Autistic Traits in Transgender Youth: Dysphoria, Stigma, and Barriers to Care

Background: There is an apparent over-occurrence of Autism Spectrum Disorder (ASD) and Gender Dysphoria (GD; e.g., de Vries et al., 2010; Strang et al., 2018^a). In qualitative interview, youth with the co-occurrence describe challenges related to being both autistic and transgender, as well as experiences of having their gender dysphoria questioned (e.g., providers and family members dismissing their experience as a symptom of ASD; Strang et al., 2018^b).

Objectives: Examine the relationship between ASD traits (as reported by parent and self) and: self-reported intensity of gender dysphoria, LGBTQ-related stigma, and specific perceived barriers to obtaining gender care.

Methods: Thirty-nine transgender youth, age 13-21 years, were recruited across the neurodiversity spectrum: transgender youth with confirmed ASD diagnoses (N=16); transgender youth with suspected, but unconfirmed ASD or autistic traits (N=10); and transgender allistic (i.e., non-autistic) youth (N=13). Measures of autistic traits were given: parent-reported Social Responsiveness Scale-2 (SRS-2; Constantino et al., 2012) and self-reported Broader Autism Phenotype Questionnaire (Hurley et al., 2007). Youth participants completed the Utrecht Gender Dysphoria Scale (UGDS; Cohen-Kettenis & van Goozen, 1997) and the LGBT Stigma Scale (Weinhardt et al., 2017, Logie & Earnshaw, 2015). Youth also answered questions regarding gender affirmation barriers including barriers related to executive function, and barriers related to social anxiety/reactions of others. Spearman correlation analyses were conducted to examine the relationship between ASD traits and GD intensity, barriers and stigma. FDR corrections for multiple comparisons were applied.

Results: Positive correlations were observed between gender goal barriers related to executive function and both SRS-2 and self-reported BAPQ scores (r=.463(p=.012) and r=.434(p=0.012) respectively). No significant correlations were found between ASD trait measures and the UGDS (intensity of gender dysphoria), the LGBT stigma scale, or other barriers.

Conclusions: Results suggest transgender people with increased autistic traits may require additional levels of executive function support to help them meet their gender related needs and goals. The lack of relationships between level of autistic traits and experienced gender dysphoria provides further evidence that gender diversity experiences of transgender autistic individuals are similar to those of transgender people in general.