Autism and transgender identity

The study by Warrier and colleagues (2020), published in Nature Communications, found in a large cohort of more than 640,000 people that transgender and gender-diverse individuals were three to six times more likely to have an autism diagnosis than cisgender people, and scored higher on autistic traits.

Findings

The study by Warrier and colleagues (2020), published in Nature Communications, found in a large cohort of more than 640,000 people that transgender and gender-diverse individuals were three to six times more likely to have an autism diagnosis than cisgender people, and scored higher on autistic traits.

Clinical significance

The Cass Review emphasizes that the high prevalence of autism and other neurodivergent characteristics in the youth gender-care population deserves attention in diagnosis and decision-making. Gender dysphoria may follow a different developmental trajectory in autistic young people.

Recommendations

International recommendations stress the importance of a comprehensive developmental and mental health assessment before medical interventions, taking into account the impact of autism on identity development, social understanding, and decision-making capacity.

Research in the Netherlands

The association was described in the Netherlands at an early stage. In 2010, Annelou de Vries and colleagues found that nearly eight percent of the children and adolescents referred to the Amsterdam gender clinic had an autism spectrum disorder, compared with approximately one percent of the general population. According to the Cass Review, approximately one-third of the young people referred to the English youth clinic had clear autistic characteristics. A recent cohort study again found that autism is strongly overrepresented among gender-diverse children.

Possible explanations

It is not known why autism and gender dysphoria so often occur together. Researchers have suggested several possibilities. Autistic young people often feel different from their peers and look for an explanation for this. They may interpret social expectations about boys and girls more literally and conclude that they do not fit their sex. The physical changes of puberty may be particularly uncomfortable because of sensory sensitivities. And the tendency to focus intensely on a single subject may also involve gender. None of these explanations has been proven, and they are not mutually exclusive. The research on the association between autism and gender dysphoria is discussed on genderautisme.nl.

Implications for care

The Dutch Protocol was developed for young people without serious co-occurring problems. The group seeking care today often does not meet that description. This is one of the reasons Finland, Sweden, and England have revised their policies. For autistic young people, a careful assessment requires more time and a clinician with expertise in autism. Also read about ADHD and social media.