Sensory Processing, Alexithymia, Masking, and Emotional Awareness in Autism and ADHD

Autism and ADHD frequently involve differences not only in attention or social communication, but in sensory processing, emotional identification, and identity formation.

Understanding these domains clinically can significantly reduce misdiagnosis, shame, and relational conflict.

The Eight Sensory Systems

Beyond the five traditional senses, we also process:

• Interoception (internal bodily awareness)

• Proprioception (body position in space)

• Vestibular input (balance and movement)

Research demonstrates atypical sensory processing is highly prevalent in autism (Robertson & Baron-Cohen, 2017).

Clients may oscillate between:

• Hyper-awareness (hearing a distant clock ticking)

• Hypo-awareness (not noticing a fire alarm)

Both experiences can coexist.

Sensory overwhelm can contribute to:

• Irritability

• Shutdown

• Fatigue

• Misinterpreted “anger”

Sometimes what appears as emotional dysregulation is actually sensory overload.

Before exploring trauma or relational dynamics, clinicians may need to assess:

• Is the environment overstimulating?

• Is visual clutter draining energy?

• Is noise contributing to stress?

• Does the client need movement input?

Small environmental adjustments can significantly improve emotional regulation.

When Anxiety Fills the Gap

If a client cannot identify that sensory input is overwhelming, the brain may interpret dysregulation as anxiety.

The body feels “off.”
The mind searches for explanation.
Anxiety becomes the narrative.

Teaching clients to differentiate:

• “I am anxious”
  from

• “I am overstimulated”

can alter intervention pathways dramatically.

Alexithymia and Emotional Identification

Alexithymia — difficulty identifying and describing emotions — is more common in autistic populations (Kinnaird et al., 2019).

Importantly, it does not mean absence of emotion. It often means difficulty labeling emotions in real time.

Some clients report:

• Emotions feeling like physical sensations

• Shutdown instead of visible anger

• Difficulty distinguishing hunger, anxiety, anger, or fatigue

Somatic tracking can be more accessible than emotion labeling:

• “What do you feel in your stomach?”

• “Is your body heavy or tight?”

• “What color would this feeling be?”

Gradually linking sensations to emotion vocabulary builds capacity.

Masking and Identity

Masking refers to consciously or unconsciously suppressing autistic or ADHD traits to appear neurotypical (Hull et al., 2017).

Unlike everyday social modulation, neurodivergent masking often involves:

• Suppressing stimming

• Monitoring facial expressions

• Forcing eye contact

• Altering speech patterns

• Hiding specialized interests

Masking may increase short-term social success but predicts long-term exhaustion and depressive symptoms (Hull et al., 2017).

Many late-diagnosed adults discover they have been masking for decades without awareness.

Therapeutic exploration includes:

• What parts of me feel authentic?

• What did I adopt for safety?

• Where can I safely unmask?

• When is strategic masking protective?

Unmasking is not all-or-nothing. Safety matters.

Structure, Routine, and Transition Time

Autistic individuals often rely on predictable routines for cognitive efficiency. Disruption can cascade:

A minor schedule change may require reprocessing the entire day’s expectations.

ADHD clients may resist rigid routine yet benefit from rhythm. A “flexible structure” often works better than strict scheduling.

Transitions are particularly taxing. Supporting clients in building transition rituals — sitting in the car before entering the house, dimming lights at night — can ease nervous system shifts.

Associative Thinking and Cognitive Style

Neurodivergent thinking often follows associative rather than linear patterns.

Linear: A → B → C
Associative: Apple → Red → Firetruck → Childhood memory → Song lyric

This supports creativity and systems thinking but can feel overwhelming.

When telling stories, clients may include contextual detail others deem irrelevant. For the speaker, those details create coherence and safety.

Psychoeducation around differing narrative styles reduces relational friction.

Clinical Integration

Across these domains, a unifying principle emerges:

Neurodivergent traits often become problematic when misunderstood — by others or by the individual themselves.

When we:

• Normalize sensory fluctuation

• Differentiate anxiety from overstimulation

• Support autonomy

• Reduce shame around masking

• Validate cognitive style

we move clients from self-blame toward self-understanding.

And that shift — more than symptom reduction alone — fosters sustainable wellbeing.

References

Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Press.

Hull, L., Petrides, K. V., Allison, C., et al. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47, 2519–2534.

Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review. Autism, 23(3), 611–626.

Robertson, C. E., & Baron-Cohen, S. (2017). Sensory perception in autism. Nature Reviews Neuroscience, 18, 671–684.