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Autism in AdulthoodVol. 5, No. 2
RoundtableFree Access
THE INTERSECTION OF AUTISM AND TRANSGENDER AND NONBINARY IDENTITIES: COMMUNITY
AND ACADEMIC DIALOGUE ON RESEARCH AND ADVOCACY
* Finn V. Gratton,
* John F. Strang,
* Minneh Song,
* Kate Cooper,
* Aimilia Kallitsounaki,
* Meng-Chuan Lai,
* Wenn Lawson,
* Anna I.R. van der Miesen, and
* Harriette E. Wimms
Finn V. Gratton
Private Consultant, Santa Cruz, California, USA.
*Joint first authors.
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,
John F. Strang
Address correspondence to: John F. Strang, PsyD, Gender and Autism Program,
Center for Neuroscience, Children's National Hospital, 15245 Shady Grove Road
Suite 350, Rockville, MD 20850, USA
E-mail Address: jstrang@childrensnational.org
https://orcid.org/0000-0002-0950-6177
Gender and Autism Program, Center for Neuroscience, Children's National
Hospital, Washington, District of Columbia, USA.
Department of Pediatrics, George Washington University School of Medicine,
Washington, District of Columbia, USA.
Department of Psychiatry and Behavioral Sciences, George Washington University
School of Medicine, Washington, District of Columbia, USA.
*Joint first authors.
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,
Minneh Song
Gender and Autism Program, Center for Neuroscience, Children's National
Hospital, Washington, District of Columbia, USA.
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,
Kate Cooper
Department of Psychology, Centre for Applied Autism Research, University of
Bath, Bath, United Kingdom.
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,
Aimilia Kallitsounaki
Division of Human and Social Sciences, School of Psychology, Keynes College,
University of Kent, Canterbury, United Kingdom.
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,
Meng-Chuan Lai
Child and Youth Mental Health Collaborative at the Centre for Addiction and
Mental Health, The Hospital for Sick Children, and Department of Psychiatry,
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Autism Research Centre, Department of Psychiatry, University of Cambridge,
Cambridge, United Kingdom.
Department of Psychiatry, National Taiwan University Hospital and College of
Medicine, Taipei, Taiwan.
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,
Wenn Lawson
Department of Disability, Inclusion and Special Needs, University of Birmingham,
Birmingham, United Kingdom.
Macquarie University, Sydney, New South Wales, Australia.
Curtin Autism Research Group, Curtin University, Perth, Western Australia,
Australia.
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Anna I.R. van der Miesen
Department of Child and Adolescent Psychiatry, Center of Expertise on Gender
Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam,
The Netherlands.
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, and
Harriette E. Wimms
The Village Family Support Center of Baltimore, Baltimore, Maryland, USA.
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Published Online:13 Jun 2023https://doi.org/10.1089/aut.2023.0042
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ABSTRACT
Many transgender people are autistic. Community expressions of the autism
transgender intersection abound. Some commentators have questioned the
proportional overrepresentation of autism among gender-diverse people,
suggesting these individuals may not be truly autistic or truly transgender.
However, increasing evidence challenges assertions that deny the authenticity of
co-occurring autistic and transgender identities. Specifically, research by
authors of this article indicates autistic transgender people show
neurophenotypes generally consistent with cisgender autistic people and implicit
gender phenotypes consistent with nonautistic transgender people. This article
features a dialogue between eight leading experts in the field of intersectional
autism and gender diversity, including clinicians, researchers, community
advocates, and experts who are themselves autistic transgender. Key topics of
discussion included: how research findings on autism and gender diversity inform
respectful and supportive responses to autistic transgender people; the benefits
and harms of increased societal attention toward the autism transgender
intersection; and research and advocacy priorities. The expert panel concluded
the following: (1) it is important to respect transgender autistic people's
wellness and resilience, while also acknowledging the pathologization and
stigmatization they face; (2) autistic gender-diverse people are experts of
their own identity and should be involved in all aspects of research and
clinical care; (3) research is needed to understand the disparities autistic
transgender people face; (4) attempts to restrict autistic transgender people's
access to gender care are unsupported by existing research; (5) adult gender
care may benefit from incorporating universal design principles and
neurodiversity-affirming strategies to reduce barriers to care and improve
clinician–client communication in treatment delivery and the informed consent
process; (6) cross-cultural and cross-societal research will improve best care
practices in diverse contexts; (7) research and advocacy must be inclusive
across ethnoracial identities, including in leadership and perspectives
represented; and (8) a life span developmental framework is needed for adult
research in this field.
Many transgender people are autistic.1 The common intersection of autism and
gender diversity (i.e., gender identity diversity) reflects a distinctive
contour of human diversity in which two apparently individual experiences (i.e.,
gender diversity and autistic neurodivergence)* naturally tend to intersect and
overlap.3–6 The contributions of autistic transgender people have been impactful
at many levels of society.7–10 Yet, autistic transgender people face striking
challenges related to marginalization and the doubts of others.11,12 Even their
existence has been questioned (i.e., the genuine co-occurrence of being autistic
and transgender).
For example, although community expressions of the common co-occurrence
abound,13,14 some commentators have asserted that autistic transgender people
may not, in fact, be autistic, but instead that pseudoautistic features might
arise from “environmental factors related to social deprivation” in transgender
individuals, namely “a high prevalence of minority stress, poor peer
relationships, and familial non-acceptance.”15,16 Work by some of the members of
this roundtable has directly challenged such assertions, demonstrating that
autism among transgender individuals is related to brain functional connectivity
profiles consistent with previously established neural characteristics of
autism, whereas gender minority stress indicators are not.17
Attempts to deny autism among transgender people may reflect ongoing societal
stigmatization of autism,18 which may drive implicit bias and assumptions about
autistic transgender people,19 including challenges to whether this intersection
even exists.20 Also of concern are clinical assumptions that the autistic
transgender intersection reflects at its root confusion by autistic people about
their gender.21 Yet no published study has demonstrated that autistic
transgender people typically experience regret regarding their gender-related
decisions and/or detransition.
Of note, a recent study found that autistic transgender and nonautistic
transgender young people were equally likely to show stability versus
instability of gender and gender-related need over time.22 Further, roundtable
member Aimilia Kallitsounaki has reported that autistic and nonautistic
transgender individuals show no differences in implicit measures (i.e., outside
of conscious control) of gender identity, with both groups demonstrating
implicit genders that align with affirmed gender and not assigned sex at
birth.23
Adding additional complexity is the current politicized atmosphere that
transgender and nonbinary people, including autistic transgender and nonbinary
people, face. The common intersection of autism and transgender identity has
entered the political fray surrounding gender diversity and gender care,24–27
again, likely due to ongoing stigmatization and distrust of autistic people,
their inner experience, and their ability to know who they are. Yet, within the
autistic community, and increasingly within the transgender community as well,
the presence and contributions of autistic transgender people are more and more
recognized and celebrated.13,28,29 This roundtable brings together researchers,
academics, and expert practitioners to consider the current state of the field
and key next steps for research and advocacy with this highly marginalized
sector of our communities.
It must be noted that this roundtable is occurring in the context of a great
deal of upheaval regarding transgender rights, which panelists highlight as
having a profound impact on not only autistic transgender individuals and
communities, but also research with these communities.
Dr. John Strang: Thank you everyone for joining today's panel on the common
intersection of autism and gender diversity. There are eight of us today
representing research, clinical care, and advocacy. Each of you has played a
role in moving forward the understanding of the common intersection of autism
and gender diversity. To get started, please take a moment to introduce yourself
and say a bit about your work with this intersection, including what you've done
and your goals for future contributions to this field. If you would like to
share anything about your background or identities, feel free to do so.
Dr. Wenn Lawson: I am a British Psychologist, a member of the Australian
Psychological Society and Australian Association of Social Work, an autistic
lecturer, advocate, researcher, writer, and poet. I am passionate about autism
research and intersections with gender diversity. I work with the Curtin
University Autism Research Group (Western Australia) and Macquarie University
(New South Wales). I am also a Tutor Practitioner with the University of
Birmingham's (United Kingdom) Master's in Education and an ambassador for “I
CAN,” Australia's largest network of autistic-led mentoring and training
services for youth, young adults, and organizations. I am on the Board for “Good
Autism Practice” United Kingdom, Editorial Board for Autism in Adulthood, and
the U.S. Autism Association's Advisory Board. In 2021, I was awarded the Lesley
Hall National Lifetime Achievement Award for Disability Leadership. I am an
autistic transgender family man with autistic offspring and autistic
grandchildren.
Dr. Harriette Wimms: I am a Maryland-licensed clinical psychologist who provides
care to children, adolescents, adults, and families—with a focus on working with
people of color, neurodivergent individuals (primarily autism spectrum disorder
[ASD] and attention-deficit/hyperactivity disorder [ADHD]), LGBTQ+ people, and
neuro- and gender-expansive clients across the life span. I have worked in
outpatient, pediatric, rehabilitation, and community psychology settings. I've
served as the founder and director of child, adolescent, and family therapy
programs within outpatient mental health, federally qualified health centers,
inpatient pediatric hospitals, LGBTQ+ specialty clinics, and school settings.
I'm an adjunct professor at the Loyola University Maryland and Academy of Jewish
Religion. I am most proud of being mother to my 18-year-old neurodivergent,
gender-diverse teen.
Dr. Anna van der Miesen: I am a White queer medical doctor in Child and
Adolescent Psychiatry and a postdoctoral researcher with the Center of Expertise
on Gender Dysphoria in Amsterdam, The Netherlands. My clinical work has focused
on autistic children, adolescents, and young adults with gender incongruence who
are seeking medical gender-affirming care. My research has also focused on the
intersection of autism and gender diversity in addition to research on the
mental health of gender-diverse individuals, community-based participatory
research, and cross-cultural research. From a personal perspective, my partner
is late-diagnosed autistic, and I am therefore very supportive of adequate
gender/gender-diversity sensitive autism assessment.
Dr. Meng-Chuan Lai: I am a child and youth psychiatrist at the Centre for
Addiction and Mental Health in Toronto, Canada, providing mental health care for
neurodivergent children, youth, young adults, and their families. I am also a
researcher at the University of Toronto studying the intersections of autism,
mental health, sex, and gender—from biology, cognition, individual development,
to health service experience. I have worked clinically in Taiwan with youth of a
range of sexual and gender identities for their mental health and been involved
in social advocacy for the LGBTQ+ communities and the first school-based survey
on gender dysphoric feelings in Taiwan.
My current research stems from the training I received in the United Kingdom
working with autistic women, whose lived experiences have greatly enriched my
understanding of the intersections of gender and autism. I work clinically with
autistic girls/women, boys/men, nonbinary, and gender-diverse youth for mental
health, and part of our team's research is to understand the gender journeys and
developmental needs of autistic people to design more tailored support. I am
cisgender and nonautistic and have a nibling who is neurodivergent.
Dr. Aimilia Kallitsounaki: I am a nonautistic cisgender psychologist with an MSc
degree in Developmental Psychology and a PhD in Psychology. I currently work as
a postdoctoral research associate at the University of Kent in the United
Kingdom on a project that explores the intersection of autism and gender
diversity in children and young people as well as in their families. Before
this, the focus of my research was on the adult population. Specifically, during
my PhD, I examined the common intersection of autism and gender diversity taking
an individual differences approach. I also conducted case–control studies with
autistic and nonautistic transgender and gender-diverse adults. In the future, I
hope my research will produce evidence that will increase our understanding of
this intersection so that autistic gender-diverse children and adults can
receive more timely and specialized support and care.
Mx. Finn Gratton: I am a White, autistic, queer, and agender somatic
psychotherapist and consultant based in California. In addition to my
psychotherapy practice, I write and provide training on neurodiversity- and
gender-affirming care. I am deeply engaged in supporting connection and capacity
among trans, queer, neurodivergent, and allied practitioners through
international group consultation. Additionally, I am engaged in an initiative in
autistic and ADHD somatic practices.
Dr. Kate Cooper: I am a clinical psychologist and academic based at the
University of Bath in the United Kingdom. I'm White, cisgender, and not
autistic. I recently completed my doctorate, which aimed to understand the
experiences of autistic people with gender dysphoria. I've worked clinically
within mental health settings with gender-diverse and neurodivergent young
people who were experiencing distress and conducted qualitative interviews with
a range of stakeholders with perspectives on the co-occurrence.
Dr. John Strang: I am a clinical neuropsychologist and founder and Director of
the Gender and Autism Program at Children's National Hospital. I identify as
neurodivergent and within the LGBTQ+. I am interested in pushing the field to
focus more on the community and clinical supports and approaches that are most
helpful to autistic transgender people. I am active within the World
Professional Association for Transgender Health (WPATH) and served on the
Standards of Care 8 (SOC-8) revision groups for the child and adolescent WPATH
care standards. Through WPATH, I colead specialized training in the Global
Education Institute on the intersection of neurodivergence and gender diversity.
Mx. Finn Gratton: We know that the inner experiences of autistic people, as well
as the authenticity of their self-report, are often doubted and even denied.
Such beliefs and perspectives have resulted in delayed or denied gender-related
care for some autistic trans folx. Currently, some of you are engaged in
research to better understand the nature of the autism gender diversity
intersection. What have we learned in these efforts that might inform a shift in
societal and medical understanding to provide more ethical and attuned care for
autistic, transgender, and nonbinary people?
Dr. Wenn Lawson: I think we have learned a number of things from research, but
even more so from anecdotal experiences. We need to listen to the autistic
voice, including the autistic gender-diverse voice. And realize that sometimes
we self-recognize our autism—it doesn't necessarily mean a clinical diagnosis
because those can be expensive and have quite long waiting lists. Importantly,
we've learned that autism diagnoses are more common among gender-diverse
individuals than among their cisgender peers. We've also learned that we need to
take what autistic transgender people say seriously. For me, going to the
psychiatrist and talking about gender dysphoria wasn't taken seriously because
of my autism, and they really were very reluctant to pursue gender-affirming
care with me.
There was a strong focus by the mental health specialists on whether my gender
experience was authentic, like they thought it was due to my autism or some
mental health issue. It took 8 months and seeing two psychiatrists to have what
I was saying about my gender confirmed.
We need to get more serious about the needs of autistic transgender people and
the disparities they face. I think this is one of the ways we can address the
concerning suicidality experienced by so many in our community. We also need
research that engages and deeply includes the autistic transgender community in
its design. Currently, I'm involved with research exploring intersections
between autism, gender identity, and mental fitness. I'm also working with a
team at a large Australian mental health organization, looking at the issues of
coproduction, which means bringing all the voices together from the very
beginning of something that we're exploring, so we make sure we get that
autistic voice included.
I don't think that, in general, researchers have included the autistic
transgender voice very seriously, but this is something that is beginning to
happen. And that's really important because autistic and autistic transgender
people are emphasizing the need to be heard.
Dr. Meng-Chuan Lai: I would first like to acknowledge that science about humans
cannot really ever be neutral, because the design of scientific studies and the
interpretation of the findings are all affected by the presumptions, biases,
stereotypes, hopes, beliefs, and ideologies held by the person who conducts the
study or reads the findings. Although scientific findings have been used to
inform social, medical, and policy changes, what's actually driving the changes
is not the findings alone, but also the presumptions held about the findings.
What I'm going to share is definitely also affected by my own biases,
presumptions, and ideologies.
I will emphasize three things from my research and clinical experiences. First
of all, autistic people have identities, period. Their identities include gender
identities. Autistic people have a range of gender and sexual identities, as do
neurotypical people; of note, autistic people's gender and sexual identities may
be even more varied. The diversity of gender and sexuality experienced by
autistic people enriches our understanding of human identities.
Second, identity is by definition personal. The person themselves is the
authority of their identity. It is subjective and comes from one's agency; that
has to be understood, respected, and acknowledged in any case. One's identity is
very much related to well-being. We now know that early identification with an
autistic identity shapes later well-being for kids and youth.30,31 A
neurodivergent lens brings better self-compassion, self-understanding, and
subjective well-being for autistic people. This is clearly also the case in the
gender and sexuality literature.32 We also know that identities may not always
be linear and may be fluid for some people.
Third, coping with one's identity development is so crucial and there are many
things going on related to the shaping of identity, including gender identity.
This involves a lot of exploration, thinking and decision-making, advocating for
one's own needs, and mental health-related issues. These processes may be
influenced by one's neurotype and whether the environment is supportive and
understanding of the person's neurotype.
Dr. Kate Cooper: I want to emphasize the need to focus on people's lived
experience. In my research, I interviewed autistic gender-diverse young people
and adults to capture their lived experiences, building upon the research
conducted by people at this roundtable and others. One finding was that both
adults and adolescents strongly asserted that they knew their own gender
identities.33 But what was different between the young people and adults was
that the adults were much more likely to reflect on autism as an important part
of who they were,34 whereas the young people that I spoke to were more focused
on their gender-related needs and were less likely to think of autism as an
important part of themselves.35 So, I think we need to help foster
self-acceptance of both gender- and neurodiversity.
We have the opportunity to help reduce feelings of self-stigma and shame after
the autism diagnostic process. To make the most of this opportunity, clinicians
could support individuals to make sense of autism in relation to their sense of
self, as well as explore their gender experiences.
As a society, we need increased acceptance of difference. Many of the autistic
gender-diverse people I've spoken with describe the challenges of feeling
different, both in relation to gender- and neurodiversity. I have wondered about
how the experience of discrimination related to both identities impacts sense of
self in autistic and transgender people. Unfortunately, many individuals
described their experiences at school of being bullied, feeling isolated, and
being othered, which is incredibly challenging and distressing. And these
negative social experiences and related distress pulled focus away from the
important process of making sense of who they are and what identities are
important to them.
Dr. Harriette Wimms: I will point out a few more things we need to consider as
researchers and clinicians. First, many individuals who are autistic do not
necessarily use speech as their primary mode of communication, and therefore,
our clinical efforts to characterize gender based on communication and responses
to verbal queries may be ineffective. For people who do not or cannot use verbal
language for communication, behavioral observation, in addition to verbal
language (and input from members of the social network), would be ideal.
I also think often about the intersections of ethnic and racial backgrounds with
neuro- and gender diversity. This is akin to the notion of intersectionality:
Kimberly Crenshaw's viewpoint that intersections of marginalized identities can
lead to increasingly negative outcomes due to complex societal impacts on
individuals at the nexus of marginalized identities.36 I believe we also need to
study in what ways there are differences in identification and identity
development for individuals who are at the crossroads of these identities, and
how these differences impact access to the needed supports and services and the
pacing of this access.
Dr. Aimilia Kallitsounaki: Using quantitative methodology, my research has shown
that transgender and gender-diverse adults identify with their experienced
gender, not only explicitly but also implicitly, regardless of whether they are
autistic or not.23 To put it simply, they report a diverse gender identity, but
also, and importantly, this identity is incorporated into their self-concept,
outside of conscious awareness or control. My research has also shown a
developmental continuity of gender-diverse feelings in both autistic and
nonautistic transgender and gender-diverse adults.23 I believe that these
findings provide counter evidence to the hypothesis that autistic trans
experiences are not “true transgender experiences.”
Dr. John Strang: In addition to Dr. Kallitsounaki's important contributions
regarding explicit and implicit gender in autistic and nonautistic people, we
can also look to the broad literature that shows that the autism gender
diversity intersection and the proportional “overoccurrence” exist not only for
young people,37 who may be exploring lots of identities, but also exist across
the age range into adulthood.1 People who doubt autistic transgender people's
identities often suggest that the gender-related experience might represent
“confusion”—that there may be some lesser authenticity to gender diversity
experiences in autistic people.
But when we see that this common co-occurrence exists across ages and into
adulthood, I think we are called to step back and consider that this may very
well be one of the beautiful contours of human diversity: that autism and gender
diversity often intersect, and that there is an authenticity to this pattern,
which is observed across ages1,37 as well as across countries and
cultures.3,38–42 Research from my own institution reported on autistic
gender-diverse compared with nonautistic gender-diverse young people.22 We found
that in these two groups reported on over time, autistic trans young people were
no more likely to experience shifts in their gender-related medical requests
than nonautistic trans people. Of course, research like this needs to be
extended over years and decades; that will help to move us toward a more ethical
and informed care practice.
Dr. Anna van der Miesen: You are all doing an incredible job increasing
awareness for the gender diversity autism intersection. However, I am worried
about the heightened politicization of transgender people in general, and those
with intersecting autistic gender-diverse identities in particular. In many
parts of the world, new laws are arising that restrict access to
gender-affirming medical care, which may disproportionately affect autistic
trans youth given the extra barriers that autistic gender-diverse people already
face in accessing care.
As researchers, we always operate in a social, political, and cultural context.
But the intergroup polarization happening alongside this politicization worries
me, as it causes people and societies to define themselves as allies or
opponents to trans people. We are losing a middle ground, and this is affecting
the potential for nuanced conversations, including in scientific circles. I
don't know how to solve this, but I've learned that we really need to keep on
going through this changing context and continue working together and producing
meaningful scientific research.
Mx. Finn Gratton: I want to note that the research you all and others are doing
has motivated many autism care and gender care providers to seek greater
understanding and to begin addressing accessibility issues for autistic trans
and nonbinary people. However, research-based understanding has not filtered
through to many medical and mental health providers, who are often gatekeepers
to more specialized care. Social stigmatization of both autism and trans
identities seems too often unmoved by scientific research. Further, as Dr. van
der Miesen was referencing, medical care is affected by social bias-fueled
politics, such as legislation, lawsuits, and threats of violence. Autistic trans
people, particularly those with higher support needs, are at greater risk of
losing timely access to medical and social transition support.
Dr. Meng-Chuan Lai: From a general medical perspective, if there is any care to
be provided, this requires a process of informed consent. The informed consent
and the capacity to receive care are not—and should not be—determined by the
diagnosis given to a person, no matter if this is autism, schizophrenia,
intellectual disability, or other diagnoses. Although on paper and in
bureaucratic systems, people use diagnostic categorization all the time, it is
very important to recognize that clinically, a person's capacity and care
planning should not be solely based on their diagnosis. We should all insist on
personalization, and we should fight against the stereotype of who is capable or
not owing to a particular diagnostic label they have.
Dr. John Strang: There has been an increasing spotlight on the common
intersection of autism and gender diversity among major academic journals,
advocacy organizations, and clinical policy associations. The intersection of
autism and gender diversity has also received heightened attention in the press
as well as in legal and political debates. What is the impact of this increased
attention? Could you offer thoughts about the helpful and potentially harmful
effects this spotlight has had for trans and nonbinary autistic people?
Dr. Wenn Lawson: When anything is spotlighted or highlighted, people can be
quite fearful and there's potential for some serious harm if we operate from
fear. But if we step back and take a more balanced look at things and we talk
about it, then we can put the intersection of autism and gender diversity into
context. Also, because so much of gender identity and autism is ingrained in who
we are, some autistic people don't think to separate these things.
Mx. Finn Gratton: My first thought follows Dr. Kallitsounaki's research showing
no difference between autistic and nonautistic trans people in their experience
of implicit gender.23 If this is true, then why put a spotlight on autistic
trans people, referring them for autism assessment that might delay or cause
denial of gender care, as their gender identity has been shown to be
incorporated into their self-concept, outside of conscious awareness? I know
that anti-trans groups have picked up on the autistic trans intersection and
used statements in WPATH SOC-8 adolescent and child sections about the autistic
trans overlap to fuel their rhetoric, feeding the incorrect belief that autistic
people are inherently impaired in their ability to know their gender or provide
informed consent.†
There has been a history of autistic people being infantilized and/or not having
their needs honored, and many are wary of gender care providers or insurance
providers delaying or denying their care because of an autism diagnosis—which,
in my experience, has and continues to occur for some autistic people. I know
that, within the autistic community, some people are choosing to try to hide
their autistic traits and to avoid pursuing a medical autism diagnosis until
they've gone through social and medical transition.
While recommendations of assessment for autistic or other neurodivergent
characteristics may be intended to serve autistic and otherwise neurodivergent
people by securing better supports and understanding, it may also present a
dilemma for some patients and their providers, as this assessment might be used
against their gender needs by uninformed medical or insurance systems. In some
locations, gender care could be legally restricted due to an autism
diagnosis.43,44 One way to approach these barriers, while also supporting the
access and effectiveness of medical and mental health care, would be an
inclusive, or a universal design-guided, approach to mental and medical health
services. It should be anticipated that autistic and other neurodivergent people
will be common in our patient/client population, as are disabled people,
immigrants, and others with different care delivery needs.
Universal design principles do not single out specific populations but include
the needs of all populations in health care systems.45 By designing forms,
protocols, communication options, and physical and online environments to be
welcoming and effective for people with a variety of executive functioning,
sensory, and communication needs, we improve access for everyone, not just those
diagnosed as autistic. When we improve the clinical experience, we improve
communication, trust, and, ultimately, treatment. Such a universal, rather than
diagnosis-segregating approach would support diagnosed autistic people, as well
as those who do not yet know, or are unwilling to share, that they may be
autistic, along with the many people who do not meet clinical criteria yet have
communication, environment, and cognitive processing needs than are included in
most standard gender protocols.
Dr. John Strang: With the spotlight on not only autistic trans people, but trans
care in general, there has been a great deal of confusion regarding what people
mean when they say “evaluation” or “assessment.” I have observed that there are
many different motivations people have in conducting and receiving assessments:
Some assessment approaches may be extremely helpful to the individual, while
others may not. In gender care circles, the term “assessment” has often focused
on seeking to understand the nature of a person's gender experience and the
“readiness” to commence requested medical care. However, as Mx. Gratton notes,
an additional motivation for assessment focuses on the individualized needs of
the trans person, and this is not exclusive to autistic trans people.
In fact, in our research, we have identified that even beyond the autism gender
diversity intersection, trans young people often experience undue gender
barriers related to executive function differences.46 And we've identified that
these executive function barriers are very much related to greater suicidality.
Some of these barriers may arise in relation to the underlying neurodivergence
and the impact of a “disabling” society. And other challenges may stem from the
impact of marginalization on the well-being and functioning of the individual.
With these perspectives, a model of assessment and related accommodation and
advocacy that seeks to characterize the personalized gender, advocacy, and
accommodation needs of individuals may be profoundly helpful in improving
outcomes for neurodivergent trans folx. This kind of broad and collaborative
assessment does not typically get discussed in the larger conversations
regarding clinician-driven gender evaluation.
Dr. Meng-Chuan Lai: I think the pros of increased attention may be more
opportunities for advocacy because when there's increased attention, it comes
with increased awareness. Depending on the resources available, political
debates can provide the momentum to make changes and facilitate discussions. The
cons may be, paradoxically, reduced room for exploration and calm types of
discussion due to the polarization. I worry a lot that the variety and richness
of the lived experiences can be overly simplified and flattened in the polarized
debate to find a solution, cause, or fix. And then the richness of experiences
that's needed for identity development for a person, especially the exploration,
and sometimes detours, gets compressed and there is limited room to discuss and
reflect on things. I worry about the flattened and overly simplified discourses.
I want to also bring up the intersectionality aspect that Dr. Wimms pointed out
earlier, because again, flattened and simplified discussions often leave out
intersectionality with race, ethnicity, poverty, and sociocultural contexts.
Thinking from a global perspective, similar to the consideration of
intersectionality, it is important to consider the cultural and political
contexts and the state of the society when discussing topics under polarized
debates, such as in many North American and European countries. These topics may
not receive the same kind of attention currently in other countries. For
example, I was recently talking with my Taiwanese psychiatrist, pediatrician,
and social advocacy friends about gender care and gender diversity awareness
among professionals. I learned that much of the social advocacy for transgender
rights at this moment in Taiwan is centering around the right to change one's
gender on legal identification documents without also having to have received
gender-affirming surgery.
At the same time, despite being one of the most LGBTQ+ friendly countries,
attention to what medical gender care might be like for teenagers in the local
context is just emerging. There is no systematic implementation of the Dutch
model47 in Taiwan yet, for instance. Prescribing pubertal blockers to
gender-diverse teens has just been piloted recently and inconsistently. Even
topics with pronoun use have different implications due to linguistic
differences. The current debates in the United States, Australia, the United
Kingdom, Sweden, and Canada may not be immediately “relatable” and translatable
for clinicians (and even autistic people and their families) in other parts of
the world, as there are immediate local contexts at play in each society and
jurisdiction.
There are historical, cultural, social, political, and legal reasons as to how
and when a society attends to, discusses, and makes changes to best care models
for autistic gender-diverse people in their local contexts. There are lots of
differences that affect what the attention and the focus of social advocacy
might be at the moment. People around the globe experience different statuses
and paths. I think it is very important to acknowledge that.
Dr. Anna van der Miesen: Dr. Lai made a good point about the pros and cons of
increased visibility. However, I think the nuance gets lost. An advantage of a
spotlight is of course that more people know about the common intersection: More
clinicians know about it, and autistic people are being asked about their gender
identity, which a few years ago, was not happening. But a disadvantage is that
when something is spotlighted, people tend to be either in favor of or against
it. So, it becomes really dichotomized. While intersectionality is not something
that is an opinion for which we should be in favor of or against, it has nuanced
layers of experiences that we need to look at from different angles, and we need
to stay away from dichotomies. And I think that's a disadvantage of the
spotlight.
Dr. John Strang: Dr. van der Miesen, can you say more about the type of nuance
you are speaking of?
Dr. Anna van der Miesen: I'll give you an example. Mental health is an
intersectional experience that may need clinical attention. And we know from our
initial studies in The Netherlands that when transgender people have access to
puberty suppression and gender-affirming hormones, their mental health
improves.48 But some clients I have known for years continue to struggle with
their mental health even after receiving gender-affirming medical care. These
struggles may stem from environmental challenges and nonacceptance and
discrimination related to neurodivergence and/or gender diversity.
Mental health challenges may also arise due to existential concerns over not
being born the way they wanted to be born. I think access to gender-affirming
care can help mental health, but there may be still mental health challenges
even with access to medical gender-affirming care. So, I think we need to be
able to handle the nuance that people may still struggle, and that should not be
a reason to deny care.
Dr. Harriette Wimms: In my clinical work, I have seen that the focus on mental
health and wellness has made a difference for some of my younger clients and
their families. For example, some of the young children I work with, who have
received diagnoses of autism and who are also gender-diverse, are communicating
gender- and neuro-expansiveness through behavior. Additionally, when they are
affirmed as being gender- and neuro-expansive, externalizing behaviors decrease.
I'd also like to broach the topic of ASD, ADHD, and race/ethnicity. Earlier in
my career, autism was not being diagnosed among African American and Latinx
people at the same rate that it was being diagnosed among White children. Black
and Brown children with the same diagnostic criteria as White children with
autism were more likely to receive incorrect diagnoses of ADHD and/or conduct
disorder.49 Recent studies suggest that the diagnostic chasm is shrinking and
that children of color are receiving more diagnoses of autism.50 Yet, Black and
Latinx communities are still less likely to receive information about early
intervention and long-term planning for autism supports.51,52 We have a long,
long arc of reckoning to erase bias in the diagnosis and treatment of autism
based on race.
Lastly, with regard to supporting gender-diverse and neurodivergent youth, my
hope is that in the same way we have beautiful books now about being nonbinary
and transgender, that one day soon we will have the same kind of affirming
materials for families who are raising gender-diverse neurodivergent
kids—especially kids of color.
Dr. Kate Cooper: As Dr. Lai mentioned regarding various cultural contexts, I'll
offer some thoughts on the United Kingdom, where I am based. There was a
judicial review recently about whether under 16s could provide informed consent
to access puberty blockers, and one of the claimants was the mother of an
autistic teenager.53 From the clinical and research work that I've done, I know
that a lot of families have been keenly aware of that judicial process, as well
as the wider societal discourse in this area, and this awareness has caused
additional challenges to families. These are families who have a child in
distress, who is dealing with understanding themselves and their gender and
being autistic and all the challenges that can bring to young people.
But then these families also have this sense of being in the spotlight and a
real fear that access to health care services will be reduced, adding additional
distress. As others have pointed out, this can lead to less space for
exploration and can lead to polarization within family units, mirroring the
wider discourse. And, because services are changing quite a lot at the moment,
there has been some uncertainty as to what services will look like in the United
Kingdom in the future. Obviously, that uncertainty would be challenging for any
family, but it's especially challenging for autistic people. So that has very
much been present in my research and my work, and I think it has made people
feel the need to really assert that they do know their gender identities and
spend a lot of time doing that.
Dr. Aimilia Kallitsounaki: I would like to add here one more point about the
positive impact of the increasing spotlight on the common intersection of autism
and gender diversity. I think this will help clinicians and researchers to
secure funding more easily, which is of paramount importance. The more research
we conduct, the better we understand autistic gender-diverse people, and
eventually, we will be able to provide better support and care. Of course, we
cannot disregard the potential harmful effects of this publicity.
Catchy headlines, misleading translations of research findings in the press, and
political and legal debates lead to misconceptions in the general public and a
general fear to engage with research related to the intersection of autism and
gender diversity. For example, institutions that would typically be open to
participate in psychological research are often less willing to engage with
researchers from this field out of fear of becoming associated with any type of
publicity and the scrutiny that comes with it. This is counterproductive and
delays the emergence of positive outcomes for the autistic gender-diverse
community.
Dr. John Strang: For almost a decade, I have been running the Gender and Autism
Program or a forerunner of that program that didn't have an official name. And I
think a positive of the national and international spotlight is that we are
seeing a much more diverse group of young people in recent years. We are seeing
lots of little ones coming in and getting supports that they need. And for the
first time, we're seeing autistic gender-expansive young people who also have
intellectual disabilities. I think the word is getting out to schools and
providers, and the community is now learning that there are some specialized
services available for young people at this intersection, allowing for
diversification in our referrals.
Mx. Finn Gratton: There's a great deal of focus on autistic gender-diverse
youth, especially teens. And perhaps this is due to the ongoing clinical and
political dialogue regarding gender-related medical decisions in youth,
including autistic youth. But this focus on youth and teens has drawn attention
away from autistic, trans, and nonbinary adults, and their needs. Given the
current lack of research and advocacy for autistic trans and nonbinary adults,
what are your top research and advocacy priorities for the adult community over
the next decade?
Dr. Wenn Lawson: If it were up to me, and I know it isn't, I would prioritize
direct funding toward autistic adults and appropriate adult care. In Australia,
we have very little support medically or socially for autistic adults who are
also trans. For example, I had to travel abroad for a lower surgery and had
issues with that, specifically in trying to find medical care back in my own
country of Australia. It was really difficult because people wouldn't see me
since they hadn't worked on me surgically. And I was really at a point of severe
need for surgical intervention. I did find help eventually, but without respect
or understanding. I was certainly made to feel less than. I'd love to see
research highlight the medical and social needs for autistic transgender adults.
This theme we've talked about throughout this roundtable of being listened to
for respect and mutuality highlights that we are human and adults, and we need
the same afforded understanding. Further, adults are in even more need quite
often because we've had years of accumulation of issues that are impacting us.
We need supportive clinics and services for various adult issues. I think this
would also contribute to fewer mental health issues, like suicidality, but we
need research and advocacy to highlight these links. These are an absolute
priority, and there has to be care for autistic and transgender people's entire
lives.
Dr. John Strang: In addition to Dr. Lawson's offering, which would be an
absolute priority in my mind, I'm also concerned about late or missed autism
identification among gender-diverse people. And absolutely, not every autistic
person needs to be clinically identified or diagnosed, but we do know that there
are associated greater risks for people who are late to receiving their
diagnosis or identifying as autistic.54 We have noticed clinically, and we're
beginning to document this in our research, that there is an apparent
intersection of late autism diagnosis and gender diversity. So, this brings me
to my first additional research priority. We need to better understand how
autism may be differently experienced and expressed by gender, especially in our
work by gender-diverse folx, and how this might lead to a missed diagnosis.
Another priority area involves moving away from the deep pathologization to a
focus on research to better understand how this intersection may be protective
and associated with great and meaningful lives. The extreme pathologization that
has occurred around this intersection is so different from the day-to-day
experience I have collaborating with autistic transgender people in their care.
We have a vibrant and creative community of autistic transgender people who are
part of our program and larger community offerings, and I can tell you that the
spirit of our community is hopeful and not one of despair. Positive and hopeful
aspects of the intersection have been largely lost in the clinical literature.
And this is an area where we as researchers need to do better in telling the
whole story.
Dr. Aimilia Kallitsounaki: I just want to add that over the next decade,
research might usefully focus more on the clinical characteristics of autistic
transgender and gender-diverse adults. Not only will this help to identify the
specific needs of relatively homogenous subgroups within the autistic
gender-diverse population, but it will also help in the design of educational
and training programs for health care professionals to provide additional and
specialized support and care attuned to individual needs. The ultimate goal of
this research should be to promote the well-being of autistic transgender and
gender-diverse adults and to support their quality of life.
Dr. Kate Cooper: I was thinking about people I interviewed for my research who
were autistic trans people in their forties plus, who spoke about really feeling
the lack of role models of people like them aging and not really having heard
stories of people like them.34 So, there is a real need for more focus on the
lived experience of what it's like to grow older as an autistic trans person.
Also, that group had the experience of not having their neurotypes or their
gender diversity acknowledged or mirrored back to them in society when they were
growing up, which had a profound impact on their sense of self and
self-knowledge.
Hopefully, younger people will have more role models and examples of different
ways to be in the world as an autistic gender-diverse person. However, there is
a generation of people who really didn't have that, and we need to be thinking
about how to support them and their particular needs as they get older.
Dr. Harriette Wimms: Although rates of identification in kids is becoming much
more equal in the States between White kids and kids of color, particularly
Latinx and African American kids,50 there is still a tremendous delay in service
provision and family education about autism.51,52 It is also a sad fact that
special education is often a prison pipeline for Black and Brown young people,
an issue also known as the school-to-prison pipeline.55–57 When autism and
gender expansivity are also considered, the outcomes can become bleaker.
Therefore, prison reform to ensure safety and wellness for autistic transgender
individuals in prison is an absolute necessity. I'm especially considering Black
trans women and the ways that mental health and social justice initiatives still
fail to serve them.
We need to identify mechanisms that support these vulnerable populations. I also
think that, as Dr. Lawson mentioned, access to long-term care planning is
essential. When we consider individuals who are people of color, disabled, and
gender-expansive, we need to consider access to financial resources, or lack
thereof. We must also consider that some adults with disabilities continue to be
cared for by their families—placing a burden on aging parents. Reform is needed
to make long-term care affordable for the families of disabled individuals, and
this planning involves services of support when parents pass away.
There must be systems that ensure access to resources to promote good adulthoods
in the same way that we want teens and young children to have access to good
lives and optimal development. Autism doesn't end when a person reaches 21.
Autism is a lifelong disability, and programs supporting aging autistic
individuals who are gender-diverse are crucial.
Mx. Finn Gratton: I want to echo what Dr. Wimms said about the impact of the
special education-to-prison pipeline for Black, Indigenous, and People of Color
(BIPOC) trans autistic people. Both gender care and affirming autism services
serve disproportionally White and economically privileged people over BIPOC and
low-income people. If we want to find the trans autistic people we're missing,
we're going to find many in the carceral system and in disabled and unhoused, or
fragilely housed, communities. The later the recognition and support for both
trans and autistic experiences, the greater the chronic physical and mental
health issues.54,58,59 Adding the allostatic load from racism60,61 to the loads
from trans and autistic discrimination is a triple hit to health and life
expectancy.
Almost all my trans autistic clients over the age of 15 are dealing with
significant and chronic health issues: chronic fatigue, fibromyalgia, migraines,
and many more. While some of these diseases may be related to high sensitivity
associated with autism, I suspect most are due to the extremely high allostatic
loads related to discrimination and oppression, along with poor access to
responsive care.
In the future, I want to see more autistic and academic collaborative research
and program development initiatives, with BIPOC and disabled trans autistic
people in leadership positions and directing program and research priorities.
I'd like to see the development of gender-affirming education and protocols for
care providers of autistic youth and adults with higher support needs, as well
as gender- and neurodiversity-affirming training and protocol development for
the incarcerated and the unhoused populations. I'd love to see the inclusion of
autistic transgender or nonbinary “standard patients” in medical training and
the development of instruments for earlier identification and support for
chronic health issues. I'd like to see more medical and mental health strategies
driven by autistic experiences of what works and doesn't work for them in health
care settings and interventions.
Dr. Anna van der Miesen: Everyone has shared extremely valuable future
directions. In addition, I'm hoping we could learn from research and clinical
work with children and adolescents in the sense that we're a bit more inclined
to take the developmental perspective or lens with youth, but as soon as someone
is 18 years old, that gets totally lost and we're only looking at sneak peeks,
or cross-sectional parts of their lives.
But human beings keep on developing through their life span and different
experiences, different intersectional experiences, could shape people's lives.
So, I'm hoping for future research on gender-diverse and autistic adults to take
a more developmental approach. I think Dr. Cooper has done an amazing job with
the interviews, but I hope we continue to look at everyone from a developmental
perspective and not solely one cross-sectional view of an adult's life, because
we continue to develop. We need to walk together through time to understand
longer term trajectories and outcomes.
Dr. Meng-Chuan Lai: I echo so much with what people have shared, from the focus
on mental health and well-being to the developmental and life span perspectives
to understand individual differences and journeys related to gender and
neurodiversity. In terms of mental health and well-being, I really want to see
more integration of individual-focused and environment- or context-focused
approaches.62 Environment and context here span from the family, the school, and
the community to how stigma and discrimination in the society have an impact.
Drawing on Dr. van der Miesen's example, many gender-diverse people, autistic or
nonautistic, even after receiving adequate gender-affirming care, may still
struggle with a lot of things in life. Many of these challenges might heavily
originate from the context or environment. When it comes to autistic
gender-diverse people, there is an added layer. There are heightened mental
health challenges faced by autistic people.63
Although these may, in part, be related to biological factors and cognitive
styles, there's evidence that they are also the results of a poor fit between
the environment and the autistic person. Many of these challenges are due to
nonautistic people's poor understanding of autistic people.64–66 Research using
the minority stress model helps to understand why there are heightened mental
health challenges.67 We need to take that forward to make changes to “treat the
environment” or “help the environment to help the autistic person” from
childhood to adulthood. The other important aspect is what Dr. van der Miesen
emphasized: the richness of the developmental perspectives and the variety of
individual journeys. The life stories pointed out by Dr. Cooper are so rich and
inspiring. We as researchers and clinicians need to be familiar with these
experiences of autistic and gender-diverse people.
Finally, I really want to see more global liaison, coordinated and integrated
with local grassroots advocacy efforts. This is because there could be different
contextual factors and different battlefields for different societies. I want to
dedicate more to global liaison and joint work, based on shared values and
beliefs about basic human rights. My view on the study of gender is to
deconstruct gender and make it a better context for people around the world.
Dr. John Strang: As we begin to wrap up this roundtable, do you have any
concluding thoughts to share?
Dr. Wenn Lawson: Research is pointless unless it is integrated translationally
into practice. We must in this work incorporate research findings into practice
across the lifespan developmentally, including for services, funding, insurance
coverage, and other real-world priorities. The intersection of autism and gender
diversity needs to be highlighted at the grassroots level and incorporated into
practical translation.
Mx. Finn Gratton: I've always wanted to turn the investigation into the
“overrepresentation of trans identity amongst autistic people” inside out. I
want research about why nonautistic people are so commonly cisgender and
heterosexual. What is it about them? What causes the high prevalence of gender
and sexuality rigidity among nonautistic people? Why can't they have the kind of
fluidity or openness that is common with autistic people? That this question has
not been asked reveals an unexamined implicit bias clinically and academically
against those who can't or won't comply with normative expectations.
Dr. Harriette Wimms: Our fields of intervention are often focused on
evidence-based practice—to the exclusion of considering practice-based evidence.
What can be learned by listening to individuals and making practice
recommendations based on lived experience? Additionally, while I am delighted
that research is more and more available from clinics and research initiatives,
I worry that we are making empirical conclusions and finding evidence only from
a group of clients who have access to hospitals and clinics. What about the
individuals and families that don't have access to care, can't or won't access
clinics, or are barred from seeking support for autism and gender expansivity.
What can be learned from these populations? Who are they? How do we reach them?
What do they need? They are a very important part of our community that does not
have a voice in the empirical literature.
Dr. Anna van der Miesen: As a research community—but also as a clinical
community—we need to look at intersectionality from various social and
cross-cultural perspectives. This is something that can only be reached by
collaboration and the exchange of ideas and perspectives not only between
researchers, but also between researchers, clinicians, policy makers, and people
with lived experience. This roundtable is a good example of a starting point.
Dr. John Strang: I want to mention that, in addition to all the complexity
related to the marginalization of autistic transgender people, individual gender
journeys can be complex. In this all-or-nothing politicized world, we don't
leave a lot of space for people for whom the gender journey is flexible or
changes over time. For people whose gender experience is flexible or changes
over time, their needs may change sometimes in subtle ways or sometimes in
really striking ways, and these journeys are not well understood.68 What has
happened is that these nuanced gender journeys are pulled into the political
wars on this topic as evidence against providing care.
And more complex gender journeys are sometimes dismissed by our community, but
as someone who has worked in gender care for a long time, I have absolutely seen
gender-related needs shift over time for some people, and this includes
nonautistic and autistic people. I'm concerned there are barriers to doing
research in this area due to controversy and politicization. I am also concerned
with the stigmatization of people whose gender needs change, as they're
generally not included in the larger dialogues. I will say that in our research,
we have been fortunate to work with people who have had these kinds of
experiences, and they've really helped us to expand and enrich the work.11,69
So, as we move forward in research, my hope is we will be inclusive of all
gender journeys over time, and not just the straightforward ones.
Dr. Aimilia Kallitsounaki: We are all coming from different backgrounds and have
different perspectives on the intersection of autism and gender diversity. Yet,
we had an honest, thoughtful, and reflexive conversation. This is something that
is currently rare in this field, but it is crucial in order for new knowledge to
emerge. Engaging with all of you today has helped me gain a deeper understanding
of this intersection and be mindful of certain aspects that I should incorporate
into my future research. I am a quantitative researcher, and I deal mostly with
surveys and numbers, so when I speak directly with autistic transgender and
gender-diverse people as well as with clinicians and qualitative researchers
about their experiences and perspectives, it highlights how impactful and
important research in this field is.
Dr. Kate Cooper: My final thought is simple: we need to listen to the individual
experiences of autistic and gender-diverse people, without imposing our own
ideas of how they should experience or enact any of their unique identities. The
polarized media narratives imply that professionals and researchers in this area
are applying one-size-fits-all approaches, but of course, we need to listen and
respond compassionately to each individual. It has been great talking today with
a group who agree that we need to put autistic and gender-diverse people's
voices at the center of this work.
Dr. John Strang: Thank you, everyone, for sharing important perspectives and
research on the intersection of autism and gender diversity. Here is a summary
and integration of key ideas from this discussion:
* When considering and studying the common intersection of autism and gender
diversity, it is important to recognize and honor the wellness and resilience
of trans autistic people, while also acknowledging the impact of
pathologization and stigmatization of these and other marginalized identity
experiences on trans autistic people.
* Autistic transgender and nonbinary people hold the authority of their
identity and gender experiences. As researchers and providers in this field,
it is of utmost importance that we prioritize autistic gender-diverse
perspectives from a range of intersectional experiences in research and
clinical care. Not to do so risks harms to autistic gender-diverse people.
This collaboration—which should include codeveloping research goals;
cocreating measures, studies, and policies; and cointerpreting and
disseminating findings and outcomes—is essential to meaningful and
appropriate research, clinical care, and policy.
* Work is needed to better understand disparities faced by autistic transgender
adults related to autism, gender diversity, and their intersection. For
example, there are concerns regarding ongoing, and even increasing,43
barriers and limits to accessing gender-affirming care for autistic adults.
* There is increasing politicization regarding the autism and gender diversity
intersection in the context of larger contemporary movements seeking to
restrict access to gender care and other related civil rights.43,44 Yet,
there is no current evidence indicating that autistic transgender people
typically regret their gender-related decision-making. Further, polarized
political debates may eclipse nuance and subtlety regarding gender
experience, gender development, and the common intersection with autism.
* Currently, the concept and practice of assessment for gender-related care
have taken on a range of different meanings among gender care providers for
autistic individuals. Assessment for gender-related medical treatment should
be focused on determining the capacity of individuals to provide true
informed consent, including recognition of their gender needs. The use of
universal or inclusive design practices in gender care settings could help to
ensure that communication methods and care protocols support an effective
informed consent process and attuned accommodations for navigating gender
discernment and gender care. Gender care providers should support trans
autistic individuals by working together to assess barriers to care.
* Our panel today is limited in its global representation. Attunement to
sociopolitical and cross-cultural perspectives will be required to advance
best care practices for autistic transgender people in diverse local
contexts. This can only be achieved via collaboration and advocacy efforts
among community members, researchers, providers, and policy makers.
Importantly, there are many circumstances and contexts in which transgender
people, autistic or not, cannot express their gender-related needs for fear
of safety, and where autistic people are not safe in revealing their
neurodivergence.
* The perspectives, experiences, and needs of BIPOC autistic gender-diverse
people have not been sufficiently included in research and advocacy. What
understanding we have of the disparities faced by autistic transgender adults
has a White bias, as almost no work has been done to understand and address
disparities related to intersectional ethnoracial identities. To move forward
equitably in this field, we will need collaborative research and clinical
initiatives led or coled by and/or including BIPOC autistic transgender
individuals.
* Whereas adolescent gender diversity and autism research has begun to include
a developmental perspective, work with autistic transgender adults has yet to
appropriately consider the developmental milestones of adulthood. We need to
take a life span approach to understanding the trajectories of autistic
transgender people through adulthood, including their health, well-being,
gender and gender-related needs, and broader needs. As with all research
areas in this field, the equitable and intentional inclusion of BIPOC
autistic transgender perspectives will be critical.
AUTHORSHIP CONFIRMATION STATEMENT
F.V.G., J.F.S., and M.S. planned the roundtable. M.S. invited each of the
discussants. F.V.G. and J.F.S. served as moderators. F.V.G., J.F.S., K.C., A.K.,
M-C.L., W.L., A.I.R.v.d.M., and H.E.W. participated in the roundtable
discussion. M.S. made significant contributions to the synthesizing of ideas
across discussants and conducted a thematic analysis to optimize the continuity
and flow of ideas in the final article. M.S. also coordinated with each
discussant to discern appropriate citations for research referred to in the
discussion. All authors edited and approved the final article. The content is
solely the responsibility of the authors and does not necessarily represent the
official views of any of the funders.
AUTHOR DISCLOSURE STATEMENT
J.F.S. was a coauthor of the Child and Adolescent chapters of the Standards of
Care 8 revision through the World Professional Association for Transgender
Health (WPATH). F.V.G., J.F.S., and A.I.R.v.d.M. are faculty members with the
WPATH Global Education Institute (GEI); they receive financial remuneration for
their WPATH GEI services.
FUNDING INFORMATION
No funding sources directly supported this project.
* The terms “gender diversity” (as a noun) and “gender-diverse” (as an
adjective) are recommended by the World Professional Association for Transgender
Health (WPATH)2 to describe the experience of a variation between assigned sex
at birth and gender identity. It is important to note that not all panelists
embrace this use of “gender-diverse,” and some prefer writing out “transgender
and nonbinary.” Therefore, there will be an intentional inconsistency in the use
of language throughout the roundtable. The term “neurodivergence” is an umbrella
descriptor used here to refer to the experience of thinking styles that differ
from what has been deigned “typical” in the general human population. One form
of neurodivergence is autism.
† It is important to note that the WPATH SOC-8 statements addressing
intersectional neurodivergence and transgender and nonbinary identities were
designed to encourage greater attention to the accommodations that
neurodivergent people may benefit from in navigating gender discernment and
gender care. These statements were not designed to restrict access to needed
gender care by autistic and neurodivergent people. This roundtable authorship
team denounces such distorted interpretations of the SOC-8 statements.
* Figures
* References
* Related
* Details
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* Recommended
* A SPECIAL ISSUE OF AUTISM IN ADULTHOOD DEDICATED TO THE INTERSECTION OF
AUTISM AND THE BROAD LGBTQ+
* John F. Strang and
* Abigail L. Fischbach
Vol. 5, No. 2 June 2023
* EXPLORING THE EXPERIENCES OF AUTISTIC TRANSGENDER AND NON-BINARY ADULTS IN
SEEKING GENDER IDENTITY HEALTH CARE
* Harley Bruce,
* Katie Munday, and
* Steven K. Kapp
Vol. 5, No. 2 June 2023
* THE GENDER-DIVERSITY AND AUTISM QUESTIONNAIRE: A COMMUNITY-DEVELOPED
CLINICAL, RESEARCH, AND SELF-ADVOCACY TOOL FOR AUTISTIC TRANSGENDER AND
GENDER-DIVERSE YOUNG ADULTS
* John F. Strang,
* Lucy S. McClellan,
* Daphne Raaijmakers,
* Reid Caplan,
* Sascha E. Klomp,
* Mindy Reutter,
* Meng-Chuan Lai,
* Minneh Song,
* Finn V. Gratton,
* Laura K. Dale,
* Anouschka Schutte,
* Annelou L.C. de Vries,
* Finn Gardiner,
* Laura Edwards-Leeper,
* Amélie Lune Minnaard,
* Niki Lou Eleveld,
* endever* Corbin,
* Yenn Purkis,
* Wenn Lawson,
* Da-Young Kim,
* Isa M. van Wieringen,
* Victoria M. Rodríguez-Roldán,
* Marvel C. Harris,
* Madeline F. Wilks,
* Gee Abraham,
* Anouk Balleur-van Rijn,
* Lydia X.Z. Brown,
* Alexandra Forshaw,
* Gary B. Wilks,
* April Dawn Griffin,
* Elizabeth K. Graham,
* Sandy Krause,
* Noor Pervez,
* Inge A. Bok,
* Amber Song,
* Abigail L. Fischbach, and
* Anna I.R. van der Miesen
Vol. 5, No. 2 June 2023
* “MY WHOLE LIFE HAS BEEN A PROCESS OF FINDING LABELS THAT FIT”: A THEMATIC
ANALYSIS OF AUTISTIC LGBTQIA+ IDENTITY AND INCLUSION IN THE LGBTQIA+
COMMUNITY
* Christine McAuliffe,
* Reubs J. Walsh, and
* Eilidh Cage
Vol. 5, No. 2 June 2023
* BRIEF REPORT: AN EXPLORATION OF ALEXITHYMIA IN AUTISTIC AND NONAUTISTIC
TRANSGENDER ADULTS
* Aimilia Kallitsounaki and
* David M. Williams
Vol. 5, No. 2 June 2023
Volume 5Issue 2
Jun 2023
Information
Copyright 2023, Mary Ann Liebert, Inc., publishers
--------------------------------------------------------------------------------
To cite this article:
Finn V. Gratton, John F. Strang, Minneh Song, Kate Cooper, Aimilia
Kallitsounaki, Meng-Chuan Lai, Wenn Lawson, Anna I.R. van der Miesen, and
Harriette E. Wimms.The Intersection of Autism and Transgender and Nonbinary
Identities: Community and Academic Dialogue on Research and Advocacy.Autism in
Adulthood.Jun 2023.112-124.http://doi.org/10.1089/aut.2023.0042
* Published in Volume: 5 Issue 2: June 13, 2023
* Online Ahead of Print:May 26, 2023
Keywords
* autism
* transgender
* nonbinary
* gender diversity
--------------------------------------------------------------------------------
PDF download
--------------------------------------------------------------------------------
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