Citation
DuBois, D., Ameis, S.H., Lai, M.-C., Casanova, M.F. & Desarkar, P. (2016). Interoception in autism spectrum disorder: a review. International Journal of Developmental Neuroscience, 52, 104–111. doi: 10.1016/j.ijdevneu.2016.05.001
Key findings
- Sensory processing is widely recognised as atypical in autism, but interoception — the processing and subjective experience of internal bodily signals — had been significantly under-researched at the time of this review.
- The available evidence suggested that interoception is atypical in autism, with a slight tendency towards reduced interoceptive awareness, though the degree and directionality of differences were inconsistent across studies.
- The review highlighted the distinction between objective interoceptive accuracy (measured by tasks like heartbeat counting) and subjective interoceptive sensibility (measured by self-report), noting that these can diverge.
- It drew attention to the potential clinical relevance of interoceptive differences for understanding self-stimulatory behaviours, pain processing, and emotional experience in autism.
- The review called for sensory processing models and autism theory to be updated to incorporate interoceptive findings.
Method in brief
This was a narrative literature review of original research on interoception in autism, conducted via systematic searches of major scientific databases (PubMed, CINAHL, PsycINFO, and others). At the time of publication, the body of research was small — the review synthesised findings from a limited number of empirical studies examining interoceptive accuracy, sensibility, and related neural substrates.
Relevance
This paper was one of the first comprehensive reviews to draw attention to interoception as a neglected domain in autism research. Its significance lies not in providing definitive answers — the evidence base was too small for that — but in establishing interoception as a legitimate and important area of investigation. The review argued persuasively that interoceptive differences may help explain several aspects of autistic experience that are poorly understood, including atypical pain responses, difficulties with emotional identification, and some self-stimulatory behaviours. It also highlighted the disconnect between the growing recognition of sensory processing differences in autism (codified in the DSM-5 in 2013) and the near-total absence of interoception from standard sensory assessments.
For practitioners, the paper’s core message remains relevant: if you only assess the external senses, you are missing a significant dimension of sensory experience.
Limitations
- The review was limited by the small number of available empirical studies, making it difficult to draw firm conclusions about the nature or extent of interoceptive differences in autism.
- Most of the studies reviewed involved autistic adults without intellectual disability; the applicability of findings to autistic children or to autistic people with intellectual disability was unknown.
- The review did not systematically control for or address the potential confounding role of alexithymia, which subsequent research has shown to be a crucial variable in this area.
- As a narrative review rather than a systematic review or meta-analysis, the paper did not quantify effect sizes or formally assess risk of bias.