Mental Health Correlates of Autism Spectrum Disorder in Gender Diverse Young People: Evidence from a Specialised Child and Adolescent Gender Clinic in Australia

Abstract

Research suggests an overrepresentation of autism spectrum diagnoses (ASD) or autistic traits in gender diverse samples, particularly in children and adolescents. Using data from the GENTLE (GENder identiTy Longitudinal Experience) Cohort at the Gender Diversity Service at the Perth Children’s Hospital, the primary objective of the current retrospective chart review was to explore psychopathology and quality of life in gender diverse children with co-occurring ASD relative to gender diverse children and adolescents without ASD. The Social Responsiveness Scale (Second Edition) generates a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) score indicating a likely clinical ASD diagnosis, which was used to partition participants into two groups (indicated ASD, n = 19) (no ASD indicated, n = 60). Indicated ASD was far higher than would be expected compared to general population estimates. Indicated ASD on the Social Responsiveness Scale 2 (SRS 2) was also a significant predictor of Internalising behaviours (Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems subscales) on the Youth Self Report. Indicated ASD was also a significant predictor of scores on all subscales of the Paediatric Quality of Life Inventory. The current findings indicate that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life outcomes. Services working with gender diverse young people should screen for ASD, and also provide pathways to appropriate care for the commonly associated mental health difficulties.

A Clinical Program for Transgender and Gender-Diverse Neurodiverse/Autistic Adolescents Developed through Community-Based Participatory Design

“…Emerging evidence suggests a range of risks and unmet needs experienced by A/ND-GD youth. Striking levels of mental health problems have been reported (Mahouda et al, 2019). Common clinical care challenges have been identified, including: 1) difficulties self-advocating around gender dysphoria-related needs, 2) the experience of GD being question/doubted by some families/providers due to assumptions about A/ND, 3) unmet A/ND-related needs, and 4) the direct impact of A/ND differences on GDrelated needs (Strang et al, 2018).…”

Reflections on the Clinician’s Role with Individuals Who Self-identify as Transgender

“…Some assume that the cause of a trans identity is ultimately from combinations of genetics, neural development, prenatal hormones (Roselli, 2018) or post-natal environmental-induced gene expression. A more interactive nature-nurture explanation is illustrated by the elevated incidence of gender dysphoria among the autistic (Leef et al, 2019;Mahfouda et al, 2019). Autism is understood to be primarily the result of embryonic processes on brain development (Estes et al, 2019).…”

Autism and Gender Identity

“…Autism and Gender Identity DOI: http://dx.doi.org/10.5772/intechopen.97517 behavioural disorders" section, instead they can be found under the "Conditions related to sexual health", chapter 17. Such move is justified based on the notion that the broader spectrum of gender identity issues is increasingly recognised as part of normal human diversity and should not be classified as a mental illness [13].…”

“…Among the general population, the prevalence of autism spectrum disorder (ASD) in children is estimated at 1% with a ratio of 1:42 for boys and 1:189 for girls respectively [33]. The evidence that suggests an overrepresentation of ASD in gender diverse samples, particularly in children and adolescents [34,35], is robust and largely accepted by scientific community. The association between GD and ASD has been of great clinical interest because it has implications for diagnosis and treatment.…”

“…GDS is a state-wide service that that has been set up in 2015 as part of local child and adolescent mental health services to provide assessment, consultation and gender-affirming treatment for young people under 18. From the outset, this recently established public service has been committed to embedding research in everyday care by developing a longitudinal cohort database "The GENder identiTy Longitudinal Experience" (GENTLE) and attracting research staff to their multidisciplinary team [13]. GDS has been conceptually developed with so-called Dutch model of care in mind after the process of comprehensive national and international consultation and developing adequate skill base.…”