If you missed part one of this series, you can view that here.

Ask many neurodivergent adults when they first remember things becoming hard, and a common answer emerges: puberty. For all young people, puberty is a time of enormous physical and emotional change. But for neurodivergent people, especially those who’ve flown under the radar in childhood, it can mark the start of a profound shift, in both experience and how they’re seen by others. And too often, it’s when the mask goes on, that the misdiagnoses begin.  

Puberty: A period of intensification  

Hormonal changes during puberty don’t just affect the body, they reshape the brain. From the age of 8 years old, those assigned female at birth can begin menstruation. This is the first time they will experience a dramatic rise in reproductive hormones for the first time, and this often comes with lots of physical and cognitive changes. 

This can be additional for neurodivergent people. It can mean a dramatic increase in sensory sensitivity, emotional dysregulation and executive dysfunction. Tasks that once felt easy suddenly overwhelming. Anxiety skyrockets. The need for structure and predictability can become urgent, while the world around demands more independence, more social navigation and more conformity.  

Cue masking. Especially for those assigned female at birth, and those raised under rigid gender expectations, adolescence is when the pressure to “fit in” becomes acute. Many begin copying peers, over-preparing for interactions and withdrawing entirely. The cost? Burnout, self-doubt and a slow erosion of authenticity that continues, for many, into adulthood.  

Being missed  

Much of the diagnostic framework for autism and ADHD is still based on male-centric models, meaning that many girls and gender-diverse young people are overlooked entirely. They may be seen as:  

• “Anxious” rather than autistic  
• “Lazy” or “moody” rather than struggling with executive function  
• “Too sensitive” rather than overwhelmed by sensory input 
• “Withdrawn” rather than burnt out from constant social masking.  

And it’s not just those assigned female at birth. Puberty often involves a huge increase in testosterone and other androgens in males, leading to many physical changes as well as significant changes in the amygdala, the part of the brain that manages emotional regulation (Vijayakumar et al., 2021). 

Instead of being identified and supported, young people are often misdiagnosed with anxiety, depression or other behavioural issues. Others are dismissed completely; told they’re just going through a “phase”. And the most painful part? Many internalise these narratives. They start to believe they’re failing at something everyone else finds easy.  

Puberty also tends to coincide with rising demands: academically, socially, emotionally. For neurodivergent young people, who are already pushing themselves to “keep up”, the added layer of hormonal flux can be the tipping point. This can add to burnout and demand avoidance as the nervous system struggles to regulate. Shutdowns might be misread as “moodiness” or “defiance”, and a growing sense of alienation, even when everything looks “fine” from the outside.  

What needs to change?  

Most people have an understanding of puberty, but it is often surprising that many do not fully understand the hormonal changes that are impacting and stimulating the brain. It is important that this understanding underpins all support structures, and that there is a thorough exploration of how a young person’s hormones might be impacting their neurodivergent traits and behaviour. In particular:  

• Educate parents, educators and professionals about how neurodivergence can emerge or intensify during puberty  
• Validate the experiences of young people rather than pathologising them – don’t just tell them that “this is the norm” for people their age.  
• Look beyond behaviour to what’s underneath: overwhelm, pain, fear of not being enough. Address these factors before they become too deep-rooted.  
• Make room for late or missed diagnosis. Understand that, unfortunately, some people will go under the radar but ensure that support is given regardless of diagnostic.  

Get in touch with us about how we can support you explore the impact of hormones and neurodivergence:  

• Training and awareness courses 
• Workplace Needs Assessments  
• Neurodiversity coaching  
• Neurodiversity consulting
• Become a Neurodiversity Workplace Needs Assessor  

References  

Vijayakumar, N., Youssef, G., Allen, N. B., Anderson, V., Efron, D., Mundy, L., Patton, G., Simmons, J. G., Silk, T. and Whittle, S. (2021) The effects of puberty and its hormones on subcortical brain development. Comprehensive Psychoneuroendocrinology.

Next up in the series: Hormones Across the Lifespan – from PMDD to perimenopause, we’ll explore how hormonal changes continue to shape neurodivergent experiences beyond adolescence.