Gender identity is a personal concept that describes one’s internal experience of gender. This is influenced by the individual’s external experience of gender or how the rest of the world treats them based on the gender they were assigned at birth.
Gender dysphoria is the experience of being assigned a different gender at birth than the gender one actually is on the inside. There is some early research showing people on the autism spectrum may experience gender dysphoria more often than neurotypical individuals.
Scientific research on this is just beginning, but small-scale studies suggest that social and communication differences between autistic brains and neurotypical brains may increase the experience of gender dysphoria in people with autism, leading to greater differences in gender self-expression.
Gender Identity, Dysphoria & Diversity in People With Autism
What is Gender Identity?
Gender identity is the personal concept of one’s gender experience. This is typically described as male or female, but it is increasingly considered a spectrum of experience.
What is Gender Dysphoria?
For most of the population, the gender they are assigned at birth is the gender they identify with. However, some people do not identify with their natal gender, or the gender they are perceived to be from birth. This can lead to gender dysphoria. Previously, this was called gender identity disorder, however, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) updated the terminology in 2013 to reflect that gender dysphoria is not a disorder.
While gender dysphoria is no longer considered a disorder, it does indicate structural differences in the brain and body compared to cisgender people. Gender role is the outward appearance or performance of gender, and for cisgender people, these are congruous. For someone who is transgender, gender fluid, or gender neutral, the gender they perceive themselves to be and the gender others perceive them to be will be different.
Autism and Gender Diversity
People who are receiving medical treatment of some type for gender dysphoria appear to have higher rates of traits of autism compared to the general population. Studies have shown rates ranging from 5.5% to 7.8%, though the sample sizes are small.
Compared to controls, one study found that children and teenagers with diagnosed autism spectrum disorder were 7.59 times more likely to express gender variance, as reported by parents.
At the same time, autism diagnoses are on the rise, largely due to better diagnostic criteria in the DSM-5. According to the Centers for Disease Control and Prevention (CDC), 1 in 44 children has been identified with a level of autism spectrum disorder, with an average prevalence around the world of between 1% and 2%.
The community of those who are both on the spectrum and are gender diverse may be rising simply due to the increased diagnoses, but more research is needed.
Research Behind the Co-Occurrence of Autism & Gender Identity Diversity
In 2020, the largest study to date to examine autism and gender identity, which included 641,860 individuals, concluded that transgender and gender-diverse individuals are 3 to 6 times more likely to be autistic than cisgender people. The transgender and gender-diverse individuals also scored higher on self-reported measures of autistic traits, such as sensory sensitivity.
Gender diverse people on the autism spectrum often reference similar themes, such as:
- Recollections of early gender nonconformity.
- Feeling or experiencing gender dysphoria.
- Challenges specific to the comorbidity of gender diversity and neurodiversity.
Potential Reasons for Higher Rates of Gender Identity Diversity With Autistic Individuals
There’s no clear answer for why there is an increased incidence of gender diversity among people with autism as compared with neurotypical individuals. Researchers do have some hypotheses, which include:
- Difficulty socializing.
For people on the autism spectrum, socializing and communicating are more difficult in general. Finding ways to socialize with people in minority gender groups could be a greater challenge, and gender self-esteem is lower in groups stigmatized by society.
- Difficulty fitting in.
Those who are gender-diverse may be more likely to report higher rates of autistic traits due to long-standing experiences and feelings of “not fitting in socially.”
- Less conformity.
Researchers from the 2020 study note that “autistic individuals may conform less to societal norms compared to non-autistic individuals, which may partly explain why a greater number of autistic individuals identify outside the stereotypical gender binary.” This is sometimes referred to as the “theory of mind differences,” which suggests that people with autism are less influenced by social rules and norms. As a result, they are more likely to express their gender variance compared to neurotypical people.
- Brain development.
The researchers also note that prenatal mechanisms that shape brain development may be at play, but that research on this is needed.
Follow-up studies have shown that as gender diversity becomes more socially acceptable, more young people on the autism spectrum are self-identifying as gender nonconforming or transgender. This may be associated with more social categories to explain identity, so learning language and communicating about these feelings is easier.
Research into the comorbidity of gender dysphoria and autism is still new, and studies are small, but it appears that there is an association. More research is needed in this area to continue understanding the connection and how best to support people with autism who are also gender diverse.
Resources & Support for People With Autism & Gender Identity Diversity
While there is an overlap between autism and gender diversity, they should be treated separately. Finding support for people with autism who are also gender diverse is vital to their long-term emotional health.
Support for autism may include applied behavior analysis (ABA) therapy, cognitive behavioral therapy (CBT), speech therapy, occupational therapy, and/or social skills training.
Support for gender diversity may include CBT to manage gender-related distress, support groups, gender-affirming care, hormone therapy, and more.
Gender-Affirming Care for People with Autism
If you are the parent or caregiver of a child with autism who is experiencing gender-related distress, you may consider seeking gender-affirming care for your child. Gender-affirming care is defined by the World Health Organization as, “any single or combination of a number of social, psychological, behavioral or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.”
According to the Association of American Medical Colleges, gender-affirming care may include:
- Altered pronouns
- Use of affirming name
- Modification of clothing expression
- Pursuit of gender-affirming medical care
Research shows that gender-affirming care is associated with positive outcomes. 13 to 20-year-olds who received gender-affirming care that included puberty blockers and gender-affirming hormones, had 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up. Another study of 13 to 24-year-olds who received gender-affirming hormone therapy (GAHT) was associated with lower odds of recent depression and seriously considering suicide compared to those who wanted GAHT but did not receive it.
Finally, further research found that those who received GAHT prior to the onset of puberty (average age 11 years old) experience lower rates of depression, anxiety, and suicidality than their counterparts receiving care after the onset of puberty (average age 16 years old).
*Note: Some gender-affirming care, such as hormone-related treatments, are blocked in some states.
Support for your child should be personalized to their needs and will look different for everyone.
At Elemy, we support children on the autism spectrum with ABA therapy services regardless of their gender identity. While our own clinicians do not offer gender-affirming therapy or medication services, we may recommend families use tools such as Psychology Today or refer to their child’s pediatrician for recommendations on experts in gender services if a family feels they may need an additional support system.
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Data & Statistics on Autism Spectrum Disorder. (June 2022). Centers for Disease Control and Prevention (CDC).
Increased Gender Variance in Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder. (March 2014). Archives of Sexual Behavior.
Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. (August 2020). Nature Communications.
Gender Dysphoria and Autism Spectrum Disorder. (May 2019). Seattle Children’s Hospital.
At the Intersection of Neurodiversity and Gender Diversity. (September 2018). Journal of Autism and Developmental Disorders.
Why We Need to Respect Sexual Orientation, Gender Diversity in Autism. (November 2018). Spectrum.
Revisiting the Link: Evidence of the Rates of Autism in Studies of Gender Diverse Individuals. (November 2018). Journal of the American Academy of Child and Adolescent Psychiatry.