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Archives of Sexual Behavior

, Volume 43, Issue 8, pp 1525–1533 | Cite as

Increased Gender Variance in Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder

  • John F. Strang
  • Lauren Kenworthy
  • Aleksandra Dominska
  • Jennifer Sokoloff
  • Laura E. Kenealy
  • Madison Berl
  • Karin Walsh
  • Edgardo Menvielle
  • Graciela Slesaransky-Poe
  • Kyung-Eun Kim
  • Caroline Luong-Tran
  • Haley Meagher
  • Gregory L. Wallace
Original Paper
First Online:

Abstract

Evidence suggests over-representation of autism spectrum disorders (ASDs) and behavioral difficulties among people referred for gender issues, but rates of the wish to be the other gender (gender variance) among different neurodevelopmental disorders are unknown. This chart review study explored rates of gender variance as reported by parents on the Child Behavior Checklist (CBCL) in children with different neurodevelopmental disorders: ASD (N = 147, 24 females and 123 males), attention deficit hyperactivity disorder (ADHD; N = 126, 38 females and 88 males), or a medical neurodevelopmental disorder (N = 116, 57 females and 59 males), were compared with two non-referred groups [control sample (N = 165, 61 females and 104 males) and non-referred participants in the CBCL standardization sample (N = 1,605, 754 females and 851 males)]. Significantly greater proportions of participants with ASD (5.4 %) or ADHD (4.8 %) had parent reported gender variance than in the combined medical group (1.7 %) or non-referred comparison groups (0–0.7 %). As compared to non-referred comparisons, participants with ASD were 7.59 times more likely to express gender variance; participants with ADHD were 6.64 times more likely to express gender variance. The medical neurodevelopmental disorder group did not differ from non-referred samples in likelihood to express gender variance. Gender variance was related to elevated emotional symptoms in ADHD, but not in ASD. After accounting for sex ratio differences between the neurodevelopmental disorder and non-referred comparison groups, gender variance occurred equally in females and males.

Keywords

Gender variance Gender identity Autism Attention deficit hyperactivity disorder Gender dysphoria 
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References

  1. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for ASEBA School-Age Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.Google Scholar
  4. Arnold, S. D. (1996). Sex differences in ADHD: Conference summary. Journal of Abnormal Child Psychology, 24, 555–569.CrossRefPubMedGoogle Scholar
  5. Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., et al. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The Special Needs and Autism Project (SNAP). Lancet, 368, 210–215.CrossRefPubMedGoogle Scholar
  6. Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in Cognitive Sciences, 6, 248–254.CrossRefPubMedGoogle Scholar
  7. Baron-Cohen, S. (2009). Autism: The empathizing-systemizing (E-S) theory. Annals of the New York Academy of Sciences, 1156, 68–80.CrossRefPubMedGoogle Scholar
  8. Beacher, F. D. C. C., Radulescu, E., Minati, L., Baron-Cohen, S., Lombardo, M. V., Lai, M., et al. (2012). Sex differences and autism: Brain function during verbal fluency and mental rotation. PLoS ONE, 7. doi: 10.1371/journal.pone.0038355.
  9. Bedard, C., Zhang, H. L., & Zucker, K. J. (2010). Gender identity and sexual orientation in people with developmental disabilities. Sexuality and Disability, 28, 165–175.CrossRefGoogle Scholar
  10. Bejerot, S., Eriksson, J. M., Bonde, S., Carlström, K., Humble, M. B., & Eriksson, E. (2012). The extreme male brain revisited: Gender coherence in adults with autism spectrum disorder. British Journal of Psychiatry, 201, 116–123.CrossRefPubMedGoogle Scholar
  11. Biddle, D. A., & Morris, S. B. (2011). Using Lancaster’s mid-P correction to the Fisher’s exact test for adverse impact analyses. Journal of Applied Psychology, 96, 956–965.CrossRefPubMedGoogle Scholar
  12. Bland, J. M., & Altman, D. G. (2000). Statistics notes: The odds ratio. British Medical Journal, 320, 1468.PubMedCentralCrossRefPubMedGoogle Scholar
  13. Center for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, fourteen sites, United States, 2008. Surveillance Summaries, 61, 1–19.Google Scholar
  14. Coates, S., & Person, E. S. (1985). Extreme boyhood femininity: Isolated behavior or pervasive disorder? Journal of the American Academy of Child Psychiatry, 24, 702–709.CrossRefPubMedGoogle Scholar
  15. Cohen-Kettenis, P. T., Owen, A., Kaijser, V. G., Bradley, S. J., & Zucker, K. J. (2003). Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis. Journal of Abnormal Child Psychology, 31, 41–53.CrossRefPubMedGoogle Scholar
  16. Constantino, J. N., & Gruber, C. P. (2005). Social Responsiveness Scale. Los Angeles, CA: Western Psychological Services.Google Scholar
  17. de Vries, A. L. C., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality, 59, 301–320.CrossRefPubMedGoogle Scholar
  18. de Vries, A. L. C., Doreleijers, T. A. H., Steensma, T. D., & Cohen-Kettenis, P. T. (2011). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52, 1195–1202.CrossRefPubMedGoogle Scholar
  19. de Vries, A. L. C., Noens, I. L., Cohen-Kettenis, P. T., Van Berckelaer-Onnes, I. A., & Doreleijers, T. A. (2010). Autism spectrum disorders in gender dysphoric children and adolescents. Journal of Autism and Developmental Disorders, 40, 930–936.PubMedCentralCrossRefPubMedGoogle Scholar
  20. Dreger, A. (2009). Gender identity disorder in childhood: Inconclusive advice to parents. Hastings Center Report, 39, 26–29.CrossRefPubMedGoogle Scholar
  21. Drescher, J., & Byne, W. (2012). Introduction to the Special Issue on “The Treatment of Gender Dysphoric/Gender Variant Children and Adolescents.” Journal of Homosexuality, 59, 295–300.Google Scholar
  22. Edwards-Leeper, L., & Spack, N. P. (2012). Psychological evaluation and medical treatment of transgender youth in an interdisciplinary “Gender Management Service” (GeMS) in a major pediatric center. Journal of Homosexuality, 59, 321–336.CrossRefPubMedGoogle Scholar
  23. Fombonne, E. (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. Journal of Clinical Psychiatry, 66, 3–8.PubMedGoogle Scholar
  24. Gallucci, G., Hackerman, F., & Schmidt, C. W. (2005). Gender identity disorder in an adult male with Asperger’s syndrome. Sexuality and Disability, 23, 35–40.CrossRefGoogle Scholar
  25. Gutmann, D. H., Aylsworth, A., Carey, J. C., Korf, B., Marks, J., Pyeritz, R. E., et al. (1997). The diagnostic evaluation and multidisciplinary management of neurofibromatosis 1 and neurofibromatosis 2. Journal of the American Medical Association, 278, 51–57.CrossRefPubMedGoogle Scholar
  26. Happé, F., & Frith, U. (2006). The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36, 5–25.CrossRefPubMedGoogle Scholar
  27. Jackson, L. K., & Atance, C. M. (2008). Future thinking in children with autism spectrum disorders: A pilot study. Journal on Developmental Disabilities, 14, 40–45.Google Scholar
  28. Kenworthy, L., Case, L., Harms, M. B., Martin, A., & Wallace, G. L. (2010). Adaptive behavior ratings correlate with symptomatology and IQ among individuals with high-functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, 416–423.PubMedCentralCrossRefPubMedGoogle Scholar
  29. Kenworthy, L., Yerys, B. E., Anthony, L. G., & Wallace, G. L. (2008). Understanding executive control in autism spectrum disorders in the lab and in the real world. Neuropsychology Review, 18, 320–338.PubMedCentralCrossRefPubMedGoogle Scholar
  30. Kraemer, B., Delsignore, A., Gundelfinger, R., Schnyder, U., & Hepp, U. (2005). Comorbidity of asperger syndrome and gender identity disorder. European Child and Adolescent Psychiatry, 14, 292–296.CrossRefPubMedGoogle Scholar
  31. Lai, M., Chiu, Y., Gadow, K. D., Gau, S. S., & Hwu, H. (2010). Correlates of gender dysphoria in Taiwanese university students. Archives of Sexual Behavior, 39, 1415–1428.CrossRefPubMedGoogle Scholar
  32. Lainhart, J. E., Bigler, E. D., Bocian, M., Coon, H., Dinh, E., Dawson, G., et al. (2006). Head circumference and height in autism: A study by the Collaborative Program of Excellence in Autism. American Journal of Medical Genetics Part A, 140, 2257–2274.CrossRefPubMedGoogle Scholar
  33. Landen, M., & Rasmussen, P. (1997). Gender identity disorder in a girl with autism: A case report. European Child and Adolescent Psychiatry, 6, 170–173.CrossRefPubMedGoogle Scholar
  34. Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., et al. (1989). Autism Diagnostic Interview: A standardized investigator-based instrument. Journal of Autism and Developmental Disorders, 19, 363–387.CrossRefPubMedGoogle Scholar
  35. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2000). Autism Diagnostic Observation Schedule (ADOS). Los Angeles: Western Psychological Services.Google Scholar
  36. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of the Autism Diagnostic Interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.CrossRefPubMedGoogle Scholar
  37. Menvielle, E. (2012). A comprehensive program for children with gender variant behaviors and gender identity disorders. Journal of Homosexuality, 59, 357–368.CrossRefPubMedGoogle Scholar
  38. Mukaddes, N. M. (2002). Gender identity problems in autistic children. Child: Care. Health and Development, 28, 529–532.CrossRefGoogle Scholar
  39. Perera, H., Gadambanathan, T., & Weerasiri, S. (2003). Gender identity disorder presenting in a girl with Asperger’s disorder and obsessive compulsive disorder. Ceylon Medical Journal, 48, 57–58.PubMedGoogle Scholar
  40. Rodrigue, J. R., Morgan, S. B., & Geffken, G. R. (1991). A comparative evaluation of adaptive behavior in children and adolescents with autism, Down syndrome, and normal development. Journal of Autism and Developmental Disorders, 21, 187–196.CrossRefPubMedGoogle Scholar
  41. Tateno, M., Tateno, Y., & Saito, T. (2008). Comorbid childhood gender identity disorder in a boy with Asperger syndrome. Psychiatry and Clinical Neurosciences, 62, 238.CrossRefPubMedGoogle Scholar
  42. Van Beijsterveldt, C. E. M., Hudziak, J. J., & Boomsma, D. I. (2006). Genetic and environmental influence on cross-gender behavior and relation to behavior problems: A study of Dutch twins at ages 7 and 10 years. Archives of Sexual Behavior, 35, 647–658.CrossRefPubMedGoogle Scholar
  43. VanderLaan, D. P., Postema, L., Wood, H., Singh, D., Fantus, S., Hyun, J., et al. (2014). Do children with gender dysphoria have intense/obsessional interests? Journal of Sex Research. doi: 10.1080/00224499.2013.860073.Google Scholar
  44. Wallien, M. S. C., Swaab, H., & Cohen-Kettenis, P. T. (2007a). Psychiatric comorbidity among children with gender identity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1307–1314.CrossRefPubMedGoogle Scholar
  45. Wallien, M. S. C., van Goozen, S. H. M., & Cohen-Kettenis, P. T. (2007b). Physiological correlates of anxiety in children with gender identity disorder. European Child and Adolescent Psychiatry, 16, 309–315.CrossRefPubMedGoogle Scholar
  46. Williams, P. G., Allard, A. M., & Sears, L. (1996). Case study: Cross-gender preoccupations with two male children with autism. Journal of Autism and Developmental Disorders, 26, 635–642.CrossRefPubMedGoogle Scholar
  47. Wolkenstein, P., Freche, B., Zeller, J., & Revuz, J. (1996). Usefulness of screening investigations in neurofibromatosis type 1: A study of 152 patients. Archives of Dermatology, 132, 1333–1336.CrossRefPubMedGoogle Scholar
  48. Wood, H. (2011, October). The relationship between gender identity disorder and autism spectrum disorder. In K. J. Zucker (Chair), Gender identity disorder in children and adolescents: Theoretical and empirical advances. Symposium presented at the joint meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry, Toronto.Google Scholar
  49. Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guildford Press.Google Scholar
  50. Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Kibblewhite, S. J., Wood, H., Singh, D., et al. (2012). Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex and Marital Therapy, 38, 151–189.CrossRefPubMedGoogle Scholar
  51. Zucker, K. J., Owen, A., Bradley, S. J., & Ameeriar, L. (2002). Gender-dysphoric children and adolescents: A comparative analysis of demographic characteristics and behavioral problems. Clinical Child Psychology and Psychiatry, 7, 398–411.CrossRefGoogle Scholar
  52. Zucker, K. J., Wood, H., & VanderLaan, D. P. (2014). Models of psychopathology in children and adolescents with gender dysphoria. In B. P. C. Kreukels, T. D. Steensma, & A. L. C. de Vries (Eds.), Gender dysphoria and disorders of sex development: Progress in care and knowledge (pp. 171–192). New York: Springer.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • John F. Strang
    • 1
  • Lauren Kenworthy
    • 1
  • Aleksandra Dominska
    • 2
  • Jennifer Sokoloff
    • 1
  • Laura E. Kenealy
    • 2
  • Madison Berl
    • 2
  • Karin Walsh
    • 2
  • Edgardo Menvielle
    • 3
  • Graciela Slesaransky-Poe
    • 4
  • Kyung-Eun Kim
    • 3
  • Caroline Luong-Tran
    • 1
  • Haley Meagher
    • 1
  • Gregory L. Wallace
    • 5
  1. 1.Center for Autism Spectrum DisordersChildren’s National Medical CenterRockvilleUSA
  2. 2.Division of NeuropsychologyChildren’s National Medical CenterRockvilleUSA
  3. 3.Department of PsychiatryChildren’s National Medical CenterWashingtonUSA
  4. 4.School of EducationArcadia UniversityGlensideUSA
  5. 5.Laboratory of Brain and CognitionNational Institute of Mental HealthBethesdaUSA

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