These answers draw in part from “Gender: Embracing Inclusivity” by Kimberly Shamoun, BCBA-D, Licensed Psychologist in NY (BehaviorLive), and extend it with peer-reviewed research from our library of 27,900+ ABA research articles. Clinical framing, BACB ethics code references, and cross-links below are synthesized by Behaviorist Book Club.
View the original presentation →Research, including a 2020 study in Nature Communications, has documented higher rates of autistic traits among transgender and gender-diverse individuals, and higher rates of gender diversity among autistic individuals, compared to the general population. Several hypotheses have been proposed to explain this association, including the possibility that autistic individuals are less influenced by social norms around gender and thus more likely to explore and express diverse gender identities. Regardless of mechanism, the practical implication for behavior analysts is that gender diversity will be encountered more frequently in autism-serving caseloads than population base rates might suggest.
Pronoun instruction should reflect the actual diversity of pronoun usage in the client's social environment. Traditional programs teaching only he/she provide incomplete language instruction in communities where they/them pronouns are used. Begin with assessment of the client's current pronoun repertoire and the pronoun usage patterns in their environment. Include they/them alongside binary pronouns in the instructional sequence. Use examples that do not reinforce rigid associations between gender presentation and pronouns. This approach teaches accurate language use while respecting gender diversity, serving the dual goals of language acquisition and social competence.
Targeting gender-nonconforming behavior for reduction raises serious ethical concerns. The BACB Ethics Code requires that interventions serve the client's best interest and respect their dignity. Gender expression that does not cause harm to the individual should not be targeted for reduction simply because it causes discomfort to others. The field's historical use of behavior analysis to modify gender expression in children has been widely recognized as harmful. If safety concerns exist in specific contexts, the intervention should address safety without suppressing gender expression, such as teaching context discrimination rather than eliminating the behavior entirely.
Agencies should audit and revise intake forms to include gender identity options beyond male/female, add preferred name and pronoun fields, and use inclusive language throughout documentation. Staff training should cover gender diversity terminology, correct pronoun usage, and the clinical rationale for inclusive practices. Hiring processes should include explicit nondiscrimination policies referencing gender identity and expression. Social skills curricula and assessment tools should be reviewed for binary gender assumptions. Bathroom and dress code policies should accommodate all gender identities. These structural changes signal genuine inclusion rather than superficial acknowledgment.
Early behavioral research explicitly targeted gender-nonconforming behavior in children for modification, using reinforcement for gender-typical behavior and punishment for gender-atypical behavior. Individuals subjected to these interventions have described lasting psychological harm. This history creates a responsibility for contemporary practitioners to ensure their current practices do not replicate these harms in subtler forms, such as through gendered social skills targets or reinforcement contingencies that inadvertently strengthen gender-conforming behavior. Awareness of this legacy informs a more careful, dignity-centered approach to any clinical situation involving gender expression.
When a child's expressed gender identity differs from how parents identify the child, behavior analysts face a complex situation requiring sensitivity and clear ethical reasoning. Begin by listening to both the child and the family. Provide information about gender diversity and the research on the autism-gender overlap. Prioritize the client's welfare while respecting the family's role in decision-making. Where applicable, follow legal protections for the child's gender identity. Document all conversations and decisions. Seek consultation from ethics resources and professionals with expertise in gender diversity. Avoid defaulting to either position without careful consideration of all factors.
Gender-inclusive social skills instruction avoids teaching different behavioral expectations based on gender, uses gender-neutral language where appropriate, includes diverse relationship models in examples, and teaches flexible rather than prescriptive social behavior. Instead of teaching boys to shake hands and girls to hug, teach all clients a range of greeting options appropriate to different social contexts. Instead of using exclusively heteronormative relationship examples, include diverse partnerships. Instead of segregating social skills groups by gender, create mixed groups with curricula that do not assume participants share the same gender identity or expression.
Using correct pronouns is a professional competency, not a matter of personal preference. Supervisors should address resistance directly, providing information about the clinical and ethical rationale for inclusive language use, the impact of misgendering on client welfare and rapport, and the organizational expectation for pronoun accuracy. If a supervisee's discomfort persists after education and support, the supervisor should document the competency concern and consider whether it affects the supervisee's ability to provide quality services. Pronoun usage should be included in competency assessments alongside other professional behaviors.
Currently, very few assessment tools have been specifically designed or validated for gender-diverse individuals with autism. Most standardized instruments in behavior analysis use binary gender categories and were normed on cisgender populations. Behavior analysts should be aware of these limitations when interpreting results. Practical strategies include using criterion-referenced measures when possible, selecting norms that match the client's gender identity rather than assigned sex, and supplementing standardized assessments with individualized procedures that do not impose gender assumptions. The field needs investment in developing and validating inclusive assessment tools.
Asking pronouns during hiring signals that the organization acknowledges gender diversity and values inclusive communication. However, this single gesture is insufficient if the organizational culture does not consistently reinforce inclusive practices. Consistent pronoun usage by all staff, policies protecting gender-diverse employees from harassment, benefits that cover gender-affirming healthcare, bathroom access aligned with gender identity, dress codes that do not impose gender norms, and leadership that models inclusive behavior are all necessary components. Without these supporting structures, asking pronouns becomes performative rather than substantive, and may actually increase cynicism among gender-diverse employees and clients.
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Gender: Embracing Inclusivity — Kimberly Shamoun · 1 BACB Ethics CEUs · $25
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.