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Schoondermark F, Spek A, Kiep M. Evaluating an Autistic Burnout Measurement in Women. J Autism Dev Disord 2024:10.1007/s10803-024-06438-8. [PMID: 38916695 DOI: 10.1007/s10803-024-06438-8] [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: 06/08/2024] [Indexed: 06/26/2024]
Abstract
This study evaluated the suitability of an unpublished autistic burnout assessment tool, focusing on autistic women. Distinguishing autistic burnout from conditions like depression or anxiety is crucial for effective interventions, emphasizing the need for nuanced research and refined measures in understanding and addressing autistic burnout. The Dutch version of the AASPIRE Autistic Burnout Measure (AABM-NL) was evaluated within a sample of 45 autistic women from the Autism Expertise Center. Preliminary findings of the AABM-NL scores demonstrated promising evidence of good internal consistency and convergent validity. Positive associations were observed between AABM-NL scores and a Likert scale assessing identification with autistic burnout, as well as with an instrument measuring physical and psychological complaints (SCL-90-R; Symptom Checklist-90-Revised). Specifically, anxiety, somatization, cognitive-performance deficits, and depression were correlated with the severity of autistic burnout. There was no significant difference between work status and the severity of autistic burnout, implying no employment-related connection. The AABM-NL effectively differentiated between women with and without autistic burnout, with 62 points as a suitable cut-off point. However, these results may not be generalized to women requiring daily living support, individuals beyond outpatient psychiatric settings, or those in institutionalized populations. The preliminary findings provide empirical evidence supporting the use of the AABM-NL as a potential tool for assessing autistic burnout in women receiving outpatient psychiatric care. Its implementation may contribute to programs aimed at recognizing and preventing autistic burnout in women. Further research is needed to enhance intervention strategies for mitigating the risk of autistic burnout.
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Affiliation(s)
- Fleur Schoondermark
- Autism Expertise Center, Goyergracht Zuid 39, Eemnes, 3755 MZ, The Netherlands.
| | - Annelies Spek
- Autism Expertise Center, Goyergracht Zuid 39, Eemnes, 3755 MZ, The Netherlands
| | - Michelle Kiep
- Autism Expertise Center, Goyergracht Zuid 39, Eemnes, 3755 MZ, The Netherlands
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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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Fischbach AL, Hindenach A, van der Miesen AIR, Yang JS, Buckley OJ, Song M, Campos L, Strang JF. Autistic and non-autistic transgender youth are similar in gender development and sexuality phenotypes. BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2024. [PMID: 38613223 DOI: 10.1111/bjdp.12486] [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: 10/31/2023] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
Increasing rhetoric regarding the common intersection of autism and gender diversity has resulted in legislation banning autistic transgender youth from accessing standard of care supports, as well as legislative efforts banning all youth gender care in part justified by the proportional over-occurrence of autism. Yet, no study has investigated whether autistic and non-autistic transgender youth present fundamentally different gender-related phenotypes. To address this gap, we extensively characterized autism, gender diversity, and sexuality among autistic and non-autistic transgender binary youth (N = 66, Mage = 17.17, SDage = 2.12) in order to investigate similarities and/or differences in gender and sexuality phenotypes. Neither autism diagnostic status nor continuous autistic traits were significantly related to any gender or sexuality phenotypes. These findings suggest that the developmental and experiential features of gender diversity are very similar between autistic and non-autistic transgender adolescents. Future research is needed to determine whether the similarity in profiles is maintained over time into adulthood.
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Affiliation(s)
- Abigail L Fischbach
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Andy Hindenach
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Ji Seung Yang
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Olivia J Buckley
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Minneh Song
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Laura Campos
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - John F Strang
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
- Department of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, DC, USA
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McQuaid GA, Ratto AB, Jack A, Khuu A, Smith JV, Duane SC, Clawson A, Lee NR, Verbalis A, Pelphrey KA, Kenworthy L, Wallace GL, Strang JF. Gender, assigned sex at birth, and gender diversity: Windows into diagnostic timing disparities in autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241243117. [PMID: 38587289 DOI: 10.1177/13623613241243117] [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] [Indexed: 04/09/2024]
Abstract
LAY ABSTRACT Later autism diagnosis is associated with risk for mental health problems. Understanding factors related to later autism diagnosis may help reduce mental health risks for autistic people. One characteristic associated with later autism diagnosis is female sex. However, studies often do not distinguish sex assigned at birth and gender identity. Gender diversity may be more common in autistic relative to neurotypical people, and autism is more common in gender-diverse populations. We studied age at autism diagnosis by sex assigned at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. We studied three separate autistic samples, each of which differed in how they were diagnosed and how they were recruited. The samples included 193 persons (8.0-18.0 years) from a research-recruited academic medical center sample; 1,550 people (1.3-25.4 years) from a clinic-based sample; and 244 people (18.2-30.0 years) from a community-enriched sample. We found significant differences in the clinic-based and community-enriched samples. People assigned female sex at birth were diagnosed with autism significantly later than people assigned male at birth. People of female gender were diagnosed significantly later than people of male gender. Gender-diverse people were diagnosed significantly later than cisgender people. Sex assigned at birth, gender identity, and gender diversity may each show unique relationships with age of autism diagnosis. Differences in how autistic people are diagnosed and recruited are important to consider in studies that examine sex assigned at birth or gender identity. More research into autism diagnosis in adulthood is needed.
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Kung KTF. Autistic Traits, Gender Minority Stress, and Mental Health in Transgender and Non-Binary Adults. J Autism Dev Disord 2024; 54:1389-1397. [PMID: 36652125 DOI: 10.1007/s10803-022-05875-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
The present study investigated the relation between autistic traits and gender minority stress and the relative importance of autistic traits and gender minority stress in predicting mental health outcomes in gender minority adults. An online survey was completed by 90 transgender women, 72 transgender men, 48 non-binary individuals assigned male at birth (AMAB), and 98 non-binary individuals assigned female at birth (AFAB). Autistic traits positively correlated with internalised transphobia in the non-binary groups. In general, higher autistic traits and gender minority stress correlated with poorer mental health outcomes. After controlling for gender minority stress, autistic traits accounted for additional variance of suicidality across gender minority groups, anxiety symptoms in the non-binary groups, and all mental health outcomes in non-binary AFAB.
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Affiliation(s)
- Karson T F Kung
- Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong.
- Gender Development Research Centre, Department of Psychology, University of Cambridge, Cambridge, United Kingdom.
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Vincent J, Ralston K. Uncovering employment outcomes for autistic university graduates in the United Kingdom: An analysis of population data. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:732-743. [PMID: 37353923 PMCID: PMC10913337 DOI: 10.1177/13623613231182756] [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] [Indexed: 06/25/2023]
Abstract
LAY ABSTRACT International research suggests that more autistic people are entering higher education. Currently, very little is known about this group in the United Kingdom, for example, we have little information about how many autistic people enrol at UK-based higher education institutions, their backgrounds, the academic programmes they study and what they do once they have graduated. Our study tries to explore these issues by comparing outcomes between autistic students, other disabled students and non-disabled students. We use population data collected by the Higher Education Statistical Agency in the United Kingdom, which included 1,326,416 graduates across the years 2012-2018. Our findings indicate that the degree subjects studied at university by autistic students are more diverse than often people think. We also found that graduates go on to work in a range of employment sectors following graduation but often experience worse outcomes in terms of access to full-time work and worse pay. We argue that universities and colleges must focus greater attention on developing better employment transition support for autistic students and graduates.
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McClellan LS, van der Miesen AIR, Tishelman AC, Fischbach AL, Song M, Campos LA, Strang JF. Cognitive and Developmental Profiles Associated with Self-Reported Sexual and Gender Minority Stigmatization Among Binary Transgender Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-17. [PMID: 38118056 DOI: 10.1080/15374416.2023.2292045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
OBJECTIVE Sexual and gender minority (SGM) stigmatization is a key factor related to transgender adolescent mental health. While previous research has focused on direct associations between stigmatization and mental health, the present study of transgender youth, equitably recruited across the autism spectrum, examines cognitive and developmental factors in relation to the self-report of experienced and perceived SGM stigmatization. METHOD 65 binary transgender adolescents (43% transfeminine; ages 13-21 years) were intentionally recruited across the spectrum of autism traits from no traits to full criteria autism. Participants completed measures of autism-related social differences, cognitive abilities, and self-reported directly experienced and perceived SGM stigma. Autism-related social differences, cognitive abilities, and age were studied in relation to both SGM stigma factors. RESULTS Autism-related social differences were negatively associated with level of directly experienced SGM stigma but unassociated with perceived stigma. Greater cognitive ability was positively associated with level of perceived SGM stigma, but unassociated with report of directly experienced stigma. Older age was positively associated with level of perceived SGM stigma. There was a statistical trend toward older age positively associated with level of directly experienced stigma. CONCLUSIONS The present study identifies candidate cognitive and developmental influences on self-reported SGM stigmatization among transgender adolescents, evenly recruited across the autism spectrum. The factors which may impact the perception and experience of stigmatization have been notably under-explored in the mental health field. The examination of these individual characteristics may allow for more precise predictive models for research with transgender youth, and ultimately, in clinical care.
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Affiliation(s)
- Lucy S McClellan
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit
| | | | - Abigail L Fischbach
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Minneh Song
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Laura A Campos
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - John F Strang
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Neurology, and Behavioral Science, George Washington University School of Medicine
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8
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Pilgrim D. British mental healthcare responses to adult homosexuality and gender non-conforming children at the turn of the twenty-first century. HISTORY OF PSYCHIATRY 2023; 34:434-450. [PMID: 37526106 PMCID: PMC10638846 DOI: 10.1177/0957154x231181461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
The roots of the recent controversy about how mental health professionals should respond to gender non-conforming children are traced. To make historical sense, this paper distinguishes between epistemological (discursive) and ontological (non-discursive) aspects and describes their features, since 1970. This helps to clarify some of the confusions at the centre of the still heated debate about sexuality and gender identity today. In the concluding discussion, the philosophical resource of critical realism is used to interpret the historical narrative provided. It cautions against the anachronistic tendency to amalgamate the short-lived, and now defunct, experiment of aversion therapy for homosexuality with more recent defences of exploratory psychotherapy. The latter have challenged a different form of experimentation: the bio-medicalisation of gender non-conforming children.
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9
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Singer J, Pilgrim D, Hakeem A, Harvey P. Constraints on Free Academic and Professional Debate in the UK About Sex and Gender. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2269-2279. [PMID: 37682506 DOI: 10.1007/s10508-023-02687-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Juliet Singer
- Child and Adolescent Mental Health Service, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
| | - David Pilgrim
- Department of Psychology, University of Southampton, Southampton, UK
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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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11
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Genovese AC, Singh SC, Casubhoy I, Hellings JA. Gender Diverse Autistic Young Adults: A Mental Health Perspective. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1339-1343. [PMID: 36287303 DOI: 10.1007/s10508-022-02443-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 05/11/2023]
Abstract
Gender diverse autistic young adults often face mental health challenges which can increase the challenge of obtaining gender-affirming care. Social and communication differences associated with autism compounds the already complex process of navigating a path toward gender affirmation for individuals with these intersecting identities. In this case series of four gender diverse autistic adults, we demonstrate that success in management of their mental health crises was achieved through enlisting family and social support, obtaining effective mental health treatment, and accessing gender-affirming healthcare. These cases selected from two neuropsychiatric outpatient tertiary referral clinics demonstrate that effective mental health treatment supports ultimate success for these individuals in their journeys toward living as the gender with which they identify. We conclude that healthcare practices and treatment recommendations which incorporate internationally recognized standards of care guidelines for gender diverse individuals improve patient outcomes.
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Affiliation(s)
- Ann C Genovese
- Department of Psychiatry and Behavioral Sciences, University of Kansas Health System, 3901 Rainbow Blvd., MS 4015, Kansas City, KS, 66160, USA.
| | - Saras Chen Singh
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Imaima Casubhoy
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jessica A Hellings
- Department of Psychiatry, University of Missouri-Kansas City, Kansas City, MO, USA
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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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13
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Strang JF, Anthony LG, Song A, Lai MC, Knauss M, Sadikova E, Graham E, Zaks Z, Wimms H, Willing L, Call D, Mancilla M, Shakin S, Vilain E, Kim DY, Maisashvili T, Khawaja A, Kenworthy L. In Addition to Stigma: Cognitive and Autism-Related Predictors of Mental Health in Transgender Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:212-229. [PMID: 34121545 DOI: 10.1080/15374416.2021.1916940] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date of autistic-transgender, non-autistic (allistic) transgender, and autistic-cisgender adolescents diagnosed using gold-standard ASD diagnostic procedures. In accordance with advancing understanding of sex/gender-related autism phenotypes, slightly subthreshold autistic diagnostic presentations (common in autistic girls/women) are modeled. METHOD This study includes 93 adolescents aged 13-21, evenly divided between autistic-transgender, autistic-cisgender, and allistic-transgender groups; 13 transgender adolescents were at the margin of ASD diagnosis and included within a larger "broad-ASD" grouping. Psychological and neuropsychological evaluation included assessment of mental health, IQ, LGBT stigma, ASD-related social symptoms, executive functioning (EF), and EF-related barriers to achieving gender-related needs. RESULTS Autistic-transgender adolescents experienced significantly greater internalizing symptoms compared to allistic-transgender and autistic-cisgender groups. In addition to stigma-related associations with mental health, ASD-related cognitive/neurodevelopmental factors (i.e., poorer EF and greater social symptoms) were associated with worse mental health: specifically, social symptoms and EF gender barriers with greater internalizing and EF problems and EF gender barriers with greater suicidality. Comparing across all ASD and gender-related groups, female gender identity was associated with greater suicidality. CONCLUSIONS Parsing the heterogeneity of mental health risks among transgender youth is critical for developing targeted assessments and interventions. This study identifies ASD diagnosis, ASD phenotypic characteristics, and EF-related gender barriers as potential risks for poorer mental health in transgender adolescents.
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Affiliation(s)
- John F Strang
- Gender Development Program, Children's National Hospital
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Laura G Anthony
- Department of Psychiatry, University of Colorado School of Medicine
- Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Amber Song
- Gender Development Program, Children's National Hospital
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Meng-Chuan Lai
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health
- Department of Psychiatry, The Hospital for Sick Children
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto
- Autism Research Centre, Department of Psychiatry, University of Cambridge
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine
| | - Megan Knauss
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Alliance of Community Health Plans
| | | | | | - Zosia Zaks
- Hussman Center for Adults with Autism, Towson University
| | - Harriette Wimms
- Youth Gender Care Services, The Village Family Support Center of Baltimore
| | - Laura Willing
- Gender Development Program, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - David Call
- Gender Development Program, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Michael Mancilla
- Youth Pride Clinic, Adolescent and Young Adult Medicine, Children's National Hospital
| | - Sara Shakin
- Department of Pediatrics, Sinai Hospital of Baltimore
| | - Eric Vilain
- Center for Genetic Medicine Research, Children's National Hospital
- Department of Genomics and Precision Medicine, George Washington University
- Epigenetics, Data, & Politics at Centre National de la Recherche Scientifique
| | - Da-Young Kim
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Tekla Maisashvili
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Ayesha Khawaja
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
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14
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Kallitsounaki A, Williams DM. Implicit and Explicit Gender-Related Cognition, Gender Dysphoria, Autistic-Like Traits, and Mentalizing: Differences Between Autistic and Non-Autistic Cisgender and Transgender Adults. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3583-3600. [PMID: 35972636 PMCID: PMC9556420 DOI: 10.1007/s10508-022-02386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Evidence indicates a link between autism spectrum disorder (ASD) and gender diversity, yet this intersection remains insufficiently understood. Here, we investigated whether (1) ASD affects gender-related cognition (i.e., mental processes of perceiving and interpreting one's own gender self-concept), (2) autistic people have increased gender dysphoria and recall limited gender-typed behavior from childhood, and (3) transgender individuals have increased ASD-like traits and difficulties in mentalizing. A total of 106 non-autistic cisgender (51 birth-assigned female), 107 autistic cisgender (57 birth-assigned female), 78 non-autistic transgender (41 birth-assigned female), and 56 autistic transgender adults (27 birth-assigned female) participated in the study. The mean age of participants was 31.01 years (range = 18 to 70). Using an explicit as well as an implicit measure, for the first time, we found that ASD affected gender-related cognition only in autistic cisgender people. Sex differences were also observed in this group. Whereas autistic cisgender birth-assigned males showed a stronger implicit gender-group identification than non-autistic cisgender birth-assigned males, autistic cisgender birth-assigned females showed a weaker gender-group identification than non-autistic cisgender birth-assigned females. Furthermore, autistic cisgender people reported significantly more gender dysphoric feelings and recalled significantly less gender-typed behavior from childhood than non-autistic cisgender individuals. No difference was observed between non-autistic and autistic transgender people. We also found that relative to non-autistic cisgender individuals, both non-autistic transgender and autistic transgender people reported significantly more ASD-like traits. However, mentalizing difficulties were observed only in the latter group. This research enhances our understanding of the link between ASD and gender diversity.
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Affiliation(s)
- Aimilia Kallitsounaki
- Division of Human & Social Sciences, School of Psychology, Keynes College, University of Kent, Canterbury, CT2 7NP, UK.
| | - David M Williams
- Division of Human & Social Sciences, School of Psychology, Keynes College, University of Kent, Canterbury, CT2 7NP, UK
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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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Zohny H, Earp BD, Savulescu J. Enhancing Gender. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:225-237. [PMID: 35129785 PMCID: PMC9233637 DOI: 10.1007/s11673-021-10163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
Transgender healthcare faces a dilemma. On the one hand, access to certain medical interventions, including hormone treatments or surgeries, where desired, may be beneficial or even vital for some gender dysphoric trans people. But on the other hand, access to medical interventions typically requires a diagnosis, which, in turn, seems to imply the existence of a pathological state-something that many transgender people reject as a false and stigmatizing characterization of their experience or identity. In this paper we argue that developments from the human enhancement debate can help clarify or resolve some of the conceptual and ethical entanglements arising from the apparent conflict between seeking medicine while not necessarily suffering from a pathology or disorder. Specifically, we focus on the welfarist account of human enhancement and argue it can provide a useful conceptual framework for thinking about some of the more contentious disagreements about access to transgender healthcare services.
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Affiliation(s)
- Hazem Zohny
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, 16-17 Saint Ebbe's St, Oxford, OX1 1PT, UK.
| | - Brian D Earp
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, 16-17 Saint Ebbe's St, Oxford, OX1 1PT, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, 16-17 Saint Ebbe's St, Oxford, OX1 1PT, UK
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17
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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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18
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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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19
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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20
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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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21
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Pilgrim D. Transgender debates and healthcare: A critical realist account. Health (London) 2021; 26:535-553. [PMID: 34608816 DOI: 10.1177/13634593211046840] [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: 11/17/2022]
Abstract
The meta-theoretical resource of critical realism (CR) is deployed in order to examine transgender and healthcare. CR treads a middle way between positivism and postmodernism, within post-Popperian discussions of the philosophy of natural and social science. It focuses on the conditions of possibility for the emergence of a phenomenon under investigation. In this case, the focus is on the emergence of debates about transgenderism in healthcare. These have been technological (about the prospect of biomedical solutions to personal problems) and ideological, with the enlarged salience of identity politics and our currently unresolved "culture wars." Identity politics have brought a focus on epistemological privilege or "lived experience" and on rights to healthcare being driven by consumer choice. The current contestation and its history are discussed in relation to our four planar social being (nature, relationality, socio-economic structures, and our particular personalities) and future scenarios are rehearsed.
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22
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Sullivan EC, Halstead EJ, Ellis JG, Dimitriou D. Anxiety, Insomnia, and Napping Predict Poorer Sleep Quality in an Autistic Adult Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9883. [PMID: 34574806 PMCID: PMC8469045 DOI: 10.3390/ijerph18189883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022]
Abstract
Autistic adults have a high prevalence of sleep problems and psychiatric conditions. In the general population sleep problems have been associated with a range of demographic and lifestyle factors. Whether the same factors contribute to different types of disturbed sleep experienced by autistic adults is unknown and served as the main aim of this study. An online survey was conducted with 493 autistic adults. Demographic information (e.g., age, gender), about lifestyle (e.g., napping), and information about comorbid conditions was collected. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and the Epworth Sleepiness Scale (ESS) was used to assess daytime somnolence. Stepwise multiple regression analyses were used to examine predictors of each subscale score on the PSQI, as well as PSQI and ESS total scores. Results indicated that individuals who reported having a diagnosis of anxiety and insomnia were more likely to have poorer sleep quality outcomes overall. Furthermore, individuals who reported habitually napping had higher daytime dysfunction, increased sleep disturbances, and increased daytime sleepiness. These results provide novel insights into the demographic and lifestyle factors that influence sleep quality and daytime somnolence in autistic adults and can be used for targeted sleep interventions.
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Affiliation(s)
- Emma C. Sullivan
- Sleep Education and Research Laboratory, Department of Psychology and Human Development, Institute of Education, University College London, London WC1H 0AA, UK;
| | - Elizabeth J. Halstead
- Sleep Education and Research Laboratory, Department of Psychology and Human Development, Institute of Education, University College London, London WC1H 0AA, UK;
| | - Jason G. Ellis
- Northumbria Sleep Research Laboratory, Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Department of Psychology and Human Development, Institute of Education, University College London, London WC1H 0AA, UK;
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23
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Rao SJ, Nickel JC, Kiell EP, Madden LL. Readability of Commonly Used Patient-Reported Outcome Measures in Laryngology. Laryngoscope 2021; 132:1069-1074. [PMID: 34498753 DOI: 10.1002/lary.29849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are used to evaluate patients' symptoms and clinical improvement after an intervention. Advocacy efforts and increased provider awareness regarding health literacy have helped to improve the readability of PROMs. Recent studies in otolaryngology in rhinology, pediatric otolaryngology, and head and neck reported PROM readability scores above the sixth-grade level. However, there is limited data regarding the readability of laryngology PROMs. Thus, this study aims to report the readability levels of PROMs in laryngology by assessing different readability indices and describing the relationship of readability levels to equitable healthcare. METHODS This is a bibliometric study that received approval from institutional review board (IRB) review as a nonhuman subject research study. Recent and widely utilized laryngology PROMs were selected from a publicly available literature search by reviewing laryngology systematic reviews, PubMed, and Google Scholar. Laryngology PROMs were selected from voice, dysphagia, airway, and other PROMs including voice questionnaires administered to patients seeking gender affirming voice care from systematic reviews and expert opinion. There were 37 PROMs included in this study. PROMs were analyzed via Gunning Fog, Simple Measure of Gobbledygook (SMOG), FORCAST, and Flesch Reading Ease Score. RESULTS All laryngology PROMs had readabilities above the recommended sixth-grade level. The mean and standard deviation (SD) of Gunning Fog was 7.30 (2.59), SMOG was 8.70 (1.51), FORCAST was 10.05 (1.51), and Flesch Reading Ease Score was 8.08 (2.76). CONCLUSION Laryngology PROMs are above the recommended middle school reading level. To further promote health equity, readability should be considered when developing future PROMs. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Joseph C Nickel
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Eleanor P Kiell
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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24
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Joyal CC, Carpentier J, McKinnon S, Normand CL, Poulin MH. Sexual Knowledge, Desires, and Experience of Adolescents and Young Adults With an Autism Spectrum Disorder: An Exploratory Study. Front Psychiatry 2021; 12:685256. [PMID: 34177667 PMCID: PMC8219850 DOI: 10.3389/fpsyt.2021.685256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Abstract
Although most persons with an Autism Spectrum Disorder (ASD) wish to have romantic and/or sexual relationships, little is known about self-report sexuality of adolescents/young adults with ASD. In this exploratory study, 172 male and female adolescents/young adults (68 with ASD and 104 without ASD) completed an online version of the Sexual Behavior Scale-Third edition. Although many more similarities than differences were observed between the groups for views and desires about romantic relationships (e.g., wishing to have a girlfriend/boyfriend), fewer participants with ASD (mostly boys) had experience with a variety of sexual/dyadic behaviors, and approximately half of girls with ASD reported negative sexual experiences. Significantly higher rates of participants with ASD felt their knowledge about sexuality was limited and found it difficult to understand sexual education compared with typically developing (TD) participants. Significantly lower rates of participants with ASD reported that they identify to their assigned gender compared with TD participants. Multiple regressions revealed that being older at first diagnosis and possessing better knowledge about sexuality were significant predictors of both positive and negative sexual experience. This study explores strengths and challenges related with the sexual health of adolescents/young adults with ASD and implications for clinical and educational practice are discussed.
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Affiliation(s)
- Christian C. Joyal
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Julie Carpentier
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Suzie McKinnon
- Integrated University Health and Social Services Centre (IUHSSC) of Saguenay-Lac-Saint-Jean, IUHSSC Bas-Saint-Laurent and IUHSSC Côte-Nord, Saguenay, QC, Canada
- Intellectual Disability and Autism Spectrum Disorder Research Institute, IUHSSC of Mauricie and Centre-du-Québec, Trois-Rivières, QC, Canada
| | - Claude L. Normand
- Intellectual Disability and Autism Spectrum Disorder Research Institute, IUHSSC of Mauricie and Centre-du-Québec, Trois-Rivières, QC, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Marie-Hélène Poulin
- Intellectual Disability and Autism Spectrum Disorder Research Institute, IUHSSC of Mauricie and Centre-du-Québec, Trois-Rivières, QC, Canada
- Department of Psychoeducation, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
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25
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Abstract
In this paper the author argues that trans-identification and its associated medical treatment can constitute an attempt to evade experiences of psychological distress. This occurs on three levels. Firstly, the trans person themselves may seek to evade dysregulated affects associated with such experiences as attachment trauma, childhood abuse, and ego-alien sexual feelings. Secondly, therapists may attempt to evade feelings, such as fear and hatred, evoked by engaging with these dysregulated affects. Thirdly, we, as a society, may wish to evade acknowledging the reality of such trauma, abuse and sexual distress by hypothesizing that trans-identification is a biological issue, best treated medically. The author argues that the quality of evidence supporting the biomedical approach is extremely poor. This puts young trans people at risk of receiving potentially damaging medical treatment they may later seek to reverse or come to regret, while their underlying psychological issues remain unaddressed.
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Kallitsounaki A, Williams D. Mentalising Moderates the Link between Autism Traits and Current Gender Dysphoric Features in Primarily Non-autistic, Cisgender Individuals. J Autism Dev Disord 2020; 50:4148-4157. [PMID: 32239391 PMCID: PMC7560908 DOI: 10.1007/s10803-020-04478-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The co-occurrence between autism and gender dysphoria has received much attention recently. We found that, among 101 adults from the general population number of autism traits, as measured using the autism-spectrum quotient was associated significantly with recalled and current gender dysphoric traits. Furthermore, performance on an objective measure of mentalising, such as the “Reading the Mind in the Eyes” test was associated with current gender dysphoric traits, but most importantly it moderated the relation between number of autism traits and number of current gender dysphoric traits, such that the association was significant only when mentalising ability was relatively low. Results suggest mentalising may represent a contributing factor to the relation between autism and gender dysphoric traits in the general population.
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Affiliation(s)
| | - David Williams
- School of Psychology, Keynes College, University of Kent, Canterbury, CT2 7NP, UK
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Kung KTF. Autistic traits, systemising, empathising, and theory of mind in transgender and non-binary adults. Mol Autism 2020; 11:73. [PMID: 32993801 PMCID: PMC7523342 DOI: 10.1186/s13229-020-00378-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Prior research examining autistic traits in gender minority adults has reported mixed findings. Most prior studies did not include non-binary individuals. Little is known about the mechanisms shaping autistic traits in gender minority adults. This study examined autistic traits, as well as constructs related to the extreme male brain theory of autism and the mindblindness theory, in transgender and non-binary adults. METHODS An online survey was conducted to assess autism-related traits in 323 gender minority adults, including 74 transgender men (individuals assigned female at birth and identify as a man), 95 transgender women (individuals assigned male at birth and identify as a woman), 104 non-binary AFAB (individuals assigned female at birth and identify as non-binary), and 50 non-binary AMAB (individuals assigned male at birth and identify as non-binary). Autistic traits, systemising, empathising, and Theory of Mind (ToM) were measured using the Autism Spectrum Quotient (AQ), the short forms of the Systemising Quotient (SQ-Short) and the Empathy Quotient (EQ-Short), the 10-item version of the Empathy Quotient (EQ-10) and the Reading the Mind in the Eyes Test (Eyes Test). Participants' scores on these measures were compared with previously published scores based on large-scale general population samples including thousands of participants. RESULTS On average, compared with control females in the general population samples, both transgender men and non-binary AFAB scored significantly higher on the AQ and the SQ-Short but scored significantly lower on the EQ-Short, the EQ-10, and the Eyes Test. No clear or consistent group differences emerged when transgender women and non-binary AMAB were compared with control males. LIMITATIONS The present study does not have a large sample of gender minority adults. It has been argued that the measures employed may not provide a precise assessment of the psychological constructs of interest. The present study has a "non-clinical" sample. However, not all gender minorities have access to or require clinical services, and so a "non-clinical" sample may be more representative of the gender minority community as a whole than samples recruited through clinics. CONCLUSIONS The current findings suggest a "masculinised" autism-related profile and reduced ToM in transgender men and in non-binary AFAB. These findings might be interpreted to support the extreme male brain theory of autism and the mindblindness theory. Further research is needed to corroborate these findings.
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Affiliation(s)
- Karson T F Kung
- Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong.
- Gender Development Research Centre, Department of Psychology, University of Cambridge, Cambridge, UK.
- School of Psychology, University of Kent, Kent, UK.
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Pilgrim D, Entwistle K. GnRHa ('Puberty Blockers') and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression. New Bioeth 2020; 26:224-237. [PMID: 32715988 DOI: 10.1080/20502877.2020.1796257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ethical concerns have been raised about routine practice in paediatric gender clinics. We discuss informed consent and the risk of iatrogenesis in the prescribing of gonadotropin-releasing hormone analogues (GnRHas) and cross sex hormones to children and adolescents respectively. We place those clinical concerns in a wider societal context and invite consideration of two further relevant ethical domains: competing rights-based claims about male and female personhood; and freedom of expression about those claims. When reflecting on the assessment and medicalization of children and adolescents presenting at gender clinics, the matters of informed consent and iatrogenic risk should be the most pressing for clinicians. However, this is not just a matter of medical ethics, it also implies the need for a full ethical debate on competing notions of personhood and the defence of freedom of expression about transgender and its implications within contemporary democracies.
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Affiliation(s)
- David Pilgrim
- Department of Psychology, University of Southampton, Southampton, UK
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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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