Apparently gender reassignment cures autism

[Siablue]

According to GIDS children ‘had no residual autistic traits’ after transitioning. This is a document from the NHS. I honestly have no words.

Nicky Clarke is writing to Matt Hancock so hopefully will get some response. But what a load of offensive bollocks. Even if they retract this there is no way that these people should be allowed to work with children.

Throughout my whole life people have been pushing a range of fake cures for autism and all of them have gone out of fashion but not before they did a massive amount of damage.

mobile.twitter.com/MrsNickyClark/status/1300736691502829568

If the paper is still up then it means this has been read by many parents who may have thought it would help their kids. Fury inducing and heartbreaking. My kid is autistic. JKR alerted me to the risks.
#NotMyDaughter

I got a response from GIRES today:

"Hello Emily,
Bearing in mind that was written in 2015, it nonetheless surprised me, because it didn't explain our position on this which I think I can reassure you, aligns with yours. We do not believe that treatment for GD can 'cure' ASD.
Hope I've attached the right thing.
Cheers, Terry"

The attachment reads:
"The phenomenon of co-occurring ASD and gender diversity is well recognised in the UK. There is also research, for instance in The Netherlands, indicating that there is a higher proportion of ASD in the gender diverse population than in the cisgender population. In the general population the prevalence of autism is thought to be about 1%. However, among young people with gender dysphoria 7.8% were diagnosed with autism in the Dutch Clinic (De Vries 2010). In adult Gender Identity Clinics, 5.5% were deemed to be autistic. (Pasterski et al. 2014).
Surprisingly, there have been reports of young people who, having been successfully treated for their gender dysphoria, then appear to have no residual ASD characteristics as adults. The symptoms seem to have disappeared completely once the dysphoria has been successfully treated.
Given the understanding of ASD as a persistent characteristic, the only explanation for this outcome is that, in these particular cases, the original diagnosis of ASD was an error. This condition does not disappear, but it may be that certain behavioural indicators in gender dysphoric and ASD groups appear similar in young people, and an assumption is made that ASD is co-occurring.
Even though it is possible, and likely, that social and/or medical transition may help to alleviate some of the difficulties related to autism, there is no evidence that treatment for gender dysphoria, or indeed any other condition, can 'cure' ASD.
GIRES' conclusion:
There is good evidence that there is a raised incidence of ASD in gender diverse groups, but no evidence that treatment targeting gender dysphoria, can overcome both gender dysphoria and autism. This confusion appears to arise because, in some young people, an incorrect assumption by clinicians gives rise to a speculative and erroneous diagnosis in that young person. ASD has not ‘disappeared’ as a result of later treatment for GD. ASD wasn’t present in the first place. Clinicians working in the field, need to be aware of this possibility. When in doubt, it may be necessary to obtain an opinion from a paediatrician who specialises in ASD, autism."

What do we think of this?
I think: it's an improvement on what they said in 2015, but: "it is possible, and likely, that social and/or medical transition may help to alleviate some of the difficulties related to autism" still is a very big claim to make without evidence. Which difficulties? How does it help them?
I'm going to ask for clarification on that, but what else should I ask, what else would we like to know or challenge them on? I've asked the same in the Gender Critical Autistics group and will collect responses and draft a reply.
And of course please contact them too, the more questions they get on this the more they know it's an important issue.

You don’t cure autism by sterilising and amputating the bodies of children.
Fury making as a parent of an Autistic girl.

And autism doesn’t need a cure.

Christ.

"it is possible, and likely, that social and/or medical transition may help to alleviate some of the difficulties related to autism" still is a very big claim to make without evidence. Which difficulties? How does it help them?

I should imagine that, for boys, some of the traits of neurodivergence around impaired executive functioning (impaired spatial awareness, lack of self-advocacy skills, etc) and other factors that can lead to a child appearing non-conformist (having unusual interests typically associated with the opposite sex, not conforming to fashion trends, etc) are less socially acceptable than those same factors in girls, because misogyny often results in girls being seen as stereotypically "ditzy" or incompetent anyway.

It stands to reason that males who are constantly ridiculed for not being "male" enough, as many neurodivergent boys are, might feel they would be judged less harshly for the same behaviours if they presented as female (and they'd probably be right). Furthermore, it seems likely that many neurodivergent children growing up today being told that "stereotypes = one's true gender" might genuinely come to believe that the fact they are so divergent from male stereotypes must mean that deep down they're actually girls.

We’ve recently gone through the process of getting an autism diagnosis for family member. The process took ages and they exhaustively eliminated all other possibilities (such as checking and rechecking early parenting such as if I had post natal depression .. attachment disorder etc.)
Diagnosing in error? Unbelievable.

Diagnosing in error? Unbelievable.

It does happen - clinicians can only use information available to them at the time and while many CAMHS teams are obviously thorough and meticulous (some, less so...), even the most conscientious teams aren't psychic and don't necessarily see everything for what it is, so there are lots of ways that a wrong diagnosis can be reached especially when a child is presenting with other issues too.

That said, it's a tad scary to think that NHS teams are mistakenly diagnosing ASD and then correcting their conclusions to "ohhh, he's just a girl - well that explains it!"

I've been talking with the other Gender Critical Autistics members and sent this in response:

"Hi Terry,
Thank you for the clarification. Apologies for the delay in responding, I was consulting with other autistic adults - there is a large group of us interested in the issue.

Though the 7.8% autism rate in the de Vries et al study is still very high, the study is now ten years old and the demographics of the cohorts at gender clinics today have changed. The Tavistock & Portman clinic's more recent figures show 35% of referrals assessed have moderate to severe autistic traits, and a further 13% with mild autistic traits. In some clinics in Australia, almost half of the patients are diagnosed with an ASD. There appears to be little explanation or appetite to find a reason for the sudden increase in autistic children referred.

"Even though it is possible, and likely, that social and/or medical transition may help to alleviate some of the difficulties related to autism" - specifically, which forms of social transition, and which medical treatments, can help to alleviate which difficulties related to autism? Autism can cause someone to have many different features and traits, and not all autistic people have all of them.
I'm also interested to see what evidence supports this claim. While it's certainly not as strong or as specific a claim as in the 2016 report, it still requires substantiation, particularly if this argument is then used to push for treatments involved in medical transition (which?) for autistic patients who may first benefit from less invasive treatment and support for their difficulties (and then, once those are resolved or those avenues have been exhausted, decide if more invasive treatments would be beneficial).

As I mentioned in my initial message, there have been many different experimental medical treatments given to autistic people with little evidence to support them, and it has resulted in medical malpractice - for example, Andrew Wakefield's experimental colonoscopies and lumbar punctures on autistic children in the late 1990s, and Mark and David Geier's attempts to cure autism with Lupron in the late 2000s. Wakefield was struck off the medical register and the Geiers lost their licenses to practise medicine when the malpractice came to light. (see: scienceblogs.com/insolence/2009/05/22/why-not-just-castrate-them-part-2) Lupron is still used to stop puberty in gender dysphoric children, and has extremely dangerous side effects including sterility and low bone density, hence the need for greater rigour in diagnosis and exhausting all safer treatment options before prescribing it.
In all medicine, the guiding principle is "first do no harm". The risk of any treatment must be weighed against the benefit it can bring, and this must be backed up by evidence - the more invasive or experimental the treatment, the more rigorous we must be in justifying its use.

This section also appears to contradict the "GIRES' conclusion" paragraph, "There is... no evidence that treatment targeting gender dysphoria, [sic] can overcome both gender dysphoria and autism". So, can medical transition alleviate some autistic difficulties, or can't it? Is there evidence to support this claim, or isn't there?

The suggestion that GD was mistaken for ASD also concerns us - if it's easy to mistake gender dysphoria for autism, that implies that autism could also be mistaken for gender dysphoria. It suggests that the diagnostic process as it currently stands is not fit for purpose.

I am encouraged by the conclusion "Clinicians working in the field need to be aware of this possibility. When in doubt, it may be necessary to obtain an opinion from a paediatrician who specialises in ASD", and would entirely agree.
Has the GIRES web-site been updated to reflect this conclusion? Currently, the 2016 report is still on the GIRES site ( www.gires.org.uk/wp-content/uploads/2016/04/GIRES-Young-People-Response-to-Service-Spec-1.pdf ) but I couldn't find anything contradicting or updating this anywhere else on the site. Could you send me the link?"

I suspect it's not actually anywhere else on the site, but I'll give her a chance to respond and possibly update it in the meantime...

@Suffrajester what a brilliant thought out response. Thank you for all the effort you have put into this.

@Siablue thank you! It's not just me, there's a few of us in the group who contributed to it, made points in the discussion on it, I just collect it all and put in my share as well as theirs. Autistics have been fighting this sort of thing for decades, there's always a new dangerous experimental "autism cure". I was diagnosed around the time of the MMR hoax when Wakefield was doing his experiments, I'd hoped it was a thing of the past since autistics (and anyone who cares about medical ethics) at the time fought it, but I think we'll always have to keep up the campaiging.

The doctor who is leading the review into care for children with gender dysphoria is an expert in childhood disability and was in charge of an autism service. It might be worth putting in a submission to her enquiry.

Thank you from me too, Suffrajester. Keep going and keep us posted!

Reading your most recent letter, one thing struck me - gender dysphoria's not the only thing that can be difficult to distinguish from autism. When I was assessed I was told that it can be difficult to diagnose autism in children who are known to have undergone serious trauma, because some of the behaviours could be equally indicative of PTSD.

I mention this because the young female transitioner cohort is known to have a high incidence of trauma as well as a high incidence of autistic traits (which is not necessarily the same thing as actually being correctly diagnosed as having ASD.)

PP makes an excellent point that we need to distinguish between diagnosed ASD and self-ID, as this latter may in some cases be based on behavioural traits rooted in C-PTSD that are being mischaracterised as autistic.

It strikes me that we're using one label - gender dysphoria - to cover three related but different developmental pathways, to the detriment of all three.

@Siablue

The doctor who is leading the review into care for children with gender dysphoria is an expert in childhood disability and was in charge of an autism service. It might be worth putting in a submission to her enquiry.

I didn't know about this, I'd love it if I could get the group together and work on a submission. Do you have any links or more information about it?

@TyroBurningDownTheCloset

Thank you from me too, Suffrajester. Keep going and keep us posted!

Reading your most recent letter, one thing struck me - gender dysphoria's not the only thing that can be difficult to distinguish from autism. When I was assessed I was told that it can be difficult to diagnose autism in children who are known to have undergone serious trauma, because some of the behaviours could be equally indicative of PTSD.

I mention this because the young female transitioner cohort is known to have a high incidence of trauma as well as a high incidence of autistic traits (which is not necessarily the same thing as actually being correctly diagnosed as having ASD.)

PP makes an excellent point that we need to distinguish between diagnosed ASD and self-ID, as this latter may in some cases be based on behavioural traits rooted in C-PTSD that are being mischaracterised as autistic.

It strikes me that we're using one label - gender dysphoria - to cover three related but different developmental pathways, to the detriment of all three.

Excellent point. I know if any child in my family came to me and said they hated their genitals, my first assumption would be that someone had abused them, and I'd want to keep them safe and deal with the abuser and their trauma before even contemplating any treatments beyond child mental health care for them.

Here's the Mumsnet thread about the review, which has a link to the NHS website, and there's a PDF there with the fuller terms.

www.mumsnet.com/Talk/womens_rights/4030690-NHS-independent-review-into-childrens-gender-ID-services

Hilary Cass is on Twitter and she wrote there:

I’m currently finalising how I will carry out my review and I plan to set out how I will involve young people, families, and stakeholders, all of whom are vital to its success. I will be in touch with you soon.

That would be my first assumption too - that level of disconnect from and disgust towards one's own body should always be considered as potentially being rooted in sexualised abuse.

Unfortunately, many abused children don't/won't/can't speak about it so directly, and so the subsequent behavioural issues are attributed (by non-experts) to other causes - perhaps an ASD, or a personality disorder, or gender dysphoria, or even (in my own case) just being a weird little shit.

I'm told autistic people often just don't get the social rules of gendered behaviour. Speaking as someone whose dysphoria is rooted in trauma, it's not so much a case of not getting the rules, as rejecting them because they're intuitively understood to be a weapon. The two situations have many commonalities and they're both driven by the highly gendered nature of the social world, but they're not the same thing, and shouldn't be treated as such. Both cohorts are harmed by lumping them in together.

I think a lot of autistic people feel a sense of dysphoria about their bodies but it is not gender dysphoria. It is very hard to come to terms with the fact you are disabled. I was about 12 when I realised that I would be disabled when I grew up. Until then I had imagined that when I grew up I would be able to do what all grown ups did (I have physical disabilities as well).

It is very hard to come to terms with the fact that you are going to be disabled for the rest of your life and the idea that you can fix yourself is very appealing.

The thing is that while transitioning can help someone whose dysphoria is around their gender it is never going to give you the right body in terms of you no longer being disabled. I think that it is easy to confuse the two when a lot of the things you can’t do are gendered like boys not being able to play football or girls not being able to do their make up or walk in high heels. You can tell that a lot of autistic people are confused by this as some people even think being autistic is a gender identity ( it’s called neurogender).

Well, I got a response at 1 last night, just read it now:

"'The suggestion that GD was mistaken for ASD also concerns us - if it's easy to mistake gender dysphoria for autism, that implies that autism could also be mistaken for gender dysphoria. It suggests that the diagnostic process as it currently stands is not fit for purpose.'

That is not what was said and the above statement in any case is not rational. It does not indicate that the opposite is plausible. Nobody has suggested, as far as I know, that ASD could be mistaken for gender incongruence.

The report to me, which I included in our material was that, in a very small number of cases, (not in the literature but arising in the context of personal experiences of trans people) ASD was diagnosed in tandem with GD during their childhood. Both conditions were found to be present, but in a few of these individuals, in adulthood, having been successfully treated for GD, apparently had no symptoms whatsoever of ASD.

Since ASD is regarded as a permanent condition in an individual, its apparent complete disappearance, which is what was being reported in these cases, would indicate that the original diagnosis of ASD was mistaken."

Didn't answer any of my other points and keep on with the woolly language of "a few", "apparently", and even saying "not in the literature". Terry does keep watering it down, but it's still an extraordinary claim to make without evidence, and a lot of parents of autistic kids might jump on it - the same sorts of parents who give their autistic children bleach enemas, vitamin overdoses or chelation as an autism cure with scant evidence, would go for this. I'm worried about them.