A Two-Hit Model of Autism: Adolescence as the Second Hit

Giorgia Picci, K. Suzanne Scherf

Research output: Contribution to journalReview articlepeer-review

139 Scopus citations


Adolescence brings dramatic changes in behavior and neural organization. Unfortunately, for some 30% of individuals with autism, there is marked decline in adaptive functioning during adolescence. We propose a two-hit model of autism. First, early perturbations in neural development function as a “first hit” that sets up a neural system that is “built to fail” in the face of a second hit. Second, the confluence of pubertal hormones, neural reorganization, and increasing social demands during adolescence provides the “second hit” that interferes with the ability to transition into adult social roles and levels of adaptive functioning. In support of this model, we review evidence about adolescent-specific neural and behavioral development in autism. We conclude with predictions and recommendations for empirical investigation about several domains in which developmental trajectories for individuals with autism may be uniquely deterred in adolescence.

Original languageEnglish (US)
Pages (from-to)349-371
Number of pages23
JournalClinical Psychological Science
Issue number3
StatePublished - May 1 2015

All Science Journal Classification (ASJC) codes

  • Clinical Psychology


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