Cognitive and affective empathy, executive functions, and the key role of personal distress: Why do autistic traits predict mental health symptoms in neurotypical adults?

Abstract

Individuals with elevated autistic traits often experience internalizing symptoms that affect their quality of life. However, the mechanisms underlying this process in neurotypical populations remain unclear. The present study investigated the mediating roles of executive functions (cognitive flexibility, working memory, inhibitory control) and social cognition (affective empathy, cognitive empathy) in this relationship. The mental health symptoms of 159 neurotypical adult participants (ranging 18-45) were assessed using the Autism Quotient, Depression Anxiety Stress-21, Patient Health Questionnaire-9, and Generalized Anxiety Questionnaire-7. Within the same participants, executive functions were assessed using the Wisconsin Card Sorting Task, N-back Task, and Go/No-Go Task, while social cognition was assessed using the Interpersonal Reactivity Index, the Eyes Test, and the Self-Assessment Manikin. Results indicated that autistic traits were positively associated with mental health symptoms. Among the examined variables, personal distress-a component of affective empathy—was the only factor showing a link between attention-switching difficulties and mental health symptoms. Neither cognitive empathy nor executive functions demonstrated significant associations. These findings suggest that heightened affective empathy may be related to greater emotional vulnerability in individuals with elevated autistic traits. The study contributes to a better understanding of the associations among autistic traits, affective empathy, and mental health, and underscores the importance of considering emotion-regulation processes in future research.