Gender Nonconformity and the Autism Spectrum in and Beyond the Clinical Context: An Examination of Children with and without Mental Health Diagnoses

Background: In recent years, there has been a strong clinical and research interest in the overlap between gender nonconformity (GNC) and autism spectrum disorder (ASD). GNC and ASD seems to frequently co-occur in clinical populations. It is unknown, however, whether these previous findings regarding the GNC-ASD link reflect a general clinical phenomenon (i.e., individuals with a clinical diagnosis in general are more prone to have a second clinical diagnosis) or suggest a unique overlap between (symptoms of) ASD and GNC.

Objectives: To investigate GNC in children with a mental health condition, including children who have been diagnosed with ASD, and to investigate potential associations between GNC and symptoms of ASD in children who never have been diagnosed with a mental health condition.

Methods: Parents of children (6-12 years of age) were recruited to participate in a parent-report online questionnaire from June–December 2016. Our participants consisted of a total sample of parents of 2445 children (1198 girls, 1247 boys). Children (Mean age = 8.82, SD = 1.99) were categorized as either typically developing (i.e., from the nonclinical subgroup; n = 2004; 1022 girls, 982 boys) or as part of a clinical subgroup of the population meaning that they had a mental health condition, including for example ASD (n = 441; 165 girls, 276 boys).The Gender Identity Questionnaire for Children (GIQC) was used to measure GNC and the Children’s Social Behavior Questionnaire (CSBQ) was used to investigate symptom levels of ASD including six different subdomains of ASD.

Results: Our findings showed that GNC was associated with children who have been diagnosed with ASD and sensory processing disorder. Among children who have never been diagnosed with a mental health condition, increased GNC was associated with increased symptoms of ASD. In addition, GNC was associated with the subdomain of ASD of stereotyped behaviors (i.e., stereotyped movements and alternate responses to sensory input) and difficulties orienting socially.

Conclusions: Increased GNC was found to be not only associated with children with an ASD diagnosis, but also with increased symptoms of ASD in a nonclinical population. These findings suggest that GNC may not be unique to ASD in clinical populations only. The relationship between symptoms of ASD and GNC might thus exists beyond the clinical domain, indicating that this association might reflect a more general phenomenon. In addition, in nonclinical populations, the specific symptoms of ASD of stereotyped behavior and orientation problems were found to be uniquely associated with GNC. Elevated levels of GNC in children may thus not be related to all facets of ASD equally.