Autism Spectrum Disorder, Externalizing Behavior and Pubertal Status in Adolescents

Adolescents with ASD show more externalizing behavior, compared to their peers. Additionally, early pubertal development can increase the risk of showing externalizing behavior. Recent input indicates that females with ASD can show early pubertal development, which raises the question of whether early pubertal development could influence externalizing behavior amongst adolescents with ASD. Therefore, this study aimed to assess the possible moderating effect of pubertal status (PDS) on the association between the likelihood of ASD (ASD-scale) and externalizing behavior, in particular rule-breaking behavior, aggressive behavior (YSR, ASEBA), and the onset of alcohol use (general substance use questionnaire). The data from the baseline measurement from the observational prospective cohort study The iBerry Study was used, consisting of 500 male and 522 female high- and low-risk adolescents (2.5:1 ratio), age 12 to 18. Higher pubertal status was associated with higher externalizing, rule-breaking, and aggressive behavior for male and female adolescents, and a smaller chance of already having used alcohol for female adolescents. A higher likelihood of ASD was associated with higher externalizing and rule-breaking behavior for female adolescents and higher aggressive behavior and chances of already having used alcohol for male and female adolescents. However, there was no interaction effect of pubertal status and the likelihood of ASD on all studied externalizing behaviors, indicating no moderating effect. Results add to current knowledge by broadening previous findings beyond the clinical population to high-risk adolescents who show sub-clinical symptoms of ASD and better comprehension of symptoms that female adolescents with ASD experience.