Monday, June 29, 2020

A Spectrum of Identity: Autism and Gender/Sexuality

In the early hours of June 28, 1969, the police raided Stonewall Inn, a gay club in Greenwich Village.  Fueled by constant harassment and discrimination, bar patrons and neighborhood members refused to disperse, and the situation quickly devolved. A quick police raid sparked 6 days of protests and clashes that would then become the catalyst for political activism in the gay rights movement.  Numerous gay rights organizations were created as a result (for example: Human Rights Campaign, GLAAD, and PFLAG). Pride Month is celebrated every June in the United States to remember the Stonewall Uprising, celebrate LGBTQ individuals and their stories, and bring awareness to the struggles the community still faces today. Autistic Pride is celebrated every June 18th

According to the Center for Disease Control, suicide is the 2nd leading cause of death among young people.  LGBT youth are 4 times more likely to consider suicide, plan for suicide, and/or attempt suicide than their peers.  Another CDC report indicated that approximately 29% of LGBT youth had attempted suicide compared to 6% of their peers. The Trevor Project estimates that 1.8 million LGBTQ youth between the ages of 13-24 seriously consider suicide in the United States each year.

The Human Rights Campaign surveyed 10,000+ LGBT youth between the ages of 13-17 and found the following:
  • 42% of LGBT youth indicated that the community that they were living in was not accepting of their gender identity or sexuality.
  • LGBT youth were 2 times as likely as their peers to have been physically assaulted.
  • 26% reported that the biggest problem that they faced was not feeling accepted by their family, trouble with bullying, or fear over coming or being out about their identity or sexuality.
  • 73% of these youth felt they could be more honest about themselves online than in their face-to-face relationships.
  • 92% reported hearing negative messages about being LGBT with the most common sources of those messages coming from school, the Internet, or their peers.

Although no particularly accurate number exists, a 2017 Gallup survey reported that 4.5% of Americans identify as LGBTQ.  The challenges for young people who feel unsupported by their families, peers, schools, and/or communities are evident.  I mentioned that June 18th is Autistic Pride Day, but how prevalent is the intersection of the autism spectrum and the gender/sexuality spectrum?

According to a growing body of research, the autism diagnosis is far more common in the transgender population than the wider general population.  De Vries et al (2010) found that 7.8% of the trans population also had an autism diagnosis compared to .6-1% of the general population.  There has been some research that has looked at autism compared to conditions such as ADHD and neurodevelopmental disorders such as epilepsy and research that has theorized possible links between autism, autistic characteristics, and gender identity.   For example, in 2020, an article was published in Research in Autism Spectrum Disorders that examined the intersection between autism and transgender identity and the implications on mental health.  The trans community has high rates of depression and anxiety while depression and anxiety are also the two most common comorbidities with autism.

Consider that in one study of 372 adults with autism, 66% reported suicidal ideation, 31% reported depression, and 35% reported detailed plans for suicide or suicide attempts.  Now combine that with the statistics for the LGBTQ community.  The Research in Autism Spectrum Disorders research article concluded that while anxiety and depression scores were higher for both autistic individuals and trans individuals than their counterparts, the highest levels of depression and anxiety were found in those individuals who were both trans and autistic.

One potential explanation for the increased anxiety and depression is because having a diagnosis of autism can make accessing support very difficult for LGBTQ individuals. Many services for trans individuals require a gender dysphoria diagnosis; those unfamiliar or inexperienced with working with autistic clients may mistake explanations or communication difficulties. One gender identity therapist summarized the challenges by stating that a gender dysphoria diagnosis requires lots of transitions, flexibility, and self-advocacy, which may be the exact skills that are most challenging for an individual on the autism spectrum.  Those challenges, though, don’t negate the individual’s reality, which is why in 2017 several prominent psychologists published their clinical recommendations that:
  • Children and adolescents presenting at gender clinics should be screened for autism spectrum disorders
  • Individuals with autism spectrum disorders should be screened for gender identity concerns, such as gender dysphoria, which is the medical term for when one’s biological sex and perceived gender do not match. 

These clinical guidelines were made on the recommendation of 22 specialists including pediatricians, psychiatrists, and endocrinologists.  

What should a parent, family member, or friend do once someone expresses that they are on this double spectrum, the autism spectrum and the gender and/or sexuality spectrum?  In May 2020, a group of transgender autistic young people along with clinical experts released the following Nothing About Us Without Us recommendations:
  • Help the individual build a community: for a positive self-identity it is crucial to be surrounded by and know others who are both transgender and autistic. 
  • Find gender diverse role models and/or neurodiverse role models
  • Gender style coaching may be crucial for individuals who are on the autism spectrum; these individuals can help navigate autism-related sensory sensitivities, and problems with planning and social understanding that are unique to the LGBTQ community that individuals on the ASD spectrum may miss or not understand.
Additionally, experts recommend that family and friends:
  • Validate the individual’s disclosure with empathy and understanding.
  • Ask what the individual needs or would like to do—don’t make assumptions.  The gender identity and sexuality spectrum is as individual and unique to each individual as the autism spectrum.
  • Be an advocate for your child within your family, the healthcare system, the school, and your community. 
  • Seek support from an expert who is versed in the intersection of neurodiversity and gender/sexuality.
  • Be kind to yourself and recognize and admit that you will not have all the answers immediately. 

    Additional Resources