Alexithymia, Autism and Mental Health: Understanding the Overlap
Alexithymia is often overlooked in conversations about children and young people’s mental health. It is not a diagnosis or a mental health condition. Instead, it describes differences in how emotions are recognised, understood, and communicated.
For many neurodivergent individuals, emotions are not easily named or described. This does not mean that they are absent. It means they are experienced and expressed in different ways.
What is Alexithymia?
As Cherry-Beth, Speech and Language Therapist and Autism Clinical Pathway Lead at Words First, explains,
“Alexithymia means ‘without words for emotions’. It is not a diagnosis, but a trait linked to difficulty identifying and describing emotions.”
It is considered subclinical, meaning it cannot be formally diagnosed, but it can be screened for and has clear implications for wellbeing, learning, and mental health.
Alexithymia exists on a spectrum. Individuals experience it in many different ways and these experiences can change over time.
Core features of Alexithymia
Alexithymia is characterised by a cluster of features related to emotional processing. Children and young people may experience the following core features, to varying degrees.
Difficulty identifying emotions
Internal sensations can feel confusing or hard to interpret. Physical states such as hunger, tiredness, or illness may be mistaken for anxiety or emotional distress.
Difficulty describing feelings
There may be challenges finding the right words for emotions or explaining internal experiences in ways that others understand.
Externally oriented thinking
Attention is often focused on events, facts, or tasks rather than internal emotional states. Feelings may not be used as a reference point when making sense of experiences.
Reduced emotional imagination
Some individuals find it difficult to use imagination to explore, reflect on, or make sense of feelings. Emotions may feel flat, distant, or hard to picture.
Reliance on others to interpret emotions
Children and young people may look to others to help them understand how they are feeling. This can make social situations feel demanding or overwhelming.
Alexithymia can be present from birth, referred to as primary or trait Alexithymia, or develop later in response to trauma, chronic stress, or mental health challenges, known as secondary or state Alexithymia.
The overlap with autism
Around 10 percent of the general population experience Alexithymia, with significantly higher rates among neurodivergent individuals. Research suggests that approximately 50 percent of autistic people experience Alexithymia, with similarly elevated rates among people with ADHD.
Difficulties with emotion recognition and empathy, often attributed to autism, may be better explained by the presence of Alexithymia.
As Cherry-Beth explains,
“The difficulty is not having emotions. It is accessing, naming, and describing them.”
When Alexithymia is not recognised, emotional differences may be misinterpreted as a lack of care, motivation, or empathy, rather than differences in emotional access and expression.
Interoception and the mind–body connection
A growing body of research links Alexithymia with differences in interoception, our ability to notice and interpret internal bodily signals such as hunger, heart rate, muscle tension, or the need to use the toilet.
Because emotions are closely tied to physical sensations, reduced interoceptive awareness can make emotional experiences harder to detect and understand. Emotions such as stress, anxiety, or anger may build gradually and only become noticeable once they feel intense or overwhelming.
As Cherry-Beth notes,
“To understand the overlap between autism and alexithymia, we need to understand interoception.”
Living with Alexithymia
For children and young people, living with Alexithymia can feel confusing and overwhelming. Emotional distress is often experienced through the body rather than as named feelings.
This may present as stomach aches, headaches, fatigue, shutdowns, irritability, or sudden emotional overwhelm.
Interpersonal difficulties can also arise. Children and young people may struggle to understand how others are feeling, respond in ways that seem unexpected, or find it hard to explain their own experiences clearly. These differences are not a lack of care or empathy. They reflect differences in emotional processing.
As Linda Bresgi, Educational Psychologist at Words First, explains,
“Alexithymia does not reduce distress. It changes how distress shows up.”
The impact of Alexithymia on mental health
When emotions are difficult to recognise or name, distress may show up through mental health challenges, including anxiety, depression, stress-related burnout, and somatic symptoms.
Linda explains,
“Distress does not appear out of nowhere. It appears late.”
Without early emotional cues, children may appear calm or coping until distress reaches an overwhelming level, leaving little opportunity for early support or regulation.
In educational and clinical settings, this distress is often misunderstood as behavioural difficulty.
As Linda cautions,
“Behaviour is usually the translation, not the source.”
What helps
Supporting children and young people with Alexithymia requires a shift in approach.
Effective support focuses on regulation before reflection, body-based and concrete strategies, and gradual development of interoceptive awareness. Emotional language is modelled without pressure, and experiences are validated even when emotions cannot be clearly named.
As Linda summarises,
“Regulation must come before reflection. A dysregulated nervous system cannot reflect.”
An interdisciplinary approach
Alexithymia sits across disciplines. Speech and Language Therapy, Occupational Therapy, Educational Psychology, and mental health support all play a role in understanding and responding to these differences.
Cherry-Beth highlights the importance of collaboration.
“Collaborative, neurodiversity-affirming planning across disciplines, working together to design environments, communication systems, and therapy approaches that honour the student’s experience.”
At Words First, our interdisciplinary teams work together to support children and young people to strengthen mind–body awareness, build emotional identification skills, and develop emotional literacy in ways that feel safe, supportive, and appropriate to each individual.
Why this matters
When Alexithymia is understood, children are less likely to be labelled, overlooked, misunderstood, or supported only at crisis points.
Recognising Alexithymia allows adults to respond more accurately, notice distress earlier, and support children in ways that fit their needs rather than forcing emotional language before it is accessible.
This understanding sits at the heart of Words First’s neurodiversity-affirming, interdisciplinary practice.
About Linda Bresgi
Linda Bresgi is an Educational Psychologist with over four decades of experience across education and psychology, including 30 years as a preschool teacher and 10 years as an Educational Psychologist. Her combined background supports a strong understanding of child development, learning, and emotional wellbeing across a range of educational contexts.
Linda has worked in schools, private practice, and non-profit settings, and spent 20 months at the Neurodiversity Centre in South Africa developing specialist expertise in neurodiversity-affirming assessment and support. Her work focuses on recognising how emotional distress is communicated when feelings are difficult to identify or describe.
About Cherry-Beth
Cherry-Beth is a Speech and Language Therapist who trained at Newcastle University and began her career in the NHS in London. She later worked for over five years in a non-profit interdisciplinary clinic in New Zealand, progressing into a Lead Speech and Language Therapist role with responsibility for clinical leadership and supervision.
As the Clinical Pathway Lead for Autism at Words First, Cherry-Beth specialises in supporting the speech, language, and communication needs of autistic young people. Her work centres on strengths-based, neurodivergent-affirming practice and collaborative support with families, schools, and interdisciplinary teams.
