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.
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
- NeuroClastic, Inc. Autistic Services, Initiatives, and Endorsements - May 2, 2020
- Lining Up and Arranging and Color Coding Objects, Oh My! - March 22, 2020
- I Dream of Plane Crashes - February 12, 2020
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..)
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. 😊
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..)
I think I misread your first paragraph then, haha!
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.
It doesn’t surprise me either! I’m glad studies are starting to clarify all the anecdotal evidence we’ve had.
Also, your comment helped me fix a typo in the intro when I re-read the article just now!
I find this very interesting. I am afab too and not really sure if I identify as amab or as non-binary, because I am not out of the closet, as I do live in what I would call an institution, but NT just call a flat for autistic people. I am not allowed to move out and be supported just as well in my own living space, so is this a prison or is it not? I simply would not be able to support myself financially without help and is allowed to make decisions for me. It has been many times that my opinion was discarded completely in favor of my mother’s more “rational” opinion. I can either live alone and not receive any help, or stay where I am. To insist that the law actually says that I have a right to support even living alone, where people come to my flat a few times a week instead of living together with other autists who have completely different needs. It does not help that the owner of our house and the organizer of our support program is the mother of another autist living here: Who will get their way: me who is very sensitive to touch, temperature, wearing clothes on my sensitive skin, or she who needs to open the windows everywhere in the house because she cannot stand it smelling even a little like something she does not like? I mean, either I am cold or she has to smell something bad. What is worse? And how can there be a compromise? You can only have the window closed or open, the room warm enough or not smelling of anything. It is simply not physically possible for both of us to be comfortable. I said I cannot sleep because I am too cold. I just get told, just wear more clothing to bed. I get no answer to my question what I should do when I cannot sleep then because clothing rubs and irritates my skin too much to sleep.
I have been sleep-deprived for years now because of this and other reasons, but I get told, get a better sleep rhythm, take sleeping pills etc.. My reason absolutely cannot be the cause, because you simply have to wear sleeping clothes while sleeping. They say it would cost too much to keep the heating on at night, nobody needs as much heat while sleeping, therefore our heating is out between 10pm and 6 am, because then you already sleep and nobody wakes up just because they are cold, that is nonsense in their opinion.
Sorry for not keeping to the topic, I simply think I had to explain that first: What I really wanted to say on the topic is this: I was diagnosed late at 23, and I am now 36, after my second of three what I now know were burnouts. After I finally got my diagnosis my mother went back to the doctors and psychiatrists who saw me after my first burnout when I was fired from my apprenticeship for not having enough social skills. What she/they said was: I was something like this, I don’t know what was said exactly but I remembered and interpreted what my mother told me as this: I almost diagnosed her (since I was neither out at the time, nor am I now, because my mother has often said transphobic things about other people when I was around) as autistic or ADHD (for which I seem to also have all the symptoms for) but of course she could not be because autism only occurs in males. And that was and still is the opinion of most of the teachers and medical personnel that have not had any female autistic patients here in Germany. So, if I had been amab I would have almost certainly been diagnosed as autistic at least at 16 and still received help when it mattered, most likely the first therapist who called my a normal if shy girl who should just go out and try and have more friends. Because girls are supposed to be shy in their opinion. Nothing is wrong with me. If I have problems paying attention in school I am lazy, if I am too direct, it is because I want to be impolite and insult people, if I think things can be done better and be easier for me, it is too expensive, has to be done “this way” instead or I am told you can speak, you are so high-functioning why do you not just get a job and move out, then you do not have to deal with your mother? Those are things people tell me when I complain. Because either I do not need help or only what help they think I need (aka behavioral therapy) What I really liked in my last therapy was that he listened to me, explained situations to me were I had no clue what NTs thought or acted in a certain kind of situation and in which ways I can react and how that will come across to people. So I got informed what a typical NTs thought process was and how I could actually communicate what I wanted instead of getting no choice. Unfortunately he went in retirement now, so I have not had any therapy in years now. And I do need it, since I had my third burnout a year ago. And my mother did look and ask any therapist in my area if they have appointments, not only people already familiar with autism or male, like I would have prefered. And of course my insurance does not pay for private or foreign therapy over video conference. I mean, languages are my special interest. Even though I am German, I really do think therapy in English would be much better for me than in my native language German. I simply have no associations with bullying, gaslighting or trauma in English. And the Internet and English and wikipedia and co. have been my closest friends since I was 15.