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Autism and Gender5 min read

Grasping the unique rela­tion­ship between autistic people and their gen­ders is an essen­tial com­po­nent of under­standing the autistic expe­ri­ence. With growing evi­dence that autistic people are more likely to be gender-diverse than non-autistics, resources can be directed toward both autism and gender clinics to check for co-occurrences.

Low autism iden­ti­fi­ca­tion rates in natal girls have lim­ited most pre­vious research to autism in natal boys (AMAB). New research showing that autistic women (AFAB) mask more effec­tively should help diag­nos­ti­cians and advo­cates bal­ance such dis­par­i­ties in autism iden­ti­fi­ca­tions.

Most of the hur­dles that gender-diverse autistic people encounter are soci­etal and sys­temic in nature; sup­port from friends and family are crit­ical in over­coming such bar­riers. It is impor­tant to affirm and empower autis­tics con­cerning their own gender iden­ti­ties and related needs.

Autistic people are more likely to be gender-diverse

Every gender iden­tity is rep­re­sented among autistic people, just like with non-autistics. However, there seems to be higher gender diver­sity among the autistic pop­u­la­tion com­pared to the gen­eral pop­u­la­tion.

“There is an increasing amount of evi­dence that sug­gests a co-occurrence between gender dys­phoria and ASD,” con­cluded a 2016 review exam­ining links between gender dys­phoria and autism (1). Gender dys­phoria is the feeling of one’s body not matching their feel­ings, or of being treated dif­fer­ently than their gender. It is not a pre­req­ui­site for a gender-diverse iden­tity, but it does occur in most instances.

Later research showed that “autistic people, par­tic­u­larly natal [women], had lower social iden­ti­fi­ca­tion with and more neg­a­tive feel­ings about a gender group” than non-autistic people (2). In other words, autistic people are more likely to have gender dys­phoria and be gender-diverse, but autistic natal women (assigned female at birth, AFAB) have an even higher like­li­hood.

Autistics find societal gender expectations confounding

Autistics can be very intro­spec­tive, a quality that helps in under­standing their own iden­tity in a deeper way than many non-autistics. The unique neu­ro­log­ical frame­work of autistic people seems to make it easier to reject soci­etal gender con­ven­tions and sub­se­quently come out as gender-diverse.

A review of first-hand autistic accounts “highlight[s] the draining and relent­less emo­tional labor” that con­forming to soci­etal gender expec­ta­tions can often require. That study con­cluded that many autistic people “respond by explic­itly rejecting or simply neglecting [gender’s] con­founding demands” to focus on their own needs (3).

A more recent study also noted the “ten­dency, delib­erate or acci­dental, of autistic people to breach social con­ven­tions.” One par­tic­i­pant wrote, “I don’t feel like a gender, I feel like myself,” in an effort to describe their iden­tity (4).

Autistic natal girls are less likely to be identified as autistic

Although gender diver­sity is high among autistic people in gen­eral, natal girls (AFAB) have been less likely to be iden­ti­fied as autistic than natal boys (AMAB), even when pre­senting sim­ilar signs. This does not mean that natal boys are more likely to be autistic; it merely means that natal girls have been under-diagnosed and uniden­ti­fied.

A recent study of autistic adults using a “newly devel­oped self-reported mea­sure of cam­ou­flaging” found greater masking in autistic women than autistic men, while also detecting no masking dif­fer­ences among non-autistic adults (5). Since autistic women are better at masking, it makes sense that natal girls are rec­og­nized as autistic less often. After all, autistic women grew from autistic girls who were just trying to fit in.

Another study dis­cov­ered that more neg­a­tive first impres­sions are formed of autistic men than autistic women; i.e., autistic women are judged more favor­ably than autistic men. All autis­tics, how­ever, were judged less favor­ably com­pared to non-autistic people (6). 

This gender bias could explain why autism rates of natal girls are lower than expected; the “less favor­able” boys are more notice­able and, thus, more readily iden­ti­fi­able. This has led to more natal boys being included in studies and more soci­etal aware­ness of autism in that group. Awareness is good, of course, but too many people are still left behind because of such lim­ited views.

Barriers to understanding

Communication dif­fer­ences due to anx­iety, exec­u­tive dys­func­tion, alex­ithymia, and other con­di­tions and cir­cum­stances may make it dif­fi­cult for an autistic person to explain their rela­tion­ship to, or seek out ways to under­stand, their gender.

For those rea­sons and more, autis­tics will often relate to fic­tional char­ac­ters when trying to under­stand them­selves. Grasping one’s iden­tity can be a com­plex process that requires much thought and assumes ideas to which a person may not have had access. Characters and sto­ries pro­vide pre-packaged iden­ti­ties and expe­ri­ences that can help people feel their iden­ti­ties and figure out how to express their per­sonal ideals.

Research on LGBTQ media rep­re­sen­ta­tion inves­ti­gating its depic­tion and impact found that tra­di­tional media, and TV in par­tic­ular, “limits LGBTQ people’s per­cep­tions of their future tra­jec­to­ries” (7). With a dearth of dis­crete char­ac­ters acting out dis­tinct sce­narios, it can be dif­fi­cult to under­stand how one’s own iden­tity might look amidst an unrep­re­sen­ta­tive media land­scape.

It is impor­tant to note that media does not cause someone to gain an iden­tity; it only pro­vides the ideas and under­standing nec­es­sary for a person to realize what has been there all along. Newer, more diverse media can fill gaps in the mind’s eye, making it easier for a person to com­pre­hend and explain their iden­tity.

Barriers to acceptance

Autistic people already struggle to fit into a society that calls out and mar­gin­al­izes people seen as dif­ferent, exem­pli­fied by sui­cide rates far higher than the gen­eral pop­u­la­tion. Gender-diverse indi­vid­uals also have high sui­cide rates, for sim­ilar rea­sons. The inter­sec­tion of these iden­ti­ties means that sup­porting gender-diverse autis­tics can mean the dif­fer­ence between life and death. The best way to show sup­port is by affirming their gender and pro­viding non­judg­mental spaces as they figure them­selves out.

Autistics may also encounter disability-related bar­riers that do not allow them to make their own gender-affirming deci­sions. When people are placed under guardian­ships or forced into insti­tu­tions, for instance, their autonomy is reduced and deci­sions can be taken out of their hands. Children are sim­i­larly lim­ited in authority over their own lives, treat­ments, and health­care. In any case, it is impor­tant to affirm and empower indi­vid­uals con­cerning their gender iden­tity and related needs.

The American Academy of Pediatrics (AAP) pub­lished rec­om­men­da­tions in 2018 with a policy state­ment calling for such a gender-affirming approach. This par­a­digm “strengthens family resiliency and takes the emphasis off height­ened con­cerns over gender while allowing chil­dren the freedom to focus on aca­d­e­mics, relationship-building and other typ­ical devel­op­mental tasks” (8). When chil­dren are forced to put energy into con­forming, they are not able to use that energy to develop, learn, and grow.

Affirmation and support is critical

Autistic people are more likely to be gender-diverse, but most prob­lems they encounter with such iden­ti­ties are soci­etal and sys­temic in nature. Gender affir­ma­tion and sup­port from friends, family, and health ser­vices to clear those bar­riers can often be the dif­fer­ence between life and death for a gender-diverse autistic person.

References:

1) Glidden et al. 2016. doi.org/10.1016/j.sxmr.2015.10.003

2) Cooper et al. 2018. doi.org/10.1007/s10803-018‑3590‑1

3) Davidson & Tamas 2016. doi.org/10.1016/j.emospa.2015.09.009

4) Kourti & MacLeod 2019. doi.org/10.1089/aut.2018.0001

5) Hull et al. 2019. doi/10.1177/1362361319864804

6) Cage & Burton 2019. doi.org/10.1002/aur.2191

7) McInroy & Craig 2016. doi.org/10.1080/13676261.2016.1184243

8) AAP Policy Statement 2018. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Policy-Statement-Urges-Support-and-Care-of-Transgender-and-Gender-Diverse-Children-and-Adolescents.aspx

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7 Comments

  1. I would like to add some­thing.. As an autistic trans woman, I get the feeling that at least part of this is.. Well, maybe not wrong but at least not cor­rect. Looking at common traits among autistic women who are either diag­nosed late or not at all, I tend to match pretty much every box. On the other hand, looking at traits more com­monly found among autistic boys/men they don’t match at all. But this article kind of makes it sound like autistic trans women = autistic cis men and vice versa.. (from an autistic point of view at least..) Not sure if that makes sense..

    I’ll admit that I haven’t checked the sources, but my guess is that the studies that com­pared autistic boys/men to autistic girls/women didn’t take trans into account. And I don’t really have friends, and the people I follow on var­ious social media are either binary trans or autistic, never both, so my sample size is rather.. Small.. But still! (and the few non-binary autis­tics I follow don’t help, since they are rarely included in studies about gender..)

    1. Author

      That’s a great ques­tion! The adult studies relied on adults’ self-reported gen­ders, while most of the kid studies were natal gen­ders (at the time of the study — follow-ups would def­i­nitely be inter­esting). Looking at the research, there were not enough non-binary people in the sam­ples, so more needs to be done there as well. Larger or more focused follow-ups would be great.

      I’m also an autistic trans woman, and I relate to more of the tra­di­tional “girl signs”. It’s prob­ably part of why I was missed for so long and thus late-diagnosed. I didn’t see the same incon­sis­tency as you though — could you elab­o­rate? I’d love to get to the bottom of this. 😊

      1. Yeah exactly! I spent years trying to get a diag­nosis, but was con­stantly met with walls of “haha of course you’re not autistic”. I sus­pect it was a com­bi­na­tion of the trans­phobic notion of trans women is really just men and their expec­ta­tions about how autism presents in men.. Anyways, ehm.. What incon­sis­tency are you refer­ring to? I’ve read my own com­ment sev­eral times now but can’t figure out what you mean 😜 (have had a tough couple of weeks and my brain is unusu­ally.. Mushy..)

        1. Author

          I think I mis­read your first para­graph then, haha!

      2. I don’t have any on hand right now and I’m in a rush to leave for work but there are studies out there done on the trans pop­u­la­tion at large that indi­cate that we tend to align more with cis people of the gender we iden­tify with than the gender we were assigned at birth. Which makes sense when you actu­ally think about it, but we’re starting to get the con­fir­ma­tion as well. So this really doesn’t sur­prise me at all.

        Personally, I’m a nonbinary/agender AMAB person but I too tend to match up with the more stereo­typ­i­cally female pre­sen­ta­tion of autism.

        1. Author

          It doesn’t sur­prise me either! I’m glad studies are starting to clarify all the anec­dotal evi­dence we’ve had.

    2. Author

      Also, your com­ment helped me fix a typo in the intro when I re-read the article just now!

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