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Who: Warrier and colleagues

Journal: Nature Communications

Published: 2020

Title: Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals

Transgender and gender-diverse individuals are 3-6x more likely to be autistic than cisgender individuals.

This study used a massive sample of people, totalling 641,860 people, from five sources. They asked these people to report different things, including whether they had been diagnosed as autistic, to complete an autism screening test, as well as to report their gender identity.

They found several interesting things from asking these questions.

• Transgender and gender-diverse people were 3-6x more likely to be autistic than cisgender people
• Transgender and gender-diverse people scored higher on measures of autism traits, systemising, and sensory sensitivity. They scored lower on measures of empathy compared to cisgender people.
• Transgender and gender-diverse people had higher rates of multiple other neurodevelopmental and psychiatric conditions.
• Transgender and gender-diverse people were more likely to report that they believed they were autistic but undiagnosed.

[A bar graph showing results from the Autism Spectrum Quotient, Empathy, Pattern recognition, and sensory perception. For each measure, there are results from “autistic” and “non-autistic” participants, which are split into cisgender male, cisgender female, or gender-diverse (GD). For the AQ, GD people scored highest regardless of whether they were autistic or not. For empathy, GD people scored lowest, regardless of whether they were autistic or not. For pattern recognition, GD people scored highest, regardless of whether they were autistic or not. For sensory perception, GD people scored highest, regardless of whether they were autistic or not.]

They wanted to think about why this may be the case. They considered…

• Transgender and gender-diverse people may be more likely to self-report autism traits due to long-standing experiences and feelings of “not fitting in socially“. However, other studies have also confirmed higher rates of autism in transgender and gender-diverse people using methods which are not self-report, and also that transgender and gender-diverse people have higher autism traits in both social and non-social domains, as well as sensory sensitivity.
• Maybe autistic transgender and gender-diverse people are more likely to participate in research. This is unlikely to have affected the results due to the massive sample size collected from five different data sets.

They also considered…

• Autistic individuals are less likely to feel that they must conform to societal norms, which may result in autistic individuals being more likely to identify outside of the stereotypical gender binary.
• Prenatal mechanisms, such as sex steroid hormones, which shapes brain development have been linked to autism and to gender role behaviour, although it is unclear whether this is linked to gender identity.
• Transgender and gender-diverse people might have increased vulnerability to multiple psychiatric challenges related to stressful life experiences, due to unfriendly environments, discrimination, abuse, and victimisation, which may lead to the increased levels of psychiatric conditions found in this study.

It is very important to interpret these results in light of the lived experiences of transgender and gender-diverse people.

• Both transgender & gender-diverse people and autistic people are marginalised groups where support and understanding is inadequate.
• Both groups are more likely to engage in self-harm and suicidal behaviours.
• Transgender and gender-diverse autistic people deserve the right to express their gender, live with dignity, and to receive social and legal recognition of their gender.

Limitations:

• Two datasets excluded intersex individuals, and three did not.

• Some non-binary, gender-neutral, or other gender-diverse people may not have identified with the term “transgender”, as in one dataset there was no “other” option.
• Some individuals may have responded with their sex rather than their gender.
• individuals with severe mental illness and intellectual disabilities are less likely to participate in research.