A momentary assessment study on emotional and biological stress in adult males and females with autism spectrum disorder (original) (raw)

Prospective momentary psychological and biological measures of real-time daily life stress experiences have been examined in several psychiatric disorders, but not in adults with an autism spectrum disorder (ASD). The current electronic self-monitoring study examined associations between momentary daily life stressors and (i) negative affect (NA; emotional stress reactivity) and (ii) cortisol levels (biological stress reactivity) in males and females with ASD (N = 50) and without ASD (N = 51). The Experience Sampling Method, including saliva sampling, was used to measure three types of daily life stress (activity-related, event-related, and social stress), NA, and cortisol. Multilevel regression analyses demonstrated significant interactions between group and stress (i.e., activity-related and event-related stress) in the model of NA, indicating stronger emotional stress reactivity in the ASD than in the control group. In the model of cortisol, none of the group × stress interactions were significant. Male/female sex had no moderating effect on either emotional or biological stress reactivity. In conclusion, adults with ASD showed a stronger emotional stress (but not cortisol) reactivity in response to unpleasant daily life events and activities. The findings highlight the feasibility of electronic self-monitoring in individuals with ASD, which may contribute to the development of more personalized stress-management approaches. Observational and experimental stress studies report increased emotional stress levels in adults with an autism spectrum disorder (ASD) with respect to controls 1,2. However, there is no intensive time-series data on real-life, real-world momentary emotional stress reactivity derived from individuals with ASD. Emotional stress reactivity, defined as the effect of subjective appraisals of everyday stressors on negative affect (NA) can be studied via ecological momentary assessment (EMA) and has been used in a wide range of psychiatric disorders. For example, an increased emotional stress reactivity has been found in individuals at high risk for psychosis 3 , with psychotic illness 4 , and remitted bipolar disorder 5 compared to the general population. Evidence also shows that dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis may play a role in the altered stress processing of individuals with ASD, indicating that the stress hormone cortisol may be disturbed. However, reports on cortisol outcome measures are not very consistent. Both increased 6,7 , decreased 8,9 , or equal 10,11 cortisol responses to social stressors have been found in children and adolescents with ASD compared to non-ASD individuals. To our knowledge, only two experimental studies have investigated the cortisol response in adults with ASD; both studies found a comparable cortisol response to a social stressor in the ASD and control group 1,12. Because of this inconsistent pattern and the artificial nature of laboratory settings, studying cortisol response in a naturalistic environment may shed new light on the relationship between stress and cortisol in ASD. In the past decades, EMA studies investigated biological stress reactivity by studying associations between minor daily life stressors and momentary cortisol levels. For example, an increased cortisol response associated with daily stressors was demonstrated in 556 females in the general population 13. In addition, studies on psychiatric samples showed an increased cortisol response to daily stressors in participants with aboveaverage risk for psychosis 14 and a blunted cortisol response in participants with 22q11.2 deletion syndrome 15 relative to controls.