Physiological Response Patterns During Social Interaction to Predict Internalizing Symptoms in Children with Autism Spectrum Disorder

Abstract

Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and interaction. Many individuals with ASD experience significant psychological and physiological stress during peer interactions. Heightened reactivity of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) may contribute to social withdrawal and eventual development of anxiety and depression. Yet minimal research has been devoted to the interactions between the HPA axis and ANS, and the extent to which unique physiological profiles define behavioral and psychological well-being in youth with ASD. The current study examined HPA axis and ANS arousal in children with ASD and typical development before and during a friendly social interaction. Physiological profiles were compared with social behavior and internalizing symptoms to define the extent to which these symptoms overlap to affect overall psychological well-being. Participants ages 10-13 years with ASD (n=50) or typical development (n=50) underwent a friendly social interaction paradigm with a novel peer, during which noninvasive measures of HPA axis (cortisol) and ANS functioning (heart rate variability) were collected. Operationalized social behaviors were observed during interactions, and participants’ internalizing symptoms were reported by parent- and self-report. Statistical models included comparison of means (ANOVA, nonparametric tests), linear regression, and linear mixed modeling. Youth with ASD demonstrated persistent elevation in HPA reactivity during the social protocol, as well as a lack of adaptive autonomic flexibility throughout the interaction. Imbalanced autonomic states, especially those favoring heightened arousal, were further associated with elevated symptoms of depression in the ASD youth. Children with ASD were significantly less engaged in the social conversation and had a harder time maintaining involvement and rapport with the other peer. Our findings support an interconnected network between social symptoms and experience, physiological functioning, and internalizing symptoms, thereby emphasizing the importance of monitoring social communicative skills and biobehavioral responses throughout development in order to efficiently identify risks and intervene to protect psychological health.