Autism Spectrum Disorder and Gender Identity
Raising Awareness & Building Support for Twice-Marginalized Youth:
The link between gender diversity & neurodiversity
More and more I have families come to me for two seemingly disparate reasons; the first is gender identity and the second is Autism Spectrum Disorder. Although at first glance these two topics appear unrelated, the latest research confirms a significant overlap between them. So, for all of you parents who have been asking about any connection between ASD and gender identity- and any of you who just want to stay informed- this month’s article is for you!
In August 2020 researchers analyzed five unrelated databases including information regarding gender, autism, and mental health; yielding the largest study (641,860 individuals) of ASD and gender diversity to date¹. They found that gender diverse individuals (those self-identified as transgender, nonbinary, two-spirit, gender-queer etc.) are three-six times more likely to be diagnosed along the autism spectrum than their cis-gender counterparts. Similarly, folks diagnosed with Autism Spectrum Disorder are more likely than their neurotypical counterparts to be gender diverse. Specifically, 5% of the cisgender participants had been diagnosed with ASD whereas 24% of the gender diverse participants had been diagnosed with ASD.
Before we can understand the implications of this significant difference, let’s take a step back and a closer look at these two groups of individuals.
What is Gender?
Gender is a social construct that historically has been used to differentiate between 2 sexes, female and male; although today, there have been upwards of 72 defined “genders”. Sex, on the other hand, refers to the categorization of people based upon their external biology. At birth, if an infant’s sex organs are non-descript or not fully formed, an assigned sex is provided. Biological sex, however, is not only defined externally, but also by internal organs, chromosomes, and hormones. These factors do not always agree, and what is assigned at birth may or may not be aligned with a person’s gender identity. Today, it is estimated that 10% of adolescents do not identify as either female or male, but rather as gender diverse.
Gender Identity
Gender identity is an individual’s personal sense of their gender; an internal truth about one’s selfhood. It may or may not match the gender assigned at birth. It may remain stable or change over time. It may or may not match one’s gender expression. The nomenclature used to describe one’s gender identity is as variable as the other attributes we use to describe ourselves. A person may identify as female, gender fluid, transgender, gender diverse, male, agender, non-binary, or numerous others self-proclaimed labels. Cisgender refers to those whose gender identity matches their biological sex and gender assigned at birth.
Gender Expression
Gender expression is how an individual chooses to present themselves to others. This can be style of dress, mannerisms, vocal tone, etc. Gender expression does not necessarily “match” assumptions of gender. Keep in mind, this is all a part of identity (who I am) and not about attraction (who I want to be with).
Gender Dysphoria
Gender Dysphoria is a clinical condition where issues around one’s gender identity are causing significant stress and dysfunction in a person’s daily life. Not everyone with gender diversity has gender dysphoria; like not every child of divorced parents has stress and familial dysfunction. With children of divorced parents, those whose parents are able to put their children’s development first and deal with their own issues behind the scenes, have children who grow up with a healthy sense of self. Similarly, parents of gender-variant children who are loving and supportive and are able to process their own stress, doubts, and grief away from their child’s awareness, raise more resilient children. They grow up with a healthy sense of identity and where they fit within this world. They are more likely to advocate for their own needs, and succeed in academic, social, and extracurricular endeavors.
What is Autism?
Autism refers to a continuum of neurodevelopmental diagnoses related to social communication deficits, sensory processing difficulties, and repetitive/ restricted interests and behaviors. There is an incredible range of functioning on this continuum and it is frequently difficult to discern casually whether someone you meet is “on the spectrum”. Children and adolescents with Autism tend to struggle with executive functions, communication, and social skills. Identifying and sharing feelings, managing anxiety, building relationships, advocating for oneself, and expressing confusing thoughts are even harder for those on the spectrum than neurotypical adolescents. Folks on the spectrum, due to their difficulties with social comprehension, tend to be less influenced by societal expectations. Although thinking differently from others can make it more challenging to fit in with peers, it also leads to some of the most revolutionary and innovative ideas and resultant changes in society!
The Connection Between ASD and Gender Identity
Gender-diverse folks report more traits associated with ASD, such as sensory issues, lower rates of empathy, and pattern-recognition skills than their cis-gendered counterparts. They are also 5 times as likely to suspect they have undiagnosed ASD¹. As research of this topic is in its infancy, we do not yet know “why” there is such an overlap between gender variance and Autism. We do, however, know that the overlap (or comorbidity) exists. Perhaps it is the very nature of the autistic brain that allows one to experience beyond the conventions of thought. When one is not constrained by societal constructs (such as manners or gender) there tends to be significantly more variation in behavior. Folks on the spectrum, therefore, may not feel the restrictive assumption of a binary gender system and be more inclined to feel a natural fluidity or variability in their gender identity. They may also have internalized less negativity regarding gender-variance due to limited social experiences as well as limited social awareness. In this case, their social skills “deficit” may actually serve as a protective factor.
Moving forward.
Gender diverse children and adolescents are at a higher risk for mental health conditions, including suicidality, depression, and anxiety. Children and adolescents with ASD are also at a higher risk for the same. As you can imagine, children who are a part of both marginalized groups are at an even greater risk and need to be identified and supported accordingly. So, what do we as a society need to do to ensure that these children are identified and supported?
- Pediatricians, neuropsychologists, therapists, BCBA’s, teachers, counselors, and parents all need to be aware of the comorbidity of ASD and gender variance so we can all be available to provide support and seek services when necessary.
- We need to be mindful of what language we use when addressing these children and adolescents.
- Do not assume you know how a person needs to be addressed- ask!!
- When you introduce yourself, show you are a safe and supportive person by stating how you prefer to be addressed, “Hi, my name is Dr. Larson, I use she/ her/ hers.”
- Listen, respect, and support children by affirming their gender identity and not making a huge deal out of it- even if you are unsure about their convictions. Gender identity, like other aspects of identity development, is an exploratory and evolutionary process.
- Do not assume that because someone is on the spectrum that they do not understand their gender identity.
- Advocate for your child with their healthcare providers, school team, and social/ extracurricular circles. You are modeling vital self-advocacy skills for them.
- By building awareness of the comorbidity of ASD and gender variance, we can help this double-marginalized group of extraordinary thinkers feel at home in their bodies and in our community.
Yours in health,
Dr. L (she/her/hers)
- Warrier, V. et al. Elevated Rates of Autism, Other Neurodevelopmental and Psychiatric Diagnoses, and Autistic Traits in Transgender and Gender-Diverse Individuals. Nature Communications. 11, 3959 (2020)
