Early Pubertal Development is a Risk Factor for Psychotic-Like Experiences in Boys and Girls

Puberty has long been identified as a risk factor for psychosis, though retrospective, cross-sectional, and single-sex indicators of puberty have limited our ability to pinpoint biopsychosocial mechanisms contributing to risk. The current study determined whether individual differences in the timing (onset) and tempo (pace) of pubertal development confers risk for psychotic-like experiences (PLEs) in youth across biological sex. Data included 11,718 youth (6,134 boys, 5,624 girls) from the Adolescent Brain Cognitive Development study (Mean age=9.9-years-old at baseline, 12.9-years-old at 3-year follow-up). Pubertal timing and tempo (overall, adrenarche, gonadarche) were derived from sex-specific linear mixed effect models using the Pubertal Development Scale. Sex-specific negative binomial multilevel models estimated effects of categorical and continuously measured pubertal timing and tempo, and their interaction, on year-three PLEs per the Prodromal Questionnaire-Brief Child. In both sexes, earlier pubertal timing is associated with elevated PLEs (βs=0.23 to 0.31) and later pubertal timing is associated with fewer PLEs (βs=-0.22 to -0.52) relative to on-time peers. In boys only, faster pubertal tempo was associated with fewer PLEs relative to on-track peers (βs=-0.21 to -0.30). Analyses with continuous pubertal timing and tempo demonstrated an association between earlier adrenarchal timing and more PLEs in females only (β=-0.21), and an interaction between adrenarchal timing and tempo in boys only (β=-0.80). Early pubertal timing in both sexes, and faster pubertal tempo in males, increases PLEs in both sexes. Understanding the unique experiences associated with a youth’s pubertal onset, particularly adrenarche, can advance identification and prevention efforts for children and adolescents at greatest clinical risk.