Diurnal Cortisol and Daily Stress in Youth with Autism Spectrum Disorder

Background:   While clinical experience suggests youth with autism spectrum disorder (ASD) experience increased levels of stress, few studies have investigated daily stressors and their potential relation to increased anxiety and ASD symptom severity in youth with ASD. Several daily stressors may be particularly relevant in ASD (e.g., the unpredictability of social interactions, sensory sensitivities to everyday environments). Further, there are few studies of HPA functioning in individuals with ASD and little research has examined the relation between cortisol levels and daily stress in individuals with ASD.

Objectives: To cross validate diurnal cortisol levels as a measure of stress in youth with ASD. A second objective is to examine the relation between daily stress, anxiety symptoms, and ASD symptom severity in youth with ASD.

Methods: Participants will include 40 high-functioning youth with ASD, aged 7-13 years. Thus far, cortisol levels have been collected for 26 youth, at four time points throughout the day for three days. Parent, child and diagnostician reports of daily stressors (e.g., Stress Schedule Survey), anxiety symptoms (e.g., Pediatric Anxiety Rating Scale), and ASD symptom severity (e.g., Social Responsiveness Scale) are collected.

Results: Preliminary findings suggest a relation between diurnal cortisol levels and parent report of daily stressors. A flattened diurnal cortisol slope was significantly related to increased parent reported stress related to sensory/personal contact (r = -.44, p < .05) and unpleasant events (r = -.40, p < .05). In contrast, the cortisol awakening response (CAR) was not significantly related to parent reports of stress. Daily stress and stressful life events were significantly correlated with increased anxiety, respectively (r = .45, p < .05; r = .44, p < .05). In particular, increased stress related to social and environmental interactions was significantly correlated with increased humiliation/rejection anxiety (r =.47, p < .05), social anxiety (r =.46, p < .05), separation anxiety (r =.54, p < .05) and total anxiety (r =.58, p < .01). The relation between stress, anxiety, and greater ASD symptom severity will be examined through mediational models. 

Conclusions: Results thus far indicate that there is a relation between cortisol patterns and stress in youth with ASD, suggesting that cortisol may have the potential to serve as an objective marker of distress in a population marked by limitations in the ability to report emotional state. Further, greater daily stress was related to increased anxiety. Additional analyses will determine if greater daily stress and anxiety contributes to greater ASD symptom severity. Because ASD is a prevalent, disabling condition, it is of considerable importance to determine the factors that are associated with greater symptom severity and functional impairment. Stressors and anxiety ultimately could prove to be important targets of treatment for some youth with ASD as part of an overall intervention strategy for reducing core symptom severity and impairment.