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Despite this knowledge, the exact neurophysiological mechanisms driving these differences and their direct impact on clinical symptoms remain unclear.\u2009This study delves deeper into understanding the neurophysiological mechanisms involved in social cue integration, moving beyond mere behavioral observations. Specifically, we investigated how autistic children and typically developing (TD) peers process congruent and incongruent social signals in everyday situations.\u2009We compared 34 male autistic (2.5\u20136\u2009years) versus 34 TD children via eye\u2010tracking and functional near\u2010infrared spectroscopy to measure gaze, pupil dilation, and frontal activation during gesture\u2010face integration. TD children exhibited heightened attention to happy faces while maintaining equal attention to neutral faces and gestures when reward gestures were paired. The ASD group did not demonstrate an effective processing strategy. ASD children exhibited heightened pupil dilation and anterior prefrontal cortex (aPFC) activation in all conditions. Crucially, their gaze patterns and aPFC activation significantly correlated with poorer adaptive functioning and positively predicted autism severity. Autistic children go through a distinct, neurologically demanding, and inefficient process to integrate multimodal social cues. This inefficient compensatory attempt results in a metabolically costly physiological state, which is directly connected to the core challenges of ASD. The identified features provide a preliminary proof\u2010of\u2010concept for objective biomarkers, offering quantifiable, physiological indices of severity, thus enabling the development of targeted neurocognitive interventions.<\/jats:p>","DOI":"10.1002\/aur.70289","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T06:45:49Z","timestamp":1781073949000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Cost of Social Integration: Distinct Neural Inefficiency in Autistic Children Underlies Symptom Severity"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0634-7991","authenticated-orcid":false,"given":"Juan","family":"Kou","sequence":"first","affiliation":[{"name":"Institute of Brain and Psychological Sciences Sichuan Normal University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyuan","family":"Yang","sequence":"additional","affiliation":[{"name":"Institute of Brain and Psychological Sciences Sichuan Normal University  Chengdu China"},{"name":"Department of Psychology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School Nanjing University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Basic Medical Sciences Chengdu University of Traditional Chinese Medicine  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Le","sequence":"additional","affiliation":[{"name":"School of Basic Medical Sciences Chengdu University of Traditional Chinese Medicine  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4647-8937","authenticated-orcid":false,"given":"Lihui","family":"Huang","sequence":"additional","affiliation":[{"name":"Institute of Brain and Psychological Sciences Sichuan Normal University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8874-923X","authenticated-orcid":false,"given":"Yi","family":"Lei","sequence":"additional","affiliation":[{"name":"Institute of Brain and Psychological Sciences Sichuan Normal University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1534582302001001003"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrn1884"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.neuro.28.061604.135709"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/bios12010033"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2025.04.008"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2025.106022"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejn.13751"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.4324\/9781003064541"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2012.11.022"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1109\/jssc.2015.2504412"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2018.1100"},{"key":"e_1_2_13_14_1","volume-title":"Social Responsiveness Scale: SRS\u20102","author":"Constantino J. 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