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Emotional Interpretation and Anxiety in Autistic Adolescents

4/16/2025

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Author: Ashley Lopez-Hernandez 

  Adolescence is a period of emotional complexity, filled with social interactions that shape a young person's identity and relationships. For autistic adolescents, one of the core challenges during this time involves interpreting emotional cues, especially facial expressions. This difficulty in reading emotions doesn't just impact social understanding it can also intensify feelings of anxiety and isolation.

​How Emotion Interpretation Differs in Autism

  Autistic adolescents often experience differences in how they perceive facial expressions, particularly in identifying whether an emotion is genuine or safe to approach. A 2024 study published by Bothe et al. found that autistic traits are associated with "...difficulty in perceptual discrimination, labeling facial expressions, discriminating the genuineness of facial expressions, and differences in making social decisions relating to facial expressions" regardless of whether individuals also experienced Alexithymia -the difficulty in identifying and describing one’s own emotions- (Bothe et al., 2024, p. 1333). This means that even without difficulty in recognizing their own emotions, autistic individuals may still struggle to assess whether someone is sincere or emotionally approachable. In particular, the study highlights that many autistic individuals were less accurate in evaluating smiles. It was found that "autistic-like social skills predicted less typical approach judgements of genuine, but not posed, happy expressions, reflecting a reduced willingness to approach genuinely happy faces." (Bothe et al., 2024, p. 1331). This can be confusing in social interactions, increasing the risk of  misunderstanding  individuals' intentions and emotions. 

Why Misreading Emotions Contributes to Anxiety

   For most, facial expressions provide valuable feedback about social safety, inclusion, and rejection. However, when facial cues are difficult to decode, this lack of clarity can contribute to heightened anxiety. Social environments become unpredictable when one cannot determine if a peer is being kind, sarcastic, judgmental, or indifferent.
This uncertainty may cause autistic teens to withdraw from social situations or avoid interactions all together. Over time, consistent avoidance behavior can lead to the development of social anxiety or exacerbate existing anxiety disorders.
A comprehensive study by Hunsche et al. (2022) supports this connection, noting that poor theory of mind- which refers to
the ability to infer the thoughts, emotions, and intentions of others- as well as similar social differences “may lead to greater peer rejection or to a sense of unpredictability and confusion in social interactions, which may then contribute to the development of social fears."(p. 199). This contribution to social fears can drastically impact anxiety levels for some Autistic adolescence. Therefore, it can be inferred that when Autistic adolescents repeatedly misinterpret social feedback, it not only impairs relationship-building but reinforces a sense of being “out of sync” with the social world around them.

Addressing Emotional Misinterpretation in Therapy

   Given the role of misinterpreting emotions in autistic anxiety, treatment approaches need to address both social cognition and emotional regulation. Theory of Mind (ToM) and facial emotion recognition interventions, when adapted for autistic youth, has shown significant promise. The Hunsche et al. (2022) study found that providing social skills training opportunities to autistic adolescence " ...may reduce the uncertainty and confusion of social interactions and provide the option to exercise neurotypical social skills when needed, the pros (e.g., greater social acceptance.."(p. 205). Interventions integrating facial expression training, emotion labeling, and social scripts can help autistic adolescents feel more confident in social environments. Building this foundation of emotional literacy can reduce social misinterpretations and, in turn, lower social anxiety levels.

Conclusion

   Understanding emotions is a key component of social functioning. For autistic adolescents, differences in emotional interpretation are not merely a communication barrier; they are tied to experiences of anxiety. As research from Bothe et al. (2024) and Hunsche et al. (2022) demonstrates, acknowledging and supporting these differences through targeted interventions can lead to more meaningful social engagement and improved mental health outcomes. By validating the emotional experiences of autistic youth and equipping them with tools to navigate the social world, we move closer to a more inclusive and supportive approach to adolescent development.
Bothe, E., Jeffery, L., Dawel, A., Donatti-Liddelow, B., & Palermo, R. (2024). Autistic traits are associated with differences in the perception of genuineness and approachability in emotional facial expressions, independently of alexithymia. Emotion, 24(5), 1322–1337. https://doi.org/10.1037/emo0001350

Hunsche, M. C., Cervin, M., Storch, E. A., Kendall, P. C., Wood, J. J., & Kerns, C. M. (2022). Social functioning and the presentation of anxiety in children on the autism spectrum: A multimethod, multiinformant analysis. Journal of Psychopathology and Clinical Science, 131(2), 198-208. doi: https://doi.org/10.1037/abn0000724
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An Evaluation of CAMOUFLAGING in Autistic Adult Populations

4/15/2025

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By: Janae Hersey

This week's article discussed Camouflaging in autistic adult populations. This qualitative study included the experiences of both clinically and self-diagnosed individuals, providing insight into their thoughts, feelings and motivations behind camouflaging. This study helps shed light on this widely unknown behavior. 

Camouflaging is described as the act of appearing more social or mirroring the social behaviors of other people to blend in in social settings. While anyone can camouflage, this is an article specifically focused on autistic individuals.  
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 The dangers reported in this article discussed how engaging in camouflage on a daily basis was exhausting and stressful, leaving individuals feeling cognitively overloaded. They described that they felt as though their brains were always working. Others reported that they felt like they couldn’t meet their basic needs because camouflaging was so draining. Some reported feeling better after resting but noted that there isn’t always much time to do so. These reports explain why many individuals related camouflaging to poor mental health outcomes. Depression, anxiety, suicidal thoughts, self-harm, and negative alcohol behaviors were reported in response to avoiding their awareness of social self. 

The third danger reported was that others often failed to accept the individuals when they were no longer camouflaging. Because of this, individuals reported feeling like they had to keep camouflaging to avoid being bullied, abused, or socially excluded. Not wishing to forfeit social acceptance, individuals continued even despite feeling inauthentic. As a result, many reported that the fear of losing social acceptance led them to isolate themselves completely. 

The last danger that was discussed was that camouflaging creates unreal perceptions of people with Autism. What the participants meant by this was that other people often do not believe that they are autistic, that they do not get enough recognition of their difficulties, or that people often get offended by them or think they are being fake when they are not camouflaging. Some even stated that camouflaging caused a delay in getting a formal diagnosis. They believe this would have been helpful when they were younger, potentially decreasing being hurt, by themselves or by others.   

The benefits the participants reported were that camouflaging helped them survive in society. They reported how there weren't many resources for them so camouflaging kept them out of bad places, alleviated bullying, or lessened the threat of being attacked. Some said it allowed them to better access the outside world, get jobs, meet people, make friends, and help with their partners and children. Others reported that they feel like it made them build resilience. They believe they built this resilience as a result of overcoming obstacles in society. 

When it came to the participants who do not camouflage, there were many different reasons for why they do not. Some reported stopping after they got their clinical diagnosis to preserve their mental health and also to educate others about Autism. Some believed that they were not that good at it and decided it was not worth it while others thought it only benefited the people around them, not themselves. Others reported only doing it around people who they do not know or do not understand, love, or feel supported by. It was also discussed that stopping the action of camouflaging was difficult, but some stated that it was rewarding as they reported feeling more positive, accepted, and confident. 

In our lab discussion, we brought up that not having to camouflage would be helpful for many people. We mentioned how camouflaging is different from code switching, which is usually only for a short period of time, at a specific event, and does not have the same risks as camouflaging. In general, it was our opinion that there were more negatives than positives to camouflaging. People generally have a lack of understanding about autism. A lack of awareness can cause camouflaging to happen for a long time, leading to the potential risks listed above. As a lab, we will continue working to reduce the need for camouflaging by fostering greater understanding and inclusivity for our participants with autism.
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 Reference: Bradley, L., Shaw, R., Baron-Cohen, S., Cassidy, S. (2021, December 7). Autistic Adults’ Experiences of Camouflaging and Its Perceived Impact on Mental Health. Autism in Adulthood. Retrieved from https://www.liebertpub.com/doi/full/10.1089/aut.2020.0071 
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Effects of Poverty on Brain Development

4/1/2025

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Author: Isabelle Sutherland

The impacts of poverty extend beyond having your power turned off and being unable to afford rent. It affects the body internally, particularly in early brain development and cognitive ability. The National Institutes of Health (NIH) has conducted numerous studies examining the development of the cerebral cortex in impoverished children, consistently finding a decrease in volume of gray matter compared to children from more financially secure households. Household eligibility for the federal poverty line is determined by family size and total income. In the United States, the average family typically has two children, with a mean federal poverty threshold of $21,250 per year for this family size (American Council on Aging, 2025). A cross-sectional study with 389 child participants found that those whose household’s income was 1.5 times above the federal poverty line had a 3-4% reduction in gray matter in the frontal cortex (related to higher level cognitive processes), temporal cortex (auditory and emotional processing), and the hippocampus (site of declarative and episodic memory). For children living at the federal poverty line, gray matter reductions were significantly greater, ranging from 8% to 9% (Hair et al., 2015). These results align with a study conducted by the NIH (Tomalski et al., 2013), which used electroencephalogram (EEG) technology to investigate baseline brain activity in the gamma frequency range (linked to higher-order executive functions) of 6- to 9-month-old infants from lower socioeconomic status families. The EEGs recorded lower high-frequency brain activity in the prefrontal cortex, suggesting potential disruptions in cognitive functions related to attention, decision-making, problem-solving, and emotional regulation as the infants mature (Tomalski et al., 2013). 

Reduced cortical mass in the brain is an equifinal event that cannot be restricted to socioeconomic status. Restriction of resources extended to the child, such as food resulting in poor nutrition, inadequate housing, and lack of access to healthcare can occur due to many factors and are not exhaustive in contributing to poor brain development. Excessive exposure to loud noises, regular chaos, and conflict among family members can serve as chronic stressors to a child causing the release of the stress hormone cortisol. Elevated levels of this hormone are associated with changes in the volume of the amygdala (a brain region responsible for processing fear and anxiety), as well as atrophy of the hippocampus and dendrites of pyramidal neurons critical to communication between the prefrontal cortex and numerous regions throughout the brain (Liston et al., 2006). Consequently, stress responses that hinder problem-solving and planning could potentially develop heightened reactivity and difficulties with attention and social cognition.

Poverty is a multifactorial issue, meaning there is not one solution to resolve it. However, there are actions that can counteract its negative effects. Positive parenting behaviors are attributed to lower cortisol levels in children and higher executive function. Despite the socioeconomic status of a child’s household, they are far more likely to be well-adjusted with a parent that offers warmth, affection, and emotional support. Screening children and their parents for mental health risks, followed with referrals to services is another way to reduce potential stress impact on a child. With the appropriate guidance, improvements in mental health and parenting styles can be achieved (Luby et al., 2018). Several studies have demonstrated that high-quality education can combat poor brain development (Luby et al., 2018) by significantly improving neurocognitive ability, regulation of attention, and the speed at which information is processed (Blair & Raver, 2015). One step in fighting poverty is to help parents build higher levels of human capital in order to increase their federal and state incomes so they can rise above the poverty line (Luby et al., 2018). America’s College Promise Act is a proposed bill that aims to drastically lower the cost of community, technical, and tribal colleges for lower-income adults (Granville, 2023). If passed through legislation, young parents could attend college and strengthen their earning potential to exit poverty and its associated stressors. By helping parents who are struggling financially to rise economically and deliver intentional parenting approaches, impoverished children can have greater opportunities for success, improving their developmental outcomes.  
References 
American Council on Aging. (2025). Federal poverty guidelines / levels for 2025 & their relevance to Medicaid eligibility. MedicaidPlanningAssistance.org. https://www.medicaidplanningassistance.org/federal-poverty-guidelines/. 
Blair, C., & Raver, C. C. (2015). Closing the achievement gap through modification of neurocognitive and neuroendocrine function: Results from a cluster randomized controlled trial of an innovative approach to the education of children in kindergarten. Proceedings of the National Academy of Sciences, 112(43), 13775–13780. https://doi.org/10.1073/pnas.1512276112. 
Granville, P. (2023, October 17). How America’s College Promise would reshape the free college landscape. The Century Foundation. https://tcf.org/content/report/how-americas-college-promise-would-reshape-the-free-college-landscape/ 
Hair, N. L., Hanson, J. L., Wolfe, B. L., & Pollak, S. D. (2015). Association of child poverty, brain development, and academic achievement. JAMA Pediatrics, 169(9), 822–829. https://doi.org/10.1001/jamapediatrics.2015.1475. 
Liston, C., Miller, M. M., Goldwater, D. S., & others. (2006). Stress-induced alterations in prefrontal cortical dendritic morphology predict selective impairments in perceptual attentional set-shifting. Journal of Neuroscience, 26(30), 7810–7818. https://doi.org/10.1523/JNEUROSCI.1245-06.2006 
Luby, J., Belden, A., Harms, M. P., Tillman, R., & Barch, D. (2018). Poverty, stress, and brain development: New directions for prevention and intervention. JAMA Pediatrics, 172(9), 810–811. https://doi.org/10.1001/jamapediatrics.2018.1326. 
Tomalski, P., Moore, D. G., Ribeiro, H., & others. (2013). Socioeconomic status and functional brain development—Associations in early infancy. Developmental Science, 16(5), 676–687. https://doi.org/10.1111/desc.12079 

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