Exploring Alexithymia, Uncertainty, Anxious Arousal, and Social Anxiety as Mediators of the Relationship Between Sensory Processing Differences and Restricted and Repetitive Behaviors in Autistic Adults.

This research looked at how sensory difficulties connect to repetitive behaviors in autistic adults. The study found that different types of repetitive behaviors (like hand flapping versus needing routines) happen through different emotional pathways involving difficulty identifying emotions, discomfort with uncertainty, and anxiety. Understanding these connections could help develop better support strategies for managing sensory challenges and related behaviors.

This study examined how sensory processing differences relate to repetitive behaviors in 426 autistic adults, exploring the mediating roles of alexithymia, uncertainty intolerance, and autism-specific anxiety measures. Results revealed distinct pathways for different types of repetitive behaviors: repetitive motor behaviors were mediated through anxious arousal and complex combinations involving alexithymia and uncertainty intolerance, while insistence on sameness behaviors were mediated primarily through uncertainty intolerance pathways. The research advances understanding by using autism-specific anxiety measures rather than general population tools, suggesting that different mechanisms underpin various types of restricted and repetitive behaviors in autism.

Results suggest tailored interventions targeting different pathways: sensory processing support, anxiety management using autism-specific approaches, uncertainty tolerance strategies, and emotion recognition skills. Different types of repetitive behaviors may require distinct therapeutic approaches rather than one-size-fits-all interventions.

The study design is unclear from the abstract. Cross-sectional nature likely limits causal inferences. Self-report measures may introduce bias. The sample characteristics and recruitment methods are not detailed, potentially affecting generalizability.

Restricted and repetitive behaviors (RRB) are associated with sensory processing (SP) differences for autistic people, and are thought to be a coping strategy to help manage the sensory environment. Previous work shows that, for autistic people, alexithymia, intolerance of uncertainty (IU), and anxiety mediate the relationship between SP differences and RRB. However, these studies use anxiety measures developed for the general population, and more recent evidence suggests that autistic people may have a different anxiety experience. This study aims to extend previous findings by unpacking the anxiety experience for autistic adults in the relationship between SP differences and RRB, using an autism-specific anxiety measure.

Data were available from 426 autistic adults. Serial mediation models tested the relationship between SP differences and RRB, with alexithymia, IU, anxious arousal, and social anxiety as mediators. We identified significant direct effects from SP differences to both repetitive motor behaviors (RMB) and insistence on sameness behaviors (ISB). For RMB, we found indirect effects through anxious arousal, alexithymia-anxious arousal, IU-anxious arousal, and alexithymia-IU-anxious arousal.

For ISB, we found indirect effects through IU and alexithymia-IU. Thus, different mechanisms may underpin RMB and ISB. Understanding the anxiety experience of autistic people, alongside the role of SP and RRB, is key to providing tailored support, adjustments, and psychological interventions to autistic people. Future research could benefit from directly investigating the impact of strategies to support SP and anxiety.