From Emotion Labeling to Functional Emotional Understanding in Autistic Children: A Narrative Review and Practice Framework for Structured Visual Intervention

Autistic children vary substantially in how they notice, identify, interpret, express, and regulate emotions. Interventions often reduce this multidimensional problem to labeling prototypical facial expressions, a task that may improve under instructional conditions without transferring to everyday interaction. This narrative review integrates research on emotion recognition, alexithymia and interoception, visual supports, technology-mediated instruction, social-cognitive training, and naturalistic intervention. It proposes a functional framework in which structured visual materials are used as temporary scaffolds across five linked targets: noticing multimodal cues, discriminating and labeling states, interpreting context and causes, connecting emotions to bodily experience and action, and generalizing flexible responses across people and settings. The literature supports explicit, predictable, and visually accessible instruction, but evidence for distal generalization and maintenance remains inconsistent. Outcomes are shaped by language and cognitive profiles, co-occurring alexithymia, sensory conditions, task demands, culture, and the responsiveness of communication partners. Accordingly, intervention should be individualized, neurodiversity-affirming, and assessed with ecologically valid measures rather than accuracy on static face tasks alone. The review concludes with practice recommendations and a research agenda emphasizing preregistered comparative trials, component analyses, multimodal outcomes, stakeholder-defined goals, and measurement of spontaneous use in natural contexts.