Understanding facial expressivity in autism spectrum disorder: An inside out review of the biological basis and clinical implications

Deficits in decoding and understanding facially expressed emotions occur commonly in persons with autism spectrum disorder (ASD), which contribute to the impairment of social communication that serves as one of its core diagnostic criteria. Research suggests that abnormalities of visual scanning of the face, activation of key nodes within the “social brain” by facially expressed emotions, functional connectivity within and between nodes of the “social brain”, and transduction of specific neurotransmitter/neuromodulatory signals contribute to the pathogenesis of these deficits in at least some persons with ASD. Importantly, the etiologies of these deficits are heterogeneous and include genetic, immunologic, and inflammatory mechanisms, as well as in utero exposures to drugs and toxins. The manifestation and severity of these deficits can also be influenced by developmental age, IQ and genetic background. Consistent with the goals of the Special Issue, the current Review is intended to familiarize the readership with several of the leading neurobiological mechanisms proposed to underlie these deficits in decoding facially expressed emotions and stimulate interest in translational preclinical and clinical investigations, whose ultimate purpose is to attenuate their severity and, thereby, improve functional outcomes of persons with ASD. •Abnormalities of visual scanning of the face are reported in persons with ASD.•Serotonin synthesis and reuptake may bias central face processing in persons with ASD.•Amygdala and fusiform gyrus (FFG) activation is altered in persons with ASD.•Oxytocin enhances attention to socially salient stimuli in persons with ASD.•FFG activation is normalized when fixation on eyes is increased in persons with ASD.