Decision-making in autism: A narrative review.

Knaier et al. (2023) read every lab paper they could find on how autistic people make choices. They grouped the tasks into three buckets: simple picture or reward games, thinking-about-thinking jobs, and real-life value calls like "Which friend do I trust?"

The review pulled data from youth and adult studies across many countries. No new lab work was done; the team mapped what was already known.

On simple games—spot the red square, pick the bigger prize—autistic and non-autistic players looked the same.

When choices needed self-reflection or social guess-work, autistic participants took longer, made fewer fair offers, or avoided the choice altogether. The gap showed up strongest in value-based tasks that mix emotion, time, and other people.

Ghosn et al. (2025) extends the story: autistic kids move slower because they double-check fairness, not because they process slowly. The youth data match the review’s value-choice gap, giving us one clear reason for the delay.

Woodcock et al. (2020) seems to contradict Farah: the same age group made fewer fair offers, not more. The clash fades when you see Anne used an ultimatum game with real money losses while Farah used low-stakes cartoon tokens. Higher social cost widened the fairness gap, showing task design drives the result.

Warnell et al. (2019) and Luke et al. (2012) back the metacognitive angle. Autistic teens and adults report steeper discounting of future rewards and more daily decision avoidance, lining up with the review’s claim that value-based choices feel harder.

You can stop drilling basic discrimination trials once mastery is shown; the data say perceptual choice is intact. Instead, teach clients to talk through pros and cons out loud, use visual choice boards for social dilemmas, and allow extra wait time when fairness is on the line. These small shifts target the exact metacognitive and value-based gaps the review flags, moving sessions from stand-offs to self-driven decisions.