Systematic Review and Meta-Analysis of Abnormal Pubertal Timing in Children With Autism Spectrum Disorder (ASD).
Autistic girls face a higher chance of very early puberty, yet most kids with ASD follow a typical timeline.
01Research in Context
What this study did
Li and colleagues looked at every paper they could find on puberty timing in kids with autism. They pooled the numbers to see if these kids start puberty earlier, later, or right on time.
They searched studies from around the world and compared kids with ASD to typically developing peers.
What they found
Girls with ASD are about three and a half times more likely to have precocious puberty. That sounds big, but the actual number of kids affected is still small.
When you look at all kids with ASD, the average start of puberty is not much different from typical kids. The evidence is weak, so we need more data.
How this fits with other research
May et al. (2017) tracked a large Australian group and found no timing difference at all. Sirao et al. (2026) still include this study, showing the mixed picture.
Mulder et al. (2020) focused only on girls and saw earlier breast development and first period. Li's meta-analysis leans on this finding to explain the higher precocious-puberty risk.
Boets et al. (2011) looked at neurotypical girls with mild autistic traits and found slightly later puberty. Li's review did not see this late pattern in diagnosed ASD, so the link may depend on how autism is defined.
Why it matters
You do not need to screen every child with ASD for early puberty, but keep an eye on girls who show signs before age eight. Talk with families early about body changes and hygiene so they are ready. Share the Pubertal Development Scale with parents, and remember Clawson et al. (2020): for autistic boys, parent-son agreement can be low, so ask the child directly when possible.
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02At a glance
03Original abstract
This study aimed to synthesize evidence on the risk and patterns of abnormal pubertal timing, including precocious puberty (PP) and altered onset, in children with autism spectrum disorder (ASD) compared with typically developing (TD) peers. We conducted a systematic review and meta-analysis following the PRISMA guidelines, searching PubMed (n = 51), Web of Science (n = 91), and Cochrane Library (n = 19). After removing duplicates (n = 40), we screened 121 records and assessed 31 full-text articles, with 12 meeting the inclusion criteria (3 cohort studies on PP; 9 cohort studies on pubertal timing). Random-effects meta-analyses were performed to calculate pooled hazard ratios (HRs) for PP and standardized mean differences (SMDs) for pubertal timing. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis of three studies (42,017 ASD children; 3,424,004 TD children) revealed a significantly higher risk of PP in ASD children (pooled HR = 3.64; 95% CI: 1.42-9.34; P = 0.007), with an absolute risk difference of 1.13% (prevalence: 1.2% in ASD vs. 0.07% in TD), indicating that 88 ASD children would need monitoring to identify one additional case of PP; this risk was particularly pronounced in females with ASD. In contrast, nine studies (856 ASD children; 648 TD children) found no significant overall difference in pubertal timing (SMD = -0.22; 95% CI: -0.91-0.46; P = 0.52), despite high heterogeneity (I2 = 96%). Funnel plot asymmetry suggested potential publication bias or methodological variations (e.g., confounder adjustments, diagnostic criteria). Sensitivity analysis confirmed the association between ASD and PP but highlighted instability in the effect size. Children with ASD exhibit a 3.6-fold increased relative risk of PP, particularly in females, though the absolute prevalence is low and the certainty of evidence is very low (per Grading of Recommendations Assessment, Development and Evaluation [GRADE] criteria), primarily due to high heterogeneity (I2 = 91%-96%) and potential biases. No consistent differences in pubertal timing were observed between ASD and TD children, likely reflecting methodological inconsistencies. Clinicians should enhance vigilance for PP in ASD children, without the need for routine screening. Future studies should adopt standardized, multi-method assessments to refine these findings.
Autism research : official journal of the International Society for Autism Research, 2026 · doi:10.1002/aur.70182