The Co-occurrence of Gender Dysphoria and Autism Spectrum Disorder in Adults: An Analysis of Cross-Sectional and Clinical Chart Data

  • Gunter Heylens
  • Lore Aspeslagh
  • Jesper Dierickx
  • Kariann Baetens
  • Birgit Van Hoorde
  • Griet De Cuypere
  • Els Elaut
Brief Report

Abstract

Quantitative studies indicate an overrepresentation of ASD in individuals with GD. This study aims to determine the prevalence of autistic traits or ASD in adults with GD using two different data collection methods: (1) cross-sectional data using the social responsiveness scale-adults (SRS-A) and the autism quotient (AQ) (n = 63). (2) Clinical chart data (n = 532). Mean SRS-A scores were significantly higher compared to a norm population. Almost 5% of the patients with GD scored above the cut-off as measured by the AQ. In 32 patients (6%), a certain ASD diagnosis was found in the patient files, which is sixfold higher compared to the general population. Significantly more “birth assigned male” were affected compared to “birth assigned female”.

Keywords

Autism spectrum disorder Gender dysphoria Comorbidity 

Notes

Acknowledgments

The authors would like to thank Prof. Dr. G. T’Sjoen for his support in the realization of this study.

Author Contributions

All authors contributed to the conception and design of the study, and acquisition of data; GH, LA, JD conducted analyses and wrote the first draft of the manuscript; GH, KB, BVH, GDC, EE contributed to manuscript revision and approved the submitted version.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

References

  1. Aitken, M., Steensma, T. D., Blanchard, R., VanderLaan, D. P., Wood, H., Fuentes, A., Spegg, C., Wasserman, L., Ames, M., Fitzsimmons, C. L., Leef, J. H., Lishak, V., Reim, E., Takagi, A., Vinik, J., Wreford, J., Cohen-Kettenis, P. T., de Vries, A. L., Kreukels, B. P., & Zucker, K. J. (2014). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. The Journal of Sexual Medicine, 12, 765–773.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Press, Washington, DC.CrossRefGoogle Scholar
  3. Arcelus, J., Bouman, W. P., Van Den Noortgate, W., Claes, L., Witcomb, G., & Fernandez-Aranda, F. (2015). Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry, 30, 807–815.CrossRefPubMedGoogle Scholar
  4. Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in Cognitive Sciences, 6, 248–254.CrossRefPubMedGoogle Scholar
  5. 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 femals, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31, 5–17.CrossRefPubMedGoogle Scholar
  6. Bishop, S. L., & Seltzer, M. M. (2012). Self-reported autism symptoms in adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 2354–2363.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Constantino, J. N., & Charman, T. (2016). Diagnosis of autism spectrum disorder: Reconciling the syndrome, its diverse origins, and variation in expression. The Lancet Neurology, 15, 279–291.CrossRefPubMedGoogle Scholar
  8. Constantino, J. N., Gruber, C. P., Noens, I., De la Marche, W., & Scholte, E. (2012). SRS-A. Screeningslijst voor autismespectrumstoornissen bij volwassenen. Amsterdam: Hogrefe.Google Scholar
  9. De Vries, A. L., 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, 930–936.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Fombonne, E. (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. Journal of Clinical Psychiatry, 66, 3–8.PubMedGoogle Scholar
  11. Glidden, D., Bouman, W. P., Jones, B. A., & Arcelus, J. (2016). Gender dysphoria and autism spectrum disorder: A systematic review of the literature. Sexual Medicine Reviews, 4, 3–14.CrossRefPubMedGoogle Scholar
  12. Hoekstra, R. A., Bartels, M., Cath, D. C., & Boomsma, D. I. (2008). Factor structure, reliability and criterion validity of the autism spectrum quotient (AQ): A study in Dutch population and patient groups. Journal of Autism and Developmental Disorders, 38, 1555–1566.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Hus, V., Bishop, S., Gotham, K., Huerta, M., & Lord, C. (2013). Factors influencing scores on the social responsiveness scale. Journal of Child Psychology and Psychiatry, 54, 216–224.CrossRefPubMedGoogle Scholar
  14. Jones, R. M., Wheelwright, S., Farrell, K., Martin, E., Green, R., Di Ceglie, D., & Baron-Cohen, S. (2012). Brief report: Female-to-male transsexual people and autistic traits. Journal of Autism and Developmental Disorders, 42, 301–306.CrossRefPubMedGoogle Scholar
  15. Kreukels, B. P., Haraldsen, I. R., De Cuypere, G., Richter-Appelt, H., Gijs, L., & Cohen-Kettenis, P. T. (2012). A European network for the investigation of gender incongruence: The ENIGI initiative. European Psychiatry, 27, 445–450.CrossRefPubMedGoogle Scholar
  16. Kung, K. T., Spencer, D., Pasterski, V., Neufeld, S., Glover, V., O’Connor, T. G., Hindmarsh, P. C., Hughes, I. A., Acerini, C. L., & Hines, M. (2016). No relationship between prenatal androgen exposure and autistic traits: Convergent evidence from studies of children with congenital adrenal hyperplasia and of amniotic testosterone concentrations in typically developing children. Journal of Child Psychology and Psychiatry, 57, 1455–1462.CrossRefPubMedGoogle Scholar
  17. Lai, M., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. Lancet, 383, 896–910.CrossRefPubMedGoogle Scholar
  18. Lehmann, K., & Leavey, G. (2016). Individuals with gender dysphoria and autism: Barriers to good clinical practice. Journal of Psychiatric and Mental Health Nursing.  https://doi.org/10.1111/jpm.12351. [Epub ahead of print].PubMedGoogle Scholar
  19. Pasterski, V., Gilligan, L., & Curtis, R. (2014). Traits of autism spectrum disorders in adults with gender dysphoria. Archives of Sexual Behavior, 43, 387–393.CrossRefPubMedGoogle Scholar
  20. Richards, C., Bouman, W. P., Seal, L., Barker, M. J., Nieder, T. O., & T’Sjoen, G. (2016). Non-binary or genderqueer genders. International Review of Psychiatry, 8, 95–102.CrossRefGoogle Scholar
  21. Schaafsma, S. M., & Pfaff, D. W. (2014). Etiologies underlying sex differences in autism spectrum disorders. Frontiers in Neuroendocrinology, 35, 255–271.CrossRefPubMedGoogle Scholar
  22. Schneider, C., Cerwenka, S., Nieder, T. O., Briken, P., Cohen-Kettenis, P. T., De Cuypere, G., Haraldsen, I. R., Kreukels, B. P., & Richter-Appelt, H. (2016). Measuring gender dysphoria: A multicenter examination and comparison of the utrecht gender dysphoria scale and the gender identity/gender dysphoria questionnaire for adolescents and adults. Archives of Sexual Behaviour, 45, 551–558.CrossRefGoogle Scholar
  23. Skagerberg, E., Di Ceglie, D., & Carmichael, P. (2015). Brief report: Autistic features in children and adolescents with gender dysphoria. Journal of Autism Developmental Disorders, 45, 2628–2632.CrossRefPubMedGoogle Scholar
  24. South, M., Carr, A. W., Stephenson, K. G., Maisel, M. E., & Cox, J. C. (2017). Symptom overlap on the SRS-2 adult self-report between adults with asd and adults with high anxiety. Autism Research, 10, 1215–1220.CrossRefPubMedGoogle Scholar
  25. Strang, J. F., Meagher, H., Kenworthy, L., de Vries, A. L., 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., Mandel, F., Caretto, A., Lewis, H. C., & Anthony, L. G. (2016). Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or Incongruence in adolescents. Journal of Clinical Child & Adolescent Psychology, 24, 1–11. [Epub ahead of print].Google Scholar
  26. Van der Miesen, A. I., Hurley, H., & De Vries, A. L. (2016). Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry, 28, 70–80.CrossRefGoogle Scholar
  27. van Schalkwyk, G. I., Klingensmith, K., & Volkmar, F. R. (2015). Gender identity and autism spectrum disorders. The Yale Journal of Biology and Medicine, 88, 81–83.PubMedPubMedCentralGoogle Scholar
  28. VanderLaan, D. P., Leef, H. L., Wood, H., Hughes, S. K., & Zucker, K. J. (2015). Autism spectrum disorder risk factors and autistic traits in gender dysphoric children. Journal of Autism and Developmental Disorders, 45, 1742–1750.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Sexology and GenderGhent University HospitalGhentBelgium

Personalised recommendations