Autism and transgender identity

[InvisibleDragon]

As an autistic person, representation matters. It matters because I will never forget, that as a child, I would constantly search for someone, anyone, who would show me that everything would be alright; that I belonged.

I saw this tweet yesterday and it made me think a lot about the statistics that report a very high percentage (40%?) of transgender teens have a confirmed or suspected autism diagnosis.

A trans identity provides an easy solution to feelings of not belonging: if you are trans, you instantly become part of an online community of other trans people, who tell you that you belong with and are accepted by them. And who tell you that your feelings of rejection / loneliness are caused by being trans and will be solved by transitioning.

I can really see how this narrative would resonate with many teenagers, with autism or otherwise, who yearn for a straightforward explanation for their feelings of loneliness and isolation. The problem is that it quickly becomes self-reinforcing: if small steps towards transition don't alleviate their sadness, the answer is to take larger steps. And rejecting trans as the answer would mean losing access to important social support from the (online) transgender community.

I'm sure there are other reasons for the over-representation of autistic teens in the transgender population (perhaps like overly rigid, black and white thinking about gender identity), but I was very struck by how an unmet need for belonging could make a transgender identity seem like the answer for some people.

(I've removed information about the account from the image, because it's not relevant and the person in question isn't trans themselves and doesn't post about trans issues.)

Out of interest, do we have any data on confirmed vs suspected ASD amongst the ROGD cohort?

I ask because trauma's also over-represented amongst teenage trans identifying people, and some behaviours rooted in trauma look a lot like autistic behaviours - I have a sneaking suspicion that there may be people self-diagnosing as having an ASD based on behavioural traits rooted in trauma.

But yes, I agree: the need for a sense of community, in which one is accepted rather than ridiculed for not fitting cultural norms is likely a strong driver. The label's the ticket to being accepted as you are instead of expected to change.

In our local National Autistic Society Facebook group the topic of gender identity camera up and I was shocked just how many parents has daughters who identified as male. There were a lot! And an interesting mix of parents who were fully onboard with Mermaids and an equally sized cohort that didn’t buy it at all.
I really wish there was some proper research into the link between autism and gender identity as there is so much anecdotal evidence out there of a link but nothing to back it up (or disprove it).

Huge piece of research on this
www.cam.ac.uk/research/news/transgender-and-gender-diverse-individuals-are-more-likely-to-be-autistic-and-report-higher-autistic

May I recommend my autistic DD’s Facebook group Gender Critical Autistics, as a safe place for any autistics to be supported and discuss the issues. She moderates it well, and TRA trolls are booted out promptly.
She posts on MN as Suffrajester, and campaigns for autistics both online and in person. You may have seen the video of her speech on the Mound in Edinburgh.

I am autistic I know quite a few autistic adults who are trans (recently a lot of women in one group I was in started to identify as non- binary. I have a young relative who transitioned and detransitioned.

I think that with people with autism being a teenager is hell and you feel that you will never fit in. A lot of the things you can’t go are gendered football for boys make up for girls. As you can’t fit in with gender roles you might think you are trans.

I think there is a confusion between gender dysphoria and the sense of dysphoria you feel about your body when you are disabled. I was about 12 when I realised I would still be disabled when I was a grown up. At that age anything that can help you ‘fix’ yourself is very appealing but it can be devastating for young people when transitioning doesn’t solve their problems.

No one (except possibly Judith Butler) knows what they mean by having a gender identity. I think there is a lot of confusion between gender identity and personality. I have seen people identifying as neurogender. Being autistic is not a gender.

I think there needs to be better support for people with autism to help them through adolescence especially girls.

Ok, my stats were a bit off in the first post.

Looking at this from GIDS, it seems that 13.3% of referrals mention co-morbid ASD in the UK. In Finland it was much higher: 26%
gids.nhs.uk/evidence-base

Kudos to your Dd, Babdoc. Sounds as if she’s doing some very useful work. The trans lobby is shameless in recruiting young people who feel they “don’t fit in“.

[quote InvisibleDragon]Ok, my stats were a bit off in the first post.

Looking at this from GIDS, it seems that 13.3% of referrals mention co-morbid ASD in the UK. In Finland it was much higher: 26%
gids.nhs.uk/evidence-base[/quote]
No, those GIDS stats are from 2012, if you look closely, when they had far, far fewer referrals - especially of girls.

Later evidence is that 48% of referrals from 2011-2018 score as having ASC traits in the mild to severe range.

As the numbers have escalated, so has the proportion who are autistic.

I’m an autistic adult and think there’s a lot of truth to this.

It is about belonging. Also a way to control what feels like a scary and uncontrollable situation (growing up and becoming independent). It might be the first way the child has really been ‘heard’ by adults, when they assert a gender identity. It makes the adults sit up, listen and do what they want (or obv they’ll kill themselves as we keep being told). We are also much likely to be ‘consistent, insistent and persistent’, because - ever met an autistic person? That almost exactly describes how we approach our interests and achieving things we set our mind to.

The online support thing is a big deal, and given how trans infiltrates nearly everything (go in any unrelated hobby group and see), there’s enormous social pressure to conform to the in-group and do what they do - or be cancelled and ostracised, which is devastating when your little nerdy friend group is all you have.

wellbehaved That is a really interesting paper!

The key sentences:
A retrospective chart review of referrals to GIDS 2009–2016 (n= 4148) showed that the vast majority of referrals were adolescents, with the sex ratio favouring female-bodied young people (1:2.1) in this age group (Carmichael, 2018). There was a sharp increase in referrals, with referrals for male-bodied adolescents increasing by 55% on average each year and for female-bodied adolescents by 105% over this 7-year period (Carmichael, 2018). A significant proportion of young people in GIDS are also neurodiverse and may present with traits of ASC and/or a diagnosis. Between April 2011 and August 2018, 48% of children and young people who were seen in GIDS and whose parents completed the social responsiveness scale (SRS), a quantitative measure of autistic behaviours in chil-dren and young people, scored in the mild to severe range (n = 2073). Ten per cent of female-bodied young people scored in the severe range, as did 7% of male-bodied young people. Taken together, these aspects signify a rapidly shifting context in the profile of many young people presenting to GIDS, which has prompted much discussion within the service and more widely about how best this group should be supported.

That also partially answers Tyro's question about diagnosis vs behavioural traits: the 48% figure comes from scores on the Social Responsiveness Scale, which evaluates behavioural traits, as reported by the parent.

So the clinician goes through a checklist of items "Does your child do X? Always/often/sometimes/never" (or something similar) and the parent's answers are combined to give a total score.

This isn't the same as a formal ASC diagnosis. Scores are correlated with ASC symptoms, but it isn't an official diagnosis. That means it's entirely possible that some of the behaviours scored are also associated with a trauma history.

To make things even more complicated, I've seen autistic people make the argument that some of their behaviours are also a trauma response: sensory processing differences make some situations / environments incredibly frightening and stressful, so that it triggers the fight/flight/freeze response and leads to long-term heightened anxiety, social withdrawal etc.

I'm generally pretty sympathetic to this idea. However, I've also seen it (mis-)used to justify excessive accommodation of social anxiety: you must never do X thing (make me go to school, expect me to do housework, call me that name?), because it will trigger my trauma and that is equivalent to violence.

As someone with my own experience of emotional trauma (waves at abusive ex), I'm familiar with how attractive avoidance is as a strategy for coping with trauma and anxiety. However, it's also very limiting and counter-productive in the long-term. It can also be controlling and abusive in itself to insist that someone else internalizes your own internal trauma minefield to avoid emotional meltdowns.

That makes me concerned when I see that the affirmation model of care used at GIDS seems to largely eschew psychological therapy in favour of medical management. It feels like it could sometimes be one giant avoidance mechanism that doesn't help young people to develop the emotional skills needed to do the long, arduous work of processing emotional trauma and/or find a way to exist comfortably in the world.

Autism in girls is underestimated and under-diagnosed so it is perhaps not surprising that the frequency of ‘autism traits’ is considerably higher than the frequency of autism diagnosis. However where they are picking up especially severe traits in the absence of diagnosis then surely they should pause any physical or hormonal treatment of ‘trans’ until an autism diagnosis has been investigated? It may then be that by understanding that aspect of themselves they may realise where their sense of ‘otherness’ comes from.

InvisibleDragon that is interesting your take on excessive avoidance as triggering social anxiety. Obviously a balance must be struck and most autistic people I talk to agree - they must ultimately live in a world which can only accommodate individuals to a point, especially where those accommodations impact on others. But not all do and some of those that don’t are very much activists and also, perhaps unsurprisingly, have difficulties with theory of mind so cannot understand the perspective of others or how their needs might impact upon others. They are, as the word ‘autism’ suggests, selfish.

Thanks @Babdoc for this. I have an autistic DS who is really vulnerable. He is starting school next week at a special base and I'm just so worried for his future. He is very trusting but not capable (yet) of independent thought or to understand nuance or anything. I appreciate maybe many other 5/6 year olds would be the same but he is very young in mind. Doesn't talk and isn't able to use toilet or do personal hygiene.

I worry about how he will progress in future and I don't want him sucked into thinking his beautiful body is somehow wrong.

@InvisibleDragon that's really interesting, I have wondered about the impact of trauma - my DD is diagnosed with autism but unfortunately has also suffered significant trauma, and although the autistic traits and particularly the avoidant behaviour are very obvious now, prior to the trauma they were very subtle. I can see some minor indicators looking back, but no-one in school or that we were involved with in the health service ever suggested there was any issue. I have wondered about the interaction between the two aspects of autism and trauma.

"It can also be controlling and abusive in itself to insist that someone else internalizes your own internal trauma minefield to avoid emotional meltdowns." This is also ringing a lot of bells with me, she has become very controlling of the environment and the family, especially me. Thank god the trans ideology is not the road she seems to be going down.