Association Between Pubertal Stage and Behavioral Profile Across Neurodevelopmental Disorders

Background:  Puberty is a time period associated with tremendous biological, social and behavioral change. Youth with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD), are not immune to these changes, and small case series have reported they may be at additional risk for behavioral deterioration at the time of puberty. To date, no research has evaluated the behavioral response to puberty across NDDs.

Objectives:  The objective of this study was to determine the association between Tanner stage of puberty and behavioral profile across NDDs.

Methods:  This was a cross-sectional study using data collected through the Ontario Brain Institute Province of Ontario Neurodevelopmental Disorders (OBI-POND) network. OBI-POND enrolls children with NDDs, including ASD, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and intellectual disability (ID). All participants had caregivers complete the Child Behaviour Checklist (CBCL). Participants aged 6 years or older (or their caregivers) completed a Tanner Staging Form, where penile/breast growth and pubic hair development are both reported compared to reference pictures.  Spearman correlation coefficients were used to determine the bivariate association between Tanner stages of growth and pubic hair development and between Tanner stages and CBCL T-scores. We then assessed the influence of Tanner stage on CBCL scores using multivariate linear regression controlling for age, gender, and diagnosis.

Results:  Three-hundred twenty participants were included in the analysis. Seventy-four percent of the sample was male (n=237). The mean age at enrollment was eleven years (standard error = 2.9 years). The distribution of NDDs was: ASD: 152 participants (48%); ADHD: 99 participants (31%); OCD 64 participants (20%); and ID 5 participants (2%). Participants were distributed through all Tanner stages (growth/pubic hair, respectively): Stage 1: 114/145; Stage 2: 67/55; Stage 3: 55/27; Stage 4: 52/51; and Stage 5: 28/39. The correlation coefficient between self-reported Tanner stages of growth and pubic hair was 0.88 (p<0.0001). There were no significant associations between CBCL internalizing behaviour scores with Tanner stage or any independent variable.  Spearman correlations were significant between Tanner stage of puberty and externalizing behavior (r= -0.19, p=0.0006; and r= -0.24, p<0.0001 for growth and pubic hair, respectively) and in univariate regression models, diagnosis and age were also significantly associated with CBCL externalizing scores (p<0.0001).  After controlling for diagnosis or age, the association between Tanner stage and externalizing behaviour scores was no longer significant.

Conclusions:  Unadjusted associations between Tanner stage and externalizing behavior showed a trend toward decreasing externalizing behavior with increasing Tanner stage; however, this relationship was not significant when controlling for diagnosis and particularly, age. Future longitudinal studies of the effects of puberty in NDDs should focus on consecutive behavioral measures at successive Tanner stages.