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Mo K, Anagnostou E, Lerch JP, Taylor MJ, VanderLaan DP, Szatmari P, Crosbie J, Nicolson R, Georgiadis S, Kelley E, Ayub M, Brian J, Lai MC, Palmert MR. Gender diversity is correlated with dimensional neurodivergent traits but not categorical neurodevelopmental diagnoses in children. J Child Psychol Psychiatry 2024; 65:1223-1236. [PMID: 38433429 DOI: 10.1111/jcpp.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Gender clinic and single-item questionnaire-based data report increased co-occurrence of gender diversity and neurodevelopmental conditions. The nuances of these associations are under-studied. We used a transdiagnostic approach, combining categorical and dimensional characterization of neurodiversity, to further the understanding of its associations with gender diversity in identity and expression in children. METHODS Data from 291 children (Autism N = 104, ADHD N = 104, Autism + ADHD N = 17, neurotypical N = 66) aged 4-12 years enrolled in the Province of Ontario Neurodevelopmental Network were analyzed. Gender diversity was measured multi-dimensionally using a well-validated parent-report instrument, the Gender Identity Questionnaire for Children (GIQC). We used gamma regression models to determine the significant correlates of gender diversity among age, puberty, sex-assigned-at-birth, categorical neurodevelopmental diagnoses, and dimensional neurodivergent traits (using the Social Communication Questionnaire and the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scales). Internalizing and externalizing problems were included as covariates. RESULTS Neither a categorical diagnosis of autism nor ADHD significantly correlated with current GIQC-derived scores. Instead, higher early-childhood dimensional autistic social-communication traits correlated with higher current overall gender incongruence (as defined by GIQC-14 score). This correlation was potentially moderated by sex-assigned-at-birth: greater early-childhood autistic social-communication traits were associated with higher current overall gender incongruence in assigned-males-at-birth, but not assigned-females-at-birth. For fine-grained gender diversity domains, greater autistic restricted-repetitive behavior traits were associated with greater diversity in gender identity across sexes-assigned-at-birth; greater autistic social-communication traits were associated with lower stereotypical male expression across sexes-assigned-at-birth. CONCLUSIONS Dimensional autistic traits, rather than ADHD traits or categorical neurodevelopmental diagnoses, were associated with gender diversity domains across neurodivergent and neurotypical children. The association between early-childhood autistic social-communication traits and overall current gender diversity was most evident in assigned-males-at-birth. Nuanced interrelationships between neurodivergence and gender diversity should be better understood to clarify developmental links and to offer tailored support for neurodivergent and gender-diverse populations.
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Affiliation(s)
- Kelly Mo
- University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- University of Toronto, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jason P Lerch
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Oxford, Oxford, UK
| | - Margot J Taylor
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Doug P VanderLaan
- University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Szatmari
- University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Jessica Brian
- University of Toronto, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Meng-Chuan Lai
- University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Cambridge, Cambridge, UK
- National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Mark R Palmert
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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2
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van der Miesen AIR, Shi SY, Lei HC, Ngan CL, VanderLaan DP, Wong WI. Gender diversity in a Chinese community sample and its associations with autism traits. Autism Res 2024; 17:1407-1416. [PMID: 38100234 DOI: 10.1002/aur.3075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/27/2023] [Indexed: 07/26/2024]
Abstract
Emerging evidence suggests that gender dysphoria or gender diversity (GD) intersects frequently with autism spectrum disorder or autism traits. However, the magnitude and interpretation of this link continue to be debated. Most child studies on this topic were performed in clinical populations, and little is known about the generalizability of this co-occurrence to the broader community, especially to non-Western samples. Also, little is known about whether specific subdomains of autism are more strongly associated with GD. Therefore, we investigated GD and its association with autism traits in a Chinese community sample of 4-12-year-olds (N = 379; 51% birth-assigned girls). Parents provided information about GD characteristics using the standardized Gender Identity Questionnaire for Children and autism traits using the Chinese version of the Autism-Spectrum Quotient-Children. In addition, broader behavioral and emotional challenges were measured by the Behavior Problem Index (BPI) to account for psychological challenges other than autism traits. In this community sample of Chinese children, increased GD was associated with increased autism traits, even after accounting for the BPI. Of the four subscales, the Imagination and Patterns subscales in birth-assigned girls and the Imagination subscale in birth-assigned boys were especially associated with GD. These findings indicate that the association between GD and autism traits generalizes to a nonclinical, non-Western sample. Clinicians and researchers working with clinical as well as community children should thus pay attention to the co-occurrence of GD and autism traits, in and outside the West.
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Affiliation(s)
- Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Sylvia Yun Shi
- Gender Studies Programme and Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hoi Ching Lei
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Cho Lam Ngan
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto, Mississauga, Ontario, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wang Ivy Wong
- Gender Studies Programme and Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong
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3
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Clyde A, Bismar D, Agnew G, Kuper LE. Autism Spectrum Disorder and Anxiety Among Transgender Youth: Use of the Social Communication Questionnaire (SCQ). J Autism Dev Disord 2024; 54:615-627. [PMID: 36422761 DOI: 10.1007/s10803-022-05814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/26/2022]
Abstract
Autism spectrum disorder (ASD) and ASD symptoms are overrepresented among gender-diverse youth across studies. Gender-diverse and ASD youth are at risk for anxiety, but anxiety is unclear among gender-diverse youth with ASD. The Social Communication Questionnaire (SCQ) is a commonly used ASD screener, including in multidisciplinary gender-affirming programs, but scholars have disagreed on the most optimal cut-off score. To date, no study has investigated the sensitivity and specificity of its established cut-off score of 15 with a sample of transgender youth. Gaining more accurate information about the utility of ASD screening tools with gender diverse youth is critical in order to help refer youth to needed services. Among a sample of 325 transgender youth, this study sought to determine an optimal cut-off score for the SCQ, the prevalence of ASD and ASD symptoms, and the relationship between ASD and anxiety within this population. The current study found that a lower cut-off score of 11 yielded optimal sensitivity and specificity (i.e., the best balance of accurately identifying individuals with ASD based on the screener), and analyses found an overrepresentation of ASD (5.2%) and ASD traits (12.1%). Transgender youth with ASD or ASD symptoms had higher anxiety, and all youth perceived themselves as more anxious than their parents. Future research is needed to identify the needs of this population, with particular consideration for the lived experiences of gender diverse and transgender youth.
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Affiliation(s)
- Alexis Clyde
- Children's Health System of Texas, 1935 Medical District Dr., Mail Code CH 12.01, Dallas, TX, 75235, USA.
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | - Gabrielle Agnew
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laura E Kuper
- Children's Health System of Texas, 1935 Medical District Dr., Mail Code CH 12.01, Dallas, TX, 75235, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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4
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Yazkan Akgül G, Yıldırım Budak B, Perdahlı Fiş N, Erdoğdu Yıldırım AB. Executive functions in adolescents with gender dysphoria. APPLIED NEUROPSYCHOLOGY. CHILD 2023:1-6. [PMID: 37862558 DOI: 10.1080/21622965.2023.2270096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Aim: Aim of this study is evaluating EF by performing neurocognitive tests, and to identify gender-related differences in EF between adolescents with and without GD.Methods: 8 Female-to-Male transgender adolescents (FtMs), and 14 Male-to-Female transsexual adolescents (MtFs) (Gender Dysphoria Group, GDG) and 29 boys, 21 girls (Control Group, CG), were tested in a cross-sectional study, using the Wisconsin Card Sorting Test (WCST), Controlled Oral Word Association Test (COWAT), and Stroop Color and Word Test (SCWT). The psychiatric diagnoses were established by using the KD-SADS.Results: Among GDG 72.7%, had at least one psychopathology. There weren't any significant differences in, estimated IQ scores, or WCST subtest scores between the 2 groups. COWAT total word count and SCWT-5 total duration test scores were better in the CG.Conclusion: CG had better performance on verbal fluency and response inhibition whereas no differences found on set shifting abilities. In consideration of the existence of EF-related impairment in adolescents with GD, appropriate support and interventions are expected to improve their adaptation skills and comorbid psychopathologies. These results should be interprete cautiously and additional larger scale studies are needed to obtain more comprehensive data related to gender differences in EF of adolescents with GD.
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Affiliation(s)
- Gözde Yazkan Akgül
- School of Medicine, Child and Adolescent Psychiatry Department, Marmara University, İstanbul, Turkey
| | - Burcu Yıldırım Budak
- School of Medicine, Child and Adolescent Psychiatry Department, Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
| | - Neşe Perdahlı Fiş
- School of Medicine, Child and Adolescent Psychiatry Department, Marmara University, İstanbul, Turkey
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5
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Strang JF, McClellan LS, Li S, Jack AE, Wallace GL, McQuaid GA, Kenworthy L, Anthony LG, Lai MC, Pelphrey KA, Thalberg AE, Nelson EE, Phan JM, Sadikova E, Fischbach AL, Thomas J, Vaidya CJ. The autism spectrum among transgender youth: default mode functional connectivity. Cereb Cortex 2023; 33:6633-6647. [PMID: 36721890 PMCID: PMC10233301 DOI: 10.1093/cercor/bhac530] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 02/02/2023] Open
Abstract
The common intersection of autism and transgender identities has been described in clinical and community contexts. This study investigates autism-related neurophenotypes among transgender youth. Forty-five transgender youth, evenly balanced across non-autistic, slightly subclinically autistic, and full-criteria autistic subgroupings, completed resting-state functional magnetic resonance imaging to examine functional connectivity. Results confirmed hypothesized default mode network (DMN) hub hyperconnectivity with visual and motor networks in autism, partially replicating previous studies comparing cisgender autistic and non-autistic adolescents. The slightly subclinically autistic group differed from both non-autistic and full-criteria autistic groups in DMN hub connectivity to ventral attention and sensorimotor networks, falling between non-autistic and full-criteria autistic groups. Autism traits showed a similar pattern to autism-related group analytics, and also related to hyperconnectivity between DMN hub and dorsal attention network. Internalizing, gender dysphoria, and gender minority-related stigma did not show connectivity differences. Connectivity differences within DMN followed previously reported patterns by designated sex at birth (i.e. female birth designation showing greater within-DMN connectivity). Overall, findings suggest behavioral diagnostics and autism traits in transgender youth correspond to observable differences in DMN hub connectivity. Further, this study reveals novel neurophenotypic characteristics associated with slightly subthreshold autism, highlighting the importance of research attention to this group.
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Affiliation(s)
- John F Strang
- Gender and Autism Program, Children’s National Hospital, 15245 Shady Grove Road, Suite 350, Rockville, MD 20850, USA
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, DC, USA
- Division of Neuropsychology, Children’s National Hospital, Washington, DC, USA
| | - Lucy S McClellan
- Division of Neuropsychology, Children’s National Hospital, Washington, DC, USA
| | - Sufang Li
- Department of Psychology, Georgetown University, Washington, DC, USA
| | - Allison E Jack
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Gregory L Wallace
- Department of Speech, Language, & Hearing Sciences, George Washington University, Washington, DC, USA
| | - Goldie A McQuaid
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Lauren Kenworthy
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, DC, USA
- Division of Neuropsychology, Children’s National Hospital, Washington, DC, USA
| | - Laura G Anthony
- Department of Psychiatry and Behavioral Sciences, University of Colorado School of Medicine, Aurora, CO, USA
| | - Meng-Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin A Pelphrey
- Department of Neurology, University of Virginia Medical School, Charlottesville, VA, USA
| | | | - Eric E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jenny M Phan
- Division of Neuropsychology, Children’s National Hospital, Washington, DC, USA
| | - Eleonora Sadikova
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Abigail L Fischbach
- Division of Neuropsychology, Children’s National Hospital, Washington, DC, USA
| | | | - Chandan J Vaidya
- Department of Psychology, Georgetown University, Washington, DC, USA
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6
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Wattel LL, Walsh RJ, Krabbendam L. Theories on the Link Between Autism Spectrum Conditions and Trans Gender Modality: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022; 11:275-295. [PMID: 38803560 PMCID: PMC11127869 DOI: 10.1007/s40489-022-00338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/16/2022] [Indexed: 10/15/2022]
Abstract
While research on the prevalence of co-occurring autism spectrum conditions (ASC) and trans gender modality (TGM) is available, less is known about the underlying mechanism of this association. Insight is needed to improve treatment of trans autistic people. This review provides an overview of theories on the ASC-TGM link and the available evidence for/against them published between January 2016 and October 2020. A systematic search was performed in PubMed, PsycINFO, Web of Science, and Scopus. This resulted in 36 studies, in which 15 theories were identified. Results indicate all theories lack substantial empirical support. Unlikely and promising theories were identified. The most promising theories were those on resistance to social norms and weakened sex differences. Future directions are provided.
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Affiliation(s)
- Luna L. Wattel
- Faculty of Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, Netherlands
| | - Reubs J Walsh
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Van der Boechorststraat 9, 1081 BT Amsterdam, Netherlands
| | - Lydia Krabbendam
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Van der Boechorststraat 9, 1081 BT Amsterdam, Netherlands
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7
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Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM. Is It Autism? A Critical Commentary on the Co-Occurrence of Gender Dysphoria and Autism Spectrum Disorder. JOURNAL OF HOMOSEXUALITY 2022; 69:1204-1221. [PMID: 33852376 DOI: 10.1080/00918369.2021.1905385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An increasing amount of literature revealed a link between GD and ASD. Both GD and ASD are complex and heterogeneous conditions characterized by a large variety of presentations. Studies have reported that individuals with GD tend to have higher prevalence rates of autistic traits in comparison to the general population. The purpose of this commentary is to provide, through the description of a clinical case, our reading and a possible interpretation of the correlation of these two conditions in light of the several methodological limitations found in literature. We hypothesize that the traits often classified as autistic could be more accurately related to the distress and discomfort evoked by GD. The autistic traits of individuals with GD as forms of psychological defenses and coping mechanisms aimed at dealing with socio-relational and identity problems are discussed.
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Affiliation(s)
- Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Guido Giovanardi
- Department of Psychology, University of Campania, "Luigi Vanvitelli," University of Caserta, Italy
| | - Eleonora Innocenzi
- Department of Letters and Philosophy, "Tor Vergata," University of Rome, Italy
| | - Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Giorgio Caviglia
- Department of Psychology, University of Campania, "Luigi Vanvitelli," University of Caserta, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
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8
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Kallitsounaki A, Williams DM. Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis. J Autism Dev Disord 2022:10.1007/s10803-022-05517-y. [PMID: 35596023 DOI: 10.1007/s10803-022-05517-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 12/26/2022]
Abstract
The suggested overlap between autism spectrum disorder (ASD) and gender dysphoria/incongruence (GD/GI) has been much disputed. This review showed a relationship between ASD traits and GD feelings in the general population and a high prevalence of GD/GI in ASD. Our meta-analyses revealed that the pooled estimate of the prevalence of ASD diagnoses in GD/GI people was 11% (p < .001) and the overall effect size of the difference in ASD traits between GD/GI and control people was significant (g = 0.67, p < .001). Heterogeneity was high in both meta-analyses. We demonstrated that the chances that there is not a link between ASD and GD/GI are negligible, yet the size of it needs further investigation.
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Affiliation(s)
- Aimilia Kallitsounaki
- School of Psychology, University of Kent, Keynes College, CT2 7NP, Canterbury, Kent, United Kingdom.
| | - David M Williams
- School of Psychology, University of Kent, Keynes College, CT2 7NP, Canterbury, Kent, United Kingdom
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9
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Munoz Murakami LY, van der Miesen AIR, Nabbijohn AN, VanderLaan DP. Childhood Gender Variance and the Autism Spectrum: Evidence of an Association Using a Child Behavior Checklist 10-Item Autism Screener. JOURNAL OF SEX & MARITAL THERAPY 2022; 48:645-651. [PMID: 35107047 DOI: 10.1080/0092623x.2022.2035870] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Childhood gender variance (GV) is associated with autism spectrum disorder (ASD) diagnosis/traits; however, this association has mainly been investigated in clinical samples. An ASD screening measure based on 10 items from the commonly used Child Behavior Checklist (CBCL) might enable investigation of this association in a wider variety of (non-clinical) populations where the CBCL and a measure of GV are available. We investigated whether GV in 6- to 12-year-olds (N = 1719; 48.8% assigned male at birth) from a community sample showed an association with the CBCL 10-item ASD screener. The Gender Identity Questionnaire for Children measured GV. The CBCL 10-item ASD screener measured ASD traits. The remaining CBCL items provided a measure of children's general emotional and behavioral challenges. Higher GV was associated with higher CBCL ASD screener scores, including when controlling for the remaining CBCL items. The CBCL 10-item ASD screener can be useful for investigating the link between GV and ASD traits in 6- to 12-year-olds. Given that the CBCL is commonly employed, secondary analyses of existing datasets that also included a measure of GV could enable investigation of how widely the association between GV and ASD applies across a variety of populations.
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Affiliation(s)
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada
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10
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Manjra II, Masic U. Gender diversity and autism spectrum conditions in children and adolescents: A narrative review of the methodologies used by quantitative studies. J Clin Psychol 2021; 78:485-502. [PMID: 34553777 DOI: 10.1002/jclp.23249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 07/06/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022]
Abstract
AIM This narrative review aimed to analyse the methodologies used by quantitative studies to evaluate their evidence for the association between gender diversity and autism spectrum conditions (ASC) in child and adolescent population samples. METHOD A systematic search was conducted for papers published between 2010 and 2020. RESULTS Fifteen papers met the inclusion criteria; all reported associations between their defined versions of gender diversity and ASC. Gender diversity was characterised as "dysphoria", "variance", and/or "diverse", and was correlated across ASC categories of "symptoms", "traits", or "empathising and systemising styles of thinking". Multiple diagnostic criteria and/or nonspecific, adult administrated measures were used to quantify youth gender experiences and ASCs. CONCLUSION Interpretations of the findings are discussed in relation to critical appraisal of methodologies used including data collection and deduction, the characteristics of the sample population, the usage of comparison groups, and the overall quality of statistical reporting amongst others.
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Affiliation(s)
- Ilham I Manjra
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Una Masic
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
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11
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Schiltz HK, McVey AJ, van Dyk IS, Adler EJ, Van Hecke AV. Brief Report: Links Between Nonconformity to Gender Norms, Autistic Features, and Internalizing Symptoms in a Non-clinical College Sample. J Autism Dev Disord 2021; 53:1717-1725. [PMID: 33893594 DOI: 10.1007/s10803-021-05033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Research shows elevated gender variance among autistic people and more autistic traits among gender diverse people, each of which is related to mental health concerns. Little work has explored broad features of these presentations in a non-clinical sample. College students (n = 174) ages 18-22 years completed questionnaires assessing the broader autism phenotype (BAP), autistic features, nonconformity to gender norms, and internalizing symptoms. Those with more BAP features or autistic communication reported more nonconformity to gender norms. Higher levels of internalizing symptoms were related to more gender nonconformity, BAP, and autistic features. Gender nonconformity marginally moderated the effect of BAP on depression but not anxiety. The BAP, autistic features, and gender nonconformity are important in understanding mental well-being.
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Affiliation(s)
- Hillary K Schiltz
- Department of Psychology, Marquette University, 604 N. 16th St., Milwaukee, WI, 53233, USA.
| | - Alana J McVey
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | | | - Elyse J Adler
- Department of Psychology, Marquette University, 604 N. 16th St., Milwaukee, WI, 53233, USA
| | - Amy V Van Hecke
- Department of Psychology, Marquette University, 604 N. 16th St., Milwaukee, WI, 53233, USA
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12
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Tankersley AP, Grafsky EL, Dike J, Jones RT. Risk and Resilience Factors for Mental Health among Transgender and Gender Nonconforming (TGNC) Youth: A Systematic Review. Clin Child Fam Psychol Rev 2021; 24:183-206. [PMID: 33594611 DOI: 10.1007/s10567-021-00344-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 11/24/2022]
Abstract
In recent years, there has been a proliferation of research regarding transgender and gender nonconforming (TGNC) people. The stigma and legal discriminations that this population faces have obvious and documented repercussions for mental health. In 2015, the American Psychological Association (APA) published Guidelines for Psychological Practice with TGNC People. The APA noted that due to the nuances of working with TGNC youth and the dearth of related literature, the guidelines focus primarily on TGNC adults. To date, there has not been a systematic review of risk and resilience factors for mental health among TGNC children, adolescents, and young adults under the age of 25. Forty-four peer-reviewed articles met inclusion criteria for this systematic review, and were evaluated for their methodological rigor and their findings. Common risk factors for negative mental health variables included physical and verbal abuse, exposure to discrimination, social isolation, poor peer relations, low self-esteem, weight dissatisfaction, and age. Across studies, older children and adolescents tended to report higher rates of psychological distress. Resilience-promoting factors for mental health were also documented, including parent connectedness, social support, school safety and belonging, and the ability to use one's chosen name. By synthesizing the existing literature using a resilience-focused and minority stress framework, the present review provides clinicians and researchers with a coherent evidence-base to better equip them to promote psychological adaptation and wellbeing among TGNC youth.
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13
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Herrmann L, Bindt C, Schweizer K, Micheel J, Nieder TO, Haaß J, Schöttle D, Becker-Hebly I. [Autism Spectrum Disorders and Gender Dysphoria Among Children and Adolescents: Systematic Review on the Co-Occurrence]. PSYCHIATRISCHE PRAXIS 2020; 47:300-307. [PMID: 32542639 DOI: 10.1055/a-1148-4873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The review systematically reviews the literature on co-occurring gender dysphoria/gender variance and autism spectrum disorder among children and adolescents. METHODS A systematic literature search was conducted for the years 1946 to December 2018. RESULTS 144 publications could be identified in the literature search. Out of these, 22 publications met the inclusion criteria for the systematic review. 4.7 to 13.3 % of the children and adolescents with primarily diagnosed gender dysphoria/variance examined in the studies also had an autism diagnosis. In samples of children and adolescents with primarily diagnosed autism gender variance was overrepresented with a prevalence of 4 to 6.5 %. CONCLUSION The results of the systematic review point towards an overrepresentation of co-occurring gender dysphoria/variance and autism spectrum disorder. Methodological and clinical implications are discussed.
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Affiliation(s)
- Lena Herrmann
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
| | - Carola Bindt
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
| | - Katinka Schweizer
- Institut und Poliklinik für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf
| | - Jan Micheel
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
| | - Timo Ole Nieder
- Institut und Poliklinik für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf
| | - Judith Haaß
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
| | - Daniel Schöttle
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
| | - Inga Becker-Hebly
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
- Institut und Poliklinik für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf
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14
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Lehmann K, Rosato M, McKenna H, Leavey G. Autism trait prevalence in treatment seeking adolescents and adults attending specialist gender services. Eur Psychiatry 2020; 63:e23. [PMID: 32114999 PMCID: PMC7315870 DOI: 10.1192/j.eurpsy.2020.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background. To assess the prevalence of autism traits in individuals accessing gender affirming treatments, we conducted a cross-sectional survey in the regional specialist gender services in Northern Ireland. Methods. One hundred and twenty-three individuals (38 adolescents and 69 adults) currently attending or who previously attended specialist gender services in Northern Ireland were recruited. Fifty-six individuals assigned male at birth (AMAB) and 66 individuals assigned female at birth (AFAB) took part in the study. Main outcome measures: Autism Quotient (AQ), Cambridge Behavior Scale (EQ), and RAADS-14. Results. Autism trait prevalence rates of 19.5% (AQ); 25.4% (RAADS-14); and 35.8% (poor empathy traits). A combined measure comprising all three provided a prevalence of 17.2%. There were no mean differences in the scores between AMAB (assigned male at birth) individuals and AFAB (assigned female at birth) individuals. Conclusions. Autism traits present additional challenges during the assessment and treatment of individuals with gender dysphoria. Autism screening tools can aid in the identification of individual with additional needs.
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Affiliation(s)
- Katrin Lehmann
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Northern Ireland, United Kingdom
| | - Michael Rosato
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Northern Ireland, United Kingdom
| | - Hugh McKenna
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, United Kingdom
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Northern Ireland, United Kingdom
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15
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Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS. Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review. J Autism Dev Disord 2019; 50:695-706. [DOI: 10.1007/s10803-019-04298-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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16
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Mahfouda S, Panos C, Whitehouse AJ, Thomas CS, Maybery M, Strauss P, Zepf FD, O’Donovan A, van Hall HW, Saunders LA, Moore JK, Lin A. Mental Health Correlates of Autism Spectrum Disorder in Gender Diverse Young People: Evidence from a Specialised Child and Adolescent Gender Clinic in Australia. J Clin Med 2019; 8:E1503. [PMID: 31547002 PMCID: PMC6832530 DOI: 10.3390/jcm8101503] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 12/30/2022] Open
Abstract
Research suggests an overrepresentation of autism spectrum diagnoses (ASD) or autistic traits in gender diverse samples, particularly in children and adolescents. Using data from the GENTLE (GENder identiTy Longitudinal Experience) Cohort at the Gender Diversity Service at the Perth Children's Hospital, the primary objective of the current retrospective chart review was to explore psychopathology and quality of life in gender diverse children with co-occurring ASD relative to gender diverse children and adolescents without ASD. The Social Responsiveness Scale (Second Edition) generates a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) score indicating a likely clinical ASD diagnosis, which was used to partition participants into two groups (indicated ASD, n = 19) (no ASD indicated, n = 60). Indicated ASD was far higher than would be expected compared to general population estimates. Indicated ASD on the Social Responsiveness Scale 2 (SRS 2) was also a significant predictor of Internalising behaviours (Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems subscales) on the Youth Self Report. Indicated ASD was also a significant predictor of scores on all subscales of the Paediatric Quality of Life Inventory. The current findings indicate that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life outcomes. Services working with gender diverse young people should screen for ASD, and also provide pathways to appropriate care for the commonly associated mental health difficulties.
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Affiliation(s)
- Simone Mahfouda
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
- School of Psychological Science, Faculty of Science, The University of Western Australia, Perth 6008, Australia;
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth 6008, Australia;
| | - Christina Panos
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia; (C.P.); (A.O.)
| | - Andrew J.O. Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
| | - Cati S. Thomas
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
- The Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth Children’s Hospital, Nedlands 6009, Australia; (H.-W.v.H.); (L.A.S.)
| | - Murray Maybery
- School of Psychological Science, Faculty of Science, The University of Western Australia, Perth 6008, Australia;
| | - Penelope Strauss
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth 6008, Australia
| | - Florian D. Zepf
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth 6008, Australia;
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University, 07743 Jena, Germany
| | - Amanda O’Donovan
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia; (C.P.); (A.O.)
| | - Hans-Willem van Hall
- The Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth Children’s Hospital, Nedlands 6009, Australia; (H.-W.v.H.); (L.A.S.)
| | - Liz A. Saunders
- The Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth Children’s Hospital, Nedlands 6009, Australia; (H.-W.v.H.); (L.A.S.)
- The School of Human Sciences (Exercise and Sports Science), The University of Western Australia, Perth 6008, Australia
| | - Julia K. Moore
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth 6008, Australia;
- The Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth Children’s Hospital, Nedlands 6009, Australia; (H.-W.v.H.); (L.A.S.)
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
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17
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Abstract
Studies have shown an increase of symptoms of autism spectrum disorder (ASD) in gender dysphoria (GD). Various hypotheses try to explain this possible co-occurrence (e.g., a role of resistance to change, stereotyped behaviors or prenatal testosterone exposure). This study examined ASD symptoms with the Children’s Social Behavior Questionnaire (CSBQ) in 490 children with GD compared to 2507 typically developing (TD) and 196 children with ASD. CSBQ total scores of the GD sample were in between scores from the TD and ASD sample. The GD sample showed elevated levels of autistic symptomatology on all subdomains, not only on stereotyped and resistance to change. Further, no gender differences and interaction effects were found on the total CSBQ, making a sole role for prenatal testosterone unlikely.
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18
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The Co-occurrence of Gender Dysphoria and Autism Spectrum Disorder in Adults: An Analysis of Cross-Sectional and Clinical Chart Data. J Autism Dev Disord 2019; 48:2217-2223. [PMID: 29427119 DOI: 10.1007/s10803-018-3480-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Quantitative studies indicate an overrepresentation of ASD in individuals with GD. This study aims to determine the prevalence of autistic traits or ASD in adults with GD using two different data collection methods: (1) cross-sectional data using the social responsiveness scale-adults (SRS-A) and the autism quotient (AQ) (n = 63). (2) Clinical chart data (n = 532). Mean SRS-A scores were significantly higher compared to a norm population. Almost 5% of the patients with GD scored above the cut-off as measured by the AQ. In 32 patients (6%), a certain ASD diagnosis was found in the patient files, which is sixfold higher compared to the general population. Significantly more "birth assigned male" were affected compared to "birth assigned female".
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19
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Nabbijohn AN, van der Miesen AIR, Santarossa A, Peragine D, de Vries ALC, Popma A, Lai MC, VanderLaan DP. Gender Variance and the Autism Spectrum: An Examination of Children Ages 6-12 Years. J Autism Dev Disord 2019; 49:1570-1585. [PMID: 30547258 DOI: 10.1007/s10803-018-3843-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Gender variance (GV) and autism spectrum disorder (ASD) frequently co-occur in clinical populations. We investigated GV in association with ASD characteristics in nonclinical children and in children with developmental/mental health diagnoses. In 6-12-year-olds (N = 2445; 51% birth-assigned boys), the Gender Identity Questionnaire for Children measured GV and the Children's Social Behavior Questionnaire measured six subdomains of ASD characteristics. Among nonclinical children, GV was associated with parent-reported difficulties orienting socially and stereotyped behaviors. GV was also associated with parent-reported clinical diagnoses of ASD, sensory processing disorder, and oppositional defiant disorder. These findings suggest associations between specific ASD characteristics and GV in nonclinical children. Also, childhood GV should be further examined in a range of clinical populations, including ASD individuals.
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Affiliation(s)
- A Natisha Nabbijohn
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Alanna Santarossa
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada.,Faculty of Medicine, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Diana Peragine
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Meng-Chuan Lai
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health and The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK.,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada. .,Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.
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20
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Hisle-Gorman E, Landis CA, Susi A, Schvey NA, Gorman GH, Nylund CM, Klein DA. Gender Dysphoria in Children with Autism Spectrum Disorder. LGBT Health 2019; 6:95-100. [DOI: 10.1089/lgbt.2018.0252] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Corinne A. Landis
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland
| | - Natasha A. Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland
| | - Gregory H. Gorman
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Cade M. Nylund
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - David A. Klein
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
- Department of Family Medicine, Uniformed Services University, Bethesda, Maryland
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21
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Akgül GY, Ayaz AB, Yildirim B, Fis NP. Autistic Traits and Executive Functions in Children and Adolescents With Gender Dysphoria. JOURNAL OF SEX & MARITAL THERAPY 2019; 44:619-626. [PMID: 29419374 DOI: 10.1080/0092623x.2018.1437489] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We aimed to examine the autistic traits and executive functions that may require clinical attention in children and adolescents with gender dysphoria (GD). The study sample consisted of 25 patients with GD and 50 controls (aged five to 17 years). The instruments were the Social Responsiveness Scale (SRS) and the Behavior Rating Inventory of Executive Function (BRIEF). The GD (mean age: 11.56 ± 4.15 years) and control (mean age: 11.42 ± 3.91 years) groups were similar with respect to age and sex; around 50% of the GD group (n = 13) and control groups were male (n = 26). The BRIEF metacognitive index (t = 7.023, p < 0.001), behavioral regulation index (t = 6.340, p < 0.001), and global executive composite (t = 7.268, p < 0.001) scores were significantly higher in the GD group when compared with the controls. Similarly, mean SRS scores were significantly higher in the GD group (t = 4.978, p < 0.001). The GD group had statistically significant higher BRIEF global scores even after controlling for SRS-key autism scores (p < 0.001). Young people with GD had relatively more disturbed behavior related to executive functions and social impairment associated with autistic traits when compared with their control counterparts. Although preliminary, our results may indicate a possible neurodevelopmental background for individuals with GD.
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Affiliation(s)
- Gözde Yazkan Akgül
- a Child and Adolescent Psychiatry Department, Marmara University Tip Fakultesi , Istanbul , Turkey
| | - Ayşe Burcu Ayaz
- a Child and Adolescent Psychiatry Department, Marmara University Tip Fakultesi , Istanbul , Turkey
| | - Burcu Yildirim
- a Child and Adolescent Psychiatry Department, Marmara University Tip Fakultesi , Istanbul , Turkey
| | - Nese Perdahli Fis
- a Child and Adolescent Psychiatry Department, Marmara University Tip Fakultesi , Istanbul , Turkey
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22
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Øien RA, Cicchetti DV, Nordahl-Hansen A. Gender Dysphoria, Sexuality and Autism Spectrum Disorders: A Systematic Map Review. J Autism Dev Disord 2018; 48:4028-4037. [PMID: 30019279 DOI: 10.1007/s10803-018-3686-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this systematic map review, we aimed (1) at identifying studies including the co-occurrence of autism spectrum disorders (ASD) and gender dysphoria (GD) between 1946 and 2018, and (2) to present the papers included in this systematic map review to provide authors in the field of GD, sexuality and ASD with an important database of studies focusing on this very complex topic. The field is of emerging interest, as observed by the large increase of studies over the past decades, especially since 2015. However, future challenges are to be addressed in future studies.
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Affiliation(s)
- Roald A Øien
- Department of Psychology, UiT - The Arctic University of Norway, PB 6050, 9037, Tromsø, Norway. .,Child Study Center, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Domenic V Cicchetti
- Child Study Center, Yale School of Medicine, Yale University, New Haven, CT, USA
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23
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Cooper K, Smith LGE, Russell AJ. Gender Identity in Autism: Sex Differences in Social Affiliation with Gender Groups. J Autism Dev Disord 2018; 48:3995-4006. [PMID: 29705922 PMCID: PMC6223803 DOI: 10.1007/s10803-018-3590-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
High rates of gender variance have been reported in autistic people, with higher variance in autistic females than males. The social component of gender identity may be affected, with autistic females experiencing lower identification with and feeling less positively about their gender groups than controls. We measured gender identification, gender self-esteem, and aspects of gender expression (masculinity and femininity) in autistic natal males and females, and controls (N = 486). We found that autistic people had lower gender identification and gender self-esteem than controls, and autistic natal females had lower gender identification than autistic natal males and natal female controls. In conclusion, autistic people, particularly natal females, had lower social identification with and more negative feelings about a gender group.
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Affiliation(s)
- Kate Cooper
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Laura G E Smith
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Ailsa J Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
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24
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Nobili A, Glazebrook C, Bouman WP, Glidden D, Baron-Cohen S, Allison C, Smith P, Arcelus J. Autistic Traits in Treatment-Seeking Transgender Adults. J Autism Dev Disord 2018; 48:3984-3994. [PMID: 29654452 PMCID: PMC6223809 DOI: 10.1007/s10803-018-3557-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The present study aimed to compare prevalence of autistic traits measured by the self-reported autism spectrum quotient-short (AQ-short) in a transgender clinical population (n = 656) matched by age and sex assigned at birth to a cisgender community sample. Results showed that transgender and cisgender people reported similar levels of possible autistic caseness. Transgender people assigned female were more likely to have clinically significant autistic traits compared to any other group. No difference was found between those assigned male. High AQ scores may not be indicative of the presence of an autism spectrum condition as the difference between groups mainly related to social behaviours; such scores may be a reflection of transgender people’s high social anxiety levels due to negative past experiences.
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Affiliation(s)
- Anna Nobili
- Nottingham National Centre for Transgender Health, Nottingham, UK
- Institute of Mental Health, University of Nottingham, Room B12, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Cris Glazebrook
- Institute of Mental Health, University of Nottingham, Room B12, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.
| | | | - Derek Glidden
- Nottingham National Centre for Transgender Health, Nottingham, UK
- Nottingham City Asperger Service, Highbury Hospital, Nottingham, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paula Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jon Arcelus
- Nottingham National Centre for Transgender Health, Nottingham, UK
- Institute of Mental Health, University of Nottingham, Room B12, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
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25
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Cheung AS, Ooi O, Leemaqz S, Cundill P, Silberstein N, Bretherton I, Thrower E, Locke P, Grossmann M, Zajac JD. Sociodemographic and Clinical Characteristics of Transgender Adults in Australia. Transgend Health 2018; 3:229-238. [PMID: 30596151 PMCID: PMC6308273 DOI: 10.1089/trgh.2018.0019] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Over the last 10 years, increases in demand for transgender health care has occurred worldwide. There are few data on clinical characteristics of Australian adult transgender individuals. Understanding gender identity patterns, sociodemographic characteristics, gender-affirming treatments, as well as medical and psychiatric morbidities, including neurobehavioral conditions affecting transgender and gender-diverse adults will help to inform optimal health service provision. Purpose: In an Australian adult transgender cohort, we aimed to first, assess referral numbers and describe the sociodemographic and clinical characteristics, and second, to specifically assess the prevalence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Methods: We performed a retrospective audit of deidentified electronic medical records in a primary care and a secondary care gender clinic in Melbourne, Australia. Annual referral rates, sociodemographic data, and prevalence of medical and psychiatric conditions were obtained. Results: Data for 540 transgender individuals were available. Rapid rises were observed in referrals for transgender health services, more than 10 times the number in 2016 compared with 2011. Median age at initial presentation was 27 years (interquartile range (22, 36), range 16–74). Around 21.3% were unemployed and 23.8% had experienced homelessness despite high levels of education. Around 44.1% identified as trans male, 36.3% as trans female, and 18.3% as gender nonbinary. Medical morbidities were rare but mental illness was very common. The prevalence of depression was 55.7%, anxiety in 40.4%, ADHD in 4.3%, and ASD in 4.8%, all higher than reported age-matched general Australian population prevalence. Conclusions: Rising demand for transgender care, socioeconomic disadvantage, and high burden of mental health conditions warrants a comprehensive multidisciplinary approach to provide optimal care for transgender individuals. Given that ASD and ADHD are prevalent, in addition to gender-affirming treatments, psychosocial interventions may assist individuals in navigating health care needs and to support social aspects of gender transition. Further studies are required to understand links between ASD, ADHD, and gender identity and to evaluate optimal models of health service provision for transgender individuals.
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Affiliation(s)
- Ada S Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Olivia Ooi
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Shalem Leemaqz
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | | | | | - Ingrid Bretherton
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Emily Thrower
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Peter Locke
- Equinox Clinic, Thorne Harbour Health, Fitzroy, Australia
| | - Mathis Grossmann
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Jeffrey D Zajac
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
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26
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Dai YC, Zhang HF, Schön M, Böckers TM, Han SP, Han JS, Zhang R. Neonatal Oxytocin Treatment Ameliorates Autistic-Like Behaviors and Oxytocin Deficiency in Valproic Acid-Induced Rat Model of Autism. Front Cell Neurosci 2018; 12:355. [PMID: 30356897 PMCID: PMC6190900 DOI: 10.3389/fncel.2018.00355] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/20/2018] [Indexed: 12/22/2022] Open
Abstract
Autism spectrum disorder (ASD) is characterized by impaired social communication and repetitive/stereotyped behaviors. The neuropeptide oxytocin (OXT) plays a critical role in regulating social behaviors in the central nervous system, as indicated in both human and animal studies. We hypothesized that central OXT deficit is one of causes of etiology of ASD, which may be responsible for the social impairments. To test our hypothesis, central OXT system was examined in valproic acid (VPA)-induced rat model of autism (VPA rat). Our results showed that adolescent VPA rats exhibited a lower level of OXT mRNA and fewer OXT-ir cells in the hypothalamus than control rats. Additionally, OXT concentration in cerebrospinal fluid (CSF) was reduced. The number of OXT-ir cells in the supraoptic nucleus (SON) of neonatal VPA rats was also lower. Autistic-like behaviors were observed in these animals as well. We found that an acute intranasal administration of exogenous OXT restored the social preference of adolescent VPA rats. Additionally, early postnatal OXT treatment had long-term effects ameliorating the social impairments and repetitive behaviors of VPA rats until adolescence. This was accompanied by an increase in OXT-ir cells. Taken together, we demonstrated there was central OXT deficiency in the VPA-induced rat model of autism, and showed evidence that early postnatal OXT treatment had a long-term therapeutic effect on the autistic-like behaviors in VPA rats.
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Affiliation(s)
- Yu-Chuan Dai
- Neuroscience Research Institute, Peking University, Beijing, China.,Key Laboratory for Neuroscience, Ministry of Education, National Health and Family Planning Commission, Peking University, Beijing, China.,Department of Neurobiology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Hong-Feng Zhang
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Collaborative Innovation Center for Brain Science, Xiamen University, Xiamen, China
| | - Michael Schön
- Institute for Anatomy and Cell Biology, Ulm University, Ulm, Germany.,International Graduate School in Molecular Medicine Ulm, Ulm University, Ulm, Germany.,Department of Neurology, Ulm University, Ulm, Germany
| | - Tobias M Böckers
- Institute for Anatomy and Cell Biology, Ulm University, Ulm, Germany.,Department of Neurology, Ulm University, Ulm, Germany
| | - Song-Ping Han
- Neuroscience Research Institute, Peking University, Beijing, China.,Key Laboratory for Neuroscience, Ministry of Education, National Health and Family Planning Commission, Peking University, Beijing, China.,Department of Neurobiology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.,Wuxi HANS Health Medical Technology Co., Ltd., Wuxi, China
| | - Ji-Sheng Han
- Neuroscience Research Institute, Peking University, Beijing, China.,Key Laboratory for Neuroscience, Ministry of Education, National Health and Family Planning Commission, Peking University, Beijing, China.,Department of Neurobiology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Rong Zhang
- Neuroscience Research Institute, Peking University, Beijing, China.,Key Laboratory for Neuroscience, Ministry of Education, National Health and Family Planning Commission, Peking University, Beijing, China.,Department of Neurobiology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
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Pang KC, Feldman D, Oertel R, Telfer M. Molecular Karyotyping in Children and Adolescents with Gender Dysphoria. Transgend Health 2018; 3:147-153. [PMID: 30094339 PMCID: PMC6083207 DOI: 10.1089/trgh.2017.0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose: The presence of a disorder of sexual development (DSD) acts as a diagnostic specifier for gender dysphoria (GD) under DSM-5, while the International Classification of Diseases (ICD)-10 specifically states that its equivalent diagnosis, gender identity disorder (GID), must not be the result of a chromosomal abnormality. For these reasons, routine karyotyping has been previously advocated in the clinical work-up of children and adolescents with suspected GD or GID. However, the utility of such testing remains unclear. Methods: The results of routine molecular karyotyping were analyzed in 128 patients attending our Australian statewide pediatric gender service from 2013 to 2016. Karyotyping was performed using an Illumina BeadChip platform and provided information on both sex chromosome composition and copy number variation (CNV). Results: No sex chromosome abnormalities directly suggestive of a DSD were discovered. The rate of CNVs among our patient cohort was 8.6% (11/128), similar to that previously reported for the general population. Unexpectedly, three trans male patients shared the same CNV, involving an almost identical 400 kbp deletion on chromosome 15q11.2. The frequency of this deletion within birth-assigned females in our cohort (3/69; 4.3%) was significantly higher than that within local control populations (0.3%; Fisher's exact test p-value=0.002), suggesting a possible association between 15q11.2 deletions and trans male identity. Conclusion: Routine molecular karyotyping failed to detect any occult DSD and indicated that the rate of CNVs was similar to that of the general population. Given these findings, we suggest that molecular karyotyping has minimal clinical utility in the routine management of children and adolescents with GD.
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Affiliation(s)
- Ken C Pang
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia.,The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Debi Feldman
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Ralph Oertel
- Victorian Clinical Genetics Service, Parkville, Australia
| | - Michelle Telfer
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
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Vermaat LE, van der Miesen AI, de Vries AL, Steensma TD, Popma A, Cohen-Kettenis PT, Kreukels BP. Self-Reported Autism Spectrum Disorder Symptoms Among Adults Referred to a Gender Identity Clinic. LGBT Health 2018; 5:226-233. [DOI: 10.1089/lgbt.2017.0178] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Lieke E.W. Vermaat
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Anna I.R. van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Annelou L.C. de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas D. Steensma
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Peggy T. Cohen-Kettenis
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Baudewijntje P.C. Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
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30
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James WH, Grech V. Homosexual Sons and the Fraternal Birth Order Effect: The Role of Elevated Maternal Intrauterine Testosterone. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:33-36. [PMID: 29159753 DOI: 10.1007/s10508-017-1113-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/01/2017] [Indexed: 06/07/2023]
Affiliation(s)
- William H James
- Galton Laboratory, Department of Genetics, Evolution and Environment, University College London, London, WC1E 6HH, UK.
| | - Victor Grech
- Paediatric Department, University of Malta Medical School, Msida, Malta
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31
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Turban JL, van Schalkwyk GI. "Gender Dysphoria" and Autism Spectrum Disorder: Is the Link Real? J Am Acad Child Adolesc Psychiatry 2018; 57:8-9.e2. [PMID: 29301673 DOI: 10.1016/j.jaac.2017.08.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/10/2017] [Accepted: 09/08/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Jack L Turban
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston.
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32
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Kuvalanka KA, Mahan DJ, McGuire JK, Hoffman TK. Perspectives of Mothers of Transgender and Gender-Nonconforming Children With Autism Spectrum Disorder. JOURNAL OF HOMOSEXUALITY 2017; 65:1167-1189. [PMID: 29161222 DOI: 10.1080/00918369.2017.1406221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study represents findings from interviews at two time points with three mothers of transgender and gender-nonconforming (TGNC) children (ages 8 to 12 years at T1) with autism spectrum disorder (ASD). Of interest was the mothers' experiences of raising a TGNC child with ASD, and whether/how the children's autism played a role in their understandings of their children's gender identities and expressions. The mothers' fear of a transphobic/cisnormative society and wondering about whether their children's ASD influenced or caused their children's gender variance were barriers to fully embracing their children's gender nonconformity. Unclear causes of children's social/emotional difficulties and lack of adequate resources and support were identified challenges. Positive interventions and resources were also discussed. Recommendations for clinicians and other professionals who serve TGNC youth with autism and their families are presented.
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Affiliation(s)
- Katherine A Kuvalanka
- a Department of Family Science and Social Work , Miami University , Oxford , Ohio , USA
| | - Derek J Mahan
- b Department of Family Social Science , University of Minnesota , Minneapolis , Minnesota , USA
| | - Jenifer K McGuire
- b Department of Family Social Science , University of Minnesota , Minneapolis , Minnesota , USA
| | - Tracey K Hoffman
- c Department of Education and Society , Miami University , Oxford , Ohio , USA
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Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102:3869-3903. [PMID: 28945902 DOI: 10.1210/jc.2017-01658] [Citation(s) in RCA: 1196] [Impact Index Per Article: 170.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009. PARTICIPANTS The participants include an Endocrine Society-appointed task force of nine experts, a methodologist, and a medical writer. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. CONCLUSION Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person's genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person's affirmed gender. Hormone treatment is not recommended for prepubertal gender-dysphoric/gender-incongruent persons. Those clinicians who recommend gender-affirming endocrine treatments-appropriately trained diagnosing clinicians (required), a mental health provider for adolescents (required) and mental health professional for adults (recommended)-should be knowledgeable about the diagnostic criteria and criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition. We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists. Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age. For the care of peripubertal youths and older adolescents, we recommend that an expert multidisciplinary team comprised of medical professionals and mental health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring mental health practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents. For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient. We suggest maintaining physiologic levels of gender-appropriate hormones and monitoring for known risks and complications. When high doses of sex steroids are required to suppress endogenous sex steroids and/or in advanced age, clinicians may consider surgically removing natal gonads along with reducing sex steroid treatment. Clinicians should monitor both transgender males (female to male) and transgender females (male to female) for reproductive organ cancer risk when surgical removal is incomplete. Additionally, clinicians should persistently monitor adverse effects of sex steroids. For gender-affirming surgeries in adults, the treating physician must collaborate with and confirm the criteria for treatment used by the referring physician. Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.
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Affiliation(s)
- Wylie C Hembree
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York 10032
| | | | - Louis Gooren
- VU University Medical Center, 1007 MB Amsterdam, Netherlands
| | | | - Walter J Meyer
- University of Texas Medical Branch, Galveston, Texas 77555
| | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota 55905
| | - Stephen M Rosenthal
- University of California San Francisco, Benioff Children's Hospital, San Francisco, California 94143
| | - Joshua D Safer
- Boston University School of Medicine, Boston, Massachusetts 02118
| | - Vin Tangpricha
- Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, Georgia 30322
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Abstract
PURPOSE OF REVIEW The combination of the core symptoms, characterizing individuals with autism-spectrum disorder (ASD), can lead to problems in romantic relationships and sexual functioning. The purpose of this article is to review studies on sexuality in individuals with ASD published since January 2016. RECENT FINDINGS Individuals with ASD and especially women show a higher diversity in sexual orientation in comparison with the non-ASD population. Furthermore, ASD women are more frequently in a relationship and usually report more previous sexual experiences. Up to now, sexual education programs specifically addressing the needs of the ASD population were scarce, which was criticized by patients, their parents, and caregivers. With the development of the Tackling Teenage Training program, a psychoeducational intervention designed specifically for ASD individuals was introduced, leading to significant improvements in psychosexual functioning and knowledge. Such programs are needed because a considerable rate of problematic sexual behaviors, including public masturbation and paraphilic sexual interests were found in the ASD population. SUMMARY Just like their typically developing counterparts, individuals with ASD show the whole range of normal-to-problematic sexual behaviors. Improving sexual knowledge could lead to less inappropriate sexual behaviors and could improve sexual health as part of a healthy and satisfying life.
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35
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Zucker KJ, Nabbijohn AN, Santarossa A, Wood H, Bradley SJ, Matthews J, VanderLaan DP. Intense/obsessional interests in children with gender dysphoria: a cross-validation study using the Teacher's Report Form. Child Adolesc Psychiatry Ment Health 2017; 11:51. [PMID: 29021824 PMCID: PMC5613451 DOI: 10.1186/s13034-017-0189-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/16/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE This study assessed whether children clinically referred for gender dysphoria (GD) show symptoms that overlap with Autism Spectrum Disorder (ASD). Circumscribed preoccupations/intense interests and repetitive behaviors were considered as overlapping symptoms expressed in both GD and ASD. METHODS To assess these constructs, we examined Items 9 and 66 on the Teacher's Report Form (TRF), which measure obsessions and compulsions, respectively. RESULTS For Item 9, gender-referred children (n = 386) were significantly elevated compared to the referred (n = 965) and non-referred children (n = 965) from the TRF standardization sample. For Item 66, gender-referred children were elevated in comparison to the non-referred children, but not the referred children. CONCLUSIONS These findings provided cross-validation of a previous study in which the same patterns were found using the Child Behavior Checklist (Vanderlaan et al. in J Sex Res 52:213-19, 2015). We discuss possible developmental pathways between GD and ASD, including a consideration of the principle of equifinality.
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Affiliation(s)
- Kenneth J. Zucker
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8 Canada
| | - A. Natisha Nabbijohn
- 0000 0001 2157 2938grid.17063.33Department of Psychology, University of Toronto Mississauga, Mississauga, ON Canada
| | - Alanna Santarossa
- 0000 0001 2157 2938grid.17063.33Department of Psychology, University of Toronto Mississauga, Mississauga, ON Canada
| | - Hayley Wood
- Psychological Services, Toronto District School Board, Toronto, ON Canada
| | - Susan J. Bradley
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8 Canada
| | - Joanna Matthews
- 0000 0001 2157 2938grid.17063.33Department of Psychology, University of Toronto Mississauga, Mississauga, ON Canada
| | - Doug P. VanderLaan
- 0000 0001 2157 2938grid.17063.33Department of Psychology, University of Toronto Mississauga, Mississauga, ON Canada ,0000 0000 8793 5925grid.155956.bUnderserved Populations Research Program, Child, Youth and Family Division, Centre for Addiction and Mental Health, Toronto, ON Canada
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Barkai AR. Troubling Gender or Engendering Trouble? The Problem With Gender Dysphoria in Psychoanalysis. Psychoanal Rev 2017; 104:1-32. [PMID: 28135154 DOI: 10.1521/prev.2017.104.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This paper reviews existing case reports in the psychoanalytic literature of children diagnosed with gender identity disorder (GID), now called gender dysphoria. It concentrates on a review of problems and psychoanalytic dilemmas inherent in the use of the term GID and elucidates the concurrent quandaries this term both signifies and is symptomatic of. The focus is on reports of child psychoanalyses published during or after 1991, when the American Psychoanalytic Association formally adopted a nondiscrimination policy against homosexuality. These cases reflect common problematic themes in these treatments, for example, the lack of neutrality in specifying the treatment goal of same-gender identification. This paper explores the effects of these problems on the treatments, raises questions regarding the emphasis on gender in the treatments, and discusses an alternative psychoanalytic approach to children with gender variation.
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Abstract
The current literature shows growing evidence of a link between gender dysphoria (GD) and autism spectrum disorder (ASD). This study reviews the available clinical and empirical data. A systematic search of the literature was conducted using the following databases: PubMed, Web of Science, PsycINFO and Scopus; utilizing different combinations of the following search terms: autism, autism spectrum disorder (ASD), Asperger's disorder (AD), co-morbidity, gender dysphoria (GD), gender identity disorder (GID), transgenderism and transsexualism. In total, 25 articles and reports were selected and discussed. Information was grouped by found co-occurrence rates, underlying hypotheses and implications for diagnosis and treatment. GD and ASD were found to co-occur frequently - sometimes characterized by atypical presentation of GD, which makes a correct diagnosis and determination of treatment options for GD difficult. Despite these challenges there are several case reports describing gender affirming treatment of co-occurring GD in adolescents and adults with ASD. Various underlying hypotheses for the link between GD and ASD were suggested, but almost all of them lack evidence.
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Affiliation(s)
- Anna I R Van Der Miesen
- a VU University Medical Centre, Centre of Expertise on Gender Dysphoria , Amsterdam , the Netherlands
| | - Hannah Hurley
- b Dr Leo Kannerhuis, Centre for Autism , Amsterdam , the Netherlands
| | - Annelou L C De Vries
- a VU University Medical Centre, Centre of Expertise on Gender Dysphoria , Amsterdam , the Netherlands
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Strang JF, Meagher H, Kenworthy L, de Vries ALC, Menvielle E, Leibowitz S, Janssen A, Cohen-Kettenis P, Shumer DE, Edwards-Leeper L, Pleak RR, Spack N, Karasic DH, Schreier H, Balleur A, Tishelman A, Ehrensaft D, Rodnan L, Kuschner ES, Mandel F, Caretto A, Lewis HC, Anthony LG. Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 47:105-115. [PMID: 27775428 DOI: 10.1080/15374416.2016.1228462] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD. There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements. The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment; guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/blurring of treatment and assessment.
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Affiliation(s)
- John F Strang
- a Division of Pediatric Neuropsychology , Children's National Health System
| | - Haley Meagher
- a Division of Pediatric Neuropsychology , Children's National Health System
| | - Lauren Kenworthy
- a Division of Pediatric Neuropsychology , Children's National Health System
| | | | - Edgardo Menvielle
- c Division of Psychiatry and Behavioral Sciences , Children's National Health System
| | - Scott Leibowitz
- d Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine
| | - Aron Janssen
- e Department of Child and Adolescent Psychiatry , New York University School of Medicine
| | | | - Daniel E Shumer
- g Division of Pediatric Endocrinology , University of Michigan Health System
| | | | - Richard R Pleak
- i Division of Child & Adolescent Psychiatry , Hofstra Northwell School of Medicine
| | - Norman Spack
- j Division of Endocrinology , Boston Children's Hospital
| | - Dan H Karasic
- k Department of Psychiatry , University of California San Francisco School of Medicine
| | - Herbert Schreier
- l Department of Psychiatry , University of California San Francisco-Benioff-Children's Hospital Oakland
| | - Anouk Balleur
- f Department of Medical Psychology , VU University Medical Center
| | - Amy Tishelman
- m Departments of Psychiatry , Endocrinology and Urology, Boston Children's Hospital and Harvard Medical School
| | - Diane Ehrensaft
- n Child and Adolescent Gender Center , Department of Pediatrics, University of California San Francisco Benioff Children's Hospital
| | - Leslie Rodnan
- o Division of Psychiatry and Behavioral Sciences, Children's National Health System
| | - Emily S Kuschner
- p Department of Radiology and Center for Autism Research , The Children's Hospital of Philadelphia
| | - Francie Mandel
- q Divisions of Endocrinology and Social Work , Boston Children's Hospital
| | | | - Hal C Lewis
- s Division of Psychiatry and Pediatrics , University of Colorado
| | - Laura G Anthony
- t Division of Pediatric Neuropsychology , Children's National Health System
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May T, Pang K, Williams KJ. Gender variance in children and adolescents with autism spectrum disorder from the National Database for Autism Research. Int J Transgend 2016. [DOI: 10.1080/15532739.2016.1241976] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Tamara May
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Kenneth Pang
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
- Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Katrina Jane Williams
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
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Cooney M, Kaufman M, Birken C, Dettmer E, Toulany A. Impact of Adolescent Gender Dysphoria on Treatment Uptake in an Obesity Management Program. J Pediatr 2016; 176:207-9. [PMID: 27283460 DOI: 10.1016/j.jpeds.2016.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/20/2016] [Accepted: 05/09/2016] [Indexed: 11/15/2022]
Abstract
A 13-year-old biological female patient presented with gender dysphoria while receiving treatment for obesity. Body distress and a desired masculine phenotype motivated his engagement with various therapies. We describe body image concerns in an obese adolescent with gender dysphoria to highlight the importance of assessing gender in adolescents.
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Affiliation(s)
- Megan Cooney
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - Miriam Kaufman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Catherine Birken
- University of Toronto, Toronto, Canada; Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Elizabeth Dettmer
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Alene Toulany
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
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Janssen A, Huang H, Duncan C. Gender Variance Among Youth with Autism Spectrum Disorders: A Retrospective Chart Review. Transgend Health 2016; 1:63-68. [PMID: 28861527 PMCID: PMC5367474 DOI: 10.1089/trgh.2015.0007] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose: Increasing clinical evidence suggests an overrepresentation of gender variance (GV) among patients with autism spectrum disorders (ASDs). This retrospective chart review aims to contribute to the existing literature on co-occurring ASD and gender dysphoria (GD). We compare the rate of parent-reported GV in patients with an ASD diagnosis to that of parent-reported GV in a normative nonreferred data set. Methods: Child Behavior Checklist (CBCL) charts were collected from 492 children and adolescents (409 natal males and 83 natal females) aged 6-18 years who have received a diagnosis of ASD at the New York University Child Study Center. Parent-reported GV was determined through endorsement of CBCL sex item 110, which assesses the presence of gender-related issues. We calculated the odds ratio of endorsement of item 110 between our ASD sample and the CBCL sample data. Results: The subjects diagnosed with ASD were 7.76 times more likely to report GV than the CBCL sample. This finding was statistically significant. About 5.1% of the patients in the ASD group and 0.7% of the CBCL nonreferred group endorsed sex item 110. 5.1% of natal males and 4.8% of natal females endorsed sex item 110. Neither gender nor age influenced the rate of endorsement. Conclusion: This finding supports the growing research suggesting a heightened co-occurrence rate of ASD and GD. Focus should be placed upon improving our understanding of the nature of this co-occurrence and on gender identity development within the atypical development of ASD.
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Glidden D, Bouman WP, Jones BA, Arcelus J. Gender Dysphoria and Autism Spectrum Disorder: A Systematic Review of the Literature. Sex Med Rev 2016; 4:3-14. [DOI: 10.1016/j.sxmr.2015.10.003] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/01/2015] [Indexed: 11/25/2022]
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Lai MC, Baron-Cohen S. Identifying the lost generation of adults with autism spectrum conditions. Lancet Psychiatry 2015; 2:1013-27. [PMID: 26544750 DOI: 10.1016/s2215-0366(15)00277-1] [Citation(s) in RCA: 337] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/06/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
Autism spectrum conditions comprise a set of early-onset neurodevelopmental syndromes with a prevalence of 1% across all ages. First diagnosis in adulthood has finally become recognised as an important clinical issue due to the increasing awareness of autism, broadening of diagnostic criteria, and the introduction of the spectrum concept. Thus, the idea of a lost generation of people who were previously excluded from a diagnosis of classic autism has arisen. Making a first diagnosis of autism spectrum conditions in adults can be challenging for practical reasons (eg, no person to provide a developmental history), developmental reasons (eg, the acquisition of learnt or camouflaging strategies), and clinical reasons (eg, high frequency of co-occurring disorders). The diagnostic process includes referral, screening, interviews with informants and patients, and functional assessments. In delineating differential diagnoses, true comorbidities, and overlapping behaviour with other psychiatric diagnoses, particular attention should be paid to anxiety, depression, obsessive-compulsive disorder, psychosis, personality disorders, and other neurodevelopmental disorders. Possible misdiagnosis, especially in women, should be explored. The creation of supportive, accepting, and autism-friendly social and physical environments is important and requires a coordinated effort across agencies and needs support from government policies.
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Affiliation(s)
- Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Centre for Addiction and Mental Health, The Hospital for Sick Children, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Abstract
PURPOSE OF REVIEW With the advent of medical treatments such as puberty suppression and cross-sex hormones in gender dysphoric minors, there has been a debate around questions of gender identity and brain development. This review aimed to identify recent empirical studies that addressed this controversial topic. RECENT FINDINGS Epidemiological data from several countries indicate that gender dysphoria in children and adolescents is far more common than initially anticipated. This is in line with the currently observed steady increase in referrals to gender clinics. Minors with gender dysphoria are a vulnerable population as they may face a high psychopathological burden. Recently published data on the long-term outcome of puberty suppression and subsequent hormonal and surgical treatment indicate that young people with gender dysphoria may benefit substantially with regard to psychosocial outcomes. Brain development studied by neuroimaging methods seems not to be disturbed by puberty suppression. SUMMARY The first reports about long-term outcome in adolescents having undergone puberty suppression have shown promising results. However, in a substantial part of gender dysphoric minors, puberty suppression is not indicated so far because of psychiatric comorbidity and long-term follow-up data from these patients are still scarce.
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