Emotion Dysregulation or Alexithymia? Reinterpreting Childhood Behavioural Symptoms in ADHD and Autism
In a recent study from the University of Edinburgh examining emotion regulation in children, researchers found that slower declines in emotional dysregulation between ages three and seven were associated with higher levels of ADHD, internalising challenges, and conduct difficulties by age seven. These findings point to emotion dysregulation as a significant factor in understanding behavioural and emotional development in childhood. However, they stop short of exploring why these patterns might vary widely within the populations studied. This is where alexithymia—a difficulty in identifying, sourcing, and describing emotions—enters the conversation. Increasingly recognised in the UK, alexithymia offers a compelling explanation for the escalation and dysregulation observed in some autistic and ADHD children. Its role as a distinct, co-occurring characteristic rather than an inherent feature of neurodivergence is crucial to understanding these behaviours.
It is worth considering that many of the “symptoms” highlighted in the study may be linked to the presence of alexithymia rather than being universal aspects of ADHD or autism. This perspective could explain why not all autistic or ADHD individuals exhibit the same levels of emotional challenges. Whilst the study correctly identifies a relationship between emotional dysregulation and behavioural outcomes, its generalised framing risks overlooking the nuanced experiences of those (like me) whose difficulties are rooted in alexithymia. Recognising this distinction not only enhances our understanding of variance within neurodivergent populations but also offers more targeted pathways for support.
Today’s article will review the study’s findings and consider them through the lens of alexithymia, discussing how its presence may shape emotional experiences for some neurodivergent individuals. By reframing these behaviours as linked to emotional self-awareness rather than intrinsic deficits, we can move closer to a strengths-based and identity-affirming approach. Finally, the article will argue for interventions that address alexithymia directly, paving the way for better outcomes for children navigating these challenges.
An Overview of the Study
The study set out to explore how patterns of emotion regulation development in early childhood relate to ADHD, internalising challenges, and conduct difficulties by the age of seven. Using data from the UK’s Millennium Cohort Study, the researchers analysed the trajectories of emotional dysregulation at ages three, five, and seven to determine whether these patterns could act as early indicators of behavioural or emotional struggles. The study’s focus on early childhood—a critical period for emotional development—underscores the importance of identifying markers that might support timely intervention. By examining changes in emotional dysregulation over time, the authors aimed to contribute to a deeper understanding of shared factors underlying these commonly co-occurring challenges.
The study revealed that children who showed slower declines in emotional dysregulation during early childhood were more likely to experience higher levels of “ADHD symptoms,” internalising behaviours, and “conduct issues” by age seven. These findings applied across both boys and girls, with slight differences in the intensity of associations. Whilst the study highlighted the importance of emotion regulation as a transdiagnostic factor, it did not delve into the potential contributors to these differences, such as the presence of alexithymia. By focusing on broad patterns, the study identified important correlations but stopped short of addressing the underlying mechanisms driving these outcomes. This omission is significant, as understanding the root causes of emotional dysregulation could offer more precise and affirming ways to support neurodivergent children.
One notable limitation of the study lies in its reliance on parent-reported measures of emotion and behaviour. Whilst these reports offer valuable insights into a child’s experiences, they are subject to interpretation and bias, particularly when parents may not fully understand or recognise the nuances of their child’s neurodivergence. Moreover, the study’s conceptualisation of emotion dysregulation was broad, grouping various behaviours together without distinguishing specific contributors such as difficulties in emotional awareness or alexithymia. This approach risks oversimplifying the challenges faced by neurodivergent children and overlooking significant variability within the population.
By framing emotional dysregulation as a singular trajectory, the study raises as many questions as it answers. For instance, why do some children show slower improvements whilst others develop emotion regulation skills more quickly? What role do external factors like environment, support systems, and co-occurring conditions play? These gaps suggest a need for further research to explore how factors like alexithymia contribute to the observed outcomes, providing a more nuanced understanding of emotion regulation and its role in neurodivergent development.
Introducing Alexithymia … Again
Alexithymia is a complex “condition” (or way of being) often described as difficulty understanding, sourcing, identifying, and articulating one’s emotions. For many, it can feel like emotions exist behind an impenetrable wall, making it challenging to recognise what is being felt or to connect those feelings with their origins. As someone who experiences alexithymia alongside hyper-empathy, I can attest to how these challenges complicate emotional processing. For example, I may sense a surge of emotion but struggle to discern whether it is sadness, frustration, or anger—or even whether it is my own emotion or something absorbed from those around me. This disconnect creates a significant hurdle in regulating emotions effectively, as the foundational step of identifying what is being experienced is often missing ... and I’m an adult with a ton of life experience.
Hyper-empathy, a heightened sensitivity to the emotions of others, can further complicate this experience. For those like me with alexithymia and hyper-empathy, emotional boundaries can blur, making it difficult to distinguish between internal feelings and the emotional states of people nearby. This often leads to overwhelming situations where emotions escalate quickly or appear disproportionate to the context. Despite these challenges, alexithymia does not mean a lack of emotion. Instead, it reflects difficulties in navigating the emotional landscape, a struggle that can feel alienating in a society where emotional fluency is often taken for granted.
Within neurodivergent populations, alexithymia is more common than in the general population, frequently co-occurring with autism and ADHD (and AuDHD). However, it is not universal; many autistic or ADHD individuals do not experience alexithymia, which helps explain the variability in emotional regulation observed within these groups. For those who do experience it, such as myself, alexithymia can present unique challenges in processing and expressing emotions, often in ways that differ from the broader neurodivergent population. These experiences highlight the importance of recognising alexithymia as a distinct factor, rather than conflating it with the broader traits of autism or ADHD.
The interplay between alexithymia and emotion regulation is particularly significant. Without the ability to identify emotions, individuals may struggle to address their feelings in constructive ways, leading to emotional escalation or withdrawal. This unawareness often contributes to meltdowns or shutdowns, where emotions become too overwhelming to manage. Whilst these behaviours may appear as general dysregulation, they often stem from the foundational issue of being unable to access or interpret one’s emotions. Unlike other forms of dysregulation, which may result from impulse control or external pressures, alexithymia-driven dysregulation is deeply internal and rooted in the challenge of emotional awareness itself.
Recognising the difference between alexithymia-related dysregulation and other forms is crucial for effective support. Traditional strategies aimed at teaching self-regulation may fall short if they do not address the underlying issue of emotional identification. For those with alexithymia, interventions must first focus on building emotional vocabulary and awareness, providing tools to connect internal experiences with external expression. Understanding these differences allows us to move away from one-size-fits-all approaches and towards a model of support that respects and accommodates individual needs, fostering a sense of agency and emotional clarity.
Reinterpreting the Study Through the Lens of Alexithymia
The study’s findings of slower emotion regulation trajectories and increased emotional escalation in children with ADHD and autism align closely with traits often observed in those with alexithymia. For children who struggle to identify and articulate their emotions, regulating those emotions becomes an uphill battle. Without clear awareness of what they are feeling or why they are feeling it, these children may appear to overreact or escalate quickly in situations others would find manageable. Such patterns of emotional dysregulation are consistent with the study’s observations but could also be explained by alexithymic traits rather than being inherent to ADHD or autism.
The lack of emotional insight characteristic of alexithymia could also mimic or amplify the core features of ADHD and autism. For example, difficulty recognising frustration might lead to repeated outbursts or impulsive reactions, behaviours commonly associated with ADHD. Similarly, an inability to identify one’s own sensory overwhelm could resemble autistic sensory processing difficulties. This overlap risks conflating alexithymia-driven behaviours with the broader diagnostic traits of ADHD and autism, potentially obscuring a clearer understanding of why certain children struggle more with emotion regulation than others. Recognising alexithymia as a distinct contributor would not only help refine our understanding of these behaviours but also lead to more targeted interventions that address emotional awareness directly.
One of the most significant implications of linking the study’s findings to alexithymia is its potential to explain the variance observed within the population. The study shows that not all children with ADHD or autism exhibit the same degree of emotional dysregulation or escalation. This variability makes sense when viewed through the lens of alexithymia, which is not universally present in these populations. Some autistic and ADHD children possess strong emotional awareness and may therefore display greater emotional resilience, whilst others, like those with alexithymia, might struggle to regulate emotions effectively because they cannot access the foundational understanding of what they are feeling. This distinction underscores the importance of treating neurodivergent populations as diverse rather than monolithic, acknowledging the range of emotional experiences that exist within these groups.
Gender differences further complicate this picture, particularly given how alexithymia and neurodivergence are often under-recognised in girls. Girls with ADHD and autism are frequently diagnosed later—or not at all—because their behaviours do not fit the stereotypical presentations often associated with these conditions. This bias extends to alexithymia, which may be overlooked in girls who mask their struggles or internalise their emotional difficulties rather than externalising them through visible outbursts. Consequently, the gender-stratified analysis in the study might not fully capture the experiences of girls who are neurodivergent and alexithymic, potentially skewing the results and perpetuating the under-diagnosis of these challenges in girls.
By interpreting the study’s findings through the lens of alexithymia, we gain a deeper understanding of the mechanisms driving emotional dysregulation in neurodivergent children. Rather than viewing dysregulation as an inherent feature of ADHD or autism, we can begin to see it as a result of co-occurring traits like alexithymia. This perspective not only explains the observed variability but also highlights the importance of addressing emotional awareness as a foundational skill. Moreover, recognising the impact of diagnostic biases, particularly for girls, ensures that support systems are better equipped to meet the needs of all children, regardless of how their challenges manifest. In doing so, we move towards a more inclusive and effective model of understanding and supporting neurodivergent individuals.
Implications for Support and Intervention
The study’s recommendations for addressing emotional dysregulation focus on building emotion regulation skills during early childhood. Whilst this is an important step, these interventions risk being ineffective if they do not first address the underlying presence of alexithymia. For children who struggle to identify and articulate their emotions, traditional approaches to emotion regulation—such as teaching self-soothing techniques or managing responses to frustration—may fail to address the root of the issue. Without the foundational skill of recognising their emotions, these children are unlikely to benefit fully from such strategies. The first step, therefore, should be screening for alexithymia in children who show patterns of emotional dysregulation. Identifying this trait would allow for tailored interventions that directly target the unique challenges faced by alexithymic individuals.
Interventions for alexithymia should go beyond generic approaches to emotion regulation and instead focus on building emotional awareness. This might involve structured programmes designed to help children connect their physical sensations to emotional states, gradually developing a vocabulary for describing their feelings. These programmes must be created and led by experts who understand alexithymia, neurodivergence, and their interplay, ensuring that the strategies are effective and affirming. Caregiver education is another critical component. Parents and educators often misinterpret the behaviours of alexithymic children, viewing them as unresponsive or overly reactive without recognising the underlying difficulty in emotional processing. Providing caregivers with the tools to understand and support these children can create environments that foster growth and emotional safety.
The role of the environment cannot be overstated. Low-pressure settings that reduce sensory and emotional overload are essential for children with alexithymia. When these children are not overwhelmed, they are better able to process and engage with their emotions. Such environments also minimise the triggers for emotional escalation, allowing children to practise newly developed skills in identifying and regulating their emotions without fear of judgment or immediate consequences.
To advance this work, future research must explicitly measure alexithymia alongside emotion dysregulation to refine our understanding of these challenges within neurodivergent populations. By exploring how alexithymia interacts with traits of autism and ADHD, researchers can provide more nuanced insights into the causes of emotional dysregulation and the variability observed within these groups. This focus would also shed light on how to design interventions that are not only inclusive but truly effective, ensuring that all children have the tools they need to navigate their emotions with confidence and clarity. Recognising alexithymia as a key factor opens the door to a deeper, more supportive approach to emotional development in neurodivergent children.
Final thoughts …
The behaviours often labelled as “emotion dysregulation” in neurodivergent children require a closer, more nuanced examination. Today’s article has argued that many of these behaviours may stem not from intrinsic features of autism or ADHD but rather from co-occurring alexithymia. By misattributing these challenges, we risk overlooking the root cause—difficulties in emotional awareness—and fail to provide the targeted support these children need. Reframing these behaviours as a response to alexithymia rather than as generalised traits of neurodivergence can lead to more effective and affirming interventions, reducing the frustration and misunderstanding faced by both children and their caregivers.
To achieve this, greater awareness of alexithymia is essential across research, education, and clinical practice. Researchers must incorporate measures of alexithymia into their studies to refine our understanding of its role in emotional dysregulation and its impact on neurodivergent populations. Educators and clinicians need training to recognise the signs of alexithymia and to differentiate its effects from other neurodivergent traits. With this knowledge, they can create environments and interventions that support emotional awareness and regulation more effectively, ensuring that children are met with understanding rather than judgment.
As we work to improve support for neurodivergent children, one question remains: How might recognising alexithymia as a key factor transform the way we view and address emotional challenges? By shifting our perspective, we have the opportunity to create systems that honour the diversity of neurodivergent experiences and provide every child with the tools to navigate their emotions with clarity and confidence. This shift represents a vital step towards a more inclusive and compassionate approach to neurodivergent development.