Autistic traits, systemising, empathising, and theory of mind in transgender and non-binary adults

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.

Age- and Sex-Specific Standard Scores for the Reading the Mind in the Eyes Test

“…Additionally, it enables comparability with other studies and facilitates application in clinical settings. The binary coding of sex/gender information may be regarded conventional as it neglects persons with differing sexual identity and personal self-concept potentially influencing socio-cognitive functioning (e.g., Kung, 2020 ). Thus, standard scores provided here may not be applicable in these cases.…”

Autistic Traits, Empathizing–Systemizing, and Gender Diversity

“…Di Ceglie et al ( 2014 ) then reported that empathizing in adolescent transgender males and transgender females was lower than that of cisgender females, though they did not find any differences for systemizing. Although findings in this area have been equivocal (for a review, see van der Miesen et al, 2016 ), Stagg and Vincent ( 2019 ) and Kung ( 2020 ) recently confirmed the pattern of findings that would be predicted by the EMB theory: in both studies, lower empathizing and higher systemizing were found in transgender males relative to cisgender females, but no significant differences were found between transgender females and cisgender males. Although Warrier et al ( 2020 ) reported lower empathizing and higher systemizing in transgender and gender-diverse individuals compared with cisgender individuals in a very large sample, no analysis by birth-assigned sex was possible in that study.…”

“…These findings are consistent with observations of an increased prevalence of autism diagnosis (Heylens et al, 2018 ) and elevated levels of autistic traits in adults attending gender clinics (Heylens et al, 2018 ; Jones et al, 2012 ; Pasterski et al, 2014 ), although it should be noted that not all studies have observed such effects (e.g., Vermaat et al, 2018 ; see also Nobili et al, 2018 ). Warrier et al ( 2020 ) also showed that transgender and gender-diverse adults scored higher on a self-report measure of autistic traits, and other researchers have reported elevated levels of autistic traits in adults with self-reported gender diversity (Kristensen & Broome, 2015 ; Kung, 2020 ). Other studies have indicated that autistic adults report elevated rates of gender variance (Cooper et al, 2018 ; George & Stokes, 2018 ) as well as an elevated likelihood of desiring to be a different gender to that assigned at birth (van der Miesen et al, 2018 ).…”

“…Furthermore, autistic individuals are more likely than neurotypical individuals to report their gender identity as atypical (i.e., not congruent with their birth sex) (Bejerot & Eriksson, 2014 ; George & Stokes, 2018 ). Self-identified non-binary individuals, on average, also score higher on self-report measures of autistic traits and systemizing, and lower on self-report measures of empathizing (Kung, 2020 ; Stagg & Vincent, 2019 ).…”

Social Responsiveness and Psychosocial Functioning in Adults with Prader–Willi Syndrome

“…ASD is more commonly diagnosed in males (3:1 male:female ratio, according to current estimates), although there seems to be a high likelihood of a gender bias in the diagnosis of ASD [ 32 ]. According to the extreme male brain theory, autistic traits in general ASD populations would represent an exaggerated version of the psychological profile typically observed in male individuals and would be associated with increased prenatal exposure to sexual steroids that impact prenatal brain development [ 33 , 34 , 35 , 36 ]. This theory is supported by the known role of sex hormones in brain organization and function during developmental periods, in addition to their activation role in adults [ 37 ].…”