# Facial Emotion Recognition in Children With Narcolepsy Type 1

## TL;DR

Children with narcolepsy type 1 struggle with understanding others' thoughts but not with recognizing emotions from faces.

## Contribution

This study is the first to compare facial emotion recognition and Theory of Mind in children with narcolepsy type 1 and typically developing peers.

## Key findings

- Children with narcolepsy type 1 showed significant impairment in Theory of Mind compared to controls.
- Facial emotion recognition was not different between children with narcolepsy and controls.
- Daytime sleepiness was linked to worse Theory of Mind performance but not emotion recognition.

## Abstract

Narcolepsy type 1 is a neurological disorder typically emerging in childhood or adolescence, characterised by excessive daytime sleepiness, cataplexy and rapid eye movement sleep‐related symptoms. Beyond its core features, increasing evidence suggests an impact on socio‐cognitive development, including difficulties in understanding others' mental states. In this study, we aimed to clarify whether such impairments extend to more basic emotional processes. We expanded previous work on Theory of Mind by including an analysis of facial emotion recognition and comparing children with narcolepsy type 1 to a newly recruited group of typically developing peers. Twenty‐two children with narcolepsy type 1 and twenty‐two age‐ and sex‐matched controls completed standardised tasks assessing Theory of Mind and facial emotion recognition. Results confirmed a significant impairment in Theory of Mind among children with narcolepsy compared to controls. In contrast, no differences emerged in facial emotion recognition, suggesting a selective disruption in higher‐order socio‐cognitive processes. Additionally, greater daytime sleepiness was associated with poorer Theory of Mind performance, but not with emotion recognition accuracy. These results indicate a specific vulnerability in social understanding during the development of type 1 narcolepsy, probably aggravated by narcoleptic symptoms. However, facial emotion recognition is not affected in these patients, suggesting the involvement of different networks. Early identification of these difficulties and targeted interventions may be crucial to support peer relationships and long‐term psychosocial outcomes in affected children.