Is afternoon cortisol more reliable than waking cortisol in association studies of children with an ASD?

• In children with ASD, cortisol is an indicator of stress and anxiety.
• Waking samples may be influenced by HPA-axis irregularities.
• Early data suggest that afternoon samples have reduced irregularities.
• Afternoon cortisol may provide a more reliable index of stress in ASD children.

Salivary cortisol may be used as a biomarker of stress and anxiety in children with an Autism Spectrum Disorder (ASD) and is particularly valuable in studies of the association between stress-related cortisol concentrations and other factors such as comorbid disorders or aspects of the ASD phenotype. Although protocols for the collection of cortisol shortly after waking are often based on the assumption of the presence of a diurnal rhythm in cortisol, that rhythm may not be as reliable in children with an ASD as in non-ASD children. Alternatively, collecting cortisol during the afternoon may represent a more reliable procedure with less inter-participant variability.