Transgender and gender-diverse adults are three to six times more likely as cisgender adults (individuals whose gender identity corresponds to their sex assigned at birth) to be diagnosed as autistic, according to a new study by scientists at the University of Cambridge’s Autism Research Centre.
This research, conducted using data from over 600,000 adult individuals, confirms previous smaller scale studies from clinics. The results are published today in Nature Communications.
A better understanding of gender diversity in autistic individuals will help provide better access to health care and post-diagnostic support for autistic transgender and gender-diverse individuals.
The team used five different datasets, including a dataset of over 500,000 individuals collected as a part of the Channel 4 documentary “Are you autistic?”.
In these datasets, participants had provided information about their gender identity, and if they received a diagnosis of autism or other psychiatric conditions such as depression or schizophrenia. Participants also completed a measure of autistic traits.
Strikingly, across all five datasets, the team found that transgender and gender-diverse adult individuals were between three and six times more likely to indicate that they were diagnosed as autistic compared to cisgender individuals.
While the study used data from adults who indicated that they had received an autism diagnosis, it is likely that many individuals on the autistic spectrum may be undiagnosed.
As around 1.1% of the UK population is estimated to be on the autistic spectrum, this result would suggest that somewhere between 3.5.-6.5% of transgender and gender-diverse adults is on the autistic spectrum.
Dr. Meng-Chuan Lai, a collaborator on the study at the University of Toronto, said: “We are beginning to learn more about how the presentation of autism differs in cisgender men and women.
Understanding how autism manifests in transgender and gender-diverse people will enrich our knowledge about autism in relation to gender and sex.
This enables clinicians to better recognize autism and provide personalised support and health care.”
Transgender and gender-diverse individuals were also more likely to indicate that they had received diagnoses of mental health conditions, particularly depression, which they were more than twice as likely as their cisgender counterparts to have experienced.
Dr. Varun Warrier, who led the study, said: “This finding, using large datasets, confirms that the co-occurrence between being autistic and being transgender and gender-diverse is robust.
We now need to understand the significance of this co-occurrence, and identify and address the factors that contribute to well-being of this group of people.”
The study investigates the co-occurrence between gender identity and autism. The team did not investigate if one causes the other.
Professor Simon Baron-Cohen, Director of the Autism Research Centre at Cambridge, and a member of the team, said:
“Both autistic individuals and transgender and gender-diverse individuals are marginalized and experience multiple vulnerabilities.
It is important that we safe-guard the rights of these individuals to be themselves, receive the requisite support, and enjoy equality and celebration of their differences, free of societal stigma or discrimination.”
A new study from Anglia Ruskin University (ARU) has found transgender and non-binary (NB) individuals are significantly more likely to have autism or autistic traits than the wider population.
The study found a higher rate of autistic traits in their transgender and NB participants out of 177 taking part in the study. This was also the first study to systematically include NB participants.
They suggest the findings could have implications in clinical support for people in gender clinics with undiagnosed autism spectrum disorder (ASD), affecting the therapists’ ability to support them appropriately.
Gender clinics have encountered increasing anecdotal reports of autistic traits being present in their patients. A recent report from the Tavistock and Portman Centre in London echoed these results.
Out of 109 transgender or NB participants, 14 per cent already had a diagnosis of Autism Spectrum Disorder (ASD). This compared with 4 per cent of the 68 participants who identified as cisgender (identifying with the same gender they were assigned with at birth) also reporting an ASD diagnosis.
This 4 percent is a higher percentage of ASD than the general population of cisgendered people. Dr Steven Stagg, lead author on the study and senior lecturer at ARU, however suggested that this could be to do with the voluntary nature of the study attracting those who already had a diagnosis to take part.
Despite this, Dr Stagg said the findings are in line with a lot of research on this subject.
Discussing the findings, Dr Stagg said: “The interesting thing is that an additional 28 per cent of the transgender and NB participants scored high enough that they would have a high likelihood of being diagnosed with ASD upon further testing.”
A further discovery was that this 28 per cent was predominantly taken up by those that were assigned female at birth and who were now NB or transmen.
This also follows statistics that show females are much less likely to receive an ASD diagnosis in childhood. Therefore there may be many children assigned female at birth who are not diagnosed but may exhibit autistic traits that are undetected or exhibit later in life.
“This is particularly important given that individuals born female are twice as likely to be referred to gender identity clinics.”
The average age for participants in this study was 35.
On being asked why he chose to look at these two populations, Dr Stagg said: “You find results in autism studies finding a much higher incidence of homosexuality in ASD than in the general populations. These have always been incidental findings of other studies and not the main subject.
“For our research, we are looking at people who are gender non-conforming. Something unusual is possibly happening with people with autism and gender identity.”
So what are the theories trying to explain this high occurrence?
He added: “One theory is that their condition means people with ASD are more nonconformist. Another theory is that women with autism have an extreme male brain- so may feel more masculine in identity as well.
This theory however, doesn’t explain everything- such as males with ASD also being more likely to be homosexual.”
The study was voluntary, recruiting from websites to take an online questionnaire involving regular screening tests that help diagnose ASD called the Autism Quotient, designed originally by Dr Simon Baren-Cohen of Cambridge University.
The main two traits often found in ASD that were different in the transgender and NB group were lower empathy levels and higher systematising (a tendency to analyse, control and use rule-based systems) as well as exhibiting a more literal understanding of language.
This can have huge implications on gender clinics capabilities to support their patients, especially those who are undiagnosed with ASD.
Dr Stagg said: “Imagine you’re dealing with a patient with ASD but you don’t know they have ASD.
One of the key features in ASD is being inflexible, taking language literally, not picking up on subtleties of language and body language.
“If you’re not aware of this as a therapist, you may be misreading the patients’ behaviour and not properly communicating with them yourself.
“People with Autism are also more likely to seek unequivocal answers to the complex issues surrounding gender identity.”
Therefore the study suggests that it is “important that gender identity clinics screen patients for autism spectrum disorders and adapt their consultation process and therapy accordingly.”
Anglia Ruskin University
More information: Warrier, V et al. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses and autistic traits in transgender and gender-diverse individuals. Nat Comms; 7 Aug 2020; DOI: 10.1038/s41467-020-17794-1