Atypical Pupil-Linked Arousal Induced by Low-Risk Probabilistic Choices, and Intolerance of Uncertainty in Adults with ASD

Abstract

Adults with autism spectrum disorder (ASD) report stress when acting in a familiar probabilistic environment, but the underlying mechanisms are 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 random "trial-and-error" searches or self-imposed risk of exploration. Here, in a sample of 46 high-functioning ASD and NT participants, 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. Using mixed-effects model analysis, we contrasted pupil dilation response (PDR) between a preferred frequently rewarded exploitative decision and its explorative alternatives. We observed that subjects with ASD learned the advantageous probabilistic choices at the same rate over time and preferred them to the same degree as NT participants both in terms of choice ratio and decision speed. Despite similar reward prediction abilities, outcome predictability modulated decision-related PDR in ASD in the opposite direction than in NT individuals. Moreover, relatively enhanced PDR elicited by exploitative low-risk decisions predicted a greater degree of self-reported intolerance of uncertainty in everyday life. Our results suggest that in a non-volatile 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.