Pubertal Timing During Early Adolescence: Advanced Pubertal Onset in Females with Autism Spectrum Disorder

Abstract

Autism spectrum disorder (ASD) is characterized by impaired social communication and poor adaptation to change; thus, the onset of puberty may be a pivotal transition. This cross-sectional study measured pubertal timing to examine hypothesized differences for sex (female vs. male) and group (ASD vs. typical development [TD]). Participants included 239 children (137 ASD, 102 TD) between 10 and 13 years. The ASD group included 35 females and 102 males; the TDs included 44 females and 58 males. Pubertal onset measured by genital or pubic stage was investigated with linear regression using main effects of sex and age-by-sex interactions in TD and ASD groups and main effects of diagnosis and diagnosis-by-age interactions in males and females, controlling for body mass index, socioeconomic status, and race. In TD, examination of main effects for genital (penis/breast) stage showed no difference for male and female children (t = 1.33, P = 0.187, rdf = 92); however, there were significant differences in ASD (t = 2.70, P = 0.008, rdf = 121). For diagnosis modeled separately by sex, there was significantly earlier pubertal development in females with ASD (t = 1.97, P = 0.053, rdf = 70, but not males (t = 1.329, P = 0.186, rdf = 143). In addition, analysis of menses revealed females with ASD had significantly earlier onset than TD (t = −2.56, P = 0.018, rdf = 21). Examination of pubic stage revealed expected sex differences for TD (t = 2,674, P = 0.009, rdf = 91) and ASD (t = 3.482, P = 0.001, rdf = 121). Females with ASD evidence advanced pubertal onset relative to ASD males and TD females. Findings underscore the need for enhanced understanding of pubertal development in ASD, as differences may have significant psychological, social, physiological, and developmental consequences.

Navigating adolescence; pubertal development in autism spectrum conditions and its relation to mental health

“…For this, longitudinal studies are necessary, starting at an early age before the onset of pubertal. Moreover, although our results are likely suggestive of an earlier pubertal development in ASC, but in contrast with previous research (Corbett et al, 2020;Pohl et al, 2014), this was not reflected in an earlier age of menarche in autistic girls, possibly due to our relatively small sample.…”

“…For those that have more difficulties dealing with change, as is often described in autism spectrum conditions (ASC), this change can have a major impact. Moreover, differential pubertal onset has been reported in ASC (Corbett et al, 2020;Ingudomnukul et al, 2007;Knickmeyer et al, 2006;Pohl et al, 2014;Tordjman et al, 1997). This differential pubertal onset has been linked to a myriad of problems, such as depression and suicidal ideation (Copeland et al, 2019;Ho et al, 2021).…”

“…There are signs that ASC also influences pubertal timing. Autistic girls appear to have a younger age of menarche (i.e., first menstruation; Corbett et al, 2020). Moreover, a large retrospective study showed that autistic women were more likely to belong to the "steroidopathic" group, which was characterized by an early growth spurt, and precocious puberty and menarche (Pohl et al, 2014).…”

“…As there are indications of early pubertal timing in ASCs (Corbett et al, 2020;Pohl et al, 2014), and elevated rates of comorbidities (Simonoff et al, 2008) are reported in those with ASCs, a thorough investigation on pubertal development and its associated psychological problems in ASC is warranted. While this is an important topic, there is currently little research into this area.…”

Diagnostic- and sex-based differences in depression symptoms in autistic and neurotypical early adolescents

“…The current findings of sex-based differences are inconsistent with findings in another study of autistic youth that did not uncover sex-based differences in depression (Mayes et al, 2011), which may be accounted for by differences in the age of the samples ( M = 6.6 years in the Mayes study). Sex-based differences may be accounted for by many developmental factors, including pubertal timing (Angold et al, 1998; Corbett et al, 2020; Kaltiala-Heino et al, 2003), social expectations for females (Robinson et al, 2013; Rose & Rudolph, 2006), camouflaging and compensatory behaviors (Cage & Troxell-Whitman, 2019; Corbett et al, 2021; Livingston et al, 2019), and other factors yet uncovered (e.g. cultural influences, neurobehavioral pathways).…”