Autism and Puberty: A Mixed Methods Systematic Review

Background Puberty is a time of profound change for all. Autistic children may find pubertal changes harder to navigate, due to sensitives surrounding sensory experiences, and difficulty with change. Autistic puberty therefore has important messages about physical health across the life course. Methods We performed a prospectively registered (registration: CRD42023446750) systematic review of puberty in Autistic people (including self-identifying) and supporters. We searched: MEDLINE, APA PsycINFO, CINAHL, and Web of Science from 2013-March 2026. We used Convergent Integrated synthesis (Joanna Briggs Institute) and two Autistic young people assisted in our analysis. We undertook quality assessments using Joanna Briggs Institute tools. Results We identified 6885 unique records and included 81 articles/theses. Most papers were high quality. We developed five themes. First, many studies compared Autistic and non-Autistic people, but few differences were identified, with puberty characterised as a universal experience. Second, parents felt unprepared for their child’s puberty, and uncertain of their future. Third, additional education in areas of puberty and sex were identified as needed for Autistic people, and those caring for them. Fourth, breaking norms was explored at length, with many parents worrying their child was not normal in behaviour and development, these concerns rarely related to anything harmful. Finally, physical changes and the challenges these bring were discussed, specifically difficulties around menarche and menstruation. Limitations of studies included a lack of diversity (ethnicity; few fathers) and restricted consideration of confounding factors and author impact on research. Conclusion Co-developed interventions are required to facilitate understanding consent, navigating pubertal changes, and learning skills. The synthesised research did not focus on comfort and wellbeing, but more so on normality, or the perceived lack of normality, of Autistic young people. Future research should prioritise topics of importance to Autistic people and should seek consent from Autistic participants.