Associations Between Parental Alexithymia and Family Dynamics in Autism Spectrum Disorder
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors1. Please add more keywords for better indexing.
2. "Factors influencing" in the title can be misleading. This is a cross-sectional study, therefore, such claims are unjustified.
3. This sentence is fully incorrect. "Alexithymia is a specific disorder of psychic functioning". Please refer to at least one classification of diseases to show the alexithymia is a disorder. Alexithymia is not a disorder.
4. Exclusion criteria should be reconsidered as they duplicate inclusion criteria (e.g., the inclusion of children aged 3-15). Exclusion criteria are not opposite to inclusion criteria. Please refer to specific literature and amend this mistake.
5. Demographics of participants were described definitely insufficiently. At least age, gender, education should be provided. These data are missing. These demographics should be presented in a form of a table.
6. References for all Croatian versions of questionnaires should be provided. Do you refer to internal consistency obtained in this study or in validation studies? This should be clearly stated as it is vague in the current form.
7. Did you obtain a permission to use the TAS-20 in your research from the authors of the original TAS-20?
8. All statistical analyses should be supplemented with effect size measures. Please calculate effect size and present it in the tables (e.g., Tables 1, 2, 3 and others).
9. In many cases, data in the text are duplicated in the tables (e.g., 300-307). Please do not overwhelm the readers by these data in the text. The text should summarize/synthesize the results.
10. Correlations should be presented with 2 decimal places as it is common practice. The code system of variables 'sex', 'employment status' and several nominal variables should be explained. How were these variables coded?
11. Regression analysis: n/p is so vague. What does "not a predictor" mean here? Why were only several CERQ strategies included in the regression analysis? All this should be clearly stated. The readers should know why such specific considerations were used. Please describe the analysis and your methodological decisions in detail.
12. In general, all values should be presented with two decimal places, except p-values which should be presented with three decimal places. Please amend.
13. Casual language must be eliminated from this study, such words as influence, impact etc. Please reread the whole paper as there are problems with potential misinterpretations and overstatements.
14. Practical implication should be clearly stated.
15. Limitations are very limited. Please consider analyse the research results more critically to provide more relevant limitations.
16. The conclusions are presented in a statistical way. Please reconsider the conclusions using a psychological language.
17. The alexithymia construct was described insufficiently. Please refer to comprehensive references:
Taylor GJ, Porcelli P, Bagby RM. Alexithymia: A Defense of the Original Conceptualization of the Construct and a Critique of the Attention-Appraisal Model. Clin Neuropsychiatry. 2024 Oct;21(5):329-357. doi: 10.36131/cnfioritieditore20240501. PMID: 39540074; PMCID: PMC11555664.
Luminet O, Nielson KA. Alexithymia: Towards an Experimental, Processual Affective Science with Effective Interventions. Annu Rev Psychol. 2024 Sep 25. doi: 10.1146/annurev-psych-021424-030718. Epub ahead of print. PMID: 39322432.
Author Response
Dear Reviewer,
We would like to express our sincere gratitude for your insightful comments and constructive feedback on our manuscript. We have carefully revised the manuscript in line with the suggestions provided, and we believe that these improvements have significantly enhanced the quality of our work.
Your comments have been invaluable in helping us clarify and refine our analysis. We have addressed each of the points raised, and we hope that the revisions meet your expectations. We believe that the revised manuscript now presents a stronger and clearer argument, and we are optimistic that it has a better chance of being accepted for publication.
We truly appreciate the time and effort you have dedicated to reviewing our work, and we look forward to hearing your feedback on the revised version.
Thank you again for your contribution to improving the manuscript.
Sincerely,
Comments 1: Please add more keywords for better indexing.
Response 1: Thank you for this suggestion. More keywords were added for better indexing, as suggested. Keywords in the revised manuscript are: Autism Spectrum Disorder; Alexithymia; family functioning; parental stress; social support; emotional regulation in parents; family flexibillity; ASD and family dynamics (lines 31 to 32)
Comments 2: "Factors influencing" in the title can be misleading. This is a cross-sectional study, therefore, such claims are unjustified.
Response 2: Thank you for highlighting this important point. We have revised the title to better align with the cross-sectional nature of the study. The updated title is: “Associations Between Parental Alexithymia and Family Dynamics in Autism Spectrum Disorder.” (lines 2 to 3)
Comments 3: This sentence is fully incorrect. "Alexithymia is a specific disorder of psychic functioning". Please refer to at least one classification of diseases to show the alexithymia is a disorder. Alexithymia is not a disorder.
Response 3: Thank you for bringing this to our attention. We acknowledge the oversight in the original statement, and the sentence has been corrected to accurately reflect the nature of alexithymia. We appreciate your careful review and valuable input in improving the manuscript. (lines 35 to 37)
Comments 4: Exclusion criteria should be reconsidered as they duplicate inclusion criteria (e.g., the inclusion of children aged 3-15). Exclusion criteria are not opposite to inclusion criteria. Please refer to specific literature and amend this mistake.
Response 4: Thank you for your observation regarding the exclusion criteria. We agree that the overlap with the inclusion criteria was inappropriate and have revised the exclusion criteria accordingly. The updated criteria now address factors beyond the inclusion parameters, ensuring clarity and alignment with the relevant literature. We appreciate your suggestion, which has helped improve the rigor and precision of the study design. (131 to 148)
Comments 5: Demographics of participants were described definitely insufficiently. At least age, gender, education should be provided. These data are missing. These demographics should be presented in a form of a table.
Response 5: Thank you for your feedback regarding the demographic data. In the revised version of the manuscript, we have included a table (Table 2) that provides an overview of the key sociodemographic characteristics of the two groups of participants: parents of children with ASD and parents of children with TD. This table includes variables such as age, education level, employment status, and the number of family members.(lines 312 to 317)
We chose not to separate the data by gender (mothers and fathers) as the primary focus of our study is on the comparison of these two groups of parents rather than gender-specific analyses. Presenting the data aggregated for the two groups offers a clearer and more relevant comparison in line with our research objectives.
We appreciate your suggestion, which has significantly improved the presentation of our data.
Comments 6: References for all Croatian versions of questionnaires should be provided. Do you refer to internal consistency obtained in this study or in validation studies? This should be clearly stated as it is vague in the current form.
Response 6: Thank you for your comments, which have helped improve the clarity and rigor of our manuscript. We have provided references for all Croatian versions of the questionnaires used in the study in the revised manuscript. Additionally, we have clarified whether the internal consistency values refer to those obtained in this study or in prior validation studies. This distinction is now stated to eliminate any ambiguity.
References:
- Profaca, B.; Arambašić, L. Questionnaire for Measuring Stressors and Intensity of Parental Stress. Suvremena psihologija, 2004, 7, 243-260, https://hrcak.srce.hr/clanak/5459
- Soldo, L.; Vulić-Prtorić, A. The Cognitive Emotion Regulation Questionnaire (CERQ), Zbirka psihologijskih skala i upitnika, Sveučilište u Zadru, Zadar, 2018, 9, 47-58,
https://lumen.kzz.hr/wp-content/uploads/2023/03/Zbirka-psihologijskih-skala.pdf
37.Medved, A.; Keresteš, G. Loneliness in Early Adolescence: Gender and Age Differences and Links with Social Relations. Društvena istraživanja, 2011, 20, 457–478. https://doi.10.5559/di.20.2.09.
Comments 7: Did you obtain a permission to use the TAS-20 in your research from the authors of the original TAS-20?
Response 7: Yes, we obtained the permission to use the TAS-20 from the authors.
Comments 8: All statistical analyses should be supplemented with effect size measures. Please calculate effect size and present it in the tables (e.g., Tables 1, 2, 3 and others).
Response 8: Thank you for your comment, all mentioned corrections have been done. (From Table 2 to Table 8)
Comments 9: In many cases, data in the text are duplicated in the tables (e.g., 300-307). Please do not overwhelm the readers by these data in the text. The text should summarize/synthesize the results.
Response 9: Thank you for your helpful suggestion. We have revised the manuscript to avoid unnecessary duplication of data between the text and the tables. The text now provides a concise summary and synthesis of the results, while the tables present the detailed data. This revision improves the clarity and readability of the manuscript, and we appreciate your guidance in enhancing the presentation of our findings.(lines 326 to 330; 336 to 338; 345 to 348; 353 to 358; 364 to 366; 372 to 375)
Comments 10: Correlations should be presented with 2 decimal places as it is common practice. The code system of variables 'sex', 'employment status' and several nominal variables should be explained. How were these variables coded?
Response 10: Thank you for your valuable feedback. To ensure clarity and consistency in data presentation, we have updated the correlation values to be rounded to two decimal places, in accordance with standard practice.
Additionally, we have included an explanation of the coding system for the nominal variables used in the regression analyses. The coding details have been added above the relevant regression tables (Tables 13 and 15) and are as follows:
- Sex: 0 = female, 1 = male.
- Education level: 0 = no schooling, 1 = elementary school, 2 = high school, 3 = college, 4 = university.
- Number of family members: 1 = 3 members, 2 = 4 members, 3 = 5 members, 4 = 6 or more members.
- Employment status: 1 = employed, 2 = occasionally employed, 3 = unemployed.
(lines 433 to 437)
These updates enhance the transparency and comprehension of the presented results.
Comments 11: Regression analysis: n/p is so vague. What does "not a predictor" mean here? Why were only several CERQ strategies included in the regression analysis? All this should be clearly stated. The readers should know why such specific considerations were used. Please describe the analysis and your methodological decisions in detail.
Response 11: Thank you for your comments and questions. To clarify the methodological decisions regarding the regression analysis, I would like to explain several key aspects: In the context of hierarchical regression analysis, the term "not a predictor" refers to variables that did not show a statistically significant correlation with the criterion variable in the previous steps of the modeling process. Specifically, in our analysis, the regression models included only those variables that demonstrated a statistically significant correlation with the results on the family cohesion and flexibility scale in the previous step. These variables were selected based on their correlations with the criterion variable, meaning they were deemed relevant for further modeling. This approach allows for the systematic evaluation of the contribution of each new variable in predicting the criterion outcome, while also ensuring that variables not significantly related to the outcome are not included. Decisions regarding the inclusion or exclusion of variables were based on the statistical analyses conducted in the previous steps and are clearly stated in the text, with references to the tables containing the regression analyses (Tables 13 and 15); (lines 420 to 432)
Comments 12: In general, all values should be presented with two decimal places, except p-values which should be presented with three decimal places. Please amend.
Response 12: Thank you for your valuable comments. We have made the necessary revisions by presenting the correlations with two decimal places.
Comments 13: Casual language must be eliminated from this study, such words as influence, impact etc. Please reread the whole paper as there are problems with potential misinterpretations and overstatements.
Response 13: Thank you for your constructive feedback. We have carefully reviewed the manuscript and eliminated any casual language, such as terms like "influence" and "impact", to avoid potential misinterpretations and overstatements. The revised version now uses more precise and appropriate terminology to accurately reflect the study's findings. (lines 25 to 26; 29 to 30)
Comments 14: Practical implication should be clearly stated.
Response 14: Thank you for your helpful comment. We have revised the manuscript to clearly state the practical implications of the study which are now outlined, highlighting how the findings can inform practice and contribute to the understanding of the topic.(lines 612 to 639)
Comments 15: Limitations are very limited. Please consider analyse the research results more critically to provide more relevant limitations.
Response 15: Thank you for your insightful feedback. We have revised the manuscript to include a more comprehensive and critical discussion of the limitations. (lines 590 to 611)
Comments 16: The conclusions are presented in a statistical way. Please reconsider the conclusions using a psychological language.
Response 16: Thank you for your valuable feedback. We have revised the conclusions to present them in a more psychological context. The revised conclusions now emphasize the psychological implications of the findings, focusing on their relevance to theory, practice, and future research. We appreciate your suggestion, which has significantly improved the overall tone and clarity of the manuscript. (lines 644 to 665)
Comments 17: The alexithymia construct was described insufficiently. Please refer to comprehensive references:
Taylor GJ, Porcelli P, Bagby RM. Alexithymia: A Defense of the Original Conceptualization of the Construct and a Critique of the Attention-Appraisal Model. Clin Neuropsychiatry. 2024 Oct;21(5):329-357. doi: 10.36131/cnfioritieditore20240501. PMID: 39540074; PMCID: PMC11555664.
Luminet O, Nielson KA. Alexithymia: Towards an Experimental, Processual Affective Science with Effective Interventions. Annu Rev Psychol. 2024 Sep 25. doi: 10.1146/annurev-psych-021424-030718. Epub ahead of print. PMID: 39322432.
Response 17: Thank you for your important comment. We have expanded the description of alexithymia in the revised manuscript, ensuring it is more comprehensive. Additionally, we have included relevant and thorough references to support the definition which provides a clearer and more complete understanding. We appreciate your suggestion, which has enhanced the quality of the manuscript.(lines 35 to 41)
Dear Reviewer,
We would like to express our sincere gratitude for your insightful comments and constructive feedback on our manuscript. We have carefully revised the manuscript in line with the suggestions provided, and we believe that these improvements have significantly enhanced the quality of our work.
Your comments have been invaluable in helping us clarify and refine our analysis. We have addressed each of the points raised, and we hope that the revisions meet your expectations. We believe that the revised manuscript now presents a stronger and clearer argument, and we are optimistic that it has a better chance of being accepted for publication.
We truly appreciate the time and effort you have dedicated to reviewing our work, and we look forward to hearing your feedback on the revised version.
Thank you again for your contribution to improving the manuscript.
Sincerely,
Comments 1: Please add more keywords for better indexing.
Response 1: Thank you for this suggestion. More keywords were added for better indexing, as suggested. Keywords in the revised manuscript are: Autism Spectrum Disorder; Alexithymia; family functioning; parental stress; social support; emotional regulation in parents; family flexibillity; ASD and family dynamics (lines 31 to 32)
Comments 2: "Factors influencing" in the title can be misleading. This is a cross-sectional study, therefore, such claims are unjustified.
Response 2: Thank you for highlighting this important point. We have revised the title to better align with the cross-sectional nature of the study. The updated title is: “Associations Between Parental Alexithymia and Family Dynamics in Autism Spectrum Disorder.” (lines 2 to 3)
Comments 3: This sentence is fully incorrect. "Alexithymia is a specific disorder of psychic functioning". Please refer to at least one classification of diseases to show the alexithymia is a disorder. Alexithymia is not a disorder.
Response 3: Thank you for bringing this to our attention. We acknowledge the oversight in the original statement, and the sentence has been corrected to accurately reflect the nature of alexithymia. We appreciate your careful review and valuable input in improving the manuscript. (lines 35 to 37)
Comments 4: Exclusion criteria should be reconsidered as they duplicate inclusion criteria (e.g., the inclusion of children aged 3-15). Exclusion criteria are not opposite to inclusion criteria. Please refer to specific literature and amend this mistake.
Response 4: Thank you for your observation regarding the exclusion criteria. We agree that the overlap with the inclusion criteria was inappropriate and have revised the exclusion criteria accordingly. The updated criteria now address factors beyond the inclusion parameters, ensuring clarity and alignment with the relevant literature. We appreciate your suggestion, which has helped improve the rigor and precision of the study design. (131 to 148)
Comments 5: Demographics of participants were described definitely insufficiently. At least age, gender, education should be provided. These data are missing. These demographics should be presented in a form of a table.
Response 5: Thank you for your feedback regarding the demographic data. In the revised version of the manuscript, we have included a table (Table 2) that provides an overview of the key sociodemographic characteristics of the two groups of participants: parents of children with ASD and parents of children with TD. This table includes variables such as age, education level, employment status, and the number of family members.(lines 312 to 317)
We chose not to separate the data by gender (mothers and fathers) as the primary focus of our study is on the comparison of these two groups of parents rather than gender-specific analyses. Presenting the data aggregated for the two groups offers a clearer and more relevant comparison in line with our research objectives.
We appreciate your suggestion, which has significantly improved the presentation of our data.
Comments 6: References for all Croatian versions of questionnaires should be provided. Do you refer to internal consistency obtained in this study or in validation studies? This should be clearly stated as it is vague in the current form.
Response 6: Thank you for your comments, which have helped improve the clarity and rigor of our manuscript. We have provided references for all Croatian versions of the questionnaires used in the study in the revised manuscript. Additionally, we have clarified whether the internal consistency values refer to those obtained in this study or in prior validation studies. This distinction is now stated to eliminate any ambiguity.
References:
- Profaca, B.; Arambašić, L. Questionnaire for Measuring Stressors and Intensity of Parental Stress. Suvremena psihologija, 2004, 7, 243-260, https://hrcak.srce.hr/clanak/5459
- Soldo, L.; Vulić-Prtorić, A. The Cognitive Emotion Regulation Questionnaire (CERQ), Zbirka psihologijskih skala i upitnika, Sveučilište u Zadru, Zadar, 2018, 9, 47-58,
https://lumen.kzz.hr/wp-content/uploads/2023/03/Zbirka-psihologijskih-skala.pdf
37.Medved, A.; Keresteš, G. Loneliness in Early Adolescence: Gender and Age Differences and Links with Social Relations. Društvena istraživanja, 2011, 20, 457–478. https://doi.10.5559/di.20.2.09.
Comments 7: Did you obtain a permission to use the TAS-20 in your research from the authors of the original TAS-20?
Response 7: Yes, we obtained the permission to use the TAS-20 from the authors.
Comments 8: All statistical analyses should be supplemented with effect size measures. Please calculate effect size and present it in the tables (e.g., Tables 1, 2, 3 and others).
Response 8: Thank you for your comment, all mentioned corrections have been done. (From Table 2 to Table 8)
Comments 9: In many cases, data in the text are duplicated in the tables (e.g., 300-307). Please do not overwhelm the readers by these data in the text. The text should summarize/synthesize the results.
Response 9: Thank you for your helpful suggestion. We have revised the manuscript to avoid unnecessary duplication of data between the text and the tables. The text now provides a concise summary and synthesis of the results, while the tables present the detailed data. This revision improves the clarity and readability of the manuscript, and we appreciate your guidance in enhancing the presentation of our findings.(lines 326 to 330; 336 to 338; 345 to 348; 353 to 358; 364 to 366; 372 to 375)
Comments 10: Correlations should be presented with 2 decimal places as it is common practice. The code system of variables 'sex', 'employment status' and several nominal variables should be explained. How were these variables coded?
Response 10: Thank you for your valuable feedback. To ensure clarity and consistency in data presentation, we have updated the correlation values to be rounded to two decimal places, in accordance with standard practice.
Additionally, we have included an explanation of the coding system for the nominal variables used in the regression analyses. The coding details have been added above the relevant regression tables (Tables 13 and 15) and are as follows:
- Sex: 0 = female, 1 = male.
- Education level: 0 = no schooling, 1 = elementary school, 2 = high school, 3 = college, 4 = university.
- Number of family members: 1 = 3 members, 2 = 4 members, 3 = 5 members, 4 = 6 or more members.
- Employment status: 1 = employed, 2 = occasionally employed, 3 = unemployed.
(lines 433 to 437)
These updates enhance the transparency and comprehension of the presented results.
Comments 11: Regression analysis: n/p is so vague. What does "not a predictor" mean here? Why were only several CERQ strategies included in the regression analysis? All this should be clearly stated. The readers should know why such specific considerations were used. Please describe the analysis and your methodological decisions in detail.
Response 11: Thank you for your comments and questions. To clarify the methodological decisions regarding the regression analysis, I would like to explain several key aspects: In the context of hierarchical regression analysis, the term "not a predictor" refers to variables that did not show a statistically significant correlation with the criterion variable in the previous steps of the modeling process. Specifically, in our analysis, the regression models included only those variables that demonstrated a statistically significant correlation with the results on the family cohesion and flexibility scale in the previous step. These variables were selected based on their correlations with the criterion variable, meaning they were deemed relevant for further modeling. This approach allows for the systematic evaluation of the contribution of each new variable in predicting the criterion outcome, while also ensuring that variables not significantly related to the outcome are not included. Decisions regarding the inclusion or exclusion of variables were based on the statistical analyses conducted in the previous steps and are clearly stated in the text, with references to the tables containing the regression analyses (Tables 13 and 15); (lines 420 to 432)
Comments 12: In general, all values should be presented with two decimal places, except p-values which should be presented with three decimal places. Please amend.
Response 12: Thank you for your valuable comments. We have made the necessary revisions by presenting the correlations with two decimal places.
Comments 13: Casual language must be eliminated from this study, such words as influence, impact etc. Please reread the whole paper as there are problems with potential misinterpretations and overstatements.
Response 13: Thank you for your constructive feedback. We have carefully reviewed the manuscript and eliminated any casual language, such as terms like "influence" and "impact", to avoid potential misinterpretations and overstatements. The revised version now uses more precise and appropriate terminology to accurately reflect the study's findings. (lines 25 to 26; 29 to 30)
Comments 14: Practical implication should be clearly stated.
Response 14: Thank you for your helpful comment. We have revised the manuscript to clearly state the practical implications of the study which are now outlined, highlighting how the findings can inform practice and contribute to the understanding of the topic.(lines 612 to 639)
Comments 15: Limitations are very limited. Please consider analyse the research results more critically to provide more relevant limitations.
Response 15: Thank you for your insightful feedback. We have revised the manuscript to include a more comprehensive and critical discussion of the limitations. (lines 590 to 611)
Comments 16: The conclusions are presented in a statistical way. Please reconsider the conclusions using a psychological language.
Response 16: Thank you for your valuable feedback. We have revised the conclusions to present them in a more psychological context. The revised conclusions now emphasize the psychological implications of the findings, focusing on their relevance to theory, practice, and future research. We appreciate your suggestion, which has significantly improved the overall tone and clarity of the manuscript. (lines 644 to 665)
Comments 17: The alexithymia construct was described insufficiently. Please refer to comprehensive references:
Taylor GJ, Porcelli P, Bagby RM. Alexithymia: A Defense of the Original Conceptualization of the Construct and a Critique of the Attention-Appraisal Model. Clin Neuropsychiatry. 2024 Oct;21(5):329-357. doi: 10.36131/cnfioritieditore20240501. PMID: 39540074; PMCID: PMC11555664.
Luminet O, Nielson KA. Alexithymia: Towards an Experimental, Processual Affective Science with Effective Interventions. Annu Rev Psychol. 2024 Sep 25. doi: 10.1146/annurev-psych-021424-030718. Epub ahead of print. PMID: 39322432.
Response 17: Thank you for your important comment. We have expanded the description of alexithymia in the revised manuscript, ensuring it is more comprehensive. Additionally, we have included relevant and thorough references to support the definition which provides a clearer and more complete understanding. We appreciate your suggestion, which has enhanced the quality of the manuscript.(lines 35 to 41)
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsI suggest the author refine this statement “Research by Gau et al. [25] showed that both parents of children with ASD exhibited higher levels of psychopathology and a lower dyadic consensus compared to parents of TD children, while mothers of children with ASD showed lower marriage satisfaction and lower levels of attachment, family flexibility and cohesion than mothers of TD children.” In the introduction section (lines 80 to 83). I understand these are important aspects to introduce, but I would not blame mothers.
Parents with high levels of alexithymia have difficulties in describing and identifying emotions, so their self-report of family cohesion and flexibility might not be accurate. For the very same reason, the differences in the cognitive emotion regulation strategies employed by parents lack specificity. If a parent has difficulty in describing and identifying the emotions, how is he/she able to identify the type of emotion regulation he/she is asked to report?
While the reported skewness and kurtosis values suggest approximate normality, these metrics alone may not fully capture the distributional characteristics of the data. It would strengthen the manuscript to provide additional evidence of normality through visualizations (e.g., histograms, Q-Q plots) or normality tests. Moreover, the authors should include this aspect in the “limitations” section of the manuscript.
Author Response
Dear Reviewer,
We would like to express our sincere gratitude for your insightful comments and constructive feedback on our manuscript. We have carefully revised the manuscript in line with the suggestions provided, and we believe that these improvements have significantly enhanced the quality of our work.
Your comments have been invaluable in helping us clarify and refine our analysis. We have addressed each of the points raised, and we hope that the revisions meet your expectations. We believe that the revised manuscript now presents a stronger and clearer argument, and we are optimistic that it has a better chance of being accepted for publication.
We truly appreciate the time and effort you have dedicated to reviewing our work, and we look forward to hearing your feedback on the revised version.
Thank you again for your contribution to improving the manuscript.
Sincerely,
Comments 1: I suggest the author refine this statement “Research by Gau et al. [25] showed that both parents of children with ASD exhibited higher levels of psychopathology and a lower dyadic consensus compared to parents of TD children, while mothers of children with ASD showed lower marriage satisfaction and lower levels of attachment, family flexibility and cohesion than mothers of TD children.” In the introduction section (lines 80 to 83). I understand these are important aspects to introduce, but I would not blame mothers.
Response 1: We sincerely thank the reviewer for the valuable suggestion to improve clarity and ensure a balanced presentation of this statement.
Revised Statement:
Research by Gau et al. [25] highlighted that parents of children with ASD exhibited higher levels of psychopathology and a lower dyadic consensus compared to parents of TD children. Additionally, the study found that mothers of children with ASD reported experiencing lower marriage satisfaction, as well as challenges in attachment, family flexibility, and cohesion, in comparison to mothers of TD children.(lines 77 to 82)
Comments 2: Parents with high levels of alexithymia have difficulties in describing and identifying emotions, so their self-report of family cohesion and flexibility might not be accurate. For the very same reason, the differences in the cognitive emotion regulation strategies employed by parents lack specificity. If a parent has difficulty in describing and identifying the emotions, how is he/she able to identify the type of emotion regulation he/she is asked to report?
Response 2: Thank you for raising this insightful question and for your comment regarding the potential impact of alexithymia on self-reported measures. We deeply appreciate your suggestion, as it has prompted us to critically evaluate this aspect of our study and improve the rigor of our interpretation. We agree that parents with high levels of alexithymia may face challenges in accurately identifying and describing their emotions, which could influence their reports on family cohesion, flexibility, and the specific cognitive emotion regulation strategies they employ. In light of your observation, we acknowledge that this limitation should be addressed in the discussion section to provide a more nuanced interpretation of the findings. Specifically, the reliance on self-reported measures may introduce biases in the results, as parents with alexithymia may not fully capture the complexity or accuracy of their emotional experiences. Furthermore, we agree that future research could benefit from incorporating alternative assessment methods, such as observational studies or physiological measures, to complement self-reports and enhance the validity of these findings. These aspects have been considered in greater detail in the discussion section of the revised manuscript to enhance the clarity and foster a more comprehensive understanding of our findings. (lines 550 to 558)
Comments 3: While the reported skewness and kurtosis values suggest approximate normality, these metrics alone may not fully capture the distributional characteristics of the data. It would strengthen the manuscript to provide additional evidence of normality through visualizations (e.g., histograms, Q-Q plots) or normality tests. Moreover, the authors should include this aspect in the “limitations” section of the manuscript.
Response 3: Thank you for your comment regarding the assessment of data normality. Following your suggestion, we have further reviewed our approach to analyzing distributional characteristics. In the manuscript, we have already included Table 1, which presents all relevant statistical parameters for the continuous measures used in the analysis, including the Kolmogorov-Smirnov test, skewness, and kurtosis values. Based on the studies cited in our paper (references 38 and 39), these metrics are reliable indicators of approximate normality and satisfy the criteria for using parametric statistical procedures. (lines 262 to 264)
While we acknowledge the utility of visualizations such as histograms or Q-Q plots, creating these for all 47 variables analyzed would be impractical and would not provide significantly more information beyond the statistical metrics already presented. Visualizations, though helpful, often rely on subjective interpretation, whereas our approach prioritizes quantitative indicators.
Moreover, we have incorporated your suggestion into the “Limitations” section of the manuscript, noting the use of approximate measures of normality and the potential impact of this approach on the results. This ensures transparency in our methodology and acknowledges possible limitations.
Once again, thank you for your valuable feedback, which has helped us further enhance the manuscript.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThank you for your very comprehensive revisions. Very well-done!
Reviewer 2 Report
Comments and Suggestions for AuthorsThe authors addressed all of my comments and I am satisfied by the revised manuscript.
