Dr. Tony Attwood’s Advice on Understanding and Expressing Emotions

It seems that a constitutional component of ASD is a difficulty understanding the subtle emotions expressed by neurotypicals and a difficulty communicating and managing emotions at the level neurotypicals find acceptable. A person with an ASD will at times feel like an alien on a strange planet where members of the dominant species (neurotypicals) are constantly exchanging fleeting facial expressions, tone of voice and body postures to express an excessive range of emotions. For example, neurotypicals have several hundred facial expressions that they expect to be easily identified by members of their species. Neurotypicals also expect other people to express emotions at just the right intensity and to be able to resonate with the emotions of fellow neurotypicals. They assume that everyone can easily, effectively and efficiently repair others’ emotions. But for those who have an ASD, the world of human emotions seems illogical, confusing, overwhelming and alien.

The difficulties experienced by those with an ASD include the inability to intuitively and instantaneously “read” the feelings of another person, and problems in accurately reading and interpreting internal feelings and communicating those feelings at the right intensity for the situation or the relationship. Neurotypicals have never really experienced these difficulties themselves, and thus can be very critical and dismissive of those who struggle to understand and express emotions.

However, understanding and expressing emotions are skills that can be acquired by those with an ASD, although they will need significant guidance and encouragement. In my opinion, children and adolescents who have an ASD need at least an hour a week, from pre-school to high school graduation, devoted to learning how to read emotions, from happy and sad for very young children, to jealousy and being in love for adolescents. The educational programme for those with an ASD should focus on reading and analyzing emotions both within themselves and others, and expressing emotions at the right level of intensity. They also need to learn how to manage and express specific emotions, such as anxiety, sadness, anger and affection, at a level which does not cause personal and interpersonal distress. In some ways, it is equivalent to having lessons in a foreign language and culture, but since it is the universal language of neurotypicals on planet Earth, it is necessary that those with an ASD become fluent in that language and familiar with the culture if they are to succeed with the dominant species of the planet.

Strategies to Understand and Express Emotions

The early signs of difficulty communicating emotions can be recognized in infancy, with the very young child tending to express extreme levels of distress and agitation that parents find difficult to repair with the usual strategies of affection and distraction. The next sign is the young child being bewildered by the myriad facial expressions made by adults. Information from facial expressions also has to be integrated and congruent with hand gestures, body posture and the prosody of speech. Without an intuitive understanding of these fleeting cues that communicate feelings, the ability to read emotions becomes an extremely complex, and at times overwhelming and elusive, cognitive rather than intuitive skill.

In the education of very young children who have an ASD, a useful metaphor can be employed, where the face is equivalent to traffic lights. The child is given guidance as to whether a particular facial expression, such as a smile, is a green light face, such that you can continue the conversation or activity, an amber light face, such as a frown, where you need to check the other person’s feelings before you continue, or a red light face, such as an angry expression or tears, indicating that you need to stop. Other games might include matching facial expressions to body language and tone of voice, and identifying the appropriate emotional response and level of expression for a particular situation.

Psychologists use the term “affective education” to describe these activities, and many suppliers of educational resources include in their catalogue games and activities on recognizing and expressing emotions. There is one recommended resource specifically designed for those with an ASD, with an age range from child to mature adult—Mind Reading: The Interactive Guide to Emotions, which is an entertaining and informative interactive DVD available from Jessica Kingsley Publishers.

Sometimes, the greatest difficulty for someone with an ASD is recognizing and reading (and expressing) his or her own internal feelings rather than the feelings of other people. For help in the acquisition of this ability it would be wise to seek the guidance of a psychologist, who can use a range of strategies and resources. One of the components of psychotherapy for those with an ASD is the development of the ability for self-reflection and self-disclosure: that is, to precisely identify a current emotion and communicate the level of expression. If the vocabulary for words to describe the various levels of emotions needs to be developed, there are resources such as The CAT-kit for cognitive affective training developed by myself and colleagues from Denmark. The CAT-kit is available from Future Horizons: for more information see www.catkit-us.com. A clinical psychologist can use cognitive behaviour therapy and other psychological therapies to help manage and express emotions of clinical concern such as depression, anxiety and anger.

People with an ASD have the greatest difficulty communicating emotions using speech during a face-to-face conversation. There can be a greater eloquence and insight when typing rather than talking, for example, sending an email or typing an entry into a diary; or expressing feelings through music, such as identifying a song that expresses the feelings in a personal and accurate way; or writing a poem, or creating a drawing or work of art. Great works of art have been made by those who may have had the characteristics of ASD, and experienced particularly intense emotions, for example Michelangelo and Vincent van Gogh.

It is important that family members and friends are aware of the difficulty with the communication of emotions associated with ASD. They may be able to read the signals of increasing emotional intensity within the person with an ASD better than the person him- or herself, due to problems with self-reflection and monitoring internal emotional states. Parents, friends, and perhaps in later life, a neurotypical partner may have the ability to read the signals of increasing emotional intensity, and know the situations that can cause agitation. They can then provide guidance and encouragement in managing and expressing emotions at an appropriate level and will be able to soothe, reassure or console their partner with an ASD when he or she is emotionally distressed or agitated.

RECOMMENDED READING

Attwood, T., Callesen, K. and Moller Nielson, A. (2008) The CAT-kit: Cognitive Affective Training: New Program for Improving Communication! Arlington, TX: Future Horizons.

Baron-Cohen, S. (2007) Mind Reading: The Interactive Guide to Emotions – Version 1.3 (DVD and CD). London: Jessica Kingsley Publishers.