Abstract
Gender variance (GV) and autism spectrum disorder (ASD) frequently co-occur in clinical populations. We investigated GV in association with ASD characteristics in nonclinical children and in children with developmental/mental health diagnoses. In 6–12-year-olds (N = 2445; 51% birth-assigned boys), the Gender Identity Questionnaire for Children measured GV and the Children’s Social Behavior Questionnaire measured six subdomains of ASD characteristics. Among nonclinical children, GV was associated with parent-reported difficulties orienting socially and stereotyped behaviors. GV was also associated with parent-reported clinical diagnoses of ASD, sensory processing disorder, and oppositional defiant disorder. These findings suggest associations between specific ASD characteristics and GV in nonclinical children. Also, childhood GV should be further examined in a range of clinical populations, including ASD individuals.
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Notes
Although SPD is not included in the DSM, it is included here for two reasons: (a) it has been conceptualized in the child development literature as a complex condition involving hyper- or hypo-sensitivity to sensory stimuli, a heightened drive for sensory experiences, difficulty discriminating sensations, and atypical responses to sensory stimuli that, together, impact daily functioning (Miller and Schaaf 2008), and (b) previous authors have forwarded the hypothesis that elevated GV might be associated with altered sensitivity towards certain sensory input (e.g. tactile sensations) that intersects with gender expression (de Vries et al. 2010; Tateno et al. 2008; Williams et al. 1996). This latter consideration is particularly relevant to the inclusion of SPD in the present study because it allows for a quantitative assessment of this previously proposed hypothesis.
References
Achenbach, T. M. (1991). Manual for the child behavior checklist 4–18 and 1991 profile. Burlington: University of Vermont Department of Psychiatry.
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for ASEBA school-age forms & profiles. Burlington: University of Vermont, Research Center for Children, Youth & Families.
Adelson, S. L. (2012). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender variance, and gender discordance in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 51(9), 957–974.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Arcelus, J., Bouman, W. P., Van Den Noortgate, W., Claes, L., Witcomb, G., & Gernandez-Aranda, F. (2015). Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry, 30(6), 807–815.
Auyeung, B., Lombardo, M. V., & Baron-Cohen, S. (2013). Prenatal and postnatal hormone effects on the human brain and cognition. Pflügers Archiv-European Journal of Physiology, 465(5), 557–571.
Avidime, O. M., Avidime, S., Olorunshola, K. V., & Dikko, A. A. U. (2011). Anogenital distance and umbilical cord testosterone level in newborns in Zaria, Northern Nigeria. Nigerian Journal of Physiological Sciences, 26(1), 23–28.
Baams, L., Beek, T., Hille, H., Zevenbergen, F. C., & Bos, H. M. (2013). Gender nonconformity, perceived stigmatization, and psychological well-being in Dutch sexual minority youth and young adults: A mediation analysis. Archives of Sexual Behavior, 42(5), 765–773.
Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in Cognitive Sciences, 6(6), 248–254.
Baron-Cohen, S., Cassidy, S., Auyeung, B., Allison, C., Achoukhi, M., Robertson, S., et al. (2014). Attenuation of typical sex differences in 800 adults with autism vs. 3,900 controls. PLoS ONE, 9(7), e102251.
Baron-Cohen, S., Lombardo, M. V., Auyeung, B., Ashwin, E., Chakrabarti, B., & Knickmeyer, R. (2011). Why are autism spectrum conditions more prevalent in males?. PLoS Biology, 9(6), e1001081.
Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The Autism-Spectrum Quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31(1), 5–17.
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B (Methodological), 57(1), 289–300.
Berndt, T. J., & Heller, K. A. (1986). Gender stereotypes and social inferences: A developmental study. Journal of Personality and Social Psychology, 50(5), 889–898.
Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103(5), 943–951.
Burke, S. M., Cohen-Kettenis, P. T., Veltman, D. J., Klink, D. T., & Bakker, J. (2014). Hypothalamic response to the chemo-signal androstadienone in gender dysphoric children and adolescents. Frontiers in Endocrinology. https://doi.org/10.3389/fendo.2014.00060.
Carlsen, S. M., Jacobsen, G., & Romundstad, P. (2006). Maternal testosterone levels during pregnancy are associated with offspring size at birth. European Journal of Endocrinology, 155(2), 365–370.
Carter, D. B., & McCloskey, L. A. (1984). Peers and the maintenance of sex-typed behavior: The development of children’s conceptions of cross-gender behavior in their peers. Social Cognition, 2(4), 294–314.
Christensen, D. L., Baio, J., Braun, K. V., Bilder, D., Charles, J., Constantino, J. N., et al. (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 Years—Autism and developmental disabilities monitoring network, 11 Sites, United States, 2012. Morbidity and Mortality Weekly Report: Surveillance Summaries, 65(3), 1–23.
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P. T., DeCuypere, G., Feldman, J., et al. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165–232.
Constantino, J. N., & Gruber, C. P. (2005). Social responsiveness scale (SRS). Los Angeles: Western Psychological Services.
Constantino, J. N., & Todd, R. D. (2003). Autistic traits in the general population: A twin study. Archives of General Psychiatry, 60(5), 524–530.
Coolidge, F. L., Thede, L. L., & Young, S. E. (2002). The heritability of gender identity disorder in a child and adolescent twin sample. Behavior Genetics, 32(4), 251–257.
de Bildt, A., Mulder, E. J., Hoekstra, P. J., van Lang, N. D., Minderaa, R. B., & Hartman, C. A. (2009). Validity of the Children’s Social Behavior Questionnaire (CSBQ) in children with intellectual disability: Comparing the CSBQ with ADI-R, ADOS, and clinical DSM-IV-TR classification. Journal of Autism and Developmental Disorders, 39(10), 1464–1470.
de Vries, A. L. C., Doreleijers, T. A., Steensma, T. D., & Cohen-Kettenis, P. T. (2011). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52(11), 1195–1202.
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(8), 930–936.
de Vries, A. L. C., Steensma, T. D., Cohen-Kettenis, P. T., VanderLaan, D. P., & Zucker, K. J. (2016). Poor peer relations predict parent-and self-reported behavioral and emotional problems of adolescents with gender dysphoria: A cross-national, cross-clinic comparative analysis. European Child & Adolescent Psychiatry, 25(6), 579–588.
Dewinter, J., De Graaf, H., & Begeer, S. (2017). Sexual orientation, gender identity, and romantic relationships in adolescents and adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(9), 2927–2934.
Di Ceglie, D., Skagerberg, E., Baron-Cohen, S., & Auyeung, B. (2014). Empathising and systemising in adolescents with gender dysphoria. Opticon1826, 6(16), 1–8.
Drummond, K. D., Bradley, S. J., Peterson-Badali, M., VanderLaan, D. P., & Zucker, K. J. (2017). Behavior problems and psychiatric diagnoses in girls with gender identity disorder: A follow-up study. Journal of Sex & Marital Therapy, 44(2), 172–187.
Flores, A. R., Brown, T. N., & Herman, J. L. (2016). Race and ethnicity of adults who identify as a transgender in the United States. Los Angeles: The Williams Institute.
George, R., & Stokes, M. A. (2017). Gender identity and sexual orientation in autism spectrum disorder. Autism, 22(8), 970–982.
George, R., & Stokes, M. A. (2018a). A quantitative analysis of mental health among sexual and gender minority groups in ASD. Journal of Autism and Developmental Disorders, 48(6), 2052–2063.
George, R., & Stokes, M. A. (2018b). Sexual orientation in autism spectrum disorder. Autism Research, 11(1), 133–141.
Hartman, C. A., Luteijn, E., Serra, M., & Minderaa, R. (2006). Refinement of the children’s social behavior questionnaire (CSBQ): An instrument that describes the diverse problems seen in milder forms of PDD. Journal of Autism and Developmental Disorders, 36(3), 325–342.
Hoekstra, R. A., Bartels, M., Verweij, C. J., & Boomsma, D. I. (2007). Heritability of autistic traits in the general population. Archives of Pediatrics & Adolescent Medicine, 161(4), 372–377.
Hurst, R. M., Mitchell, J. T., Kimbrel, N. A., Kwapil, T. K., & Nelson-Gray, R. O. (2007) Examination of the reliability and factor structure of the Autism-Spectrum Quotient (AQ) in a non-clinical sample. Personality and Individual Differences, 43(7), 1938–1949
Janssen, A., Huang, H., & Duncan, C. (2016). Gender variance among youth with autism spectrum disorders: A retrospective chart review. Transgender Health, 1(1), 63–68.
Johnson, L. L., Bradley, S. J., Birkenfeld-Adams, A. S., Kuksis, M. A. R., Maing, D. M., Mitchell, J. N., et al. (2004). A parent-report gender identity questionnaire for children. Archives of Sexual Behavior, 33(2), 105–116.
Jones, R. M., Wheelwright, S., Farrell, K., Martin, E., Green, R., Di Ceglie, D., et al. (2012). Brief report: Female-to-male transsexual people and autistic symptoms. Journal of Autism and Developmental Disorders, 42(2), 301–306.
Kaltiala-Heino, R., Sumia, M., Työläjärvi, M., & Lindberg, N. (2015). Two years of gender identity service for minors: Overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health, 9(1), 1–9.
Kuyper, L., & Wijsen, C. (2014). Gender identities and gender dysphoria in the Netherlands. Archives of Sexual Behavior, 43(2), 377–385.
Lai, M.-C., Chiu, Y. N., Gadow, K. D., Gau, S. S. F., & Hwu, H. G. (2010). Correlates of gender dysphoria in Taiwanese university students. Archives of Sexual Behavior, 39(6), 1415–1428.
Lai, M.-C., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. Lancet, 383(9920), 896–910.
Landen, M., & Rasmussen, P. (1997). Gender identity disorder in a girl with autism—A case report. European Child & Adolescent Psychiatry, 6(3), 170–173.
Landolt, M. A., Bartholomew, K., Saffrey, C., Oram, D., & Perlman, D. (2004). Gender nonconformity, childhood rejection, and adult attachment: A study of gay men. Archives of Sexual Behavior, 33(2), 117–128.
Li, G., Pollitt, A. M., & Russell, S. T. (2016). Depression and sexual orientation during young adulthood: Diversity among sexual minority subgroups and the role of gender nonconformity. Archives of Sexual Behavior, 45(3), 697–711.
Lippa, R. A. (2008). The relation between childhood gender variance and adult masculinity–femininity and anxiety in heterosexual and homosexual men and women. Sex Roles, 59(9), 684–693.
Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56, 466–474.
Luteijn, E., Luteijn, F., Jackson, S., Volkmar, F., & Minderaa, R. (2000). The Children’s Social Behavior Questionnaire for milder variants of PDD problems: Evaluation of the psychometric characteristics. Journal of Autism and Developmental Disorders, 30(4), 317–330.
Luteijn, E. F., Serra, M., Jackson, S., Steenhuis, M. P., Althaus, M., Volkmar, F., et al. (2000). How unspecified are disorders of children with a pervasive developmental disorder not otherwise specified? A study of social problems in children with PDD-NOS and ADHD. European Child & Adolescent Psychiatry, 9(3), 168–179.
Martin, C. L., Andrews, N. C., England, D. E., Zosuls, K., & Ruble, D. N. (2017). A dual identity approach for conceptualizing and measuring children’s gender identity. Child Development, 88(1), 167–182.
Martin, C. L., & Ruble, D. (2004). Children’s search for gender cues: Cognitive perspectives on gender development. Current Directions in Psychological Science, 13(2), 67–70.
May, T., Pang, K., & Williams, K. J. (2017). Gender variance in children and adolescents with autism spectrum disorder from the National Database for Autism Research. International Journal of Transgenderism, 18(1), 7–15.
Meerwijk, E. L., & Sevelius, J. M. (2017). Transgender population size in the United States: A meta-regression of population-based probability samples. American Journal of Public Health, 107(2), e1–e8.
Miller, L. J., & Schaaf, R. C. (2008). Sensory processing disorder. In M. M. Haith & J. B. Benson (Eds.), Encyclopedia of infant and early child development (pp. 127–136). Amsterdam: Elsevier.
Nakamura, B. J., Ebesutani, C., Bernstein, A., & Chorpita, B. F. (2009). A psychometric analysis of the Child Behavior Checklist DSM-oriented scales. Journal of Psychopathology and Behavioral Assessment, 31(4), 178–189.
Ofner, M., Coles, A., Decou, M., Do, M. T., Bienek, A., Snider, J., & Ugnat, A. (2018). Autism spectrum disorder among children and youth in Canada 2018: A report of the national autism spectrum disorder surveillance system. Public Health Agency of Canada. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/autism-spectrum-disorder-children-youth-canada-2018/autism-spectrum-disorder-children-youth-canada-2018.pdf. Accessed 10 Apr 2018.
Pasterski, V., Gilligan, L., & Curtis, R. (2014). Traits of autism spectrum disorders in adults with gender dysphoria. Archives of Sexual Behavior, 43(2), 387–393.
Schoen, S. A., Miller, L. J., Brett-Green, B. A., & Nielsen, D. M. (2009). Physiological and behavioral differences in sensory processing: A comparison of children with autism spectrum disorder and sensory modulation disorder. Frontiers in Integrative Neuroscience, 3(3), 1–11.
Shiffman, M., VanderLaan, D. P., Wood, H., Hughes, S. K., Owen-Anderson, A., Lumley, M. M., et al. (2016). Behavioral and emotional problems as a function of peer relationships in adolescents with gender dysphoria: A comparison with clinical and nonclinical controls. Psychology of Sexual Orientation and Gender Diversity, 3(1), 27–36.
Skagerberg, E., Di Ceglie, D., & Carmichael, P. (2015). Brief report: Autistic features in children and adolescents with gender dysphoria. Journal of Autism and Developmental Disorders, 45(8), 2628–2632.
Steensma, T. D., Biemond, R., de Boer, F., & Cohen-Kettenis, P. T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology and Psychiatry, 16(4), 499–516.
Strang, J. F., Kenworthy, L., Dominska, A., Sokoloff, J., Kenealy, L. E., Berl, M., et al. (2014). Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Archives of Sexual Behavior, 43(8), 1525–1533.
Strang, J. F., Meagher, H., Kenworthy, L., de Vries, A. L., Menvielle, E., Leibowitz, S., et al. (2016). 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.
Tateno, M., Tateno, Y., & Saito, T. (2008). Comorbid childhood gender identity disorder in a boy with Asperger syndrome. Psychiatry and Clinical Neurosciences, 62(2), 238.
Toomey, R. B., Ryan, C., Diaz, R. M., Card, N. A., & Russell, S. T. (2010). Gender-nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Developmental Psychology, 46(6), 1580–1589.
Turban, J. L., & van Schalkwyk, G. I. (2018). “Gender dysphoria” and autism spectrum disorder: Is the link real? Journal of the American Academy of Child & Adolescent Psychiatry, 57(1), 8–9.
van Beijsterveldt, C. E. M., Hudziak, J. J., & Boomsma, D. I. (2006). Genetic and environmental influences 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(6), 647–658.
van de Grift, T. C., Elaut, E., Cerwenka, S. C., Cohen-Kettenis, P. T., De Cuypere, G., Richter-Appelt, H., & Kreukels, B. P. C. (2017). Effects of medical interventions on gender dysphoria and body image: A follow-up study. Psychosomatic Medicine, 79(7), 815–823.
van der Miesen, A. I. R., de Vries, A. L., Steensma, T. D., & Hartman, C. A. (2018a). Autistic symptoms in children and adolescents with gender dysphoria. Journal of Autism and Developmental Disorders, 48(5), 1537–1548.
van der Miesen, A. I. R., Hurley, H., Bal, A. M., & de Vries, A. L. C. (2018b). Prevalence of the wish to be of the opposite gender in adolescents and adults with autism spectrum disorder. Archives of Sexual Behavior, 47(8), 1–11.
van der Miesen, A. I. R., Hurley, H., & de Vries, A. L. (2016). Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry, 28(1), 70–80.
VanderLaan, D. P., Leef, J. H., Wood, H., Hughes, S. K., & Zucker, K. J. (2015). Autism spectrum disorder risk factors and autistic symptoms in gender dysphoric children. Journal of Autism and Developmental Disorders, 45(6), 1742–1750.
Wallien, M. S., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child & Adolescent Psychiatry, 47(12), 1413–1423.
Wallien, M. S., Swaab, H., & Cohen-Kettenis, P. T. (2007). Psychiatric comorbidity among children with gender identity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(10), 1307–1314.
Wallien, M. S., Veenstra, R., Kreukels, B. P. C., & Cohen-Kettenis, P. T. (2010). Peer group status of gender dysphoric children: A sociometric study. Archives of Sexual Behavior, 39(2), 553–560.
Williams, P. G., Allard, A. M., & Sears, L. (1996). Case study: Cross-gender preoccupations in two male children with autism. Journal of Autism and Developmental Disorders, 26(6), 635–642.
Wing, L. (1999). Diagnostic interview for social and communication disorders. Manual. Bromley: Centre for Social and Communication Disorders.
Wood, E., & Halder, N. (2014). Gender disorders in learning disability–a systematic review. Tizard Learning Disability Review, 19(4), 158–165.
Zucker, K. J. (2005). Gender identity disorder in children and adolescents. Annual Review of Clinical Psychology, 1, 467–492.
Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health, 14(5), 404–411.
Zucker, K. J., Wilson-Smith, D. N., Kurita, J. A., & Stern, A. (1995). Children’s appraisals of sex-typed behavior in their peers. Sex Roles, 33(11–12), 703–725.
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We thank Dr. Carla Mazefsky and two anonymous reviewers for thoughful comments on earlier drafts of this article. ANN and AS were supported by the Social Sciences and Humanities Research Council (SSHRC) of Canada Undergraduate Research Awards. This research was funded by a University of Toronto Mississauga Research and Scholarly Activity Fund Award and a SSHRC Insight Development Grant awarded to DPV.
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ANN, AS, and DPV conceived and designed the study. ANN, AS, DEP, and DPV collected the data. ANN, AIRvdM, DEP, MCL and DPV conducted the data analyses. All authors participated in writing and revising the manuscript.
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Nabbijohn, A.N., van der Miesen, A.I.R., Santarossa, A. et al. Gender Variance and the Autism Spectrum: An Examination of Children Ages 6–12 Years. J Autism Dev Disord 49, 1570–1585 (2019). https://doi.org/10.1007/s10803-018-3843-z
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DOI: https://doi.org/10.1007/s10803-018-3843-z