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 would also say the opposite @GreenAndSpringy

Gender dysphoria/ transgender is a socially constructed condition. That doesn't mean that people are really suffering with ocd/ body dysphoria about their sex. But its links to social ideas of male and female are inextricable. Babies are not born with GD.

Autism is a neurological difference that is innate. And extremely diverse.

Absolutely. A shockingly low percentage of people on the autistic spectrum manage to hold down a job or career. Terrible waste of talent for society as a whole and not a good outcome for the individuals concerned, given the knock-on effects on their mental and physical health.

I think it is very clear to anyone who has been following this for the last few years to see a very clear link between autism and trans.

I think the problem has come from being trans being part of the LGBT community. If an autistic child told a professional that they were gay then it wouldn’t be a problem, just who they are. But with being trans being seen as being part of the same ‘group’ professionals feel they can’t question someone saying they are trans as it’s ’the same’ as being gay.

@BonfireLady, your daughter might be interested in Jasmin Paris, who is an astounding British ultramarathon runner and also a vet, an academic and the mother of two young children. The reaction of the running community to Jasmin's recent achievement of being the first woman ever to finish the insanely difficult 100+ mile Barkley Marathons was incredibly heartening. https://www.instagram.com/p/C45tCzHLxUR Write up from one of the other four finishers, who were all male.

https://www.runnersworld.com/uk/training/ultra/a25930252/who-is-jasmin-paris/

You would say the opposite to “nothing about us without us” ?

You seem to think the opinion you have somehow linked to what I said is a fact.

Thankfully, I’ve never shared your certainty, and if I had it would have made me very uncomfortable when my toddling daughter expressed her certainty that she and I (her mother - in a loving relationship with her father) would eventually get married.

It’s extremely common for children to express the wish to be married to their parent (of either sex). It’s nothing to do with being autistic or gender or sexual preferences.

That doesn't mean that people are really suffering with ocd/ body dysphoria about their sex.

Is there a missing 'not' here, @WarriorN ?

Autism is a neurological difference that results in being bullied and socially excluded. But instead of being diagnosed with autism, people are being diagnosed with gender dysphoria.

I tend to think that GD is an “easier” thing to diagnose people with than ASD.

Firstly the diagnosis is easier - do you present as the opposite gender, end of diagnosis. It’s not complicated by masking and other issues.

Secondly there’s medical treatment for GD and there isn’t any treatment for autism (other than expensive talking therapies that the NHS doesn’t want to provide).

Thirdly there is still a general assumption that you can’t have autism if you don’t have learning difficulties (even though it’s 30 years since the medical establishment agreed this isn’t the case).

It is.

But being Autistic means being an outlier.
And little girls with conventionally paired parents with no exposure to same sex parented families who decide they will make their own family with their mother are very much an outlier minority.

I still present as “male”. Short hair, trousers, no makeup, computer programmer. But I’m a middle aged woman with kids so nobody is trying to tell me I’m trans. Also now I’m older (and no longer sexually attractive) I’m finding that men who share my interests are more willing to be friends with me.

@GreenAndSpringy that’s not my experience. In fact I would say it’s extremely common. Perhaps it’s less common for it to be linked in any way with gender or homosexuality.

@Stigglet I recognised your post about growing up all too well.

Yours is exactly the kind of voice that should be heard and included as we go forward with our understanding of the lived Neurodiverse experience and the inevitable cognitive/emotional/social dissonance that we are forced to try and navigate within frameworks imposed on us by communities and policies that lessen us for not being able to conform to them.

I ended up in a smallish boarding unit in a larger singe sex day school where one to one interactions made friendly relationships eventually possible, being around each other 24/7 forced a degree of understanding.
I’m not sure I would have survived the full standard secondary school experience. You’re amazing!

I’m Autistic.

Can you be specific?

What is extremely common?

I’ve agreed that a male presenting child wanting to marry their mother is common and a female presenting child wanting to marry their father is common.

Or are you saying that your experience is of girls wanting to marry their mothers and boys wanting to marry their fathers (all children with conventionally paired parents) being extremely common?

I've no idea whether it's common or not, but toddlers say all sorts of odd things and my general rule was not to take any of it literally.

@GreenAndSpringy yes

I wanted to be Justine Frischmann or Louise Wener. Except they didn't look as good with guitars as men. Unfortunately I was also short and not flat chested so the fashion didn't suit my shape. I dressed massively awkwardly trying to be that ultra cool. I missed and I knew I was missing. I wore a lot of second hand seventies and eighties top and oversized shirts. I didn't fancy the blokes in bands I just liked the music but felt treated like a total groupie.

I wanted to be a bloke and I remember expressing that explicitly to a friend on a number of occasions.

It was a sort of frustration at not being able to fit the box I wanted and trying to do something but not quite getting it right.

Ironically in hindsight, I think I probably was a lot cooler and hit the mark more than I thought. It's just that I had a perfectionism and an idealised concept in my head. I was also starving myself and making a point of eating once every two days at most and then only a tiny amount. It was 100% about control. The attention I got was about my boobs and not me as a person and I hated that. In the crowd in a gig I could disappear and be part of something and going and seeing the same bands multiple times you did become part of a scene and the bands did start to notice. It was a special thing but not a sexualised thing which I don't really think it acknowledged because we have these preconceived ideas about groupism. Quite frankly backstage was almost without exception dull and was only interesting because I got to hang out with mates (I didn't particularly like hanging out with bands although I did get that type of access).

Fast forward to now and the K-pop look is the rage for these kids which isn't that dissimilar and I can definitely see massive parallels.

One of the big culture shifts is that the music scene doesn't exist as it did and the trendy thing is now politics which I think helps precisely no one.

I do know exactly what I'd be doing and where I'd be socially if I was 17/18 now and it's scary.

Never met anyone else who did this, so you’ll need to expound on this for me to give this statement any credibility.

How do you define “extremely common”?

I myself define “outlier” behaviour as something no more than 5% of the population would typically do

Apologies @GreenAndSpringy Ive answered several questions with one answer which is unnecessarily confusing.

I’m Autistic.

Can you be specific?
Yes
What is extremely common?
As I said “It’s extremely common for children to express the wish to be married to their parent (of either sex).”
I’ve agreed that a male presenting child wanting to marry their mother is common and a female presenting child wanting to marry their father is common.

Or are you saying that your experience is of girls wanting to marry their mothers and boys wanting to marry their fathers (all children with conventionally paired parents) being extremely common?
Yes that is my experience.

Yes

My eyes are shut at the moment

I’d say it’s extremely common because I have had countless experiences of people telling me their child has done this. Of course in that population some of the children will be autistic and some homosexual. I’m not sure what you mean by “credibility”. If you’re suggesting I’m lying about it can I ask politely why I would do that?

I cannot give you “credibility” because you aren’t making any effort to differentiate between “extremely common” in numbers and “extremely common” as a percentage of children in conventionally paired partnerships.

That you have as many experiences as you say you have makes me understand that the context of those experiences is skewed - and you yourself will know why that is.

My point, is that if you were to enter an average school and, somehow, gather data, on the children who say they want to marry a parent, the amount of children from conventional partnerships who want to marry their same gendered parent, would be in the outlier territory (less than 5%)

Yes, in numbers, 5%, 4%, 3% is, commutatively a LOT of children. But that doesn’t make it “extremely common”. That you are intent on conflating these concepts is what affects your credibility here.

”Nothing about us without us” has pressed one of your buttons. I am starting to understand why.

Phew!

I wanted to pop a "thanks" on to your post but the missing word is what stopped me! 😁

On a personal note, we have finally secured a handover from CAMHS to the Occupational Therapy team (via the EHCP process) which explicitly sets out my daughter's needs around body disassociation and how these should be met by the OT team. I knew it was going to be a difficult subject, so I liaised with the receiving OT team (including looping in the school) to make sure that professionals could talk to professionals (I'm simply the layman "glue" to make this possible) to get everything moving in the right direction. This all went very well and and receiving OT team was completely on board with why work on body disassociation with an autistic girl with puberty-related distress was so important and how this needed to be considered within their work plan.
Until..... the OT supervisor decided it was all irrelevant and left it all out of this year's planned work.
Suffice to say I'm not going to take that lying down. This is just a small example of the hand-cranking that I'm having to do at every stage of this to get the right support for my daughter. After a frustrating beginning, things have gone in the right direction with CAMHS. I will now push the OT team. We've not come this far just to have it dismissed. I'm expecting the escalation journey that I'm about to go on to be slightly easier now that a) I have my MP's support (he's aware of this block and is ready to help me as soon as I ask for it) and b) we have the Cass Report.

It's been a long time since I posted it, but here is the earlier part of our journey, up to the start of 2023:
https://www.transgendertrend.com/teenage-gender-identity-crisis/

It's taken over a year, but we finally got a differential diagnosis from CAMHS and a recommendation for specific body disassociation (OT) and cognitive processing (SALT) work to address her needs. I'm not giving up. My daughter's future mental and physical health is too important. I'm also working with CAMHS (and my MP) to understand how the positive parts of their approach can be scaled up to help others. So far so good.

Suffice to say, when I wrote this my daughter did "finally realise that she was female"... and, inevitably, since then the risk that I have been mindful of the whole time did come to pass: she went back to ruminating on it. That's why I have kept going, working as hard as I can to remove the influence of bias. The risk hasn't gone away.

What I can't understand is why you are giving this any thought, though. When a tiny child says something about the world that an adult can see is nonsense, that is because she is a tiny child with very little life experience and her brain is still at a very early stage of development. Hence the number of children who say they are dogs or cats or unicorns or announce that when they grow up they will be Emperor of the World or similar unachievable things.

I hope I've got this wrong, but I'm getting a sense that you thought your very young daughter saying she wanted to marry you when she grew up was a sign that she might be a lesbian or, alternatively, that she might have a female body but a male gender. This for me would be on a par with that US psychologist who thought pre-verbal girls were indicating their transness by pulling the hairclips out of their hair, or pre-verbal boys undoing the poppers on their onesies so they superficially resembled a dress. Children do odd things. Lots of children hate having things in their hair or find the poppers irresistible. No very young child can have any grasp of what life will be like on the other side of puberty when they are adults. They can try to imagine it but they will be missing such huge chunks of knowledge about what it's like to have an adult body and especially an adult brain that they can't possibly get it right.

My point, is that if you were to enter an average school and, somehow, gather data, on the children who say they want to marry a parent, the amount of children from conventional partnerships who want to marry their same gendered parent, would be in the outlier territory (less than 5%) How do you know this?

As is said it’s common in my experience, and I have a larger than average family so obviously have conversations with a large number of parents. People often ask me about things that worry them and tell me about things they find cute or funny in their children. I am perfectly happy to accept that you don’t find it common and it’s a very niche and telling experience in your experience. I wonder why you find it hard to extend me the same understanding?

”Nothing about us without us” has pressed one of your buttons. I am starting to understand why. I’m not sure I have “buttons” or that I was particularly focused on that slogan, though now you highlight it, yes it is a bit daft. What is your understanding of why that phrase would “press my buttons”? It’s sounds weirdly threatening and like you are trying to imply I’m some sort of anti-autism bigot? Am I supposed to be frightened to tell you my experience of what kids say about marrying their parents?