A Special Issue of Autism in Adulthood Dedicated to the Intersection of Autism and the Broad LGBTQ+

Abstract

Autism in AdulthoodAhead of Print EditorialFree AccessA Special Issue of Autism in Adulthood Dedicated to the Intersection of Autism and the Broad LGBTQ+John F. Strang and Abigail L. FischbachJohn F. StrangAddress correspondence to: John F. Strang, PsyD, Gender and Autism Program, Division of Neuropsychology, Children's National Hospital, 15245 Shady Grove Road Suite 350, Rockville, MD 20850, USA E-mail Address: jstrang@childrensnational.orgAutism and LGBTQ+ Intersection Special Issue Guest Editor, Gender and Autism Program, Division of Neuropsychology, Children's National Hospital, Washington, District of Columbia, USA.Search for more papers by this author and Abigail L. FischbachGender and Autism Program, Children's National Hospital, Washington, District of Columbia, USA.Search for more papers by this authorPublished Online:6 Jun 2023https://doi.org/10.1089/aut.2023.0056.editorialAboutSectionsPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This special issue of Autism in Adulthood, dedicated to the common intersection of autism and LGBTQ+ identities,1–3 presents 10 new contributions to the field, including 8 new empirical studies, an international expert roundtable discussion, and a personal insight essay. Although the publication of the collective studies that make up this special issue represents a milestone to be celebrated by the field, the special issue also comes at a time when the rights of LGBTQ+ people, and autistic LGBTQ+ people specifically, are at increasing risk. Since the call went out for this issue, multiple states in the United States have advanced legislation restricting a range of LGBTQ+ rights.4,5 Recent legislation in several U.S. states specifically mentions the common intersection of autism and gender diversity as a reason to potentially restrict care.6,7In the United Kingdom, autism factored prominently in the legal proceedings against the national Tavistock gender clinic, even though the autistic young person whose parents were among the claimants had not been seen for services in the clinic. It seems that anti-LGBTQ+ movements are beginning to capitalize on the painful societal legacies of stigma against autistic people, drawing upon tropes that autistic people lack the authority to know about who they are and what they need. The contributions to this special issue richly reflect the self-determination of autistic people regarding their sexual and gender identities, and the importance of including autistic people in LGBTQ+ research and advocacy.Of the 10 articles accepted for this issue, a majority (i.e., 6) focus on the common intersection of autism and gender diversity. Two of the others focus on the broad LGBTQ+, and only two focus on sexual minority experiences, specifically. This is notable, given that there is a proportional over-representation of broad LGBTQ+ identities—not just gender diversity—and autism. In fact, McQuaid and colleagues (page 139) report that more than 41% of their sample of autistic adults recruited from a large-scale U.S. database have a sexual minority identity.Research interest in, funding for, and clinical pathways supporting sexual minority autistic individuals have been notably lacking. This may relate to the overarching disparity within LGBTQ+ research and care, broadly, where only two areas have received particular research funding and clinical attention: HIV-related research that pertains especially to subsets of the LGBTQ+ communities and research on gender diversity/transgender care.McQuaid and colleagues' findings (page 139) of much greater mental health risk faced by sexual minority autistic versus heterosexual autistic adults highlight the importance of research and clinical attention to this understudied population. The findings of this study also suggest the importance of disaggregation across sexual identities (i.e., analyzing distinct identities separately) to probe mechanisms, which may differ across the diverse sexualities.A majority of articles in this special issue have a primary focus on challenges, risks, and disparities faced by individuals at the intersection of autism and LGBTQ+ identities: disparities in access to needed care (i.e., Wallisch and colleagues [page 165], Bruce and colleagues [page 191], and Strang and colleagues [page 109]), mental health risks/disparities (i.e., McQuaid and colleagues [page 139] and Wallisch and colleagues [page 165]), and barriers and challenges to accessing LGBTQ+ community and support (i.e., McAuliffe and colleagues [page 127] and Strang and colleagues [page 109]). Prior evidence supports that the challenges faced by autistic LGBTQ+ persons are at least additive (i.e., the challenges faced by autistic and LGBTQ+ populations independently combined).8However, several studies in this special issue highlight the specific intersectional disparities of overlapping autism and sex and gender minority identities. For example, McAuliffe and colleagues (page 127) identify potential mechanisms that may serve as barriers to autistic people connecting with and benefiting from LGBTQ+ communities and resources. Their study also provides the beginnings of a roadmap for how to potentially reduce these barriers. Bruce and colleagues (page 191) conducted a multilevel qualitative study, investigating experiences and barriers autistic gender-diverse people face accessing gender care at the individual (i.e., patient) level, the provider level, and health care systems level.Through community-based participatory methods of cocreation, Strang and colleagues (page 109) codeveloped and refined a new self-report tool to capture key intersectional experiences, challenges, unmet needs, and resilience factors among autistic transgender young adults. And finally, the international roundtable article on intersectional autistic and transgender and nonbinary identities (Gratton and colleagues [page 112]) takes a global lens to disparities faced by autistic gender-diverse people, and strongly emphasizes the ethical imperative for the inclusion of autistic gender-diverse people in the design of research and policies relevant to this population.This special issue also includes articles that focus primarily on intersectional autism and LGBTQ+ topics aside from the characterization of disparities or risks. Broadening the lens beyond disparities is important for this field, as although both autistic and LGBTQ+ communities face profound disparities and risks in multiple societal contexts, there are many other important research topics relevant to this population that deserve our attention. For example, Coburn and colleagues (page 154) compare the qualities of narrative discourse across gender, assigned sex at birth, and traditionally overstudied (i.e., cisgender male) versus understudied groupings.The model Coburn and colleagues advance for analytics in this population, comparing across multiple permutations of gender and assigned sex, is innovative. We also learn from this article that such approaches may be demanding of sample size. Notably, Coburn and colleagues identified potential differences in initial analyses, but that then did not survive multiple comparison corrections, suggesting (1) the potential importance of multidimensional approaches to analysis (e.g., including gender- and assigned sex- related comparisons) and (2) the need for large samples to fully investigate such multidimensional comparisons.In thinking about future funding opportunities for this field, an argument for autism-only samples that could boost power for iterative multidimensional analyses across relevant categorizations of gender, assigned sex, and potentially their interaction in autistic people may be defensible (for another early example of these approaches, see Strang and colleagues analytics with transgender autistic and transgender nonautistic youth9).The article contributed by Steinberg and colleagues (page 204) addresses a critical research infrastructure topic for our field: how to equitably capture gender-related identities among autistic individuals. This timely study identifies that a breadth of questioning is needed to appropriately characterize gender identities in autism. Unfortunately, the recent U.S. National Institutes of Health-funded National Academies of Sciences, Engineering, and Medicine workgroup on standards for characterizing gender identity and assigned sex did not include in their outcomes reference to whether their recommendations are attuned to and appropriate for neurodivergent populations.10The findings of Steinberg and colleagues suggest that to equitably identify and study gender minorities in autistic populations, a much broader approach to assessment of gender may be necessary. Of note, there are currently initiatives underway and recently completed that aim to develop gender characterization tools attuned specifically to autistic populations.11,12The work of Amilia Kallitsounaki, one of the youngest contributor researchers to this special issue, has been particularly impactful in the field. As discussed within this special issue's roundtable article (Gratton and colleagues [page 112]), Kallitsounaki's previous work demonstrated that autistic transgender people, on a task of implicit gender, show implicit genders that align with their affirmed gender, not their sex assigned at birth.13 This finding challenges problematic assumptions that autistic transgender individuals are unable to “know” their own inner gender experience, assumptions that appear to be driving some of the political rhetoric regarding gender-diverse people's rights.6In their research contribution to this special issue, Kallitsounaki and Williams (page 210) identify over-represented alexithymia among autistic and nonautistic transgender people. Through a careful logic sequence, the authors propose that these findings challenge another problematic supposition in the field that has been asserted by some commentators: namely, theories that autistic transgender people may not be truly autistic.14 It is work such as that of Kallitsounaki and Williams that, through a range of cognitive psychology approaches, is helping to debunk unfounded assumptions about the nature of intersectional autism and gender diversity.This special issue includes a personal insight essay on sexuality and autistic identity by Jack Pemmet (page 125). Pemmet shares with us his inner experience of sapiosexuality, which he personally does not consider part of the LGBTQ+, and muses over its intersections with his autistic identity and experience. One of the many takeaways from this piece is a reminder that the experience and labeling of sexual and gender identities may be particularly salient within the autistic community. Future research may consider identity development broadly for autistic people, and how identity-related developmental processes may—or may not—intersect with named sex and gender identities.When reflecting on this collection of new articles that make up this special issue, several themes come to mind. First, the already heavy burden autistic LGBTQ+ people faced at the times when the studies in this special issue were conducted is likely increasing in some locations, given trends toward regressive LGBTQ-related legislation, with some legislation naming autism, specifically, as a potential reason for denying care.6 It is critical for researchers and advocates to address these concerning developments with clarity of communication and scientific excellence.Second, sexual minority autistic identities are extremely common (i.e., McQuaid and colleagues [page 139]), yet there is a dearth of research in this area, specifically. Given the clear disparities faced by sexual minority autistic people, we need to support researchers who are dedicated to this work. Third, cocreation of research studies by autistic LGBTQ+ people is an ethical imperative, given the risk that research on these multiminority populations, without careful community coleadership, can further marginalize these communities.And finally, although community and research expressions of the common intersection of autism and sex and gender minority identities abound, major LGBTQ+ advocacy organizations have been slow to acknowledge the many autistic people within their communities, with one recent exception.15 It is time for the common intersection of LGBTQ+ identities and autism to be embraced by the broad LGBTQ+ communities and advocacy organizations, as autistic communities have for too long carried the torch of welcome and support all alone.