by Laurel Duggan
Children with autism make up an outsized proportion of the transgender-identified population, and autism spectrum traits make them particularly vulnerable to thought patterns that can lead youth to pursue gender transitions, according to research and medical professionals.
Transgender individuals are about three to six times more likely to be autistic than non-transgender people, research shows; the connection between transgenderism and autism has been a subject of interest for researchers since at least 2010, and the Gender Development Identity Service at Tavistock, the world’s largest pediatric gender clinic, came under fire in recent years over allegations that as many as 97.5% of its gender patients had autism. Dr. Susan Bradley, a Canadian psychiatrist and pioneer in treating gender dysphoria, told the DCNF that she now believes most pediatric gender patients are actually on the autism spectrum and are being exploited by medical professionals.
“When we were seeing these kids from a very young age, we had kids who would come into the clinic, a little girl who thinks she’s a boy or vice versa. It wasn’t uncommon to find that one of them thought they were a dog or a cat or something else,” said Bradley, who chaired the DSM-IV Subcommittee on Gender Disorders.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the official manual of the American Psychiatric Association, which is used for classifying and diagnosing mental disorders; Bradley led eight other doctors in establishing those guidelines in its 1994 edition.
Bradley began treating children with gender dysphoria around 1975, and over the years she observed that many of the patients had the traits of high-functioning autism, she told the DCNF. People with autism tend to focus very intensely on their subjects of interest and have great difficulty letting go of something once they believe it’s true, both of which make autistic adolescents particularly susceptible to issues with their gender identity and body image, she said.
“They have early difficulty with social understanding and the feeling that they don’t fit in; they struggle to understand that they are different in a certain kind of way that other people don’t understand either, and they often feel left out in peer groups. Many of them don’t have a good friend. They’ll often say other kids tease them or leave them out,” she said. “These kids are even less well equipped than your average teen to manage strong feelings, and they just get totally disregulated at times. That’s why they become so much more vulnerable, they get suicidal, they get anxious, depressed, very down on themselves.”
“When somebody happens to mention that, you know, they’re trans or they hear about trans kids and go online, even if all they do is say, ‘I wonder if I’m trans,’ a lot of these kids are automatically accepted. ‘Well, you must be trans if you’ve even thought about that.’ And for them, that is a very helpful reaction, because all of a sudden, they feel as though that explains all of the trouble all the way along,” Bradley told the DCNF.
Children with high-functioning autism previously showed up at eating disorder clinics with suicidal and anxious depression and body image distortions, but as pediatric gender clinics began cropping up, autistic adolescents began gravitating more toward those, Bradley said.
Chloe Cole, a young woman who underwent cross-sex hormones and a double mastectomy between ages 13 and 17 and now regrets medically transitioning, told the DCNF that doctors failed to meaningfully address her autism spectrum traits and the ways those impacted her gender identity.
“I’ve spoken to a non-transgender person who also was on the spectrum about some of my symptoms of dysphoria and how things like puberty felt for me, and she told me that’s literally just how it feels to be autistic and going through puberty,” Cole said. “It’s common for girls who have autism to present with some more traditionally masculine behaviors or more tomboyish personality. That was definitely my experience growing up and it made it more difficult for me to relate personally with other girls my age.”
Cole is suing the hospital and medical professionals who participated in her gender transition. Her attorneys argue that doctors should have offered her psychotherapy to address her autism spectrum symptoms and mental health issues, but instead made her gender dysphoria the top priority.
“It’s horrifying that none of these kids are really getting an appropriate screening, not only for autism, but really for a lot of other parts of their background that might play a role in the development of their dysphoria,” she said, listing social anxiety, personality disorders, depression and histories of abuse. “They’re just being allowed through the system and [their gender dysphoria] is just being treated as a completely standalone issue.”
The Clarke Institute of Toronto, which is now the Centre for Addiction and Mental Health, opened its pediatric gender clinic in the mid-1970s, when clinicians were offering a therapy-centered approach and 80% to 90% of patients outgrew their gender confusion and came to terms with their biological sex, according to Bradley. The clinic eventually began putting minors on puberty blockers to alleviate gender distress in keeping with practices emerging out of the Netherlands; Bradley views this as a mistake, noting that blockers cement what would otherwise likely be a temporary transgender phase and carry serious physical side effects.
Dr. Lawrence Fung, a psychiatrist at Stanford University, believes there may be a biological factor that drives autistic people to identify as transgender and believes autistic people tend to be more androgynous; he told NPR more research was needed on the subject.
“Females on the spectrum seem to have more testosterone and masculine features on their faces. On the other hand, males on the autism spectrum – they have more feminine features,” he told the outlet.
The World Professional Association for Transgender Health (WPATH), which vocally supports medical transitions for minors, acknowledges that “autistic/neurodivergent transgender youth represent a substantial minority subpopulation of youth served in gender clinics globally,” and the group encourages providers to pursue additional training on the needs of their autistic patients in its latest standards of care. The group notes that autism traits, including rigid thinking and differing abilities to consider and plan for the future, necessitate extra time and support for gender transition patients.
“The autistic mindset tends to see things in black and white, and so if a child doesn’t feel like a girl — and this might be because they don’t feel pretty enough to be a girl — then they believe they must be a boy,” Stella O’Malley, a psychotherapist and founder of Genspect, an organization that’s critical of child transitions, told the DCNF.
“Autistic people also tend to be very literal and so they can believe if people use their preferred pronouns and names, then they must be a boy. Children on the spectrum also tend to be gender nonconforming, and nonconforming in many other ways, and this leads them to believe that perhaps they must be a boy,” O’Malley said.
Transgender identification has exploded over the past decade, especially among the youth population, and clinics offering gender transition procedures to children have boomed from approximately zero 15 years ago to a current estimate of 100 in the U.S., according to Reuters. About 300,000 minors in the U.S. now identify as transgender, and approximately 10,000 to 30,000 are seeking some form of gender-related medical intervention.
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Laurel Duggan is a reporter at Daily Caller News Foundation.
Photo “Child” by Kelly Sikkema.