Social Communication and Repetitive Behaviours in Gender Dysphoric Children: Exploring the Specificity of Autistic Traits

Background: Gender dysphoria (GD) is characterized by distress due to incongruence between assigned gender and experienced/expressed gender (APA, 2013). Evidence suggests a higher-than-expected co-occurrence of GD and autism spectrum disorder (ASD) in children, adolescents and adults (vanderMiesen, et al., 2015). The GD-ASD link has been explored in samples of children with GD (de Vries, et al., 2010; VanderLaan, et al., 2015) and in those with ASD (Strang, et al., 2014). However, studies of GD children have not explored whether ASD traits found in these samples are specific to GD, or whether these traits are also found in children referred for other psychiatric/psychological concerns.

Objectives: To explore whether traits of ASD are elevated in gender dysphoric children relative to children clinically referred for other concerns.

Methods: Data collected from two groups were analyzed. The GD group included 51 children (aged 4-12 years) referred to a specialized Gender Identity Service (males=38). The comparison (clinical control; CC) group included 39 age- and sex-matched children (males=27) referred to the same psychiatric hospital as the GD group for concerns other than GD or ASD (e.g., mood/anxiety).

The study analyzed parent reports on two ASD-specific measures—the Social Communication Questionnaire (SCQ) and the Social Responsiveness Scale (SRS).

Results: ANOVA (controlling for age) revealed a significant group effect for SCQ total score (F=7.97, p=.006, η_p²=.084), with significantly higher scores in the GD (mean=6.71, SD=4.85) than the CC group (mean=4.72, SD=3.25). Based on the a priori hypothesis of an association between GD and perseverative/intense interests, we explored SCQ item #24 specifically. Chi² analysis revealed a significant association (Χ²=5.73, p=.026), with 30.4% of the GD group endorsing this symptom (versus 8.6% of the CC group). ANOVA failed to find a group effect for SRS Total T-scores (p=.38). Further examination of SRS domains revealed a group by sex interaction for Social Cognition T-Score (F=4.89, p=.03, η_p²=.045), and sex main effects for Social Awareness, Social Communication, Social Motivation, and Autistic Mannerisms (all p’s ≤ .002). In all domains natal females’ mean T-scores were above 60.

Conclusions: Preliminary findings corroborate our hypothesis that symptoms of ASD are more common in children with GD than those referred for other concerns, with a medium effect size (SCQ; Field, 2013). Furthermore, the symptom of perseverative/intense interests was endorsed more frequently (30.4%) for GD children than CC children (8.6%)—consistent with recent findings of intense/obsessional interests in GD children (Zucker, et al., 2017). Further exploration of similar items on the SCQ and SRS will be conducted. The failure to find significant group differences on the SRS Total Score may be due to low power, given our sample size. Natal females tended to have SRS T-scores in the Mild-to-Moderate range (T-score ≥ 60), suggesting they have more severe social-communication deficits than natal males seeking psychiatric/psychological services. Perhaps this parallels the emerging shifts in the male:female ratios reported in both GD (Aiken, et al., 2015) and ASD literatures (Lai, et al., 2015). Further analyses will account for other demographic characteristics, referral questions and degree of gender nonconformity.