Gender dysphoria and ASD
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This article also appeared in the Spring 2016 issue of ARI's Autism Research Review International newsletter.

Young people with gender dysphoria have an elevated rate of Asperger syndrome, according to a new study. Individuals with gender dysphoria feel distress because there is a mismatch between their physical gender and their perceived gender.

Daniel Shumer and colleagues conducted a retrospective review of patient chart data from 39 consecutive patients between 8 and 20 years of age seen at a gender clinic. Of this group, 22 were biologically male and 17 were biologically female. The researchers report, “Overall, 23.1% of patients (9 of 39) presenting with gender dysphoria had possible, likely, or very likely Asperger syndrome as measured by the Asperger Syndrome Diagnostic Scale (ASDS).”

They note, however, that the ASDS is not validated as an ASD diagnostic tool in the absence of other diagnostic information, and that some answers that elevate scores on the test (for instance, “appears to be aware that he or she is different from others”) could also pertain to gender dysphoria.

However, the researchers say their findings “are consistent with growing evidence supporting increased prevalence of ASD [autism spectrum disorders] in gender dysphoric children.” For example, they note that a Dutch study reported a 7.8% prevalence of ASD in patients evaluated using a standardized diagnostic test (the Diagnostic Interview for Social and Communication Disorders) at a gender dysphoria clinic. In addition, they note that children with ASD evaluated at a U.S. neuropsychology clinic “were 7.59 times more likely than nonreferred children to have gender variance as measured by the parent-reported Child Behavior Checklist.”

The researchers say, “Our data support inclusion of ASD screening as part of any comprehensive gender assessment, especially as diagnosis of ASD has implications for management of gender dysphoria. For example, a patient with ASD and gender dysphoria may require specialized psychosocial interventions, focused on navigating unique social challenges encountered during hormonal and social transition from the natal sex to the affirmed gender.”

The researchers say the cause of the association between Asperger syndrome and gender dysphoria is unknown. However, they note that genetic factors and differences in exposure to androgens (hormones that influence the development of male characteristics) have been implicated in both autism spectrum disorders and gender dysphoria.

“Evaluation of Asperger syndrome in youth presenting to a gender dysphoria clinic,” Daniel E. Shumer, Sari L. Reisner, Laura Edwards-Leeper, and Amy Tishelman, LGBT Health, January 2016 (online). Address: Daniel Shumer, University of Michigan Health System, Division of Pediatric Endocrinology, Medical Professional Building, Room D1205, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, [email protected]
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“Youths with gender dysphoria have higher rates of Asperger syndrome,” news release, Mary Ann Liebert, Inc., January 13, 2016.