Disordered recognition of facial identity and emotions in three Asperger type autists

In this report we aim to explore severe deficits in facial affect recogniti on in three boys all of whom meet the criteria of Asperger's syndrome (AS), as well as overt prosopagnosia in one (B) and covert prosopagnosia in the remaining two (C and D). Subject B, with a familially-based talent of being highly gifted in physics and mathematics, showed no interest in people, a quasi complete lack of comprehension of emotions, and very poor emotional r eactivity. The marked neuropsychological deficits were a moderate prosopagn osia and severely disordered recognition of facial emotions, gender and age . Expressive facial emotion, whole body psychomotor expression and speech p rosody were quasi absent as well. In all three boys these facial processing deficits were more or less isolated, and general visuospatial functions, a ttention, formal language and scholastic performances were normal or even h ighly developed with the exception of deficient gestalt perception in B. We consider the deficient facial emotion perception as an important pathogene tic symptom for the autistic behaviour in the three boys. Prosopagnosia, th e absent facial and bodily expression, and speech prosody were important bu t varying co-morbid disorders. The total clinical picture of nonverbal diso rdered communication is a complex of predominantly bilateral and/or right h emisphere cortical deficits. Moreover, in B, insensitivity to pain, smells, noises and internal bodily feelings suggested a more general emotional ana esthesia and/or a deficient means of expression. It is possible that a limb ic component might be involved, thus making affective appreciation also def icient.