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

This is old news and sums up my dd - autistic and has identified as trans for four years now. What would be news is some sort of evidence- based guidance on how to support her without affirming.

Thats the whole problem with this concept of gender and trans, it is hugely based on sex stereotypes, its misogynistic, its regressive, its rigid (like cars/computers and have short hair = a boy!), its homphobic.

Gina Rippon ruthlessly challenged Cohen on that sexist theory, including publicly debating him.

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.

I would have an entirely different understanding of having "less compulsion to conform" to societal and peer norms.

And individual just wears and enjoys what they personally happen to feel
most comfortable with. When that's strongly against the gender stereotypes that society has constructed, society labels them "wrong" and that they're therefore "in the wrong body."

It is, and also autism diagnosis relies somewhat on gender stereotyping too.

Whilst it's been very important to understand and define the way autistic girls may 'present,' which has in the past has meant they have missed out of diagnoses, boys can also have those traits. I know a number of boys who 'mask' and have taught many autistic boys who would fit the descriptions I read of autistic girls on the NAS some years ago.

From personal observations, I associate masking with much fewer, if any, learning difficulties. But males are much more likely to have learning difficulties.

@BonfireLady there are loads of great female athletes I enjoy watching - you and your DD might look out for Katarina Johnson-Thompson, UK and world heptathlon champion in 2023 (although she does have a history of dramatic injury problems so everyone's hoping she'll make it to the Olympics in one piece!) or perhaps the great Femke Bol of the Netherlands, 400 metre world champion and also champion hurdler over the same distance.

There are plenty more, I can think of others if you like 😊

I agree @WarriorN , I would say not needing to conform (or possibly more accurately not recognising what conforming would look like) makes it hard to see why transition would be an option. If you are free to like or dislike any presentation, and to like or dislike behaviour then what would you be doing if you transitioned? I’m not sure I really understand how you can be a feminist and not be GC.

As it happens, I've got two Baren-Cohen books in my reading pile, yet to be read: 1) the essential difference and 2) zero degrees of empathy

I'm tempted to start reading the first one ASAP to see how he's framing it all. On the face of it, it sounds like some really interesting ideas about stereotypical behaviours that have been observed in men and women, when overlaid with stereotypical behaviours observed in autistic girls, produce an interesting overlap (when looked at against a female neurotypical control).

And that there are two possible logical conclusions: a) these autistic girls and women are really just boys and men, trapped in girls and women's bodies, and transition is a sensible thing to do b) it goes some way to explaining why this cohort believes that they should transition

Obviously I haven't read the book yet, so I may be jumping the gun on my suggestion of logical conclusions.

Katarina Johnson Thompson is a British Heptathlete/Pentathlete. She's well regarded and popular.

Brilliant, thank you!

I'll have a look at both those ladies and learn a few facts about them. As much as I do genuinely enjoy watching big football matches on TV or live and big events like the Olympics, I'm not really that in to sport in general, so tend to be a bit clueless on it all. By contrast, it's one of my daughter's favourite interests. She's naturally more drawn to the celebrity and celebration of the male records because they will always be faster/stronger/higher.

As a child, I remember the nation adoring Flo Jo and I really loved watching her with my family. Obviously that didn't turn out so well 😬 but the buzz at the time was incredible. A buzz that is more often reserved for the male athletes.

Sky Brown is a 15 year old skateboarder.....that would be good to watch..because it is a sport more associated with boys.

Ooh, she'd love that. She (my daughter) can skateboard a bit and used to teach herself tricks. She's not bothered for a while so this might inspire her again. We've just recently been skiing and she was doing some of the jumps in the snowpark.

Sounds like skateboarding will be a good event to look out for then; maybe the stunt bike riding events would be good, too. BMX Freestyle - I think it is called.

or possibly more accurately not recognising what conforming would look like

Yes it's exactly this.

A lack of comprehension of social interaction.

I can't understand how you can be an "expert in autism" and not understand how GD, which is as a socially defined and generated condition, is linked.

This is the Rippon / Cohen debate; I haven't listened to it though

Ps sorry for the minor derail folks!

To the poster who said that they would prefer the professionals' focus to be on how to help a child in the situation, not just acknowledging that the link between gender identity belief and autism exists, I am totally with you. My layman's approach has been to a) understand as much about the reasons for the link as I can b) learn about gender dysphoria therapeutic approaches (I read the excellent book by Sue and Marcus Evans on this) and c) focus on her mental health in general (there was a time when she spent days under the duvet, during the worst of her mental health crisis) and positive female role models in areas that interest her. Re-igniting her interest in all the things she loves - and had turned her back on because she was caught in depression - has been a long journey, but it is gaining more momentum all the time.

@BonfireLady wrote
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.

I was thinking of computer code...

There are some amazing female surfers

Yes, me too but probably not explaining myself well.
When she talks about the differences between men and women, she's very clinical about it. She breaks it down in to data points and values those that fall under the male grouping far more than the female. She values speed, strength, distance, height etc. She's very tall, so is happy with that.. but I think that's mostly because she sees it as being on the winning "team". She's never overtly identified as male, but is clearly very attracted to the pull of that idea.

Rowing is good for tall, strong girls. Have a look at single sculls. If there’s a biggish river near you, there’s probably a club with a Junior section.

I’m autistic. In my early teens I presented in a way that could be described as masculine. I gave no shits about women’s fashion or makeup or nail varnish etc. I wore loose tshirt, jeans and boots pretty much all the time, with a baggy mens jacket. I also wore a tight vest which flattened my breasts. My interests were typically masculine.

Thankfully it was the 90s so nobody suggested I was trans. I can tell you exactly why I dressed like that - to be invisible.

I was completely unable to navigate puberty. People had begun to comment on my breasts growing and I found it upsetting and embarrassing. Sexual harassment from boys was a constant problem, and due to my communication difficulties I was unable to handle flirting. I also found that the boys who shared my interests were starting to exclude me as my femaleness became more obvious. So I hid my female body as much as I could.

As I got older, other girls increasingly shunned me. Girls are much worse for excluding girls with autism than boys are for excluding boys with autism. I had no friends and I was constantly bullied, and I didn’t know why.

At the time I would have latched onto any explanation for the way I was being treated. I would have grabbed any solution that would make the bullying and harassment stop and allow me to have friends. So if I’d been told I was trans, “and that’s why girls don’t want to be your friend, and that’s why you’re not interested in flirting with boys, and that’s why you have male interests”, then I’d have accepted that as the answer. And if I was also told “if you’re trans then the boys who share your interests will be friends with you and the bullying and harassment will stop” - I’d have leapt on that as a way to have friends.

But it was the 90s. So I was just bullied and isolated for a number of years, and tried to kill myself several times. My body grew and I learned to cope with harassment and embarrassment. In fact I learned that my body was a tool that I could use to get friends - because if I let boys have sex with me they would be my friends.

It’s a long and sad story. Suffice to say I’m now in my 40s with kids and clearly not trans. But I completely understand why teens in the same situation grab onto that as an answer and solution to their problems.

I agree, but what is interesting is that I think even just a few weeks ago people would have regarded a discussion of this as transphobic and ableist. It’s an article that probably couldn’t even have been published until now because of the toxicity surrounding this issue.

And I think there seriously needs to be research, support and a pretty much wholesale review in how we support autistic individuals and their families - especially girls but also those regarded as ‘high functioning’ because they don’t have SEN needs, as such. There is a narrative that if a kid is able to get good GCSEs then their ASD is somehow less acute, when this attitude has it’s roots in the days when ‘autism’ was only recognised in non-verbal, pre-pubescent boys. This fails to acknowledge what autism actually is and focuses on a small number of associated co-morbidities/symptoms. As the definition - and thus the spectrum umbrella - has broadened over the last 20 years, DoE and the NHS should have adapted.

Successive govts have failed in this, the current one (even allowing for the necessary prioritising of Covid management) has failed to step up.

This just adds legitimacy to what is obvious to Autistic people:
”Nothing about us without us”

No one Autistic voice is going to provide the answers. An Autistic minority is not enough either.

What is very, very definitely clear here is that too many professionals who understand Autism academically have set the framework. It’s a framework where Autism and Gender Dysphoria have been split into separate sections.
If more people affected had been included it would have been understood from the start that these cannot be segmented.

I would say this is the polar opposite of my thoughts.

The BMX Freestyle Olympic qualifiers happen next month so the athletes aren’t confirmed yet, but Charlotte Worthington of the UK is heavily tipped @BonfireLady - she was Olympic champion in Tokyo. A very good model of a strong, confident female.

I hope things are better for you now.