Blythe Corbett, PhD, professor of Psychiatry and Behavioral Sciences and investigator with the Vanderbilt Kennedy Center, recently led a study which found that on average, females with autism spectrum disorder (ASD) experienced the onset of puberty 9.5 months earlier than their peers.
Corbett, Simon Vandekar, PhD, Rachael Anne Muscatello, PhD, and Yasas Tanguturi, MD, made up the research team, representing the Departments of Psychiatry, Psychology, Biostatistics, Biomedical Research and Pediatrics. Their study found that females with ASD tend to undergo puberty earlier than males with ASD and females with typical development (TD).
The study followed 239 children between the ages of 10 and 13. One hundred and thirty-seven children had ASD, and 102 had TD. The study was longitudinal, with annual visits occurring across a four-year span. The large sample size allowed researchers to cover a broad range of development, and annual visits ensured the ability to observe the developmental process case by case.
“Using standard physical exams, we found that youth with autism spectrum disorder — in particular, females — showed advanced pubertal onset not only compared to males with autism spectrum disorder, but importantly, compared to typically developing females,” Corbett explained.
Pubertal onset at any age can be a unique challenge for those with ASD and their families. “This is because individuals with autism spectrum disorder, by definition, tend to struggle with change,” Corbett said. “This includes developmental change, such as puberty.”
But Corbett says early onset of puberty in girls with ASD has significant psychological, social, physiological and developmental consequences. “For example, considerable research has shown that early puberty in typically developing females is linked to an increased risk for depression and anxiety,” she said.
The unique profile of females with ASD may complicate mental health challenges. In fact, girls with ASD may be at an increased risk for anxiety, due to fear of rejection from their peers. As children grow, social expectations increase significantly, and trying to live up to these higher standards can cause significant anxiety.
Mental health is only one of the challenges girls with ASD may face when undergoing early onset puberty. Girls with ASD also report heightened and intensified sensory experiences, which can affect mood and emotion regulation, health, pain and hygiene.
Research on the change from youth to adolescence in children with ASD is limited, but there is an abundance of research on the change from adolescence to adulthood. Based on previous studies and her research, Corbett infers that the transition from childhood to adolescence is equally as challenging as later changes for youth with ASD.
Corbett offers many possible solutions to the challenges adolescent females with ASD and their families may experience during puberty — the first being education. “We know from our research that girls with autism can have difficulty adapting to menstruation. If we know some of our girls are going to have early onset, we should prepare them even earlier. Normalizing the process is a huge part of making their transition as easy as possible.”
Another solution is socialization. “We’re talking about a population that can have difficulty with social communication. Compounding that with early development can create a significant gap between physical and cognitive maturation,” Corbett said. This can lead to feelings of loneliness and isolation from peers with typical development.
Early onset of puberty in girls with ASD can make an already difficult situation more complicated. Corbett also points out the importance of understanding that girls with autism are more likely to be misdiagnosed, or not diagnosed at all.
“Girls tend to mask some of their challenges, especially in their interactions with peers,” Corbett said. Masking allows girls to hide in plain sight while struggling beneath the surface, but Corbett thinks these findings will shed light on a topic that has been under researched in the past.
“It is my hope that the research will help us learn more about the impact and trajectory of pubertal development on girls with autism spectrum disorder in order to provide enhanced education, awareness and support to improve psychological and social outcomes for adolescent girls and their families,” she said.
To hear more from Dr. Corbett on this topic, listen to the Kennedy Center’s podcast here.
