A systematic review of how emotional self-awareness is defined and measured when comparing autistic and non-autistic groups

Background: Poor emotional self-awareness, often referred to as ‘alexithymia’ may be a common area of difficulty in autism. However, emotional self-awareness is labelled and defined differently in various strands of research, and is often measured by self-report. These issues may influence differences in emotional self-awareness between autistic and non-autistic groups. Thus, we need to examine how emotional self-awareness is defined and measured in this literature. Method: We systematically reviewed studies comparing emotional self-awareness in autistic and non-autistic participants. Forty-seven papers were identified for inclusion, and how emotional self-awareness was defined was extracted from each. Thematic analysis was conducted on extracted definitions. The measurement tools used in each paper were also reviewed, to assess the extent to which studies are reliant upon self-report. Results: We identified seven key themes in definitions of emotional self-awareness, with little consistency. Also, the themes identified mapped poorly onto the tools used to measure them. Most studies relied exclusively on self-report, and few used more than one tool. Only three behavioural measurement tools were identified. Conclusion: Emotional self-awareness has been variably defined by researchers in different strands of autism research. Moreover, most studies exclusively use self-report alone to measure this outcome, and this may not be reliable. To account for the multi-faceted nature of emotional self-awareness, future research would benefit from specifically defining which aspect of emotional self-awareness is under study and utilising multi-method approaches.