Increased Rates of Gender Identity Issues Among Children and Adolescents with Autism Spectrum Disorders

Background:  Seven case reports have described patients with co-morbid gender identity and autism spectrum disorders (ASDs; e.g., Gallucci et al., 2005; Tateno et al., 2008).  A recent study reported high rates of ASDs among children and adolescents referred to a major gender identity clinic in the Netherlands (de Vries et al., 2010).  Over-representation of ASDs in gender identity referrals has been discussed by clinicians at several U.S. gender identity clinics (clinical reports by Children’s National Medical Center’s Gender and Sexuality Development Program, Boston Children’s Hospital’s Gender Management Service, and Johns Hopkins University Hospital’s Sexual Behavior’s Unit).  To date, reports have originated from gender identity clinics describing ASDs within gender patient referrals.  This is the first study to examine rates of gender identity issues among children and adolescents with ASDs.  

Objectives:  The current study examines rates of parent reported atypical gender behaviors among children and adolescents with ASDs as compared to normative and comparative samples.  Given observations of increased rates of ASDs among clients with gender identity issues, we hypothesize that rates of gender issues will be greater among people with ASDs.

Methods:  Children and adolescents with ASDs (n=136), typically developing controls (n=166), and a medical comparison group consisting of children and adolescents with epilepsy or neurofibromatosis type I (n=116) participated in the study.  Subject data from the non-referred standardization sample of the Child Behavior Checklist (CBCL) (Achenbach & Rescorla, 2001) was used to create an additional comparison group (n=1605).  Rates of endorsement of the CBCL gender identity item (item 110), “Wishes to be of opposite sex” are reported as percentage endorsement, and Mann Whitney U tests are used to compare levels of endorsement between groups.  

Results:  Rate of endorsement of atypical gender behaviors (CBCL Item 110) in children and adolescents with ASDs was more than 7 times greater than in the non-referred comparison sample (CBCL sample) and three times greater than in the medical comparison group.  There was no endorsement of gender identity issues in our control group.  Percentage endorsement of CBCL Item 110 was 5.1% for the ASD group, 0.7% for the non-referred comparison sample (CBCL sample), 1.7% for the medical comparison group, and 0% for the control group.  Mann Whitney U tests showed significantly higher endorsement of gender identity symptoms in the ASD group than the non-referred CBCL comparison sample, U = 104336.00, p < .001 as well as the control group, U = 10707.00, p = .003. 

Conclusions:  Findings support the hypothesis of increased rates of atypical gender behaviors or gender identity issues among young people with ASDs compared to non-referred controls.  Taken with previous case reports of co-morbid gender identity issues and ASDs and a 2010 study reporting increased rates of ASDs among gender identity referrals, this study indicates the importance of further inquiry into this co-morbidity, including the clinical implications for clients who struggle with both gender and autism-related difficulties.