How Does Puberty Affect Therapy Approaches for Autism?

PostedDecember 26, 2025

UpdatedJanuary 6, 2026

ByMy Patient Advice

Author: Beatrice Holloway, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Puberty can be a challenging developmental stage for autistic young people, and UK clinical guidance highlights the need for therapy approaches to adapt during this period. According to NICE CG170, behaviour that challenges may be triggered by “developmental change, including puberty,” alongside social, emotional and environmental pressures. Because of this, therapies used in childhood often require adjustment during adolescence to support emerging needs in mood, relationships, sensory processing, and behaviour.

NICE also notes that the “changing needs that arise with puberty, including understanding intimate relationships and sexuality,” should be considered when assessing risk and planning ongoing support, as described in the full CG170 guideline. This highlights that puberty is not only a physical transition but also a period of new social demands and vulnerabilities, requiring proactive, coordinated therapeutic responses.

Emotional, behavioural and sensory changes

Puberty brings hormonal shifts that can influence emotional regulation and behaviour. A 2024 longitudinal study found that autistic adolescents showed higher depressive symptoms than their non-autistic peers, with mood difficulties interacting with pubertal stage. Similarly, a 2025 qualitative study reported that puberty often intensifies anxiety, self-harm risk and behavioural crises for autistic teenagers, especially when school and social pressures increase.

For autistic young people assigned female at birth, puberty can add further challenges. A 2025 study reported increased anxiety, sensory distress and confusion around body changes and sexuality, with many participants calling for more explicit, autism-adapted education and emotional support during adolescence.

NICE emphasises that behaviour assessments during adolescence must consider factors such as changes in routine, communication demands, sensory overload and exploitation risks, as described in CG170 recommendations

How therapy approaches adapt during puberty

NICE recommends that therapies for autistic young people including CBT-informed approaches, social learning programmes and behaviour support should be adapted to developmental stage, communication profile and co-existing conditions. These expectations are outlined in NICE CG170 and form the basis for adolescent-focused practice.

During puberty, therapists may:

emphasise emotional recognition and regulation strategies

use more concrete language, visual supports and predictable structure

involve parents and carers more actively

integrate puberty, sexuality and relationship education tailored to autism

explore identity, friendship and belonging, which NHS -linked resources note become especially important during adolescence (e.g., behavioural challenges information)

For young people with learning disabilities or those at risk of behaviour that challenges, NICE NG93 and its recommendations emphasise proactive, community-based support. Services are expected to anticipate developmental changes, provide early intervention and offer skilled staff who can recognise distress signals and adjust communication and environments during adolescence.

NICE also stresses the importance of screening for physical or mental health conditions, such as anxiety or depression, which may emerge or worsen during puberty. Management plans should be reviewed regularly as social contexts shift, as described in the CG170 risk-assessment guidance.

Takeaway

Puberty is a predictable period of complexity for autistic young people, influencing mood, sensory responses, social understanding, and behaviour. According to NICE, therapy approaches must adjust during adolescence with greater focus on emotional regulation, communication support, autism-adapted psychological interventions, and coordinated risk-assessment. With tailored support and early planning, families and professionals can help young people navigate this transition more confidently.

Beatrice Holloway, MSc

Author

Beatrice Holloway is a clinical psychologist with a Master’s in Clinical Psychology and a BS in Applied Psychology. She specialises in CBT, psychological testing, and applied behaviour therapy, working with children with autism spectrum disorder (ASD), developmental delays, and learning disabilities, as well as adults with bipolar disorder, schizophrenia, anxiety, OCD, and substance use disorders. Holloway creates personalised treatment plans to support emotional regulation, social skills, and academic progress in children, and delivers evidence-based therapy to improve mental health and well-being across all ages.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.