Exploring adolescence: investigating the association between attachment style and alexithymia traits, and examining the factors that contribute to aggressive behaviour in autism

Abstract

BACKGROUND: Adolescence is a developmental period during which there is rapid physical, cognitive and psychosocial growth. Social cognitive processes, such as taking others’ perspectives, regulating emotions, and interacting appropriately with others, are particularly important for navigating the social environment during this time and can promote resilience to mental health problems. However, aggressive behaviours, such as hitting, biting or kicking another person or object, are found in a large proportion of adolescents, especially within autistic adolescents, and result in long-term negative implications for these individuals. Despite this, the causes of such behaviours are poorly understood. This thesis aimed to investigate the factors that contribute to the development of appropriate social and emotional cognitive and behavioural abilities in adolescence. Specifically, this thesis aimed to conduct a systematic review and meta-analysis investigating the association between two factors linked to the ability to regulate emotions: attachment style and alexithymia traits. It also aimed to explore the underlying mechanisms of aggressive behaviour in both autistic and non-autistic adolescents within a proposed conceptualised framework.

METHODS: Firstly, a systematic search of the literature was completed, and two meta-analyses were carried out to determine the size of the effect found between secure and insecure attachment styles and alexithymia traits within adolescents. Secondly, a cross-sectional study was conducted using standardised caregiver-report questionnaires to identify the associations between several factors linked to aggressive behaviour in autistic and non-autistic adolescents: autistic traits, emotion dysregulation, alexithymia traits, avoidance from caregiver, sensory processing difficulties and aggressive behaviour. Exploration of this data involved serial mediation and moderated serial mediation analyses to evidence a conceptualised framework of these factors.

RESULTS: The systematic review and meta-analysis included 16 studies. Both meta-analyses revealed moderate effects: a secure attachment style was negatively associated with higher alexithymia traits, while an insecure attachment style was positively associated with higher alexithymia traits. The results from the second study indicated that within both autistic and non-autistic adolescents higher autistic traits was associated with more emotion dysregulation, which was associated with more avoidance by their caregiver, which was also associated with more aggressive behaviour. Several of the associations found, particularly in relation to avoidance from the caregiver, were conditional upon the level of alexithymia traits and sensory processing difficulties of the adolescents.

CONCLUSION: The significant associations between secure and insecure attachment style and alexithymia traits support theories proposing there is a potential underlying mechanism between attachment style and emotion processing abilities in the development of social cognitive abilities during adolescence. The findings of the second study highlight difficulties with emotion regulation and avoidance from caregivers are associated with increased aggressive behaviour in adolescents with higher autistic traits. Screening for these difficulties when an adolescent presents to services with aggressive behaviour would provide clinicians with an in-depth understanding of the adolescent’s difficulties, to which they could tailor interventions. Moreover, interventions targeted at improving an adolescent’s attachment style, emotion recognition and regulation abilities, their caregiver’s emotional and behavioural responses and sensory processing difficulties, may aid in reducing both mental health difficulties and aggressive behaviour. Future research would benefit from investigating these associations within a longitudinal design to establish causality.