“They Thought It Was an Obsession”: Trajectories and Perspectives of Autistic Transgender and Gender-Diverse Adolescents

Abstract

Despite research exploring autism in gender-diverse adolescents, no studies have elicited these individuals’ perspectives. In-depth interviews with 22 well-characterized autistic gender-diverse adolescents revealed critical themes, including: recollections of pre-pubertal gender nonconformity; vivid experiences of gender dysphoria; a fear of social gender expression due to perceived animosity toward transgender people; and specific challenges that result from the interplay of gender diversity and neurodiversity. During the ~ 22 month study social gender affirmation increased in six participants and gender dysphoria attenuated in four participants. Given the ethical imperative to understand and prioritize the voiced perspectives and needs of autistic gender minority adolescents as well as the discovery of shared themes and experiences in this population, results should inform clinical research approaches and priorities.

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Acknowledgments

The study was made possible by the National Institutes of Health (NIH) Clinical and Translational Science Awards (CTSA) program. Dr. John F. Strang received financial support through Award Number: KL2TR001877. The authors wish to thank Alice Lupke Strang for her support with the technical aspects of language and writing.

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JFS conceived of the study and its design, assembled the key stakeholder collaborators, performed the data analyses, interpreted the data, and drafted the manuscript; MDP conceived of the study and its design, performed the data analyses, interpreted the data, and drafted the manuscript; MK performed the data analyses, interpreted the data, and drafted the manuscript; ES performed the data analyses and interpreted the data, SFL interpreted the data and provided specialized consultation regarding characterization of DSM-V GD diagnosis; LK conceived of the study and its design and provided technical consultation for engagement with key stakeholders; ES performed the data analyses, developed visual representations of the data, and interpreted the data; SW performed the data analyses and interpreted the data; LW interpreted the data; RC performed the data analyses and interpreted the data; NP performed the data analyses and interpreted the data; JN interpreted the data; DG performed the data analyses and interpreted the data; VGL interpreted the data; DC interpreted the data; LGA conceived of the study and its design and provided specialized consultation for engagement with key stakeholders. All authors read and approved the final manuscript.

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Correspondence to John F. Strang.

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Conflict of interest

John F. Strang, Meredith D. Powers, Megan Knauss, Ely Sibarium, Scott F. Leibowitz, Lauren Kenworthy, Eleonora Sadikova, Shannon Wyss, Laura Willing, Reid Caplan, Noor Pervez, Joel Nowak, Dena Gohari, Veronica Gomez-Lobo, David Call, Laura G. Anthony declares that they have no conflict of interest.

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All procedures performed in studies were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants in the study.

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Strang, J.F., Powers, M.D., Knauss, M. et al. “They Thought It Was an Obsession”: Trajectories and Perspectives of Autistic Transgender and Gender-Diverse Adolescents. J Autism Dev Disord 48, 4039–4055 (2018). https://doi.org/10.1007/s10803-018-3723-6

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Keywords

  • Autism spectrum disorder
  • Autistic
  • Neurodiversity
  • Transgender
  • Gender dysphoria
  • Gender nonbinary
  • Gender minority
  • Gender-diverse