Puberty in autism: A window into emerging mental health risk

Puberty is a period of major neural reorganization, accompanied by changing demands to navigate increasingly complex social environments and the emergence of many mental health disorders. Although pubertal processes are becoming well-documented in neurotypical youth, the field has only begun to interrogate these processes in youth with autism. In this mini-review, we evaluate evidence regarding altered pubertal development in autism based on studies examining physical development milestones and neuroendocrine axes pertinent to adrenarche and gonadarche. We review studies linking pubertal factors with mental health symptoms in autistic youth to assess potential puberty-related links to risk for co-morbid psychopathology. We bring together multiple literatures across human and animal models to assess evidence of consensus across fields. Findings suggest that aspects of puberty may be accelerated in autism, and that they may be at elevated risk for co-morbid mental health symptoms. We conclude with recommendations for future research, including the need for integration across pubertal, neural, and mental health measures to delineate how trajectories of risk may unfold in youth with autism.