Hypothalamus-pituitary-adrenal-axis associations with self- vs. parental ratings of depression in boys with an autism spectrum disorder

Background: Depression can be a major comorbidity in young people with an autism spectrum disorder (ASD). Although there is an association between major depressive disorder (MDD) and cortisol concentrations in non-ASD children, relatively little is known about that relationship in children with an ASD, or whether there are development effects on the relationship. It is also unclear whether self-reports or parents' reports of depression in these children are more closely associated with cortisol. Methods: Salivary cortisol from morning and afternoon, plus Child and Adolescent Symptom Inventory responses for MDD, were collected from a sample of 139 boys with an ASD. Parents of these boys also provided ratings of their sons on the Child and Adolescent Symptom Inventory for MDD. Results: Afternoon cortisol was significantly correlated with total depression scores for younger boys but not for older boys. There were also significant differences between the parents' and the boys' ratings for five of the 10 MDD symptoms. Parents' ratings of their sons' MDD symptoms of irritability, feeling sad or depressed, and sleeping problems were significantly correlated with the boys' cortisol concentrations. Both boys' and their parents' ratings for thoughts of death, feeling worthless, and concentration problems were significantly associated with the boys' cortisol concentrations. Conclusion: A reliable assessment of MDD in young people with an ASD requires careful consideration of the relative validity of parents' and children's reports of the latter's individual MDD symptomatology.