The Overlap Between Autism Spectrum Disorder (ASD) and Gender Diversity

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Research indicates that children, adolescents, and adults with ASD are more likely to identify as transgender and gender diverse compared to neurotypical individuals. Although there is no strong empirical evidence to explain this overlap, studies show that mental health concerns (e.g., suicidality, depressive symptoms, anxiety) are intensified for gender diverse people with ASD. Consequently, it is important for gender diverse people with ASD to receive comprehensive support and gender-affirming care.

Gender Identity and Gender Diversity

Gender identity is a person’s internal perception of their gender (e.g., man, woman, both, neither) and is different from sex assigned at birth (i.e., people are classified as male or female based on external genitalia). Gender identity may or may not align with one’s sex assigned at birth.

Gender diversity is an umbrella term that describes a range of gender identities that people may identify with. For example, people may identify as:

  • Transgender: A person whose gender identity, expression, and/or behavior do not align with their sex assigned at birth
  • Non-binary: A person who does not identify within the gender binary of male/female
  • Genderqueer, agender, and genderfluid are additional identities that people may resonate with

Co-occurrence of ASD and Gender Diversity

In the past decade, research about the overlap between ASD and gender diversity has increased. Not only are people with ASD more likely to identify as gender diverse, but there is also a bidirectional effect. People who identify as gender diverse are also more likely to have ASD.

Although research supports the co-occurrence of ASD and gender diversity, the mechanisms for this association are not well understood. Researchers have hypothesized a couple of theories about this association. For example, people with ASD may be less likely than neurotypical people to “conform” to societal norms. Hence, more people with ASD may identify outside of the traditional gender binary. A second theory is that prenatal mechanisms that contribute to brain development may impact both ASD and gender development. It is important to note that none of these theories have substantial empirical support and more research is needed.

Impact on Mental Health

Mental health concerns (e.g., depressive symptoms, suicidality, anxiety, substance use disorders) are more prevalent in gender diverse people. Gender diverse individuals also experience social stressors and discrimination, which can intensify mental health concerns. Similarly, people with ASD experience a higher prevalence of mental health concerns as well. In turn, gender diverse people who also have ASD experience higher rates of mental health disorders, physical health concerns, limited insurance coverage, and refusal of services compared to cisgender people (i.e., those whose gender identity corresponds with their assigned sex at birth) with ASD.

These statistics underscore the importance of comprehensive mental health services and support for this population. People with ASD who seek gender-affirming care (e.g., changes in gender expression, hormone therapy, etc.) can experience improvement in mental health concerns. Some people with ASD may find it more difficult to decide on hormone therapy or gender-affirming surgery due to ASD characteristics of rigidity and resistance to change. However, case studies suggest that with continued support, people with ASD who do transition exhibit less suicidality, anxiety, and depression, as well as higher levels of self-esteem and life satisfaction. Consequently, it is important for gender diverse people with ASD to receive comprehensive support.

Summary

Research demonstrates that there is a co-occurrence between ASD and gender diversity. Gender diverse people experience their gender in a way that does not correspond with their sex assigned at birth. People may identify as transgender, nonbinary, agender, and more. Research indicates that gender diverse people with ASD experience more intense mental health concerns compared to their cisgendered peers with ASD. These findings underscore the importance of making comprehensive support and gender-affirming care accessible to gender diverse people with ASD.

Gender-affirming providers at Upside Therapy recognize the overlap of ASD and gender diversity, and the ways that these identities can contribute to minority stress. Upside Therapy offers individual therapy and a support group for parents of gender diverse people. If you are interested in services, please call 972-519-1692 or email info@upsidetherapy.com.

Additional Resources

References

Cooper, K., Butler, C., Russell, A., & Mandy, W. (2022). The lived experience of gender dysphoria in autistic young people: A phenomenological study with young people and their parents. European Child & Adolescent Psychiatry, 1–12.https://doi.org/10.1007/s00787-022-01979-8

Hadland, S. E., Solomon, E. D., & Guss, C. E. (2023). Affirming care for autism and gender diversity. Pediatrics, 152(2). https://doi.org/10.1542/peds.2023-061813

Hall, J. P., Batza, K., Streed, C. G., Boyd, B. A., & Kurth, N. K. (2020). Health disparities among sexual and gender minorities with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(8), 3071–3077. https://doi.org/10.1007/s10803-020-04399-2

Kahn, N. F., Sequeira, G. M., Garrison, M. M., Orlich, F., Christakis, D. A., Aye, T., Conard, L. A., Dowshen, N., Kazak, A. E., Nahata, L., Nokoff, N. J., Voss, R. V., & Richardson, L. P. (2023). Co-occurring autism spectrum disorder and gender dysphoria in adolescents. Pediatrics, 152(2). https://doi.org/10.1542/peds.2023-061363

Pinto, M. B., Tavares, F., & Viseu, M. (2022). Gender dysphoria and mental health. European Psychiatry, 65(S1), S855–S856. https://doi.org/10.1192/j.eurpsy.2022.2217

Van Der Miesen, A. I. R., Hurley, H., & De Vries, A. L. C. (2016). Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry, 28(1), 70-80. https://doi.org/10.3109/09540261.2015.1111199

Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M.-C., Allison, C., & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature Communications, 11(1). https://doi.org/10.1038/s41467-020-17794-1