Higher Rates of Gender Diversity in Children with ASD Based on Self-Report, Not Parent Report

Background: Gender diversity refers to gender experiences that vary from common experiences of gender. One form of gender diversity is gender dysphoria, an incongruence between one’s experienced gender and gender assumed at birth. Emerging research suggests an increased proportion of gender diversity in individuals with autism spectrum disorder (ASD), and over-representation of autism among individuals clinically referred for gender diversity and dysphoria. Previous research with youth has predominantly relied on parent-report based on a single parent-report item. Furthermore, the extent to which parent perceptions are consistent with child-report of gender diversity experiences is unknown.

Objectives: The current study compared the endorsement of gender diversity (i.e. dysphoria and agender experiences) in 147 children 10-to-13 years of age with ASD (11.31) and typical development (TD; 11.46). Additionally, parent perceptions of their child’s gender diversity was compared between the groups. The prevalence of gender diversity and associations between self-and parent-report measures were investigated.

Methods: The Gender Development Scale Short Report (GDSSR) is a self-report (GDSSR-S) and parent-report (GDSSR-P) measure assessing the broad spectrum of gender-related characteristics in youth (Strang et al., 2017). Using the GDSSR, gender dysphoria and agender GDSSR-S variables were collected on 147 children with high-functioning ASD (N = 94) and TD (N = 53) and GDSSR-P from 122 parents of children with ASD (N = 78) and TD (N = 44). Item-level analysis of Child Behavior Checklist (CBCL) item 110, “Wishes to be the opposite sex” was also collected. Independent sample t-tests were used to compare group differences, Pearson correlations to examine associations, and cross-tab calculations to determine group proportions.

Results: There were significant differences between the groups showing children with ASD endorsing higher rates of experienced gender dysphoria t(145) = -2.63, p = 0.0001 and agender experiences, t(145) = -3.97, p = 0.0001. In contrast, there were no significant differences between the groups for GDSSR-P for gender dysphoria t(122) = -.73, p = 0.47 or agender experiences t(122) = -.52, p = 0.61 or CBCL Item 110 t(121)= -0.86, p = 0.39. Despite a lack of difference in parent reports between diagnostic groups, there were small-to-medium correlations between GDSSR-S and GDSSR-P dysphoria r = .26, p = 0.004; and CBCL Item 110 and GDSSR-S dysphoria r = .39, p = 0.0001 and GDSSR-P dysphoria r = .45, p = 0.0001. Using cross tabulation, the proportion of the ASD sample that reported gender dysphoria based on a strict cut-off of greater than 6 (Goldstein et al., 2017) was 4.3% whereas the TD sample was 0%.

Conclusions: Results extend recent reports showing increased rates of experienced gender diversity in children with ASD albeit based on self-report. There were no significant differences on parent-reports for children with and without ASD. Importantly, not all parents elected to complete the GDSSR-P due to religious or undisclosed reasons. Therefore, under-reporting of gender diversity is plausible. Findings corroborate clinical and research observations and underscore the need to better understand and support the unique and complex needs of children with ASD who experience gender diversity.