Decision-making in autism: A narrative review.

This review looked at how autistic people make decisions by examining 104 research studies. While autistic people often struggle with real-life decisions, they perform just as well as others on many laboratory tests. The main differences appear in tasks involving self-awareness of performance and making choices based on personal values. This suggests that decision-making challenges in autism may be specific to certain types of thinking rather than general difficulties.

This narrative review examined decision-making abilities in autism across 104 studies involving 2,712 autistic and 3,189 comparison participants. The research identified four categories of decision-making tests: perceptual, reward learning, metacognition, and value-based decisions. Results showed that autistic individuals perform similarly to non-autistic individuals on perceptual and reward-learning tasks. However, differences emerged in metacognitive and value-based decision-making, where autistic participants showed distinct patterns in evaluating their own performance and weighing subjective values of different options.

These findings suggest that reported real-life decision-making difficulties may relate to specific cognitive processes rather than general decision-making impairments.

Findings suggest interventions should focus on metacognitive skills and value-based decision-making rather than basic decision processes. Support strategies may benefit from addressing self-awareness and helping individuals understand their own preferences and performance patterns in real-world contexts.

As a narrative review, this study does not provide statistical meta-analysis of pooled effects. The authors note a discrepancy between laboratory performance and real-life decision-making difficulties that requires further investigation. Study quality and methodological variations across the 104 reviewed studies are not detailed.

Many autistic people report difficulties with real-life decision-making. However, when doing decision-making tests in laboratory experiments, autistic people often perform as well or better than non-autistic people. We review previously published studies on autistic people's decision-making, across different types of tests, to understand what type of decision-making is more challenging. To do this, we searched four databases of research papers.

We found 104 studies that tested, in total, 2712 autistic and 3189 comparison participants on different decision-making tasks. We found that there were four categories of decision-making tests that were used in these experiments: perceptual (e.g. deciding which image has the most dots); reward learning (e.g. learning which deck of cards gives the best reward); metacognition (e.g. knowing how well you perform or what you want); and value-based (e.g. making a decision based on a choice between two outcomes that differ in value to you). Overall, these studies suggest that autistic and comparison participants tend to perform similarly well at perceptual and reward-learning decisions. However, autistic participants tended to decide differently from comparison participants on metacognition and value-based paradigms.

This suggests that autistic people might differ from typically developing controls in how they evaluate their own performance and in how they make decisions based on weighing up the subjective value of two different options. We suggest these reflect more general differences in metacognition, thinking about thinking, in autism.