Emotional self-awareness in autism: A meta-analysis of group differences and developmental effects

Abstract

Emotional self-awareness is increasingly suggested to be an area of difficulty in autism that may predict socioemotional outcomes for this population. However, whether emotional self-awareness is consistently diminished in autism across age and methodology remains unclear. We systematically reviewed 47 papers measuring emotional self-awareness in autistic ( n = 1387) and non-autistic ( n = 1433) participants. Most studies relied on self-report. Of studies testing for group differences, the majority (32/41) found significantly poorer emotional self-awareness in autism. Meta-analyses of self-report measures found that emotional self-awareness was significantly poorer in autism ( d = 1.16). However, when examining age groups individually, autistic children of age 12 years and under were not significantly different from their peers ( d = 0.03). Instead, difficulties emerged during adolescence ( d = 0.63) and increased with age ( d = 1.16 – 1.58). The pattern of emotional self-awareness difficulties being more common in autism, and worsening with age is similar to the development of mental health difficulties in autism. However, findings rely on self-perception and so may reflect poor self-beliefs of socioemotional competence. We propose that negative self-beliefs in autistic populations may account for findings of low emotional self-awareness. Lay abstract Autistic people are thought to have difficulties with identifying and understanding their own emotions. This is referred to as emotional self-awareness. It is important to study emotional self-awareness as people who are more able to understand their own emotions, whether they are autistic or not, are more able to respond to them appropriately, as well as to identify them in other people. It has not yet been confirmed whether autistic people have difficulties with emotional self-awareness, or if any reported difficulties are actually due to the way in which emotional self-awareness is measured in autistic people. If these difficulties do exist, it is also not known when these difficulties emerge. In this research, we reviewed 47 existing studies that measured emotional self-awareness in autistic and non-autistic adults and children. We also compared studies that measured emotional self-awareness in different ways. We found that autistic adults did seem to have poorer emotional self-awareness compared to their neurotypical peers. However, this was not the case with autistic children of age 12 years and below. Instead, differences in emotional self-awareness only seemed to emerge during adolescence. Moreover, these difficulties seemed to increase with age. These results suggest that difficulties with emotional self-awareness may not be inherent in autism. Instead, they may emerge alongside the greater social and mental health difficulties that are experienced by many autistic people during adolescence. We therefore suggest that it is important to find out more about, and subsequently support, the emotional self-awareness difficulties that autistic adolescents may encounter.

Facing up to others' emotions: No evidence of autism‐related deficits in metacognitive awareness of emotion recognition

“…Although a recent meta‐analysis (Huggins, Donnan, et al, 2021) clearly demonstrated poorer emotional self‐awareness in autistic individuals, and especially in adults, Huggins et al note the heavy reliance on self‐report measures such as the Toronto Alexithymia Scale (Bagby et al, 1994). They suggest that such self‐reports may simply reflect autistic individuals' underestimation of their own competencies in this domain.…”

Defining and Measuring Indices of Happiness and Unhappiness in Children Diagnosed with Autism Spectrum Disorder

“…Other researchers have reported similar challenges when examining self-reported measures of pain in autistic children with intellectual disability (Fitzpatrick et al, 2020 ). Furthermore, meta-analyses of self-report measures have shown that emotional self-awareness is diminished in autism (Huggins et al, 2021 ). This barrier could be explained by alexithymia, which is a common trait in autism characterized by difficulties in identifying and describing one’s own emotions (Griffin et al, 2016 ; Kinnaird et al, 2019 ).…”

Age differences and brain maturation provide insight into heterogeneous results in autism spectrum disorder

“…Emotional self-awareness, generally assessed by self-reported alexithymia measures, did not differ between children with and without ASD before the age of 12. However, individuals with ASD become less aware of their own emotions from adolescence into adulthood, while TD adolescents and adults do not exhibit age-related changes (see Figure 6 in Huggins et al, 2021 ). This decrease in emotional self-awareness is likely to undermine emotion regulation, an important skill, by adulthood in those with ASD ( Reyes et al, 2019 ).…”