Reduced eye fixation and deficits in emotion identification accuracy have been commonly reported in individuals with autism spectrum disorder (AS), but are not ubiquitous. There is growing evidence that emotion processing deficits may be better accounted for by comorbid alexithymia (i.e., difficulty understanding and describing one's emotional state), rather than AS symptoms per se. Another possible explanation is anxiety, which is often comorbid with AS; emotion processing difficulties, including attentional biases, have also been observed in anxiety disorders, suggesting that anxiety symptoms may also influence emotion processing within AS. The purpose of the current study was to test the role of dimensional symptoms of autism, anxious apprehension (AA), and alexithymia in mediating eye fixation across two different facial processing tasks with three adult samples: adults diagnosed with autism (AS; n = 30), adults with clinically-elevated anxiety without autism (HI-ANX; n = 29), and neurotypical adults without high anxiety (NT; n = 46). Experiment 1 involved participants completing an emotion identification task involving short video clips. Experiment 2 was a luminescence change detection task with an emotional-expression photo paired with a neutral-expression photo. Joy, anger, and fear video and photo stimuli were used. Dimensional, mixed-effects models showed that symptoms of autism, but not alexithymia, predicted lower eye fixation across two separate face processing tasks. There were no group differences or significant dimensional effects for accuracy. Anxious apprehension was negatively related to response time in Experiment 1 and positively related to eye fixation in Experiment 2. An attentional avoidance of negative emotions was observed in the NT and HI-ANX group, but not the AS group. The bias was most pronounced at lower levels of AS symptoms and higher levels of AA symptoms. The results provide some evidence for a possible anxiety-related subtype in AS, with participants endorsing high autism symptoms, but low anxious apprehension, demonstrating more classic emotion processing deficits of reduced eye fixation.

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