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Key points
- Correlation does not equal causation: autism spectrum disorder does not cause gender dysphoria.
- Those with autism spectrum disorder born as female are more likely to experience gender dysphoria.
- Those with autism spectrum disorder are more likely to internalize negative emotions and suicidality.
In January of 2023, research published in the Journal of Autism released the latest evidence in a question that scientists have spent more than a decade trying to empirically prove: Is gender diversity (also known as gender divergence, or gender body incongruence) overrepresented in autistic youth?
(And if that last sentence felt a bit awkward and wobbly to read, can you imagine how long it took for me to find a way to write it?)
The fact is that it is the phrasing, the wording of this correlation between autism and gender identity that is extremely important because we are on the cusp of finding a way to scientifically explain something that many parents and professionals within the autistic community, and many autistic youths themselves, have long "felt" or seemingly understood, even before it seemed acceptable to attempt to gather the statistics to validate this community feeling.
The History of Autism and Gender Identity
The first research to explore the connection between autism and what was then termed "gender confusion," essentially blamed the child's autism for pathologizing their gender identity. In other words, the autistic child didn't understand their assigned gender and thus was doing something wrong by taking on characteristics typically assigned to the opposite gender. (Williams, Allard & Sears, 1996) and (Landen & Rasmussen, 1997)
Recall that this was in the 90s, when we were just starting to understand that homosexuality wasn't a pathology, most of the world only knew about the trans community through entertainment venues, and homosexual men were still largely feared to be potential child abusers by most of suburban America.
However, as early as 2010, researchers began to look into the correlation between gender diversity (a term that is meant to include those who identify as a gender other than the one they were assigned at birth, those who identify as non-binary, trans, and gender fluid) and those diagnosed with autism, or autism spectrum disorder (ASD). In a 2010 study led by de Vries, Noens, Cohen-Kettenis, van Berckelaer-Onnes, and Doreleijers, 7.8 percent of children and adolescents who were referred for gender diversity services met diagnostic criteria for autism. This was ten times the prevalence in the general population at the time.
In 2018, a similar study was published by Van der Miesen et al that specifically looked at those with ASD and gender dysphoria, and found that 14.5 percent of those with gender dysphoria met the criteria for autism.
Most recently, in 2023, Corbett et al published the first widespread study to examine gender identity and ASD through the lens of both self-report and parent reports. This is important for many reasons, but perhaps the most important is that both youths with gender diversity and those with ASD are more likely to suffer from anxiety, depression, suicidal thoughts, and other psychological ailments—perhaps as a partial result of the burden of being or feeling "different" than their peers. Parents have the potential to be the primary source of support, but only if they are tuned in to their child's needs.
What Did We Learn From Corbett's 2023 Study?
The short answer is a lot.
- Parents of children with ASD reported notably higher levels of gender diversity (referred to as gender body incongruence on this particular measure) than did parents of children who had typical development. However, a surprising number of parents declined to fill out the gender diversity portion of this study, a finding we will return to later.
- Those children who were born/assigned the gender of female at birth were reported by their parents as having greater body incongruence, as in not feeling comfortable in their skin, than were children who were born/assigned the gender of a male at birth.
- Parents' and children's responses about gender identity and gender diversity did not correlate, which means we still have some work to do to improve both communication and education.
- Children with gender diversity and ASD reported more internalized negative feelings and suicidality in general compared to their typical development peers.
- However, while gender diversity in the typical development group was associated specifically with an increase in depression and suicidality, gender diversity in the ASD group was not. One thought is that individuals in the ASD group may experience less stress or anxiety due to less awareness of social judgment.
Correlation vs. Causation
What does this correlation between autism and gender diversity mean? What can it be twisted to mean? Will it make some of our children more vulnerable, or perhaps less? Perhaps Corbett's point about some people with ASD being less aware of social judgment may have given worried parents a glimmer of hope for an easier future for a child who falls into this category.
First, let us be clear that correlation does not mean causation: Just because two things are related, does not mean one causes the other. My children used to wear their pajamas inside out and backward, sleep with a spoon under their pillow, and flush an ice cube down the toilet because this was supposed to guarantee a snow day.
If a snow day occurred, they felt all-powerful (correlation).
If they did not get a snow day, they assumed they had done something wrong (still correlation).
Those with ASD may report more gender diversity because their lack of social anxiety-social awareness makes them more likely to be true to themselves, while others with typical development hold back out of fear of reprimand or retribution. But, it is just as likely that there is an entirely different variable that we have not yet discovered.
Assigned Female at Birth and Higher Rates of Gender Diversity in ASD
This question, I imagine, will take quite a while to prove empirically, but as a cis-woman who has had to deal with training bras, my first period, pregnancy, fear of childbirth, sexual harassment, and much more, the answer is likely to be not only complex but also perhaps a bit individualized for each person.
Higher Levels of Internalization and Suicidality in ASD
This is the most important takeaway, in so far as it is the one that may need the most immediate attention to help our children. Researchers are already focusing on ways to educate teachers and mental health practitioners on the different presentations of anxiety, depression, and other disorders that may appear in an individual with both ASD and gender diversity, versus an individual with ASD, versus someone of typical development.
References
Williams PG, Allard AM, & Sears L (1996). Case study: cross-gender preoccupations with two male children with autism. J Autism Dev Disord, 26(6), 635–642.
Landen M, & Rasmussen P (1997). Gender identity disorder in a girl with autism--a case report. Eur Child Adolesc Psychiatry, 6(3), 170–173.
Out of the Past: 400 Years of Lesbian and Gay History in America (PBS Online); Bending the Mold: An Action Kit for Transgender Youth (NYAC & Lambda Legal); The American Gay Rights Movement: A Timeline; Just the Facts about Sexual Orientation and Youth: A Primer for Principals, Educators, and School Personnel (Just the Facts Coalition)
Corbett BA, Muscatello RA, Klemencic ME, West M, Kim A, Strang JF. Greater gender diversity among autistic children by self-report and parent-report. Autism. 2023 Jan;27(1):158-172.
