The Weaponization of the Overrepresentation of Autism in Transgender Individuals
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As societal acceptance of both transgender and autistic people continues to increase, so does our understanding of them. New and increased research including these individuals and the different ways in which their environment affects them is helping to cast more light onto issues that outside groups have little understanding of. These understandings help to improve access to care, diagnostic procedures, and future research for these groups. However, as more people are becoming more comfortable with their identities and can reach out to receive professional care, more instances of gender dysphoria and distress transgender people may experience as their assigned sex at birth does not match their gender identity, are being noticed alongside autism diagnoses and higher rates of autistic traits. Numerous recent studies have been conducted to further investigate this overlap and the possible reasons behind it. Instead of this data being seen as a potential indicator that autistic people are more likely to be aware of their gender identity compared to allistic people, many transphobic people are using this data to discredit transgender individuals, citing ableist beliefs such as the idea that autistic people can be more easily swayed or deceived into believing they are transgender. This essay will review several studies outlining the rates of autism within transgender people, discuss common critical takeaways of this data that are used against transgender people, and explain how these views are misguided and only work to preserve harmful stereotypes.
Despite the relative recency of this research topic, many studies and reviews presenting strong findings already exist. In a 2020 study which procured its sample through information from four large scale, internet-based data sets and one longitudinal dataset and used multiple self-report tests to measure a wide range of autistic traits, results showed that transgender and gender-diverse individuals were around 3 to 6 times more likely to be autistic than cisgender individuals and attained significantly higher scores on the self-report measures (Warrier, V., et al). An article from 2020 reviewing 21 studies that measured the prevalence of autism spectrum disorder (ASD) in individuals with gender dysphoria (GD) concluded that of all the studies reviewed the most definitive findings came from research with a sample of over 48,000 children diagnosed with ASD (Thrower, E., et al). This study found that based on ICD-9 diagnostic criteria, children with ASD were over four times more likely to be diagnosed with GD than those without (Thrower, E., et al). The review also found that of the 7 studies which used clinical diagnostic measures for ASD, prevalence rates for ASD in adults with GD ranged from 4.8 to 13% (Thrower, E., et al), compared to 1 to 2% of the general population (Warrier, V., et al., 2020). From this multitude of research conducted on the topic, it becomes clear that there is an overrepresentation of ASD in people with GD and transgender individuals.
While the similar findings of these studies seem to point to one conclusion, there are multiple factors that call many of the articles’ validity into question. A 2018 study looking at a sample of treatment seeking transgender adults has as a good example of a weak methodology that limits its findings. The study found that compared to transgender people assigned male at birth (AMAB) and a cisgender community sample, transgender people assigned female at birth (AFAB) were more likely to have clinically significant autistic traits (Nobili, A., et al., 2018). However, this study only used the AQ-short, a self-report questionnaire that is not considered a diagnostic tool, as its means of measuring autistic traits. Because of this methodology, the results found have a weakened significance and have a large room for interpretation and error. This worry is confirmed in the 2020 review of studies discussed previously. Findings from three studies using samples from GD clinics and two cross-sectional analyses that used the AQ to measure autistic traits were inconsistent with each other (Thrower, E., et al., 2020). The three studies suggested prevalence rates of 2.1 to 5.5% while the cross-sectional analyses found no significant difference between adults referred to a GD clinic and those who had not been (Thrower, E., et al., 2020). These inconsistencies highlight a clear limitation with the use of the AQ to in screenings for people with GD (Thrower, E., et al., 2020). Aside from limiting methodologies, the fact that most studies tend to obtain their sample group from GD clinics could also be skewing results (Warrier, V., et al., 2020). Taking these samples could be problematic because not all transgender or gender diverse people have GD and most people going to GD clinics are likely to be experiencing the most severe effects of dysphoria, meaning that the rates of autistic transgender people without GD may be different than the rates observed in these studies (Warrier, V., et al., 2020). A lack of reliable screening tools, minimal use of diagnostic criteria, and sample sizes that are unable to be generalized to the whole transgender population makes it difficult to separate the strong studies from the weak ones. This lack of proper and consistent methods has the potential to be dangerous when these numbers are taken from studies with no context and spread to the general population who may be unfamiliar with identifying studies with severe limitations.
With these results having been widely discussed and exposed to public opinion, differing viewpoints have arisen. People who refuse to acknowledge the existence of transgender people have taken this data and twisted it into various arguments, ignoring any areas for discussion left by the researchers, to discredit different gender identities. Some of the main points brought up are that autistic people may misdirect their sensory issues as GD and body dysmorphia, be more easily convinced that they are transgender, and mistake their interests or hyperfixations with topics typically associated with a different gender as a sign that they should be another gender. At first glance some may be inclined to agree with some of these points, after all they are pulling their conclusions from scholarly sources with data that seems to support their argument. However, one scratch at the surface reveals that there is nothing beneath them besides ableism and transphobia. While 90% of autistic do experience some level of sensory processing issues, a wide range of sensitivities exist (Allen, A., 2022). Lumping all autistic people into one category or experience is incorrect because it relies heavily on past stereotypes and ignores the fact that everyone will experience their autism differently. Some people may not be able to leave their home without noise-canceling headphones while others may enjoy and be attracted to loud noises. Additionally, body dysmorphia associated with GD is a distinctly different experience than sensory issues. This point usually leads into the next argument, which is that autistic people will be more likely to mistake those experiences as being the same because they can be more easily influenced to do so.
Like the previous point, this logic is based on a stereotype that autistic people are gullible and easily tricked. These people do not believe that autistic individuals can think for themselves or critically evaluate their gender without relying on outside help. One interviewee from a study aiming to get a closer look into the experiences of autistic trans and gender-diverse people describes being held to this stereotype when they first came out, with people saying such phrases as, “you know there is a lot of overlap between people who are on the spectrum and people who are transgender,” which they interpreted as, “are you sure this isn’t just the autism talking?” (Strang, J.F., et al., 2018, p. 4049). Transphobic people may also see an autistic person coming out as transgender as just a hyperfixation or interest in topics not typically associated with their sex assigned at birth. Once again, this belief ignores the extreme difference between having an interest in a certain area or object and actively realizing they are another gender besides the one they were assigned at birth. Another interviewee describes their confusion when people questioned their affirmed gender just because they had an autism diagnosis, explaining that “they viewed it as an obsession, but it’s really not the same thing and I don’t know how they thought that” (Strang, J.F., et al., 2018, p. 4049). Throughout the interviews all the subjects carry this common theme of having difficulties coming out or explaining their gender to others because of having their identity doubted due to their ASD diagnosis or not being able to verbalize what being transgender feels like because it is just a natural part of their life experience (Strang, J.F., et al., 2018). This sentiment may be telling of the fact that rather than autistic people mistaking themselves as transgender, they are instead better able to recognize their gender identity and present themselves in a way that matches it than allistic people. In other words, the increased occurrence of autistic transgender people is likely because there are more of these individuals who have come out of the closet than allistic people.
Within the pages of a multitude of autism-centered websites, social media apps, and blogs are days’ worth of reading material of autistic people’s stories, including stories about the intersection of gender identity and autism. To break formality for a moment, however, as an autistic nonbinary person I would like to add to these stories. The common sentiment shared among many autistic people that they feel like they do not fit in socially or understand various societal norms and that this extends to ideas surrounding gender is something I can personally connect and agree with. As different invisible walls were placed during childhood between the only two genders recognized, I found myself increasingly confused as to why I was being restricted in certain ways and why no one else seemed as I lost as I felt. I enjoyed playing with both the boys and the girls and did not see the supposedly obvious differences between them that everyone insisted were there. Once I had been gradually pushed away from the boys’ groups by both the boys and adults, I found myself set solely into the role of a girl, which didn’t bother me at first because I enjoyed the people I was around. It wasn’t until there were odd expectations set on me that I began to feel a unique discomfort I could not name. I was told that my leg hair was gross, that I must have a crush on certain boys just because I wanted to hang out with them, that I needed to stop being “childish” and accept the rules that no one had explained to me. Suddenly I was lost and began to distance myself from others to protect myself from being perceived wrong. I didn’t understand when everything changed and left me behind. Then puberty hit, and a sense of dread washed over me as I felt trapped into forever being seen as something I so obviously was not. But it was only obvious to me. It was not until the return to school following the COVID-19 pandemic that I began to simultaneously realize I was neurodivergent and nonbinary thanks to social support I received which allowed me to research and explore my identity. With the words now discovered to describe my feelings, I could recognize where in my upbringing I didn’t pick up on the same cues as my peers and finally accept myself as different from both neurotypical and gendered expectations. Even if it is still hard to describe, I can now identify the capability I possess, which I previously misjudged as an incapability, to observe the phenomenon of gender from my own place outside of it.
Despite the plentiful stories from autistic trans people detailing how they were able to discover they were trans, others will often overlook them, usually because they do not consider that these stories even exist. They will instead fall back on the past stereotypes that have been ingrained into society ever since the beginning research on ASD only used white middle class boys as their sample group to base their understandings of autism from. While these stereotypes may have been able to lie dormant and not directly harm anybody, the spread of harmful ideas attacking transgender individuals has the potential to play off these underlying beliefs and lead more people to discredit someone they haven’t even gotten the chance to know. The public discourse and toxicity created from the pairing of stereotypes and the results discussed in this paper are perfect examples for why you should always listen to the voices of the subjects of studies and examine the social structures they exist in before jumping to conclusions. Taking more time to think critically before believing every headline or statistic you read can help you to decide whether you can trust an article and if it is telling the full story. Without a complete understanding of a situation, no meaningful or productive conversations can occur, and people will only be distracted from larger issues affecting the community. It is only through listening to people different than us that we can actively break down negative stereotypes and beliefs about groups we have little understanding of and provide more compassion for those around us.
References
Allen, A. (2022, May 27). Sensory processing vs autism: What’s the difference? Ivy Rehab.
Mazzoli, F., Cassioli, E., Ristori, J., et al., (2022). Apparent autistic traits in transgender people: a prospective study of the impact of gender-affirming hormonal treatment. Journal of Endocrinological Investigation, 45, 2059–2068. https://doi.org/10.1007/s40618-022- 01835-1
Nobili, A., Glazebrook, C., Bouman, W.P., et al., (2018). Autistic Traits in Treatment-Seeking Transgender Adults. Journal of Autism and Developmental Disorders, 48, 3984–3994. https://doi.org/10.1007/s10803-018-3557-2
Strang, J.F., Powers, M.D., Knauss, M., et al., (2018). “They Thought It Was an Obsession”: Trajectories and Perspectives of Autistic Transgender and Gender-Diverse Adolescents. Journal of Autism and Developmental Disorders, 48, 4039–4055. https://doi.org/10.1007/s10803-018-3723-6
Thrower, E., Bretherton, I., Pang, K.C., et al., (2020). Prevalence of Autism Spectrum Disorder
and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review. Journal of Autism and Developmental Disorders, 50, 695–706. https://doi.org/10.1007/s10803-019-04298-1
Warrier, V., Greenberg, D.M., Weir, E., et al., (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature Communications, 11. https://doi.org/10.1038/s41467-020-17794-1
Van der Miesen, A., Cohen-Kettenis, P.T., & De Vries, A., (2018). Is There a Link Between Gender Dysphoria and Autism Spectrum Disorder? Journal of the American Academy of Child & Adolescent Psychiatry, 57(11), 884-885. https://doi.org/10.1016/j. jaac.2018.04.022