Individuals with gender dysphoria and autism: barriers to good clinical practice

Lehmann, Katrin; Leavey, Gerard

doi:10.1111/jpm.12351

Cited by 7 publications

(6 citation statements)

References 44 publications

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“…This suggests that gender diverse participants with ASD have a reduced quality of life across their physical health, social and emotional wellbeing, and school functioning compared to gender diverse participants without indicated ASD. These findings complement studies that indicate high levels of stigma and prejudice in gender diverse young people with co-occurring ASD, who receive less parental support when disclosing concerns about gender identity [31]. The finding of reduced quality of life indicators in this high-risk group underscore the importance of providing psychosocial support to gender diverse young people with co-occurring ASD and their families.…”

Section: Discussionsupporting

confidence: 74%

“…Mental health difficulties, including generalised anxiety disorder, suicidal ideation and intent, and attention-deficit hyperactivity disorder, are significantly more prevalent in young gender diverse [24,25,26] and ASD [27,28,29,30] groups. In addition, while each group is exposed to significant levels of stigma and prejudice, gender diverse young people with ASD experience lower rates of parental support when disclosing concerns around their gender identity, which may exacerbate distress should they wish to transition socially (which might include a change in gender pronouns) or medically (via hormonal interventions) [31].…”

Section: Introductionmentioning

confidence: 99%

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

Mahfouda

Panos

Whitehouse

et al. 2019

JCM

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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.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

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

Mahfouda

Panos

Whitehouse

et al. 2019

JCM

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“…A protective factor against depression in transgender adolescents is parental support (21). Unfortunately, as seen in this patient, those with a GD-ASD comorbidity often face parental skepticism when reporting gender-related distress, thus intensifying their distress, and hopelessness (21,22).…”

Section: Discussionmentioning

confidence: 87%

“…However, respecting diversity when providing care to all individuals is very important. Clinical services for such individuals require considerable awareness and sensitive adjustment throughout the care pathway to avoid further marginalization, or oppression and to consider their specific needs (22,28). We aimed for this goal in the care of the presented patient.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Adolescent With Autism and Gender Dysphoria

et al. 2021

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There is increasing clinical evidence of an association between gender variability, gender dysphoria (GD), and autism spectrum disorder (ASD). This seems to be a two-way relationship, a person with GD is more likely to be diagnosed with ASD and vice versa. In youth, it is important to distinguish whether the presented symptoms are a manifestation of ASD focus on special interests or symptoms of co-occurring GD. This distinction is crucial in the process of planning reversible and especially irreversible medical procedures in the context of treatment. We present the case of a birth-assigned female adolescent with GD, who enrolled in our clinic at the age of 16.5 years with “being transgender” as her main complaint accompanied by a wish for surgical breast removal. His (as the patient prefers to use male pronouns) medical and developmental history involved obesity, hyperlipidemia, delays in social and language development and specific interests and rituals. He presented with half a year of untreated depression, suicidal thoughts and non-suicidal self-injuring, social phobia and relative social isolation. Comprehensive clinical assessments revealed a female karyotype (46, XX), normal female genitalia and unremarkable hormonal status. Clinical psychological assessments reported GD, ASD with average intellectual abilities and co-occurring symptoms of depression and anxiety. Other disorders, such as psychosis, personality disorder and dysmorphophobia, were excluded during longer-term diagnostic and psychotherapeutic processes. Our first aim was to build a good therapeutic alliance with the patient and treat depression and suicidality. He refused to take sertraline, but took a St. John's Wort over-the-counter peroral preparation in the form of infusions. His mood improved, he was no longer suicidal and started social transitioning, yet he remained socially phobic. At the time of writing, he is 20 years old, waiting for bilateral mastectomy and receiving regular triptorelin depot and testosterone depot intramuscular injections. Even though the diagnostic procedures and transition process in autistic gender diverse adolescents may take longer than in non-autistic individuals, ASD is not a contraindication to the gender transition process. We present a well-documented case of a slow social and medical transition resulting in gradual improvement of co-occurring symptoms of GD.

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“…The social stigma and prejudice associated with both ASD and GD may cause those with both minority statuses to experience more difficulties in school and employment environments and hence suffer from a higher risk of being bullied and exploited and become the victim of violence and social isolation (Strang, Meagher, et al, 2018). Consider that some autistic adults might struggle with gender-variant feelings, receive less support for their gender identity development, and suffer from prejudice and stigma (Lehmann & Leavey, 2017). The diagnosis of ASD should not keep people away from social and mental health and medical support to explore their gender (Strang, Meagher, et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Mental health correlates and potential childhood predictors for the wish to be of the opposite sex in young autistic adults

Chang

Lai

Tai

et al. 2021

Autism

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Cross-sectional research has demonstrated the overrepresentation of gender dysphoria in children and adults with autism spectrum disorder. However, the predictors and underlying mechanisms of this co-occurrence remain unclear. This follow-up study aimed to explore baseline (childhood/adolescence) predictors for the follow-up (adulthood) self-reported wish to be of the opposite sex and to investigate its mental health correlates in a sample of 88 autistic individuals as compared with 42 typically developing controls. An item on the Adult Self-Report Inventory-4, “I wish I was the opposite sex,” was used. We compared mental health symptoms between adults with and without this item endorsement. We used prediction models to explore family and autism-related predictors in childhood/adolescence to endorse this item in adulthood. There were more adults endorsing the item in the autism spectrum disorder group compared with the typically developing group. Autistic adults who endorsed the item experienced more mental health challenges, more bullying victimization, more suicidal ideations, and worse quality of life. Lower parent-reported family support and more stereotyped/repetitive behaviors during childhood/adolescence predicted the self-reported wish to be of the opposite sex in adulthood in autistic individuals. It is necessary to raise more attention to gender development and related mental health impact in autistic individuals. Lay abstract Autistic people/people with autism spectrum disorder are more likely to experience gender dysphoria. However, the possible longitudinal predictors and underlying mechanisms of this co-occurrence are unclear. To fill this knowledge gap, we assessed 88 people with autism spectrum disorder and 42 typically developing individuals at their average ages of 13.0 (baseline, childhood/adolescence) and 20.2 years old (follow-up, adulthood). At follow-up, their endorsement on the item “I wish I was the opposite sex” was used to evaluate gender dysphoric symptoms. We compared mental health symptoms between adults with and without this item endorsement at the follow-up assessment. We explored parent-reported family and autism characteristics-related predictors in childhood/adolescence to this item endorsement in adulthood. We found that more autistic adults reported the wish to be of the opposite sex than did typically developing individuals. Autistic adults who endorsed this item experienced more mental health challenges, more school bullying and cyberbullying, more suicidal ideation, and worse quality of life. Moreover, parent-reported lower family support and more stereotyped/repetitive behaviors during childhood/adolescence predicted the self-reported wish to be of the opposite sex in adulthood in autistic individuals. More attention and support should be provided to autistic people regarding gender development and related mental health and quality of life impact, especially during the transition period to young adulthood.

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Individuals with gender dysphoria and autism: barriers to good clinical practice

Cited by 7 publications

References 44 publications

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

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

Case Report: Adolescent With Autism and Gender Dysphoria

Mental health correlates and potential childhood predictors for the wish to be of the opposite sex in young autistic adults

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