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

My eyes are shut at the moment

SHIT!

My eyes are shit. Waiting for new trial contacts and taking ages

@Gasp0deTheW0nderD0g
You and I have very little (if anything) in common with relation to parenting. I’ve always listened to my child and taken her seriously. She’s 14 now and we have only become closer and closer. She’s not much different now to who she was back then.

——
Am just about to box and pack away these thoughts, but just before doing that I have dredged up a recent data set to check my own assumption about my kid’s certainty that we would marry (this insistence lasted over 3 years, well into Reception, maybe even year 1) being an outlier example (5% or less). Am also taking into account that the Reddit list is skewed and leans towards accounts that are likely to have been considered noteworthy by the contributors.

https://www.reddit.com/r/Preschoolers/comments/15fa5jh/daughter_wants_to_marry_daddy/

Nothing in there to change my perception of it being outlier behaviour.

I’m sorry I don’t really understand what you mean by a “recent data set”? Do you mean you read a thread on Reddit (that appears to have children professing their wish to marry all sorts of responsible adults in their lives regardless of sex or age) and this lead you to believe it was ver niche behaviour? How did you come up with the figure of 5%?

Did I miss a bit here, what does wanting to marry a parents have to do with autistic children being trans?

😂😂😂
This is the best typo loop ever 🙃❤️
Sending hugs, virtual contact lenses and an empathy for the "fat finger" moment (that bloody u being next to the i).

If it helps to know, I took your "shut" eyes as a metaphor about accidental typos ❤️

It made a sort of sense as shut, though. I assumed you were very tired and touch typing anyway.

And thinking of metaphors, I agree that retorts of "transphobia" are an excellent parallel to describe the gagging effect of knowing that you're constantly a whisker away from being called ableist, ignorant, condescending or similar when you're a neurotypical person who is commenting on the issues related to the autism/gender identity link.
When I first joined X, I had lots of conversations with autistic people where I ignored the barrage of insults that were slung my way and focused on the substance of the conversation. Many ended with no substance left to discuss (just lots of posts throwing a variety of insults at me in a scattergun way - so I whack-a-moled them down with a repeated single polite/sarcastic exit comment, depending on the context) but some took me to interesting places and the insults stopped being hurled. To exit on a positive goodbye was a good outcome for me because it gave me hope that such conversations are possible as long as I'm prepared to take the insults on a "reasonable adjustments" basis, if there is a good conversation lurking in there somewhere.

You and I have very little (if anything) in common with relation to parenting.

How would you know? I have no memory of ever interacting with you here before. Maybe you've name changed recently. I haven't. I've said nothing at all on this thread up to now about my own children, who are both over 30 now. One of them is on the autistic spectrum, diagnosed while at primary school. I too have always listened to my children and taken them seriously - we wouldn't have ended up at CAMHS as early as that otherwise - but I haven't always taken what they said literally, any more than I do with anyone else. I check for reasonableness, I look for supporting evidence, and so on and so forth. Misunderstandings happen, memory can be faulty, children who get a reaction often say or do the same thing again and again to get attention, without understanding that they are causing concern.

For what it's worth, we're a very close family too.

I will draw a line under this now, however, as we're not getting anywhere.

Fair point - he could have been lobbying behind the scenes.

i do feel that rather than finding women who succeed in traditionally male areas (ultra competitive sport, maths, physics etc) we’d be better off levelling up society’s opinion of traditionally female things, so that they aren’t associated with shame or inferiority. Big boobs should be no more remarkable than being tall or having brown hair, caring professions should be seen as a successful career etc.

Completely agree on all of that! I don't think it's a coincidence that doctors' pay has fallen so far behind during the period when it's become a profession with so many women in it.

I wanted to be a bloke and I remember expressing that explicitly to a friend on a number of occasions.
Me too. But not because I wanted to be male. It was because I wanted the freedom and physical strength that comes with being male. I wanted acceptance into male social groups (which I found easier to navigate because they’re less complex than female social groups). I wanted to be welcomed to join in with male hobbies (which matched my interests better than female hobbies). And I wanted to be free from sexual harassment and basically being treated as a walking pair of tits.

I’m only able to express this complex reasoning now because I’m mature. At 16 I would just have said “I want to be a boy”.

I was saying "to the contrary" to this bit:

". 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."

My DC as toddlers declared at various times a wish to marry me, my DH, the cat, various friends of both sexes, their teddy, their sibling…. In terms of a DD toddler saying they want to marry mum it is more likely because they seen mum as the carer/protector and the idea of being without that is scary so marrying mum simply means that they will be there the whole time when they are older.

“nothing about us without us”

What is meant by those demanding this is ‘we set the priorities and decide what is best’. There are three issues with this:

1. who is ‘us’? ‘Us’ is generally a politically active subset with very specific goals they see as beneficial to themselves. It is a bit like ‘include lived experience’ or ‘must be [condition] led’ which often means ‘include me’ or ‘led by me’ or at least ‘people with the same set of priorities as me’. There is no attempt to assess whether this is actually a widely held view in the whole population.

2. It ignores bias.

3. It ignores the value of prior knowledge/expertise

‘Gender affirming treatment’ on tap is the outcome of precisely this approach. No external assessment is permitted, no application of knowledge allowed, no differentiation or safeguarding. The ‘us’ (adult men) apply their wants to another group (young teenage girls) by suggesting they are the same. This also happens in autism. For example the rounding on that DNA study of autism. A study which may or may not have had other issues but much of which is now being carried out elsewhere. There were cries of ‘eugenics!’ But also ignoring those who have autism as part of possibly unknown genetic syndromes and what identifying and building knowledge about those could do to help syndromes that come with a range of health issues.

‘Nothing about us without us’ would be fine if it meant that studies involved gathering views from a wide range of sources, including ensuring efforts were made to engage with those offline and those who purposefully disengaged from groups. But it generally doesn’t as that is too much like hard work when you have a group of activists ready to jump in.

He has done so much harm to autistic women and girls.

I’m autistic. I don’t feel less compulsion to conform with social norms. I still say excuse me when I burp, keep to the right on the escalator, give old people my seat on the bus, etc.

If you’re talking about wearing dresses and makeup because I’m female, then I don’t feel that’s a social norm so much nowadays? Or that I’m violating social norms by not doing those things? A woman in hoody and jeans is hardly a revelation.

we’d be better off levelling up society’s opinion of traditionally female things, so that they aren’t associated with shame or inferiority

This, otherwise we are just promoting misogyny and fueling more "I wish I was a boy" thinking.

That was my point. We feel as much compulsion if not more to comply with social norms.

But @VitoCorleoneOfMNMafia and @Stigglet are you the single face of autism? I think you are describing the experience of some high functioning female autistics who are a small proportion of the autistic population.

@AstonsDataThief thats a very good post. Well said.

I've been out and wanted to come back to @GreenAndSpringy

"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."

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

No, I agree with what you've written in these two paragraphs.

I meant 'I think the opposite' regarding this comment:

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

My reply was around the fact that GD is a very different condition to autism

But now I understand that you meant that the traits of gender non conformity which is wrongly interpreted as "trans" hasn't been included in frameworks of autism?

Has he?
In the context of trans ideology being pushed onto vulnerable young people, I don't see how a scientist exploring a theory can be said to have "done so much harm".

The "extreme male brain" model of autism caused systematic underdiagnosis of women and girls for decades. That would be the harm to which I refer.

Great post.

I would also add that "nothing about us, without us" has a very different (and much more positive) meaning when the group that applies it to itself has a single, factual core around which diversity in other attributes exists.

E.g.

1. Being a woman (or man)
2. Being L, G or B
3. Being a British citizen (and within that, being within a devolved nation)

The moment there is no single, factual core, the risk of "capture" is introduced

Obviously there is always risk of capture in any group because of egos, power, money etc. But if the boundaries of the group are clear and can never shift, the risk is much lower.

What does/doesn't count as autism is contested - it's a very wide umbrella, even within the parts that aren't.

Obviously being a woman, being LGB and being British are also wide umbrellas, under which smaller interest groups exist. But no smaller interest group should speak on behalf of the whole group. That's what happens in autism and gender identity... (and arguably in Westminster about the devolved nations in the areas where devolved autonomy doesn't exist, but that's a whole other topic and why we have a democratic parliamentary system with elected representatives).

I don't think that autistic women and girls with concurrent severe learning disabilities are likely to be concerned with gender identity. Severe LD kind of precludes engaging with the concept.

The whole notion that autistic people are more likely to be gender dysphoric is based on extrapolation from the ones who don't have severe learning difficulties.

My point is that, far from freedom from social norms removing barriers to transition in non-LD autistics, a desire to comply with social norms to the extent of wanting to alter one's own apparent sex to make that compliance easier is more likely to drive transition in non-LD autistic females.

The linked and quoted piece is an example of a "high-functioning" autistic male talking for and over both severely-LD autistics and female autistics.