Michael Craig at Tavi: Are autism and gender dysphoria linked?

[RethinkingLife]

Thoughtful piece.

For six months during the Covid lockdown, Professor Michael Craig sat in remotely on sessions with patients at the Tavistock gender clinic in London. They were children who were being seen for gender dysphoria, the term used to describe a sense of distress caused by somebody feeling that their biological sex does not match their gender identity. But as Craig watched them pass through he says he was “perturbed” by how many also seemed to have another condition: autism.
“There were certainly some days where I was fairly convinced 40-50 per cent of the patients I was seeing were autistic,” he said. Overall, he estimates about 20 per cent might have qualified for an autism diagnosis.
“I was trying to find out what it is that might explain this overlap, but it’s a difficult area to research for all sorts of reasons.”
…
That the two conditions often seem to occur together was highlighted in a review by Dr Hilary Cass this month, on the state of NHS services for children identifying as trans. One of its recommendations is that children presenting at gender clinics should be screened for neurological conditions, especially autism. “Clinicians report seeing teenage girls who have good cognitive ability and are articulate, but are struggling with gender identity, suicidal ideation and self-harm,” Cass explained. “In some of these young people the common denominator is undiagnosed autism, which is often missed in adolescent girls.”

https://www.thetimes.co.uk/article/autism-transgender-professor-michael-craig-cass-review-2s9tkn8qz

https://archive.ph/P4WfQ

I only started a new puberty blockers thread yesterday, trying to work out how these drugs came to be used in the first place.

I'm having trouble to say the least!

Is he? He sat in on these sessions remotely for six months during lockdown. We don't know what steps he took to communicate his thoughts concerns to the staff at GIDS or to feed back to his colleagues at KCL, SLAM or the National Autism Unit. If he and colleagues have been writing this research up it will all have taken time to get to the stage of being published after peer review. Also, he is an autism specialist, not a gender specialist, albeit one with far more knowledge of hormones and endocrinology than most psychiatrists, because one of his earlier areas of research was on pregnancy and hormones. Very unusually indeed for a psychiatrist, he switched from obs and gynae to psychiatry and is dual qualified.

If you say Professor Craig is a coward, how about the rest of the medical profession? He's speaking up now. Not a word yet from most of his colleagues.

I was wondering in particular what Professor Simon Wessely thinks about all of this. He was sent death threats when he spoke on the record about some of his thoughts and concerns about the appropriate treatment for CFS/ME and the possibility that there was a psychological cause. I don't know the details, so this may not be quite right, but I do remember that some patients and activists were absolutely outraged at his views, because they assumed he was saying they were making it all up, and there was clearly a stigma for them in being told they might have a psychological illness. From what I know about Professor Wessely, he absolutely wasn't saying any of that, but his views were misrepresented and he was portrayed as a bigot etc etc just for wanting to explore a different line of research.

The parallels with the behaviour of activists in gender ideology are very strong.

Ah, OK.
I should imagine that's got lots of pathways under a large strategic plan that maps in to the Dentons' strategy.
I suspect you've accidentally volunteered yourself to start the much needed public inquiry! 😁

". People with autism feel less compulsion to conform to societal norms, he says — an idea also mentioned by Baron-Cohen in his study. “This frees us up to connect more readily with our true gender,” Lawson said."

Again this goes down to sex stereotypes. A girl with autism might prefer cars, engineering which have straightforward rules compared things like English which requires understanding social conventions. She might also like short hair due to sensory issues. And may follow these interest due to ‘feeling less compelled to conform’. But none of this makes her a boy. There is nothing about engineering and short hair that stops them being for girls. On the otherhand it is surely the need to conform that drives them to trans.

I don’t believe in self ID or claiming your gender. To me gender is societal rather than individual. (So boys might be expected to display their masculinity by becoming plasterers or sculptors, but girls can use the same skill set femininely icing cakes). Either way they don’t choose to see these behaviours as “gender appropriate” to one gender or another the stereotype is already there.

I think that for an autistic child being told some people are “born in the wrong body”, and that some activities are “for boys/girls” the logical conclusion is that if you are one of the millions who actually enjoy activities that might previously have been for the opposite sex, you must be trans. If you also can hang your social failures, anxiety, discomfort at hitting puberty, inability to fit in on the same trans hook of course you are going to embrace it. I think it’s attractive to some parents too for similar reasons. No failure on their part, just there child is trans and suddenly they slip into the cool parents crowd.

I was wondering in particular what Professor Simon Wessely thinks about all of this. He was sent death threats when he spoke on the record about some of his thoughts and concerns about the appropriate treatment for CFS/ME and the possibility that there was a psychological cause.

It's contested that the death threats happened. There are some concerns that this was part of a tactic to undermine people who had concerns about the trial.

https://me-pedia.org/wiki/PACE_trial

It was clear that (Professor Anderson’s) assessment of activist behaviour was, in our view, grossly exaggerated and the only actual evidence was that an individual at a seminar had heckled Professor Chalder.
================
Professor Chalder’s evidence when she accepts that unpleasant things have been said to and about PACE researchers only, but that no threats have been made to researchers or participants. The highest she could put it was that some participants stated that they had been made to feel “uncomfortable” as a result of their contact with and treatment from her, not because of their participation in the trial per se.
================

Some screenshots of the appeal tribunal decision (non-searchable pdf):

https://informationrights.decisions.tribunals.gov.uk//DBFiles/Decision/i1854/Queen%20Mary%20University%20of%20London%20EA-2015-0269%20(12-8-16).PDF

So this was all exaggeration? https://www.theguardian.com/society/2011/aug/21/chronic-fatigue-syndrome-myalgic-encephalomyelitis

Some useful history from Lorelei/Hatpin Woman. Some of the methods used to discredit critics might be familiar. As above, the Tier 1 appeal tribunal found no evidence of such threats to PACE researchers and highlighted what might some as a hyperbolic and exaggerated response to scrutiny.

Michael Hanlon told us that Simon Wessely had been facing, “a sustained terror campaign of ME activism”.
So dangerous were the duvet dwellers our hero was up against that a specialised unit at the Metropolitan Police had supposedly been established and dedicated to monitoring the threat.
“No one at Scotland Yard will speak publicly about this” , Hanlon wrote breathily.
“Probably” , as David Black said in Scottish Legal News, “because no such ‘specialised unit’ existed.”
Ironically, it is M.E advocates who have the most noticeable history of trying to find evidence of these kinds of claims. This is the case both here, and in America, where similar claims have been made about patients by clinicians with similar vested interests.
One writer discusses a story about a single crank phone call gaining legs and turning into a story of multiple threats and harassment. Others believe there may be kernels of truth in the claim doctors have received threats but agree there has also been a great deal of exaggeration.22
No evidence has been found of anyone with M.E being charged by the police or convicted in the U.K. courts for harassing or threatening these doctors.
More revealing even than that is documentation obtained under the Freedom of Information Act here from behind the scenes meetings, in 2013. These meetings were attended by some of PACE’s principal investigators. Wessely was also there.23
They discussed the harassment researchers had received and said “harassment is most damaging in the form of vexatious Freedom of Information requests” and noted that “complaints are also causing problems. Researchers are still dealing with complaints about them to the GMC.”
This is a very different picture to the one pushed to the general public. Instead of death threats, their biggest concern amounted to people asking for information and submitting complaints.
Another FOI reveals more. Peter White was one of the co-lead investigators of the PACE trial. His institution, Queen Mary University of London, received 35 FOI requests over the course of four years. Despite this being less than one request a month they “cannot see an end to these requests”.24
White asserted that the requests were “not in the public interest” and were part of a campaign to “discredit the trial”.
Additionally, “the effect of these requests has been that the team involved in the PACE trial, and in particular the professor involved, now feel harassed and believe that the requests are vexatious in nature.”
What they felt and believed may have been sincere but we have managed to move remarkably far away from accusations of terrorism to what amounts to them not enjoying scrutiny of their work.

https://loreleihatpin.substack.com/p/before-the-truth-can-get-its-boots

ME Association's complaint to the Press Complaints Commission documents the newspaper articles that asserted or repeated these claims.

https://www.investinme.org/Article-505%20PCC%20Complaint%20Aug%202011%20I03.shtml

The offtopic convo might merit its own thread.
The autism - trans link deserves thorough discussion.
Are autistic kids experiencing a greater amount of trans promotion than other kids and consequently conforming to the norms of the groups within which they socialise?
Or:
Are autistic kids doing the same repetitious, systematised, eccentric, esoteric activities they always have done, outside wider society's norms, and being trans is merely a contemporary manifestation of that? ie a special interest that offers a "get out of puberty free" card?
Or:
Is it a big feedback loop?

Is he? He sat in on these sessions remotely for six months during lockdown. We don't know what steps he took to communicate his thoughts concerns to the staff at GIDS or to feed back to his colleagues at KCL, SLAM or the National Autism Unit. If he and colleagues have been writing this research up it will all have taken time to get to the stage of being published after peer review. Also, he is an autism specialist, not a gender specialist, albeit one with far more knowledge of hormones and endocrinology than most psychiatrists, because one of his earlier areas of research was on pregnancy and hormones. Very unusually indeed for a psychiatrist, he switched from obs and gynae to psychiatry and is dual qualified.

This is interesting. On the thread about Cass’ interview in the Times today there was discussion about who might take on the adult service review. It sounds like Michael Craig has an unusual but relevant range of expertise.

On the thread about Cass’ interview in the Times today there was discussion about who might take on the adult service review. It sounds like Michael Craig has an unusual but relevant range of expertise

After Cass' experience, it would seem unwise for someone who isn't retired to take on this task.

As per Cass, it would seem important and relevant to explore the plausible association of autism and gender dysphoria. I would like to see appropriate levels of funding for CAMHS and support services for distressed young people.

I fear autism research is going the way of a lot of so-called transgender research where an activist saying ‘because we said so’ is considered sufficient evidence. Still more good research but it is being undermined by activism.

It would be interesting to know if the same proportion of people with ASD who also have LD are identifying as trans. Surely if the trans-ness is connected to the autism then it would be visible in the entire ASD population? The characteristics of the autistic population have changed quite significantly in recent times but I believe that those with LD are still the majority.

All three unfortunately @SaltPorridge

This.

And all three of these.

To the contrary: we are well aware that we don't fit in and autistic girls in particular mask like crazy to try to. Transition is an escape from masking and sexual harassment for an autistic girl. An autistic girl who becomes a boy doesn't have to mask her often-masculine-coded special interests any more. She doesn't have to feign interest in feminine-coded special interests like fashion if she becomes a boy. And if she can lose or prevent het tits from growing, great, she doesn't have to deal with male attention.

Imagine going to a computer club and being the only girl there and all the boys hitting on you and mansplaining instead of talking to you about computers like a peer. Transition promises a route to being treated like "one of the guys" by becoming one. Shame that it's not actually physically possible.

@VitoCorleoneOfMNMafia I am sure that also happens as you describe.
I was thinking of autistic girls who look like boys - muscular, heavy set, big hands and feet. Who have to wear mens shoes and gloves because womens styles aren't available in size ginormous. Who aren't the object of male attention except as a source of bits of code, or the notes from Advanced Maths extra twilight session.

@TomeTome , I have wondered exactly the same thing !

This idea treats gender identity as a given, and then proposes that there are people who are suppressing their "true" gender identity in order to conform to societal norms.
This idea appears in Castellon's book. My feelings are that it would appeal to the autistic trait of wanting to be "right", in the sense of being more "authentic", of being an individual.
I don't believe there is such a thing as an innate gender identity.

Followed by... (from a different poster)

To the contrary: we are well aware that we don't fit in and autistic girls in particular mask like crazy to try to. Transition is an escape from masking and sexual harassment for an autistic girl. An autistic girl who becomes a boy doesn't have to mask her often-masculine-coded special interests any more. She doesn't have to feign interest in feminine-coded special interests like fashion if she becomes a boy. And if she can lose or prevent het tits from growing, great, she doesn't have to deal with male attention.

I'm not sure if the "to the contrary" was specifically about the section that I copied, but both of these comments resonated with me very much from listening to my daughter.

Totally out of the blue yesterday (she doesn't generally want to talk about gender identity related things with me these days because I apparently don't know anything and am annoying - I posted an example of a conversation this week on a different thread about autism), she told me that she was thinking about reducing (her already very small) breasts instead of removing them completely because "I think it would be sensible to keep some tissue in case I ever want breasts back". We actually had an interesting conversation about the impact of the male gaze at this point: I shared with her that I had hated how small mine were at her age and didn't really "feel like a girl" in a different way. I felt less worthy than the other girls, who were getting all that attention. We had all watched the original Top Gun together a while ago now so I spoke about how, when I was growing up, girls were effectively told via films like that and that the only thing that made them interesting to men was their sex appeal. Thankfully she didn't shut me down but instead asked me what age I thought she might be ready to make a decision like this. I opened with 25, which she didn't like. We ended up shaking hands on an agreement to explore breast reduction surgery together at when she is 21. She's about to turn 15 right now. Obviously I think any surgery would be a mistake - but the fact that she's starting to critically examine her own thoughts on this, and allow herself to accept that they might change, is a positive step that I've not seen before.

This also sounds like my daughter's descriptions of men and women.. and why she values the male "code" more. She doesn't use that word but it's very clear that she thinks men are better than women because of it.
Thankfully she really enjoys playing football on her girls' team and watching women's football on the TV (and in Wembley - we've been to see the Lionesses and an FA Cup final), so hopefully she will continue to see good female role models.

She's looking forward to the Olympics this year. I'm clueless on athletics. Does anyone know if there is a female "celebrity" athlete? It doesn't matter what the sport or country. It would be great to watch it together and know who to look out for and support.

@VitoCorleoneOfMNMafia

To the contrary: we are well aware that we don't fit in and autistic girls in particular mask like crazy to try to.

@SaltPorridge

Who aren't the object of male attention except as a source of bits of code, or the notes from Advanced Maths extra twilight session.

Both stereotypes that while common in media/entertainment are not the norm in the autistic population. Interestingly the subset you both describe are most visible when behaving or expressing views similar to those you read about being expressed by people who wish to “transition”. There is much made of how they are not being recognised as autistic, and anyone who suggests that there are other presentations that may be being overshadowed is instantly denying them entry to the diagnosis, and “hates” them. Their opinion on what it is to be autistic and the autistic experience trumps all others, not just for themselves (which would obviously be fine and right) but for all. They hate parents and characterise them as oppressors and have very very limited understanding of autistics with LD or those who are non verbal (despite these groups making up the majority of the autistic population). Vocabulary has been repurposed so it’s hard to discuss without “offending” and strict adherence to inaccurate repurposed descriptors. Meaningful research becomes ever harder to find or produce and funding, provision and support is spread ever thinner as all focus is pulled towards a smaller section of the autistic population.

In short I would say the autistic community are years ahead on a very similar journey and the young autistic children caught up in this are the very visible casualties.

This is exactly right, I think Im worried about some of the narrative around this because although I have been advocating for a couple of years about this, that mainly its girls with ASD wither undignosed or not, who identify as trans and that it is their autism and feeling 'different' and isolated and unsure that needs support...... I feel that there is a different narrative to this link that professionals are now seeing fit to talk about and that different narrative can spill very easily into autism = trans or trans = autism

Ive seen this referenced before somewhere but cant remember where.

The whole “male brain” idea was mooted by Baron-Cohan wasn’t it? Perhaps that particular bit of nonsense is at the root of this?

Excellent point @TomeTome

And yes, as I said upthread, there is certainly less awareness of the basic concept of "gender" amongst autistic cohorts with learning difficulties.

Because it's a social construct.

Social interaction, comprehension and communication can be severely affected in children and adults with learning difficulties and autism.