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THE AUTISM TRANSGENDER CONNECTION One Family s Story
ZACK S STORY
MOM S STORY
Autism is often overlooked in the presence of a gender identity diagnosis; gender identity is often overlooked in the presence of an autism diagnosis.
PREVALENCE Incidence of autistic-transgender are above average 7.8% of a group of trans-identity children tested were identified as being on the autistic spectrum. Participants on the autism spectrum were 7.50 times more likely to express gender variance.
RISK A study showed 30% of transgender youth report at least one suicide attempt, and nearly 42% report a history of self-injury, such as cutting. There is a higher risk of victimization for autistic-trans people. People with autism can be more likely to die from suicide attempts because they often have less awareness of permanent consequences. People with autism who are transgender experience more social isolation than people with either diagnosis alone.
WHY AUTISM AND TRANSGENDER? Female to male transgender people may be influenced by the male brain. Male to female transgender autistic people may identify as female because they feel bullied and uncomfortable around males as a result of the common trait of social challenges among autistic people. Autistic people are less restricted by society s definition of gender. An aha experience can seem like the answer to gender confusion; being transgender can seem to explain the sense of alienation common with autistic people.
THEORIES One theory is that transgender occurrence among autistic people is related to obsessive preoccupations (a common trait of autism.) One theory suggests that testosterone and androgen levels effect fetus leading to co-occurrence of autism and gender variance
PERCEPTION OF SELF Autistic transgender people may approach being transgender differently (for example changing internal identity but not outward expression.) People with autism are less likely to feel restricted by how others see things Autistic transgender individuals sometimes change their preference from being transgender to not being transgender. Non-binary* behaviors are also common. Autistic transgender people may be vague in terms of outward expression. Communications about gender can be challenging for people with autism. Gender identity may mean something different to people with autism in comparison to the perceptions of members of the LGBTQ community.
GENDER REASSIGNMENT TREATMENTS Transgender autistic individuals are less likely to understand the finality of sex reassignment surgery. People who are autistic and transgender may not always understand long term consequences. Expectations of gender reassignment may fall short of results. Some cases of autistic transgender people undergoing treatment have led to regret Medical professionals are encouraged to consult experts on both autism and gender and must consider both simultaneously
SPECIFIC CHALLENGES SOCIAL Difficult/anxiety provoking to express gender publicly Some trans-autistic people are unconcerned/unaware with how others experience them Co-occurrence can lead to increased social isolation Struggle to fit in with ASD treatment/social groups due to GD Struggle to fit in to LGBTQ groups because of ASD-related social differences
SPECIFIC CHALLENGES MEDICAL TREATMENTS ASD diagnosis should not automatically exclude the potential for hormone therapy or other GD treatments More caution may need to be taken in this population when deciding on treatments Because it is harder for an adolescent with ASD to comprehend long-term risks and complications, consenting for treatment may be more complex. Clinicians should develop a specific plan for ASD and GD with benefits and risks presented in a concrete manner.
SPECIFIC CHALLENGES RISK OF VICTIMIZATION/SAFETY These youth are at high risk for being bullied and exploited; even becoming victims of violence Some struggle with gender transition, making them less likely to pass as their affirmed gender which may increase their risk for victimization They may be less aware of the relative safety level of different settings/situations (what places are transgender friendly, etc.) In addition, societal prejudice combined with poor coping strategies and rigid thinking and increased social difficulties may contribute to suicidal isolation
SPECIFIC CHALLENGES SCHOOL AND EMPLOYMENT May have more difficulties in work or school due to stigma and a cooccurring diagnosis often compounds these difficulties Have more difficulty with how others perceive them Have trouble navigating their gender presentation at work or school Finding and maintaining a job/developing a career is challenging for many people with ASD and with additional GD-related issues of stigma/bias they may have even fewer job opportunities
SPECIFIC CHALLENGES ROMANTIC RELATIONSHIPS It can be difficult for someone with ASD and GD to understand why a potential partner may feel and respond differently to transgender person A person with ASD and GD may struggle to understand why a potential partner does not just accept them as their intended gender It may be difficult for someone with this occurrence to understand how their transition may affect their partner This co-occurring population may have increased difficulty finding an understanding partner who can accept both ASD and GD
STEPS TO BETTER SERVE AUTISTIC TRANSGENDER POPULATION Learn to use language that is respectful and supportive of neurodivergent people Always use the language your client uses Take a basic course on neurodiversity and/or transgender issues Review blogs written by neuroqueer people Think about how you can make your office and your communication more comfortable and accessible for both ASD and GD clients Develop a consulting relationship with a gender specialist Develop a list of resources
STEPS TO BETTER SERVE AUTISTIC TRANSGENDER POPULATION Stay abreast of language through the use of internet resources and gender specialists If you work with schools/agencies, review policies and how they may impact/protect transgender people Develop a referral list for transgender support in your community (therapists, physicians, support groups, etc.) Include autistic and other neurodivergent people as consultants in your work
AUTISTIC-TRANS LANGUAGE It is important to use language that does not favor one or the other TRANSGENDER Person whose sense of personal identity and gender does not correspond with their birth sex. CISGENDER Person whose sense of identity and gender does correspond with their birth sex. NEURODIVERSE Neurological differences in human genome such as autism and ADHD. NEUROTYICAL Not displaying or characterized by autistic or other neurologically atypical patterns of thought or behavior.
AUTISTIC-TRANS LANGUAGE Gender vague - a term used by some researchers to describe a perception of gender that is nondescript and could be used to describe the perception of gender unique to people with autism. Gender variant - another way to describe transgender *Non-binary - gender that is not specific to male or female identification. Neuroqueer a term used for people who are transgender and also have a mental health related diversity such as Autism Gender fluid relating to a person who does not identify themselves as having a fixed gender Gender Expression how one expresses oneself, in terms of dress, mannerisms and/or behaviors
AUTISTIC-TRANS LANGUAGE GenderQueer a person whose gender identity and/or gender expression falls outside of the dominant societal norm for their assigned sex (is beyond gender or is some combination of them) LGBTQ abbreviation for Lesbian, Gay, Bisexual, Transgender, Questioning/Queer Queer this can include gay, lesbian, bisexual, transgender, intersex and asexual people. The term has different meanings to different people. Transgender the term most commonly used. Someone whose gender identity or expression does not fit assigned birth sex and gender Transsexual a person who lives full-time in a gender different than their assigned birth sex and gender
RESOURCES Zur Institute Autism Self-Advocacy Network Transgender Law Center Barking Sycamores (http://barkingsycamores.wordpress.com/) Neuroqueer (http://neuroqueer.blogspot.com/) Teaching Languages to: Nonverbal Thinkers/The US Book by Michael Scott Monje, Jr.
REFERENCES What Can We Do to Support Transgender Autistic People: Remembering Kayden Clarke by Vivian Gratton, June 29, 2016 Gender Dysphoria in Asperger s Syndrome: A Caution, John Parkinson, Austrian Psychiatry, 2014 The Link Between Autism and Trans Identity, Bryony White, The Atlantic, November 15, 2016 initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents, John F. Strang, Journal of Clinical Child & Adolescent Psychology, January 11, 2016 Increased Gender Variance in Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder, J.F. Strang, L. Kenworth, A. Domimska; March 12, 2014 Cincinnati Children's Hospital Medical Center. "High rates of suicide and selfharm among transgender youth." ScienceDaily. ScienceDaily, 31 August 2016.
Being autistic doesn t cause my gender identity, but it is inextricably related to how I understand and experience gender. ~Lydia X. Z. Brown, Activist