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PLoS One. 2018 Aug 7;13(8):e0200340. doi: 10.1371/journal.pone.0200340. eCollection 2018.

Pupil response to social-emotional material is associated with rumination and depressive symptoms in adults with autism spectrum disorder.

Author information

Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
Department of Psychiatry, University of Pittsburgh Medical Center, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America.
Neuroscience Graduate Program, Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, United States of America.
Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.



Autism spectrum disorder (ASD) is marked by repetitive thinking and high rates of depression. Understanding the extent to which repetitive negative thinking in ASD reflects autistic stereotypy versus general depressive thinking patterns (e.g., rumination) could help guide treatment research to improve emotional health in ASD. We compared associations between rumination, depressive symptoms, and pupil response to social-emotional material in adults with ASD and typically developing (TD) adults with and without depression.


N = 53 verbally fluent young adults were recruited to three cohorts: ASD, n = 21; TD-depressed, n = 13; never-depressed TD-controls, n = 19. Participants completed Ruminative Response Scale and Beck Depression Inventory self-reports and a passive-viewing task employing emotionally-expressive faces, during which pupillary motility was assessed to quantify cognitive-affective load. Main and interactive effects of cohort, emotion condition, and time on pupil amplitude were tested via a linear mixed effects analysis of variance using restricted maximum likelihood estimation. Similar procedures were used to test for effects of rumination and depressive symptoms on pupil amplitude over time within ASD.


Responsive pupil dilation in the ASD cohort tended to be significantly lower than TD-depressed initially but increased to comparable levels by trial end. When viewing sad faces, individuals with ASD who had higher depression scores resembled TD-depressed participants' faster, larger, and sustained pupil response. Within ASD, depressive symptoms uniquely predicted early pupil response to sad faces, while rumination and depression scores each independently predicted sustained pupil response.


People with elevated depressive symptoms appear to have faster and greater increases in pupil-indexed neural activation following sad stimuli, regardless of ASD status, suggesting the utility of conceptualizing rumination as depression-like in treatment. Ruminative processes may increase more slowly in ASD, suggesting the potential utility of interventions that decrease reactions before they are uncontrollable. Findings also reinforce the importance of testing for effects of internalizing variables in broader ASD research.

Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: Author K.G. receives royalties from the publisher of the Autism Diagnostic Observation Schedule (ADOS-2). This measure was used for confirming autism spectrum diagnosis in this sample and was not primary to outcome in this paper. K.G. donates to charity all royalties from Vanderbilt University Medical Center. Author J.B. also authored the Repetitive Behavior Scale-Revised (RBS-R) and the Interests Scale (IS), two instruments used in this study to measure restricted and repetitive behaviors associated with autism spectrum disorders. J.B. reports no financial interests or additional potential conflicts of interest with regard to this study. Authors G.S., G.H., A.T., R.C., and D.S. declare that they have no competing interests, financial or otherwise.

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