Mental health difficulties among trans and gender diverse young people with an autism spectrum disorder (ASD): Findings from Trans Pathways

Strauss, Penelope; Cook, Angus; Watson, Vanessa; Whitehouse, Andrew J. O.; Albrecht, Nicole; Toussaint, Dani Wright; Lin, Ashleigh

doi:10.1016/j.jpsychires.2021.03.005

Cited by 43 publications

(20 citation statements)

References 34 publications

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“…It is also important to note that the high co-occurrence between ASD and GD/GI is underrecognized among health care professionals (Murphy & Livesey, 2017). Evidence about a link between ASD and GD/GI might stimulate the development of appropriate trainings to raise their awareness (Strauss, et al, 2021), so that GD/GI people are screened for ASD and autistic people for gender related issues (Mahfouda et al, 2019;Strang, Meagher, et al, 2018). Gender related issues in autistic people could be detected by using self/parent-report measures, such as the GIDYQ-AA (Deogracias et al, 2007) and the Gender Identity Questionnaire for Children (Johnson et al, 2004) and by including a few gender related questions on a clinical intake form or a clinical interview (Strang, Meagher, et al, 2018).…”

Section: Referencesmentioning

confidence: 99%

Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis

Kallitsounaki

Williams

2022

J Autism Dev Disord

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The suggested overlap between autism spectrum disorder (ASD) and gender dysphoria/incongruence (GD/GI) has been much disputed. This review showed a relationship between ASD traits and GD feelings in the general population and a high prevalence of GD/GI in ASD. Our meta-analyses revealed that the pooled estimate of the prevalence of ASD diagnoses in GD/GI people was 11% (p < .001) and the overall effect size of the difference in ASD traits between GD/GI and control people was significant (g = 0.67, p < .001). Heterogeneity was high in both meta-analyses. We demonstrated that the chances that there is not a link between ASD and GD/GI are negligible, yet the size of it needs further investigation.

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Section: Referencesmentioning

confidence: 99%

Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis

Kallitsounaki

Williams

2022

J Autism Dev Disord

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“…Mental health problems are more common in autistic people ( Lai et al., 2019 ) and in transgender individuals ( Dhejne et al, 2016 ). There is emerging evidence that being both transgender and autistic is associated with yet higher rates of mental health problems ( George & Stokes, 2018 ; Murphy et al, 2020 ; Strang et al, 2021 ; Strauss et al, 2021 ). While there have been numerous studies investigating the increased prevalence of transgender identities in autistic people ( Glidden et al, 2016 ), there have been fewer attempts to understand the inner experiences of this group.…”

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confidence: 99%

The lived experience of gender dysphoria in autistic adults: An interpretative phenomenological analysis

Cooper

Mandy

Butler

et al. 2021

Autism

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Autistic people are more likely to be transgender, which means having a gender identity different to one’s sex assigned at birth. Some transgender people experience distress about this incongruence or gender dysphoria. Few studies have aimed to understand the inner experiences of this group. In this study, we used Interpretive Phenomenological Analysis to understand the lived experience of gender dysphoria. Twenty-one autistic adults were interviewed about their experience of incongruence between their gender identity and sex assigned at birth, and any associated distress. The interviews were transcribed and analysed using Interpretive Phenomenological Analysis. Participants described significant distress because their bodies did not match their gender identities, their need to understand their identities more broadly and to manage complex intersecting needs. Participants experienced distress due to living in a world which is not always accepting of gender- and neuro-diversity. Participants described barriers in accessing healthcare for their gender needs. Some participants felt being autistic had facilitated their understanding of their gender identity. Other participants described challenges such as a tension between their need to undergo a physical gender transition versus a need for sameness and routine. In conclusion, there can be both positive experiences and additional challenges for autistic transgender people. Lay Abstract Autistic people are more likely to be transgender, which means having a gender identity different to one’s sex assigned at birth. Some transgender people experience distress about their gender and sex assigned at birth not matching which is called gender dysphoria. Research has focused on finding out why autistic people are more likely to have gender dysphoria, and less on what the experience of gender dysphoria is like for autistic people. We interviewed 21 autistic adults about their experience of incongruence between their gender identity and sex assigned at birth, and any associated distress. We carefully read the transcripts of the interviews, focusing on how participants understood their experiences. We found a range of themes from the interviews. Participants were distressed because their bodies did not match their gender identities. Participants told us they had to work hard to understand themselves and who they were, and to manage having multiple different needs such as mental health needs. It was upsetting for participants to experience discrimination because of being autistic and/or transgender. Some participants said it was more difficult to get transgender healthcare as an autistic person. Some participants thought being autistic had helped them understand their gender identity more than non-autistic people. Other participants found it was challenging to be both autistic and transgender. For example, most participants wanted to change their bodies to match their gender identity, but some participants were nervous about making changes to themselves and their routine due to being autistic. We conclude that autism can in some ways be helpful and other ways contribute to challenges for transgender autistic people.

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“…We should note here that researchers, with the exception of Jones et al ( 2012 ), Murphy et al ( 2020 ), and Warrier et al ( 2020 ), either did not control for (or did not collect/report information about) the presence of autistic people in the gender diverse samples in their studies. This is important because research has shown a high prevalence of ASD diagnoses in this population (e.g., Strauss et al, 2021 ; for a meta-analysis see Kallitsounaki & Williams, 2022 ), and as expected based on their diagnosis, autistic transgender people show significantly more ASD traits than neurotypical transgender people (Warrier et al, 2020 ). Arguably, the inclusion of autistic people in these studies could have inflated the AQ/SRS score of gender diverse samples.…”

Section: Introductionmentioning

confidence: 94%

“…Research has provided strong evidence that the co-occurrence of ASD and gender diversity is accompanied by an increase in internalizing conditions (e.g., anxiety and depression), self-harm, and suicidality (George & Stokes, 2018a ; Mahfouda et al, 2019 ; Strang et al, 2021 ; Strauss et al, 2021 ). This highlights the need for specialized and tailored support and care for this group.…”

Section: Introductionmentioning

confidence: 99%

Implicit and Explicit Gender-Related Cognition, Gender Dysphoria, Autistic-Like Traits, and Mentalizing: Differences Between Autistic and Non-Autistic Cisgender and Transgender Adults

Kallitsounaki

Williams

2022

Arch Sex Behav

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Evidence indicates a link between autism spectrum disorder (ASD) and gender diversity, yet this intersection remains insufficiently understood. Here, we investigated whether (1) ASD affects gender-related cognition (i.e., mental processes of perceiving and interpreting one’s own gender self-concept), (2) autistic people have increased gender dysphoria and recall limited gender-typed behavior from childhood, and (3) transgender individuals have increased ASD-like traits and difficulties in mentalizing. A total of 106 non-autistic cisgender (51 birth-assigned female), 107 autistic cisgender (57 birth-assigned female), 78 non-autistic transgender (41 birth-assigned female), and 56 autistic transgender adults (27 birth-assigned female) participated in the study. The mean age of participants was 31.01 years (range = 18 to 70). Using an explicit as well as an implicit measure, for the first time, we found that ASD affected gender-related cognition only in autistic cisgender people. Sex differences were also observed in this group. Whereas autistic cisgender birth-assigned males showed a stronger implicit gender-group identification than non-autistic cisgender birth-assigned males, autistic cisgender birth-assigned females showed a weaker gender-group identification than non-autistic cisgender birth-assigned females. Furthermore, autistic cisgender people reported significantly more gender dysphoric feelings and recalled significantly less gender-typed behavior from childhood than non-autistic cisgender individuals. No difference was observed between non-autistic and autistic transgender people. We also found that relative to non-autistic cisgender individuals, both non-autistic transgender and autistic transgender people reported significantly more ASD-like traits. However, mentalizing difficulties were observed only in the latter group. This research enhances our understanding of the link between ASD and gender diversity.

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Mental health difficulties among trans and gender diverse young people with an autism spectrum disorder (ASD): Findings from Trans Pathways

Cited by 43 publications

References 34 publications

Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis

Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis

The lived experience of gender dysphoria in autistic adults: An interpretative phenomenological analysis

Implicit and Explicit Gender-Related Cognition, Gender Dysphoria, Autistic-Like Traits, and Mentalizing: Differences Between Autistic and Non-Autistic Cisgender and Transgender Adults

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