Differences in HPA-axis and heart rate responsiveness to psychosocial stress in children with autism spectrum disorders with and without co-morbid anxiety

Matthew J. Hollocks, Patricia Howlin, Andrew S. Papadopoulos, Mizanur Khondoker, Emily Simonoff

Research output: Contribution to journalArticlepeer-review

101 Citations (Scopus)


Children and adolescents with autism spectrum disorder (ASD) have much higher rates of anxiety disorders relative to their typically developing peers. However, there have been few attempts to investigate what physiological parameters may be associated with this elevated rate of anxiety. Therefore, this study investigated the physiological correlates of anxiety in ASD, with a focus on whether measures of heart rate and cortisol responsiveness to psychosocial stress differentiate those participants with ASD with and without a co-occurring anxiety disorder. A total of 75 male participants aged 10-16 years with normal intellectual ability underwent a psychosocial stress test. The participants included healthy controls (n = 23), ASD only (ASD; n = 20) and ASD with a comorbid anxiety disorder (ASDanx; n = 32). Heart rate, heart rate variability and salivary cortisol were compared by fitting a piecewise regression model to examine baseline levels and change over time within and between the rest, stress and recovery phases of the stress test. The ASDanx group had different response patterns from both the ASD and control groups. The ASDanx group was characterized by a blunted cortisol and heart rate response to psychosocial stress. Furthermore, in the ASDanx group, reduced heart rate and cortisol responsiveness were significantly related to increased anxiety symptoms. This is the first study to report a possible physiological basis for co-occurring anxiety disorders in children and adolescents with ASD. It is possible that a non-adaptive physiological response to psychosocial stress may be related to the high prevalence of co-occurring anxiety disorders in people with ASD. (C) 2014 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)32-45
Number of pages14
Early online date18 Apr 2014
Publication statusPublished - Aug 2014


  • Autistic disorder
  • Cortisol
  • Developmental disorders
  • Emotion
  • Mood disorders

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