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

Abstract

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.

A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability

“…Higher prevalence of suicidality is also found in autistic people who are transgender, and gender nonconforming compared to those who are cisgender (i.e. identify with sex assigned at birth) [33,34]. Despite this, studies have only recently begun to acknowledge the joint impact of diverse gender identities and autism on mental health outcomes.…”

Autism and Gender Dysphoria: A Narrative Review of Their Coexistence and Clinical Implications

“…There is evidence that adults with ASD may experience an increased desire to be the opposite sex, related in part to the social isolation characteristic of ASD, which can influence the perception of belonging to their own gender (CHANG et al, 2022). Also indicating that adults with ASD who lacked family support during childhood and adolescence may present stereotypical behaviors and face mental health challenges, such as depression and anxiety, which significantly affect quality of life and may interact with GD experiences (CHANG et al, 2022). These factors are corroborated by studies that identified a higher incidence of bullying in autistic individuals who express a divergent gender identity (CRESSWELL et al, 2019).…”