Alexithymia Questionnaire for Children

The Alexithymia Questionnaire for Children (AQC) is a validated self-report instrument adapted from the widely used adult Toronto Alexithymia Scale (TAS-20).

Questions: 20
Duration: 10 min
Original title: Alexithymia Questionnaire for Children (Questionnaire d'Alexithymie pour Enfants – QAE)
Adaptation: Alexithymia Questionnaire for Children
Authors: Rieffe, C., Oosterveld, P., & Meerum Terwogt, M.
Created: 2006

The Alexithymia Questionnaire for Children (AQC) is a validated self-report instrument adapted from the widely used adult Toronto Alexithymia Scale (TAS-20). Designed for children and young adolescents, it assesses the core dimensions of alexithymia: the inability to recognize, articulate, and process internal emotional states. This measure provides clinicians with a structured way to evaluate a young patient's foundational emotional awareness before initiating more complex psychological interventions.

In pediatric clinical practice, alexithymia often presents alongside somatic complaints, anxiety, or disruptive behavior. Because many therapeutic modalities rely on the patient's capacity to name and differentiate feelings, measuring these skills at intake is highly valuable. When a child struggles to link physical sensations to emotional distress, cognitive-behavioral work, such as catching their automatic thoughts, can stall. Similarly, teaching effective coping strategies relies on the child knowing what feeling they are trying to regulate. By quantifying these specific emotional blind spots, the AQC helps clinicians adapt their approach.

Using this repeatable measure allows for targeted treatment planning. Rather than assuming emotional literacy, clinicians can use the AQC to identify whether therapy must first focus on building a basic emotions vocabulary or connecting behavior to underlying needs.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

19/ 40

The QAE (French version of the Alexithymia Questionnaire for Children by Rieffe, Oosterveld & Meerum Terwogt, 2006) is a 20-item self-report questionnaire designed to assess alexithymia in children and preadolescents (from approximately 8 years of age). Adapted from the TAS-20 by rephrasing items into child-comprehensible language, it measures three dimensions: difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally-oriented thinking (EOT). It is used in developmental psychology, child and adolescent psychiatry, and research investigating the links between alexithymia, somatic complaints, and internalizing symptoms.

généralemales · community sample · 9–16 years · France · n = 43 · 2010 · Loas et al. (2010)

040

M = 17.32 ± 5.37

généralefemales · community sample · 9–16 years · France · n = 37 · 2010 · Loas et al. (2010)

040

M = 16.81 ± 5.68

cliniquemixed · clinical population · 12–18 years · Belgium · n = 105 · 2018 · Delhaye et al. (2018)

040

M = 20.84 ± 6.11

Scoring

Sum (total score + subscale scores), total score from 0 to 40, each item is rated on a 3-point scale (from 0 to 2).

Difficulty describing feelings

5/ 10

Difficulty Describing Feelings (Difficulty describing one's feelings). Composed of 5 items (0-10).

items 2, 4, 11, 12, 17

généralemales · students · Netherlands · n = 207 · 2006 · Rieffe et al. (2006)

010

M = 4.15 ± 2.5

généralefemales · students · Netherlands · n = 193 · 2006 · Rieffe et al. (2006)

010

M = 4.65 ± 2.55

généralemales · students · Netherlands · n = 173 · 2006 · Rieffe et al. (2006)

010

M = 3.25 ± 2.5

généralefemales · students · Netherlands · n = 167 · 2006 · Rieffe et al. (2006)

010

M = 3.15 ± 2.75

Difficulty identifying feelings

7/ 14

Difficulty Identifying Feelings (Difficulty identifying one's feelings). Composed of 7 items (0-14).

items 1, 6, 7, 9, 13, 14, 3

généralemales · students · Netherlands · n = 207 · 2006 · Rieffe et al. (2006)

014

M = 4.13 ± 2.87

généralefemales · students · Netherlands · n = 193 · 2006 · Rieffe et al. (2006)

014

M = 5.39 ± 3.22

généralemales · students · Netherlands · n = 173 · 2006 · Rieffe et al. (2006)

014

M = 3.08 ± 2.66

généralefemales · students · Netherlands · n = 167 · 2006 · Rieffe et al. (2006)

014

M = 3.15 ± 2.8

Externally-oriented thinking

7/ 16

Externally-Oriented Thinking (Externally oriented thinking). Composed of 8 items (0-16).

items 5, 8, 10, 15, 16, 18, 19, 20

généralemales · students · Netherlands · n = 207 · 2006 · Rieffe et al. (2006)

016

M = 7.28 ± 2.16

généralefemales · students · Netherlands · n = 193 · 2006 · Rieffe et al. (2006)

016

M = 7.28 ± 2.08

généralemales · students · Netherlands · n = 173 · 2006 · Rieffe et al. (2006)

016

M = 6.8 ± 2.56

généralefemales · students · Netherlands · n = 167 · 2006 · Rieffe et al. (2006)

016

M = 5.6 ± 2.48

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What the test measures

The AQC evaluates the construct of alexithymia through three distinct but interrelated clinical dimensions of emotional processing.

Difficulty Identifying Feelings (DIF): The inability to recognize specific emotional states and distinguish between emotional arousal and physical sensations.
Difficulty Describing Feelings (DDF): The struggle to find the right words to communicate internal emotional experiences to others.
Externally Oriented Thinking (EOT): A cognitive style that focuses on concrete, external events and practical details rather than inner reflection or psychological motives.

The instrument is validated for children and young adolescents, providing a developmental snapshot of their emotional awareness and introspective capacity.

When and why to use it

Clinicians typically administer the AQC to evaluate whether a child possesses the necessary emotional literacy to engage in insight-oriented or cognitive-behavioral therapies.

Intake baseline: To measure emotional awareness early on, helping clinicians decide if foundational psychoeducation on mental health basics is required before addressing specific symptoms.
Somatic presentations: To explore the emotional component of unexplained physical complaints, clarifying whether the child struggles to differentiate emotions from autonomic nervous system arousal.
Anger and behavioral issues: To assess whether explosive reactions stem from an inability to detect early anger warning signs or articulate distress.
Monitoring progress: To track improvements in emotional vocabulary and self-reflection over the course of therapy.

A validated score provides a clear, dimensional profile of emotional processing deficits, offering a more precise target for intervention than clinical impression alone.

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The questions

Read each sentence and decide how true it is for you. Choose 'Not true', 'Sometimes true', or 'Often true'.
1. Often, I'm not really sure what I'm feeling inside.
Probes the child's general clarity regarding their internal emotional states.
- Not true
- Somewhat true
- Definitely true
2. I find it hard to say what I'm feeling inside.
Assesses the perceived challenge of verbalizing personal emotions.
- Not true
- Somewhat true
- Definitely true
3. I feel things in my body that even doctors don't understand.
Explores the tendency to experience unexplained somatic sensations that may mask emotional distress.
- Not true
- Somewhat true
- Definitely true
4. I can easily say what I'm feeling inside.
Evaluates the child's confidence in their ability to articulate their inner feelings clearly.
- Not true
- Somewhat true
- Definitely true
5. When I have a problem, I want to know where it comes from and not just talk about it.
Examines the preference for concrete problem-solving over exploring the emotional dimensions of an issue.
- Not true
- Somewhat true
- Definitely true
6. When I'm upset, I don't know if I'm sad, scared, or angry.
Checks the child's ability to differentiate between specific primary emotions during moments of high arousal.
- Not true
- Somewhat true
- Definitely true
7. I'm often puzzled by things I feel in my body.
Investigates confusion around physical sensations which often occurs when emotional arousal is misinterpreted.
- Not true
- Somewhat true
- Definitely true
8. I prefer to wait and see what happens, rather than think about why things happen.
Assesses a passive and externally oriented cognitive style that avoids psychological introspection.
- Not true
- Somewhat true
- Definitely true
9. Sometimes, I can't find the words to say what I'm feeling inside.
Highlights episodic difficulties in accessing the appropriate emotional vocabulary.
- Not true
- Somewhat true
- Definitely true
10. It's important to understand what you're feeling inside.
Probes the value the child places on emotional awareness and self-reflection.
- Not true
- Somewhat true
- Definitely true
11. I find it hard to say how I feel about other people.
Evaluates the challenge of expressing interpersonal emotions and relational feelings.
- Not true
- Somewhat true
- Definitely true
12. Other people tell me I should talk more about what I'm feeling inside.
Captures external feedback regarding the child's emotional reticence or withdrawal.
- Not true
- Somewhat true
- Definitely true
13. I don't know what's going on inside me.
Assesses a pervasive sense of opacity regarding internal psychological and emotional processes.
- Not true
- Somewhat true
- Definitely true
14. Very often, I don't know why I'm angry.
Checks for a disconnect between strong emotional reactions and their underlying cognitive or contextual triggers.
- Not true
- Somewhat true
- Definitely true
15. I prefer to talk to people about their daily activities rather than their feelings.
Examines the tendency to steer social interactions toward concrete topics rather than emotional sharing.
- Not true
- Somewhat true
- Definitely true
16. I prefer watching fun TV shows rather than movies about people's problems.
Explores the avoidance of emotionally complex narratives in favor of light and external entertainment.
- Not true
- Somewhat true
- Definitely true
17. It's hard for me to say what I'm really feeling inside, even to my best friend.
Assesses the inability to share vulnerable emotions even in the safest and closest relationships.
- Not true
- Somewhat true
- Definitely true
18. I can feel close to someone, even if we're sitting still and not saying anything.
Probes the capacity for non-verbal emotional connection, an item that is reverse-scored to indicate emotional presence.
- Not true
- Somewhat true
- Definitely true
19. When I want to solve my problems, it helps me to think about what I'm feeling.
Evaluates the recognition that emotional awareness is a useful tool for navigating challenges.
- Not true
- Somewhat true
- Definitely true
20. I like a movie less if I have to concentrate to understand its story.
Assesses an aversion to complex narratives that require perspective-taking and psychological engagement.
- Not true
- Somewhat true
- Definitely true