Clinicians' Perspectives on the Co-Occurrence of Gender Dysphoria and Autism Spectrum Disorder: A Pilot Study

Background: The co-occurrence of gender dysphoria (GD) and autism spectrum disorder (ASD) is an area of inquiry by researchers with the vast majority of publications reporting an increase in (symptoms of) ASD in individuals diagnosed with (symptoms of) GD and vice versa. All clinicians may therefore encounter individuals with the sometimes challenging co-occurrence of ASD and gender identity questions. But how comfortable are these clinicians in assessing and/or working with individuals with both GD and neurodiversity and what is their approach?

Objectives: This pilot study assesses experiences, perspectives and needs of clinicians working with neurodiverse and gender diverse individuals.

Methods: A questionnaire with both multiple choice as well as open ended questions was used to assess the views of clinicians working with individuals with (symptoms of) GD and ASD on their feelings of competence, their ideas and hypotheses on the co-occurrence, the topics they consider important to discuss during assessment, and their professional needs in improving their approaches. This pilot study included 44 mental health professionals working with different age-groups.

Results: While none of the participants worked in a specialized gender identity service, all had at least some experience with assessment of individuals with (symptoms of) GD and 95.5% had at least some experience with individuals with ASD. A total of 72.7% had experience with assessment of individuals with ASD for (symptoms of) GD. A total of 22.7% of clinicians would discuss similar topics with neurotypical as well as with neurodiverse individuals. But there were also clinicians (22.7%) who had no idea which topics they should discuss with neurodiverse individuals. Others mentioned that they would take specific aspects of autism during the counseling into account such as rigid thinking, problems with abstract thinking, and the difficulties during social transition and treatment. Some clinicians were able to mention hypotheses about why neurodiversity and gender diversity could co-occur, but others had no idea. Of the clinicians, 51.2% considered themselves competent to talk about gender/GD with neurodiverse individuals because of experience and specific education. A total of 23.3% felt incompetent and 25.6% felt as well competent and incompetent.

Conclusions: Being an expert in the separate fields of neurodiversity or gender diversity alone doesn’t seem to be enough for clinicians to feel competent in working with neurodiverse and gender diverse individuals, especially with regard to scientific background and clinical approach. Clinicians assessing and treating neurodiverse and gender diverse individuals stated that they want to broaden their knowledge of the current state of literature and the different views that exist on co-occurring GD-ASD. Being well-equipped with these scientific findings would enable the clinicians to adapt their clinical guidance on a case to case basis, thereby improving the assessment and care for neurodiverse and gender diverse individuals. In the present talk, specific implication for clinical practice will be discussed.