HaptiKart: An engaging videogame reveals elevated proprioceptive bias in individuals with autism spectrum disorder.

An overreliance on proprioceptive (intrinsic) sensory input from the body, compared to visual (extrinsic) input from the environment, may underpin core features of autism spectrum disorder (ASD). We developed an engaging videogame ("HaptiKart") as a tool to examine differences in sensory-motor bias (proprioceptive vs. visual) in children and adults with ASD and whether bias correlates with age, core autism features, and intellectual ability. Eighty-one participants (33 ASD, 48 typically-developing, TD) aged 8-31 years played "HaptiKart," a driving videogame with a force-feedback steering wheel that provided "steering assist" during gameplay. In separate trials, proprioceptive and visual feedback were selectively delayed, and differences in driving error between the conditions were used to calculate perceptual bias scores. Effects of autism diagnosis and age on bias scores were examined, controlling for sex, as were associations of perceptual bias with autism symptom severity (ADOS-2, SRS-2), attention-deficit symptom severity (Conners4 ADHD Total Scores) ratings, and IQ (general ability index, GAI). The ASD group exhibited significantly higher proprioceptive bias than did the TD group (p = 0.002). There was a trend for decreasing proprioceptive bias with age, but no significant diagnosis-by-age interaction. Increased proprioceptive bias correlated with higher autism severity and with lower IQ, but not ADHD symptoms. HaptiKart provides a highly scalable approach for measuring sensory-motor bias, revealing that individuals with ASD show elevated proprioceptive bias, correlating with autism severity. HaptiKart's sensory-motor bias measure may thereby serve as a digital biomarker for addressing autism heterogeneity in ways that can improve targeted intervention.