Understanding anxiety in autistic adolescents: The predictive role of interoceptive beliefs and insight

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Craik, L., Quadt, L., Garner, M., & Pfeifer, G. (2026). Understanding anxiety in autistic adolescents: The predictive role of interoceptive beliefs and insight. Research in Autism, 132, 202860. https://doi.org/10.1016/j.reia.2026.202860

Publication date: 14 Feb 2026 Added to AutiHub: 25 Sep 2026 Type: Article Article language: English
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Authors

Publication authors
4
Publication authors identified as autistic
1 / 4 (25.0%)
  1. Lauren Craik
  2. Lisa Quadt *
  3. Matt Garner
  4. Gaby Pfeifer

Abstract

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.

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Cited references
90
With a DOI
80
Without a DOI, from raw bibliography text
10
1 / 90 (1.1%) cited references include at least one author identified as autistic.
References with data to complete
1 / 90 (1.1%)
References with detected author names
90 / 90 (100.0%)
Without detected author names
0
Without a structured title
1
Without a stable identifier
10
References with raw author names still to review
0
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
585
From DOI or external metadata
585
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
105 / 585 (17.9%) names are linked to an author already present in AutiHub. 480 / 585 (82.1%) names are not yet linked.
Names linked to a person identified as autistic
2 / 585 (0.3%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 2 / 105 (1.9%). Distinct people identified as autistic: 2 / 534 (0.4%).
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