J Autism Dev Disord. 2018 Dec;48(12):3973. doi: 10.1007/s10803-018-3735-2.
van Schalkwyk GI1.
1Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA. Gerrit_Van_schalkwyk@brown.edu.
The intersection of gender diversity and neurodiversity is a focus of considerable interest, discussion, and research. As reflected in the contents of this special issue, literature has explored this intersection both clinically and conceptually. The opinions, integrations, and new data presented in this volume support the presence of a complex relationship between gender diversity and neurodiversity, but suggest that the common framing of gender dysphoria and autism spectrum disorder being ‘comorbid’ is limited. As described in the letter by Diane Ehrensaft, individuals who are both gender and neurodiverse bring to life new conceptualizations of gender as fluid and intersectional. This articulates with the hypothesis that gender diversity is an expected outcome in individuals who are less contingent on social information for identity development. Correspondingly, Jack Turban argues as to the potential for gender diverse youth to have reversible challenges with social functioning related to their experience of minority stress, potentially limiting the value of screening and diagnostic instruments to make strict, categorical statements.
The important work by Nobili et al. is unique in this literature by its inclusion of a control group—remarkably, autism caseness based on Autism Quotient scores was found to be comparable in both the transgender and cisgender group, although the subgroup of transgender individuals assigned female at birth were twice as likely to have clinically significant scores. Consistent with the argument made by Turban, this difference was related mainly to the presence of additional social difficulties in this group, highlighting both the limitations of screening instruments, and the need for more detailed conceptualizations that better capture the complexity of these youths’ experience and identity.
Where better to start than with the individuals themselves? Strang et al. describe a remarkable study that sought to understand the experience of gender in youth with diagnoses of Autism Spectrum Disorder through an in-depth qualitative approach. The participants are given a clear voice in a study that emphasized the challenges of both defining and communicating gender identity for neurodiverse youth, and the need for clinicians to create supportive spaces in which this can occur. Participants showed discomfort at simplistic reframing of their gender as a superficial ‘obsession,’ describing an altogether different and more complex character for their gender experiences.
Additional manuscripts in this issue describe a range of related issues, including sexual orientation, gender differences and ASD symptoms, and gender preferences in friendships for children with ASD. Overall, this special issue touches on key themes at the intersection of gender and ASD and should prove to be an invaluable resources to clinicians and researchers hoping to further their understanding in this area. It is clear that gender is an important issue in understanding neurodiversity, and that individuals who are neurodiverse may place importance on gender. Further work is needed to understand how these individuals may be best supported, but enough is known to provide a clear impetus for a clinical approach rooted in the knowledge that neurodiverse youth may have complex gender narratives that warrant affirmation and support.