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Is there a link between ‘gender dysphoria’ & autism?

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Here’s how Slate begins its article on the concerning trend of autistic people being diagnosed as trans:

Gender specialists first noticed decades ago that a large number of people who seek treatment for gender dysphoria also seemed to have autistic traits. Research on this phenomenon goes back to at least the 1990s, when the first case study of an autistic child with gender dysphoria (then called gender identity disorder) was published.

As studies investigating the co-occurrence (or correlation) between gender dysphoria and autism spectrum disorder (ASD) have trickled in, there is a growing consensus in the medical community that the two do co-occur at disproportionate rates. This consensus is based on numerous studies reporting that gender-dysphoric youth are more likely to be autistic than would be expected based on autism rates in the general population. (This may also hold true for adults, although the research on adults is sparser.)

This co-occurrence has implications for the treatment of both gender dysphoria and autism in young people, and hints at a connection between the biological causes of both transgender identity and ASD.

Cited are the following papers:

  • Gender identity disorder in a girl with autism —a case report, 1997
  • A 2017 Atlantic article that itself cites a 2010 paper titled, Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents
  • A 2016 paper titled, Gender Dysphoria and Autism Spectrum Disorder: A Systematic Review of the Literature that predominately considers a pre-2013 dataset.

In fact, the 2016 study warns researchers that:

Notably, 1 study explored the link between the DSM-IV diagnosis GID and ASD in a clinical sample of children and adolescents using the more comprehensive Diagnostic Interview for Social and Communication Disorders (DISCO), a semistructured 2- to 4-hour interview. This study identified 1 child (of 52 with GID) who also met criteria for ASD according to the DISCO… In conclusion, current research has not established an overrepresentation of GD among those with ASD or the converse.

Yup, this is the paper that Slate cites as an example of supporting that:

A.) There is a consensus that “gender-dysphoric youth are more likely to be autistic than would be expected based on autism rates in the general population”; and,

B.) “This co-occurrence has implications for the treatment of both gender dysphoria and autism in young people”

The Slate article states, “Research on this phenomenon goes back to at least the 1990s, when the first case study of an autistic child with gender dysphoria (then called gender identity disorder) was published. As studies investigating the co-occurrence (or correlation) between gender dysphoria and autism spectrum disorder (ASD) have trickled in, there is a growing consensus in the medical community that the two do co-occur at disproportionate rates.”

The problem is that Gender Dysphoria and Gender Identity Disorder are two very different diagnostic populations.

The Slate article reinforces the mistaken belief that GID was merely renamed “Gender Dysphoria” when the new DSM-5 was published in 2013. This isn’t true. GID and GD are two VERY different diagnostic populations.

Here’s a breakdown:

Gender Identity Disorder: MOSTLY people who are gender nonconforming (GNC) in some way with a small group of gender dysphoric people thrown in.

During its heyday, Dr. Zucker’s CAMH clinic was likely the most prestigious gender clinic for kids in the world, and the majority of kids he “treated” were non-gender dysphoric GNC kids, not GD kids. Zucker’s treatments consisted of trying to force gender nonconforming kids into conforming to gender roles; Zucker himself said that only around 30% of the kids he “treated” had gender dysphoria.

For GID, one only need be gender nonconforming to get a diagnosis of GID. There was no diagnostic requirement to have GD to get a GID diagnosis.

Gender Dysphoria: A group 100% comprised of people who have phenotype dysphoria.

Most (if not all) research linking autism to being trans uses GID for its diagnostic metric. That means if autistic people have difficulty conforming to gender roles, they’ve reached the diagnostic threshold for GID.

That’s right. An autistic boy could clearly state, “I’m a boy, I love that I’m a boy, I love my body’s sexed attributes, and don’t want to be a girl!” but because they are gender nonconforming in some way, they could have ethically received “treatments” for GID.

Consider the following from a 2018 paper published in the Journal of the American Academy of Child & Adolescent Psychiatry:

More recently, growing attention has been paid to a putative relation between gender dysphoria (GD) and autism spectrum disorder (ASD). This concept has become particularly popular in the lay press. Some individuals have gone so far as to suggest that transgender identity is a result of underlying psychopathology, with ASD being one example. These conclusions are not supported by extant research, and practicing child and adolescent psychiatrists should be aware of the literature on this topic and its limitations.

This paper is titled, “Gender Dysphoria” and Autism Spectrum Disorder: Is the Link Real?

As this paper correctly notes, the idea that autism and GD share a link has, “become particularly popular in the lay press.”

If you care to see how these misconceptions are used as propaganda, check out the way this misconception is used on this ex-trans site, a site that recently helped publish an ex-trans booklet targeting schools and school children. Click here to see the 100s of news articles on google fretting over the link between autism and being trans.

In an article titled TransAdvocate 101, I wrote about the way cis understandings of trans issues shape the work of trans activism today. I find that this is a particularly salient moment to recall the how and why of this dynamic:

There are, by orders of magnitude, more cis people than trans people in the world. When one considers the amount of discourse happening around the trans experience, due to sheer numbers, a cis understanding of “trans issues” is dominant in our society today. This dynamic ensures that the dominant “trans” narrative is also a false narrative that is repeated, analyzed, and criticized ad nauseum by a largely cis audience, reinforcing the validity of this dominant (and factually inaccurate) “trans” narrative.

When trans people protest the propagation of the dominant (and factually inaccurate) “trans” narrative about the trans experience, trans people are told that we are stifling free speech, that we are snowflakes, or that we just need to learn to perform better public “debates.”

When trans activists express anger, resentment, and/or frustration with this dynamic, cis people can respond with their own anger, resentment, and/or frustration because a lot of cis people have already invested more time and attention into trying to understand the dominant (and factually inaccurate) “trans” narrative than they ever wanted to in the first place and come to perceive trans activists as pushy, bossy, and unreasonable.

Resolving these misunderstandings in the face of an army of trolls who traffic misinformation, civic leaders who attempt to pass anti-trans laws, and cis anger, resentment, and/or frustration while also trying to support equality for cis, trans, and intersex people is the primary purpose of trans advocacy today.

Not only do we have to do the work of differentiating the cis narrative of the trans experience from the actual trans experience, we have to use a linguistic framework cis people invented for us. What makes this process even more difficult is that trans people almost always initially experience “transgender” in ways that are defined by cis people.

For some of us, we heard cis people tell us what “trans” means and thought, “well, that certainly doesn’t include me.” For others, we hear from cis people that we, as trans people, think gender dysphoria is a “feeling” wherein we “feel like a man” or “feel like a woman” or worse, “feel born in the wrong body.”

This means that there are many trans people who still believe the cis narrative that GID is the same thing as GD, that gender nonconforming people are probably gender dysphoric, and that research on GID directly applies to GD people.

While it’s possible there is, in fact, a link between autism and being trans, the reality is that we do not have evidence to substantiate that hypothesis. Until we have clear data that substantiates the claims Slate and others regularly make, we need to remain agnostic to such claims, no matter how often these claims are made.

While there are certainly autistic people who have gender dysphoria (just like there are autistic people who are gender nonconforming or gay) this reality doesn’t mean that being GNC, gay, or GD is any more likely than the general population to be autistic.

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