Comparing cortisol, stress, and sensory sensitivity in children with autism.
Autistic kids fall into high- or low-cortisol groups tied to sensory sensitivity, so tailor stress supports to the profile, not the label.
01Research in Context
What this study did
The team collected spit samples from 43 autistic kids and 30 neurotypical kids. They measured cortisol at wake-up and bedtime for two days.
Parents filled out forms about daily stress and sensory issues. Kids were 6-12 years old.
What they found
Morning cortisol went down as parent stress went up. Evening cortisol went up with stress.
Kids with more sensory problems showed both very high and very low cortisol. Two clear groups popped out: 'hyper-responders' and 'hypo-responders'.
How this fits with other research
Bravo Balsa et al. (2024) later saw the same two-group pattern in teens and young adults. They also found flatter daytime slopes in kids who struggled most with social life. The 2009 child data now looks like an early snapshot of the same trend.
MacFarland et al. (2025) showed sensory sensitivity stays strong even after removing ADHD symptoms. That backs the idea that sensory issues, not just general behavior problems, link to cortisol differences.
Lievore et al. (2026) used heart-rate instead of spit. They also found autistic kids split into low and high physiological reactors under social stress. Different body signal, same split.
Why it matters
Do not assume an autistic child is 'stressed' or 'calm' from behavior alone. Measure cortisol if you can, or at least track sensory triggers. Use the data to pick coping tools: active sensory input for hypo-responders, quiet spaces for hyper-responders. Update behavior plans when you see a flip from one group to the other.
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02At a glance
03Original abstract
Previously we reported that children with autism show significant variability in cortisol. The current investigation was designed to extend these findings by exploring plausible relationships between cortisol and psychological measures of stress and sensory functioning. Salivary cortisol values for diurnal rhythms and response to stress in children with and without autism were compared to parent-report measures of child stress, the Stress Survey Schedule (SSS), sensory functioning, Short Sensory Profile (SSP), and Parenting Stress Index. In autism, a negative relationship between morning cortisol and the SSS revealed that higher observed symptoms of stress were related to lower cortisol. Lower cortisol is seen in conditions of chronic stress and in social situations characterized by unstable social relationships. Sensory sensitivity painted a more complicated picture, in that some aspects of SSP were associated with higher while others were associated with lower cortisol. We propose that increased sensory sensitivity may enhance the autistic child's susceptibility to the influence of zeitgeibers reflected in variable cortisol secretion. Evening cortisol was positively associated with SSS such that the higher the level of evening cortisol, the higher the child's parent-reported daily stress, especially to changes, such as in daily routine. Regarding the response to stress, the psychological and parent variables did not differentiate the groups; rather, discrete subgroups of cortisol responders and nonresponders were revealed in both the autism and neurotypical children. The results support a complex interplay between physiological and behavioral stress and sensory sensitivity in autism and plausible developmental factors influencing stress reactivity across the groups.
Autism research : official journal of the International Society for Autism Research, 2009 · doi:10.1002/aur.64