A comprehensive study involving more than 600,000 individuals revealed that people who do not identify with the sex they were assigned at birth are three to six times more likely to be autistic than cisgender people. Gender-diverse individuals are also more likely to exhibit traits of autism and suspect they have undiagnosed autism.
Researchers define ‘gender diverse’ as an umbrella term for individuals whose gender identities, such as transgender, nonbinary, or gender-queer, differ from the sex they were assigned at birth. ‘Cisgender’ or ‘cis’ refers to individuals whose gender identity matches their assigned sex.
The study analysed five unrelated databases that contain information on autism, mental health, and gender. According to Varun Warrier, a research associate at the University of Cambridge and study investigator, “All these findings across different datasets tend to tell a similar story.”
Previous research showed that autistic people are more likely than neurotypical individuals to be gender diverse, and gender-diverse individuals are more likely to have autism than cisgender individuals. However, most prior studies focused on people seeking gender-related medical care, such as for gender dysphoria, which does not represent the full spectrum of gender-diverse individuals. Aron Janssen, an associate professor of psychiatry and behavioural sciences at Northwestern University, emphasises the importance of studying this connection outside clinical contexts, providing a more accurate understanding of the overlap.
Gender and Autism
The combined datasets include 641,860 people, mostly adults, with 30,892 diagnosed as autistic and 3,777 identifying as gender diverse. The largest dataset, comprising about 514,000 participants, originated from a 2017 online survey conducted for a BBC documentary about autism.
These datasets used online questionnaires with varied options for sex and gender, including terms like ‘nonbinary’ and ‘other.’ About 5 percent of cisgender participants in the study are autistic, compared to 24 percent of gender-diverse participants.
Gender-diverse individuals report, on average, more autism-associated traits, such as sensory difficulties, pattern recognition skills, and lower ability to identify emotions—defined as accurately understanding and responding to another person’s emotional state. One dataset showed that gender-diverse individuals are five times more likely to suspect they have undiagnosed autism compared to cis individuals.
The findings, published in Nature Communications, also examine the link between gender identity and six mental health conditions, including schizophrenia, depression, and ADHD. Gender-diverse individuals have higher rates of these conditions, with the strongest association observed between autism and depression.
Clinical Implications
The study confirms trends identified in smaller studies, suggesting a need for clinicians and educators to discuss gender identity with autistic individuals and recognise the mental health impacts of ‘minority stress’—the difficulties faced by marginalised groups. Being both autistic and gender-diverse can exacerbate such stress.
Clinicians and practitioners in autism and gender identity fields must recognise this association to provide better mental health support. Nearly 70 percent of autistic gender-diverse adolescents in a 2018 study reported needing gender-related medical care, with 32 percent having their gender identity questioned due to autism diagnosis.
Warrier emphasises that having strong gender dysphoria and wanting to transition should not be delayed by trying to ‘cure’ autism. The study highlights that both identities can coexist, advocating for the necessity of understanding and supporting both.
Gender Identity, Prejudice, and Neurodivergence
Neurodivergent individuals often face significant obstacles to accessing gender-affirming healthcare. A 2018 study revealed that one-third of respondents had their gender identity questioned due to their autism. This prejudice assumes neurodivergent individuals lack the competence to understand their own sexuality or gender identity, leading to the under-diagnosis of neurological conditions within the LGBTQIA+ community.
The overlap between neurodivergent and queer communities may stem from neurodivergent individuals’ tendency to be less aware of or inclined to follow societal norms. In a binary society where heterosexual and cisgender identities are the default, neurodivergent individuals may feel more liberated to express their gender or sexuality without fear of judgment.
To achieve greater acceptance of neurodivergent individuals, society must also embrace non-traditional sexualities and gender identities. These experiences are closely linked, as both neurodivergent and LGBTQIA+ individuals often face the challenge of repeatedly ‘coming out’ to new people, which can lead to feelings of shame. Despite progress, some still view autism and being gay as conditions to be ‘cured,’ contributing to higher rates of mental health issues. However, acceptance brings joy and strength as the world slowly evolves. We remain dedicated to fostering a society that fully values the contributions of both neurodiverse and LGBTQIA+ communities.
References
Dattaro, L. (2020, September 14). Largest study to date confirms overlap between autism and gender diversity: People who do not identify with the sex they were assigned at birth are three to six times as likely to be autistic as cisgender people are. The Transmitter. https://doi.org/10.53053/WNHC6713
Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., Allison, C., & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature communications, 11(1), 3959. https://doi.org/10.1038/s41467-020-17794-1
Walsh, R. J., Krabbendam, L., Dewinter, J., & Begeer, S. (2018). Brief Report: Gender Identity Differences in Autistic Adults: Associations with Perceptual and Socio-cognitive Profiles. Journal of autism and developmental disorders, 48(12), 4070–4078. https://doi.org/10.1007/s10803-018-3702-y
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George, R., & Stokes, M. A. (2018). A Quantitative Analysis of Mental Health Among Sexual and Gender Minority Groups in ASD. Journal of autism and developmental disorders, 48(6), 2052–2063. https://doi.org/10.1007/s10803-018-3469-1
Strang, J. F., Powers, M. D., Knauss, M., Sibarium, E., Leibowitz, S. F., Kenworthy, L., Sadikova, E., Wyss, S., Willing, L., Caplan, R., Pervez, N., Nowak, J., Gohari, D., Gomez-Lobo, V., Call, D., & Anthony, L. G. (2018). “They Thought It Was an Obsession”: Trajectories and Perspectives of Autistic Transgender and Gender-Diverse Adolescents. Journal of autism and developmental disorders, 48(12), 4039–4055. https://doi.org/10.1007/s10803-018-3723-6
Anderson, J. (n.d.). LGBTQIA+ and neurodiversity: The links between neurodivergence and being LGBTQ+. The Brain Charity. https://www.thebraincharity.org.uk/lgbtqia-neurodiversity-neurodivergent-lgbtq/
