Co-Occurrence of Autism Spectrum Disorders in Individuals with Gender Dysphoria

Background: Clinical experience suggests that the co-occurrence of gender dysphoria and autism spectrum disorders (ASD) is not a rare phenomenon; it occurs more frequently than one would expect by chance. To date, however, only case studies have been published and authors have very different views on how to understand the co-existence of ASD and gender dysphoria.

Objectives: This study seeks (1) to examine the incidence of ASD in individuals with gender dysphoria in a gender identity clinic, and (2) to gain more insight in the relation between ASD and gender dysphoria.

Methods: From April 2004 to December 2007, all children and adolescents referred to the Amsterdam Gender Identity Clinic were screened for ASD features. Referred individuals received a standardized clinical evaluation, consisting of a psychodiagnostic assessment, interviews with the child or adolescents, interviews with the parents about developmental history and current functioning, and information from the teacher. When an ASD was either suspected or previously diagnosed, the Dutch version of the Diagnostic Interview for Social and Communication Disorders-10th revision (DISCO-10; Wing, 1999; Dutch version: van Berckelaer-Onnes et al., 2003) was administered from the caregivers. In addition, the DISCO-10 was administered from the caregivers of seven young adults (all males, age 19-25) who were referred to the gender identity clinic and either had a histery of ASD or were suspected to suffer from ASD.

Results: Preliminary results indicate that at least 6 % of the 233 referred children and adolescents has an ASD. This percentage remains almost the same for the referrals with a confirmed Gender Idenity Disorder (GID) or Gender Identity Disorder-Not Otherwise Specified (GID-NOS) diagnosis. The group of individuals with ASD and GID (seven adults included) is heterogeneous in various respects: sex (both male and female), GID classification (GID, GID-NOS, transvestic fetishism), ASD classification (AD, Asperger syndrome, PDD-NOS), age of onset of GID (before or after puberty), and developmental trajectory (cross-sex behavior temporary or persistent).

Conclusions: The results of this study indicate clearly that the co-occurence of ASD and gender dysphoria is a frequent occasion. The developmental trajectories of individuals with ASD and GID very considerably and thus require a differentiated clinical approach.