Gender dysphoria and autism spectrum disorder (ASD) are two complex conditions that researchers have recognized can co-occur in some individuals. However, the biological mechanisms behind this relationship are not well understood. While some have attempted to causally link autism to gender dysphoria, the evidence for a definitive connection remains unclear. Tying gender dysphoria too closely to autism also risks perpetuating harmful stereotypes. This article will explore the current research on autism and gender dysphoria, the uncertainties that remain, and the importance of an open, accepting approach when working with individuals with diverse gender identities and neurological differences.
What is Gender Dysphoria?
Gender dysphoria refers to psychological distress stemming from a discrepancy between a person’s assigned gender at birth and their experienced or expressed gender. People with gender dysphoria may desire to live as a gender other than their assigned one.
- Previously referred to as transsexualism or gender identity disorder, gender dysphoria is the most current clinical terminology.
- Preferred treatments for gender dysphoria include counseling, social transitioning, hormone therapy, and gender affirmation surgeries.
- Many people with gender dysphoria take steps to align their outward presentation and physical characteristics with their internal gender identity.
What is Autism Spectrum Disorder?
Autism spectrum disorder encompasses a wide range of characteristics and abilities.
- Features associated with ASD include difficulties with social interaction, communication challenges, repetitive behaviors, and restricted interests.
- Autism exists on a spectrum. Support needs vary greatly from person to person.
- Autism has a strong genetic component, though environmental factors may also play a role.
- According to the CDC, 1 in 44 children has ASD. Diagnoses are on the rise, likely due in part to broader diagnostic criteria and awareness.
Recognizing Co-Occurrence
In recent years, researchers have noted that gender dysphoria appears to co-occur with autism more frequently than previously recognized. However, quantifying this relationship has proven challenging.
- In a 2010 study of children and adolescents with gender dysphoria, 7.8% were also diagnosed with ASD.
- A 2014 study found that 5.5% of adults with gender dysphoria also had autistic traits.
- Small sample sizes and shifting terminology complicate measuring co-occurrence. The relationship appears complex.
Proposed Explanations
With an awareness of co-occurrence between gender dysphoria and autism, researchers have proposed numerous hypotheses for why this relationship exists:
Extreme Male Brain Theory
- Suggests exposure to high testosterone levels in the womb leads to an “extreme male brain” pattern of systematic thinking. This could predispose someone to both autism and gender dysphoria associated with a male gender identity.
Social Difficulties
- Challenges with social interaction associated with autism could theoretically contribute to gender dysphoria in some cases. For example, an autistic child bullied by peers may come to reject their assigned gender group.
Missed Social Cues
- Limitations in social communication could also lead to misinterpretations of someone’s gender identity by others. This mismatch could contribute to gender dysphoria.
Special Interests
- Gender dysphoria could manifest as an obsessive special interest for some autistic children. However, this does not equate to true dysphoria.
Need for Consistency
- The rigidity associated with autism may make it difficult for some individuals to reconcile cross-gender feelings with their assigned sex. Distress could become exacerbated.
Atypical Gender Development
- Differences in social cognition may contribute to variations in gender identity development for autistic individuals. This could increase tendencies toward gender dysphoria.
Reduced Gender Empathy
- Weak central coherence associated with autism could make it difficult for an individual to fully identify with or understand the experience of their assigned gender group.
While these hypotheses attempt to explain the co-occurrence between autism and gender dysphoria, significant gaps in understanding remain. More research is needed to uncover additional factors that may contribute to or drive the development of gender dysphoria in autistic individuals.
Treatment Considerations
Appropriately treating co-occurring gender dysphoria and autism poses a number of challenges:
- There is currently no clinical consensus on best practices. However, experts emphasize the need for an interdisciplinary, thoughtful approach.
- Hormone therapy and gender affirmation surgeries carry long-term effects. Understanding treatment implications may be difficult for some autistic individuals.
- Mental health support focused on coping strategies and self-understanding is recommended to complement any physical transitioning.
- Building communication and social skills through autism interventions could potentially help an individual gain self-insight related to gender.
- Parents and families also need information and support in understanding the nuances of gender dysphoria and autism.
While more research is still needed, the limited current evidence points to a gentle, personalized approach to gender dysphoria in autistic individuals.
Risks of Linking Gender Dysphoria Too Closely to Autism
Some experts have expressed concerns that over-emphasizing the autism link carries risks of perpetuating harmful assumptions. Consider the concept of cisgenderism:
- Cisgenderism refers to the embedded societal assumption that gender is binary, unchanging, and unambiguous.
- This imposes external expectations for conformity to gender norms.
- Transgender identities are often wrongly pathologized as abnormal.
Tying gender dysphoria too closely to the deficits associated with autism could further stigmatize transgender identities as disordered. However, the distress associated with dysphoria may also stem in part from the pressures of cisgenderism.
Instead of focusing on causality, providers should create open, supportive environments for gender-diverse youth. Autistic traits do not invalidate someones gender identity.
The Need for Further Research
The relationship between autism and gender dysphoria remains complex and poorly understood. While the two conditions appear to co-occur at higher than average rates, the reasons behind this association are still unclear. Hypotheses regarding social, developmental, and neurobiological factors require additional research.
Crucially, gender identity itself should not be pathologized. The distress of gender dysphoria may be exacerbated by societal pressures to conform to binary gender norms. An open, accepting approach can help reduce distress and improve outcomes. More work is needed to identify best practices for care.
With further research, providers can gain insights to better support autistic individuals exploring their gender. However, the end goal should be empowering people of all neurotypes to express their gender freely and live as their true, authentic selves.
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References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
Baron-Cohen S. The extreme male brain theory of autism. Trends in Cognitive Sciences. 2002;6(6):248-254. doi:10.1016/s1364-6613(02)01904-6.
de Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA. Autism spectrum disorders in gender dysphoric children and adolescents. Journal of Autism and Developmental Disorders. 2010;40(8):930-6. doi:10.1007/s10803-010-0935-9.
Kennedy N. Cultural cisgenderism: Consequences of the imperceptible. Psychology of Women Section Review. 2013;15(2):3-11.
Pasterski V, Gilligan L, Curtis R. Traits of autism spectrum disorders in adults with gender dysphoria. Archives of Sexual Behavior. 2014;43(2):387-93. doi:10.1007/s10508-013-0154-5.
Shumer DE, Reisner SL, Edwards-Leeper L, Tishelman A. Evaluation of Asperger syndrome in youth presenting to a gender dysphoria clinic. LGBT Health. 2016;3(5):387-90. doi:10.1089/lgbt.2015.0070.
Strang JF, Powers MD, Knauss M, et al. Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents. Journal of Clinical Child & Adolescent Psychology. 2018;47(1):1-11. doi:10.1080/15374416.2016.1228462.