Characterizing Interoceptive Differences in Autism: A Systematic Review and Meta-analysis of Case-control Studies.

This research looked at how well autistic people can sense what's happening inside their bodies (like feeling their heartbeat). The study combined results from 15 research studies with nearly 1,000 people. It found that autistic people were less accurate at counting their heartbeats but felt more confident about their ability to do so. This suggests autistic people may experience their internal body signals differently than non-autistic people.

This systematic review and meta-analysis examined interoception (the body's ability to perceive internal states) in autism across 15 studies with 945 participants total. The analysis compared autistic and neurotypical individuals on heartbeat perception tasks and self-reported interoceptive awareness. Results showed autistic participants had significantly reduced accuracy in heartbeat counting tasks but paradoxically higher confidence in their performance compared to neurotypical controls. No significant differences were found in heartbeat discrimination tasks or self-reported interoceptive attention.

These findings suggest specific patterns of interoceptive differences in autism rather than global impairments.

Findings suggest interoceptive training programs for autistic individuals should focus on accuracy rather than confidence. Clinicians should consider that autistic clients may overestimate their body awareness abilities. These differences may relate to broader sensory processing patterns and could inform body-based therapeutic interventions.

The study does not report on the quality assessment of included studies, potential publication bias, or heterogeneity between studies. Sample sizes of individual studies and demographic characteristics are not detailed, which may limit generalizability of findings.

Interoception, the body's perception of its own internal states, is thought to be altered in autism, though results of empirical studies have been inconsistent. The current study systematically reviewed and meta-analyzed the extant literature comparing interoceptive outcomes between autistic (AUT) and neurotypical (NT) individuals, determining which domains of interoception demonstrate robust between-group differences. A three-level Bayesian meta-analysis compared heartbeat counting performance, heartbeat discrimination performance, heartbeat counting confidence ratings, and self-reported interoceptive attention between AUT and NT groups (15 studies; n = 467, n = 478). Autistic participants showed significantly reduced heartbeat counting performance [g = - 0.333, CrI(- 0.535, - 0.138)] and higher confidence in their heartbeat counting abilities [g = 0.430, CrI(0.123, 0.750)], but groups were equivalent on other meta-analyzed outcomes.

Implications for future interoception research in autism are discussed.