Research on the overlap between autism and gender diversity—a term used to define those who, either by nature or choice, do not conform to conventional gender-based expectations—is a relatively new field. Earlier this year, Spectrum, a website dedicated to in-depth analyses of autism research, published an extensive investigation that explores this relatively untrodden ground, explaining that over the past five years, there have been only a handful of studies that trace a co-occurrence between the autism and gender diversity. In one of the first major studies, carried out in Holland, researchers examined 204 children and adolescents who identified as gender-dysphoric—a condition where a person experiences discomfort or distress due to a mismatch between their biological sex and gender identity—and found a 7.8 percent prevalence of autism.
Researchers in the field have speculated about the reasons behind this co-occurrence, but the social and cultural implications of this correlation are proving problematic for trans, autistic communities. Some health-care professionals are now telling trans individuals on the autism spectrum that the need to transition is a result of their autism—a classic misreading of causation versus correlation. And, as in Clarke’s case, the mistake appears to be limiting access to medical care.
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The way that the relationship between gender diversity and autism is perceived stems from autism’s gendered history. The disorder has long been referred to as a predominately male condition—think of the portrayal of Raymond in Rain Man as the male, autistic savant. More than a decade ago, Simon Baron Cohen, the director of the University of Cambridge’s Autism Research Centre, hypothesized that autism was a symptom of the “extreme male brain.”
Defining autism in this way has led to issues with the diagnosis of women and girls. In 2009, a survey found that 1.8 percent of men and boys in England had a diagnosis of autism, compared to 0.2 percent of women and girls. However, recent studies speculate that many women and girls with autism are never referred for diagnosis, and so are simply missing from statistics, even though they could equally be in need of support. Since this 2009 survey, the National Autistic Society’s Lorna Wing Centre for Autism, in the United Kingdom, has placed an emphasis on the different manifestations of behavior in autism as seen in women and girls compared with men and boys, and it has seen a steady increase in the number of women and girls referred for diagnosis.
While this shift has ensured many cisgender women are now finding diagnoses, approaching autism in strictly male/female terms has still largely excluded gender-diverse people from the conversation.
There are case studies of gender diversity on the autism spectrum dating back to 1996, but the first study to assess the convergence of autism and “gender dysphoria” was published just six years ago. Since this point, there have been several studies, with a watershed moment occurring for the world of autism research in 2014. John Strang, a neuropsychologist in the Center for Autism Spectrum Disorders at Children's National Medical Center, in Washington, D.C., assessed gender diversity in children with autism, rather than measuring the incidence of autism among gender-dysphoric children and adolescents as the previous studies had done. The study found that participants on the autism spectrum were 7.59 times more likely to “express gender variance.”