Voice Change Across Childhood and Adolescence: A Systematic Review of Fundamental Frequency and Maturity Markers

This systematic review aimed to evaluate the use of voice change, specifically, changes in fundamental frequency (F₀), as a nonnvasive objective indicator of somatic and pubertal maturation in boys. Traditional maturity assessment methods, such as skeletal age or secondary sexual characteristics, are often invasive, costly, and logistically complex. Voice analysis offers a potentially simpler and more scalable alternative.

A comprehensive search was conducted across PubMed, Web of Science, and Scopus up to December 2024, adhering to preferred reporting items for systematic reviews and meta-analyses guidelines. Inclusion criteria targeted studies examining the relationship between chronological age (CA), peak height velocity (PHV), and voice parameters (primarily F₀) in boys aged 8-17. A total of 52 studies involving 6250 male participants were included. Data on voice tasks, analytical methods, and maturational indicators were extracted and assessed for quality using the mixed methods appraisal tool.

The majority of studies reported a significant negative correlation between F₀ and CA, with F₀ decreasing notably during adolescence. Age at voice change typically ranged from 11 to 13 years, while age at peak voice change was most commonly observed between 12 and 14 years. These milestones closely aligned with pubertal events such as PHV and Tanner stages.

Voice parameters, particularly F₀, are strongly associated with biological and pubertal maturation in boys and offer a promising, noninvasive proxy for assessing maturational timing. Future research should aim to standardize protocols and validate voice-based assessments against established biological maturity markers.