Examination of pubertal timing and tempo in females and males with autism spectrum disorder compared to typically developing youth.

Attrition was substantial: 174 participants remained at Year 2 and 163 at Year 3, with overall attrition of 28% and 33% after initial enrollment. Some participants could not complete the full physical examination because of COVID-19 restrictions at Year 2 and Year 3, affecting 43 and 59 participants. The study used annual visits, but pubertal progression is nonlinear, so more frequent visits might have captured onset and tempo better. Many females had already entered puberty at Year 1, so the study could not determine absolute onset and full progression for them. The physical examination may have contributed to dropout after initial participation. Internalizing symptoms were based on parent-report Child Behavior Checklist domains, not clinical interviews. The sample required an IQ score of 70 or higher and excluded medications or medical conditions that affect puberty, so findings may not apply to children with lower cognitive scores or other medical complexity.

The authors declared no conflicts of interest. The supplied publication types list NIH extramural research support.

Do not conclude that autism causes early puberty or emotional problems. The study was observational, male timing differences were not significantly different from typically developing males, and pubertal timing did not predict Year 3 anxiety or affective problems.