Abstract: Interoception, the perception and integration of signals from within the body, has become a candidate mechanism for understanding the emotional and social difficulties observed in autism spectrum disorder (ASD). Despite growing empirical attention, the literature remains fragmented across measurement paradigms, developmental stages, and comorbidity profiles, leaving the conditions under which interoceptive atypicalities arise insufficiently characterized. This review synthesizes evidence across three dimensions of interoception, namely accuracy, sensibility, and awareness, and advances an integrative framework that organizes three established theoretical accounts into a hierarchical explanatory structure.
Behavioral, neural, and qualitative findings together suggest that individuals with ASD exhibit a dissociated profile rather than a uniform deficit. Objective accuracy on heartbeat detection tasks tends to be reduced, although estimates vary substantially across developmental stages and instruments. Self-reported sensibility appears elevated in adult samples on frequency-based measures such as the Body Perception Questionnaire, yet diminished on multidimensional instruments such as the MAIA, suggesting that conclusions are sensitive to what each instrument captures. Awareness, indexed by the discrepancy between objective performance and subjective evaluation, shows a systematic mismatch whereby individuals tend to overestimate their interoceptive capacity. This three-dimensional dissociation captures what generic deficit accounts cannot easily reconcile, namely the simultaneous presence of heightened bodily sensing and impaired bodily discerning.
The review further argues that three influential mechanistic accounts, predictive coding, weak central coherence, and the alexithymia hypothesis, are more parsimoniously understood as nested levels within a developmental cascade than as competing explanations. At the computational level, atypical precision weighting in Bayesian inference renders individuals with ASD overly reliant on bodily input while limiting context-sensitive adjustment. At the cognitive level, weak central coherence further impedes the integration of locally detected signals into coherent multimodal representations of bodily state. At the affective level, the resulting failure to anchor integrated interoceptive representations onto emotional categories manifests as alexithymia, which co-occurs with ASD in approximately half of cases. The insula and anterior cingulate circuitry, atypical across age groups in ASD, provides a plausible neural substrate for this organization. Marr's tri-level analytic framework, developmental timing considerations, and the non-universality of alexithymia within ASD jointly motivate the proposed nesting.
Several factors appear to moderate the expression of interoceptive atypicality. Age effects are dimension-specific. Accuracy differences are shaped by intellectual functioning, comorbidity, and task demands, and current cross-sectional evidence is insufficient to establish a unitary developmental trajectory. Signal type also matters, with cardiac and respiratory channels that depend on cross-modal integration appearing more vulnerable than channels with stable behavior-outcome mappings such as hunger. Comorbid anxiety, alexithymia, attention-deficit/hyperactivity disorder, and eating disorders each contribute to the heterogeneous expression observed in ASD. Methodological confounds in heartbeat counting tasks, including resting heart rate and body mass index, may inflate apparent group differences if left uncontrolled.
Three priorities are identified for future research. First, simultaneously measuring all three interoceptive dimensions within the same sample is needed to clarify their interrelations and to determine which dimension exerts the greatest functional impact on emotion regulation and social functioning. Second, partitioning the contributions of alexithymia and other comorbidities through stratified or mediation designs is necessary to test whether the proposed cascade applies uniformly across symptom domains. Third, longitudinal designs combined with multimodal indices that go beyond heartbeat detection are needed to capture the developmental dynamics of interoceptive atypicality. Implications for educational practice include staged interoceptive training tailored to a learner’s dimensional profile, metacognitive calibration exercises that address overconfidence in bodily judgment, and emotion regulation strategies adjusted to the individual's interoceptive capacity.
The three-dimensional dissociation identified here also has implications for educational and clinical practice. Rather than applying uniform interoceptive training, instruction may benefit from being staged according to each learner’s dimensional profile, beginning with body-scan exercises that link bodily cues to emotion vocabulary for those who detect signals but struggle to interpret them, and progressing to context-sensitive discrimination for those whose subjective and objective indices diverge. Metacognitive calibration through feedback comparison helps address the overconfidence that often accompanies impaired awareness, while emotion regulation instruction may need to shift from body-based strategies toward cognitive reappraisal when interoceptive accuracy is markedly reduced.
By foregrounding the dissociation between bodily sensing and discerning, and by situating the three dominant mechanistic accounts within a single developmental hierarchy, this review offers a more coherent framework for interpreting the heterogeneous interoceptive profile of ASD and for guiding targeted intervention.

Key words: autism spectrum disorders, interoception, predictive coding, weak central coherence, alexithymia