Understanding and Supporting Puberty in Autistic Girls and Boys

Blythe A. Corbett, Ph.D., discusses her lab’s research on puberty, adolescence, and mental health in autistic individuals. She emphasizes puberty as a period of significant biological maturation involving several physical, biological, hormonal, and social factors. The speaker details her lab’s latest research on pubertal onset, mental health, hormonal changes, and gender identity in autistic young people compared to allistic (non-autistic) groups. Corbett repeatedly emphasizes how puberty can be particularly complex for autistic youth (especially those assigned female at birth), who are already vulnerable to change and stress. She summarizes the presentation and underscores the importance of exploring how puberty’s hormonal, psychological, and social changes interact with the autism phenotype before the Q&A.

Handouts are online HERE

In this webinar:

1:15 – Outline
5:10 – Adolescence, puberty & associated risks
9:25 – Measuring puberty
13:15 – Autistic vs. allistic pubertal onset
19:00 – Cortisol levels in autistic young people
25:25 – Depression in young people with autism
32:15 – Testosterone and development
37:00 – Gender identity
43:00 – Conclusions & future research
47:30 – Q&A

Adolescence & puberty in autism

Corbett describes autism as a neurodevelopmental condition characterized by differences in social communication (e.g., social-emotional reciprocity, non-verbal communication) and restricted, repetitive patterns of behavior, interests, or activities (e.g., insistence on sameness, sensory sensitivities) (01:35). Adolescence, she explains, is a transformative stage characterized by significant psychological, social, emotional, and hormonal shifts, typically spanning ages 10 to 24. Within this broader period of adolescence, puberty specifically marks the biological maturation that leads to reproductive capacity and further psychosocial development (5:10). For autistic individuals, who often experience challenges with social communication, adaptability to change, and sensory sensitivities, navigating these developmental milestones can be particularly complex.

The presenter explains that early onset puberty can increase the risk for mental health problems, such as anxiety, depression, and suicidality, which are already more prevalent in adolescents with autism (05:58). Until recently, research on puberty and autism has been limited. Some recent studies suggest that while social cognition might improve during puberty, social withdrawal can intensify, and about a third of youth experience significant psychosocial problems. Further, female-presenting autistic people have reported challenges with emotion regulation and heightened sensory experiences during menstruation (08:06).

• A Two-Hit Model of Autism: Adolescence as the Second Hit (Picci & Scherf, 2015)
• Changes in Maladaptive Behaviors From Midchildhood to Young Adulthood in Autism Spectrum Disorder (Anderson et al., 2011)
• Autism after Adolescence: Population-based 13- to 22-year Follow-up Study of 120 Individuals with Autism Diagnosed in Childhood (Billstedt et al., 2005)
• Autism spectrum disorders and menstruation (Hamilton et al., 2011)
• In Search of Explanations for Early Pubertal Timing Effects on Developmental Psychopathology (Ge & Natsuaki, 2009)
• Pubertal Timing, Depression, and Externalizing Problems: A Framework, Review, and Examination of Gender Differences (Negriff & Susman, 2011)
• Other-Sex Relationship Stress and Sex Differences in the Contribution of Puberty to Depression (Llewellyn et al., 2012)
• Depressive and Anxiety Symptom Trajectories From School Age Through Young Adulthood in Samples With Autism Spectrum Disorder and Developmental Delay (Gotham et al., 2015)

Puberty onset and measurements

Corbett briefly describes methods for measuring puberty, including Tanner staging (physical exam), parent report (e.g., Pubertal Development Scale), and self-report (e.g., gender-specific self-assessment questionnaire) (09:27). She outlines a recent publication by her team which found that pubertal assessments by parent or child are not reliable indices of precise pubertal staging, compared to physical exams (11:05). Corbett and her team use all three methods of measurement in their studies to compare perceived development with physical indices. The speaker touches on models and frameworks used to help understand the links between mental health, puberty, and autism.

A study published by Corbett and colleagues in 2020 shows that autistic females experience significantly earlier breast development and onset of menses compared to typically developing females, while pubertal onset for autistic males is similar to neurotypical males (13:15). A longitudinal study assessing the progression of puberty in the same participants between 10 and 15 years of age verified these findings. Corbett reiterates that pubertal onset “sets into motion a cascade of events which may magnify and further complicate an already vulnerable trajectory, especially in females (17:00).” 

• Pubertal Development Measurement in Children With and Without Autism Spectrum Disorder: A Comparison Between Physical Exam, Parent- and Self-Report (Corbett et al., 2019)
• Pubertal Timing During Early Adolescence: Advanced Pubertal Onset in Females with Autism Spectrum Disorder (Corbett et al., 2020)
• Examination of pubertal timing and tempo in females and males with autism spectrum disorder compared to typically developing youth (Corbett et al., 2022)

Altered cortisol levels in autism

The speaker describes the Hypothalamic-Pituitary-Adrenal (HPA) axis, which plays a vital role in our stress response by triggering a neuroendocrine cascade to produce cortisol. Cortisol, she continues, is a widely used biological marker found in blood and saliva (19:00). Normally, cortisol levels peak in the morning and decline throughout the day. However, Corbett’s research consistently shows that autistic children exhibit significant variability in cortisol levels, with persistently elevated evening cortisol and a “blunted slope” compared to their allistic peers. This means their cortisol doesn’t rise or drop to the same level, impacting their ability to feel energized during the day and rest well during the night (20:30). Another longitudinal study on cortisol trajectory further revealed that HPA axis maturation is impacted by age, puberty, sex, and an autism diagnosis, where females had higher overall cortisol and higher evening cortisol than the males in both groups (22:00). 

• The developmental trajectory of diurnal cortisol in autistic and neurotypical youth (Corbett et al., 2023)

Psychological well-being: depression in autistic adolescence

The presenter notes that half of all people who will suffer from mental illnesses have their onset by age 14, making adolescence a critical period for mental health, especially for autistic youth. A study conducted by Corbett and Dr. Jessica Schwarzman found that depressive symptoms are significantly higher in both autistic males and females as early as 10-13 years of age. Parents corroborated these findings, reporting higher depressive symptoms in their autistic children, especially in females (25:25). The presenter therefore asserts that screening and intervention for depressive symptoms for autistic individuals should begin very early in adolescence. She notes that symptoms were often related to interpersonal problems and feelings of worthlessness, which are crucial intervention targets (28:00).

Corbett outlines a recent longitudinal study on the trajectory of depressive symptoms which revealed that while autistic individuals reported significantly higher depression symptoms at age 10, their symptoms actually decrease through adolescence, contrasting with an increase seen in allistic youth around ages 14-15 (30:00). The speaker notes that if replicated, this data warrants significant attention, potentially pointing to earlier identification and treatment for autistic youth.

• Higher depressive symptoms in early adolescents with Autism Spectrum Disorder by self- and parent-report compared to typically-developing peers (Schwartzman & Corbett, 2020)
• Diagnostic- and sex-based differences in depression symptoms in autistic and neurotypical early adolescents (Schwartzman et al., 2022)
• Trajectory of depressive symptoms over adolescence in autistic and neurotypical youth (Corbett et al., 2024)

Hormonal differences

Corbett explains that imbalances in hormones such as testosterone may modulate autism phenotypes. However, there is limited research regarding variations in testosterone during adolescence in autism (34:15). She details a recent study comparing salivary testosterone between autistic and allistic groups and male vs. female participants, with considerations of developmental stage. Data show that in autistic youth, both males and females exhibited significantly elevated testosterone compared to allistic youth. While male testosterone levels rapidly increased as expected during adolescence, females initially had higher testosterone until around 11.5 years of age before plateauing. Corbett states that these findings may suggest testosterone does play a role in autism, especially during periods of hormonal change (36:00). 

• Salivary testosterone in male and female youth with and without autism spectrum disorder: considerations of development, sex, and diagnosis (Muscatello et al., 2022)

Gender diversity in autistic young people

Adolescence is a time of profound self-exploration, including gender identity, or a person’s innate sense of gender. The speaker highlights recent research suggesting a higher prevalence of gender diversity in individuals diagnosed with autism or having autistic traits compared to their allistic peers. Corbett’s team used both self-report and parent report questionnaires to confirm this finding in autistic children (37:00). Parents of autistic children reported significantly greater “gender body incongruence” in their children compared to parents of allistic children. Furthermore, within the autistic group, those assigned female at birth reported significantly more experiences of gender body incongruence than those assigned male. Self-reports from autistic youth also indicated significantly more reports of both “gender diversity” and “non-binary diversity” (40:00).

A follow-up study assessing gender diversity throughout adolescence found that gender incongruence was relatively stable across puberty in males (autistic and allistic). In contrast, autistic females endorsed greater incongruence around age 10, followed by a short plateau and then another increase. Allistic females reported the opposite pattern. Corbett summarizes these findings, highlighting the sex-based differences that indicate greater gender diversity in autistic females assigned at birth (AFAB). She also reiterates that gender identity formation is nuanced and likely influenced by pubertal progression, hormone patterns, and psychosocial factors (42:00). 

• Greater Gender Diversity among Autistic Children by Self Report and Parent Report (Corbett et al., 2023)
• Gender diversity in autistic and neurotypical youth over adolescence and puberty: A longitudinal study (Corbett et al., 2024)

Conclusions & future research

Corbett summarizes the presentation, highlighting that autistic females enter puberty earlier than autistic males and allistic groups. Autistic young people also have a higher rate and earlier onset of depression and a greater prevalence of gender diversity, especially in females. The speaker underscores the need for comprehensive measurements of psychological variables based on self-report, parent-report, and clinical-report. She emphasizes the need to identify risks and opportunities for resilience to elucidate and support the dynamic transition of puberty (43:00). 

Corbett and her team recently received funding to renew their longitudinal study of pubertal development. The renewed study aims to examine pubertal development through age 17 by observing physical development, hormones, menstruation, social communication, and internalizing symptoms. It also aims to observe the nervous system during these periods in a group of more than 300 participants (45:00). She notes an ongoing female development study before the Q&A (47:30). 

Originally published January 29th, 2025