Salivary cortisol and behavioral response to social evaluative threat in adolescents with autism spectrum disorder.
Autistic teens stay cool during public speaking because the social threat feels small, but that does not mean they live stress-free.
01Research in Context
What this study did
Edmiston et al. (2017) put teens with autism and typical teens through the Trier Social Stress Test.
The test asks kids to give a speech and do math in front of strangers.
The team measured spit cortisol before and after the task and watched for calm-down moves like rocking or hand rubbing.
What they found
Typical teens spiked their cortisol during the speech task.
Autistic teens kept flat cortisol and used fewer self-soothing moves.
The result says social judgment may not feel scary to them.
How this fits with other research
Bozkurt et al. (2021) saw higher resting cortisol in young autistic boys.
The two papers seem opposite, but Hasan looked at baseline blood in children while Kale looked at spit reactivity in teens.
Bravo Balsa et al. (2024) later tracked autistic teens at home and found higher total daily cortisol linked to social trouble.
Together the trio shows: young kids may run high, teens may not react to one speech, yet chronic daily stress can still climb.
Why it matters
Do not assume a calm face means no stress.
Flat cortisol during a speech does not rule out high daily load.
Pair brief social challenges with parent logs or hair samples to see the full picture.
Adjust social skills goals to include anxiety checks and teach coping moves that fit the teen’s own body signals.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add a quick calm-down rating scale after each social task and track it for two weeks.
02At a glance
03Original abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social behavior. One possible explanation for social communication deficits in ASD could be differences in biological systems that support responses to environmental stimuli. If so, it is unclear if differences in the arousal response to social stimuli in ASD are due to reduced interest in social information, or to an increased stress response. The hypothalamic pituitary adrenal axis facilitates arousal and the stress response to sensory input, including social stimuli. Previous research shows blunted cortisol response to social evaluative threat in children with ASD. The majority of prior work has focused on children with ASD, but adolescents with ASD are understudied. The adolescent period is of interest, as this developmental epoch is associated with increased salience of social evaluative threat in typically developing (TD) populations. In this study, we employed the Trier Social Stress Test (TSST), a laboratory paradigm that involves exposure to social evaluative threat, to study the cortisol and behavioral response to social evaluative threat in ASD and TD adolescents. Salivary cortisol data were collected at six time points before and after the TSST. Behavioral data were collected using video recordings of the TSST, which were then operationalized and coded. Paired sample t-tests were used to calculate within-group cortisol response to the TSST. Cortisol significantly increased in response to the TSST in the TD group but not the ASD group. The TD group showed a trend for more self-soothing behaviors during the stressor than the ASD group. The lack of a cortisol response to the TSST in the ASD group suggests that the TSST is not interpreted as stressful or salient for ASD adolescents. Autism Res 2017, 10: 346-358. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
Autism research : official journal of the International Society for Autism Research, 2017 · doi:10.1002/aur.1660