B-48: Structural and Functional Neural Markers of Alexithymia in Autism Spectrum Disorder

Abstract

Objective: Autism spectrum disorder (ASD) is associated with socio-emotional difficulties, including atypical emotion processing and interoception. Evidence suggests that these features may be driven by co-occurring alexithymia, a trait characterized by impaired emotional awareness. This review synthesizes structural and functional neuroimaging findings to identify neural markers of alexithymia in ASD and clarify its distinct contribution to socio-emotional dysfunction. Method/Data Selection: Literature was identified through searches of the following databases: APA PsycINFO and Google Scholar, using combinations of the following search terms: ‘autism spectrum disorder,’ ‘Alexithymia,’ ‘Neural Markers.’ A total of 6 peer-reviewed journal articles from 2014 to 2026 met the inclusion criteria Results/Data Synthesis: Findings display that ASD is associated with disruptions in sociocognitive networks supporting Theory of Mind, involving dorsomedial prefrontal and temporo-parietal regions. In contrast, alexithymia is linked to altered structural and functional connectivity within socioaffective and interoceptive networks, including the insula, fronto-insular cortex, amygdala, anterior temporal semantic hubs, and monoaminergic neuromodulatory systems. Task-based neuroimaging demonstrates that neural responses during facial emotion processing correlate with alexithymia severity rather than ASD diagnosis. Structural analyses reveal reduced network modularity associated with alexithymia. Controlling alexithymia substantially attenuates or eliminates ASD-related differences in emotional brain activation and interoceptive accuracy. Conclusions: Structural and functional neural alterations underlying emotional and interoceptive deficits in ASD are attributable to co-occurring alexithymia. Alexithymia is a key component of insula-centered and front-limbic dysfunction, providing a link between interoceptive processing deficits and impaired emotional awareness. These findings underscore the importance of distinguishing alexithymia-related neural markers from core ASD mechanisms to improve neurobiological models, assessment, and intervention strategies.