This PRISMA-ScR scoping review synthesized evidence from 19 studies (2016–2026) examining how off-time pubertal timing interacts with pre-existing theory of mind (ToM) deficits in children and adolescents with ASD and ADHD, and the resulting psychopathological risks.
Three mechanisms linking off-time puberty and ToM impairment were identified: (1) demand-capacity mismatch amplification, (2) masking and camouflaging under elevated social load, and (3) physical-cognitive developmental asynchrony. ASD is associated with elevated rates of precocious puberty and altered pubertal tempo; ADHD in females is linked to earlier pubertal onset with internalizing symptom exacerbation. No primary studies have directly tested ToM as a moderator of the puberty-psychopathology relationship in NDD populations.
- Single-author scoping review with no independent screening, raising risk of selection bias. - No primary studies directly examined ToM as a moderator, so proposed mechanisms remain theoretical. - Only studies from 2016–2026 were included, potentially missing earlier relevant evidence.
Clinicians managing adolescents with ASD or ADHD—especially females—should proactively monitor pubertal timing and screen for new or worsening internalizing symptoms, as early puberty may amplify existing social-cognitive vulnerabilities. Camouflaging behaviors may mask distress during this period, warranting structured assessment beyond surface-level functioning.
