Atypical pupil-linked arousal induced by low-risk probabilistic choices, and intolerance of uncertainty in adults with ASD

Adults with autism spectrum disorder (ASD) experience stress when operating in a probabilistic environment, even if it is familiar, but the underlying mechanisms remain 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 exploration. Here, in a sample of 46 high-functioning ASD and NT participants, using mixed-effects model analysis, 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. We found that subjects with ASD learned and preferred advantageous probabilistic choices at the same rate and to the same extent as NT participants, both in terms of choice ratio and response time. Although both groups exhibited similar predictive behaviors, learning to favor advantageous choices led to increased pupillary arousal for these choices in the ASD group, while it caused a decrease in pupillary arousal in the NT group. Moreover, greater pupil-linked arousal during decisions with higher expected value correlated with greater degree of self-reported intolerance of uncertainty in everyday life. Our results suggest that in a nonvolatile 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.