How does autism influence expectations about emotional support from friends?

PostedDecember 22, 2025

UpdatedDecember 22, 2025

ByMy Patient Advice

Author: Beatrice Holloway, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Autistic people may experience, seek, and recognise emotional support in friendships differently to neurotypical peers. These differences are linked to communication style, emotional processing, and traits such as alexithymia (difficulty identifying or describing feelings) and theory of mind variation. Recent UK and international research (2023–2025) show that while expressions of care may look different, they are no less genuine.

Why emotional support can look different

According to research published in Autism (Sage Journals, 2023), autistic people often use more literal and direct communication, which can make emotional exchanges less reliant on tone or facial cues. Emotional support is frequently expressed through practical help, honesty, or loyalty, rather than verbal reassurance.

Another study in Autism (Sage Journals, 2022) found that alexithymia, which commonly co-occurs with autism, predicts difficulty both recognising one’s own emotions and interpreting others’ emotional needs. This means autistic people may struggle to notice when a friend needs comfort, or to signal when they do it themselves, even though they care deeply.

Understanding emotional empathy and reciprocity

Many autistic individuals experience emotional empathy (feeling with someone) within the typical range, but cognitive empathy (identifying another mental state) can differ. This can lead to mismatched expectations, for example, an autistic person offering practical solutions while their friend seeks emotional validation.

Researchers note that these patterns reflect different communication norms, not lack of empathy. As the National Autistic Society explains, recognising and respecting these differences helps both autistic and non-autistic friends maintain understanding and trust.

What NHS and NICE recommend

The NHS and NICE guidelines (CG142, CG170) emphasise the importance of clear, direct communication and structured emotional support for autistic people. Guidance suggests:

Asking open, direct questions about how to help or support.

Allowing extra processing time during emotional conversations.

Recognising that support may be expressed through actions rather than words.

Structured social communication support recommended in NICE CG170 helps both autistic people and their friends understand emotional differences and build resilience in relationships.

A reassuring takeaway

Autistic people often express care through consistency, honesty, and practical help rather than overt emotional gestures. When friends learn to recognise these expressions and communication needs clearly: emotional connections become more balanced and authentic.

As NHS and NICE guidelines stress, emotional understanding in autism grows best through mutual respect and explicit communication, not assumptions.

Beatrice Holloway, MSc

Author

Beatrice Holloway is a clinical psychologist with a Master’s in Clinical Psychology and a BS in Applied Psychology. She specialises in CBT, psychological testing, and applied behaviour therapy, working with children with autism spectrum disorder (ASD), developmental delays, and learning disabilities, as well as adults with bipolar disorder, schizophrenia, anxiety, OCD, and substance use disorders. Holloway creates personalised treatment plans to support emotional regulation, social skills, and academic progress in children, and delivers evidence-based therapy to improve mental health and well-being across all ages.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.