Autistic traits in individuals self-defining as transgender or nonbinary

Abstract

Background: Autism spectrum traits are increasingly being reported in individuals who identify as transgender, and the presence of such traits have implications for clinical support. To-date little is known about autism traits in individuals who identify as nonbinary. Aims: To empirically contribute to current research by examining autistic traits in a self-identifying transgender and nonbinary gender group. Method: One hundred and seventy-seven participants responded to a survey consisting of the Autism Spectrum Quotient (AQ), the Empathy Quotient (EQ), the Systematising Quotient (SQ) and the Reading the Mind in the Eyes Task (RME). Comparisons were made between cisgender, transgender and nonbinary groups. Results: Individuals with autism spectrum disorder (ASD) or meeting the AQ cutoff score for ASD were over-represented in both the transgender and nonbinary groups. The key variables differentiating the transgender and nonbinary groups from the cisgender group were systematising and empathy. Levels of autistic traits and cases of ASD were higher in individuals assigned female at birth than those assigned male at birth. Conclusions: A proportion of individuals seeking help and advice about gender identity will also present autistic traits and in some cases undiagnosed autism. Lower levels of empathy, diminished theory of mind ability and literalness may impede the delivery of effective support. Clinicians treating transgender and nonbinary individuals, should also consider whether clients, especially those assigned female at birth, have an undiagnosed ASD.

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

“…Similar findings have been reported in subsequent studies [2-5, but also see 6]. Regarding comparisons between gender minority adults assigned male at birth and control males, findings from these prior studies were mixed [1][2][3][4][5][6]. All these studies employed versions of the Autism Spectrum Quotient, a self-reported questionnaire, to assess autistic traits [1][2][3][4][5][6].…”

“…Regarding comparisons between gender minority adults assigned male at birth and control males, findings from these prior studies were mixed [1][2][3][4][5][6]. All these studies employed versions of the Autism Spectrum Quotient, a self-reported questionnaire, to assess autistic traits [1][2][3][4][5][6]. Prior studies recruited gender minority adults through clinics [1,2,[4][5][6] and online platforms [3].…”

“…All these studies employed versions of the Autism Spectrum Quotient, a self-reported questionnaire, to assess autistic traits [1][2][3][4][5][6]. Prior studies recruited gender minority adults through clinics [1,2,[4][5][6] and online platforms [3]. All prior studies included transgender men and transgender women [1][2][3][4][5][6], and two of the studies also included non-binary individuals [2,3].…”

“…Prior studies recruited gender minority adults through clinics [1,2,[4][5][6] and online platforms [3]. All prior studies included transgender men and transgender women [1][2][3][4][5][6], and two of the studies also included non-binary individuals [2,3]. Only one study analysed data for non-binary individuals separately, although results were generally similar across the transgender and non-binary groups [3].…”

Both sex- and gender-related factors should be considered in autism research and clinical practice

“…There is an increasing recognition of the prevalence of gender experiences that fall outside of the 'male' and 'female' binary categories (Vincent, 2019), including experiences of having components of both, neither or fluidity of the binary genders. Emerging evidence suggests that nonbinary experiences and identities may be particularly common in autism (Dewinter et al, 2017;Stagg & Vincent, 2019;Walsh et al, 2018). We currently have no validated means of measuring nonbinary gender experiences in autism, and there is limited information on nonbinary autistic individuals' gender-related needs, experiences or mental health.…”