Abstract
Purpose of Review
While there are reports of differences in emotion processing in autism, it is less understood whether the emotion of disgust, in particular, plays a significant role in these effects. Here, we review literature on potential disgust processing differences in autism and its possible associations with autistic traits.
Recent Findings
In autism, there is evidence for differences in physical disgust processing, pica behaviors, attention away from other’s disgust facial expressions, and differences in neural activity related to disgust processing. In typically developing individuals, disgust processing is related to moral processing, but modulated by individual differences in interoception and alexithymia.
Summary
Autistic individuals may experience atypical disgust, which may lead to difficulty avoiding contaminants and affect socio-emotional processing. In autism, such outcomes may lead to increased occurrences of illness, contribute to gastrointestinal issues, diminish vicarious learning of disgust expression and behaviors, and potentially contribute to differences in processes related to moral reasoning, though further research is needed.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
It is well known that autistic children face differences in emotional processing; however, it is less understood how some of these differences may be specifically associated with the emotion of disgust. Disgust is a negative basic emotion, mostly associated with “bad taste” [1,2,3, 4•, 5, 6]. Basic emotions (disgust, happy, sad, anger, surprise, fear) are a special set of emotions that are the most distinct and universal across cultures and species and most related to survival [5]. Disgust is thought to be one of the earliest emotions to have been developed evolutionarily due to how critical it is for avoiding contaminants and increasing survival [7,8,9]. Furthermore, feelings of disgust may have evolved to serve as the basis of feelings of contempt and socio-moral evaluations [10]. Autistic children may show differences in disgust processing, potentially leading to pica behaviors, gastrointestinal (GI) disturbances, and socio-emotional issues [11, 12]. However, despite its importance, disgust has been understudied and often rolled together with research on other basic emotions or research on sensory sensitivities. In this narrative review, we introduce the topic of disgust and then explore data on potential disgust processing differences in the autistic population and how they may impact other symptomatology.
Disgust: Background
Most present-day definitions of disgust are derivations of Angyal’s [13] description as the repulsive response to the thought of orally ingesting some aversive or offensive material. Disgust is thought to have evolved in humans as an embodied defense mechanism against contamination and, by extension, society from potentially toxic substances or situations [14, 15]. Damasio [10] has described the social dimension of disgust as akin to contempt. He characterizes contempt as a “biological metaphor for disgust” and acts as a somatic marker that elicits a rejection response to immoral or toxic behaviors, similar to how physical disgust protects us from toxic substances (Somatic Marker Hypothesis: [10, 16,17,18]). This feeling of contempt would have informed early civilizations about the morality of actions, thus laying the foundation for ancient forms of law and socio-cultural norms [19].
Elicitors of disgust may be categorized into different domains. Rozin and colleagues [20] suggested a four-factor model to explain different domains of disgust elicitors: core (i.e., disgusting foods, smells, objects), animal reminder (e.g., injections), interpersonal (e.g., unwanted contact with strangers), and socio-moral disgust (e.g., violating a social norm). Alternatively, Tybur and colleagues [21] proposed a three-factor functional model that includes: pathogen-related disgust (which combines Rozin’s core, animal reminder, and interpersonal contact domains), sexual disgust, and socio-moral disgust. Examples of these situations and descriptions of the domain-specific behavioral signatures can be found in Table 1. In this review, in keeping with relevance to autistic young individuals (henceforth used to refer to both children and adolescents), we focus primarily on core pathogen-related and socio-moral disgust. The methodology for article search can be found in the Supplemental Materials.
Disgust in Autism
Core Disgust in Autism: Behavior
The literature on disgust experiences in autism is considerably limited [22•], due to researchers commonly studying disgust alongside other basic emotions and general emotion and sensory processing differences [23, 24••, 25•]. About 53–94% of autistic individuals experience sensory sensitivities [26], some of which may contribute to the feeling of disgust. There is evidence for both smell hyposensitivity [27•, 28,29,30] and hypersensitivity [31] in autism, which may vary as a factor of age. Furthermore, smell detection distances have been correlated with autistic symptomatology [31]. Olfactory and gustatory sensitivities in particular may play a critical role in the development of food behaviors in autistic children [32, 33]. Particularly, the appraisal of food odors as pleasurable or disgusting and individual olfactory sensitivity was found to significantly influence reluctance to eat new foods in autistic children, but not in the comparison group [33, 34]. However, it has not been established if sensory sensitivities in olfaction or gustation are necessarily linked to higher disgust feelings. It is possible that they are simply more unpleasant rather than specifically invoking disgust. Given that there are many food selectivity issues in autism [35], further studies are needed to better understand how disgust processing may serve as a mediating factor.
Autism is a highly heterogeneous condition and may encompass a wide range of disgust proneness traits that affect food-related behaviors [36, 37]. Disgust proneness [38,39,40,41] encompasses three aspects that moderate individual differences in the experience of disgust: disgust propensity (how often you feel disgusted; [42]), disgust reactivity (how disgusted you are by an aversive stimulus; [41]), and disgust sensitivity (how bad you feel after feeling disgusted; [41, 43]). Previous research has reported that about 50% of youth with ASD exhibit unusual patterns of physical disgust sensitivity [24••]. For instance, potentially indicating lower disgust proneness, young autistic individuals are more likely to eat items that were not meant for consumption, with about 23% displaying pica behaviors [44]. On the other hand, in autism, higher levels of sensory sensitivities are thought to be the main influence on food selectivity, and such sensitivities may interact with disgust proneness [37]. Such interaction may present itself as heightened disgust proneness [45], resulting in more food pickiness. One of the ways children learn about food and contamination-related behaviors during development is through social learning and communication [46,47,48], both of which may be considerably challenging for young autistic individuals [49, 50] and may underlie their diminished contamination sensitivity [24••, 51]. A reduced sensitivity to processing others’ negative emotions may further cause difficulties with disgust learning in autistic individuals [52, 53].
There is also increasing evidence that about 9–91% of autistic children suffer from GI symptoms [54,55,56]. Given that disgust processing disturbances may affect food preferences (i.e., eating foods not meant for consumption or, more subtly, preference for high-carbohydrate foods), issues in disgust processing may indirectly exacerbate GI problems in autism [57,58,59, 60•]. In general, few studies focus on potential differences in core disgust processing in autistic individuals and further research on this topic is needed [11, 24••, 51].
Core Disgust in Autism: Neurobiology
Are there neurological signatures of potential differences in disgust processing in autism? To answer this question, we first discuss the general neural substrates of disgust processing.
Early stimulation studies revealed the insula as a hub for processing nauseated behaviors [61]. Lesion studies found that while several limbic structures were involved in disgust processing [62, 63], damage to the insula in particular was associated with difficulty recognizing disgust, indiscriminate food consumption, and the absence of contaminant-avoiding behavior [64]. Thus, while the insula and associated regions are important in the processing of many emotions, there is evidence that the anterior insula (AI) in particular seems critical for processing core disgust [65]. Furthermore, the AI has also been implicated in processing disgusted facial expressions [66,67,68] and may be an important neural correlate of moral disgust processing [69, 70]. Neuroimaging evidence suggests that dysfunctional integrity and connectivity within the AI can result in divergent disgust experiences, for both core and vicarious disgust [71]. Furthermore, individual differences in disgust proneness, socio-cultural factors, and educational environments may modulate neural activity associated with disgust [22•, 72,73,74].
In autistic individuals, the differential functional integrity of the AI compared to peers has been consistently found to be associated with difficulties with emotion, empathic, and social processing, including disgust-related processing [75,76,77,78,79, 80••, 81, 82]. Hence, atypical functional activity and connectivity in the AI in young autistic individuals may underlie difficulties with disgust emotion processing. However, the insula is a complicated structure, working alongside networks of regions [83, 84], and involved in a multitude of social [85, 86], emotional [87, 88, 89•, 90], sensory [91] (see also Somatic Marker Hypothesis: [16,17,18, 92]), and cognitive tasks [93, 94]. Indeed, disgust may activate a network of regions between the insula and frontotemporal regions involved in interoceptive, emotional, and socio-cognitive processing [95]. It has been argued that the AI, in part, processes domain-specific disgust experiences and serves as a hub for disgust experiences, managing inputs from emotion-related regions (amygdala, striatum, putamen, medial prefrontal, orbitofrontal, sensory, and anterior cingulate cortices) as well as from the viscera [22•]. How these networks uniquely differ during core disgust processing in autism remains to be better understood [96].
Facial Recognition and Vicarious Learning of Disgust in Autism
Around the age of seven, children learn about disgust vicariously, by watching others or hearing of others having disgust experiences [97]. The ability to recognize another person’s disgusted facial expression, a first step to vicarious disgust processing, involves neural activity in facial emotion recognition (FER) circuits (inferior occipital regions, fusiform face area [FFA], the posterior superior temporal sulcus [pSTS]), and emotion-related brain regions like the insula and amygdala [39, 97].
Interestingly, personally feeling disgusted and observing another person experiencing disgust tend to activate the same regions in the AI and anterior cingulate cortex (ACC) [98, 99], suggesting shared circuits for self and vicarious disgust processing [99,100,101]. Vicario and colleagues [74] further found that individual differences in disgust sensitivity predicted not only the suppression of tongue motor activity (cortico-hypoglossal inhibition) upon viewing disgusting stimuli, but also upon viewing others experiencing disgust. Taken together, these results indicate that we implicitly mirror others’ experiences of disgust [74].
In autistic individuals, many studies have found compelling evidence of difficulties with FER, especially for others’ disgust and anger facial expressions [23, 25•, 102,103,104,105, 106••, 107••]. Behaviorally, for example, Zhao and colleagues [25•] found that young autistic individuals exhibit increased attention bias and hypervigilance when viewing disgusted facial expressions, which leads to avoidant gaze behavior toward the entire set of emotional face stimuli. Similarly, Yeung and colleagues [106••] found that young autistic individuals may have emotion-specific FER difficulties (i.e., for specific negative emotions, like disgust) above and beyond differences in face processing seen in autism. Thus, differences in processing disgust faces may impact other socio-emotional processing. These differences may have important downstream implications for the learning of disgust stimuli and appropriate disgust responses from parents, peers, and teachers.
Neuronally, a number of brain regions including the ACC, precuneus, fusiform, inferior frontal gyrus pars opercularis (IFGop), and amygdala may be differentially activated in FER in autism [86, 102, 108,109,110,111,112,113,114,115,116,117] and differences may be impacted by development [118]. However, most studies have focused on numerous facial expressions, not just disgust facial expressions, making it difficult to infer disgust-specific neuronal FER differences in ASD. One study by Bastiaansen and colleagues [118] explored potential differences between viewing disgust, pleasure, and neutral facial expressions in autistic versus non-autistic participants and found no group by emotion differences. However, looking across facial expressions, they found that younger individuals in the autistic group showed lower activity in the IFGop compared to both a typically developing group and a group with schizophrenia [118], and that activity in the IFGop correlated with autistic symptomatology, a finding that has also been shown in other studies that considered observation of facial expressions of different emotions in autistic populations [108, 110]. To better understand if disgust facial expressions may be neuronally processed differently than other negative emotions in autism, further studies are necessary.
Socio-moral Disgust in Autism
Background
Rationalist theories of morality dominated early thinking of moral development and decision-making [119,120,121,122]. These theories purported the importance of understanding the intentions of the moral agents via the theory of mind (ToM) or mentalizing, role-taking, recognition of the victim’s emotional state, and empathic processing. However, more recently, another moral decision-making theory, the “social intuitionist theory” [123] has developed to suggest a critical interplay between disgust processing and moral processing, as well as the impact of culture in influencing moral reasoning [20, 124, 125]. The intuitionist theory is in many ways similar to Damasio’s theory on feelings of contempt arising from disgust [10]. It suggests that in the same way, physical disgust deems smelly food “bad,” negative evaluations of social norm violations can lead to feelings of “impurity” which influence aversive behaviors directed towards immoral agents, deemed as “bad and harmful” [126,127,128]. Moral foundations theory [129,130,131], an extension of social intuitionist theory, redefines these moral intuitions into moral foundations (care/harm, fairness/cheating, loyalty/betrayal, authority/subversion, sanctity/degradation, liberty/oppression), developed to resolve social problems [130, 132, 133]. Of these moral foundations, sanctity (or purity) violations (degrading acts [i.e., drunken groping], sexually deviant acts, or acts that pose a risk of contamination [i.e., urinating in a public pool]) have been most closely linked with the emotion of disgust [134••, 135, 136]. Supporting this claim, sanctity violations have been associated with disgust facial responses [137, 138]. However, some researchers suggest that disgust is likely linked with all the moral foundations to some degree [135, 139,140,141,142].
In support of these theories, in non-autistic participants, prior work indicates that the perception of a physically disgusting stimulus can bias moral judgment during evaluations of moral actors [99, 141, 143••, 144]. This may be due to core and socio-moral disgust both inducing the same oral-nasal rejection behavioral and facial responses [69, 138, 145]. Cannon and colleagues [137] found the disgust facial response was most associated with moral transgressions involving violations of purity and fairness, while anger facial responses were more associated with harm violations. Additionally, they found that the intensity of the facial response corresponded with the perceived severity of the moral violations [137], with similar findings in children [146].
Furthermore, feelings of core and socio-moral disgust may be manipulated using olfactory stimuli that either inhibit or elicit nausea [99, 140, 141, 147]. Wheatley and Haidt [142] found that the sensation of an extrinsically disgusting odor can elicit more stringent moral evaluations. Expanding on this relationship, Schnall and colleagues [140] conducted a series of experiments to test the effect of extrinsic disgusting stimuli on moral evaluations. They found that the perception of a disgusting odor, being in a disgusting room, watching disgusting videos, or vividly remembering a disgusting experience can elicit more stringent moral evaluations. However, in some cases, these results only held true in participants with higher levels of interoceptive awareness [140].
Disgusting smells can also influence feelings of interpersonal trust, which may undermine social trust and relationships and bias moral evaluations of others. For instance, Lee and colleagues [148] found priming participants with a fishy odor (an embodied metaphor of suspicion) induced higher feelings of mistrust. Finally, one study found that the inability to differentiate emotions, a common feature of alexithymia, was found to predict reduced effects of disgust priming on moral judgments [149]. Taken together, there is evidence to support intuitionist/moral foundation theory, with studies indicating a strong relationship between physical and moral disgust processing, though these may be modulated by interoceptive ability and the presence of alexithymia. Thus, in autism, where there are common co-existing differences in disgust processing [24••], interoceptive awareness [150], and/or high co-occurrence of alexithymia [151, 152], one may expect differences in moral judgments. These, in turn, could adversely affect social relationships [153], if not properly understood.
Socio-moral Processing in Autism
Most studies on autism have focused on mentalizing abilities, in line with rationalist theories of moral judgments [154,155,156,157,158,159,160]. These studies indicate that young autistic individuals show differences in mentalizing ability when compared to non-autistic peers, though they can often ascribe others’ mental states just as well as non-autistics with more time [154, 160]. In addition, one review indicated that in judging accidental situations (i.e., accidentally causing someone to fall while playing and running around), autistic individuals tend to have more outcome-based reasoning compared to non-autistic peers, who instead relied more on intent-based reasoning [161]. Another study in autistic adults also found differences in moral reasoning for transgressions of others during a social intentionality task (e.g., a confidant giving away embarrassing information either purposely or by mistake), in which autistic individuals made more rigid and relatively more stringent judgments for both intentional and unintentional actions as compared to non-autistic individuals [162]. Understanding these potential differences in reasoning is important, because stricter and more stringent judgments by some autistic children may result in awkward social interactions with non-autistics, loss of friendships or acquaintances, and social ostracism [163].
On a closer look, while several studies indicate autistic individuals tend to prioritize outcomes over intents in justifying moral decisions [164••], some researchers found that autistic children tend to make similar judgments as peers without autism [134••]. Incidentally, punishment recommendations in the autism group were more predicted by perceived wrongness of transgressions rather than autistic traits [134••]. Nevertheless, autistic children were found to make significantly more punishment recommendations for moral transgressions than the comparison group (particularly for social norm violations [134••]). By contrast, Margoni and colleagues [165•] found that autistic children were able to make intent-based moral judgments and that previous differences could be explained by the prevalence of executive dysfunction and difficulties inhibiting a prepotent outcome response [151, 162, 166]. Furthermore, autistic individuals may require that the moral agent’s intentions be explicitly described in order to make intent-based moral judgments [162, 167], while unclear or vague descriptions of intentions will predispose them to making outcome-based moral decisions and more stringently meting out punishment to unintentional acts by moral agents [168,169,170]. This is consistent with prior reports of differences in intention understanding in autism [161, 169, 171]. Interestingly, one study found that autistic and alexithymic traits had opposite effects on utilitarian decision-making during a moral decision-making task (the trolley problem), with higher alexithymic traits (rather than autistic traits) resulting in more utilitarianism [158]. Taken together, prior research indicates that there may be an interplay between intention understanding, executive functioning ability, and alexithymia in moral reasoning in autism.
How might disgust processing differences also impact differences of moral reasoning in autism? Is there also evidence for the intuitionist/moral foundation theory in autism, with disgust impacting the processing of moral reasoning? Previously, we discussed the heterogeneity within autism, which could possibly lead to a range of disgust proneness [36, 37], interoception ability, and levels of alexithymia. However, given some autistic individuals experience potential differences in disgust processing [24••], interoception ability [150, 172,173,174], and increased prevalence of co-occurring alexithymia (55%; see [175, 176•]), all of which are known to impact moral decisions in non-autistic populations, one may expect a dynamic interplay of these factors in some autistic children [150, 177]. However, to our knowledge, there have not been extensive studies on this topic, and further work is needed to better understand the potential impact of disgust processing differences (alongside alexithymia and interoception processing differences) with potential differences in moral reasoning in autism. Given that such outcome-oriented decisions may dampen cooperative social behavior in autistic children, leading to social ostracism [163], a better understanding of such factors could facilitate improved social relationships for autistic children, all of which we discuss in the sections below.
The Potential Importance of an Intuitionist and Neurodiversity Approach
According to Haidt’s intuitionist approach [123] and the philosophy of neurodiversity [178,179,180,181], autistic individuals may recruit more learned rules-based resources and fewer emotion-based resources, and, as a consequence, even if they do not show differences with moral decision-making, their sources for moral judgments and moral development may prioritize different foundational domains [164••]. For example, in autistic individuals, from an intuitionist perspective, respecting authority and following rules could be the driving force behind making more outcome-based moral, rule-bound decisions [161, 162, 182, 183]. This may interact with co-occurring differences in disgust and interoceptive processing in autism, as well as the increased incidence of alexithymia, all leading to differential moral reasoning; namely less emotion-based decisions and more rule-based decisions. Indeed, there is evidence that hunter-gatherer societies also engage in outcome-based (rather than intention-based) moral reasoning and that the role intentions play in moral reasoning may instead depend on culture and context (see weak moral intent hypothesis, [177]), consistent with the notion that discussing these differences as “deficiencies” may not be appropriate. This unique neurodiverse perspective offers an alternate approach toward understanding potential differences in the processing of moral attributions in autistic individuals, but requires more research.
In contrast to the rationalist approach to understanding moral behaviors in autism — which has been the dominant way of investigating moral judgments in autism to date — an embodied cognition perspective could explore potential neuropsychological links between disgust processing and moral decision-making in young autistic individuals. This appears to be an open area of investigation, with startlingly few prior studies. Future studies in this area could help better understand how seemingly disparate autism symptomologies (sensory sensitivities, disgust processing differences, pica and food pickiness, potential interoception issues, alexithymia, FER disturbances, outcome-based moral decisions), may be interrelated and share common neural substrates and interactions. Such a theory could exist in parallel to those stressing the impact of executive functioning and ToM difficulties in autism, both providing avenues for interventions that can improve social relationships once better science is applied. We note that such theories for decision-making and mentalizing processing being influenced by emotion processing have been previously described in research related to the Somatic Marker Hypothesis [17, 18, 79, 184,185,186,187,188]. Thus, in Fig. 1, we adapt the somatic marker hypothesis model as a proposal of one possible conceptual neural network representation highlighting the relationships between the disgust, sensory, and moral processing neural systems.
Conceptual model of the relationship between disgust, sensory, and moral processing regions in the brain and the hypothesized effect of autistic traits on these functional connections. Functional links are shown in arrows with triangular tips, somatic state linkage is shown with an arrow with diamond tips, and potential effects of autistic traits are shown in dashed arrows with rounded tips. ACC, anterior cingulate cortex; VMPFC, ventromedial prefrontal cortex; OFC, orbitofrontal cortex; DLPFC, dorsolateral prefrontal cortex; PCC, posterior cingulate cortex; SMA, supplementary motor area. Adapted from the Somatic Marker Hypothesis model in Bechara 2013; Koob et al. 2019; Saive et al. 2014 [193,194,195]
Conclusions
Here we summarized the literature on disgust processing and disgust-relevant behaviors in autism and compared it with research conducted on non-autistic individuals. There is evidence for behavioral and neurological differences in disgust processing in autism, in particular with physical disgust, as well as with processing other people’s disgust experiences, though further studies focusing particularly on disgust are necessary. In addition, in the future, this literature will need to be expanded to encompass individual differences on disgust propensity in autism, much like the sensory processing research has focused on both hypo- and hyper-individual sensory sensitivity differences. While we found no prior studies directly focusing on moral disgust in autism, based on the existing literature in non-autistics, we believe this is a rich avenue for future inquiry. It will be especially interesting to probe for potential relationships between alexithymia, interoception, disgust processing, sensory sensitivities, and moral disgust in autism both behaviorally and neurologically.
Indeed, further research on disgust processing in autism is important, due to the impact of disgust on health and activities of daily living. Young autistic individuals are prone to pica behaviors [44] and food selectivity [37], which can lead to further GI distress, disease, or toxicosis. Additionally, autistic children also have an early attentional bias away from attending to disgusted facial expression [25•, 189]. This bias away from attending to disgusted faces, especially those of one’s caregivers, may preclude the proper processing of disgusted faces required for vicarious learning of disgust [25•] during development. Thus, inefficient disgust processing and disgust learning in young autistic individuals may affect their physical, mental, and social health. Furthermore, given the tendency to make stricter judgments of unintentional actions, young autistic individuals may face difficulties with forming social relationships [162] and cooperative behavior [190], though data on alterations in disgust processing impacting these social judgments in autism remains to be determined. Furthermore, there is a need for a neural model in autism that better explains the potential impacts of sensory (exteroceptive and interoceptive) and emotional processing on cognitive, executive, and decision-making processes. How this model may interact with current Bayesian [191] and allostatic learning models of autism [192] remains an exciting future prospect.
Data Availability
No datasets were generated or analysed during the current study.
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Ekman P. Are there basic emotions? Psychol Rev. 1992;99:550–3.
Ekman P, Cordaro D. What is meant by calling emotions basic. Emot Rev [Internet]. 2011 [cited 2023 Jan 30];3:364–70. Available from: https://doi.org/10.1177/1754073911410740.
Izard CE. Forms and functions of emotions: matters of emotion–cognition interactions. Emot Rev. 2011;3:371–8.
• Knowles KA, Cox RC, Armstrong T, Olatunji BO. Cognitive mechanisms of disgust in the development and maintenance of psychopathology: a qualitative review and synthesis. Clin Psychol Rev [Internet]. 2019 [cited 2020 Oct 6];69:30–50. Available from: http://www.sciencedirect.com/science/article/pii/S0272735817304038. This qualitative review highlights the cognitive biases associated with disgust, particularly attentional biases, and how they might relate to psychopathology.
Levenson RW. Basic emotion questions Emot Rev. 2011;3:379–86.
Olatunji BO, Sawchuk CN. Disgust: characteristic features, social manifestations, and clinical implications. J Soc Clin Psychol [Internet]. 2005 [cited 2020 Oct 2];24:932–62. Available from: https://doi.org/10.1521/jscp.2005.24.7.932https://guilfordjournals.com/doi/abs/10.1521/jscp.2005.24.7.932.
Curtis V, de Barra M, Aunger R. Disgust as an adaptive system for disease avoidance behaviour. Philos Trans R Soc B Biol Sci [Internet]. 2011 [cited 2023 Mar 23];366:389–401. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3013466/.
Darwin C. The expression of the emotions in man and animal. 1872.
Darwin C, Prodger P. The expression of the emotions in man and animals. Oxford University Press. 1998.
Damasio A. Neural basis of emotions. Scholarpedia [Internet]. 2011 [cited 2021 May 3];6:1804. Available from: http://www.scholarpedia.org/article/Neural_basis_of_emotions.
Dimopoulou S, Kalyva E, Siegal M. Autism, communication impairment, and gastrointestinal symptoms. 2006;256. Available from: http://seerc.org/docs/phd-resources/DSC2006.pdf#page=264.
Madra M, Ringel R, Margolis KG. Gastrointestinal issues and autism spectrum disorder. Child Adolesc Psychiatr Clin N Am [Internet]. 2020 [cited 2022 Feb 7];29:501–13. Available from: https://www.sciencedirect.com/science/article/pii/S1056499320300171.
Angyal A. Disgust and related aversions. J Abnorm Soc Psychol. 1941;36:393–412.
Harrison NA, Gray MA, Gianaros PJ, Critchley HD. The embodiment of emotional feelings in the brain. J Neurosci [Internet]. 2010 [cited 2021 May 4];30:12878–84. Available from: https://www.jneurosci.org/content/30/38/12878.
Reyes BM-A. Disgust as a protective emotion of physical and mental health. Int J Innov Sci Res Technol. 2019;4.
Damasio A. Feelings of emotion and the self. Ann N Y Acad Sci. 2003;1001:253–61.
Damasio AR, Everitt BJ, Bishop D, Roberts AC, Robbins TW, Weiskrantz L. The somatic marker hypothesis and the possible functions of the prefrontal cortex. Philos Trans R Soc Lond B Biol Sci [Internet]. 1996 [cited 2020 Oct 28];351:1413–20. Available from: https://royalsocietypublishing.org/doi/abs/10.1098/rstb.1996.0125.
Bechara A, Damasio AR. The somatic marker hypothesis: a neural theory of economic decision. Games Econ Behav [Internet]. 2005 [cited 2023 Feb 3];52:336–72. Available from: https://www.sciencedirect.com/science/article/pii/S0899825604001034.
Herz R. That’s disgusting: unraveling the mysteries of repulsion. Illustrated edition. New York London: W. W. Norton & Company. 2013.
Rozin P, Haidt J, McCauley CR. Disgust. Handb Emot 3rd Ed. New York, NY, US: The Guilford Press; 2008;757–76.
Tybur JM, Lieberman D, Kurzban R, DeScioli P. Disgust: evolved function and structure. Psychol Rev. 2013;120:65–84.
• Vicario CM, Rafal RD, Martino D, Avenanti A. Core, social and moral disgust are bounded: a review on behavioral and neural bases of repugnance in clinical disorders. Neurosci Biobehav Rev [Internet]. 2017 [cited 2020 Oct 7];80:185–200. Available from: http://www.sciencedirect.com/science/article/pii/S0149763416308168. This review highlights the role of the insula in different domains of disgust and how there are distinct and common regions within the insula associated with each domain. While not focused on autism, the review also highlights the role of serotonin levels a topic of interest in autism research in disgust sensitivity in psychopathology.
MB Harms A Martin GL Wallace Facial emotion recognition in autism spectrum disorders: a review of behavioral and neuroimaging studies. Neuropsychol Rev [Internet]. 2010 [cited 2020 Oct 6];20:290–322 Available from: https://doi.org/10.1007/s11065-010-9138-6.
•• Kalyva E, Pellizzoni S, Tavano A, Iannello P, Siegal M. Contamination sensitivity in autism, Down syndrome, and typical development. Res Autism Spectr Disord [Internet]. 2010;4:43–50. Available from: http://www.sciencedirect.com/science/article/pii/S1750946709000828. This study provides evidence of reduced disgust sensitivity in autism. While not recent research, we note our literature search found that this was the only published research that directly addressed physical disgust differences in autism since 2000.
• Zhao X, Zhang P, Fu L, Maes JHR. Attentional biases to faces expressing disgust in children with autism spectrum disorders: an exploratory study. Sci Rep [Internet]. 2016 [cited 2020 Oct 6];6:19381. Available from: https://www.nature.com/articles/srep19381. This study finds that children with autism develop early cognitive biases towards disgusted faces resulting in attentional avoidance of these faces.
Kirby AV, Bilder DA, Wiggins LD, Hughes MM, Davis J, Hall-Lande JA, et al. Sensory features in autism: findings from a large population-based surveillance system. Autism Res [Internet]. 2022 [cited 2023 Jan 30];15:751–60. Available from:https://onlinelibrary.wiley.com/doi/abs/10.1002/aur.2670.
• Kumazaki H, Muramatsu T, Fujisawa TX, Miyao M, Matsuura E, Okada K, et al. Assessment of olfactory detection thresholds in children with autism spectrum disorders using a pulse ejection system. Mol Autism [Internet]. 2016 [cited 2022 Sep 27];7:6. Available from: https://doi.org/10.1186/s13229-016-0071-2. This study finds children with autism have reduced olfactory adaptation traits when compared to a comparison group.
Kumazaki H, Muramatsu T, Miyao M, Okada K, Mimura M, Kikuchi M. Brief report: olfactory adaptation in children with autism spectrum disorders. J Autism Dev Disord [Internet]. 2019 [cited 2022 Sep 27];49:3462–9 Available from: https://doi.org/10.1007/s10803-019-04053-6.
Muratori F, Tonacci A, Billeci L, Catalucci T, Igliozzi R, Calderoni S, et al. Olfactory processing in male children with autism: atypical odor threshold and identification. J Autism Dev Disord [Internet]. 2017 [cited 2022 Sep 26];47:3243–51 Available from: https://doi.org/10.1007/s10803-017-3250-x.
Wicker B, Monfardini E, Royet JP. Olfactory processing in adults with autism spectrum disorders. Mol Autism [Internet]. 2016 [cited 2022 Sep 27];7:4 Available from: https://doi.org/10.1186/s13229-016-0070-3.
Ashwin C, Chapman E, Howells J, Rhydderch D, Walker I, Baron-Cohen S. Enhanced olfactory sensitivity in autism spectrum conditions. Mol Autism [Internet]. 2014 [cited 2022 Sep 14];5:53 Available from: https://doi.org/10.1186/2040-2392-5-53.
Chistol LT, Bandini LG, Must A, Phillips S, Cermak SA, Curtin C. Sensory sensitivity and food selectivity in children with autism spectrum disorder. J Autism Dev Disord [Internet]. 2018 [cited 2022 Sep 27];48:583–91 Available from: https://doi.org/10.1007/s10803-017-3340-9.
Luisier AC, Petitpierre G, Ferdenzi C, Clerc Bérod A, Giboreau A, Rouby C, et al. Odor perception in children with autism spectrum disorder and its relationship to food neophobia. Front Psychol [Internet]. 2015 [cited 2022 Sep 27];6. Available from:https://www.frontiersin.org/articles/10.3389/fpsyg.2015.01830.
Stafford LD, Tsang I, López B, Severini M, Iacomini S. Autistic traits associated with food neophobia but not olfactory sensitivity. Appetite [Internet]. 2017 [cited 2022 Sep 27];116:584–8. Available from: https://www.sciencedirect.com/science/article/pii/S0195666317300120.
Cermak S, Curtin C, Bandini L. Food selectivity and sensory issues in children with autism spectrum disorders. 2009.
Nimbley E, Golds L, Sharpe H, Gillespie-Smith K, Duffy F. Sensory processing and eating behaviours in autism: a systematic review. Eur Eat Disord Rev [Internet]. 2022 [cited 2023 Jun 25];30:538–59. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/erv.2920.
Bourne L, Mandy W, Bryant-Waugh R. Avoidant/restrictive food intake disorder and severe food selectivity in children and young people with autism: a scoping review. Dev Med Child Neurol [Internet]. 2022 [cited 2023 Jun 25];64:691–700. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/dmcn.15139.
Olatunji BO, Armstrong T, Elwood L. Is disgust proneness associated with anxiety and related disorders? A qualitative review and meta-analysis of group comparison and correlational studies. Perspect Psychol Sci [Internet]. 2017 [cited 2020 Oct 8];12:613–48 Available from: https://doi.org/10.1177/1745691616688879.
Reynolds G, Askew C. Effects of vicarious disgust learning on the development of fear, disgust, and attentional biases in children. Emot Wash DC. 2019;19:1268–83.
Sica C, Caudek C, Belloch A, Bottesi G, Ghisi M, Melli G, et al. Not just right experiences, disgust proneness and their associations to obsessive–compulsive symptoms: a stringent test with structural equation modeling analysis. Cogn Ther Res [Internet]. 2019 [cited 2020 Oct 9];43:1086–96 Available from: https://doi.org/10.1007/s10608-019-10029-8.
Viar-Paxton M, Olatunji BO. 21 - Measurement of disgust proneness. In: Meiselman HL, editor. Emot Meas [Internet]. Woodhead Publishing; 2016 [cited 2020 Oct 8];513–35. Available from: http://www.sciencedirect.com/science/article/pii/B9780081005088000217.
van Overveld WJM, de Jong PJ, Peters ML, Cavanagh K, Davey GCL. Disgust propensity and disgust sensitivity: separate constructs that are differentially related to specific fears. Personal Individ Differ [Internet]. 2006 [cited 2020 Oct 8];41:1241–52. Available from: http://www.sciencedirect.com/science/article/pii/S0191886906002017.
Olatunji BO, Cisler JM. Disgust sensitivity: Psychometric overview and operational definition. Disgust and its disorders: Theory, assessment, and treatment implications. Washington, DC, US: American Psychological Association; 2009. p. 31–56.
Fields VL, Soke GN, Reynolds A, Tian LH, Wiggins L, Maenner M, et al. Pica, Autism, and Other Disabilities. Pediatrics [Internet]. 2021 [cited 2023 Jan 31];147:e20200462. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188765/.
Jayashankar A, Kilroy E, Butera C, Harrison L, Ringold S, Aziz-Zadeh L. Anterior insula reactivity is associated with disgust propensity in children with autism spectrum disorder (ASD). ISRE 2022 Program. Los Angeles, CA; 2022;168. Available from: https://doi.org/10.13140/RG.2.2.25569.89444.
Rozin P. Development in the food domain. Dev Psychol. 1990;26:555–62.
Rozin P, Millman L. Family environment, not heredity, accounts for family resemblances in food preferences and attitudes: a twin study. Appetite [Internet]. 1987 [cited 2020 Oct 23];8:125–34. Available from: http://www.sciencedirect.com/science/article/pii/S0195666387800053.
Siegal M. Marvelous minds: the discovery of what children know. Oxford University Press. 2008.
Russo N, Nicol T, Trommer B, Zecker S, Kraus N. Brainstem transcription of speech is disrupted in children with autism spectrum disorders. Dev Sci [Internet]. 2009 [cited 2020 Oct 24];12:557–67. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-7687.2008.00790.x.
Watson LR, Baranek GT, DiLavore PC. Toddlers with autism: developmental perspectives. Infants Young Child [Internet]. 2003 [cited 2020 Oct 24];16:201–14. Available from: https://journals.lww.com/iycjournal/fulltext/2003/07000/toddlers_with_autism__developmental_perspectives.3.aspx?casa_token=qDoSoANIzngAAAAA:i2dhrLKyzpFNXtbm1TcqHnKJtRIEUfIzPf-SAaZVJnbfuuOOKfdXN6qr1o6NcHJHe-K5xwdELqgG0uY9dZBsLhA.
Siegal M, Fadda R, Overton PG. Contamination sensitivity and the development of disease-avoidant behaviour. Philos Trans R Soc B Biol Sci [Internet]. 2011 [cited 2020 Oct 24];366:3427–32. Available from: https://royalsocietypublishing.org/doi/full/10.1098/rstb.2011.0036.
Losh M, Capps L. Understanding of emotional experience in autism: insights from the personal accounts of high-functioning children with autism. Dev Psychol. 2006;42:809–18.
Uljarevic M, Hamilton A. Recognition of emotions in autism: a formal meta-analysis. J Autism Dev Disord [Internet]. 2013 [cited 2020 Oct 9];43:1517–26 Available from: https://doi.org/10.1007/s10803-012-1695-5.
Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ. Gastrointestinal factors in autistic disorder: a critical review. J Autism Dev Disord. 2005;35:713–27.
Mayer EA, Padua D, Tillisch K. Altered brain-gut axis in autism: comorbidity or causative mechanisms?: prospects & overviews. BioEssays [Internet]. 2014 [cited 2019 Oct 30];36:933–9. Available from: http://doi.wiley.com/10.1002/bies.201400075.
Wang J, Ma B, Wang J, Zhang Z, Chen O. Global prevalence of autism spectrum disorder and its gastrointestinal symptoms: a systematic review and meta-analysis. Front Psychiatry [Internet]. 2022 [cited 2023 Mar 23];13:963102. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445193/.
Alharthi A, Alhazmi S, Alburae N, Bahieldin A. The human gut microbiome as a potential factor in autism spectrum disorder. Int J Mol Sci [Internet]. 2022;23:1363. Available from: https://pubmed.ncbi.nlm.nih.gov/35163286.
Fouquier J, Moreno Huizar N, Donnelly J, Glickman C, Kang D-W, Maldonado J, et al. The gut microbiome in autism: study-site effects and longitudinal analysis of behavior change. mSystems [Internet]. 2021 [cited 2022 Jun 1];6:e00848–20. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546984/.
Kral TVE, Eriksen WT, Souders MC, Pinto-Martin JA. Eating behaviors, diet quality, and gastrointestinal symptoms in children with autism spectrum disorders: a brief review. J Pediatr Nurs [Internet]. 2013 [cited 2020 Oct 24];28:548–56. Available from: http://www.sciencedirect.com/science/article/pii/S0882596313000961.
• Ristori MV, Quagliariello A, Reddel S, Ianiro G, Vicari S, Gasbarrini A, et al. Autism, gastrointestinal symptoms and modulation of gut microbiota by nutritional interventions. Nutrients [Internet]. 2019 [cited 2020 Oct 24];11:2812. Available from: https://www.mdpi.com/2072-6643/11/11/2812. This review addresses the food selectivity, nutrient intake, and GI issues of children with autism. It also highlights the need for further research on nutritional interventions and how they affect behavioral patterns in autism.
Penfield FM Jr W. The insula: further observations on its function. Brain [Internet]. 1955 [cited 2021 Sep 7];78:445–70 Available from: https://doi.org/10.1093/brain/78.4.445.
Adolphs R, Tranel D, Hamann S, Young AW, Calder AJ, Phelps EA, et al. Recognition of facial emotion in nine individuals with bilateral amygdala damage. Neuropsychologia. 1999;37:1111–7.
Dal Monte O, Krueger F, Solomon JM, Schintu S, Knutson KM, Strenziok M, et al. A voxel-based lesion study on facial emotion recognition after penetrating brain injury. Soc Cogn Affect Neurosci [Internet]. 2013 [cited 2020 Oct 23];8:632–9. Available from: https://academic.oup.com/scan/article/8/6/632/1610264.
Adolphs R, Tranel D, Damasio AR. Dissociable neural systems for recognizing emotions. Brain Cogn [Internet]. 2003 [cited 2021 May 3];52:61–9. Available from: https://www.sciencedirect.com/science/article/pii/S0278262603000095.
Adolphs R. Neural systems for recognizing emotion. Curr Opin Neurobiol [Internet]. 2002 [cited 2020 Oct 9];12:169–77. Available from: http://www.sciencedirect.com/science/article/pii/S095943880200301X.
Borg C, Bedoin N, Peyron R, Bogey S, Laurent B, Thomas-Antérion C. Impaired emotional processing in a patient with a left posterior insula-SII lesion. Neurocase [Internet]. 2013 [cited 2020 Oct 23];19:592–603 Available from: https://doi.org/10.1080/13554794.2012.713491.
Fusar-Poli P, Placentino A, Carletti F, Landi P, Allen P, Surguladze S, et al. Functional atlas of emotional faces processing: a voxel-based meta-analysis of 105 functional magnetic resonance imaging studies. J Psychiatry Neurosci JPN [Internet]. 2009 [cited 2020 Oct 23];34:418–32. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2783433/.
Murphy FC, Nimmo-Smith I, Lawrence AD. Functional neuroanatomy of emotions: a meta-analysis. Cogn Affect Behav Neurosci [Internet]. 2003 [cited 2020 Oct 23];3:207–33 Available from: https://doi.org/10.3758/CABN.3.3.207.
Chapman HA, Kim DA, Susskind JM, Anderson AK. In bad taste: evidence for the oral origins of moral disgust. Science [Internet]. 2009 [cited 2021 May 3];323:1222–6. Available from: https://science.sciencemag.org/content/323/5918/1222.
Sanfey AG, Rilling JK, Aronson JA, Nystrom LE, Cohen JD. The neural basis of economic decision-making in the ultimatum game. Science [Internet]. 2003 [cited 2020 Oct 23];300:1755–8. Available from: https://www.jstor.org/stable/3834595.
Shoemaker WJ. The social brain network and human moral behavior. Zygon® [Internet]. 2012 [cited 2021 Jul 8];47:806–20. Available from: https://onlinelibrary.wiley.com/doi/abs/https://doi.org/10.1111/j.1467-9744.2012.01295.x.
Curtis V. Why disgust matters. Philos Trans R Soc B Biol Sci [Internet]. 2011 [cited 2020 Oct 23];366:3478–90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3189359/.
Davey GCL. Disgust: the disease-avoidance emotion and its dysfunctions. Philos Trans R Soc B Biol Sci [Internet]. 2011 [cited 2020 Oct 23];366:3453–65. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3189352/.
Vicario CM, Rafal RD, Borgomaneri S, Paracampo R, Kritikos A, Avenanti A. Pictures of disgusting foods and disgusted facial expressions suppress the tongue motor cortex. Soc Cogn Affect Neurosci [Internet]. 2017 [cited 2020 Oct 9];12:352–62. Available from: https://academic.oup.com/scan/article/12/2/352/2823707.
Anderson JS, Druzgal TJ, Froehlich A, DuBray MB, Lange N, Alexander AL, et al. Decreased interhemispheric functional connectivity in autism. Cereb Cortex [Internet]. 2011 [cited 2021 Dec 16];21:1134–46 Available from: https://doi.org/10.1093/cercor/bhq190.
Anderson JS, Nielsen JA, Froehlich AL, DuBray MB, Druzgal TJ, Cariello AN, et al. Functional connectivity magnetic resonance imaging classification of autism. Brain [Internet]. 2011 [cited 2021 Dec 16];134:3742–54 Available from: https://doi.org/10.1093/brain/awr263.
Bird G, Silani G, Brindley R, White S, Frith U, Singer T. Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain [Internet]. 2010 [cited 2021 Dec 16];133:1515–25 Available from: https://doi.org/10.1093/brain/awq060.
Caria A, de Falco S. Anterior insular cortex regulation in autism spectrum disorders. Front Behav Neurosci [Internet]. 2015 [cited 2021 Dec 16];9:38. Available from: https://doi.org/10.3389/fnbeh.2015.00038https://www.frontiersin.org/article/10.3389/fnbeh.2015.00038.
Ebisch SJH, Gallese V, Willems RM, Mantini D, Groen WB, Romani GL, et al. Altered intrinsic functional connectivity of anterior and posterior insula regions in high-functioning participants with autism spectrum disorder. Hum Brain Mapp [Internet]. 2011 [cited 2021 Dec 16];32:1013–28. Available from:https://onlinelibrary.wiley.com/doi/abs/10.1002/hbm.21085.
•• Lassalle A, Zürcher NR, Porro CA, Benuzzi F, Hippolyte L, Lemonnier E, et al. Influence of anxiety and alexithymia on brain activations associated with the perception of others’ pain in autism. Soc Neurosci [Internet]. 2019 [cited 2023 Feb 5];14:359–77. Available from: https://doi.org/10.1080/17470919.2018.1468358. This study finds that, when viewing disgusting videos, differences in neural processing between autistic and control participants were explainable by the alexithymic traits of participants.
Molnar-Szakacs I, Uddin LQ. Anterior insula as a gatekeeper of executive control. Neurosci Biobehav Rev [Internet]. 2022 [cited 2023 Feb 5];139:104736. Available from: https://www.sciencedirect.com/science/article/pii/S0149763422002251.
Nomi JS, Molnar-Szakacs I, Uddin LQ. Insular function in autism: update and future directions in neuroimaging and interventions. Prog Neuropsychopharmacol Biol Psychiatry [Internet]. 2019 [cited 2023 Feb 5];89:412–26. Available from: https://www.sciencedirect.com/science/article/pii/S0278584618304378.
Couto B, Sedeño L, Sposato LA, Sigman M, Riccio PM, Salles A, et al. Insular networks for emotional processing and social cognition: comparison of two case reports with either cortical or subcortical involvement. Cortex [Internet]. 2013 [cited 2020 Oct 23];49:1420–34. Available from: http://www.sciencedirect.com/science/article/pii/S0010945212002456.
Kirby LAJ, Robinson JL. Affective mapping: an activation likelihood estimation (ALE) meta-analysis. Brain Cogn [Internet]. 2017 [cited 2020 Oct 23];118:137–48. Available from: http://www.sciencedirect.com/science/article/pii/S0278262615000469.
Haxby JV, Hoffman EA, Gobbini MI. The distributed human neural system for face perception. Trends Cogn Sci [Internet]. 2000 [cited 2020 Oct 24];4:223–33. Available from: http://www.sciencedirect.com/science/article/pii/S1364661300014820.
Hubl D, Bölte S, Feineis–Matthews S, Lanfermann H, Federspiel A, Strik W, et al. Functional imbalance of visual pathways indicates alternative face processing strategies in autism. Neurology [Internet]. 2003;61:1232. Available from: http://n.neurology.org/content/61/9/1232.abstract.
Barrett LF, Mesquita B, Ochsner KN, Gross JJ. The experience of emotion. Annu Rev Psychol [Internet]. 2006 [cited 2021 Apr 5];58:373–403 Available from: https://doi.org/10.1146/annurev.psych.58.110405.085709.
Cauda F, Costa T, Torta DME, Sacco K, D’Agata F, Duca S, et al. Meta-analytic clustering of the insular cortex: characterizing the meta-analytic connectivity of the insula when involved in active tasks. Neuroimage. 2012;62:343–55.
• Chang LJ, Yarkoni T, Khaw MW, Sanfey AG. Decoding the role of the insula in human cognition: functional parcellation and large-scale reverse inference. Cereb Cortex [Internet]. [cited 2021 Dec 14];23:739–49. Available from: 2013. https://doi.org/10.1093/cercor/bhs065. This study identifies the key and distinct roles of the different regions of the insula — the dorsal anterior, the ventral anterior, and the posterior regions.
Menon V, Uddin LQ. Saliency, switching, attention and control: a network model of insula function. Brain Struct Funct [Internet]. 2010 [cited 2020 Oct 23];214:655–67. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899886/.
Uddin LQ, Nomi JS, Hebert-Seropian B, Ghaziri J, Boucher O. Structure and function of the human insula. J Clin Neurophysiol Off Publ Am Electroencephalogr Soc [Internet]. 2017 [cited 2023 Feb 27];34:300–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032992/.
Damasio AR, Grabowski TJ, Bechara A, Damasio H, Ponto LLB, Parvizi J, et al. Subcortical and cortical brain activity during the feeling of self-generated emotions. Nat Neurosci [Internet]. 2000 [cited 2021 Apr 5];3:1049–56. Available from: https://www.nature.com/articles/nn1000_1049.
Nestor PJ, Graham NL, Fryer TD, Williams GB, Patterson K, Hodges JR. Progressive non-fluent aphasia is associated with hypometabolism centred on the left anterior insula. Brain [Internet]. 2003 [cited 2021 Apr 5];126:2406–18 Available from: https://doi.org/10.1093/brain/awg240.
Ogar J, Willock S, Baldo J, Wilkins D, Ludy C, Dronkers N. Clinical and anatomical correlates of apraxia of speech. Brain Lang [Internet]. 2006 [cited 2021 Apr 5];97:343–50. Available from: https://www.sciencedirect.com/science/article/pii/S0093934X06000125.
Adolfi F, Couto B, Richter F, Decety J, Lopez J, Sigman M, et al. Convergence of interoception, emotion, and social cognition: a twofold fMRI meta-analysis and lesion approach. Cortex [Internet]. 2017 [cited 2020 Oct 23];88:124–42. Available from: http://www.sciencedirect.com/science/article/pii/S0010945216303720.
Pitskel NB, Bolling DZ, Kaiser MD, Pelphrey KA, Crowley MJ. Neural systems for cognitive reappraisal in children and adolescents with autism spectrum disorder. Dev Cogn Neurosci [Internet]. 2014 [cited 2023 Jan 30];10:117–28. Available from: https://www.sciencedirect.com/science/article/pii/S1878929314000589.
Askew C, Çakır K, Põldsam L, Reynolds G. The effect of disgust and fear modeling on children’s disgust and fear for animals. J Abnorm Psychol [Internet]. 2014;123:566–577 Available from: https://doi.org/10.1037/a0037228.
Jabbi M, Bastiaansen J, Keysers C. A common anterior insula representation of disgust observation, experience and imagination shows divergent functional connectivity pathways. PLOS ONE [Internet]. 2008 [cited 2020 Oct 9];3:e2939. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0002939.
Wicker B, Keysers C, Plailly J, Royet J-P, Gallese V, Rizzolatti G. Both of us disgusted in my insula: the common neural basis of seeing and feeling disgust. Neuron [Internet]. 2003 [cited 2021 Apr 5];40:655–64. Available from: https://www.cell.com/neuron/abstract/S0896-6273(03)00679-2.
Keysers C, Gazzola V. Expanding the mirror: vicarious activity for actions, emotions, and sensations. Curr Opin Neurobiol. 2009;19:666–71.
Rizzolatti G, Sinigaglia C. The mirror mechanism: a basic principle of brain function. Nat Rev Neurosci [Internet]. 2016 [cited 2020 Oct 24];17:757–65. Available from: https://www.nature.com/articles/nrn.2016.135.
Ashwin C, Baron-Cohen S, Wheelwright S, O’Riordan M, Bullmore ET. Differential activation of the amygdala and the ‘social brain’ during fearful face-processing in Asperger syndrome. Neuropsychologia [Internet]. 2007 [cited 2020 Oct 24];45:2–14. Available from: http://www.sciencedirect.com/science/article/pii/S0028393206001564.
Enticott PG, Kennedy HA, Johnston PJ, Rinehart NJ, Tonge BJ, Taffe JR, et al. Emotion recognition of static and dynamic faces in autism spectrum disorder. Cogn Emot [Internet]. 2014 [cited 2020 Oct 6]; Available from: https://www.tandfonline.com/doi/pdf/https://doi.org/10.1080/02699931.2013.867832?needAccess=true.
Law Smith MJ, Montagne B, Perrett DI, Gill M, Gallagher L. Detecting subtle facial emotion recognition deficits in high-functioning autism using dynamic stimuli of varying intensities. Neuropsychologia [Internet]. 2010 [cited 2020 Oct 24];48:2777–81. Available from: http://www.sciencedirect.com/science/article/pii/S0028393210000977.
White SW, Maddox BB, Panneton RK. Fear of negative evaluation influences eye gaze in adolescents with autism spectrum disorder: a pilot study. J Autism Dev Disord [Internet]. 2015 [cited 2023 Feb 5];45:3446–57 Available from: https://doi.org/10.1007/s10803-014-2349-6.
•• MK Yeung TL Lee AS Chan Impaired recognition of negative facial expressions is partly related to facial perception deficits in adolescents with high-functioning autism spectrum disorder. J Autism Dev Disord [Internet]. 2020 [cited 2020 Oct 9];50:1596–606 Available from: https://doi.org/10.1007/s10803-019-03915-3 This study finds that, in addition to facial emotion recognition differences of negative emotions in autism, there are emotion-specific recognition differences in autism.
•• Yeung MK. A systematic review and meta-analysis of facial emotion recognition in autism spectrum disorder: The specificity of deficits and the role of task characteristics. Neurosci Biobehav Rev [Internet]. 2022 [cited 2023 Feb 4];133:104518. Available from: https://www.sciencedirect.com/science/article/pii/S0149763421005893. This systematic review highlights how difficulties in facial emotion recognition of disgust in autism are greater than all other basic emotions. Yet, due to the heterogeneity of recognition differences across the studies in the review, further research is warranted.
Dapretto M, Davies MS, Pfeifer JH, Scott AA, Sigman M, Bookheimer SY, et al. Understanding emotions in others: mirror neuron dysfunction in children with autism spectrum disorders. Nat Neurosci [Internet]. 2006 [cited 2020 Oct 24];9:28–30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713227/.
Greimel E, Schulte-Rüther M, Kircher T, Kamp-Becker I, Remschmidt H, Fink GR, et al. Neural mechanisms of empathy in adolescents with autism spectrum disorder and their fathers. NeuroImage [Internet]. 2010 [cited 2020 Oct 24];49:1055–65. Available from: http://www.sciencedirect.com/science/article/pii/S1053811909008477.
Kilroy E, Harrison L, Butera C, Jayashankar A, Cermak S, Kaplan J, et al. Unique deficit in embodied simulation in autism: an fMRI study comparing autism and developmental coordination disorder. Hum Brain Mapp [Internet]. 2021 [cited 2021 May 13];42:1532–46. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834792/.
Monk CS, Weng S-J, Wiggins JL, Kurapati N, Louro HMC, Carrasco M, et al. Neural circuitry of emotional face processing in autism spectrum disorders. J Psychiatry Neurosci JPN [Internet]. 2010 [cited 2020 Oct 6];35:105–14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834792/.
Nomi JS, Uddin LQ. Face processing in autism spectrum disorders: from brain regions to brain networks. Neuropsychologia [Internet]. 2015 [cited 2020 Oct 24];71:201–16. Available from: http://www.sciencedirect.com/science/article/pii/S0028393215001347.
Patriquin MA, DeRamus T, Libero LE, Laird A, Kana RK. Neuroanatomical and neurofunctional markers of social cognition in autism spectrum disorder. Hum Brain Mapp [Internet]. 2016 [cited 2020 Oct 24];37:3957–78. Available from: https://onlinelibrary.wiley.com/doi/abs/https://doi.org/10.1002/hbm.23288.
Pelphrey KA, Morris JP, McCarthy G, LaBar KS. Perception of dynamic changes in facial affect and identity in autism. Soc Cogn Affect Neurosci [Internet]. 2007 [cited 2020 Oct 24];2:140–9. Available from: https://academic.oup.com/scan/article/2/2/140/2736774.
Pierce K, Redcay E. Fusiform function in children with an autism spectrum disorder is a matter of “who.” Biol Psychiatry [Internet]. 2008 [cited 2020 Oct 24];64:552–60. Available from: http://www.sciencedirect.com/science/article/pii/S0006322308006446.
Piggot J, Kwon H, Mobbs D, Blasey C, Lotspeich L, Menon V, et al. Emotional attribution in high-functioning individuals with autistic spectrum disorder: a functional imaging study. J Am Acad Child Adolesc Psychiatry [Internet]. 2004 [cited 2020 Oct 24];43:473–80. Available from: http://www.sciencedirect.com/science/article/pii/S0890856709612545.
Wang AT, Dapretto M, Hariri AR, Sigman M, Bookheimer SY. Neural correlates of facial affect processing in children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry [Internet]. 2004 [cited 2020 Oct 24];43:481–90. Available from: http://www.sciencedirect.com/science/article/pii/S0890856709612557.
Bastiaansen JA, Thioux M, Nanetti L, van der Gaag C, Ketelaars C, Minderaa R, et al. Age-related increase in inferior frontal gyrus activity and social functioning in autism spectrum disorder. Biol Psychiatry [Internet]. 2011 [cited 2023 Mar 13];69:832–8. Available from: https://www.sciencedirect.com/science/article/pii/S0006322310011686.
Kohlberg L. Stage and sequence: the cognitive-developmental approach to socialization. Handb Social Theory Res. 1969;347:480.
Kohlberg L. From is to out: How to commit the naturalistic fallacy and get away with it in the study of moral development. Cogn Dev Epistemol. 1971.
Piaget J. The moral judgment of the child. (Translated by Marjorie Gabain). Routledge & K. Paul (1965, 1932) 1965.
Turiel E. The development of social knowledge: morality and convention. Cambridge University Press. 1983.
Haidt J. The emotional dog and its rational tail: a social intuitionist approach to moral judgment. Psychol Rev. 2001;108:814–34.
Graham J, Haidt J, Nosek BA. Liberals and conservatives rely on different sets of moral foundations. J Pers Soc Psychol. 2009;96:1029–46.
Haidt J, Rozin P, Mccauley C. IS Body psyche, and culture: the relationship between disgust and morality. Psychol Dev Soc [Internet]. 1997 [cited 2020 Oct 23];9:107–31 Available from: https://doi.org/10.1177/097133369700900105.
Curtis V, Biran A. Dirt, disgust, and disease: is hygiene in our genes? Perspect Biol Med [Internet]. 2001 [cited 2021 Apr 5];44:17–31. Available from: https://muse.jhu.edu/article/26017.
Hedblom C. Sense and sensibility : three components of moral sensitivity and their underlying neural mechanisms [Internet]. 2019 [cited 2021 Apr 5]. Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-17487.
Rozin P, Lowery L, Imada S, Haidt J. The CAD triad hypothesis: a mapping between three moral emotions (contempt, anger, disgust) and three moral codes (community, autonomy, divinity). J Pers Soc Psychol. 1999;76:574–86.
Curtis R, Moore C. Moral Foundations Questionnaire for kids. Unpubl Quest Dep Psychol Neurosci Halifax NS Dalhous Univ. 2019.
Graham J, Haidt J, Koleva S, Motyl M, Iyer R, Wojcik SP, et al. Chapter two - Moral foundations theory: the pragmatic validity of moral pluralism. In: Devine P, Plant A, editors. Adv Exp Soc Psychol [Internet]. Academic Press; 2013 [cited 2021 Jul 7]. p. 55–130. Available from: https://www.sciencedirect.com/science/article/pii/B9780124072367000024.
Peverill S. The development of moral foundations in 2- and 4-year-olds. 2020 [cited 2022 May 17]; Available from: https://DalSpace.library.dal.ca//handle/10222/79795.
Haidt J. The righteous mind: why good people are divided by politics and religion. New York, NY, US: Pantheon/Random House. 2012;421.
Iyer R, Koleva S, Graham J, Ditto P, Haidt J. Understanding libertarian morality: the psychological dispositions of self-identified libertarians. PLOS ONE [Internet]. 2012 [cited 2021 Jul 7];7:e42366. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0042366.
•• Dempsey EE, Moore C, Johnson SA, Stewart SH, Smith IM. Moral foundations theory among autistic and neurotypical children. Front Psychol [Internet]. 2022 [cited 2022 Apr 8];12. Available from: https://www.frontiersin.org/article/https://doi.org/10.3389/fpsyg.2021.782610. This study finds that young autistic children show no significant differences in rating purity moral violations when compared to controls. This observation was attributed to the young age of their participants.
Horberg EJ, Oveis C, Keltner D, Cohen AB. Disgust and the moralization of purity. J Pers Soc Psychol. 2009;97:963–76.
Horberg EJ, Oveis C, Keltner D. Emotions as moral amplifiers: an appraisal tendency approach to the influences of distinct emotions upon moral judgment. Emot Rev [Internet]. 2011 [cited 2021 Jul 7];3:237–44 Available from: https://doi.org/10.1177/1754073911402384.
Cannon PR, Schnall WM S, Transgressions expressions: affective facial muscle activity predicts moral judgments. Soc Psychol Personal Sci [Internet]. 2011 [cited 2021 Dec 14];2:325–31 Available from: https://doi.org/10.1177/1948550610390525.
Ekman P, Friesen WV, Ellsworth P. Emotion in the human face: guidelines for research and an integration of findings. Elsevier; 2013.
Eskine KJ, Kacinik NA, Prinz JJ. A bad taste in the mouth: gustatory disgust influences moral judgment. Psychol Sci. 2011;22:295–9.
Schnall S, Haidt J, Clore GL, Jordan AH. Disgust as embodied moral judgment. Pers Soc Psychol Bull [Internet]. 2008 [cited 2021 Jul 2];34:1096–109. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562923/.
Tracy JL, Steckler CM, Heltzel G. The physiological basis of psychological disgust and moral judgments. J Pers Soc Psychol. 2019;116:15–32.
Wheatley T, Haidt J. Hypnotic disgust makes moral judgments more severe. Psychol Sci. 2005;16:780–4.
•• Inbar Y, Pizarro DA. Chapter Three - How disgust affects social judgments. In: Gawronski B, editor. Adv Exp Soc Psychol [Internet]. Academic Press; 2022 [cited 2023 Feb 5]. p. 109–66. Available from: https://www.sciencedirect.com/science/article/pii/S0065260121000289. This book chapter highlights in-depth how disgust processing affects and influences moral judgment in the general population.
Schnall S, Benton J, Harvey S. With a clean conscience: cleanliness reduces the severity of moral judgments. Psychol Sci [Internet]. 2008 [cited 2021 Apr 5];19:1219–22 Available from: https://doi.org/10.1111/j.1467-9280.2008.02227.x.
Chapman HA, Anderson AK. Things rank and gross in nature: a review and synthesis of moral disgust. Psychol Bull. 2013;139:300–27.
Danovitch J, Bloom P. Children’s extension of disgust to physical and moral events. Emotion. 2009;9:107–12.
Royet JP, Hudry J, Zald DH, Godinot D, Grégoire MC, Lavenne F, et al. Functional neuroanatomy of different olfactory judgments. NeuroImage [Internet]. 2001 [cited 2021 Apr 5];13:506–19. Available from: https://www.sciencedirect.com/science/article/pii/S1053811900907043.
Lee DS, Kim E, Schwarz N. Something smells fishy: olfactory suspicion cues improve performance on the Moses illusion and Wason rule discovery task. J Exp Soc Psychol [Internet]. 2015 [cited 2021 Dec 14];59:47–50. Available from: https://www.sciencedirect.com/science/article/pii/S0022103115000281.
Cameron CD, Payne BK, Doris JM. Morality in high definition: emotion differentiation calibrates the influence of incidental disgust on moral judgments. J Exp Soc Psychol [Internet]. 2013 [cited 2021 Jul 8];49:719–25. Available from: https://www.sciencedirect.com/science/article/pii/S0022103113000425.
Mul C, Stagg SD, Herbelin B, Aspell JE. The feeling of me feeling for you: interoception, alexithymia and empathy in autism. J Autism Dev Disord [Internet]. 2018 [cited 2023 Mar 13];48:2953–67 Available from: https://doi.org/10.1007/s10803-018-3564-3.
Hill EL. Executive dysfunction in autism. Trends Cogn Sci. 2004;8:26–32.
Cuve HC, Murphy J, Hobson H, Ichijo E, Catmur GC. Bird Are autistic and alexithymic traits distinct? A factor-analytic and network approach. J Autism Dev Disord [Internet]. 2022 [cited 2023 Jun 9];52:2019–34 Available from: https://doi.org/10.1007/s10803-021-05094-6.
Dempsey EE, Moore C, Richard AE, Smith IM. Moral foundations theory in autism spectrum disorder: a qualitative investigation. Autism [Internet]. 2020 [cited 2022 May 19];24:2202–12 Available from: https://doi.org/10.1177/1362361320939331.
Baron-Cohen S, Leslie AM, Frith U. Does the autistic child have a “theory of mind”? Cognition [Internet]. 1985 [cited 2021 Apr 6];21:37–46. Available from: https://www.sciencedirect.com/science/article/pii/0010027785900228.
Bos J, Stokes MA. Cognitive empathy moderates the relationship between affective empathy and wellbeing in adolescents with autism spectrum disorder. Eur J Dev Psychol [Internet]. 2019 [cited 2023 Mar 13];16:433–46 Available from: https://doi.org/10.1080/17405629.2018.1444987.
Dziobek I, Rogers K, Fleck S, Bahnemann M, Heekeren HR, Wolf OT, et al. Dissociation of cognitive and emotional empathy in adults with Asperger syndrome using the Multifaceted Empathy Test (MET). J Autism Dev Disord. 2008;38:464–73.
Mazza M, Pino MC, Mariano M, Tempesta D, Ferrara M, De Berardis D, et al. Affective and cognitive empathy in adolescents with autism spectrum disorder. Front Hum Neurosci [Internet]. 2014 [cited 2021 Apr 6];8. Available from: https://www.frontiersin.org/articles/10.3389/fnhum.2014.00791/full.
Patil I, Melsbach J, Hennig-Fast K, Silani G. Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism. Sci Rep [Internet]. 2016 [cited 2021 Apr 6];6:23637. Available from: https://www.nature.com/articles/srep23637.
Rueda P, Fernández-Berrocal P, Baron-Cohen S. Dissociation between cognitive and affective empathy in youth with Asperger syndrome. Eur J Dev Psychol [Internet]. 2015 [cited 2021 Apr 6];12:85–98 Available from: https://doi.org/10.1080/17405629.2014.950221.
Senju A, Southgate V, White S, Frith U. Mindblind eyes: an absence of spontaneous theory of mind in Asperger syndrome. Science [Internet]. 2009 [cited 2021 Apr 4];325:883–5. Available from: https://science.sciencemag.org/content/325/5942/883.
Margoni F, Surian L. Mental state understanding and moral judgment in children with autistic spectrum disorder. Front Psychol [Internet]. 2016 [cited 2021 Apr 5];7. Available from: https://www.frontiersin.org/articles/https://doi.org/10.3389/fpsyg.2016.01478/full.
Bellesi G, Vyas K, Jameel L, Channon S. Moral reasoning about everyday situations in adults with autism spectrum disorder. Res Autism Spectr Disord [Internet]. 2018 [cited 2021 Apr 6];52:1–11. Available from: https://www.sciencedirect.com/science/article/pii/S1750946718300722.
Howlin P, Moss P, Savage S, Rutter M. Social outcomes in mid- to later adulthood among individuals diagnosed with autism and average nonverbal IQ as children. J Am Acad Child Adolesc Psychiatry [Internet]. 2013 [cited 2021 Apr 5];52:572–581.e1. Available from: https://www.sciencedirect.com/science/article/pii/S0890856713001615.
•• Dempsey EE, Moore C, Johnson SA, Stewart SH, Smith IM. Morality in autism spectrum disorder: a systematic review. Dev Psychopathol [Internet]. 2020 [cited 2021 Mar 27];32:1069–85. Available from: http://www.cambridge.org/core/journals/development-and-psychopathology/article/morality-in-autism-spectrum-disorder-a-systematic-review/CBC37C81E0DCEB9C89E6089B449C6DBA. This systematic review addresses the differences in moral decision-making between autistic and non-autistic individuals and advocates for an intuitionist approach towards understanding morality in autism.
• Margoni F, Guglielmetti G, Surian L. Brief report: young children with autism can generate intent-based moral judgments. J Autism Dev Disord [Internet]. 2019 [cited 2021 Apr 4];49:5078–85. Available from: https://doi.org/10.1007/s10803-019-04212-9. This brief report finds that autistic children make intent-based moral decisions rather than outcome-based decisions for accidental moral transgressions, provided they receive detailed explanations of the situation.
Vyas K, Jameel L, Bellesi G, Crawford S, Channon S. Derailing the trolley: everyday utilitarian judgments in groups high versus low in psychopathic traits or autistic traits. Psychiatry Res [Internet]. 2017 [cited 2023 Mar 13];250:84–91. Available from: https://www.sciencedirect.com/science/article/pii/S0165178116304450.
CM Grant J Boucher KJ Riggs A Grayson Moral understanding in children with autism. Autism [Internet]. 2005 [cited 2021 Apr 6];9:317–31 Available from: https://doi.org/10.1177/1362361305055418.
M Buon E Dupoux P Jacob P Chaste M Leboyer T Zalla The role of causal and intentional judgments in moral reasoning in individuals with high functioning autism. J Autism Dev Disord [Internet]. 2013 [cited 2021 Apr 6];43:458–70 Available from: https://doi.org/10.1007/s10803-012-1588-7.
Koster-Hale J, Dungan J, Saxe R, Young L. Thinking in patterns: using multi-voxel pattern analyses to find neural correlates of moral judgment in neurotypical and ASD populations. Proc Annu Meet Cogn Sci Soc [Internet]. 2012 [cited 2021 Mar 27];34. Available from: https://escholarship.org/uc/item/0km5x647.
Salvano-Pardieu V, Blanc R, Combalbert N, Pierratte A, Manktelow K, Maintier C, et al. Judgment of blame in teenagers with Asperger’s syndrome. Think Reason [Internet]. 2016 [cited 2021 Apr 6];22:251–73 Available from: https://doi.org/10.1080/13546783.2015.1127288.
Young L, Camprodon JA, Hauser M, Pascual-Leone A, Saxe R. Disruption of the right temporoparietal junction with transcranial magnetic stimulation reduces the role of beliefs in moral judgments. Proc Natl Acad Sci U S A [Internet]. 2010 [cited 2021 May 4];107:6753–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872442/.
Butera C, Kaplan J, Kilroy E, Harrison L, Jayashankar A, Loureiro F, et al. The relationship between alexithymia, interoception, and neural functional connectivity during facial expression processing in autism spectrum disorder. Neuropsychologia [Internet]. 2023 [cited 2023 Feb 5];180:108469. Available from: https://www.sciencedirect.com/science/article/pii/S0028393223000039.
Butera CD, Harrison L, Kilroy E, Jayashankar A, Shipkova M, Pruyser A. Relationships between alexithymia, interoception, and emotional empathy in autism spectrum disorder. Autism [Internet]. et al 2022 [cited 2023 Mar 13];13623613221111310 Available from: https://doi.org/10.1177/13623613221111310.
DuBois D, Ameis SH, Lai M-C, Casanova MF, Desarkar P. Interoception in autism spectrum disorder: a review. Int J Dev Neurosci [Internet]. 2016 [cited 2023 Mar 23];52:104–11. Available from: https://www.sciencedirect.com/science/article/pii/S073657481630096X.
Milosavljevic B, Carter Leno V, ESimonoff E, Baird G, Pickles A, Jones CRG, et al. Alexithymia in adolescents with autism spectrum disorder: its relationship to internalising difficulties, sensory modulation and social cognition. J Autism Dev Disord [Internet]. 2016 [cited 2023 Feb 3];46:1354–67 Available from: https://doi.org/10.1007/s10803-015-2670-8.
• Vaiouli P, Luminet O, Panayiotou G. Alexithymic and autistic traits in children and adolescents: a systematic review of the current state of knowledge. Autism [Internet]. [cited 2023 Feb 3];26:308–16. Available from: 2022. https://doi.org/10.1177/13623613211058512. This systematic review highlights current research on and difficulties in studying alexithymia in autistic youth and highlights considerations for future research studies.
Oakley BFM, Brewer R, Bird G, Catmur C. Theory of mind is not theory of emotion: a cautionary note on the reading the mind in the eyes test. J Abnorm Psychol [Internet]. 2016 [cited 2021 Jul 8];125:818–23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976760/.
Davidson J. Autistic culture online: virtual communication and cultural expression on the spectrum. Soc Cult Geogr [Internet]. 2008 [cited 2021 Apr 6];9:791–806 Available from: https://doi.org/10.1080/14649360802382586.
Jaarsma P, Welin S. Autism as a natural human variation: reflections on the claims of the neurodiversity movement. Health Care Anal. 2012;20:20–30.
Lewin N, Akhtar N. Neurodiversity deficit perspectives in The Washington Post’s coverage of autism. Disabil Soc [Internet]. 2021 [cited 2022 May 9];36:812–33. Available from: https://doi.org/10.1080/09687599.2020.1751073.
Wolbring G. Neurodiversity, neuroenhancement, neurodisease, and neurobusiness. Innov Watch. 2007;15.
Fadda R, Parisi M, Ferretti L, Saba G, Foscoliano M, Salvago A, et al. Exploring the role of theory of mind in moral judgment: the case of children with autism spectrum disorder. Front Psychol [Internet]. 2016 [cited 2021 Apr 6];7. Available from: https://www.frontiersin.org/articles/10.3389/fpsyg.2016.00523/full.
Barrett HC, Bolyanatz A, Crittenden AN, Fessler DMT, Fitzpatrick S, Gurven M, et al. Small-scale societies exhibit fundamental variation in the role of intentions in moral judgment. Proc Natl Acad Sci. 2016;113:4688–93.
Damasio A. Descartes’ error: emotion, reason and the human brain. Random House. 2008.
Dunn BD, Dalgleish T, Lawrence AD. The somatic marker hypothesis: a critical evaluation. Neurosci Biobehav Rev [Internet]. 2006 [cited 2023 Feb 3];30:239–71. Available from: https://www.sciencedirect.com/science/article/pii/S0149763405001053.
Hinson JM, Jameson TL, Whitney P. Somatic markers, working memory, and decision making. Cogn Affect Behav Neurosci [Internet]. 2002 [cited 2023 Mar 23];2:341–53 Available from: https://doi.org/10.3758/CABN.2.4.341.
Poppa T, Bechara A. The somatic marker hypothesis: revisiting the role of the ‘body-loop’ in decision-making. Curr Opin Behav Sci [Internet]. 2018 [cited 2023 Mar 23];19:61–6. Available from: https://www.sciencedirect.com/science/article/pii/S2352154617300736.
Sinclair SJ, Gansler DA. Integrating the somatic marker and social cognition theories to explain different manifestations of antisocial personality disorder. New Sch Psychol Bull [Internet]. 2006 [cited 2023 Mar 23];4:25–47. Available from: http://www.nspb.net/index.php/nspb/article/view/144.
Xu L, Ma X, Zhao W, Luo L, Yao S, Kendrick KM. Oxytocin enhances attentional bias for neutral and positive expression faces in individuals with higher autistic traits. Psychoneuroendocrinology [Internet]. 2015 [cited 2020 Oct 8];62:352–8. Available from: http://www.sciencedirect.com/science/article/pii/S0306453015009038.
Li J, Zhu L, Gummerum M. The relationship between moral judgment and cooperation in children with high-functioning autism. Sci Rep [Internet]. 2014 [cited 2021 Apr 5];4:4314. Available from: https://www.nature.com/articles/srep04314.
Proff I, Williams GL, Quadt L, Garfinkel SN. Sensory processing in autism across exteroceptive and interoceptive domains. Psychol Neurosci. 2022;15:105–30.
Djerassi M, Ophir S, Atzil S. What is social about autism? The role of allostasis-driven learning. Brain Sci [Internet]. 2021 [cited 2023 Mar 23];11:1269. Available from: https://www.mdpi.com/2076-3425/11/10/1269.
Bechara A. Chapter 35 - The neural basis of decision making in addiction. In: Miller PM, editor. Biol Res Addict [Internet]. San Diego: Academic Press; 2013 [cited 2021 Jul 9]. p. 341–52. Available from: https://www.sciencedirect.com/science/article/pii/B9780123983350000352.
Koob GF, Arends MA, McCracken M, Le Moal M. Chapter 3 - Neurobiological theories of addiction. In: Koob GF, Arends MA, McCracken M, Le Moal M, editors. Introd Addict [Internet]. Academic Press; 2019 [cited 2021 Jul 9]. p. 125–262. Available from: https://www.sciencedirect.com/science/article/pii/B9780128168639000030.
Saive AL, Royet JP, Plailly J. A review on the neural bases of episodic odor memory: from laboratory-based to autobiographical approaches. Front Behav Neurosci [Internet]. 2014 [cited 2021 Jul 25];0. Available from: https://www.frontiersin.org/articles/10.3389/fnbeh.2014.00240/full.
Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropr Med [Internet]. 2006 [cited 2023 Jan 19];5:101–17. Available from: https://www.sciencedirect.com/science/article/pii/S0899346707601426.
Bottema-Beutel K, Kapp SK, Lester JN, Sasson NJ, Hand BN. Avoiding Ableist language: suggestions for autism researchers. Autism Adulthood [Internet]. 2021 [cited 2023 Jan 30];3:18–29. Available from: https://www.liebertpub.com/doi/full/10.1089/aut.2020.0014.
Acknowledgements
We thank Jonas Kaplan, Sharon Cermak, and Mary Helen Immordino-Yang for their feedback on an earlier version of this manuscript. We additionally thank Fernanda Loureiro, Laura Harrison, Christiana Butera, Emily Kilroy, Sofronia Ringold, Riley McGuire, Tom Williamson, and Akila Kadambi for helpful discussions on this topic.
Funding
Open access funding provided by SCELC, Statewide California Electronic Library Consortium. Funding was awarded by the Department of Defense through the Idea Development Award under award number AR170062.
Author information
Authors and Affiliations
Contributions
A.J. and L.A.Z. conceptualized the manuscript. A.J. conducted the majority of the literature research and drafted the manuscript. L.A.Z revised and edited the manuscript. A.J. and L.A.Z. conceptualized and created Fig. 1. Funding was acquired by L.A.Z. All authors have read and agreed to the published version of the manuscript.
Corresponding author
Ethics declarations
Disclaimer
Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense.
Conflict of Interest
The authors declare no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Lay Summary: Disgust plays an important role in our daily life, from influencing our food choices to guiding our social behavior and moral understanding. Young autistic individuals may experience differences in disgust processing both behaviorally and neuronally, which may lead to issues related to health, eating, and social relationships. This review summarizes potential differences in disgust processing in autism. Better understanding of these experiences and factors could help in providing insight into the role of disgust as a developmental risk factor.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Jayashankar, A., Aziz-Zadeh, L. Disgust Processing and Potential Relationships with Behaviors in Autism. Curr Psychiatry Rep 25, 465–478 (2023). https://doi.org/10.1007/s11920-023-01445-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11920-023-01445-5