Maryam Masoomi ¹ Mahdieh Saeidi ^2,3 Rommy Cedeno ⁴ Zahra Shahrivar ¹ Mehdi Tehrani-Doost ⁵ Zerimar Ramirez ² Divya Aishwarya Gandi ⁶ Sasidhar Gunturu ^7,8*

• ¹ Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Alborz, Iran
• ² Department of Psychiatry, BronxCare Health System, New York, New York, United States
• ³ New York State Psychiatric Institute (NYSPI), New York, New York, United States
• ⁴ Department of Molecular Pharmacology and Therapeutics in Psychiatry, New York State Psychiatric Institute/Columbia Univeristy Irving Medical Center, New York, United States
• ⁵ Research Center for Cognitive and Behavioral Sciences, Roozbeh Psychiatry Hospital, Tehran University of Medical Sciences, Tehran, Iran
• ⁶ Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
• ⁷ Bronx-Lebanon Hospital Center, New York, United States
• ⁸ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Abstract Background: Autism spectrum disorder is a neurodevelopmental condition characterized by persistent challenges in social communication and restricted, repetitive behaviors. Emotion recognition deficits are a core feature of ASD, impairing social functioning and quality of life. This meta-analysis evaluates emotion recognition accuracy and response time in individuals with autism spectrum disorder compared to neurotypical individuals and those with other neurodevelopmental disorders. Methods: This systematic review with a meta-analysis was conducted following PRISMA guidelines. A comprehensive literature search across PubMed, Scopus, Cochrane Library, and Web of Science identified 13 studies published between 2006 and 2024. Data on emotion recognition accuracy and response times were synthesized using standardized mean differences in random-effects models. Heterogeneity was assessed using the I² statistic, and sensitivity analyses were performed to ensure robustness. Results: Individuals with ASD exhibited significantly lower overall emotion recognition accuracy compared to TD individuals (SMD = -1.29, 95% CI: -2.20 to -0.39, p < 0.01) and NDDs (SMD = -0.89, 95% CI: -1.23 to -0.55, p = 0.02). Response times were significantly prolonged in ASD compared to TD individuals (SMD = 0.50, 95% CI: 0.36 to 0.63, p < 0.01) but not when compared to NDDs. Emotion-specific analyses did not consistently reveal significant differences across emotions (fear, anger, happiness, sadness, disgust, surprise), with substantial heterogeneity observed across studies (I² > 50%). Conclusions: This systematic review with a meta-analysis highlights significant impairments in emotion recognition accuracy and processing speed among individuals with autism spectrum disorder, particularly compared to neurotypical individuals. These findings underscore the importance of developing targeted interventions to address these deficits, which are foundational to improving social cognition and quality of life in autism spectrum disorder. Future research should prioritize standardized methodologies and explore cultural and contextual factors influencing emotion recognition abilities.