Emotional Interpretation and Anxiety in Autistic Adolescents

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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