A systematic review was conducted for studies exploring the link between gaze patterns, autonomic arousal and emotion recognition deficits (ERD) in young adults with Autism Spectrum Conditions (ASC) in the context of the eyeavoidance/hyperarousal and the orientation/hypoarousal hypotheses. These hypotheses suggest that ERD in ASC can be explained by either exacerbated physiological arousal to eye-contact interfering with emotion recognition, or blunted arousal not engaging the necessary attention and awareness mechanisms to process emotionally salient cues, respectively. Most studies have suggested that individuals with ASC display an overall reduced attention to the eyes, however, this was not always associated with ERD, and some studies also reported ERD with no evidence of atypical gaze patterns. The evidence from psychophysiological studies is also mixed. While some studies supported that individuals with ASC are hypoaroused during emotion processing, others reported hyperarousal or even partially supported both. Overall, these results suggest that the current autonomic arousal and gaze hypotheses cannot fully account for ERD in ASC. A new integrative model is proposed, suggesting a two-pathway mechanism, in which avoidance and orientation processes might independently lead to ERD in ASC. Current methodological limitations, the influence of alexithymia, and implications are discussed.

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Atypical eye gaze is thought to underlie impaired emotion recognition in autism.• Mixed evidence of atypical eye gaze in autism may be explained by alexithymia.• Novel methods reveal alexithymia is the best predictor of temporal dynamics of gaze to eyes.• Atypical eye gaze in alexithymia reflects reduced modulation by top-down priors to emotion.

Despite the heterogeneity in autism, socioemotional difficulties are often framed as universal. Increasing evidence, however, suggests that socioemotional difficulties may be explained by alexithymia, a distinct yet frequently co-occurring condition. If, as some propose, autistic traits are responsible for socioemotional impairments, then alexithymia may itself be a symptom of autism. We aimed to determine whether alexithymia should be considered a product of autism or regarded as a separate condition. Using factor-analytic and network approaches, we provide evidence that alexithymic and autistic traits are distinct. We argue that: (1) models of socioemotional processing in autism should conceptualise difficulties as intrinsic to alexithymia; and (2) assessment of alexithymia is crucial for diagnosis and personalised interventions.