Mental Health Correlates of Autism Spectrum Disorder in Gender Diverse Young People: Evidence from a Specialised Child and Adolescent Gender Clinic in Australia.

Simone Mahfouda,Amanda O’Donovan,Ashleigh Lin,Julia K Moore,Andrew J.O Whitehouse,Penelope Strauss,Cati S Thomas,Florian D Zepf,Hans-Willem Van Hall,Christina Panos,Liz A Saunders,Murray Maybery

doi:10.3390/jcm8101503

Abstract

Research suggests an overrepresentation of autism spectrum diagnoses (ASD) or autistic traits in gender diverse samples, particularly in children and adolescents. Using data from the GENTLE (GENder identiTy Longitudinal Experience) Cohort at the Gender Diversity Service at the Perth Children’s Hospital, the primary objective of the current retrospective chart review was to explore psychopathology and quality of life in gender diverse children with co-occurring ASD relative to gender diverse children and adolescents without ASD. The Social Responsiveness Scale (Second Edition) generates a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) score indicating a likely clinical ASD diagnosis, which was used to partition participants into two groups (indicated ASD, n = 19) (no ASD indicated, n = 60). Indicated ASD was far higher than would be expected compared to general population estimates. Indicated ASD on the Social Responsiveness Scale 2 (SRS 2) was also a significant predictor of Internalising behaviours (Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems subscales) on the Youth Self Report. Indicated ASD was also a significant predictor of scores on all subscales of the Paediatric Quality of Life Inventory. The current findings indicate that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life outcomes. Services working with gender diverse young people should screen for ASD, and also provide pathways to appropriate care for the commonly associated mental health difficulties.

Highlights

The past decade has seen increasing clinical and empirical interest in the co-occurrence of gender diversity and autism spectrum disorders (ASD)
At entry to the Gender Diversity Service (GDS), 9.62% (n = 10) of the sample reported a formal diagnosis of autism spectrum diagnoses (ASD); this information was available for 10.58% (n = 11 of the sample)
Emerging research suggests an overrepresentation of ASD diagnoses and autistic traits in gender diverse children and adolescents [4,5,6,7,8] compared to general population prevalence estimates [41,42]

Summary

Introduction

The past decade has seen increasing clinical and empirical interest in the co-occurrence of gender diversity and autism spectrum disorders (ASD). Data from Trans Pathways, the largest study conducted in Australian trans and gender-diverse young people (n = 859; mean age = 19.4), found that 22.5% of the sample reported having received a formal ASD diagnosis, while more than one third (35.2%) warranted further diagnostic assessments to clarify whether ASD was present [11]. Causal underpinnings of this co-occurrence remain poorly understood, and while theories have been postulated (see Van Der Miesen & Colleagues for a review of underlying hypotheses [12]), a robust evidence base is lacking. The clinical consensus is that in most cases, gender diverse identities and behaviours are not secondary to ASD but co-occur as an aspect of personal identity [13,14,15,16]

Methods

Results

Discussion

Conclusion