Objective: The study aims to examine the prospective association and sex differences of pubertal timing and tempo with behavior problems. Methods: Participants from two primary schools in grade 1-3 were selected through clustering convenience sampling method in Bengbu, Anhui Province was established since 2013 (T1), with informed consent, 2 084 students were recruited, and follow-up surveys were conducted in 2015 (T2), 2017 (T3) and 2019 (T4) respectively. Demographic information, non-suicidal self-injury (NSSI), suicidal ideation, suicide plan, suicide attempt and externalizing symptoms were collected through questionnaire investigation, and pubertal development in boys and girls were evaluated by secondary sexual development (testicular volume for boys and breast development for girls). At T4, externalizing symptoms were evaluated by MacArthur Health & Behavior Questionnaire-Child (HBQ-C). Using SAS PROC NLMIXED to fit nonlinear growth model to estimate pubertal timimg and tempo. Puberty timing was classified into early, on-time, and delayed groups; and the puberty tempo into fast, average, and slow groups. Multivariable logistic regression model was used to analyze the predictive effects of modeling pubertal timing and tempo on multi-disciplinary behavior problems in adolescence boys and girls. Results: There were 1 909 people with complete baseline and follow-up questionnaires and puberty development information. Reported rates of externalizing symptoms, NSSI, suicidal ideation, suicide plan, suicide attempt and were 13.9% (265), 24.4% (466), 14.2% (271), 4.6% (88) and 2.3% (43) respectively. Logistic regression analysis results show that fast pubertal tempo increases the risk of externalization [OR(95%CI)=2.85(1.53-5.31) and NSSI [OR(95%CI)=2.11(1.22-3.65)] for boys, and the risk of suicide attempt [OR(95%CI)=2.99(1.07-8.35)] for girls. Slow tempo can reduce the risk of suicidal ideation and suicide plan for boys [OR(95%CI)=0.40(0.18-0.87), 0.07(0.01-0.67)], the externalizing symptoms and suicidal ideation for girls [OR(95%CI)=0.33(0.13-0.81)，0.38(0.17-0.85)]. Early pubertal timing will increase the risk of suicide plan for boys [OR(95%CI)=3.60(1.04-12.43)], meanwhile late timing can reduce the risk of NSSI in girls [OR(95%CI)=0.39(0.19-0.80)]. Conclusion The tempo of pubertal development may be a useful predictor of adolescent behavioral problems.