EMOTIONS
Executive function in AS has characteristics of being disinhibited and impulsive, with a relative lack of insight. This can affect the cognitive control of emotions. There is a tendency to react to emotional cues without thinking. A fast and impulsive retaliation can cause a child with AS to be considered to have a conduct disorder or a problem with anger management.
Neuroimaging studies in autistic people have identified structural and functional abnormalities of the amygdala, a part of the brain associated with the recognition and regulation of emotions including anger, anxiety, and sadness.
People with AS may also have prosopagnosia or face blindness and thus difficulty reading facial expressions and processing facial information. Faces are processed as if they were objects focusing only on the individual components of the face. For example, a furrowed brow can be a sign of anger but also can indicate feelings of confusion. Typical people integrate all the facial signs and context to determine which emotion is being conveyed.
Alexithymia describes someone with an impaired ability to identify and describe feeling states. People with AS have a limited vocabulary of words to describe feeling states, especially the more subtle or complex emotions.
The emotional maturity of children with AS is at least 2-3 years behind that of their peers. They may express anger and affection at a level expected of a much younger child. They have a limited vocabulary to describe emotions and a lack of subtlety and variety in emotional expression. When other children are sad, confused, embarrassed, anxious, or jealous, the child may have only one response, and that is to feel angry. The degree of expression of negative emotions such as anger, anxiety, and sadness can be extreme and described by parents as an on/off switch set at maximum volume.
Identifying emotions in facial expressions is achieved by time-consuming intellectual analysis. AS children can usually identify the extremes of basic emotion, such as intense sadness, anger, or happiness, but the understanding of more subtle expressions such as confusion, jealousy, or disbelief may be elusive.
Children and adults with AS have difficulty making the facial expression of a designated emotion with difficulty, often by physically manipulating their face, providing only one element, such as the mouth shape associated with being sad, or producing a grimace that does not appear to resemble the facial expression of any emotion. They may explain that it is difficult to express the emotion as they are not experiencing that feeling at that moment.
A person with AS might lack subtle facial emotional expressions and be unusually ‘wooden’ or mask-like, sometimes having an unnatural expression or appearing unusually serious. Adults may say “I’ve just got one facial look” or “People tell me to smile, even though I feel great inside.”
Adults with AS may not sympathize with characters in a film, and have a ‘poker face’.
The ability to understand, express, and regulate emotions can be assessed by asking specific questions:
• Does the child have any unusual emotional mannerisms, such as flapping their hands when excited or gently rocking when trying to concentrate or relax?
• Does the child understand the need in some situations for an expression of gratitude, an apology, or an expression of remorse?
• Does the child have difficulty reading the signs of someone being bored, annoyed or embarrassed?
• Does the child lack subtlety or maturity in their expression of anger, affection, anxiety, and sadness?
• Does the child have rapid mood changes?
• How does the child express and respond to affection?
Children may be able to suppress feelings of confusion and frustration at school but release them at home on their loving parent or younger siblings – a Dr. Jekyll and Mr. Hyde – an angel at school but a devil at home and is described by the word masquerading. They are more confused, frustrated, and stressed at school than their body language communicates. It is not the problem of a parent who does not know how to control their child.
Inappropriate or unconventional emotional reactions include giggling or releasing built-up emotions in a ‘volcanic’ emotional explosion. They keep their thoughts and emotions to themselves and replay them recurrently to try to understand what happened. Each replay causes a reexperience of the emotion and eventually, they can cope no longer and express very agitated behaviour. They are unable to effectively articulate and explain their feelings to their parents and don’t seem to know how a parent could help them understand or solve the problem.
Children may be overly attached or detached from a parent or have intense emotional reactions to changes in routines or expectations, or when experiencing frustration and failure. They may switch rapidly from one emotion to another, like a pinball machine. Life can be ‘happy’ or ‘not happy’, ‘angry’ or ‘not angry’ with all the ‘in-between’ emotions on the continuum getting missed. They jump from calm to panic in one major step.
AS people are often most happy when alone or when engaged in their special interest. They may not associate happiness with people or not know what to do when someone is happy. Sometimes happiness is expressed in an immature or unusual way, such as literally jumping for joy or flapping hands excitedly.
When discussing emotions, adults with AS may intellectualize feelings, despise emotionality in others and describe difficulties understanding specific emotions like love. There is often a conspicuous emotional immaturity. Despite their being notorious for becoming irritable over a relatively trivial matter, some adults with AS are renowned for remaining calm in a crisis when some typical adults would panic. They can be useful as a Dr. in an Accident and Emergency department, or soldiers on active duty.
They may not understand that someone can have two feelings at the same time, for example being delighted to have a promotion at work but also anxious about the new responsibilities.
Repairing emotions. If someone unexpectantly is crying, both typical and AS children ask what is wrong, but rather than quickly suggesting words or gestures of affection to cheer them up, the AS child tends to prefer practical action, such as getting tissues for the tears, making a cup of tea, doing their homework, talking to them about their special interest (which is what would cheer up the child) or leaving them alone so they could get over it more quickly. They don’t know why a hug would help except they know that is what you are supposed to do. They care and genuinely want them to feel better, but emotional repair is achieved by practical action, solitude, or imitating the observed response of others. The conspicuous absence or quality of words and gestures of affection is clinically significant.
There may be problems regarding the confidence to respond appropriately. Those who do develop the ability to read the signals may not have the confidence to respond in case they make a mistake and there can be a limited range of emotional repair mechanisms.
Rating scales for emotions. The concept of an emotion ‘thermometer’, bar graph, or a ‘volume scale can be used. A list of behavioural indicators of mood changes can include an increase in time engaged in solitude or in the special interest; rigidity or incoherence in thought processes due to anxiety or depression, or behaviour intended to impose control in the person’s daily life and over others. Also included are panic attacks, comments indicating low self-worth, and episodes of anger. Daily mood diaries can help determine the cyclical nature of or specific triggers for mood changes.
People with AS are often perfectionists, then to be exceptionally good at noticing mistakes, and have a conspicuous fear of failure. There can be a relative lack of optimism, with a tendency to expect failure and not be able to control events. As the adolescent achieves greater intellectual maturity, this can have increased insight into being different and self-perception of being irreparably defective and socially stupid.
ANGER
It is not known how common anger issues are in AS but problems with anger make the family members very keen to reduce the frequency, intensity, and consequences of anger. The rapidity and intensity of anger, often in response to a relatively trivial event, can be extreme. A typical child can gradually increase their expression of anger through all volume levels from one to ten. There may be only two settings, between one and two, and nine and ten. There appears to be a faulty emotion regulation or control mechanism for expressing anger.
When feeling angry, they do not appear to be able to pause and think of alternative strategies to resolve the situation, considering their intellectual capacity and age. There is often an instantaneous physical response without careful thought. When the anger is intense, it may become a ‘blind rage’ and unable to see the signals indicating that it would be inappropriate to stop.
Feelings of anger can also be the response in situations where we would expect other emotions. When sad, some teenagers said their response was ‘try and smash glass’, play violent computer games and ‘hit my pillow’. There can be a confusing combination of anger and depression. When sad, some may get angry with someone who is trying to cheer them up. Words and gestures of affection may not be an emotional restorative. Crying may not work instead get angry and this may repair the sad feeling. Unfortunately, others interpret otherwise. Those with AS have a limited vocabulary of emotional expression that lacks subtlety and precision and can be easily misinterpreted by others.
For some, aggression can have the function of achieving solitude. Anger can be a tool to push people away. They can rely on immature, but sometimes effective, confrontation strategies and emotional blackmail. They may develop a conduct disorder by using threats and acts of violence to control their circumstances.
Aggression can be a means to make people stop what someone is doing. This may especially happen to end bullying.
The amygdala’s functions include the perception and regulation of emotions, especially fear and anger. A metaphor to help understand the function of the amygdala is that of a vehicle being driven on a highway. The frontal lobes of the brain are the driver, who makes executive decisions on what to do, where to go, etc. The amygdala functions as the dashboard of the car, providing the driver with warning signals regarding the temperature of the engine, the amount of oil and fuel, and the speed of the vehicle. In AS, the ‘dashboard’ is not functioning consistently. Information on the increasing emotional ‘heat’ and functioning of the engine (emotion and stress levels) are not available to the driver as a warning of impending breakdown.
This can explain why they don’t appear to be consciously aware of increasing emotional stress, their thoughts and behaviour are not indicative of deterioration in mood. Eventually, the degree of emotion or stress is overwhelming, but it may be too late for the cognitive or thoughtful control of the emotion. There were no early warning signals of an emotional meltdown in observable behaviour that could be used by another person to repair the mood or warning signals in the conscious thoughts of the person with AS to enable him or her to use self-control.
This should not be used as an excuse to avoid appropriate responsibilities and consequences.
Other reasons for problems with anger management include having difficulty expressing feelings using words (alexithymia), and using physical acts to articulate the mood and release the emotional energy.
The anger may make someone feel better. This is an example of negative reinforcement. Hurting someone else may end their distress and can be a powerful reinforcement for aggressive behaviour.
Sometimes acts of aggression are pre-emptive strikes, especially for the bully. “He was going to be mean to me, so I hurt him first.”
Unfortunately, feelings of anger and subsequent aggressive behaviour further alienate the child from constructive interactions with peers. Since peers do not consider the child with AS to be their friend, they can relinquish any responsibility to calm the child down when they are angry.
Managing rage. When the feelings of anger are extremely intense and lead to an explosive rage (Intermittent Explosive Disorder – IED), the DSM-IV defines it as: The person has several discrete episodes of failure to resist impulses that result in serious assault or destruction of property, the degree of aggression is greatly out of proportion to any precipitating psychosocial stressors and not accounted for by other mental disorders such as a personality disorder, psychotic disorder, conduct disorder or ADHD, or alcohol or drugs.
Some actions can cause feelings of anger to increase; these include raising your voice, confrontation, sarcasm, being emotional, and using physical restraint. They may inflame the situation and cause them to become more agitated and less flexible in thinking, which inhibits the ability to consider appropriate options to reduce the feeling of anger. Sarcasm makes them more confused. The others can ‘add fuel to the fire.’
A hug from their mother gets the response “No, it makes me madder.” Touch and physical restraint can increase feelings of anger and energy levels. Asking ‘What’s the matter?” can also inflame the situation, because of their poor ability to articulate the cause of the anger and create further frustration.
The recommended approach is to use a quiet and assertive voice focusing on distracting or releasing more constructive means of releasing emotional energy. This can include suggesting access to the special interest, which can be mentally absorbing and extremely enjoyable, such that the angry feelings are excluded from the person’s thoughts, solitude, to slowly calm down; or an energetic physical activity, such as a long run, to ‘burn off’ the destructive energy.
LOVE
Besides anxiety, sadness, and anger as reasons for clinical referral, love may also be a reason. A person with AS may not understand why typical people are so obsessed with expressing reciprocal love and affection. A hug can be experienced as an uncomfortable squeeze, and the young child with AS may soon learn not to cry, as this will elicit a squeeze from someone. When considering the feeling of love, the person with AS may enjoy a very brief and low-intensity expression of affection and become confused or overwhelmed when greater levels of expression are experienced or expected. The reverse can also occur with the person with AS needing frequent expressions of affection (sometimes for reassurance) and often expressing affection that can be overbearing for others. There may not be a varied vocabulary of affection expression that includes subtle expressions. For some people with AS, the expression is excessive. “We feel and show affection but not often enough, and at the wrong intensity.”
A psychoanalytic study of AS suggests that such people do not fall in love readily.
The neurotypical partner thinks of love as:
• Love is tolerant, non-judgemental, supportive.
• Love is a complex of beliefs that tap into our childhood languages and experiences; it is inspired when you meet someone who has a quality that maybe you admire, or do not have – or that they reflect back to your ideal self which is what you want to be or see yourself as.
Love is passion, acceptance, affection, reassurance, mutual enjoyment.
•Love is what I feel for myself when I am with another person.
The Asperger’s partner may describe love as:
• Love is helping and doing things for your lover. Love is an attempt to connect to the other person’s feelings and emotions.
• Love is companionship, someone to depend on to help you in the right direction.
• Love is I have no idea what is involved.
• Love is tolerant, and loyal, and allows ‘space’.
• Love is I don’t know the correct answer.
• Love is yet to be felt and experienced by myself.
In relationships, AS men are often very honest, loyal, and hardworking, most will be faithful and remain with their chosen partner for life. They will give and offer love in the ways that they can. If their partners understand AS they will appreciate that this giving will often take a practical form. It is unlikely that an AS man will be able to offer emotional support or empathetic feelings. Some women will not be able to love the emptiness and loneliness that this can bring.
Tears trickling down a face can indicate emotional pain, and there are practical actions that they could do to alleviate emotional pain in someone.
A child with AS may intensely dislike public praise. They have a limited tolerance of affectionate and sentimental behaviour in others. Most detest sentimentality, which they think is a wilful display of empty emotion over matters of no consequence, and it really should be avoided because it devalues the true expression of feeling.
If you become anxious about solving a problem, your IQ drops 30 points, and if you become angry, your IQ drops 60 points. When calm and in control of feelings, the solution will be less elusive and more easily discovered.