Abstract
Gender diverse autistic young adults often face mental health challenges which can increase the challenge of obtaining gender-affirming care. Social and communication differences associated with autism compounds the already complex process of navigating a path toward gender affirmation for individuals with these intersecting identities. In this case series of four gender diverse autistic adults, we demonstrate that success in management of their mental health crises was achieved through enlisting family and social support, obtaining effective mental health treatment, and accessing gender-affirming healthcare. These cases selected from two neuropsychiatric outpatient tertiary referral clinics demonstrate that effective mental health treatment supports ultimate success for these individuals in their journeys toward living as the gender with which they identify. We conclude that healthcare practices and treatment recommendations which incorporate internationally recognized standards of care guidelines for gender diverse individuals improve patient outcomes.
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Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., … Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165–232. https://doi.org/10.1080/15532739.2011.700873
Davy, Z., & Toze, M. (2018). What is gender dysphoria? A critical systematic narrative review. Transgender Health, 3(1), 159–169. https://doi.org/10.1089/trgh.2018.0014
Genovese, A. (2021). Exploring three core psychological elements when treating adolescents on the autism spectrum: Self-awareness, gender identity, and sexuality. Cureus, 13(3), e14130. https://doi.org/10.7759/cureus.14130
George, R., & Stokes, M. A. (2018). Gender identity and sexual orientation in autism spectrum disorder. Autism, 22(8), 970–982. https://doi.org/10.1177/1362361317714587
Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The autism diagnostic observation schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37(4), 613–627. https://doi.org/10.1007/s10803-006-0280-1
Hall, J. P., Batza, K., Streed, C. G., Boyd, B. A., & Kurth, N. K. (2020). Health disparities among sexual and gender minorities with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(8), 3071–3077. https://doi.org/10.1007/s10803-020-04399-2
Kapp, S. K., Gillespie-Lynch, K., Sherman, L. E., & Hutman, T. (2013). Deficit, difference, or both? Autism and neurodiversity. Developmental Psychology, 49(1), 59–71. https://doi.org/10.1037/a0028353
Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: Review of concepts, controversies and their relation to psychopathology classification systems. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2015.01511
Stagg, S. D., & Vincent, J. (2019). Autistic traits in individuals self-defining as transgender or nonbinary. European Psychiatry, 61, 17–22. https://doi.org/10.1016/j.eurpsy.2019.06.003
Strang, J. F., Meagher, H., Kenworthy, L., de Vries, A., Menvielle, E., Leibowitz, S., Janssen, A., Cohen-Kettenis, P., Shumer, D. E., Edwards-Leeper, L., Pleak, R. R., Spack, N., Karasic, D. H., Schreier, H., Balleur, A., Tishelman, A., Ehrensaft, D., Rodnan, L., Kuschner, E. S., … Anthony, L. G. (2018a). Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents. Journal of Clinical Child & Adolescent Psychology, 47(1), 105–115. https://doi.org/10.1080/15374416.2016.1228462
Strang, J. F., Powers, M. D., Knauss, M., Sibarium, E., Leibowitz, S. F., Kenworthy, L., Sadikova, E., Wyss, S., Willing, L., Caplan, R., Pervez, N., Nowak, J., Gohari, D., Gomez-Lobo, V., Call, D., & Anthony, L. G. (2018b). “They thought it was an obsession”: Trajectories and perspectives of autistic transgender and gender-diverse adolescents. Journal of Autism and Developmental Disorders, 48(12), 4039–4055. https://doi.org/10.1007/s10803-018-3723-6
Thrower, E., Bretherton, I., Pang, K. C., Zajac, J. D., & Cheung, A. S. (2020). Prevalence of autism spectrum disorder and attention-deficit hyperactivity disorder amongst individuals with gender dysphoria: A systematic review. Journal of Autism and Developmental Disorders, 50(3), 695–706. https://doi.org/10.1007/s10803-019-04298-1
van der Miesen, A., Hurley, H., Bal, A. M., & de Vries, A. (2018). Prevalence of the wish to be of the opposite gender in adolescents and adults with autism spectrum disorder. Archives of Sexual Behavior, 47(8), 2307–2317. https://doi.org/10.1007/s10508-018-1218-3
Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M., Allison, C., & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature Communications, 11(1), 3959. https://doi.org/10.1038/s41467-020-17794-1
World Health Organization. (2019). ICD-11: International classification of diseases (11th rev.). Retrieved from https://icd.who.int/.
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Charlotte Iannaci assisted with document preparation
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Dr. Genovese contributed and described the first two cases, wrote the abstract, introduction, discussion, and references sections, reviewed and edited the revised manuscript. Medical students Ms. Singh and Casubhoy provided descriptions for the second two cases. Dr. Hellings provided the second two cases and edited the revised manuscript.
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Genovese, A.C., Singh, S.C., Casubhoy, I. et al. Gender Diverse Autistic Young Adults: A Mental Health Perspective. Arch Sex Behav 52, 1339–1343 (2023). https://doi.org/10.1007/s10508-022-02443-z
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DOI: https://doi.org/10.1007/s10508-022-02443-z