Authors: Lauren Craik, Lisa Quadt, Matt Garner and Gaby Pfeifer
Published: 2026
Publication: Research in Autism
It is well-established that anxiety and sensory differences are common among autistic adolescents. Interoception has been increasingly studied in relation to anxiety, with alexithymia also considered due to its role in emotional processing and its higher prevalence in autistic populations. This study examined the relationships between interoception, alexithymia, and anxiety in 37 autistic adolescents. Participants completed questionnaires assessing autism traits, anxiety, alexithymia, and interoceptive beliefs, along with cardiac interoception tasks measuring interoceptive accuracy and insight. Correlation, regression, and moderated mediation analyses were conducted. Interoceptive beliefs reflecting autonomic reactivity (BPQ-ANSR) significantly predicted anxiety and remained the only interoceptive variable associated with anxiety in regression models. Interoceptive insight and heartbeat counting accuracy were both associated with alexithymia, although alexithymia did not predict anxiety and did not mediate the interoception–anxiety relationship. Moderated mediation analyses showed that autism traits amplified the direct effect of interoceptive beliefs on anxiety. These findings highlight the importance of considering subjective interoceptive beliefs, particularly those perceived as distressing, rather than focusing solely on objective accuracy. They further suggest that interoceptive-affective mismatches may initially manifest as alexithymia during adolescence, potentially serving as a precursor to later anxiety.
Lay summary
Autistic adolescents that reported greater attention to feelings from their autonomic nervous system (the system that controls processes in the body such as heart rate, blood pressure, digestion, and breathing), but not generally from their bodies, also reported being more anxious. The other factors explored, namely participants’ accuracy at detecting their internal bodily signals and their reported difficulty identifying and understanding their emotions (alexithymia), were not associated with anxiety. However, adolescents who were more accurate at detecting their heartbeats, or more aware of their bodily signals, tended to report greater difficulty identifying and describing their emotions. While alexithymia was not linked to anxiety in this age group, these difficulties may play a role in emotional development and could contribute to anxiety later in life. We also found that autistic traits strengthened the link between distressing bodily sensations and anxiety.
Craik, L., Quadt, L., Garner, M. and Pfeifer, G. (2026). Understanding anxiety in autistic adolescents: The predictive role of interoceptive beliefs and insight. Research in Autism. 132 (2026) 202860. https://doi.org/10.1016/j.reia.2026.202860
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