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TABLE 2

Common Differences of Timing of Puberty in Patients with Disabilities

Early-Onset PubertyTypical PubertyDelayed Puberty
Congenital brain malformations Varies by family, ethnic, and racial groups Severe nutritional deficiency 
Hydrocephalus Attention-deficit/hyperactivity disorder Hormonal abnormalities 
Neural tube defects; myelomeningocele Children with ASD with typical growth Sex chromosome abnormalities 
Epilepsy Other behavioral and mental health issues Chromosome abnormalities (ie, trisomy 21) 
Severe cognitive disabilities Mild and moderate cognitive disabilities Complex disabilities 
Brain injuries  Psychiatric medications causing high prolactin 
Some genetic conditions such as fragile X, neurofibromatosis 1, tuberous sclerosis, and McCune-Albright syndrome   
Early-Onset PubertyTypical PubertyDelayed Puberty
Congenital brain malformations Varies by family, ethnic, and racial groups Severe nutritional deficiency 
Hydrocephalus Attention-deficit/hyperactivity disorder Hormonal abnormalities 
Neural tube defects; myelomeningocele Children with ASD with typical growth Sex chromosome abnormalities 
Epilepsy Other behavioral and mental health issues Chromosome abnormalities (ie, trisomy 21) 
Severe cognitive disabilities Mild and moderate cognitive disabilities Complex disabilities 
Brain injuries  Psychiatric medications causing high prolactin 
Some genetic conditions such as fragile X, neurofibromatosis 1, tuberous sclerosis, and McCune-Albright syndrome   
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