Facial expression recognition is linked to clinical and neurofunctional differences in autism.
Hannah Meyer-Lindenberg, Carolin Moessnang, Bethany Oakley and 18 others
PMID 36357905WHAT IT FOUND
Facial expression recognition tests split autistic people into two groups: those with typical recognition and those with significant difficulties.
The low-recognition group had more severe social symptoms and distinct brain activity patterns, suggesting these tests could help target interventions to the right patients.
Key findings
01Cluster analysis identified two subgroups among autistic participants: a high-performing group (69.7%) and a low-performing group (30.3%) with difficulties in facial expression recognition.
02The low-performing autistic subgroup showed significantly higher severity in social symptoms, autism traits, and repetitive behaviours, and lower social adaptive functioning compared to the high-performing subgroup.
03Autistic individuals in the low-performing subgroup had lower brain activation in the amygdala and fusiform gyrus during an emotional face-matching task, whereas no such brain-behaviour link was found in the control group.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The study is cross-sectional, so it cannot determine if expression recognition difficulties cause social symptoms or are a consequence of them. The control group included individuals with mild intellectual disability, which may have influenced comparisons, as expression recognition correlates with IQ. The fMRI analysis was limited to a small subset of participants (n=132) and excluded those with mild ID, reducing generalisability. The clustering boundaries for 'low performance' were more stringent in the autism group than the control group, potentially biasing the proportion of identified subgroups. The study did not test whether these subgroups respond differently to specific interventions, so clinical utility remains hypothetical.
Declared interests
The study was part of the EU-AIMS project, funded by the Innovative Medicines Initiative (a public-private partnership involving the European Commission and pharmaceutical companies). The authors declared no direct conflicts of interest regarding the specific analysis reported, but the broader LEAP study had industry involvement.
The easy way to misread this
Do not assume that all autistic patients have facial expression recognition difficulties. The study shows that only about 30% of the autistic group had significant deficits, and a similar proportion of controls did too. Treating this as a universal deficit in autism may lead to misdirected therapy for those who actually understand facial cues well.