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Shimoyama S, Endo T. Revisiting the Link: A qualitative analysis of the diverse experiences of gender dysphoria as a subset of pervasive social dysphoria co-occurring with autism in Japan. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241235722. [PMID: 38465656 DOI: 10.1177/13623613241235722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
LAY ABSTRACT Studies have suggested that autistic people are more likely to experience gender dysphoria, which refers to the gender-related distress emerging from personal factors and gender norms that some transgender people experience. Transgender people are diverse; some experience gender incongruence (i.e. an incompatibility between a person's gender identity and that expected of them based on their birth-assigned gender), whereas others do not. Therefore, the association of autistic transgender people's gender dysphoria with gender incongruence varies, and the literature has overlooked such diversity. Interviews with 15 Japanese autistic transgender adults revealed diverse gender dysphoria experiences independent of gender incongruence, such as resistance to the societal gender norms themselves, physical dysphoria caused by the imposition of gender, sensory disgust related to autistic sensory sensitivities, uncertainty about the gender norms of the social majority, and the autistic burden of living in a gendered society. Moreover, we found that most participants had not only accumulated distress over gender norms (i.e. gender dysphoria) but also over pervasive social norms, termed Pervasive Social Dysphoria. Our findings suggests that future co-occurrence research and practice must affirm these internal perspectives more, such as by providing support for both gender dysphoria and Pervasive Social Dysphoria, as autistic transgender people may experience gender dysphoria as a subset of Pervasive Social Dysphoria.
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2
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Mazzoli F, Cassioli E, Ristori J, Castellini G, Rossi E, Cocchetti C, Romani A, Angotti T, Giovanardi G, Mosconi M, Lingiardi V, Speranza AM, Ricca V, Vignozzi L, Maggi M, Fisher AD. Apparent autistic traits in transgender people: a prospective study of the impact of gender-affirming hormonal treatment. J Endocrinol Invest 2022; 45:2059-2068. [PMID: 35779204 PMCID: PMC9525411 DOI: 10.1007/s40618-022-01835-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated differences in Autism Spectrum Quotient (AQ) scores between a sample of hormone-naïve transgender and cisgender people and the impact of gender-affirming hormonal treatment (GAHT) on AQ scores across time. Furthermore, we assessed alexithymia and social anxiety as possible mediators of changes in AQ scores. METHODS A cross-sectional comparison between cisgender and transgender people before GAHT and a prospective study on the effects of GAHT over time were performed. Transgender and cisgender people completed several psychometric tests. A total sample of 789 persons (n = 229 cismen; n = 172 ciswomen; n = 206 transmen; n = 182 transwomen) referring to the Florence and Rome Gender Clinics between 2018 and 2020 was enrolled. Of these, 62 participants referring to the Florence Gender Clinic were evaluated in a prospective study at baseline and 12 months after GAHT. RESULTS Groups showed significant differences in terms of autistic traits: ciswomen showed lower scores of AQ, while cismen reported higher scores of AQ than all other groups. Transgender individuals showed significant higher levels of Gender Dysphoria (GD), body uneasiness, alexithymia and social anxiety, compared to cisgender ones. No significant differences in general psychopathology were found between groups. Across time, transmen and transwomen showed a significant reduction in AQ scores. The decrease in alexithymia and social anxiety after GAHT did not predict the change in AQ scores. CONCLUSIONS The autistic traits in our sample may represent an epiphenomenon of GD rather than being part of an Autism Spectrum Disorder (ASD) condition, since they significantly decreased after 12 months of GAHT.
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Affiliation(s)
- F Mazzoli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - E Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - J Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - G Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - E Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - C Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - A Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - T Angotti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - G Giovanardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - M Mosconi
- Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - V Lingiardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A M Speranza
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - V Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - A D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy.
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy.
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3
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Maggio MG, Calatozzo P, Cerasa A, Pioggia G, Quartarone A, Calabrò RS. Sex and Sexuality in Autism Spectrum Disorders: A Scoping Review on a Neglected but Fundamental Issue. Brain Sci 2022; 12:1427. [PMID: 36358354 PMCID: PMC9688284 DOI: 10.3390/brainsci12111427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/16/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2023] Open
Abstract
ASD consists of a set of permanent neurodevelopmental conditions, which are studded with social and communication differences, limited interests, and repetitive behaviors. Individuals with ASD have difficulty reading eye gestures and expressions, and may also have stereotyped or repetitive language, excessive adherence to routines, fixed interests, and rigid thinking. However, sexuality in adolescents and young adults with ASD is still a poorly studied and neglected issue. This review aims to evaluate sexual function and behavior in individuals with ASD to foster a greater understanding of this important, although often overlooked, issue. This review was conducted by searching peer-reviewed articles published between 01 June 2000 and 31 May 2022 using the following databases: PubMed, Embase, Cochrane Database, and Web of Science. A comprehensive search was conducted using the terms: "Autism" OR "ASD" AND "Sexuality" OR "Romantic relation" OR "sexual behavior" AND/OR "sexual awareness". After an accurate revision of 214 full manuscripts, 11 articles satisfied the inclusion/exclusion criteria. This review found that, although individuals with ASD may have sexual functioning, their sexuality is characterized by higher prevalence rates of gender dysphoria and inappropriate sexual behavior. Furthermore, sexual awareness is reduced in this patient population, and the prevalence of other variants of sexual orientation (i.e., homosexuality, asexuality, bisexuality, etc.) is higher in adolescents with ASD than in non-autistic peers. Sexual health and education should be included in the care path of patients with ASD in order to improve their quality of life and avoid/reduce inappropriate and risky behaviors.
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Affiliation(s)
- Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy
| | - Patrizia Calatozzo
- Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, 98124 Messina, Italy
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98164 Messina, Italy
- Sant’Anna Institute, 88900 Crotone, Italy
- Pharmacotechnology Documention and Transfer Unit, Preclinical and Traslation Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Calabria, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98164 Messina, Italy
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4
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Kallitsounaki A, Williams DM. Implicit and Explicit Gender-Related Cognition, Gender Dysphoria, Autistic-Like Traits, and Mentalizing: Differences Between Autistic and Non-Autistic Cisgender and Transgender Adults. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3583-3600. [PMID: 35972636 PMCID: PMC9556420 DOI: 10.1007/s10508-022-02386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
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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Affiliation(s)
- Aimilia Kallitsounaki
- Division of Human & Social Sciences, School of Psychology, Keynes College, University of Kent, Canterbury, CT2 7NP, UK.
| | - David M Williams
- Division of Human & Social Sciences, School of Psychology, Keynes College, University of Kent, Canterbury, CT2 7NP, UK
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5
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Chang JC, Lai MC, Tai YM, Gau SSF. Mental health correlates and potential childhood predictors for the wish to be of the opposite sex in young autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:146-159. [PMID: 34120486 DOI: 10.1177/13623613211024098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
| | - Meng-Chuan Lai
- National Taiwan University Hospital, Taiwan.,Centre for Addiction and Mental Health, Canada.,The Hospital for Sick Children, Canada.,University of Toronto, Canada.,University of Cambridge, UK
| | | | - Susan Shur-Fen Gau
- National Taiwan University Hospital, Taiwan.,Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taiwan
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6
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Sala G, Pecora L, Hooley M, Stokes MA. As Diverse as the Spectrum Itself: Trends in Sexuality, Gender and Autism. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020. [DOI: 10.1007/s40474-020-00190-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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7
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Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS. Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review. J Autism Dev Disord 2019; 50:695-706. [DOI: 10.1007/s10803-019-04298-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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8
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Shapira S, Granek L. Negotiating psychiatric cisgenderism-ableism in the transgender- autism nexus. FEMINISM & PSYCHOLOGY 2019. [DOI: 10.1177/0959353519850843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most of the literature on autism and gender is rooted in a medical deficiency model. This study aimed to critically examine the discursive position of mainstream clinicians-researchers and to explore how their position affects, and may be affected by, autistic transgender individuals. We analyzed nine psychiatric case studies depicting autistic transgender individuals, and five texts written by transgender Aspie (i.e. having Asperger’s syndrome) individuals in online blogs and forums. The critical discourse analysis revealed that within the case studies’ cisgenderist-ableist lens, co-occurring autism and transgender were considered co-morbidities. Aspie transgender individuals reported difficulties in receiving social recognition of their gender. We discussed their ambivalence toward the cisgenderist-ableist discourse in light of recent cultural negotiations over the normativity of transgenderism and autism which start broadening the intelligibility of neuroqueer positions.
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9
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Abstract
Studies have shown an increase of symptoms of autism spectrum disorder (ASD) in gender dysphoria (GD). Various hypotheses try to explain this possible co-occurrence (e.g., a role of resistance to change, stereotyped behaviors or prenatal testosterone exposure). This study examined ASD symptoms with the Children’s Social Behavior Questionnaire (CSBQ) in 490 children with GD compared to 2507 typically developing (TD) and 196 children with ASD. CSBQ total scores of the GD sample were in between scores from the TD and ASD sample. The GD sample showed elevated levels of autistic symptomatology on all subdomains, not only on stereotyped and resistance to change. Further, no gender differences and interaction effects were found on the total CSBQ, making a sole role for prenatal testosterone unlikely.
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10
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Nabbijohn AN, van der Miesen AIR, Santarossa A, Peragine D, de Vries ALC, Popma A, Lai MC, VanderLaan DP. Gender Variance and the Autism Spectrum: An Examination of Children Ages 6-12 Years. J Autism Dev Disord 2019; 49:1570-1585. [PMID: 30547258 DOI: 10.1007/s10803-018-3843-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Gender variance (GV) and autism spectrum disorder (ASD) frequently co-occur in clinical populations. We investigated GV in association with ASD characteristics in nonclinical children and in children with developmental/mental health diagnoses. In 6-12-year-olds (N = 2445; 51% birth-assigned boys), the Gender Identity Questionnaire for Children measured GV and the Children's Social Behavior Questionnaire measured six subdomains of ASD characteristics. Among nonclinical children, GV was associated with parent-reported difficulties orienting socially and stereotyped behaviors. GV was also associated with parent-reported clinical diagnoses of ASD, sensory processing disorder, and oppositional defiant disorder. These findings suggest associations between specific ASD characteristics and GV in nonclinical children. Also, childhood GV should be further examined in a range of clinical populations, including ASD individuals.
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Affiliation(s)
- A Natisha Nabbijohn
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Alanna Santarossa
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada.,Faculty of Medicine, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Diana Peragine
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Meng-Chuan Lai
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health and The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK.,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Road, Office 4098, Mississauga, ON, L5L 1C6, Canada. .,Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.
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11
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Abstract
BACKGROUND There is growing awareness and exposure in both the medical community and the lay media about the characteristics and complex needs of individuals who believe that their gender identity does not match their birth sex. Despite research and lay publications about teens with gender dysphoria and those who identify as transgender, little guidance is available regarding young (prepubertal) children with questions about their gender identity. Although many terms are used to describe these children, we have chosen to describe them as "gender nonconforming" (GNC). OBJECTIVE Primary care and developmental-behavioral pediatric providers are often the first professionals with whom young gender nonconforming children and their families discuss their concerns about their emerging gender identity. It is important, therefore, that pediatric providers be knowledgeable about the dilemmas, conflicts, and choices that are typical of these children and their families to guide them appropriately. OVERVIEW In this special article, we present observations, informed by clinical experience, an emerging body of research, and a developmental-behavioral pediatric framework, of the complex needs of prepubertal gender nonconforming children and their families and an approach to their care. The article begins by outlining the cognitive and biological bases for gender identity development, as well as the natural history of gender nonconforming preferences and behaviors. It then sets the context for understanding the care of GNC children as an area in which developmentally sophisticated providers can play a crucial role in support of the complex developmental patterns and need for advocacy in multiple settings among these children.
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12
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Øien RA, Cicchetti DV, Nordahl-Hansen A. Gender Dysphoria, Sexuality and Autism Spectrum Disorders: A Systematic Map Review. J Autism Dev Disord 2018; 48:4028-4037. [PMID: 30019279 DOI: 10.1007/s10803-018-3686-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this systematic map review, we aimed (1) at identifying studies including the co-occurrence of autism spectrum disorders (ASD) and gender dysphoria (GD) between 1946 and 2018, and (2) to present the papers included in this systematic map review to provide authors in the field of GD, sexuality and ASD with an important database of studies focusing on this very complex topic. The field is of emerging interest, as observed by the large increase of studies over the past decades, especially since 2015. However, future challenges are to be addressed in future studies.
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Affiliation(s)
- Roald A Øien
- Department of Psychology, UiT - The Arctic University of Norway, PB 6050, 9037, Tromsø, Norway. .,Child Study Center, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Domenic V Cicchetti
- Child Study Center, Yale School of Medicine, Yale University, New Haven, CT, USA
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13
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Cooper K, Smith LGE, Russell AJ. Gender Identity in Autism: Sex Differences in Social Affiliation with Gender Groups. J Autism Dev Disord 2018; 48:3995-4006. [PMID: 29705922 PMCID: PMC6223803 DOI: 10.1007/s10803-018-3590-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
High rates of gender variance have been reported in autistic people, with higher variance in autistic females than males. The social component of gender identity may be affected, with autistic females experiencing lower identification with and feeling less positively about their gender groups than controls. We measured gender identification, gender self-esteem, and aspects of gender expression (masculinity and femininity) in autistic natal males and females, and controls (N = 486). We found that autistic people had lower gender identification and gender self-esteem than controls, and autistic natal females had lower gender identification than autistic natal males and natal female controls. In conclusion, autistic people, particularly natal females, had lower social identification with and more negative feelings about a gender group.
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Affiliation(s)
- Kate Cooper
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Laura G E Smith
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Ailsa J Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
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14
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Nobili A, Glazebrook C, Bouman WP, Glidden D, Baron-Cohen S, Allison C, Smith P, Arcelus J. Autistic Traits in Treatment-Seeking Transgender Adults. J Autism Dev Disord 2018; 48:3984-3994. [PMID: 29654452 PMCID: PMC6223809 DOI: 10.1007/s10803-018-3557-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The present study aimed to compare prevalence of autistic traits measured by the self-reported autism spectrum quotient-short (AQ-short) in a transgender clinical population (n = 656) matched by age and sex assigned at birth to a cisgender community sample. Results showed that transgender and cisgender people reported similar levels of possible autistic caseness. Transgender people assigned female were more likely to have clinically significant autistic traits compared to any other group. No difference was found between those assigned male. High AQ scores may not be indicative of the presence of an autism spectrum condition as the difference between groups mainly related to social behaviours; such scores may be a reflection of transgender people’s high social anxiety levels due to negative past experiences.
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Affiliation(s)
- Anna Nobili
- Nottingham National Centre for Transgender Health, Nottingham, UK
- Institute of Mental Health, University of Nottingham, Room B12, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Cris Glazebrook
- Institute of Mental Health, University of Nottingham, Room B12, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.
| | | | - Derek Glidden
- Nottingham National Centre for Transgender Health, Nottingham, UK
- Nottingham City Asperger Service, Highbury Hospital, Nottingham, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paula Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jon Arcelus
- Nottingham National Centre for Transgender Health, Nottingham, UK
- Institute of Mental Health, University of Nottingham, Room B12, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
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15
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van der Miesen AIR, Hurley H, Bal AM, de Vries ALC. Prevalence of the Wish to be of the Opposite Gender in Adolescents and Adults with Autism Spectrum Disorder. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2307-2317. [PMID: 29736809 PMCID: PMC6245048 DOI: 10.1007/s10508-018-1218-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 05/25/2023]
Abstract
Several studies have suggested an overrepresentation of (symptoms of) autism spectrum disorder (ASD) among individuals with gender dysphoria. Three studies have taken the inverse approach in children with ASD and showed increased parent report of the wish to be of the opposite gender in this group. This study compared the self-reported wish to be of the opposite gender (one item of the Youth Self-Report [YSR] and the Adult Self-Report [ASR]) of 573 adolescents (469 assigned boys and 104 assigned girls) and 807 adults (616 assigned males and 191 assigned females) with ASD to 1016 adolescents and 846 adults from the general population. Emotional and behavioral problems were measured by the DSM-oriented scales of the YSR and ASR. In addition, the Children's Social Behavior Questionnaire and the Adult Social Behavior Questionnaire were used to measure specific subdomains of the ASD spectrum to test whether specific subdomains of ASD were particularly involved. Significantly more adolescents (6.5%) and adults (11.4%) with ASD endorsed this item as compared to the general population (3-5%). In adolescents, assigned girls endorsed this item more than assigned boys. No significant gender differences were found in the adults with ASD. In addition, on all DSM-oriented scales of both the YSR and ASR, adolescents and adults with ASD who endorsed the gender item had significantly higher scores compared to those without. There were no significant associations between endorsement of the gender item and any specific subdomain of ASD, providing no evidence for a sole role of one of the ASD subdomains and endorsement of the wish to be the opposite gender.
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Affiliation(s)
- Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Hannah Hurley
- Dr. Leo Kannerhuis, Center for Autism, Amsterdam, The Netherlands
| | - Anneloes M Bal
- Dr. Leo Kannerhuis, Center for Autism, Amsterdam, The Netherlands
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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16
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Turban JL, van Schalkwyk GI. "Gender Dysphoria" and Autism Spectrum Disorder: Is the Link Real? J Am Acad Child Adolesc Psychiatry 2018; 57:8-9.e2. [PMID: 29301673 DOI: 10.1016/j.jaac.2017.08.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/10/2017] [Accepted: 09/08/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Jack L Turban
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston.
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17
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Kuvalanka KA, Mahan DJ, McGuire JK, Hoffman TK. Perspectives of Mothers of Transgender and Gender-Nonconforming Children With Autism Spectrum Disorder. JOURNAL OF HOMOSEXUALITY 2017; 65:1167-1189. [PMID: 29161222 DOI: 10.1080/00918369.2017.1406221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study represents findings from interviews at two time points with three mothers of transgender and gender-nonconforming (TGNC) children (ages 8 to 12 years at T1) with autism spectrum disorder (ASD). Of interest was the mothers' experiences of raising a TGNC child with ASD, and whether/how the children's autism played a role in their understandings of their children's gender identities and expressions. The mothers' fear of a transphobic/cisnormative society and wondering about whether their children's ASD influenced or caused their children's gender variance were barriers to fully embracing their children's gender nonconformity. Unclear causes of children's social/emotional difficulties and lack of adequate resources and support were identified challenges. Positive interventions and resources were also discussed. Recommendations for clinicians and other professionals who serve TGNC youth with autism and their families are presented.
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Affiliation(s)
- Katherine A Kuvalanka
- a Department of Family Science and Social Work , Miami University , Oxford , Ohio , USA
| | - Derek J Mahan
- b Department of Family Social Science , University of Minnesota , Minneapolis , Minnesota , USA
| | - Jenifer K McGuire
- b Department of Family Social Science , University of Minnesota , Minneapolis , Minnesota , USA
| | - Tracey K Hoffman
- c Department of Education and Society , Miami University , Oxford , Ohio , USA
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18
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Zucker KJ, Nabbijohn AN, Santarossa A, Wood H, Bradley SJ, Matthews J, VanderLaan DP. Intense/obsessional interests in children with gender dysphoria: a cross-validation study using the Teacher's Report Form. Child Adolesc Psychiatry Ment Health 2017; 11:51. [PMID: 29021824 PMCID: PMC5613451 DOI: 10.1186/s13034-017-0189-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/16/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE This study assessed whether children clinically referred for gender dysphoria (GD) show symptoms that overlap with Autism Spectrum Disorder (ASD). Circumscribed preoccupations/intense interests and repetitive behaviors were considered as overlapping symptoms expressed in both GD and ASD. METHODS To assess these constructs, we examined Items 9 and 66 on the Teacher's Report Form (TRF), which measure obsessions and compulsions, respectively. RESULTS For Item 9, gender-referred children (n = 386) were significantly elevated compared to the referred (n = 965) and non-referred children (n = 965) from the TRF standardization sample. For Item 66, gender-referred children were elevated in comparison to the non-referred children, but not the referred children. CONCLUSIONS These findings provided cross-validation of a previous study in which the same patterns were found using the Child Behavior Checklist (Vanderlaan et al. in J Sex Res 52:213-19, 2015). We discuss possible developmental pathways between GD and ASD, including a consideration of the principle of equifinality.
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Affiliation(s)
- Kenneth J. Zucker
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8 Canada
| | - A. Natisha Nabbijohn
- 0000 0001 2157 2938grid.17063.33Department of Psychology, University of Toronto Mississauga, Mississauga, ON Canada
| | - Alanna Santarossa
- 0000 0001 2157 2938grid.17063.33Department of Psychology, University of Toronto Mississauga, Mississauga, ON Canada
| | - Hayley Wood
- Psychological Services, Toronto District School Board, Toronto, ON Canada
| | - Susan J. Bradley
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8 Canada
| | - Joanna Matthews
- 0000 0001 2157 2938grid.17063.33Department of Psychology, University of Toronto Mississauga, Mississauga, ON Canada
| | - Doug P. VanderLaan
- 0000 0001 2157 2938grid.17063.33Department of Psychology, University of Toronto Mississauga, Mississauga, ON Canada ,0000 0000 8793 5925grid.155956.bUnderserved Populations Research Program, Child, Youth and Family Division, Centre for Addiction and Mental Health, Toronto, ON Canada
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19
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George R, Stokes MA. Gender identity and sexual orientation in autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:970-982. [PMID: 28914080 DOI: 10.1177/1362361317714587] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical impressions indicate that there is an overrepresentation of gender-dysphoria within the autism spectrum disorder. However, little is presently known about the demographics of gender-identity issues in autism spectrum disorder. Based upon what little is known, we hypothesized that there would be an increased prevalence of gender-dysphoria among those with autism spectrum disorder compared to a typically developing population. We surveyed gender-dysphoria with the Gender-Identity/Gender-Dysphoria Questionnaire among 90 males and 219 females with autism spectrum disorder and compared these rates to those of 103 males and 158 females without autism spectrum disorder. When compared to typically developing individuals, autistic individuals reported a higher number of gender-dysphoric traits. Rates of gender-dysphoria in the group with autism spectrum disorder were significantly higher than reported in the wider population. Mediation analysis found that the relationship between autistic traits and sexual orientation was mediated by gender-dysphoric traits. Results suggest that autism spectrum disorder presents a unique experience to the formation and consolidation of gender identity, and for some autistic individuals, their sexual orientation relates to their gender experience. It is important that clinicians working with autism spectrum disorder are aware of the gender-diversity in this population so that the necessary support for healthy socio-sexual functioning and mental well-being is provided.
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20
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Lehmann K, Leavey G. Individuals with gender dysphoria and autism: barriers to good clinical practice. J Psychiatr Ment Health Nurs 2017; 24:171-177. [PMID: 28032410 DOI: 10.1111/jpm.12351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/28/2022]
Affiliation(s)
- K Lehmann
- Knowing Our Identity Service, Belfast Health and Social Care Trust, Beechcroft, Northern Ireland.,HSC Research & Development Division, Public Health Agency, Belfast, Northern Ireland
| | - G Leavey
- Bamford Centre for Mental Health and Wellbeing, University of Ulster, Coleraine Campus, Northern Ireland
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21
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Abstract
The current literature shows growing evidence of a link between gender dysphoria (GD) and autism spectrum disorder (ASD). This study reviews the available clinical and empirical data. A systematic search of the literature was conducted using the following databases: PubMed, Web of Science, PsycINFO and Scopus; utilizing different combinations of the following search terms: autism, autism spectrum disorder (ASD), Asperger's disorder (AD), co-morbidity, gender dysphoria (GD), gender identity disorder (GID), transgenderism and transsexualism. In total, 25 articles and reports were selected and discussed. Information was grouped by found co-occurrence rates, underlying hypotheses and implications for diagnosis and treatment. GD and ASD were found to co-occur frequently - sometimes characterized by atypical presentation of GD, which makes a correct diagnosis and determination of treatment options for GD difficult. Despite these challenges there are several case reports describing gender affirming treatment of co-occurring GD in adolescents and adults with ASD. Various underlying hypotheses for the link between GD and ASD were suggested, but almost all of them lack evidence.
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Affiliation(s)
- Anna I R Van Der Miesen
- a VU University Medical Centre, Centre of Expertise on Gender Dysphoria , Amsterdam , the Netherlands
| | - Hannah Hurley
- b Dr Leo Kannerhuis, Centre for Autism , Amsterdam , the Netherlands
| | - Annelou L C De Vries
- a VU University Medical Centre, Centre of Expertise on Gender Dysphoria , Amsterdam , the Netherlands
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22
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Strang JF, Meagher H, Kenworthy L, de Vries ALC, Menvielle E, Leibowitz S, Janssen A, Cohen-Kettenis P, Shumer DE, Edwards-Leeper L, Pleak RR, Spack N, Karasic DH, Schreier H, Balleur A, Tishelman A, Ehrensaft D, Rodnan L, Kuschner ES, Mandel F, Caretto A, Lewis HC, Anthony LG. Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 47:105-115. [PMID: 27775428 DOI: 10.1080/15374416.2016.1228462] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD. There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements. The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment; guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/blurring of treatment and assessment.
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Affiliation(s)
- John F Strang
- a Division of Pediatric Neuropsychology , Children's National Health System
| | - Haley Meagher
- a Division of Pediatric Neuropsychology , Children's National Health System
| | - Lauren Kenworthy
- a Division of Pediatric Neuropsychology , Children's National Health System
| | | | - Edgardo Menvielle
- c Division of Psychiatry and Behavioral Sciences , Children's National Health System
| | - Scott Leibowitz
- d Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine
| | - Aron Janssen
- e Department of Child and Adolescent Psychiatry , New York University School of Medicine
| | | | - Daniel E Shumer
- g Division of Pediatric Endocrinology , University of Michigan Health System
| | | | - Richard R Pleak
- i Division of Child & Adolescent Psychiatry , Hofstra Northwell School of Medicine
| | - Norman Spack
- j Division of Endocrinology , Boston Children's Hospital
| | - Dan H Karasic
- k Department of Psychiatry , University of California San Francisco School of Medicine
| | - Herbert Schreier
- l Department of Psychiatry , University of California San Francisco-Benioff-Children's Hospital Oakland
| | - Anouk Balleur
- f Department of Medical Psychology , VU University Medical Center
| | - Amy Tishelman
- m Departments of Psychiatry , Endocrinology and Urology, Boston Children's Hospital and Harvard Medical School
| | - Diane Ehrensaft
- n Child and Adolescent Gender Center , Department of Pediatrics, University of California San Francisco Benioff Children's Hospital
| | - Leslie Rodnan
- o Division of Psychiatry and Behavioral Sciences, Children's National Health System
| | - Emily S Kuschner
- p Department of Radiology and Center for Autism Research , The Children's Hospital of Philadelphia
| | - Francie Mandel
- q Divisions of Endocrinology and Social Work , Boston Children's Hospital
| | | | - Hal C Lewis
- s Division of Psychiatry and Pediatrics , University of Colorado
| | - Laura G Anthony
- t Division of Pediatric Neuropsychology , Children's National Health System
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23
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May T, Pang K, Williams KJ. Gender variance in children and adolescents with autism spectrum disorder from the National Database for Autism Research. Int J Transgend 2016. [DOI: 10.1080/15532739.2016.1241976] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Tamara May
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Kenneth Pang
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
- Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Katrina Jane Williams
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
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24
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Skagerberg E, Di Ceglie D, Carmichael P. Brief Report: Autistic Features in Children and Adolescents with Gender Dysphoria. J Autism Dev Disord 2016; 45:2628-32. [PMID: 25772537 DOI: 10.1007/s10803-015-2413-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This paper looks at the association between gender dysphoria (GD), scores on the Social Responsiveness Scale (SRS), and reported diagnoses of autism spectrum disorder (ASD). Parents of 166 young people presenting with GD (Mean age = 14.26, SD = 2.68) completed the SRS. Information concerning an ASD diagnosis was also extracted from the patient files. 45.8% fell within the normal range on the SRS and of those 2.8% had an ASD diagnosis. 27.1% fell within the mild/moderate range and of those 15.6% had an ASD diagnosis and 6.7% an ASD query. 27.1% fell within the severe range and of those 24.4% had an ASD diagnosis and 26.7% an ASD query. No difference was found in autistic features between the natal females and males.
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Affiliation(s)
- Elin Skagerberg
- Tavistock and Portman NHS Foundation Trust, 120 Belsize Lane, London, NW3 5BA, UK,
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25
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Janssen A, Huang H, Duncan C. Gender Variance Among Youth with Autism Spectrum Disorders: A Retrospective Chart Review. Transgend Health 2016; 1:63-68. [PMID: 28861527 PMCID: PMC5367474 DOI: 10.1089/trgh.2015.0007] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose: Increasing clinical evidence suggests an overrepresentation of gender variance (GV) among patients with autism spectrum disorders (ASDs). This retrospective chart review aims to contribute to the existing literature on co-occurring ASD and gender dysphoria (GD). We compare the rate of parent-reported GV in patients with an ASD diagnosis to that of parent-reported GV in a normative nonreferred data set. Methods: Child Behavior Checklist (CBCL) charts were collected from 492 children and adolescents (409 natal males and 83 natal females) aged 6-18 years who have received a diagnosis of ASD at the New York University Child Study Center. Parent-reported GV was determined through endorsement of CBCL sex item 110, which assesses the presence of gender-related issues. We calculated the odds ratio of endorsement of item 110 between our ASD sample and the CBCL sample data. Results: The subjects diagnosed with ASD were 7.76 times more likely to report GV than the CBCL sample. This finding was statistically significant. About 5.1% of the patients in the ASD group and 0.7% of the CBCL nonreferred group endorsed sex item 110. 5.1% of natal males and 4.8% of natal females endorsed sex item 110. Neither gender nor age influenced the rate of endorsement. Conclusion: This finding supports the growing research suggesting a heightened co-occurrence rate of ASD and GD. Focus should be placed upon improving our understanding of the nature of this co-occurrence and on gender identity development within the atypical development of ASD.
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26
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Adolescent boys with autism spectrum disorder growing up: follow-up of self-reported sexual experience. Eur Child Adolesc Psychiatry 2016; 25:969-78. [PMID: 26791194 PMCID: PMC4990619 DOI: 10.1007/s00787-016-0816-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 01/05/2016] [Indexed: 11/24/2022]
Abstract
Systematic research on sexual development in adolescents with autism spectrum disorder (ASD) remains scant, notwithstanding the often-suggested relation between ASD, atypical, and even sexually offensive behaviours. This study compared follow-up data related to lifetime sexual experience (LTSE) in a homogeneous group of adolescent boys with ASD (n = 30), aged 16-20, with a matched group of boys in the general population (n = 60). Most boys in the ASD and control groups reported masturbation and having experienced an orgasm. The proportion of boys with ASD that had no partnered sexual experience was larger than in the control group. This difference was mostly explained by significantly fewer boys with ASD, compared with controls, who reported experience with kissing and petting; no significant differences emerged relating to more intimate partnered sexual experiences. The results suggest the existence of a subgroup of boys who have not (yet) entered the arena of partnered sexual experiences-a finding in line with research in adult samples. There were no differences relating to sexual abuse or coercion. Exploration of the partnered experiences revealed a variety of types of partners, mostly of comparable age. Several boys with ASD had not anticipated their sexual debut. Although they felt ready for it, some boys reported regret afterward. The hypothesised sexual developmental trajectories are subject to further research, but the sexual experience in this sample and the assumed developmental differences indicate the need for early, attuned, and comprehensive sexuality-related education and communication.
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27
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Shumer DE, Reisner SL, Edwards-Leeper L, Tishelman A. Evaluation of Asperger Syndrome in Youth Presenting to a Gender Dysphoria Clinic. LGBT Health 2015; 3:387-90. [PMID: 26651183 DOI: 10.1089/lgbt.2015.0070] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE There is evolving evidence that children and adolescents with gender dysphoria have higher-than-expected rates of autism spectrum disorder (ASD), yet clinical data on ASD among youth with gender dysphoria remain limited, particularly in North America. This report aims to fill this gap. METHODS We conducted a retrospective review of patient chart data from 39 consecutive youth ages 8 to 20 years (mean age 15.8 years, natal male: n = 22, natal female: n = 17) presenting for evaluation at a multidisciplinary gender clinic in a large U.S. pediatric hospital from 2007 to 2011 to evaluate the prevalence of ASD in this patient population. RESULTS Overall, 23.1% of patients (9/39) presenting with gender dysphoria had possible, likely, or very likely Asperger syndrome as measured by the Asperger Syndrome Diagnostic Scale (ASDS). CONCLUSION These findings are consistent with growing evidence supporting increased prevalence of ASD in gender dysphoric children. To guide provision of optimal clinical care and therapeutic intervention, routine assessment of ASD is recommended in youth presenting for gender dysphoria.
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Affiliation(s)
- Daniel E Shumer
- 1 Department of Medicine, Division of Pediatric Endocrinology, Boston Children's Hospital , Boston, Massachusetts.,2 Department of Pediatrics and Communicable Diseases, Division of Pediatric Endocrinology, University of Michigan , Ann Arbor, Michigan
| | - Sari L Reisner
- 3 Department of Pediatrics, Boston Children's Hospital , Boston, Massachusetts
| | | | - Amy Tishelman
- 1 Department of Medicine, Division of Pediatric Endocrinology, Boston Children's Hospital , Boston, Massachusetts.,5 Department of Psychology, Boston Children's Hospital , Boston, Massachusetts.,6 Department of Psychiatry, Boston Children's Hospital , Boston, Massachusetts.,7 Department of Urology, Boston Children's Hospital , Boston, Massachusetts
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28
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Brief Report: Autistic Traits in Mothers and Children Associated with Child's Gender Nonconformity. J Autism Dev Disord 2015; 45:1489-94. [PMID: 25358249 DOI: 10.1007/s10803-014-2292-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We examined relationships between autistic traits in children, mothers, and fathers and gender nonconformity (GNC) in children using data from the Nurses' Health Study II and the Growing Up Today Study 1. Autistic traits of mothers, fathers and children were measured using the Social Responsiveness Scale (SRS). GNC in children was measured using questions from the Recalled Childhood Gender Identity/Gender Role Questionnaire. In multivariable analyses increase in child's SRS score was associated with increased odds (OR 1.35; p = 0.03) of being in a higher GNC category. Increase in maternal SRS score was also associated with increased odds (OR 1.46; p = 0.005) of the child being in a higher GNC category. Paternal SRS scores were not related to child's GNC category.
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29
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Tateno M, Teo AR, Tateno Y. Eleven-year follow up of boy with Asperger's syndrome and comorbid gender identity disorder of childhood. Psychiatry Clin Neurosci 2015; 69:658. [PMID: 26126993 PMCID: PMC5573258 DOI: 10.1111/pcn.12328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/13/2015] [Accepted: 06/26/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Masaru Tateno
- Tokiwa Child Development Center, Tokiwa Hospital, Sapporo, Japan. .,Department of Neuropsychiatry, School of Medicine, Sapporo Medical University, Sapporo, Japan.
| | - Alan R Teo
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, USA
| | - Yukie Tateno
- Tokiwa Child Development Center, Tokiwa Hospital, Sapporo, Japan
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30
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VanderLaan DP, Postema L, Wood H, Singh D, Fantus S, Hyun J, Leef J, Bradley SJ, Zucker KJ. Do children with gender dysphoria have intense/obsessional interests? JOURNAL OF SEX RESEARCH 2015; 52:213-9. [PMID: 24558954 DOI: 10.1080/00224499.2013.860073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study examined whether children clinically referred for gender dysphoria (GD) show increased symptoms of autism spectrum disorder (ASD). Circumscribed preoccupations or intense interests were considered as overlapping symptoms expressed in GD and ASD. In gender-referred children (n = 534; 82.2% male) and their siblings (n = 419; 57.5% male), we examined Items 9 and 66 on the Child Behavior Checklist, which measure obsessions and compulsions, respectively. Non-GD clinic-referred (n = 1,201; 48.5% male) and nonreferred (n = 1,201; 48.5% male) children were also examined. Gender-referred children were elevated compared to all other groups for Item 9, and compared to siblings and nonreferred children for Item 66. A gender-related theme was significantly more common for gender-referred boys than male siblings on Item 9 only. A gender-related theme was not significantly more common for gender-referred girls compared to their female siblings on either item. The findings for Item 9 support the idea that children with GD show an elevation in obsessional interests. For gender-referred boys in particular, gender-related themes constituted more than half of the examples provided by their mothers. Intense/obsessional interests in children with GD may be one of the factors underlying the purported link between GD and ASD.
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Affiliation(s)
- Doug P VanderLaan
- a Gender Identity Service, Child, Youth, and Family Services, Centre for Addiction and Mental Health
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31
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Strang JF, Kenworthy L, Dominska A, Sokoloff J, Kenealy LE, Berl M, Walsh K, Menvielle E, Slesaransky-Poe G, Kim KE, Luong-Tran C, Meagher H, Wallace GL. Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1525-33. [PMID: 24619651 DOI: 10.1007/s10508-014-0285-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 10/26/2013] [Accepted: 01/01/2014] [Indexed: 05/12/2023]
Abstract
Evidence suggests over-representation of autism spectrum disorders (ASDs) and behavioral difficulties among people referred for gender issues, but rates of the wish to be the other gender (gender variance) among different neurodevelopmental disorders are unknown. This chart review study explored rates of gender variance as reported by parents on the Child Behavior Checklist (CBCL) in children with different neurodevelopmental disorders: ASD (N = 147, 24 females and 123 males), attention deficit hyperactivity disorder (ADHD; N = 126, 38 females and 88 males), or a medical neurodevelopmental disorder (N = 116, 57 females and 59 males), were compared with two non-referred groups [control sample (N = 165, 61 females and 104 males) and non-referred participants in the CBCL standardization sample (N = 1,605, 754 females and 851 males)]. Significantly greater proportions of participants with ASD (5.4%) or ADHD (4.8%) had parent reported gender variance than in the combined medical group (1.7%) or non-referred comparison groups (0-0.7%). As compared to non-referred comparisons, participants with ASD were 7.59 times more likely to express gender variance; participants with ADHD were 6.64 times more likely to express gender variance. The medical neurodevelopmental disorder group did not differ from non-referred samples in likelihood to express gender variance. Gender variance was related to elevated emotional symptoms in ADHD, but not in ASD. After accounting for sex ratio differences between the neurodevelopmental disorder and non-referred comparison groups, gender variance occurred equally in females and males.
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Affiliation(s)
- John F Strang
- Center for Autism Spectrum Disorders, Children's National Medical Center, 15245 Shady Grove Road, Suite 350, Rockville, MD, 20850, USA,
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32
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33
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Pasterski V, Gilligan L, Curtis R. Traits of autism spectrum disorders in adults with gender dysphoria. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:387-93. [PMID: 23864402 DOI: 10.1007/s10508-013-0154-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 05/31/2013] [Accepted: 06/05/2013] [Indexed: 05/12/2023]
Abstract
The literature examining the co-occurrence of gender dysphoria (GD) and autistic traits has so far been limited to a series of small case studies and two systematic studies, one looking at autistic traits in gender dysphoric children and the other set within the context of the extreme male brain hypothesis and looking at adults. The current study examined this co-occurrence of GD and autistic traits in an adult population, to see whether this heightened prevalence persisted from childhood as well as to provide further comparison of MtF versus FtM transsexuals and homosexual versus nonhomosexual individuals. Using the Autistic Spectrum Quotient (AQ), 91 GD adults (63 male-to-female [MtF] and 28 female-to-male [FtM]) undertaking treatment at a gender clinic completed the AQ. The prevalence of autistic traits consistent with a clinical diagnosis for an autism spectrum disorder (ASD) was 5.5 % (n = 3 MtF and n = 2 FtM) compared to reports of clinical diagnoses of 0.5-2.0 % in the general population. In contrast to the single previous report in adults, there was no significant difference between MtF and FtM on AQ scores; however, all of those who scored above the clinical cut-off were classified as nonhomosexual with respect to natal sex. Results were considered in the context of emerging theories for the observed co-occurrence of GD and autistic traits.
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Affiliation(s)
- Vickie Pasterski
- Department of Psychology, New Museum Site, Free School Lane, Cambridge, CB2 3RQ, UK,
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Lemaire M, Thomazeau B, Bonnet-Brilhault F. Gender identity disorder and autism spectrum disorder in a 23-year-old female. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:395-8. [PMID: 23835847 DOI: 10.1007/s10508-013-0141-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 04/18/2013] [Accepted: 04/26/2013] [Indexed: 05/12/2023]
Abstract
We describe the case of a 23-year-old woman with Gender Identity Disorder (GID) asking for a cross-sex hormonal treatment with sex reassignment surgery and who was recently diagnosed with Autism Spectrum Disorder (ASD). Gender identity clinics are now reporting an overrepresentation of individuals with ASD among GID patients. The prevalence of ASD is 10-fold higher among GID patients than in general population. However, few case reports or studies have explored the co-occurrence of ASD and GID. This co-occurrence is relevant for diagnostic and clinical management and also raises important theoretical issues.
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Affiliation(s)
- Mathieu Lemaire
- Centre Universitaire de Pédopsychiatrie, CHRU de Tours, Boulevard Tonnellé, 37044, Tours Cedex 9, France,
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Bejerot S, Eriksson JM. Sexuality and gender role in autism spectrum disorder: a case control study. PLoS One 2014; 9:e87961. [PMID: 24498228 PMCID: PMC3909328 DOI: 10.1371/journal.pone.0087961] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/25/2013] [Indexed: 11/19/2022] Open
Abstract
The ‘extreme male brain theory of autism’ describes an extreme male pattern of cognitive traits defined as strong systemising abilities paired with empathising weaknesses in autism spectrum disorder. However, beyond these cognitive traits, clinical observations have suggested an ambiguous gender-typed pattern regarding several sexually dimorphic traits. The aim of the present study was to investigate if patterns of non-cognitive sexually dimorphic traits differed between the autism spectrum disorder and control groups. Fifty adults with autism spectrum disorder and intelligence within the normal range, and 53 neurotypical controls responded to questions on gender role, self-perceived gender typicality and gender identity, as well as sexuality. Measures used were a Swedish modification of the Bem Sex Role Inventory and questions on sexuality and gender designed for the purpose of this study. Our results showed that one common gender role emerged in the autism spectrum disorder group. Masculinity (e.g. assertiveness, leadership and competitiveness) was weaker in the autism spectrum disorder group than in the controls, across men and women. Self-perceived gender typicality did not differ between the groups but tomboyism and bisexuality were overrepresented amongst women with autism spectrum disorder. Lower libido was reported amongst both male and female participants with autism spectrum disorder compared with controls. We conclude that the extreme male patterns of cognitive functions in the autistic brain do not seem to extend to gender role and sexuality. A gender-atypical pattern for these types of characteristics is suggested in autism spectrum disorder.
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Affiliation(s)
- Susanne Bejerot
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Jonna M. Eriksson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Dewinter J, Vermeiren R, Vanwesenbeeck I, van Nieuwenhuizen C. Autism and normative sexual development: a narrative review. J Clin Nurs 2013; 22:3467-83. [PMID: 24112137 DOI: 10.1111/jocn.12397] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the existing knowledge on sexuality and autism spectrum disorders. To this end, the concept of normative sexual development was used as an organising framework. BACKGROUND Sexual health can be seen as a developmental task for all children, adolescents and adults. Core autism features are related with skills central to sexual development and functioning. More insight in sexual development in people with autism is relevant for education, support and interventions by parents and professionals in somatic and mental health care. METHODS A comprehensive search of scientific online databases and reference lists was conducted. Publications based on qualitative and quantitative research, including case studies, were selected. RESULTS Fifty-five articles and reports were selected and discussed. Information was grouped according to three domains: sexual behaviour, sexual selfhood and sexual socialisation. CONCLUSION Sexual development is a part of life for people with autism of all developmental levels and is generally understudied in this population. Most information was available on behavioural aspects and experiences of socialising agents, such as parents and professionals. Developmental processes and the relation between sexual behaviour, selfhood and socialisation remained unclear. RELEVANCE TO CLINICAL PRACTICE Nurses working in schools, institutions and general health care support children, adolescents and adults with autism and advice their families, teachers, other educators and caregivers on sexuality issues. They can have an important role in daily assessment and support of this developmental domain by actively enquiring about the different aspects of sexual development and by offering information. Our findings offer an overview on the existing knowledge and support the idea that sexual development is normative for people with autism just as for anybody else.
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Affiliation(s)
- Jeroen Dewinter
- Tranzo, Tilburg University, Tilburg, The Netherlands; Center for Child and Adolescent Psychiatry, GGzE, Eindhoven, The Netherlands
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Abstract
The 'extreme male brain' theory suggests females with Autism Spectrum Conditions are hyper-masculinized in certain aspects of behavior. We predicted that females with Gender Identity Disorder (who are masculinized) would have elevated Autism Spectrum Quotient (AQ) scores. AQ scores from five groups were compared: (1) n = 61 transmen (female-to-male transsexual people); (2) n = 198 transwomen (male-to-female transsexual people); (3) n = 76 typical males; (4) n = 98 typical females; and (5) n = 125 individuals with Asperger Syndrome (AS). Transmen had a higher mean AQ than typical females, typical males and transwomen, but lower than individuals with AS. Transmen have more autistic traits and may have had difficulty socializing with female peers and thus found it easier to identify with male peer groups.
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de Vries ALC, Noens ILJ, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA. Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord 2010; 40:930-6. [PMID: 20094764 PMCID: PMC2904453 DOI: 10.1007/s10803-010-0935-9] [Citation(s) in RCA: 238] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Only case reports have described the co-occurrence of gender identity disorder (GID) and autism spectrum disorders (ASD). This study examined this co-occurrence using a systematic approach. Children and adolescents (115 boys and 89 girls, mean age 10.8, SD = 3.58) referred to a gender identity clinic received a standardized assessment during which a GID diagnosis was made and ASD suspected cases were identified. The Dutch version of the Diagnostic Interview for Social and Communication Disorders (10th rev., DISCO-10) was administered to ascertain ASD classifications. The incidence of ASD in this sample of children and adolescents was 7.8% (n = 16). Clinicians should be aware of co-occurring ASD and GID and the challenges it generates in clinical management.
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Affiliation(s)
- Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
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