DuBois et al. (2016) — Interoception in Autism Spectrum Disorder: A review
The wiki had met autism interoception only in passing — a paragraph in Quadt et al. (2018), the ASD row on interoceptive-psychopathology, and the source study behind the ITPE (Garfinkel et al. 2016) named but not read. This is the dedicated review, published two years earlier, and its main service is to show how little there was: a systematic PRISMA search of three databases across 35 years returned exactly five original studies that measured interoception in ASD. Everything the wiki says about autism and interoception rests, ultimately, on this handful.
The five studies
| study | design | n | interoceptive finding |
|---|---|---|---|
| Barttfeld et al. (2012) | fMRI (rest / oddball / interoceptive focus) | 12 hfASD, 12 TD (adults) | Interoceptive-state connectivity increased in ASD (exteroceptive task the reverse); hyperconnectivity correlated with ADOS severity |
| Garfinkel et al. (2016) | 3-dimension model; heartbeat tracking + BPQ | 18 ASD, 18 TD (male adults) | Impaired accuracy, elevated sensibility, awareness intact → enlarged ITPE predicting anxiety |
| Schauder et al. (2014) | Heartbeat counting (children) | 21 ASD, 24 TD (8–17y) | No accuracy difference; ASD sustained attention to heartbeat more constantly |
| Fiene & Brownlow (2015) | Online BAQ + Thirst Awareness Q | 74 ASD, 228 TD (adults) | Decreased body/thirst awareness (d=−1.26 / −1.02) |
| Elwin et al. (2012) | Qualitative (10 autobiographies) | 10 | Lifelong hyposensitivity to interoceptive cues and pain |
Why it matters to the wiki: the sensibility direction is genuinely contested
The wiki’s ITPE and interoceptive-psychopathology pages carry the “low accuracy + high sensibility” signature (Garfinkel’s BPQ result) as the autism interoceptive profile, with a one-line caveat that “at least one study finds decreased subjective body awareness.” This review names and quantifies that dissenting study — Fiene & Brownlow (2015), a large-effect decrease in body and thirst awareness — and adds a second (Elwin’s qualitative hyposensitivity). So the ASD sensibility literature does not point one way. Two of the three sensibility-relevant studies find reduced sensibility; the ITPE’s elevated-sensibility premise comes from one. The review’s own overall read — a “slight tendency toward hyporeactivity in interoceptive awareness” — sides with the majority, against the ITPE story it also reports. This is the tension worth carrying, and it is filed on autism-interoception (created with this ingest). It is not a hard contradiction with existing wiki content: the ITPE page already flags the inconsistency; this review supplies the underlying studies.
The instrument problem, sharpened by the population
Both physiological studies used heartbeat paradigms, so the wiki’s single-channel worry applies here with unusual force: the review itself argues that in ASD the evolutionarily salient interoceptive cues — hunger, thirst, urgency to void, gastrointestinal discomfort (all elevated in autism) — are where the action likely is, yet the measured literature is cardiac. Fiene & Brownlow’s own result dramatizes the point: ASD participants’ thirst awareness dissociated entirely from their fluid intake. The review’s methodological prescription is the one the whole wiki keeps arriving at — multidimensional designs combining neuroimaging, physiology and self-report, guided by an explicit model — plus, specific to autism, adapted non-verbal measures for the majority-of-the-spectrum the five studies excluded (the non-verbal measurement gap that also thins the developmental and dementia ends of this wiki).
Where it lands
- autism-interoception (created here) — the construct’s home page: mixed accuracy, contested sensibility, the ITPE signature and its dissent, insula connectivity, and the predictive-coding framing.
- interoceptive-trait-prediction-error — supplies the Garfinkel (2016) source study first-hand, and names the countervailing Fiene & Brownlow finding.
- interoceptive-psychopathology — the dedicated ASD review behind that page’s autism row; earlier and more focused than Quadt et al.
- sensory-over-responsivity / interoception-exteroception-boundary — the interoceptive half of the “atypical sensory processing in autism” story whose exteroceptive half Schwarzlose et al. carry; both invoke “autism as a disorder of prediction.”
- insular-cortex — ASD insula hypo-/hyperconnectivity (posterior→anterior disconnection; salience/DMN alterations), added as a lesion-free connectivity dissociation.
Brakes
A narrative review of five small, selected, cardiac-heavy, male, normal-IQ samples reaches a hedged conclusion by authorial judgement, not meta-analysis. Its value is not a verdict but a census: it dates and bounds the autism-interoception literature, exposes that its headline sensibility signature is one of two directions, and states plainly that the spectrum’s majority — non-verbal, developmentally disabled — has never been measured at all.