'Experts' Weigh In: The Intersection of Autism and Transgender Identities
A ‘roundtable’ explores the intersection of autism and transgender identities, affirming their co-occurrence as authentic. Experts call for inclusive care, participatory research, and intersectional, lifespan-informed approaches.
Citation
Gratton, F. V., Strang, J. F., Song, M., Cooper, K., Kallitsounaki, A., Lai, M. C., Lawson, W., van der Miesen, A. I. R., & Wimms, H. E. (2023). The Intersection of Autism and Transgender and Nonbinary Identities: Community and Academic Dialogue on Research and Advocacy. Autism in adulthood : challenges and management, 5(2), 112–124. https://doi.org/10.1089/aut.2023.0042
Introduction
In a recent roundtable discussion published in “Autism in Adulthood,” eight ‘leading experts’ in the field of intersectional autism and gender diversity came together to explore the complex relationship between autism and transgender identities. This comprehensive dialogue, titled “The Intersection of Autism and Transgender and Nonbinary Identities: Community and Academic Dialogue on Research and Advocacy,” offers crucial insights into a topic that’s both deeply personal and increasingly relevant in today’s society. As an autistic trans woman who regularly engages with such studies, I find this paper particularly significant. It not only validates the experiences of individuals like myself who exist at this intersection but also challenges misconceptions and stigma that we often face. The experts’ discussion spans from current research findings to clinical practices, societal impacts, and future priorities, providing a nuanced and multifaceted view of our lived experiences. This study’s emphasis on the authenticity of co-occurring autistic and transgender identities resonates strongly with my own journey and the stories I’ve heard from others in our community. Moreover, the paper’s focus on improving care practices, addressing disparities, and prioritising the involvement of autistic transgender individuals in research and clinical decisions aligns with the advocacy work many of us are engaged in. By examining this study, we can gain valuable insights into how our community is perceived by ‘experts’ in the field and the directions in which research and support may be heading.
Study Background
The study takes the form of a moderated roundtable discussion, bringing together a diverse group of eight ‘experts’ in the field of autism and gender diversity. This format allows for a dynamic exchange of ideas and perspectives, creating a rich and nuanced exploration of the topic. The discussion was led by Dr. John Strang, a clinical neuropsychologist and director of the Gender and Autism Program at Children's National Hospital.
The participants represent a wide range of expertise and backgrounds. They include clinicians, researchers, community advocates, and individuals with lived experience as autistic and/or transgender people. Among them are Dr. Wenn Lawson, an autistic transgender psychologist and advocate; Dr. Harriette Wimms, a clinical psychologist focusing on neurodivergent and LGBTQ+ individuals; and Dr. Anna van der Miesen, a medical doctor specialising in child and adolescent psychiatry. Other participants bring expertise in areas such as developmental psychology, somatic psychotherapy, and clinical research.
The roundtable covered a broad spectrum of key topics related to the intersection of autism and transgender identities. These included the authenticity of co-occurring autistic and transgender identities, the impact of increased societal attention on this intersection, and the challenges faced by autistic transgender individuals in accessing appropriate care. The experts also discussed current research findings, including neurobiological insights and gender identity development in autistic individuals. They explored the implications of these findings for clinical practice and advocacy efforts. Additionally, the discussion touched on the importance of involving autistic transgender individuals in research and care decisions, the need for a lifespan developmental approach in studying this intersection, and the critical role of intersectionality in understanding diverse experiences within this community.
Major Findings and Discussions
The roundtable discussion yielded several significant findings and insights into the intersection of autism and transgender identities. One of the most prominent themes was the affirmation of the authenticity of co-occurring autistic and transgender identities. The experts emphasised that this intersection represents a natural aspect of human diversity, challenging notions that autistic individuals might be confused about their gender identity. Dr. Aimilia Kallitsounaki’s research, for instance, demonstrated that autistic transgender adults show implicit gender identities consistent with their affirmed gender, similar to non-autistic transgender individuals.
The experts also addressed prevalent misconceptions and stigma surrounding this intersection. They highlighted how societal biases and lack of understanding often lead to doubts about the validity of autistic individuals' gender experiences. Dr. Kate Cooper’s qualitative research with autistic gender-diverse youth and adults revealed strong self-assertion of gender identities, countering assumptions of confusion or indecision. The discussion emphasised the need to take autistic transgender people’s self-reported experiences seriously, rather than dismissing them due to their neurodivergence.
Neurobiological insights provided further support for the authenticity of this intersection. Dr. Strang referenced research showing that autistic transgender individuals exhibit brain functional connectivity profiles consistent with established characteristics of autism, whilst their gender-related patterns align with those of non-autistic transgender people. These findings offer a biological basis for understanding the co-occurrence of autism and gender diversity.
The increased societal attention on this intersection was noted to have both positive and negative impacts. On one hand, it has raised awareness and potentially improved access to support and resources. Dr. van der Miesen pointed out that more clinicians are now aware of this intersection and are more likely to inquire about gender identity when working with autistic individuals. However, the ‘experts’ also cautioned about the risks of oversimplification and polarisation in public discourse. They stressed the importance of maintaining nuance in discussions and research, acknowledging the complexity and diversity of experiences within this intersection.
Clinical and Practical Implications
The roundtable discussion yielded several important clinical and practical implications for supporting autistic transgender individuals. A key recommendation was the implementation of inclusive and accessible gender care practices. The participants emphasised the need for universal design principles in gender care settings to accommodate the diverse needs of autistic individuals. This approach involves creating environments and protocols that are sensitive to sensory issues, communication differences, and executive functioning challenges that many autistic people experience. Dr. Meng-Chuan Lai highlighted the importance of personalised care, stressing that a person's capacity for informed consent should not be determined solely by their autism diagnosis.
The participants unanimously underscored the critical importance of involving autistic transgender individuals in all aspects of research and care decisions. This participatory approach ensures that the lived experiences and unique perspectives of autistic transgender people inform study designs, clinical protocols, and policy recommendations. Mx. Finn Gratton advocated for autistic and academic collaborative research initiatives, with autistic transgender individuals, particularly those from BIPOC communities, in leadership positions. This approach not only enhances the relevance and effectiveness of research but also empowers the community.
Addressing disparities in access to care and support emerged as a crucial concern. Dr. Wimms highlighted the intersectional challenges faced by autistic transgender individuals, particularly those from racial and ethnic minority backgrounds. She pointed out the delays in autism diagnosis and support for children of colour, which can have long-lasting impacts on access to appropriate gender care. They called for targeted efforts to improve access to both autism-related services and gender-affirming care for marginalised communities. They also emphasised the need for long-term care planning and support systems for autistic transgender adults, recognising that both autism and gender-related needs persist throughout the lifespan.
The discussion also touched on the importance of training healthcare providers to better understand and support autistic transgender individuals. This includes developing cultural competence not only in gender diversity but also in neurodiversity, ensuring that clinicians can provide affirming and effective care that respects both aspects of an individual’s identity.
Future Directions
The participants outlined several crucial directions for future research and advocacy in the field of autism and gender diversity. A primary focus was the need for more extensive research on adult autistic transgender individuals, an area that has been relatively understudied compared to youth populations. Dr. Lawson emphasised the importance of investigating the long-term medical and social needs of this group, particularly as they age. The roundtable also highlighted the necessity of adopting a lifespan developmental approach in research. Dr. van der Miesen stressed that human development continues throughout adulthood, and understanding the evolving needs and experiences of autistic transgender individuals over time is crucial. Additionally, they unanimously called for greater attention to intersectionality in future studies. Dr. Wimms pointed out the critical need to include diverse ethnoracial perspectives and examine how factors such as race, ethnicity, and socioeconomic status intersect with autism and gender diversity. This intersectional approach is vital for developing more comprehensive and equitable support systems and policies that address the complex realities of autistic transgender individuals from all backgrounds.
Critical Analysis
This roundtable discussion demonstrates several significant strengths. The diversity of ‘expert’ perspectives, including researchers, clinicians, and individuals with lived experience, provides a comprehensive and multifaceted view of the intersection between autism and transgender identities. This approach allows for a rich exploration of the topic, balancing academic insights with real-world experiences. The study’s comprehensive coverage, touching on everything from neurobiological research to clinical practices and social implications, offers a holistic understanding of the complexities involved.
However, the study also has limitations. Whilst it acknowledges the importance of intersectionality, there could be more in-depth exploration of how factors like race, socioeconomic status, and cultural background specifically impact autistic transgender individuals. Additionally, whilst the participants discuss the need for research on adults, there’s still a noticeable focus on youth experiences, reflecting a broader trend in the field.
From my perspective as an autistic trans woman, this study’s findings are deeply relevant to our community. The affirmation of the authenticity of co-occurring autistic and transgender identities is particularly validating. It’s refreshing to see researchers and practitioners challenging the misconceptions and stigma we often face, rather than perpetuating them.
Notably, the discussion seems to lean more towards a social model of disability, emphasising the need for society and healthcare systems to adapt to the needs of autistic transgender individuals, rather than viewing autism or gender diversity as problems to be “fixed.” This aligns with the neurodiversity paradigm and is a welcome shift from more pathologising approaches.
The experts’ call for involving autistic transgender individuals in research and care decisions is crucial. Too often, research about us is conducted without us, leading to misguided conclusions or irrelevant focuses. We need more discussions like this one, where our perspectives are centered and valued.
It’s particularly important to note the contrast between this type of research and the abundance of studies aimed at “correcting” autistic or transgender traits or finding drug “therapies” to make us more “normal.” This roundtable’s approach, focusing on understanding and supporting our authentic selves rather than changing us, is the direction research in this field should take.
Moving forward, it’s essential that these types of discussions drive research priorities and clinical practices. By centering the voices and experiences of autistic transgender individuals, we can ensure that future studies and support systems truly meet our needs and enhance our well-being, rather than trying to mold us into neurotypical or cisgender norms.
Final thoughts …
This groundbreaking discussion offers several key takeaways that significantly impact our understanding of the intersection between autism and transgender identities. The participants’ affirmation of the authenticity of co-occurring autistic and transgender identities, their emphasis on person-centred care, and the call for greater involvement of autistic transgender individuals in research and clinical decisions are particularly noteworthy. These insights have profound implications for the autistic transgender community, potentially leading to more affirming healthcare practices, improved support systems, and a greater societal understanding of our experiences.
For readers looking to engage with this information, consider advocating for the implementation of these findings in local healthcare settings, educational institutions, and community organisations. Share this research with healthcare providers, educators, and policymakers to promote more inclusive and informed approaches to supporting autistic transgender individuals.
It’s important to note that this study was conducted without direct funding support, which offers a degree of independence from institutional agendas or biases. This independence can lead to more authentic and community-centred discussions. However, it also highlights a significant challenge: the costs associated with organising and publishing such discussions must be covered somehow, often through institutional support or personal contributions from the people involved.
This financial reality may limit the occurrence of such valuable discussions to regions with more resources, primarily in the Global North. As a result, perspectives and experiences from the Global South or less resourced areas may be underrepresented in the academic discourse on autism and gender diversity. Moving forward, it’s crucial to find ways to support and amplify diverse voices in this field, ensuring that the full spectrum of autistic transgender experiences is represented in research and policy discussions.