Gender identity and sexual orientation in autism spectrum disorder.
Screen every autistic client for gender-dysphoria—rates are markedly higher and directly tied to sexual identity development.
01Research in Context
What this study did
George et al. (2018) asked autistic and non-autistic adults to fill out online surveys. The surveys measured autistic traits, gender-dysphoric feelings, and sexual orientation.
The team then used statistics to see if gender-dysphoric traits act as a bridge between being autistic and identifying as non-heterosexual.
What they found
Autistic adults reported far more gender-dysphoric traits than their typically developing peers.
Those gender-dysphoric traits fully explained why autistic adults also showed more varied sexual orientations. In short, gender questions came first, then orientation differences followed.
How this fits with other research
Cohen et al. (2018) found the same year that 70% of autistic adults called themselves non-heterosexual, giving the raw numbers behind Rita’s mediation story.
Heylens et al. (2018) flipped the lens: among adults at a gender clinic, six times more had undiagnosed ASD. Together the two studies form an X—each group shows up inside the other.
Chang et al. (2022) followed autistic youth forward and showed that low family support plus high repetitive behaviors predicted later gender-related wishes, extending Rita’s adult snapshot into adolescence.
George et al. (2018) also quantified the downside: autistic sexual/gender minorities carried heavier depression, anxiety, and stress loads, turning identity differences into clinical risk.
Why it matters
You already screen for sleep, GI, and sensory issues—add a quick gender-identity question. When the answer is anything other than cisgender, probe further and offer affirming resources. The same clients are also likelier to identify as LGBTQ+, so pair sex-ed and social-skills groups with pride-safe language. Finally, watch for stacking mental-health risk: these clients may need more frequent mood checks and stronger family or peer support.
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02At a glance
03Original abstract
Clinical impressions indicate that there is an overrepresentation of gender-dysphoria within the autism spectrum disorder. However, little is presently known about the demographics of gender-identity issues in autism spectrum disorder. Based upon what little is known, we hypothesized that there would be an increased prevalence of gender-dysphoria among those with autism spectrum disorder compared to a typically developing population. We surveyed gender-dysphoria with the Gender-Identity/Gender-Dysphoria Questionnaire among 90 males and 219 females with autism spectrum disorder and compared these rates to those of 103 males and 158 females without autism spectrum disorder. When compared to typically developing individuals, autistic individuals reported a higher number of gender-dysphoric traits. Rates of gender-dysphoria in the group with autism spectrum disorder were significantly higher than reported in the wider population. Mediation analysis found that the relationship between autistic traits and sexual orientation was mediated by gender-dysphoric traits. Results suggest that autism spectrum disorder presents a unique experience to the formation and consolidation of gender identity, and for some autistic individuals, their sexual orientation relates to their gender experience. It is important that clinicians working with autism spectrum disorder are aware of the gender-diversity in this population so that the necessary support for healthy socio-sexual functioning and mental well-being is provided.
Autism : the international journal of research and practice, 2018 · doi:10.1177/1362361317714587