Gender Diverse Youth on the Spectrum

Recent research has shown that people who identify differently from the sex they were assigned at birth are more likely to be diagnosed with autism spectrum disorder (ASD) or exhibit traits that correspond with ASD (Spectrum News, 2020). The largest study to date found that gender diverse individuals are three to six times more likely to be diagnosed with autism than cisgender individuals. With such a large intersectionality of gender identity and ASD, there is a need for a greater understanding of this connection in order to better serve our community. 

Terms and Definitions

Let’s start with some terms and definitions. First, what is the difference between sex and gender? Sex refers to the biological characteristics of an individual (male, female, or intersex), while gender is a social construct refering to how one’s identity is expressed. Therefore, one’s gender identity is an individual’s sense of what their gender is. This can include male, female, both, or neither. In comparison, gender diverse is a general term used to refer to individuals who have gender idenities that are different from their birth sex. For example, members of the transgender, nonbinary, and genderqueer communities may also identify as gender diverse. Cisgender is a term used to refer to people whose gender identities align with that of the sex that they were assigned at birth.

Implications

Like adding weights to a dumbbell, marginalized identities add up. The more of these identities a person holds, the greater chance they have of experiencing mental health challenges as a consequence of the oppression and discrimination that they may face. According to a study conducted in Australia, it was found that about 78% of gender diverse adolescents with ASD had a history of mental health issues, self-harming behaviors, and/or suicidal intent or attempts (Mahfouda et al., 2019). Due to this increased risk of depression, anxiety, and gender dysphoria, amongst other mental health concerns, it is critical that we identify and support our gender diverse youth on the spectrum. 

One challenge that these individuals may face is increased scrutiny from others. Although individuals with autism are just as capable of deciding their gender identity as neurotypical individuals, others may sometimes question their ability to do so based on their ASD identity, assuming it is a “fad” or restricted interest. According to a study, 32% of gender-diverse adolescents on the spectrum report being questioned about their gender identity due to their autism diagnosis (Spectrum News, 2020). This skepticism most commonly comes from clinicians and family members. Questioning the competence of an individual’s ability to determine their own gender identity can lead to harmful feelings of self-doubt and lack of confidence, which in turn can be detrimental to their overall mental health. 

Another key challenge that gender diverse individuals on the spectrum can face is gender dysphoria, which is the feeling of discomfort that occurs when one’s gender identity differs from the sex they were born with. The distress experienced from gender dysphoria can result in anxiety, depression, self-harm, and substance abuse (Spectrum News, 2020). The social communication and emotion challenges an individual often faces due to their ASD diagnosis can make it challenging to identify their gender dysphoria, leading to an internalized negative self-image. 

As clinicians and parents, it is critical that we work on implementing evidence-based strategies to support our gender diverse adolescents and adults on the spectrum. When an individual with autism shares their gender identity with you, acknowledge and support them. Additionally, monitor their mental health. Keep channels of communication open so that they know that they can come to you for future support. 

Resources

If you or someone you know would like to learn more about gender diversity on the spectrum or receive additional support, you may find the resources below to be helpful.

Mental Health

Rachel Sienko, PhD, LP
Integrative Psychology of Ann Arbor
(734) 462-3210 ext. 2
https://www.integrativea2.com

Jordan Harrison, PsyD, LP
Ann Arbor Center for the Family
734-995-5181
https://www.annarborcenter.com

Amy Advey LCSW
https://www.amyadvey.com

Jennifer Tang, PhD 
Everwell Health & Counseling Services
admin@everwellhc.com
734-219-9260  
https://www.everwellhealthandcounseling.com

Reena Liberman, MS
734.741.1655
https://rmlsexualhealth.net

Amanda Klingensmith, PhD
McCaskill Family Services
734-416-9098
office@mccaskillfamilyservices.com
http://www.mccaskillfamilyservices.com

Lisa C. Wolf, PsyD, LP CST
734-730-5534
https://lisacwolf.com

Barb Gamble, MS, LLP
734-646-6406
http://barbaralgamble.com

Connally Counseling
https://www.connallycounseling.com

Amplify Collectivo
https://amplifycolectivo.com

Integrative Empowerment
https://www.integrativeempowerment.com

Healthcare

UofM’s Comprehensive Gender Services https://www.uofmhealth.org/conditions-treatments/transgender-services

Reading

Transgender Teen: A Handbook for Parents and Professionals Supporting Transgender and Non-Binary Teens https://www.abebooks.com/Transgender-Teen-Handbook-Parents-Professionals-Supporting/30764346505/bd

References

American Psychological Association. (2015). Key Terms and Concepts in Understanding Gender Diversity and Sexual Orientation Among Students. Retrieved January, 2021, from https://www.apa.org/pi/lgbt/programs/safe-supportive/lgbt/key-terms.pdf

Mahfouda, S., Panos, C., Whitehouse, A. J., Thomas, C. S., Maybery, M., Strauss, P., . . . Lin, A. (2019). Mental Health Correlates of Autism Spectrum Disorder in Gender Diverse Young People: Evidence from a Specialised Child and Adolescent Gender Clinic in Australia. Journal of Clinical Medicine, 8(10), 1503rd ser. doi:10.3390/jcm8101503

Mayo Clinic (2019) Gender dysphoria https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/symptoms-causes/syc-20475255

Spectrum News (2020) Largest study to date confirms overlap between autism and gender diversity https://www.spectrumnews.org/news/largest-study-to-date-confirms-overlap-between-autism-and-gender-diversity/

Spectrum News (2020) Living between gendershttps://www.spectrumnews.org/features/deep-dive/living-between-genders/