When asked, “How are you?” some children, after a long hesitation, can only say, “I don’t know.” Others sense from a stomachache that something is wrong, but can’t say whether it’s fear, anger, or sadness. There’s a specific term for this, which literally means “no words for feelings”: alexithymia. It’s often lumped together with autism, even though they’re two different things.
What exactly is alexithymia?
A personality trait, not a diagnosis. People with pronounced alexithymia have difficulty recognizing their own feelings and putting them into words. Their attention tends to focus on things they can see or touch rather than on their own inner life. In the general population, this affects about 5 percent of people. Among people on the autism spectrum, the rate is around 50 percent—ten times as high. It is precisely this high prevalence that leads to confusion, because what is often considered a typical autistic trait may actually be a symptom of alexithymia.
What does this have to do with emotion recognition?
On average, people with autism perform worse at recognizing emotions in facial expressions. However, the average says little about individuals, as there are people with autism who have significant difficulties and others who are exceptionally good at it. The so-called alexithymia hypothesis posits that these difficulties stem less from autism itself than from accompanying alexithymia. A Berlin study involving 120 adults investigated this for the first time using brain imaging. At the behavioral level, alexithymia made no difference: autistic participants with and without alexithymia performed similarly in recognizing facial expressions. In the brain, however, the picture was different. The brain scan images revealed that autistic individuals with alexithymia exhibited different activation patterns in social brain regions. The results thus make it clear that differences in the processing of emotions do not necessarily manifest in observable behavior.
What does this mean for everyday life?
Above all, we should take a closer look. If a child can barely put their feelings into words, that’s not a matter of empathy, nor is it an automatic part of autism. A child can certainly feel deep empathy and still be unable to find the words to express it. Anything that takes a detour through the body is helpful—such as describing together what’s being felt in the moment (“your stomach is tightening; that might be excitement”). Emotion cards or a simple scale from one to five provide a tool when words fail. And a phrase like “I don’t know” deserves patience rather than probing, because sometimes it’s the most honest answer a child can give.
Want to see more from JuCare?
A child who can’t put their feelings into words doesn’t feel any less—they just need different ways to express them. That’s exactly what we work on in autism therapy. If you’re considering therapy for your child, you can request it directly here.
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