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Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review

  • Emily Thrower
  • Ingrid Bretherton
  • Ken C. Pang
  • Jeffrey D. Zajac
  • Ada S. CheungEmail author
Original Paper

Abstract

Autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD) can compromise health and may be more prevalent amongst individuals with gender dysphoria (GD). Symptoms such as attention or social difficulties can impact assessment of GD, understanding of health information, and engagement in clinical care. To ensure neurodevelopmental conditions are adequately considered in gender health services, we aimed to systematically review the literature examining the prevalence of ASD and ADHD amongst individuals with GD. In this systematic review based on the PRISMA guidelines. MEDLINE and PsycINFO databases were searched for studies examining the prevalence of ASD and/or ADHD in individuals with GD or investigated the rate of GD in cohorts with ASD or ADHD. All English peer-reviewed publications were included. The search strategy identified 179 studies. After applying exclusion criteria, a total of 30 studies were identified, 22 studies which examined the prevalence of ASD or ADHD in people with GD. A further 8 studies examined the reverse; prevalence of GD in people with ASD. The few studies employing diagnostic criteria for ASD suggest a prevalence of 6–26% in transgender populations, higher than the general population, but no different from individuals attending psychiatry clinics. Few studies examine prevalence of ADHD. Low-level evidence exists to suggest a link between ASD and GD. Further population-based and controlled studies using diagnostic criteria for ASD and ADHD are required.

Keywords

Transgender persons Gender dysphoria Attention-deficit hyperactivity disorder Autism disorders 

Notes

Acknowledgments

Ada Cheung is supported by an Australian Government National Health and Medical Research Council Early Career Fellowship (#1143333) and receives research support from the Viertel Charitable Foundation Clinical Investigator Award, Endocrine Society of Australia Postdoctoral Award and the Royal Australasian College of Physicians Vincent Fairfax Family Foundation. Ken Pang is supported by the Royal Children’s Hospital Foundation and receives research support from the Royal Australasian College of Physicians.

Author Contributions

ET, IB, KCP, JDZ, and ASC made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with Ethical Standards

Conflict of interest

The authors have nothing to declare.

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine (Austin Health)The University of MelbourneHeidelbergAustralia
  2. 2.Department of Adolescent MedicineRoyal Children’s HospitalParkvilleAustralia
  3. 3.Murdoch Children’s Research InstituteParkvilleAustralia
  4. 4.Department of PaediatricsThe University of MelbourneParkvilleAustralia

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