Reasoning on the Autism Spectrum: A Dual Process Theory Account

Atypical pupil-linked arousal induced by low-risk probabilistic choices, and intolerance of uncertainty in adults with ASD

Adults with autism spectrum disorder (ASD) experience stress when operating in a probabilistic environment, even if it is familiar, but the underlying mechanisms remain unclear. Their decision-making may be affected by the uncertainty aversion implicated in ASD and associated with increased autonomic arousal. Previous studies have shown that in neurotypical (NT) people, decisions with predictably better outcomes are less stressful and elicit smaller pupil-linked arousal than those involving exploration. Here, in a sample of 46 high-functioning ASD and NT participants, using mixed-effects model analysis, we explored pupil-linked arousal and behavioral performance in a probabilistic reward learning task with a stable advantage of one choice option over the other. We found that subjects with ASD learned and preferred advantageous probabilistic choices at the same rate and to the same extent as NT participants, both in terms of choice ratio and response time. Although both groups exhibited similar predictive behaviors, learning to favor advantageous choices led to increased pupillary arousal for these choices in the ASD group, while it caused a decrease in pupillary arousal in the NT group. Moreover, greater pupil-linked arousal during decisions with higher expected value correlated with greater degree of self-reported intolerance of uncertainty in everyday life. Our results suggest that in a nonvolatile probabilistic environment, objectively good predictive abilities in people with ASD are coupled with elevated physiological stress and subjective uncertainty regarding the decisions with the best possible but still uncertain outcome that contributes to their intolerance of uncertainty.

Paranoia and Data-Gathering Biases in Autism

Previous research has identified contradictory patterns in autism upon probabilistic reasoning tasks, and high levels of self-report paranoia symptoms have also been reported. To explore this relationship, the present study assessed 64 non-autistic and 39 autistic adults on two variants of a probabilistic reasoning task which examined the amount of evidence required before making a decision and 'jumping to conclusions' (a neutral beads task and an emotionally-salient words variant). The autism group was found to require significantly more evidence before making a decision and to have significantly less jumping to conclusions than the non-autistic group. For those with relatively low levels of paranoia, the emotionally-salient variant impacted on the non-autistic group, but not the autism group.

Understanding decision-making in autistic children and adolescents: Insights from deliberative processes and behavioral economic paradigms

Prior research has shown conflicting findings on decision-making differences between autistic and non-autistic individuals. To address this issue, we applied the Ultimatum and Dictator Games to examine explicit measures (probability of endorsing monetary offers) and implicit measures (response times) associated with decision-making behaviors. By analyzing response times, we aimed to determine whether decisions were intuitive (rapid) or deliberative (slower) reasoning processes. In addition, we administered an executive functions questionnaire to explore how cognitive skills correlate with implicit and explicit decision-making behaviors. The study included 24 autistic and 24 non-autistic children and adolescents aged 8-18 years. Results showed that autistic participants were less likely to propose selfish offers in the Dictator Game than their non-autistic peers. Among autistic participants, this lower tendency to propose selfish offers correlated with better executive function skills. Regarding response times, autistic participants exhibited slower responses than non-autistic participants when accepting and proposing selfish offers in both games. These findings reveal differences in selfish offer tendencies and deliberative reasoning among participants, suggesting that slower decision-making in autistic participants reflects a focus on fairness and sociomoral reasoning. Future research can explore how this reasoning style influences social interactions in various scenarios.Lay AbstractAutistic kids and teens often have unique ways of communicating and socializing with others. Making decisions is important in how we behave daily and how we socialize. To study if autistic participants tend to make more cooperative or selfish choices, we used two games where participants had to share money between themselves and another player. Previous results were not consistent and that is why general assumptions could not be established. Also, previous results focused on the final decisions and did not consider the process that leads to making decisions. To fill the gap in what we know, this study dug deeper by evaluating how quickly or slowly participants made decisions and explored executive functions needed for daily decisions. The study found that autistic participants, with better executive functions, made less selfish offers (where they could keep more money than their peers) than non-autistic participants. Also, autistic participants took more time to decide than non-autistic participants, only when they could earn more money than the other player. Interestingly, these results are consistent with studies indicating that autistic children distribute resources without a primary focus on personal gains. These findings reshape how we view social exchanges and recognize that slow, deliberate thinking can lead to less selfish decisions in autistic children and adolescents. Future research could explore how this reasoning style influences social interactions in varied contexts.

Autistic people differ from non-autistic people subjectively, but not objectively in their reasoning

LAY ABSTRACT

Autistic people often experience challenges in social contexts, and when decisions need to be made quickly. There is evidence showing that autistic people have a tendency for greater deliberation and lower intuition, compared to non-autistic people. This has led to the researchers' proposal that autism is associated with an enhanced level of rationality. However, these theories have been mostly explored through the lens of either only non-social domain or only social domain. To address this gap, we recruited autistic adults and carefully matched them with non-autistic adults for comparison. We used a task representing both social and non-social interactions in a comparison structure and asked participants' moral judgements on scenarios' main characters. This was complemented by subjective and objective measures of reasoning. Our findings did not reveal meaningful differences between groups in terms of deliberation. However, we did observe that autistic participants self-reported lower levels of intuition, compared to non-autistic participants. Autistic people consistently rate themselves as less intuitive than their counterparts. Nevertheless, objective evidence supporting this across tasks and studies is inconsistent.

Iowa Gambling Task performance in individuals with schizophrenia: the role of general versus specific cognitive abilities

Objective

We aimed to explore how specific cognitive processes, such as attention and executive functions, account for variance in decision-making measured by Iowa Gambling Task (IGT) performance among individuals with schizophrenia spectrum disorders.

Methods

Adults (N = 65, M age = 25.4) with schizophrenia spectrum disorders participating in a clinical trial (registered at clinicaltrials.gov NCT03048695) completed the IGT, neuropsychological tests of attention, response inhibition, mental flexibility, working memory, and planning, as well as subtests from the Wechsler tests of intelligence to estimate IQ. Associations between performance on specific tasks, a composite score of executive function and attention, and IGT performance measured in two ways, one using the total net score, decks (C+D) - (A+B) and the other as preference for decks with more frequent gains than losses, decks (B+D) - (A+C), were analyzed with correlational and hierarchical regression analysis controlling for estimated IQ and psychotic symptoms, measured by the Positive and Negative Syndrome Scale.

Results

In the regression analyses, the strongest predictor of IGT performance measured as the total net score was estimated IQ (b = 1.43, p <.001). Neither specific cognitive tasks nor the composite score of executive functioning significantly contributed to explaining variance in IGT total net score beyond IQ and symptoms of psychosis. However, IQ and symptoms of psychosis did not predict tendency towards selecting decks with different gain-to-loss frequency, whereas poorer composite executive functioning predicted a pattern of selecting decks A and C with more frequent losses, (b = 8.30, p <.05).

Discussion

The results suggest that both IQ and executive functions contribute to IGT performance, but in distinct ways. Whereas lower IQ may contribute to overall more disadvantageous decision-making, poorer executive functioning may contribute to a more risk-aversive decision-making style. A clinical implication may be that individuals with schizophrenia and lower IQ or poorer executive functioning will have a higher need for support and interventions targeting decision-making.

Roles of empathy in altruistic cooperation in adults with and without autism spectrum disorder

Background

Altruistic cooperation (AC) is essential in human social interactions. Previous studies have investigated AC-related behavior in children with autism spectrum disorder (ASD), revealing that there is considerable individual variability in the behavior. However, this issue is still largely unexplored especially in the adult population.

Aims

To investigate individual differences in AC-related behavior, we conducted the resource allocation task (RAT) and modified version of the ultimatum game (mUG) among adults with and without ASD.

Methods and procedures

The study employed a cross-sectional design, involving 27 adults with ASD (mean age 29.1 ± 4.3 years; three females) and 27 adults with typical development (TD) (mean age 25.8 ± 6.7 years; two females), who completed the RAT and mUG tasks. Beyond clinical characteristics, we assessed three primary psychological metrics: the interpersonal reactivity index (IRI), Barratt impulsiveness scale, and the behavioral inhibition and activation systems.

Outcomes and results

No significant differences were observed in the proportions of participants with high AC when assessed by RAT (p = 0.15) and mUG (p = 0.59) between the TD and ASD groups. Participants with high AC from the RAT demonstrated higher perspective-taking scores on the IRI than those with low AC within both the TD (p = 0.04) and ASD groups (p = 0.03). In the TD group, high AC individuals also scored higher on the IRI's fantasy subscale as per the mUG (p = 0.03); however, this trend was not present in the ASD group.

Conclusions and implications

The present findings indicate that empathy plays an important role in individual differences in AC-related behavior among adults with and without ASD, although the role could be different depending on the types of AC-related behavior between TD and ASD populations.

Autistic Adults Avoid Unpredictability in Decision-Making

Decision-making under unpredictable conditions can cause discomfort in autistic persons due to their preference for predictability. Decision-making impairments might furthermore be associated with a dysregulation of sex and stress hormones. This prospective, cross-sectional study investigated decision-making in 32 autistic participants (AP, 14 female) and 31 non-autistic participants (NAP, 20 female) aged 18-64 years. The Iowa Gambling Task (IGT) and the Cambridge Risk Task (CRT) were used to assess decision-making under ambiguity and under risk with known outcome probabilities, respectively. Cortisol, estradiol, and testosterone serum levels were related to decision-making performance. Groups did not differ in overall IGT and CRT performance, but compared with NAP, AP preferred less profitable card decks with predictable outcomes while avoiding those with unpredictable outcomes. AP required more time to reach decisions compared to NAP. Additionally, AP without comorbid depression performed significantly worse than NAP in the IGT. Estradiol and cortisol concentrations were significant predictors of CRT scores in NAP, but not in AP. The study results imply that AP are 'risk-averse' in decision-making under ambiguity as they avoided choice options with unpredictable losses in comparison to NAP. Our findings highlight the intolerance for uncertainty, particularly in ambiguous situations. Thus, we recommend being as transparent and precise as possible when interacting with autistic individuals. Future research should explore decision-making in social situations among individuals with ASD, factoring in person-dependent variables such as depression.

Highly logical and non-emotional decisions in both risky and social contexts: understanding decision making in autism spectrum disorder through computational modeling

In risky contexts, autism spectrum disorder (ASD) individuals exhibit more logical consistency and non-emotional decisions than do typical adults (TAs). This way of deciding could be also prevailing in social contexts, leading to maladaptive decisions. This evidence is scarce and inconsistent, and further research is needed. Recent developments in computational modeling allow analysis of decisional subcomponents that could provide valuable information to understand the decision-making and help address inconsistencies. Twenty-seven individuals with ASD and 25 TAs were submitted to a framing-task and the ultimatum game (UG). The Rescorla-Wagner computational model was used to analyze UG decisions. Results showed that in the UG, the ASD group exhibited a higher utilitarianism, characterized by lower aversion to unfairness and higher acceptance of offers. Moreover, this way of deciding was predicted by the higher economic rationality found in the framing task, where people with ASD did not manifest emotional biases such as framing effect. These results could suggest an atypical decision making, highly logical and non-emotional, as a robust feature of ASD.

Putting the Spotlight Back Onto the Flanker Task in Autism: Autistic Adults Show Increased Interference from Foils Compared with Non-autistic Adults

Autistic people may have a less focused spotlight of spatial selective attention than non-autistic people, meaning that distracting stimuli are less effectively suppressed. Previous studies using the flanker task have supported this suggestion with observations of increased congruency effects in autistic participants. However, findings across studies have been mixed, mainly based on research in children and on response time measures, which may be influenced by differences in response strategy between autistic and non-autistic people rather than differences in selective attention. In this pre-registered study, 153 autistic and 147 non-autistic adults completed an online flanker task. The aims of this study were to test whether increased congruency effects replicate in autistic adults and to extend previous work by fitting a computational model of spatial selective attention on the flanker task to the data. Congruency effects were increased in the autistic group. The modelling revealed that the interference time from the foils was increased in the autistic group. This suggests that the activation of the foils was increased, meaning suppression was less effective for autistic participants. There were also differences in non-interference parameters between the groups. The estimate of response caution was increased in the autistic group and the estimate of perceptual efficiency was decreased. Together these findings suggest inefficient suppression, response strategy and perceptual processing all contribute to differences in performance on the flanker task between autistic and non-autistic people.

Autistic adults' experiences of financial wellbeing: Part II

LAY ABSTRACT

Money matters in people's lives. It helps to meet people's basic needs (food, clothes, shelter) and live the lives they want to. When people talk about 'financial wellbeing', they mean how much you feel in control over day-to-day finances and how much freedom you have to make choices to enjoy life. We don't know what autistic people think about these things. That's why we did our study. We spoke to 21 autistic adults (24-69 years) about how they felt about their financial situation. We deliberately spoke to people who had told us previously they felt 'financially well' or 'financially unwell' so we could hear a range of opinions. Autistic people told us financial wellbeing meant having enough money to pay for their basics needs, to have a safety net for unexpected bills and not having to worry about money now or in the future. But many felt that good financial wellbeing was not possible for them. They often did not have a stable income to cover day-to-day expenses. This limited the choices they could make. Despite these challenges, autistic people told us they worked hard to budget and save money when they could - because feeling financial insecure was just too stressful, especially when they could not rely on family or friends for support. It made them feel mentally unwell. Our study shows there are many factors that influence autistic people's financial wellbeing. We need more research to help us understand how autistic people can be supported to achieve financial security.

Autistic adults show enhanced generosity to socially distant others

LAY ABSTRACT

Autistic people show differences in their social behaviour. But how autism affects decisions to share resources, an important part of cooperation, was previously unclear. In our study, participants made decisions about how to share money with different people, including people they felt close to, such as a friend, and people they felt less close to, such as a stranger. We found that compared to a group of non-autistic participants, autistic adults shared more money overall and this was driven by greater generosity to strangers. The results suggest that autistic adults were more generous because they made fair decisions (an equal split of the money) more consistently regardless of how close they felt to the person they were sharing with. By showing that autistic adults display greater generosity, our results could help to change public perceptions of autism and potentially improve opportunities for autistic people.

Identifying cognitive profiles in children with neurodevelopmental disorders using online cognitive testing

Children with neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) tend to exhibit similar deficits in attention and memory ability. Early screening of cognitive deficits in children with NDDs, particularly in preschool children, is fundamental to improving cognitive and academic outcomes. In order to determine cognitive profiles in children with ASD and ADHD, we developed accessible audiovisual instructions for an online battery of 13 cognitive tests. Children ages 4-16 who were diagnosed with ADHD (n = 83), or ASD (n = 37), or who were typically developing children (TD) (n = 86) were recruited. Data were analyzed using a stepwise Discriminant Analysis to determine which cognitive tasks were the strongest discriminators between the diagnostic groups. Results revealed four tasks reflective of working memory, reasoning, and attentional processes, which correctly classified approximately 53-60% of each group. The ADHD group had lower scores on attentional tasks compared to TD, while ASD group had lower scores on reasoning tasks compared to the TD children, and made more attempts across all four tasks. The results from this study stress the need for cognitive screening assessments that include domain-specific items to improve the characterization of executive function deficits and promote academic achievement in all children with NDDs.

Autistic adults' inclination to lie in everyday situations

LAY ABSTRACT

Differences in social communication and understanding others' mental states may mean that autistic adults are less likely to deceive others than non-autistic individuals. We investigated whether autistic and non-autistic adults differ in their inclination to lie and which psychological factors are involved in the inclination to lie. We found that autistic and non-autistic groups reported a similar inclination to lie, and the extent to which participants viewed lying as acceptable helped to explain their inclination to deceive others. However, the other underlying psychological factors associated with deception inclination differed between autistic and non-autistic groups. Autistic adults' belief about their ability to lie and also how quickly they could lie helped to explain whether they were more or less inclined to lie. For non-autistic adults, their memory and ability to understand others' mental states helped to explain their lie inclination. We discuss these findings and recommend areas for future research.

Cognitive biases as an adaptive strategy in autism and schizophrenia spectrum: the compensation perspective on neurodiversity

This article presents a novel theoretical perspective on the role of cognitive biases within the autism and schizophrenia spectrum by integrating the evolutionary and computational approaches. Against the background of neurodiversity, cognitive biases are presented as primary adaptive strategies, while the compensation of their shortcomings is a potential cognitive advantage. The article delineates how certain subtypes of autism represent a unique cognitive strategy to manage cognitive biases at the expense of rapid and frugal heuristics. In contrast, certain subtypes of schizophrenia emerge as distinctive cognitive strategies devised to navigate social interactions, albeit with a propensity for overdetecting intentional behaviors. In conclusion, the paper emphasizes that while extreme manifestations might appear non-functional, they are merely endpoints of a broader, primarily functional spectrum of cognitive strategies. The central argument hinges on the premise that cognitive biases in both autism and schizophrenia spectrums serve as compensatory mechanisms tailored for specific ecological niches.

Differences in Art Appreciation in Autism: A Measure of Reduced Intuitive Processing

Art appreciation reflects an initial emotional and intuitive response to artwork evaluation, although this intuitive evaluation can be attenuated by subsequent deliberation. The Dual Process Theory of Autism proposes that individuals with Autism Spectrum Disorder (ASD) have a greater propensity to deliberate and reduced intuition compared to matched controls. Evaluations of high- and low-quality artworks were undertaken by 107 individuals with a diagnosis of ASD and 145 controls. Controls consistently evaluated high-quality artworks to be much better quality than the low-quality artworks, reflecting intuitive processing. The ASD sample showed a reduced difference in evaluations between high- versus low-quality artwork, which reflects reduced intuitive processing and greater deliberative processing and is consistent with predictions by the Dual Process Theory of Autism.

Neural underpinnings of processing combinatorial unstated meaning and the influence of individual cognitive style

We investigated the neurocognitive mechanisms underlying the processing of combinatorial unstated meaning. Sentences like "Charles jumped for 5 minutes." engender an iterative meaning that is not explicitly stated but enriched by comprehenders beyond simple composition. Comprehending unstated meaning involves meaning contextualization-integrative meaning search in sentential-discourse context. Meanwhile, people differ in how they process information with varying context sensitivity. We hypothesized that unstated meaning processing would vary with individual socio-cognitive propensity indexed by the Autism-Spectrum Quotient (AQ), accompanied by differential cortical engagements. Using functional magnetic resonance imaging, we examined the processing of sentences with unstated iterative meaning in typically-developed individuals and found an engagement of the fronto-parietal network, including the left pars triangularis (L.PT), right intraparietal (R.IPS), and parieto-occipital sulcus (R.POS). We suggest that the L.PT subserves a contextual meaning search, while the R.IPS/POS supports enriching unstated iteration in consideration of event durations and interval lengths. Moreover, the activation level of these regions negatively correlated with AQ. Higher AQ ties to lower L.PT activation, likely reflecting weaker context sensitivity, along with lower IPS activation, likely reflecting weaker computation of events' numerical-temporal specifications. These suggest that the L.PT and R.IPS/POS support the processing of combinatorial unstated meaning, with the activation level modulated by individual cognitive styles.

Exploring randomness in autism

Introduction

The fast, intuitive and autonomous system 1 along with the slow, analytical and more logical system 2 constitute the dual system processing model of decision making. Whether acting independently or influencing each other both systems would, to an extent, rely on randomness in order to reach a decision. The role of randomness, however, would be more pronounced when arbitrary choices need to be made, typically engaging system 1. The present exploratory study aims to capture the expression of a possible innate randomness mechanism, as proposed by the authors, by trying to isolate system 1 and examine arbitrary decision making in autistic participants with high functioning Autism Spectrum Disorders (ASD).

Methods

Autistic participants withhigh functioning ASD and an age and gender matched comparison group performed the random number generation task. The task was modified to limit the contribution of working memory and allow any innate randomness mechanisms expressed through system 1, to emerge.

Results

Utilizing a standard analyses approach, the random number sequences produced by autistic individuals and the comparison group did not differ in their randomness characteristics. No significant differences were identified when the sequences were examined using a moving window approach. When machine learning was used, random sequences' features could discriminate the groups with relatively high accuracy.

Conclusions

Our findings indicate the possibility that individual patterns during random sequence production could be consistent enough between groups to allow for an accurate discrimination between the autistic and the comparison group. In order to draw firm conclusions around innate randomness and further validate our experiment, our findings need to be replicated in a bigger sample.

Thinking, fast and slow on the autism spectrum

What is already known about the topicDaniel Kahneman wrote a highly influential book titled 'thinking, fast and slow'. He proposes that people usually think in a rapid, automatic, intuitive style. When people realise their intuitive thinking may be wrong, a slower, effortful, deliberative style of thinking takes over. It has recently been proposed that thinking in autistic individuals can be characterised as usually thinking in the deliberative style (rather than the intuitive style that non-autistic people usually think in).What this paper addsAs intuitive thinking is fast and deliberative thinking is slow, this research manipulated the time available to complete a series of reasoning questions. These questions have been developed to have intuitive answers (which are incorrect) and deliberative answers (which are correct). For the first time, a fast time manipulation (you must answer quickly) and slow (you must think about your answer before responding) was undertaken with autistic individuals. Autistic participants did produce more deliberative answers than the non-autistic participants. However, both groups produced comparably more intuitive answers and less deliberative answers in the fast condition. This shows that while autistic people tend not to use their intuition, autistic people can be encouraged to use their intuition.Implications for practice, research or policyUsing rapid intuition can be useful in fast-changing contexts, such as some social situations. Future research can explore how to support autistic individuals to use their intuition when the need arises. In addition, the propensity for deliberation resulting in unbiased, correct responses reflects a strengths-based account of autism. This requires more mental effort and is less susceptible to bias and errors. This is called 'Dual Process Theory'.

The Development of Intuitive and Analytic Thinking in Autism: The Case of Cognitive Reflection

The cognitive reflection test (CRT) is a short measure of a person's ability to resist intuitive response tendencies, and to produce normatively correct responses that are assumed to be based on effortful, analytic thinking. A remarkable characteristic of the CRT is that although the questions are open-ended, for each item, the vast majority of people either produce a correct, analytic response or a typical incorrect (i.e., intuitive) response. This unique feature of the CRT makes it possible to investigate the question of whether autistic and neurotypical people share the same intuitions. We report a study that included adolescents and young adults. In both age groups, autistic and neurotypical participants were matched on age, gender, cognitive ability, and educational background. In line with previous findings, the results showed an age-related increase in analytic responding on the CRT, and a decrease in intuitive responding. Crucially, the proportion of both intuitive and analytic responses across autistic and neurotypical participants was identical in both age groups. The current results are in contrast with claims that autistic individuals have an increased tendency toward an analytic/rational type of processing, which is commonly attributed to an impairment within their intuitive reasoning mechanisms.

Psychometric Properties of the Chinese Version of the Comprehensive Autistic Trait Inventory

Background

The Comprehensive Autistic Trait Inventory (CATI) was an appropriate assessment tool that included all the principal dimensions related to autism defined in DSM-5 for the general population. However, its validity and reliability in the general Chinese population still need to be examined.

Purpose

We revised the inventory and estimated the validity and reliability of the Chinese version of the CATI among 2232 general undergraduates.

Methods

The Chinese version of the CATI (CATI-C) was administered to 2259 undergraduates using the online Questionnaires Star electronic system. Internal consistency, convergent validity, discriminant validity, test-retest reliability, and measurement invariance across gender were calculated. In order to determine the diagnostic accuracy and optimal cut-off score of the CATI-C, an analysis using the Receiver Operating Characteristic (ROC) was performed.

Results

The CATI-C includes 35 items of two factors and six dimensions. CFA demonstrated that the fit index of the structure of the scale was good (Satorra-Bentler chi-square/degrees of freedom [S-Bχ² /df] = 2.406, Standardized Root Mean Square Residual [SRMR] = 0.038, Root Mean Square Error of Approximation [RMSEA] = 0.037, Comparative Fit Index [CFI] = 0.929, Tucker-Lewis Index [TLI] = 0.917). The convergent validity examined based on the Autism Spectrum Quotient total score was satisfactory (r = 0.54). The internal consistency reliability of social factor, non-social factor, and total scores were 0.87, 0.85, and 0.90. The test-retest reliability was 0.80. A cut-off score of 115 provided optimal sensitivity and specificity for the CATI-C (sensitivity = 0.926, specificity = 0.781, and Youden's index = 0.707).

Conclusion

The CATI-C has satisfactory reliability and validity in measuring autistic traits. It showed a good model fit for social and non-social second-order bifactors and measurement invariance across gender.

A rule-based theoretical account of social stories to address the double empathy problem

Social Stories™ (SS) is one of the most popular and researched interventions for autistic children. To date, research that focuses on outcomes has been prioritized over the investigation of the psychological mechanisms that inform the intervention. In this article we consider theoretical accounts proposed thus far which could underpin SS. We argue that mechanisms that are based on social deficit theories lack validity, and propose a rule-based theoretical account to inform a strengths-based approach toward conceptualizing the mechanisms that underpin SS. We apply this account to the 'double-empathy problem' to propose that SS can be adapted to involve all parties in the development and delivery of SS support by adopting a rule-based perspective. We use the example of systemizing (the drive to analyze and explore systems in terms of 'if-and-then' rules), which is proposed to be a relative autistic strength, as a form of rule-based thinking that can provide a theoretical account of SS and a framework to address the double-empathy problem.

Sex differences in autistic adults: A preliminary study showing differences in mentalizing, but not in narrative coherence

Studying autism might be a complex endeavor due to its clinical heterogeneity. Little is currently known about potential sex differences in autistic adults, especially regarding mentalizing and narrative coherence. In this study, male and female participants told a personal story about one of their most positive and most negative life events and performed two mentalizing tasks. One of these mentalizing tasks was a recently developed Picture and Verbal Sequencing task that has shown cerebellar recruitment, and which requires mentalizing in a sequential context (i.e., participants chronologically ordered scenarios that required true and false belief mentalizing). Our preliminary comparison shows that males were faster and more accurate on the Picture Sequencing task compared to female participants when ordering sequences involving false beliefs, but not true beliefs. No sex differences were found for the other mentalizing and narrative tasks. These results highlight the importance of looking at sex differences in autistic adults and provide a possible explanation for sex-related differences in daily life mentalizing functions, which suggest a need for more sensitive diagnosis and tailored support.

Antivax attitude in the general population along the autism-schizophrenia continuum and the impact of socio-demographic factors

Introduction

One of the most important inventions in human history is vaccines. However, to date a consistent amount of people exhibit a hesitant approach toward them and mixed results have emerged in the attempt to characterize which factors may play a role in predicting such negative attitude. Here, we aimed at investigating how the individual scoring along the autism-schizophrenic continuum component and socio-cultural factors contribute toward vaccination attitudes in the general population.

Methods

To test whether individual position along the autism-schizophrenic continuum could predict vaccine attitude, we used principal component analysis (PCA) to extract the component showing diametric loading between the Schizotypal Personality Questionnaire (SPQ) and Autistic Quotient (AQ) subscales. Then, we performed a series of multiple linear regression analyses to understand the relation between the ASD-SSD continuum component and Vax scores. We also included socio-demographic factors (i.e., gender, education level, and age) as predictors.

Results

Multiple regression analysis revealed that the closer the individual lied on the positive schizotypal pole, the higher was their negative attitude toward vaccines. A diametric, more favorable disposition was found for individuals closer to the autistic end of the continuum. Furthermore, we reported that among the socio-cultural factors, only age can be considered a significant predictor of vaccination attitudes, with younger participants showing a more positive attitudes toward vaccination, while the level of education is an important protective factor in mitigating the negative impact that the proximity to the SSD pole and age play against vaccination disposition.

Discussion

These findings are relevant to improve targeted public health interventions, highlighting the crucial role of demographic, psychological, and social correlates in predicting anti-vax beliefs, which have the devasting potential to increase the spread of infectious disease.

A capabilities approach to understanding and supporting autistic adulthood

There is little comprehensive research into autistic adulthood, and even less into the services and supports that are most likely to foster flourishing adult autistic lives. This limited research is partly because autism is largely conceived as a condition of childhood, but this focus of research has also resulted from the orthodox scientific approach to autism, which conceptualizes autistic experience almost entirely as a series of biologically derived functional deficits. Approaching autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this Review, we adopt an alternative research strategy: we apply Martha Nussbaum's capabilities approach, which focuses on ten core elements of a thriving human life, to research on autistic adulthood. In doing so, we identify areas where autistic adults thrive and where they often struggle, and highlight issues to which researchers, clinicians and policymakers should respond. The resulting picture is far more complex than conventional accounts of autism imply. It also reveals the importance of engaging autistic adults directly in the research process to make progress towards genuinely knowing autism and supporting flourishing autistic lives.

Facing up to others' emotions: No evidence of autism-related deficits in metacognitive awareness of emotion recognition

Emotion recognition difficulties are considered to contribute to social‐communicative problems for autistic individuals and awareness of such difficulties may be critical for the identification and pursuit of strategies that will mitigate their adverse effects. We examined metacognitive awareness of face emotion recognition responses in autistic (N = 63) and non‐autistic (N = 67) adults across (a) static, dynamic and social face emotion stimuli, (b) free‐ and forced‐report response formats, and (c) four different sets of the six “basic” and six “complex” emotions. Within‐individual relationships between recognition accuracy and post‐recognition confidence provided no indication that autistic individuals were poorer at discriminating correct from incorrect recognition responses than non‐autistic individuals, although both groups exhibited marked inter‐individual variability. Although the autistic group was less accurate and slower to recognize emotions, confidence‐accuracy calibration analyses provided no evidence of reduced sensitivity on their part to fluctuations in their emotion recognition performance. Across variations in stimulus type, response format and emotion, increases in accuracy were associated with progressively higher confidence, with similar calibration curves for both groups. Calibration curves for both groups were, however, characterized by overconfidence at the higher confidence levels (i.e., overall accuracy less than the average confidence level), with the non‐autistic group contributing more decisions with 90%–100% confidence. Comparisons of slow and fast responders provided no evidence of a “hard‐easy” effect—the tendency to exhibit overconfidence during hard tasks and underconfidence during easy tasks—suggesting that autistic individuals' slower recognition responding may reflect a strategic difference rather than a processing speed limitation.

Speed and accuracy of emotion recognition in autistic adults: The role of stimulus type, response format, and emotion

Emotion recognition difficulties are considered to contribute to social-communicative problems for autistic individuals. Prior research has been dominated by a focus on forced-choice recognition response accuracy for static face presentations of basic emotions, often involving small samples. Using free-report and multiple-choice response formats, we compared emotion recognition in IQ-matched autistic (N = 63) and nonautistic (N = 67) adult samples using 12 face emotion stimuli presented in three different stimulus formats (static, dynamic, social) that varied the degree of accompanying contextual information. Percent agreement with normative recognition responses (usually labeled "recognition accuracy") was slightly lower for autistic adults. Both groups displayed marked inter-individual variability and, although there was considerable overlap between groups, a very small subset of autistic individuals recorded lower percent agreement than any of the nonautistic sample. Overall, autistic individuals were significantly slower to respond and less confident. Although stimulus type, response format, and emotion affected percent agreement, latency and confidence, their interactions with group were nonsignificant and the associated effect sizes extremely small. The findings challenge notions that autistic adults have core deficits in emotion recognition and are more likely than nonautistic adults to be overwhelmed by increasingly dynamic or complex emotion stimuli and to experience difficulties recognizing specific emotions. Suggested research priorities include clarifying whether longer recognition latencies reflect fundamental processing limitations or adjustable strategic influences, probing age-related changes in emotion recognition across adulthood, and identifying the links between difficulties highlighted by traditional emotion recognition paradigms and real-world social functioning. LAY SUMMARY: It is generally considered that autistic individuals are less accurate than nonautistic individuals at recognizing other people's facial emotions. Using a wide array of emotions presented in various contexts, this study suggests that autistic individuals are, on average, only slightly less accurate but at the same time somewhat slower when classifying others' emotions. However, there was considerable overlap between the two groups, and great variability between individuals. The differences between groups prevailed regardless of how stimuli were presented, the response required or the particular emotion.

Autistic Adults Show Similar Performance and Sensitivity to Social Cues on a Visual Perspective Taking Task as Non-autistic Adults

Autistic and non-autistic adults completed a visual perspective taking (VPT) task, reporting an object’s location from an actor’s perspective, or their own. On half the trials the actor looked at and reached for the object, and on half did not. Accuracy and reaction time were measured. In Experiment 1, both groups (N = 34, mean age = 24 years) responded slower when reporting the actor’s perspective, with no group differences in this effect. Experiment 2 included “other” VPT trials only. Both groups (N = 30, mean age = 25 years) showed sensitivity to the actor’s behaviour, more accurately reporting his perspective when he acted upon the object. No group differences were observed. In contrast to developmental studies, these experiments suggest similar VPT abilities in autistic and non-autistic adults.

Intergroup bias in punishing behaviors of adults with autism spectrum disorder

Groups are essential elements of society, and humans, by nature, commonly manifest intergroup bias (i.e., behave more positively toward an ingroup member than toward an outgroup member). Despite the growing evidence of various types of altered decision-making in individuals with autism spectrum disorder (ASD), their behavior under the situation involving group membership remains largely unexplored. By modifying a third-party punishment paradigm, we investigated intergroup bias in individuals with ASD and typical development (TD). In our experiment, participants who were considered as the third party observed a dictator game wherein proposers could decide how to distribute a provided amount of money while receivers could only accept unconditionally. Participants were confronted with two different group situations: the proposer was an ingroup member and the recipient was an outgroup member (IN/OUT condition) or the proposer was an outgroup member and the recipient was an ingroup member (OUT/IN condition). Participants with TD punished proposers more severely when violating social norms in the OUT/IN condition than in IN/OUT condition, indicating that their decisions were influenced by the intergroup context. This intergroup bias was attenuated in individuals with ASD. Our findings deepen the understanding of altered decision-making and socioeconomic behaviors in individuals with ASD.

The Impact of Stigma, Autism Label and Wording on the Perceived Desirability of the Online Dating Profiles of Men on the Autism Spectrum

Those seeking romantic relations are increasingly using online dating sites, including young men on the autism spectrum. This study presented dating profiles with and without an explicit label of autism and positive or negative wording to 306 'females seeking a male partner'. Participants assessed the men's dating profiles in terms of perceived attractiveness, trustworthiness and desire-to-date. They also completed a questionnaire on their level of stigmatisation of, and familiarity with, autism. An explicit autism label and positive wording positively impacted perceived attractiveness. With positively worded profiles, those with highly stigmatising views reported decreased desire-to-date when an explicit label of autism was present; those with low levels of stigmatising reported increased desire-to-date when an explicit autism label was present.

The Role of Decision-Making in Psychological Wellbeing and Risky Behaviours in Autistic Adolescents Without ADHD: Longitudinal Evidence from the UK Millennium Cohort Study

This study examined the development of decision-making and its association with psychological wellbeing and risky behaviours in adolescents with and without autism. Participants included 270 autistic and 9,713 typically developing adolescents. In both samples, those with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) were excluded. Data came from the Millennium Cohort Study, a nationally representative population-based birth cohort. Decision-making was assessed using the Cambridge Gambling Task at ages 11 and 14. Psychological wellbeing (happiness, self-esteem, depressive symptoms and self-harm) and risky/antisocial behaviours were self-reported at age 14. After adjusting for sex, cognitive ability, spatial working memory, socioeconomic status and pubertal status, autistic adolescents showed comparable quality of decision-making to that of their peers at both ages but also a more deliberative decision-making style as they aged. Only in autistic adolescents was this decision-making style associated with positive outcomes.

Enhanced rationality in autism spectrum disorder

Challenges in social cognition and communication are core characteristics of autism spectrum disorder (ASD), but in some domains, individuals with ASD may display typical abilities and even outperform their neurotypical counterparts. These enhanced abilities are notable in the domains of reasoning, judgment and decision-making, in which individuals with ASD often show 'enhanced rationality' by exhibiting more rational and bias-free decision-making than do neurotypical individuals. We review evidence for enhanced rationality in ASD, how it relates to theoretical frameworks of information processing in ASD, its implications for basic research about human irrationality, and what it may mean for the ASD community.

Autism - A Comprehensive Array of Prominent Signs and Symptoms

BACKGROUND

Autism Spectrum Disorder (ASD) is a multifaceted neurodevelopmental condition characterized by multiple psychological and physiological impairments in young children. According to the recent reports, 1 out of every 58 newly-born children is suffering from autism. The aetiology of the disorder is complex and poorly understood, hindering the adaptation of targeted and effective therapies. There are no well- established diagnostic biomarkers for autism. Hence the analysis of symptoms by the pediatricians plays a critical role in the early intervention.

METHODS

In the present report, we have emphasized 24 behavioral, psychological and clinical symptoms of autism.

RESULTS

Impaired social interaction, restrictive and narrow interests, anxiety, depression; aggressive, repetitive, rigid and self-injurious behavior, lack of consistency, short attention span, fear, shyness and phobias, hypersensitivity and rapid mood alterations, high level of food and toy selectivity; inability to establish friendships or follow the instructions; fascination by round spinning objects and eating non-food materials are common psychological characteristics of autism. Speech or hearing impairments, poor cognitive function, gastrointestinal problems, weak immunity, disturbed sleep and circadian rhythms, weak motor neuromuscular interaction, lower level of serotonin and neurotransmitters, headache and body pain are common physiological symptoms.

CONCLUSION

A variable qualitative and quantitative impact of this wide range of symptoms is perceived in each autistic individual, making him/her distinct, incomparable and exceptional. Selection and application of highly personalized medical and psychological therapies are therefore recommended for the management and treatment of autism.

A Quick Measure of Theory of Mind in Autistic Adults: Decision Accuracy, Latency and Self-Awareness

Autistic adults often experience difficulties in taking the perspective of others, potentially undermining their social interactions. We evaluated a quick, forced-choice version of the Adult Theory of Mind (A-ToM) test, which was designed to assess such difficulties and comprehensively evaluated by Brewer et al. (2017). The forced-choice version (the A-ToM-Q) demonstrated discriminant, concurrent, convergent and divergent validity using samples of autistic (N = 96) and non-autistic adults (N = 75). It can be administered in a few minutes and machine-scored, involves minimal training and facilitates large-scale, live, or web-based testing. It permits measurement of response latency and self-awareness, with response characteristics on both measures enhancing understanding of the nature and extent of perspective taking difficulties in autistic individuals.

The effect of autism on information sampling during decision-making: An eye-tracking study

Recent research has highlighted a tendency for more rational and deliberative decision-making in individuals with autism. We tested this hypothesis by using eye-tracking to investigate the information processing strategies that underpin multi-attribute choice in a sample of adults diagnosed with autism spectrum condition. We found that, as the number of attributes defining each option increased, autistic decision-makers were speedier, examined less of the available information, and spent a greater proportion of their time examining the option they eventually chose. Rather than indicating a more deliberative style, our results are consistent with a tendency for individuals with autism to narrow down the decision-space more quickly than does the neurotypical population.

Cognitive and Affective Processes Associated with Social Biases

BACKGROUND

Our social activities are quite often erroneous and irrational, based on biased judgements and decision-making, known as social biases. However, the cognitive and affective processes that produce such biases remain largely unknown. In this study, we investigated associations between social schemas, such as social judgment and conformity, entailing social biases and psychological measurements relevant to cognitive and affective functions.

METHOD

This study recruited 42 healthy adult subjects. A psychological test and a questionnaire were administered to assess biased social judgements by superficial attributes and social conformity by adherence to social norms, respectively, along with additional questionnaires and psychological tests for cognitive and affective measurements, including negative affects, autistic traits, and Theory of Mind (ToM). Associations of social judgment and conformity with cognitive and affective functions were examined using a multiple regression analysis and structural equation modeling.

RESULTS

Anxiety and the cognitive realm of ToM were mutually associated with both social judgments and conformity, although social judgements and conformity were still independent processes. Social judgements were also associated with autistic traits and the affective realm of ToM, whereas social conformity was associated with negative affects other than anxiety and an intuitive decision-making style.

CONCLUSIONS

These results suggest that ToM and negative affects may play important roles in social judgements and conformity, and the social biases connoted in these social schemas.

Pattern Unifies Autism

Autism is a highly heterogeneous condition, genetically and phenotypically. This diversity of causation and presentation has impeded its definition, recognition, assessment, and treatment. Current diagnostic criteria for autism involve two domains, restricted interests and repetitive behavior (RRBs) and social deficits, whose relationship remains unclear. I suggest that the large suite of traits associated with autism can be usefully conceptualized under the single rubric of "pattern," a term that connects autism with basic brain and cognitive functions and structures its phenotypes within a single theoretical framework. Autism thus involves increases and enhancements to pattern perception, pattern recognition, pattern maintenance, pattern generation, pattern processing, and pattern seeking. RRBs result from increased and imbalanced pattern-related perception and cognition, and social alterations result in part from the usual lack of clear pattern in social interactions, combined with the interference of RRBs with social development. This framework has strong implications for assessment of social and non-social autism-related traits, personalized therapy, and priorities for research.

Less Illusion of a Just World in People with Formally Diagnosed Autism and Higher Autistic Traits

People differ in how strongly they believe that, in general, one gets what (s)he deserves (i.e., individual differences in the general belief in a just world). In this study (N = 588; n = 60 with a formal autism diagnosis), whether or not autistic people and those with high autistic traits have a relatively low general belief in a just world is examined. The results revealed the expected relationship between autism/higher autistic traits and a lower general belief in a just world. In a subsample (n = 388), personal belief in a just world, external locus of control, and self-deception mediated this relationship. These findings are discussed in terms of autistic strengths (less biased information processing) and problems (lowered well-being).

Impact of past experiences on decision-making in autism spectrum disorder

People are often influenced by past costs in their current decision-making, thus succumbing to a well-known bias recognized as the sunk cost effect. A recent study showed that the sunk cost effect is attenuated in individuals with autism spectrum disorder (ASD). However, the study only addressed one situation of utilization decision by focusing on the choice between similar attractive alternatives with different levels of sunk costs. Thus, it remains unclear how individuals with ASD behave under sunk costs in different types of decision situations, particularly progress decisions, in which the decision-maker allocates additional resources to an initially chosen alternative. The sunk cost effect in progress decisions was estimated using an economic task designed to assess the effect of the past investments on current decision-making. Twenty-four individuals with ASD and 21 age-, sex-, smoking status-, education-, and intelligence quotient-level-matched typical development (TD) subjects were evaluated. The TD participants were more willing to make the second incremental investment if a previous investment was made, indicating that their decisions were influenced by sunk costs. However, unlike the TD group, the rates of investments were not significantly increased after prior investments in the ASD group. The results agree with the previous evidence of a reduced sensitivity to context stimuli in individuals with ASD and help us obtain a broader picture of the impact of sunk costs on their decision-making. Our findings will contribute to a better understanding of ASD and may be useful in addressing practical implications of their socioeconomic behavior.

Evaluation of a Transition to University Programme for Students with Autism Spectrum Disorder

Applying to university can be an anxiety-provoking time for many autistic students, though enrolment can be increased by actively involving them in transition planning. We provide an evaluation of a transition to university pilot programme (Autism Summer School) for autistic students (16–19 years) who are seeking to apply/attend university. The content focused on introducing students to various aspects of university life including academic (sample lectures), social (e.g., clubs and societies), and daily living (eating in university canteen and staying in student accommodation). Students’ quantitative and qualitative feedback are positive and promising, showing significant reduction across a range of concerns related to transition to university after the programme, as well as general optimism related to starting university.

"Reading the Mind in the Eyes" in Autistic Adults is Modulated by Valence and Difficulty: An InFoR Study

Autism spectrum disorders (ASD) are heterogeneous and complex neurodevelopmental conditions that urgently need reliable and sensitive measures to inform diagnosis properly. The Reading the Mind in the Eyes Task (or Eyes Test from now on) is widely used for this purpose. A recent study showed that subcategories of items of the children version of the Eyes Test could be especially discriminative to distinguish ASD and control children. Here, we analyzed the performance on the Eyes Test of 30 high functioning (IQ > 70) adults with ASD and 29 controls from the InFoR cohort multicentric study, using a Generalized Linear Mixed Model. We found that valence and difficulty modulate the performance on the Eyes Test, with easy and positive items being the most discriminative to distinguish ASD and controls. In particular, we suggest this result might be actionable to discriminate ASD patients from controls in subgroups where their overall scores show less difference with controls. We propose for future research the computation of two additional indexes when using the Eyes Test: the first focusing on the easy and positive items (applying a threshold of 70% of correct responses for these items, above which people are at very low risk of having ASD) and the second focusing on the performance gain from difficult to easy items (with a progression of less than 15% showing high risk of having ASD). Our findings open the possibility for a major change in how the Eyes Test is used to inform diagnosis in ASD.

Lay Summary

The Eyes Test is used worldwide to inform autism spectrum disorders (ASD) diagnosis. We show here that ASD and neurotypical adults show the most difference in performance on subgroups of items: ASD adults do not improve as expected when comparing easy and difficult items, and they do not show an improvement for items displaying a positive feeling. We advise clinicians to focus on these comparisons to increase the property of the test to distinguish people with ASD from neurotypical adults.

Digitally-Mediated Social Stories Support Children on the Autism Spectrum Adapting to a Change in a 'Real-World' Context

Social Stories™ (SS) is a widely used intervention for children on the autism spectrum. A preliminary survey of 103 practitioners highlighted that SS are often used to support adapting to a change. This study investigated the use of digitally-mediated SS to support ten children on the autism spectrum attending a school summer camp. Teacher perceptions of anxiety, understanding and closeness to the goal of the SS were assessed before and after the intervention (prior to the event). The pre- post-intervention comparisons highlighted significant improvements in child understanding, anxiety, and closeness to goal with medium-large effect sizes. The child’s understanding and closeness to SS goal post-intervention related to their difficulties with the SS goal and their anxiety during the event.

The fair decision-making of children and adolescents with high-functioning autism spectrum disorder from the perspective of dual-process theories

BACKGROUND

Fairness has received much attention in our society. At present, the findings regarding fair decision-making in high-functioning autism spectrum disorder (HF-ASD) are inconsistent. Previous studies have shown that the fair decision-making of typically developing children is influenced by theory of mind (ToM) and executive functioning (EF). As those with HF-ASD have defects in both domains, this study aims to explore the differences in fair decision-making between children and adolescents with HF-ASD and those with typical development (TD).

METHODS

We used a simple ultimatum game (UG) to explore 31 children and adolescents with HF-ASD and 38 children and adolescents with TD. T tests and chi-square tests were used to compare group differences, and Pearson correlation analysis and stepwise regression analysis were used to analyse the mechanisms influencing the two groups' unfair acceptance rates.

RESULTS

The results show that children with HF-ASD are more likely to accept unfair offers, but for adolescents, the difference is not significant. Regression analysis showed that the interaction between the behavior regulation index (BRI) and age could negatively predict the unfair acceptance rate of children and adolescents with HF-ASD. Working memory and ToM can negatively predict the unfair acceptance rate of those with TD.

CONCLUSION

This study concluded that the development of fair decision-making by children and adolescents with HF-ASD falls far behind that of those with TD. Intuition processes play a dominant role in the fair decision-making processes of children and adolescents with HF-ASD, and we believe that comorbidity, age, experience and emotional management are important factors influencing the fair decision-making of individuals with HF-ASD.

Putting Your Money Where Your Mouth is: Examining Metacognition in ASD Using Post-decision Wagering

It has been argued that metacognition and mindreading rely on the same cognitive processes (Carruthers in The opacity of mind: an integrative theory of self-knowledge, Oxford University Press, Oxford, 2011). It is widely accepted that mindreading is diminished among individuals diagnosed with autism (Brunsdon and Happé in Autism 18(1):17–30, 2014), however, little is known about metacognition. This study examined metacognition in relation to mindreading and autism using post-decision wagering. Results from a student sample showed negative associations between autism traits and metacognitive accuracy, and metacognitive reaction times and mindreading. These findings were replicated in a general population sample, providing evidence of a reliable association between metacognition, mindreading and autism traits. However, adults diagnosed with autism showed equivalent levels of metacognitive accuracy to age- and IQ-matched comparison participants, albeit only with an overall increase in meta-level processing time.

Is There a Relationship Between Cyber-Dependent Crime, Autistic-Like Traits and Autism?

International law enforcement agencies have reported an apparent preponderance of autistic individuals amongst perpetrators of cyber-dependent crimes, such as hacking or spreading malware (Ledingham and Mills in Adv Autism 1:1–10, 2015). However, no empirical evidence exists to support such a relationship. This is the first study to empirically explore potential relationships between cyber-dependent crime and autism, autistic-like traits, explicit social cognition and perceived interpersonal support. Participants were 290 internet users, 23 of whom self-reported being autistic, who completed an anonymous online survey. Increased risk of committing cyber-dependent crime was associated with higher autistic-like traits. A diagnosis of autism was associated with a decreased risk of committing cyber-dependent crime. Around 40% of the association between autistic-like traits and cyber-dependent crime was mediated by advanced digital skills.

Does testosterone impair men's cognitive empathy? Evidence from two large-scale randomized controlled trials

The capacity to infer others' mental states (known as 'mind reading' and 'cognitive empathy') is essential for social interactions across species, and its impairment characterizes psychopathological conditions such as autism spectrum disorder and schizophrenia. Previous studies reported that testosterone administration impaired cognitive empathy in healthy humans, and that a putative biomarker of prenatal testosterone exposure (finger digit ratios) moderated the effect. However, empirical support for the relationship has relied on small sample studies with mixed evidence. We investigate the reliability and generalizability of the relationship in two large-scale double-blind placebo-controlled experiments in young men (n = 243 and n = 400), using two different testosterone administration protocols. We find no evidence that cognitive empathy is impaired by testosterone administration or associated with digit ratios. With an unprecedented combined sample size, these results counter current theories and previous high-profile reports, and demonstrate that previous investigations of this topic have been statistically underpowered.