Puberty in girls tied to adverse childhood experiences

Girls with a history of adverse childhood experiences are more likely to begin puberty earlier than girls who have not had these potentially traumatic experiences — but the same is not true for boys, new Kaiser Permanente and UC Berkeley research shows.

The study, published in the Journal of Adolescent Health, included 52,573 boys and girls screened during pediatric visits at Kaiser Permanente Northern California for adverse childhood experience (ACEs).

“This study adds to what we know about the relationship between adverse childhood experiences and health outcomes,” said lead author Ai Kubo, MPH, PhD, epidemiologist and research scientist at the Kaiser Permanente Northern California Division of Research. “The findings also highlight the need for pediatricians who screen for these early traumas to think about early puberty onset as one of the potential negative health outcomes girls with many ACEs may experience.”

Screening for ACEs

KPNC began routine ACEs screening in 2021. The ACEs questionnaire covers sexual, physical, and emotional abuse; emotional and physical neglect; caregiver substance abuse, incarceration, or mental illness; witnessing violence directed at a caregiver; and parental separation or divorce.

Previous studies suggest that children with 4 or more ACEs are at higher risk of developing chronic health problems, mental illness, and substance misuse in adulthood. In addition, studies suggest that toxic stress from ACEs can change brain development as well as affect how the body responds to stress.

The new study is among the first to look at the association between the timing of puberty and the number of ACEs a child has experienced. Puberty onset was based on routine sexual maturity ratings assessed by pediatricians and recorded in the electronic medical record. ACEs and age at first period were assessed using well-child and well-teen questionnaires completed at pediatric appointments. Among the 52,573 children, 39,577 (75.3%) had 0 ACEs; 10,637 (20.2%) had 1 to 3; 1,930 (3.7%) had 4 to 6; and 429 (.8%) had 7 to 10. The 3 most common ACEs were parental mental illness (11.7%), change in parental relationship (9.5%), and witnessing abuse of a parent (8.9%).

Analyses showed that girls with ACEs were more likely to start their period before age 12 than girls with no ACEs, and there was a clear relationship between the number of ACEs girls experienced and the odds of earlier menstruation. In addition, girls who had 4 or more ACEs were at significantly higher risk of earlier onset of breast development. The study found no association between the number or types of ACEs and timing of puberty in boys.

Earlier puberty

Over the last few decades, girls and boys have begun starting puberty at an earlier age. Adolescents who experience earlier puberty are more likely to initiate sexual activity earlier. They also are at increased risk for sexual abuse, feelings of isolation, and other emotional issues that have the potential to impact their social development. Early puberty has also been tied to an increased risk of cancer and cardiovascular disease in adults.

The research team looked at both the number and specific types of ACEs children experienced. They found that girls with 7 to 10 ACEs were 38% more likely to have earlier periods and breast development and 27% more likely to have earlier pubic hair growth than girls with no ACEs. Girls who had a parent who was incarcerated were 15% more likely to begin earlier breast development and 32% more likely to haver earlier periods compared to girls who did not have ACEs. In addition, girls who were sexually abused were 18% more likely to have earlier breast development and 41% more likely to have earlier periods while girls who experienced emotional neglect were 38% more likely to have earlier breast development and earlier periods than girls with no ACEs.

“Our findings confirm previous studies linking sexual abuse and father absence to early puberty, and, like these other studies, we only saw this association in girls,” said Kubo. “From an evolutionary perspective, this suggests the potential for adversity to accelerate puberty in girls to enhance reproduction.”

The study was funded by the National Institute of Child Health and Human Development.

Co-authors include Sara Aghaee, MPH, of the Division of Research, and Julia Acker, MS, and Julianna Deardorff, PhD, of the University of California, Berkeley.