Gender Identity in People with Autism

Background:

Females have traditionally been under-represented in autism research, and recently there has been increased interest in sex differences in autism. A related area of significance is gender identity, defined as the label an individual gives their gender, and gender identification, defined as social affiliation with members of one’s gender group. There is evidence that people with autism are more gender variant compared to typically developing people, and they may therefore have lower gender identification. Further, autism identification (sense of affiliation with others with autism) may be lower in women with autism who are in the minority compared to men with autism. Social identification is frequently associated with psychological well-being, and so differences in autism and gender identification could have implications for mental health outcomes.

Objectives:

This study used well-validated measures which have not yet been applied to the autism population to investigate sex differences in autism identification, gender identity and gender identification, as well as comparisons to controls. A further aim was to investigate the relationship between autism and gender identification and psychological well-being.

Methods:

A total of 539 adults participated, including participants with autism (129 women and 143 men) and typically developing controls (143 women and 114 men). Participants reported having been diagnosed with an Autism Spectrum Disorder. Participants completed a survey online that included demographic information and self-report measures of gender identity, gender identification, autism identification and psychological well-being (self-esteem, depression and anxiety measures). Data was analysed using Chi-square, Pearson’s correlation and 2x2 MANOVAs (sex by autism).

Results:

People with autism were significantly less likely to be gender congruent (have a gender identity congruent with sex assigned at birth; χ²=45.98, p<.001), and significantly more likely to be gender dysphoric (have intent to change from their sex assigned at birth; χ²=12.40, p<.001) than controls. Women with autism had lower gender congruence χ²=150.24, p<.001 and higher gender dysphoria χ²=11.85, p=.001 compared to men with autism. As predicted, people with autism had lower gender identification than controls F(1,535)=149.49, p<.001. Contrary to the predicted outcome men and women with autism had equivalent scores in gender and autism identification. People with autism had significantly lower self-esteem F(4,527)=29.34, p<.001 and higher depression F(4,527)=38.77, p<.001 and anxiety F(4,527)=46.20, p<.001 scores compared to controls. Gender identification was positively associated with self-esteem R=.195, p=.001 and negatively associated with depression R=-.311, p<.001 and anxiety R=-.240, p<.001. Autism identification was positively associated with self-esteem R=.174, p<.01. 

Conclusions:

People with autism experience differences in their gender identity and gender identification as compared to the typically developing population. Women with autism have more varied gender identities compared to men with autism, although both groups had equivalent levels of gender and autism identification. Poor gender identification is associated with poor mental health outcomes, with females at most risk due to their increased gender variance. However, while autistic participants reported poorer mental health than average, having a positive autism social identity appeared to offer a protective mechanism and is therefore a potential target for intervention.