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Autistic adolescents experience a secondary wave of social cognitive challenges which impact interpersonal success. We investigated self-conscious emotion (SCE) processing in autistic and neurotypical adolescents. Participants watched videos of peers acting embarrassed and proud and rated inferred and empathic SCEs. We compared intensity ratings across groups and conducted correlations with social cognitive abilities and autistic features. Autistic adolescents recognized SCEs and felt empathic SCEs; however, they made atypical emotion attributions when perspective-taking demands were high, which more strongly reflected the situational context. Atypical attributions were associated with perspective-taking difficulties and autistic feature intensity. An over-reliance on contextual cues may reflect a strict adherence to learned social rules, possibly compensating for less reflexive mentalizing, which may underlie interpersonal challenges in ASD.

This fMRI study investigated neural responses while making appraisals of self and other, across the social and academic domains, in children and adolescents with and without autism spectrum disorders (ASD). Compared to neurotypical youth, those with ASD exhibited hypoactivation of ventromedial prefrontal cortex during self-appraisals. Responses in middle cingulate cortex (MCC) and anterior insula (AI) also distinguished between groups. Stronger activity in MCC and AI during self-appraisals was associated with better social functioning in the ASD group. Although self-appraisals were significantly more positive in the neurotypical group, positivity was unrelated to brain activity in these regions. Together, these results suggest that multiple brain regions support making self-appraisals in neurotypical development, and function atypically in youth with ASD.