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Tollit MA, Maloof T, Hoq M, Haebich K, Pace CC, Rodriguez ZM, Sial M, Payne JM, Pang K. A comparison of gender diversity in transgender young people with and without autistic traits from the Trans 20 cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 47:101084. [PMID: 38799613 PMCID: PMC11127512 DOI: 10.1016/j.lanwpc.2024.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/29/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
Background There is an elevated co-occurrence of autism in trans individuals, with recent meta-analyses suggesting that 11% of trans individuals are autistic. The presence of autism in trans young people can create clinical challenges by adding complexity to the presentation, assessment and management of those presenting to gender clinics. Although many trans young people display traits of autism, how these traits relate to the nature of their gender diversity is unclear. Methods This study compared gender identity, gender expression and gender dysphoria (GD) in trans young people with and without autistic traits. Baseline data from a cohort study of trans children and adolescents who first attended the Royal Children's Hospital Gender Service (Victoria, Australia) between February 2017 and January 2020 were analysed cross-sectionally. Autistic traits were assessed via the Social Responsiveness Scale-2. Gender was assessed using tools that measure gender identity, social transition, GD, body dissatisfaction, voice dysphoria, and chest dysphoria. Findings 522 participants were included, of whom 239 (45.8%) exhibited autistic traits (SRS total T-score ≥60). Those with and without autistic traits were similar in their age (mean (SD) age 14.0 (2.9) and 13.1 (3.6) years respectively) and gender identity: the majority (73.7% (n = 174) and 70.5% (n = 198) respectively) identified in a binary way. Higher rates of social transition (specifically, changing pronouns) were noted in those with autistic traits (Difference in proportion 11.7, 95% confidence interval [CI] 2.4-21.1, p = 0.014). GD was high in both groups with ∼95% displaying clinically relevant levels of GD. Chest dysphoria was similar between groups, while voice dysphoria was higher in those with autistic traits (standardised mean difference [SMD] = 0.3, 95% confidence interval [CI]: 0.1-0.5 p = 0.00087). Dissatisfaction with secondary gendered characteristics (SMD = 0.3, CI: 0.1-0.5 p = 0.0011) and hormonally unresponsive body characteristics (SMD = 0.2, CI: 0.1-0.4 p = 0.016) was higher in trans young people with autistic traits. Interpretation The similarly high severity of GD in those with and without autistic traits reinforces the importance of trans young people with and without autistic traits being availed the same opportunities to access gender-affirming care. Subtle differences identified between the groups in other areas of gender diversity suggest trans young people with autistic traits may have distinct needs and that gender-affirming care may need to be tailored accordingly. Funding The Royal Children's Hospital Foundation, Hugh D.T. Williamson Foundation; Australian National Health and Medical Research Council-Clinical Trials and Cohort Studies scheme (GNT 2006529).
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Affiliation(s)
- Michelle A. Tollit
- Murdoch Children's Research Institute, The Royal Children's Hospital, Department of Paediatrics, The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Tiba Maloof
- The Royal Children's Hospital, The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Monsurul Hoq
- Murdoch Children's Research Institute, The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Kristina Haebich
- Murdoch Children's Research Institute, Department of Paediatrics, The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Carmen C. Pace
- The Royal Children's Hospital, Murdoch Children's Research Institute, The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | | | - Muhammad Sial
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Jonathan M. Payne
- The Royal Children's Hospital, Murdoch Children's Research Institute, Department of Paediatrics, The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Ken Pang
- The Royal Children's Hospital, Murdoch Children's Research Institute, The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
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Mittertreiner EJ, Ng-Cordell E, McVey AJ, Kerns CM. Research methods at the intersection of gender diversity and autism: A scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241245595. [PMID: 38661070 DOI: 10.1177/13623613241245595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
LAY ABSTRACT Research has increasingly focused on the intersection between gender diversity and autism. To better understand this literature, this scoping review systematically searched five databases for peer-reviewed literature on gender diversity and autism published between 2018 and 2023. Included studies (N = 84) were of English language, featured original qualitative or quantitative findings, and examined a psychosocial connection between autism and gender spectra variables. Most studies focused on measuring prevalence of autism among gender-diverse individuals. While the overall study rigor was acceptable, weaknesses in measurement, sample selection, and definition of key terms were noted. Promisingly, studies in this area appear to be shifting away from a pathologizing lens and towards research methods that engage in meaningful collaboration with the autistic, gender-diverse community to investigate how to best enhance the quality of life and wellbeing of this population.
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Affiliation(s)
| | | | - Alana J McVey
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Autism Center, Seattle Children's Hospital, Seattle, WA, United States
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Parenteau CI, Lampinen LA, Ghods SS, Taylor JL, Adams RE, Bishop SL, Zheng S. Self-reported Everyday Sources of Happiness and Unhappiness in Autistic Adults. J Autism Dev Disord 2024; 54:1538-1548. [PMID: 36689096 PMCID: PMC9869319 DOI: 10.1007/s10803-023-05892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Daily mood can be influenced by a range of experiences. Identifying everyday life experiences that make autistic adults happy and unhappy holds potential to foster positive mood and tackle mental health problems amongst this group. METHODS A total of 293 autistic adults between the ages of 18 to 35 years old (mean age of 26.51 years old (SD = 4.62); 43.3% female gender, 4.8% nonbinary) provided open-text responses regarding everyday sources of happiness and unhappiness. Using an iterative process of inductive coding, 14 happy themes and 22 unhappy themes of mood-changing life experiences were identified based on self-report qualitative data. RESULTS Common themes across the happy and unhappy domain involved social partners, social interactions, and engagement in recreational and employment activities, with additional distinct themes specific to happy or unhappy mood. Top themes identified in the happy domain emphasizes encouraging quality relationships and positive interactions with others and cultivating supportive work/societal environments to build a sense of achievement and value. Meanwhile, emotional tolls accompanied negative relationships and interactions, underscoring the necessity to provide autistic adults with conflict resolution and coping skills to increase feelings of happiness. CONCLUSION Overall, the wide range of sources of happy and unhappy everyday experiences highlights the importance of considering personal preferences in engagement with others and activities in treatment.
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Affiliation(s)
- China I Parenteau
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA.
| | - Linnea A Lampinen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | - Sheila S Ghods
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | | | - Ryan E Adams
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Somer L Bishop
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | - Shuting Zheng
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
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Shimoyama S, Endo T. Revisiting the Link: A qualitative analysis of the diverse experiences of gender dysphoria as a subset of pervasive social dysphoria co-occurring with autism in Japan. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241235722. [PMID: 38465656 DOI: 10.1177/13623613241235722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
LAY ABSTRACT Studies have suggested that autistic people are more likely to experience gender dysphoria, which refers to the gender-related distress emerging from personal factors and gender norms that some transgender people experience. Transgender people are diverse; some experience gender incongruence (i.e. an incompatibility between a person's gender identity and that expected of them based on their birth-assigned gender), whereas others do not. Therefore, the association of autistic transgender people's gender dysphoria with gender incongruence varies, and the literature has overlooked such diversity. Interviews with 15 Japanese autistic transgender adults revealed diverse gender dysphoria experiences independent of gender incongruence, such as resistance to the societal gender norms themselves, physical dysphoria caused by the imposition of gender, sensory disgust related to autistic sensory sensitivities, uncertainty about the gender norms of the social majority, and the autistic burden of living in a gendered society. Moreover, we found that most participants had not only accumulated distress over gender norms (i.e. gender dysphoria) but also over pervasive social norms, termed Pervasive Social Dysphoria. Our findings suggests that future co-occurrence research and practice must affirm these internal perspectives more, such as by providing support for both gender dysphoria and Pervasive Social Dysphoria, as autistic transgender people may experience gender dysphoria as a subset of Pervasive Social Dysphoria.
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Polidori L, Sarli G, Berardelli I, Pompili M, Baldessarini RJ. Risk of suicide attempt with gender diversity and neurodiversity. Psychiatry Res 2024; 333:115632. [PMID: 38320410 DOI: 10.1016/j.psychres.2023.115632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/25/2023] [Accepted: 11/25/2023] [Indexed: 02/08/2024]
Abstract
There is growing concern about psychiatric illness co-occurring with gender-diversity and neurodiversity, including risk of suicidal behavior. We carried out systematic reviews of research literature pertaining to suicide attempt rates in association with gender- and neurodiversity, with meta-analysis of findings. Rates of suicidal acts ranked: gender-diverse versus controls (20.1% vs. 1.90%; highly significant) > autism spectrum disorder (4.51% vs. 1.00%; highly significant) > attention deficit-hyperactivity disorder (7.52% vs. 4.09%; not significant). Attempt rates also were greater among controls who included sexual minorities (5.35% vs. 1.41%). The rate among male-to-female transgender subjects (29.1%) was slightly lower than in female-to-male subjects (30.7%), who also were encountered 24.3% more often. In sum, suicidal risk was much greater with gender-diversity than neurodiversity. Suicide attempts rate was somewhat greater among female-to-male transgender subjects. Available information was insufficient to test whether suicidal risk would be even greater among persons with both gender- and neurodiversity.
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Affiliation(s)
- Lorenzo Polidori
- Psychiatry Residency Training Program, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Giuseppe Sarli
- Psychiatry Residency Training Program, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; International Consortium for Mood & Psychotic Disorder Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorder Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Ghiasi Z, Khazaei F, Khosravi M, Rezaee N. Physical and psychosocial challenges of people with gender dysphoria: a content analysis study. BMC Public Health 2024; 24:16. [PMID: 38166956 PMCID: PMC10759397 DOI: 10.1186/s12889-023-17537-z] [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] [Received: 02/20/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The mismatch between the gender experienced by a person and the gender attributed to him/her leads to gender dysphoria. It seems that people's perception of gender dysphoria is affected by individual, cultural, and sociological factors and these factors affect different aspects of their biological, psychological, and social health. To this end, this qualitative study aimed to identify the physical, psychological, and social challenges of people with gender dysphoria referring to the Department of forensic medicine in Iran. METHODS This qualitative study was conducted using conventional content analysis on 9 individuals who were selected through purposive sampling. A total of 16 interviews were conducted with 9 participants. Each interview lasted 60-90 min. The participants' gender dysphoria was confirmed by the Department of forensic medicine. The data were collected through face-to-face semi-structured interviews with the participants. RESULTS The data revealed 3 main categories and 10 subcategories. The main categories were living in agony, confusion, and social concerns. The subcategories were annoying physical characteristics, mental suffering, disturbing sexual changes, concerns about public reaction, helplessness, surrender, the final solution, retreating to isolation, stressful family conditions, and lack of public recognition. CONCLUSION The findings showed that people with gender dysphoria suffer from some problems including living in agony, confusion, and social concerns. Each of these problems is associated with several challenges. It seems that most of the challenges faced by people with gender dysphoria are caused by unawareness of their conditions by the family and the public, which in turn is caused by the failure of related organizations and experts in this field to provide adequate information about the conditions of these people. Thus, the findings of the present study can have some implications for resolving the challenges faced by people with gender dysphoria.
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Affiliation(s)
- Zahra Ghiasi
- School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Mohsen Khosravi
- Department of Psychiatry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Nasrin Rezaee
- Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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Layton H, Tremayne P, Norton W. Supporting transgender patients with their personal hygiene. Nurs Stand 2023; 38:29-34. [PMID: 37599637 DOI: 10.7748/ns.2023.e12110] [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: 02/23/2023] [Indexed: 08/22/2023]
Abstract
Attending to one's personal hygiene is a private and ritualistic act that is linked to self-expression and is important for one's well-being and self-esteem. Providing effective support with personal hygiene to patients can demonstrate thoughtfulness and sensitivity to their individual needs. Nurses in all fields of nursing may encounter patients who identify as transgender, but many nurses have expressed concerns about their lack of knowledge and confidence in that area of care. This article discusses the use of gender-affirming language and the factors to consider when supporting transgender patients with their personal hygiene as part of personalised, equitable and inclusive nursing care.
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Affiliation(s)
- Helen Layton
- The Leicester School of Nursing and Midwifery, De Montfort University Leicester, Leicester, England
| | - Penny Tremayne
- The Leicester School of Nursing and Midwifery, De Montfort University Leicester, Leicester, England
| | - Wendy Norton
- Faculty of Health and Life Sciences, De Montfort University Leicester, Leicester, England
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Brickhill R, Atherton G, Piovesan A, Cross L. Autism, thy name is man: Exploring implicit and explicit gender bias in autism perceptions. PLoS One 2023; 18:e0284013. [PMID: 37611041 PMCID: PMC10446214 DOI: 10.1371/journal.pone.0284013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/18/2023] [Indexed: 08/25/2023] Open
Abstract
Males are around three times more likely to possess an autism diagnosis than females. For years this was explained by accounts that considered the male gender more compatible with the autistic phenotype. However, new research suggests that a lack of understanding and recognition of the female autistic phenotype, and a predisposition to associate males with autistic traits, could lead to structural inequalities that hinder the identification of autistic females. To explore how autism and gender are more widely perceived, the present study tested implicit and explicit associations between autism and binary gender using the Implicit Association Test (IAT) and the Autism Quotient (AQ) presented alongside a male or female vignette. A significant association was found on the IAT, identifying an implicit bias towards males and autistic traits. The vignette AQ pairing also revealed some specific items perceived as explicitly male traits, while only reverse-scored items were perceived as female. These findings suggest that current perceptions and even metrics of autism are skewed towards males, which may hinder the identification and understanding of the female autistic phenotype.
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Affiliation(s)
- Rae Brickhill
- Department of Psychology, Edge Hill University, Liverpool, United Kingdom
| | - Gray Atherton
- Department of Psychology, Edge Hill University, Liverpool, United Kingdom
| | - Andrea Piovesan
- Department of Psychology, Edge Hill University, Liverpool, United Kingdom
| | - Liam Cross
- Department of Psychology, Edge Hill University, Liverpool, United Kingdom
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McAuliffe C, Walsh RJ, Cage E. " My whole life has been a process of finding labels that fit": A Thematic Analysis of Autistic LGBTQIA+ Identity and Inclusion in the LGBTQIA+ Community. AUTISM IN ADULTHOOD 2023; 5:127-138. [PMID: 37346993 PMCID: PMC10280209 DOI: 10.1089/aut.2021.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Being nonheterosexual and noncisgender appears to be more common among autistic people. This intersection of identities is often stigmatized in research and society. However, we know that community involvement can protect against negative mental health outcomes associated with being a minority; researchers found this effect in separate studies examining participation in the autistic and Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual plus other gender and sexual orientation-based identity (LGBTQIA+) communities. This study examined how autistic LGBTQIA+ individuals navigate their multiple marginalized identities and the LGBTQIA+ community. Methods Twelve autistic LGBTQIA+ people from the United Kingdom took part in semistructured interviews. Questions focused on identity and community. We analyzed the interviews using reflexive thematic analysis. Results We identified four overarching themes-Identity (Re)Development, Navigating Authenticity, Exclusion from Community Spaces, and Creating Change. Participants viewed accessing a community of similar others as a means of increasing understanding, self-knowledge, and self-acceptance. We identified several barriers to inclusion, including accessibility and gatekeeping. Participants discussed strategies to combat these obstacles, such as the creation of intersectional community spaces and activism and representation as a means of increasing autism understanding. Conclusions This study suggests that similar to other marginalized groups, autistic LGBTQIA+ individuals are motivated to engage in communities relevant to their identities. However, community spaces for autistic LGBTQIA+ are often inaccessible due to social, sensory, and identity-based barriers. Participants highlighted autism understanding as a barrier to coming out both in community and noncommunity settings. This suggests that improving autism acceptance and understanding is crucial to achieve accessible, intersectional, and inclusive community spaces.
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Affiliation(s)
| | - Reubs J. Walsh
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Centre for Applied Transgender Studies, Chicago, Illinois, USA
| | - Eilidh Cage
- Department of Psychology, University of Stirling, Stirling, Scotland
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Bruce H, Munday K, Kapp SK. Exploring the Experiences of Autistic Transgender and Non-Binary Adults in Seeking Gender Identity Health Care. AUTISM IN ADULTHOOD 2023; 5:191-203. [PMID: 37346990 PMCID: PMC10280216 DOI: 10.1089/aut.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background This study sought to obtain an in-depth understanding of autistic transgender and/or non-binary adults' experiences in accessing, or trying to access, gender identity health care (GIH). To our knowledge, no prior study researched this topic. Methods Through semi-structured interviews, we obtained the first-hand experiences of 17 participants. H.B. (cisgender, non-autistic) conducted a reflexive thematic analysis using an inductive approach, in collaboration with K.M., an autistic transgender disability community researcher, and under the supervision of S.K.K., a cisgender autistic autism researcher. Results Thematic analysis determined that poor knowledge of professionals, accessibility issues, and bureaucratic and economic barriers impacted participants' experiences when accessing GIH. Participants experienced a perceived lack of professional knowledge around autism and gender diverse health care needs, limited communication methods and accommodations, and misdiagnosis of mental health difficulties. Accessibility issues included unmet sensory needs, disruption to routine, and a lack of local provision. Further, participants shared that they struggled with unclear processes, standardization of care, long waiting lists, and confusing or inaccessible insurance coverage. Recommendations for improvements highlighted the need to listen to service users to positively impact their experiences in accessing GIH. Conclusion This study suggests that more training needs to be given to health care providers and professionals around autistic experience to help improve providers' competence in communication and providing person-centered accommodations. More training around gender diverse identities is needed, as well as increased knowledge on the co-occurrence of autism and transgender/non-binary identities, to positively impact patient experiences and help improve access to care.
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Affiliation(s)
- Harley Bruce
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Katie Munday
- Department of Education and Sociology, University of Portsmouth, Portsmouth, United Kingdom
| | - Steven K. Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
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Bouzy J, Brunelle J, Cohen D, Condat A. Transidentities and autism spectrum disorder: A systematic review. Psychiatry Res 2023; 323:115176. [PMID: 36996732 DOI: 10.1016/j.psychres.2023.115176] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
Transidentity and autism frequently co-occur. Previous reviews have focused mainly on frequencies. Here, we conducted a systematic review to condense all the studies and themes on this co-occurrence and to offer a global view. We followed the PRISMA method and selected 77 articles (including 59 clinical studies) in April 2022. We found 5 main themes (sex ratio, theories, sexual orientation, clinical and social consequences, and care implications) in addition to frequencies. Many theories have been proposed to explain the co-occurrence. One posits that social difficulties related to autism would lead to less identification with gender norms and less pressure to conform to these norms, allowing for greater gender diversity in people with autism. Given their difficulties with social interactions and communication, the announcement of one's transidentity to one's social group is often discredited, increasing the risk of suffering and delayed care. Many reports reaffirm the importance of providing specialised care for transgender people with autism. Autism is not a contraindication for gender-affirming treatment. However, some cognitive specificities can affect the planning of care, and transgender people with autism are at high risk of discrimination and harassment. We conclude that there is a need to raise awareness about gender and autism.
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Affiliation(s)
- Juliette Bouzy
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Julie Brunelle
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France.
| | - Agnès Condat
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; UR14 "Santé et droits sexuels et reproductifs", Ined, Paris, France
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Cooper K, Mandy W, Butler C, Russell A. Phenomenology of gender dysphoria in autism: a multiperspective qualitative analysis. J Child Psychol Psychiatry 2023; 64:265-276. [PMID: 36089890 PMCID: PMC10087378 DOI: 10.1111/jcpp.13691] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Autistic people are overrepresented in gender clinic settings, but limited evidence is available to guide clinical decision making for this patient group. We aimed to generate a comprehensive understanding of the phenomenology of gender dysphoria in autistic people. METHODS We conducted a multi-perspectival interpretative phenomenological analysis (IPA), from five different perspectives; autistic young people and adults with experience of gender dysphoria, parents of young people, and clinicians working with autistic people with gender dysphoria in both adult and young person settings (n = 68). RESULTS IPA analysis resulted in two themes, 'discovering gender identity' and 'the complexities of moving towards gender comfort'. Participants agreed that there was often an interaction between gender dysphoria and features of autism such as sensory sensitivities. There was relative consensus across groups about the need for autism adaptations to be made in gender clinics. Autistic adults were more likely to see autism as an important identity than young people, but both groups were clear that autism did not impair their understanding of gender. In contrast, some parents and clinicians working with young people expressed concern that autism did impact self-understanding. DISCUSSION While the groups tended to agree on the ways in which particular features of autism can compound gender dysphoria, there were a range of perspectives on the ways in which autism impacted on self-knowledge. CONCLUSION Recommendations for adaptations when working with autistic people with gender dysphoria are presented.
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Affiliation(s)
- Kate Cooper
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, UK
| | - William Mandy
- Research Department of Clinical, Educational, and Health Psychology, London, UK
| | | | - Ailsa Russell
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, UK
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Cooper K, Mandy W, Russell A, Butler C. Healthcare clinician perspectives on the intersection of autism and gender dysphoria. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:31-42. [PMID: 35285287 PMCID: PMC9806459 DOI: 10.1177/13623613221080315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
LAY ABSTRACT Autistic people are more likely to have a gender identity which does not match their sex assigned at birth. Some people experience distress about their sex and gender not matching, which is called gender dysphoria. Such individuals may wish to attend a gender clinic to access healthcare support for gender dysphoria. Currently, there is limited evidence to help clinicians best support autistic people who need healthcare for gender dysphoria. We wanted to find out what healthcare clinicians think about working with autistic patients with gender dysphoria. We interviewed 16 clinicians who work in healthcare services with adults and young people who are autistic and experience gender dysphoria. We recorded the interviews and carefully analysed the content to find key themes. We found that clinicians worked with patients to try and better understand their experiences of gender dysphoria. Clinicians identified features of autism that they believed were related to gender identity and dysphoria including different thinking styles, social differences, and sensory sensitivities. Clinicians noticed that autistic people spoke about their gender in different ways to non-autistic people. Clinicians tried to adapt their practice to better meet the needs of their autistic patients. These adaptations tended to focus on differences in the assessment process, for example, offering longer or shorter appointments and changing their communication style. We conclude that clinicians were offering an individualised approach to autistic patients experiencing gender dysphoria. However, these clinicians were particularly interested in working with autistic people, and so may not be representative of the wider clinician population. Clinicians working in this area should receive training on autism adaptations and the intersection of autism and gender dysphoria.
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Affiliation(s)
- Kate Cooper
- University of Bath, UK,Kate Cooper, Department of Psychology,
Centre for Applied Autism Research, University of Bath, Claverton Down, Bath BA2
7AY, UK.
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14
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Verbeek W, Baici W, MacKinnon KR, Zaheer J, Lam JSH. "Mental Readiness" and Gatekeeping in Trans Healthcare. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:828-830. [PMID: 35603661 PMCID: PMC9561692 DOI: 10.1177/07067437221102725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gatekeeping refers to clinicians' strict application of eligibility criteria to determine a trans patient's "fitness" to engage in medical transition, resulting in significant barriers to gender-affirming care. Gatekeeping often uses "mental readiness" as a prerequisite to medical transition, which contributes to patient distress and systemic discrimination. Changing international trans health guidelines (the new World Professional Association for Transgender Health Standards of Care version 8) recommends clinicians shift from a gatekeeping model towards an informed consent model, which improves access to care. This commentary offers recommendations on how clinicians can reconsider existing "mental readiness" frameworks around medical transition to facilitate improved access to care.
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Affiliation(s)
| | - Wayne Baici
- 7938University of Toronto, Toronto, Ontario, Canada.,7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Juveria Zaheer
- 7938University of Toronto, Toronto, Ontario, Canada.,7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - June Sing Hong Lam
- 7938University of Toronto, Toronto, Ontario, Canada.,7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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15
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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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16
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Goetz TG, Adams N. The Transgender and Gender Diverse and Attention Deficit Hyperactivity Disorder Nexus: A Systematic Review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022; 28:2-19. [PMID: 38577478 PMCID: PMC10989732 DOI: 10.1080/19359705.2022.2109119] [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: 03/14/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
Introduction Prior work suggests an increased prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among transgender and/or gender diverse (TGD) individuals. This systematic review summarizes primary literature on TGD/ADHD experience. Methods Texts from databases, reference lists, and referral were screened per PRISMA guidelines, with author consensus. Results Since 2014, 17 articles have been published on the TGD/ADHD nexus. Gender-affirming care specialists authored 65%. 71% reported prevalence, per medical records. Only case reports discussed implications. None avoided deficit-framing, nor included explicit TGD/ADHD authorship. Conclusions The paucity of literature and lack of explicit TGD/ADHD community involvement are striking; each warrants increased attention.
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Affiliation(s)
- Teddy G Goetz
- University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Noah Adams
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
- Center for Applied Transgender Studies, Chicago, IL USA
- Transgender Professional Association for Transgender Health
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17
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Hendriks O, Wei Y, Warrier V, Richards G. Autistic Traits, Empathizing-Systemizing, and Gender Diversity. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2077-2089. [PMID: 35467170 PMCID: PMC9192400 DOI: 10.1007/s10508-021-02251-x] [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] [Received: 05/17/2020] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 05/27/2023]
Abstract
Previous research indicates a link between autism and transgender and gender-diverse identities, though the association is not yet fully understood. The current study examined autistic traits (Autism Spectrum Quotient [AQ]), empathizing (Empathizing Quotient-Short [EQ-S]), and systemizing (Systemizing Quotient-Short [SQ-S]) in a sample of 89 adults and aimed to test whether gender-diverse individuals exhibit cognitive profiles consistent with predictions derived from the Extreme Male Brain (EMB) theory. As most research has considered only cisgender people, we recruited a more diverse sample by contacting > 200 UK LGBTQ+ organizations and posting on social media. A range of non-cisgender identities (e.g., transgender male, transgender female, non-binary, genderqueer, transmasculine) and non-heterosexual orientations (e.g., bisexual) were represented, and participants were categorized into one of four groups: (1) assigned female at birth but does not identify as female (transgender AFAB) (n = 32), (2) cisgender female (n = 21), (3) assigned male at birth but does not identify as male (transgender AMAB) (n = 18), and (4) cisgender male (n = 18). After controlling for age and autism diagnostic status, transgender AFAB participants had marginally higher AQ scores, and significantly higher SQ-S and systemizing-relative-to-empathizing (D) scores, compared with the cisgender female group. No such differences were detected between the transgender AMAB and cisgender male groups. Our findings are broadly in line with predictions derived from the EMB theory, though as no transgender AFAB participants reported being heterosexual, it was not possible to determine whether these effects relate specifically to gender identity, to sexual orientation, or to both.
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Affiliation(s)
- Olivia Hendriks
- School of Psychology, Faculty of Medical Sciences, Newcastle University, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK
| | - Yimeng Wei
- School of Psychology, Faculty of Medical Sciences, Newcastle University, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK
| | - Varun Warrier
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, UK
| | - Gareth Richards
- School of Psychology, Faculty of Medical Sciences, Newcastle University, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, UK.
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18
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Moore I, Morgan G, Welham A, Russell G. The intersection of autism and gender in the negotiation of identity: A systematic review and metasynthesis. FEMINISM & PSYCHOLOGY 2022. [DOI: 10.1177/09593535221074806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Influenced by theories of intersectionality, performativity and gender hegemony, this review sought to explore the intersection of autism and gender in qualitative research into autistic identity. Twelve papers were subjected to a thematic metasynthesis following a systematic search. Study participants were predominantly cisgender female or gender-diverse: perspectives of cisgender autistic males were lacking. The three superordinate themes developed related to: (1) the ways in which autism discourses restricted gender identities, through the influence of the “extreme male brain” and “masking” narratives and the use of autism to explain gender non-conformity and gender diversity; (2) the ways in which gendered autistic identities were positioned within social power hierarchies as “othered”, subordinate and less acceptable ways of being; and (3) possibilities for finding spaces of belonging and resistance. While autism as an identity may offer community and freedom from normative expectations, dominant autism discourses act to restrict and police gender, reinforcing existing power hierarchies. We encourage practitioners to reflect on the clinical, ethical and political implications of their positioning in relation to the constructs of “autism” and “gender”, and to explore alongside people seeking support the personal and political impacts of gendered autism discourses.
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Affiliation(s)
- Isobel Moore
- Leicestershire Partnership NHS Trust, UK
- University of Leicester, UK
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19
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Cooper K, Mandy W, Butler C, Russell A. The lived experience of gender dysphoria in autistic adults: An interpretative phenomenological analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:963-974. [PMID: 34376079 PMCID: PMC9014767 DOI: 10.1177/13623613211039113] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Autistic people are more likely to be transgender, which means having a gender
identity different to one’s sex assigned at birth. Some transgender people
experience distress about this incongruence or gender dysphoria. Few studies
have aimed to understand the inner experiences of this group. In this study, we
used Interpretive Phenomenological Analysis to understand the lived experience
of gender dysphoria. Twenty-one autistic adults were interviewed about their
experience of incongruence between their gender identity and sex assigned at
birth, and any associated distress. The interviews were transcribed and analysed
using Interpretive Phenomenological Analysis. Participants described significant
distress because their bodies did not match their gender identities, their need
to understand their identities more broadly and to manage complex intersecting
needs. Participants experienced distress due to living in a world which is not
always accepting of gender- and neuro-diversity. Participants described barriers
in accessing healthcare for their gender needs. Some participants felt being
autistic had facilitated their understanding of their gender identity. Other
participants described challenges such as a tension between their need to
undergo a physical gender transition versus a need for sameness and routine. In
conclusion, there can be both positive experiences and additional challenges for
autistic transgender people.
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20
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Rosendale N, Wong JO, Flatt JD, Whitaker E. Sexual and Gender Minority Health in Neurology: A Scoping Review. JAMA Neurol 2021; 78:747-754. [PMID: 33616625 DOI: 10.1001/jamaneurol.2020.5536] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Little is known about the neurologic health needs of sexual and gender minority (SGM) individuals, and existing research indicates health care disparities for this group. Objective To describe the current state of science in SGM neurology and highlight areas of knowledge and gaps to guide future research. Evidence Review All articles published before April 12, 2020, in PubMed, Embase, Web of Science, PsycInfo, CINAHL, and BIOSIS Previews were searched using a search string encompassing SGM descriptors and neurologic disorders. A total of 8359 items were found and entered into EndNote, and 2921 duplicates were removed. A blind title and abstract review was performed followed by full-text review in duplicate, with conflicts settled through consensus, to identify 348 articles eligible for data abstraction. Articles presenting primary data about an identified adult SGM population addressing a clinical neurology topic were included. Descriptive statistics were used for abstracted variables. Findings Of 348 studies, 205 (58.9%) were case reports or series, 252 (72.4%) included sexual minority cisgender men, and 247 (70.9%) focused on HIV. An association was found between autism spectrum disorder and gender dysphoria in 9 of 16 studies (56.3%), and a higher risk of ischemic stroke in transgender women was shown in other studies. Literature in neuroinfectious disease, the most common topic, largely focused on HIV (173 of 200 studies [86.5%]). Findings in other neurologic topics were limited by lack of data. Conclusions and Relevance In this rigorous compendium of SGM neurology literature, several deficiencies were found: most studies focused on a limited breadth of neurologic pathology, included only a portion of the overall SGM community, and did not assess other aspects of sociodemographic diversity that may contribute to disparities in health care access and outcomes among SGM individuals. Expanding neurologic research to include broader representation of SGM individuals and incorporating sociodemographic factors, like race/ethnicity and socioeconomic status, are essential steps toward providing equitable neurologic care for this community.
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Affiliation(s)
- Nicole Rosendale
- Department of Neurology, University of California, San Francisco Medical Center, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco
| | | | - Jason D Flatt
- School of Public Health, University of Nevada, Las Vegas
| | - Evans Whitaker
- Health Science Library, University of California, San Francisco
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21
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Experiences of LGBTIQA+ People with Disability in Healthcare and Community Services: Towards Embracing Multiple Identities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218080. [PMID: 33147846 PMCID: PMC7662209 DOI: 10.3390/ijerph17218080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022]
Abstract
Healthcare and disability support services are increasing their efforts towards inclusion and recognising the needs of different groups. This research project was conducted by academic and peer researchers (LGBTIQA+ people with disability) in Victoria, Australia using four focus groups with LGBTIQA+ people with disability. We report on two overarching themes relating to participants’ experiences of accessing health services as LGBTIQA+ people with disability: difficulties in managing multiple identities and the impacts of community services and supports. Participants described having to repeatedly ‘come out’ in a range of ways and contexts as complex and layered processes in which it was difficult to present their full range of needs and experiences to services. We also found that the role of community in promoting a sense of belonging and resilience increased capacity to manage health service use and advocacy. Services and communities aiming to be inclusive to all have the opportunity to recognise and respond to the issues faced by LGBTIQA+ people with disability as a way to pay attention to how overt and subtle practices of discrimination continue to operate despite repeated attempts at or claims of being ‘inclusive.’ Our research suggests actual inclusive, accessible services can be achieved in part through policy and practice that actively responds to the specific needs of LGBTIQA+ people with disability, in addition to LGBTIQA+ education for disability services and disability and accessibility education for LGBTIQA+ focused services. As we do in this article, we argue that this work must be done by prioritising authentic participation of LGBTIQA+ people with disability in the services and research that is about them.
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22
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Quality Control: A Congratulatory Critique. J Autism Dev Disord 2020; 51:3014-3015. [PMID: 33040270 DOI: 10.1007/s10803-020-04745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
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