To study the association between internalizing and externalizing symptoms and prosocial behavior at age 7 years and pubertal timing in boys and girls.

This cohort study included 11,090 children from the Puberty Cohort within the Danish National Birth Cohort (DNBC). Data on internalizing and externalizing symptoms and prosocial behavior was derived from a parent-reported Strengths and Difficulties Questionnaire (SDQ) at age 7 years, and categorized as normal (lowest 79th percent), at-risk (80th – 89th percent) or abnormal (≥90th percent). Several pubertal markers were measured half-yearly from the age of 11 until the age of 18 or full maturity, and adjusted interval-censored regression models were made for each pubertal marker and for a combined marker for pubertal timing.

Boys with at-risk externalizing symptom scores showed a slight trend towards earlier pubertal timing (estimate for combined marker: -0.8; 95 % CI [−1,9; 0.4] months). This trend also applied for boys with abnormal symptom scores (estimate for combined marker: -0.6; 95 % CI [−1.9; 0.8] months) while, for girls, the trend was apparent in breast development only. However, for both boys and girls, the age differences were small with overlapping confidence intervals.

No associations between internalizing and externalizing symptoms and prosocial behavior and pubertal timing in boys and girls were observed. Results were robust across analyses.

Danish National Birth Cohort

Strengths and Difficulties Questionnaire

Directed Acyclic Graph

Child mental health

Child stress

Psychosocial symptoms

Strengths and difficulties questionnaire

Puberty

© 2025 The Author(s). Published by Elsevier B.V.