Diurnal cortisol profiles in autistic adolescents and young adults: Associations with social difficulties and internalizing mental health symptoms.
Autistic teens and young adults make more total daily cortisol, and those with the roughest social lives have the flattest daytime drop—a body stuck in idle.
01Research in Context
What this study did
Bravo Balsa et al. (2024) tracked spit-cortisol four times a day for two weekdays in 60 autistic and 60 non-autistic teens and young adults.
They also asked about social struggles and mood to see if stress hormone patterns line up with real-life problems.
What they found
Autistic youth pumped out more total cortisol across the day, even though morning and bedtime levels looked the same.
Kids who said they had the hardest time with peers showed the flattest daytime drop—cortisol stayed high instead of sliding.
How this fits with other research
Johnson et al. (2009) first spotted that autistic kids split into “high” and “low” cortisol groups; Laura’s 2024 data now show the high group keeps that edge into young adulthood.
Howard et al. (2023) found poor social well-being predicts later depression in the same age band; Laura links the same social pain to a tired, flat stress curve—different marker, same risk.
Lievore et al. (2026) saw autistic youth show low heart-rate reactivity during speech stress; Laura adds that their daily cortisol is also blunted, pointing to a body that stays on alert too long.
Why it matters
Flat cortisol plus high daily output is a red flag for burnout and mood problems. When an autistic teen says “people are hard,” check saliva or watch for fatigue, not just skill drills. Pair social goals with stress breaks, outdoor time, or mindfulness to give the hormone system a rest.
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02At a glance
03Original abstract
Several autism-related characteristics, such as social difficulties, may contribute to high perceived stress and increased exposure to stressful life events in some autistic individuals. Repeated exposure to stress might lead to the dysfunction of the hypothalamic-pituitary-adrenocortical-axis and be a vulnerability factor for developing mental health difficulties. Previous studies show contradictory findings on salivary cortisol in autism. In the current study, we investigated diurnal cortisol profiles in autistic adolescents and young adults, as well as their associations with social difficulties, stress exposure, and mental health symptoms. Autistic (n = 48, Mage = 17.6) and nonautistic (n = 51, Mage = 18.4) participants collected salivary cortisol at home six times a day for 2 days. Social difficulties, exposure to stressful life events/bullying, and mental health symptoms were assessed with questionnaires and clinical interviews. Similar diurnal cortisol slopes (DCS) and cortisol awakening responses were observed between the groups, but autistic participants showed higher total cortisol output (AUCG, area under the curve with respect to ground) during the day (b = 19.09, p = 0.009). In the autistic group, more severe social difficulties were associated with flatter DCS (b = 0.01, p = 0.007). Finally, cortisol alterations were associated with self-reported mental health symptoms, especially in autistic females in analyses uncorrected for multiple comparisons. In conclusion, our results do not indicate autism-related group-level alterations in most diurnal cortisol measures, but autistic youth showed higher total cortisol (AUCG) compared with nonautistic peers. More detailed investigation of interindividual variability in cortisol profiles within autistic people might give us important insights into vulnerability to developing stress-related mental health difficulties.
Autism research : official journal of the International Society for Autism Research, 2024 · doi:10.1002/aur.3184