Salivary Cortisol Levels and Diurnal Patterns in Children with Autism Spectrum Disorder

  • Susan K. Putnam
  • Christopher Lopata
  • Marcus L. Thomeer
  • Martin A. Volker
  • Jonathan D. Rodgers


Autism spectrum disorder (ASD) is characterized by significant heterogeneity in functional levels that can reportedly affect stress. This study examined the diurnal patterns and cortisol levels of low-functioning children with ASD, high-functioning children with ASD, and typically-developing children between the ages of 7 and 12 years. Saliva was collected from each participant three times per day (AM, noon, and PM) during two consecutive weekends. Results indicated that all three groups demonstrated the typical diurnal pattern (highest cortisol at AM, followed by noon, and lowest at PM). Although results revealed no significant group x time interaction, significant main effects were found for time and group. These effects indicated that collectively, all three groups demonstrated mean differences in cortisol levels across the day. In addition, the low-functioning ASD group yielded significantly higher mean cortisol levels than the high-functioning ASD and typically-developing groups; the high-functioning ASD and typically-developing groups did not significantly differ.


Autism spectrum disorder Salivary cortisol Diurnal cycle Stress L-HPA axis 



The research reported in this article was supported by a grant from the John R. Oishei Foundation. Findings and conclusions are those of the authors and do not necessarily reflect the views of the funding agency. We would also like to express our gratitude to the children and parents who participated in this study, and to all of the research assistants who were instrumental in carrying out this project.

Conflict of Interest

None declared.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.Google Scholar
  2. Ashburner, J., Ziviani, J., & Rodger, S. (2010). Surviving in the mainstream: capacity of children with autism spectrum disorders to perform academically and regulate their emotions and behavior at school. Research in Autism Spectrum Disorders, 4, 18–27.CrossRefGoogle Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, text revision (4th ed.). Washington: Author.Google Scholar
  4. Bayley, N. (2006). Bayley scales of infant and toddler development (3rd ed.). San Antonio: The Psychological Corporation.Google Scholar
  5. Brosnan, M., Turner-Cobb, J., Munro-Naan, Z., & Jessop, D. (2009). Absence of normal cortisol awakening response (CAR) in adolescent males with Asperger syndrome (AS). Psychoneuroendocrinology, 34, 1095–1100.PubMedCrossRefGoogle Scholar
  6. Chrousos, G. P. (2009). Stress and disorders of the stress system. National Review of Endocrinology, 5, 374–381.CrossRefGoogle Scholar
  7. Cicchetti, D., & Rogosch, F. A. (2001). The impact of child maltreatment and psychopathology on neuroendocrine functioning. Development and Psychopathology, 13(4), 783–804.PubMedGoogle Scholar
  8. Corbett, B. A., Mendoza, S., Abdullah, M., Wegelin, J. A., & Levine, S. (2006). Cortisol circadian rhythms and response to stress in children with autism. Psychoneuroendocrinology, 31(1), 59–68.PubMedCrossRefGoogle Scholar
  9. Corbett, B. A., Mendoza, S., Wegelin, J. A., Carmean, V., & Levine, S. (2008). Variable cortisol circadian rhythms in children with autism and anticipatory stress. Journal of Psychiatry and Neuroscience, 33(3), 227–234.PubMedCentralPubMedGoogle Scholar
  10. Corbett, B. A., Schupp, C. W., Levine, S., & Mendoza, S. (2009). Comparing cortisol, stress, and sensory sensitivity in children with autism. Autism Research, 2, 39–49.PubMedCentralPubMedCrossRefGoogle Scholar
  11. Dunn, L. M., & Dunn, D. M. (2007). Peabody picture vocabulary test (4th ed.). Minneapolis: Pearson.Google Scholar
  12. Elliott, C. D. (2007). Differential ability scales (2nd ed.). San Antonio: Harcourt.Google Scholar
  13. Evans, D. W., Canavera, K., Kleinpeter, F. L., Maccubbin, E., & Taga, K. (2005). The fears, phobias, and anxieties of children with autism spectrum disorders and Down syndrome: comparison with developmentally and chronologically age matched children. Child Psychiatry and Human Development, 36(1), 3–26.PubMedCrossRefGoogle Scholar
  14. Fenton, G., D’Ardia, C., Valente, D., Del Vecchio, I., Fabrizi, A., & Bernabei, P. (2003). Vineland adaptive behavior profiles in children with autism and moderate to severe developmental delay. Autism, 7(3), 269–287.PubMedCrossRefGoogle Scholar
  15. Gjevik, E., Eldevik, S., Fjaeran-Granum, T., & Sponheim, E. (2011). Kiddie-SADS reveals high rates of DSM-IV disorders in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 41, 761–769.PubMedCrossRefGoogle Scholar
  16. Gunnar, M. R., & Vazquez, D. M. (2001). Low cortisol and a flattening of expected daytime rhythm: potential indices of risk in human development. Development and Psychopathology, 13(3), 515–538.PubMedCrossRefGoogle Scholar
  17. Hoshino, Y., Ohno, Y., Murata, S., Kaneko, M., & Kumashiro, H. (1987). The diurnal variation and response to dexamethasone suppression test of saliva cortisol level in autistic children. The Japanese Journal of Psychiatry and Neurology, 41(2), 227–235.PubMedGoogle Scholar
  18. Howlin, P. (1999). Children with autism and Asperger syndrome: A guide for practitioners and careers. Chichester: Wiley & Sons.Google Scholar
  19. Kidd, S. A., Corbett, B. A., Granger, D. A., Boyce, W. T., Anders, T. F., & Tager, I. B. (2012). Daytime secretion of salivary cortisol and alpha-amylase in preschool-aged children with autism and typically developing children. Journal of Autism and Developmental Disorders, 42, 2648–2658.PubMedCentralPubMedCrossRefGoogle Scholar
  20. Lanni, K. E., Schupp, C. W., Simon, D., & Corbett, B. A. (2012). Verbal ability, social stress, and anxiety in children with autistic disorder. Autism, 16(2), 123–138.PubMedCentralPubMedCrossRefGoogle Scholar
  21. Lopata, C., & Thomeer, M. L. (2014). Autism and anxiety in school. In T. E. Davis, S. W. White, & T. H. Ollendick (Eds.), Handbook of autism and anxiety (pp. 201–214). New York: Springer.Google Scholar
  22. Marinovic-Curin, J., Marinovic-Terzic, I., Bujas-Perkovic, Z., Zekan, L., Skrabic, V., Dogas, Z., et al. (2008). Slower cortisol response during ACTH stimulation test in autistic children. European Child and Adolescent Psychiatry, 17(1), 39–43.PubMedCrossRefGoogle Scholar
  23. McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179.PubMedCrossRefGoogle Scholar
  24. Morgan, K. (2006). Is autism a stress disorder? What studies of nonautistic populations can tell us. In M. G. Baron, J. Groden, G. Groden, & L. P. Lipsitt (Eds.), Stress and coping in autism (pp. 129–182). New York: Oxford University Press.Google Scholar
  25. Perry, A., Flanagan, H., Geier, J. D., & Freeman, N. L. (2009). Brief report: the Vineland adaptive behavior scales in young children with autism spectrum disorders at different cognitive levels. Journal of Autism and Developmental Disorders, 39, 1066–1078.PubMedCrossRefGoogle Scholar
  26. Putnam, S. K., Lopata, C., Fox, J. D., Thomeer, M. L., Rodgers, J. D., Volker, M. A., Lee, G. K., Neilans, E. G., & Werth, J. (2012). Comparison of saliva collection methods in children with high-functioning autism spectrum disorders: acceptability and recovery of cortisol. Child Psychiatry and Human Development, 43(4), 560–573.PubMedCrossRefGoogle Scholar
  27. Richdale, A. L., & Prior, M. R. (1992). Urinary cortisol circadian rhythm in a group of high-functioning children with autism. Journal of Autism and Developmental Disorders, 22(3), 433–447.PubMedCrossRefGoogle Scholar
  28. Rodgers, J., Riby, D. M., Janes, E., Connolly, B., & McConachie, H. (2012). Anxiety and repetitive behaviours in autism spectrum disorders and Williams syndrome: a cross-syndrome comparison. Journal of Autism and Developmental Disorders, 42, 175–180.PubMedCrossRefGoogle Scholar
  29. Romanczyk, R. G., & Gillis, J. M. (2006). Autism and the physiology of stress and anxiety. In M. G. Baron, J. Groden, G. Groden, & L. P. Lipsitt (Eds.), Stress and coping in autism (pp. 183–204). New York: Oxford University Press.Google Scholar
  30. Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., McCracken, J. T., Tierney, E., Williams White, S., Lecavalier, L., & Vitiello, B. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36, 117–128.PubMedCrossRefGoogle Scholar
  31. Szatmari, P., & McConnell, B. (2011). Anxiety and mood disorders in individuals with autism spectrum disorder. In D. G. Amaral, G. Dawson, & D. H. Geschwind (Eds.), Autism spectrum disorders (pp. 330–338). New York: Oxford University Press.CrossRefGoogle Scholar
  32. White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29, 216–229.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Susan K. Putnam
    • 1
  • Christopher Lopata
    • 1
  • Marcus L. Thomeer
    • 1
  • Martin A. Volker
    • 1
  • Jonathan D. Rodgers
    • 1
  1. 1.Canisius CollegeBuffaloUSA

Personalised recommendations