The relationship between autism and gender identity has been a source of much discussion in the last two decades. While work has since been done to address the under-diagnosis of autistic girls and women, gendered thinking remains an ongoing issue, particularly in the LGBT community. This is especially apparent in high number of transgender and gender non-conforming people who are autistic. This has led to a great deal of debate among support providers over how much the two identities influence each other. Autism Europe’s International Congress saw a panel discussion of both support providers and community members sit down to share their knowledge on the subject.
Glossary of Terms:
Cisgender: Gender expression and identity match the assigned sex as birth
Gender Dysphoria: Marked incongruence between the experienced gender and that assigned at birth coupled with the wish to be of another gender
Gender Incongruence: A marked and persistent incongruence between the gender felt or experienced and the gender assigned at birth.
Intersectionality: Identity markers do not exist independently, people may experience discrimination differently
Minority Stress: High levels of stress faced by stigmatized groups
Gender Affirming Care (GAC): A combination of social, legal and medical measures that help people feel happy, health and safe in their gender.
Ewa Furgal member of the Congress’ scientific council and founder of the Girls on the Spectrum Foundation, moderated the discussion. She outlined her foundation as the first association in Poland representing autistic women and LGBT community members. She explained that the LGBT community are the subject of frequent public discussion, particularly trans people. Therefore, she welcomed seeing greater discussion about autism and gender identity before introducing the speakers.
–Anna Van der Miesen: Medical doctor and post-doctoral researcher in the Institute for Gender Dysphoria.
–Marta Dora: Psychologist, sexologist and collaborator with Girls on the Spectrum
–Adam Nemeth: Psychologist in diagnosis at Autism Foundation in Budapest/private practitioner for LGBT neurodivergent clients
–Marianthi Kourti: Autistic non-binary doctoral researcher at Birmingham University
The panel pointed to elevated levels of depression and anxiety in autistic transgender or gender non-conforming people. Part of this is caused by minority stress, being ‘the invisible of the invisible.’ Executive dysfunction could also play a role in mental health difficulties; pointing out that executive dysfunction interferes with effective planning and moving forward with GAC.
Minority stress can build up over time (as seen in diagram on the left) and ongoing feelings of stigma and exclusion can put people into a state of high anxiety, constantly alert for signs of rejection. The strain from ‘masking’ or camouflaging autistic traits can worsen anxiety. Additionally, lack of accessibility and institutional barriers were further triggers for depression and anxiety.
Several speakers talked about the impact of these two identities on autism diagnosis and gender assessments.
They identified a trend of autism professionals disregarding trans identity in autistic people as ‘fake’ or a consequence of obsessive behaviour. As a result the WPATH (World Professional Association for Transgender Health) recommendation for gender clinicians to work more closely with autism diagnostic professionals is insufficient. This guidance failed to acknowledge that these very professionals were often the ones blocking care.
In contrast being LGBT or gender non-conforming can interfere with someone getting an autism diagnosis. Elements of the assessment process use heteronormative examples such as ‘mother/father/boyfriend/girlfriend’ which may make queer patients more stressed and less likely to communicate. Furthermore, gender incongruence can cause people to withdraw socially, which may mean stronger masking in undiagnosed trans or gender non-conforming people.
As a ‘double minority,’ autistic trans and gender non-conforming people both seek a sense of community with their peers. Indeed, peer and family acceptance are proven defenses against minority stress. However, LGBT people may not be accepted by their family, leading to a greater emphasis on community with their peers. This is complicated by the ‘double minority’ factor: not having access to same peer supports as cisgender autistic people or neurotypical trans people.
Autistic gender-variant people can it hard to use neurotypical language to describe themselves and their identities. However they often have a sense of identity revolving around interests/company more than societal factors.
All panelists agreed that an autism diagnosis shouldn’t exclude anyone from accessing gender-affirming care. Replying to the perception that autistic people are pursuing transition as a result of obsessive thinking, Marta Dora commented “I personally see no reason why you could call someone’s suffering a special interest.”
Adam Nemeth’s philosophy of affirmative care provides a good starting point. He describes best practice as based on cultural humility, a willingness to consider one’s own experience and privilege, being knowledgeable about both communities and being proactive rather than neutral.