Autism; Facial Expressions; EmotionDedication iv Acknowledgements To Elina, who has given me the freedom and encouragement to pursue my interests and who has invested an immeasurable amount of time and resources into my career development. Her guidance has propelled me towards a career trajectory I couldn’t be more excited about. I am grateful to have had her as my supervisor for these past six years. To Grace, who has been an invaluable role model to me and with whom I share a common goal of prioritizing research that aims to improve the lives of individuals with ASD and their families. The research conducted in Chapter 3 would not have been possible without the Social Science Camp that Grace runs each summer for children with and without ASD. To Maureen, with whom I’ve shared so many fascinating conversations over the years on all topics ranging from development, cognition, and the scientific method. Maureen has always pushed to be a better thinker and a better researcher. To Robyn, who taught me (among other things) that there are actual grammatical rules for when to use a comma. v Table of Contents Approval ............................................................................................................................. ii Ethics Statement................................................................................................................. iii Abstract .............................................................................................................................. iv Acknowledgements ............................................................................................................. v Table of Contents ............................................................................................................... vi List of Tables ...................................................................................................................... x List of Figures .................................................................................................................... xi Glossary ............................................................................................................................ xii Chapter 1. General Introduction .................................................................................. 1 1.1. Autism Spectrum Disorder ....................................................................................... 1 1.2. Overview and Rationale of the Present Dissertation Research ................................. 2 1.3. Alexithymia .............................................................................................................. 4 1.4. The ‘Alexithymia Hypothesis’ .................................................................................. 5 1.5. Extant Literature on Alexithymia and Nonverbal Emotional Expression ................ 9 1.6. Facial Expressions: How They Develop and the Functions They Serve ................ 13 Development of Facial Expressions ............................................................... 13 Spontaneous Facial Expressions ..................................................................... 14 Automatic Mimicry ........................................................................................ 16 Voluntary Expressions .................................................................................... 18 1.7. Atypical facial expressions in ASD ........................................................................ 20 Empirical Evidence......................................................................................... 20 Theories Addressing Atypical Facial Expressions in ASD ............................ 23 Mirror Neuron System (MNS) Impairment ............................................................... 23 Mentalizing Frameworks ........................................................................................... 24 Social Motivation ...................................................................................................... 25 A Pervasive Gap in ASD and Facial Expression Theories........................................ 26 1.8. The Present Studies ................................................................................................. 26 Chapter 2. A Meta-Analysis of Facial Expressions in Individuals with ASD ........ 29 2.1. Introduction ............................................................................................................. 29 Summary of Relevant Empirical Research ..................................................... 30 Conceptualization and Operationalization of Facial Expressions .................. 31 The Present Study ........................................................................................... 33 2.2. Method .................................................................................................................... 33 Procedure ........................................................................................................ 33 Inclusionary Criteria ....................................................................................... 34 Exclusionary Criteria ...................................................................................... 35 Study Coding Procedures ............................................................................... 35 vi Hypothesized Moderating Variables .............................................................. 37 Covert elicitation/explicit elicitation ......................................................................... 37 Age and Intellectual Functioning .............................................................................. 38 Matching procedures ................................................................................................. 38 Data Analysis Plan.......................................................................................... 39 Effect size Calculation ............................................................................................... 39 Statistical analysis of effect sizes .............................................................................