Current research indicates that autistic people have higher rates of LGBT identities and feelings than the general population. [1] [2] [3] A variety of explanations for this have been proposed, such as prenatal hormonal exposure, which has been linked with both sexual orientation, gender dysphoria and autism. Alternatively, autistic people may be less reliant on social norms and thus are more open about their orientation or gender identity. A narrative review published in 2016 stated that while various hypotheses have been proposed for an association between autism and gender dysphoria, they lack strong evidence. [4]
A study of autistic LGBT people in the US report more unmet health care needs than their peers, especially in places with fewer protections for LGBT health care. [5]
Early claims that autistic people lack a sex drive or desire for sexuality have been regarded as an inaccurate and negative stereotype. [6] [7] [8] These claims were a result of methodological problems. More recent evidence indicates that most autistic people express an interest in both romance and sexuality. [8]
Autistic people are less likely to identify as heterosexual than their non-autistic counterparts. [9] [3] [10] Some attempt to explain this as part of an association between autism, prenatal hormones, and sexual orientation. [11] [12] [8] That is not the only proposed explanation, however. [2] While there is a broad consensus that autistic people are substantially less likely to be heterosexual than the general population and to belong to gender minorities, there is great variation in estimates of the size of these effects, [13] and most research suggests that the majority of autistic people are heterosexual. [14] Studies on sexual orientation and autism suggest that more autistic people have homosexual and bisexual feelings compared to the general population. [6] [15] Studies have indicated higher incidence of asexuality among autistic people, though a 2019 review article stated that this "should be interpreted with caution, bearing in mind the difficulty of establishing social relations in persons with ASD." [16] Similarly, a survey of asexual individuals found that about 7% to 8% of respondents had acquired an autism diagnosis, approximately 4 times larger than the American population estimate. [17] [18] [19] [20]
The decreased incidence of heterosexuality in the autistic population is present when measuring for self-reported sexual orientations, behaviors, and interests alike. [21]
Some studies have indicated that autistic women have lower rates of heterosexual orientation than autistic men do. [22] [21] This was also corroborated by an online survey conducted by the University of Cambridge and published in Autism Research . That survey suggested that autistic women had a wider range of sexual identification than both non-autistic women and autistic men. Younger respondents had a higher likelihood for reporting themselves as homosexual than did older respondents. [23] According to a 2021 review, some studies indicated that autistic women were about three to four times as likely to be bisexual when compared to non-autistic women. [21]
Autistic people are more likely to exhibit diverse gender identities or gender variance (also known as gender non-conformity) than the general population. [2] [24] : 515 The size of the difference varies significantly based on the methodology of studies and so cannot be said conclusively. [25]
In 2016, researchers published a study that examined gender variance in a sample of 492 children and adolescents that had been diagnosed with an autism spectrum disorder at the New York University's Child Study Center between 2011 and 2015. They analyzed the parents' responses to the Child Behavior Checklist (CBCL) that was administered as part of the initial evaluation of all children at the center. The study, which was reported on in the popular press, [26] concluded that autistic children were seven times more likely to exhibit gender variance than their non-autistic peers. [27]
A study on the gender identity of autistic people (mostly adults) without intellectual disability published in 2018 found that this group, and especially those assigned female at birth, had lower identification with their assigned gender, and lower self-esteem about that gender, than non-autistic controls. In discussing the limitations of their study, the researchers noted that they observed an unusually high occurrence of gender and sexual orientation diversity as well as mental health problems across all participants, which they attribute to a selection bias due to the recruitment of participants through various only channels. [28] A comparable study published in 2020 focused on autistic people (mostly adults) assigned female at birth concluded that these were more likely to identify as transgender compared to a non-autistic control group. [2] [11] Similar to the 2018 study, the researchers cautioned that their recruitment methods likely led to a selection bias, as they observed an unusually high occurrence of non-heterosexual orientations among the non-autistic participants. Further, the number of transgender people in the sample was relatively small. [11]
Some autistic people have non-binary gender identities. Many people feel that autism causes them to have a very different understanding of their gender than is expected of them. [29] [30] Autistic people can struggle to infer social expectations, intentions and abstract concepts which lack tangible rules and reasons, [31] such as socially constructed expectations like gender, which can vary between different cultures. [32] [33]
Some autistic people, including some with non-binary gender identities such as agender, identify their own genders at a young age. However, self-acceptance can be delayed due to the dominant discourse of gender as binary as well as lack of knowledge of the correct language to self-describe. [34]
Some autistic individuals use the term "autigender" to describe the unique experience they have with their sense of gender. [35] Autigender is often incorrectly interpreted as saying that "autism" is one's gender. [30] [36]
Gender dysphoria is a diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disoders (DSM-5, since 2013, revised 2022) given to people who experience discomfort related to their gender identity. [24] : 511–514 The 11th edition of the International Classification of Diseases (ICD-11, since 2022) maintained by World Health Organization describes a similar condition under the term gender incongruence. [37]
Among people diagnosed with gender dysphoria, autism spectrum traits are observed more often than in the general population. [24] : 515 [25] A 2022 meta analysis concluded that there is a high prevalence of gender dysphoria in people diagnosed with an autism spectrum disorder. [25] The authors conclude that the data suggests a link between autism and gender dysphoria, but the nature and scope of the link requires further investigation. [25]
According to the DSM-5-TR, gender dysphoria can be difficult to diagnose in autistic people, as these might think concretely and rigidly around gender roles and/or have difficulties understanding their social context. [24] : 519–520 In 2018, a first proposal for clinical guidelines for co-occurring gender dysphoria and autism was published by a team of psychiatrists from across the US. [38]
While numerous case studies of gender dysphoria in autistic people were reported in the scientific literature, the first study to assess the convergence of gender dysphoria and autism was not published until 2010, [39] [40] when researchers in the Netherlands examined 129 children and adolescents who were diagnosed with gender identity disorder (the precursor to gender dysphoria defined in the DSM-IV) at a gender identity clinic, finding that 6 individuals (4.7%) were also diagnosed as autistic. [41] A 2016 review of the available literature concluded that the prevalence of autism spectrum conditions among children and adolescents diagnosed with gender dysphoria was higher than in the general population. [42] A narrative review published in 2016 concluded that hypotheses regarding the underlying causes lacked evidence. [4]
A 2022 meta analysis concluded that there is a relationship between autistic traits and feelings of gender dysphoria. However, the researchers noted that little is known about autistic traits in those that are non-autistic. [25]
Some studies have noted an overlap between those with autism and those who are transgender. [43] [44] British researchers in 2011 concluded that trans men had more autistic traits than trans women. [45] However, a study by British researchers in 2013 concluded that there was "no significant difference" between trans men and trans women in autistic traits observed. [46] Steven Stagg and Jaime Vincent of Anglia Ruskin University concluded in September 2019 that some of those seeking advice and help for their gender identity may be autistic, whether diagnosed or not, with these abilities impeding possible support, and urged clinicians treating individuals who are transgender or non-binary, especially those assigned female at birth, to consider whether they have undiagnosed ASD. [43] Four researchers in January 2020 suggested "overlap between autism and transgender identity", possibly more in trans men than trans women, and stated that anxiety and depression were the highest in autistic individuals who were transgender. [44] Scientists with the Autism Research Centre at University of Cambridge, using data from 600,000 adults in the UK, concluded in August 2020 that adults who were transgender or gender diverse were three to six times more likely to have an autistic diagnosis than those who were cisgender, and suggested that between 3.5 and 6.5% of transgender and gender diverse adults in the UK are autistic. [47] [48]
Other researchers have noted the prevalence of autistic traits among those who identify as non-binary or genderqueer. [43] Two Warwick University researchers, utilizing data from 446 UK adult respondents, concluded in January 2016 that, based on their sample, genderqueer individuals were more likely to be autistic than any other group with gender dysphoria. [49] [50]
In December 2014, four researchers concluded that being on the autism spectrum does not "preclude gender transition" and suggested methods for assisting such individuals in "exploring their gender identities". [51] One of the study's authors, Katherine Rachlin, said that, sometimes, being transgender can "look like the spectrum experience" to clinicians. [49] In March 2015, a study from researchers at the Yale School of Medicine stated that those on the autism spectrum should be treated equally to other individuals for gender dysphoria, and suggested that clinicians "broaden the social frame" and facilitate an "exploration of gender roles". [52] A Finnish study in April 2015 recommended that the autism spectrum be recognized seriously in developing guidelines for treating "child and adolescent gender dysphoria". [53]
A 2022 survey of gender clinic healthcare clinicians found there were often differences in communication and thinking styles between the clinicians and autistic patients. [54] The study concluded that adaptations should be made, including training for clinicians on working with autistic patients, and adjustments made in the clinical setting. [54]
WPATH SOC Version 8, published in August 2022, states that there is no evidence that withholding gender-affirming care from individuals with neurodevelopmental conditions has any benefit. [55] WPATH SOC 8 further recommends that healthcare professionals working with gender-diverse adolescents receive training and develop expertise in autism spectrum disorder and other neurodevelopmental presentations. [55]
In a 2021 study on autistic camouflaging, gender-diverse autistic adults were found to use more autistic camouflaging than cisgender autistic adults. [56]
A January 2023 study on trans and non-binary adults found that higher autistic traits and higher gender minority stress were correlated with poorer mental health outcomes. [57]
Autistic characters that are part of the LGBTQ community are occasionally depicted in popular culture, whether in literature, animated or live-action series. Some have called for better representation. For instance, in June 2015, author Heidi Cullinan wrote in Spectrum that there is not nearly enough works of fiction with autistic people and even fewer who are part of the LGBTQ community, inspiring them to write a story with a gay autistic protagonist. [58] They also said that autistic people deserve to see themselves in stories, like anyone else. In March 2021, queer autistic novelist Naoise Dolan echoed this in an interview with PinkNews, calling for more visibility, saying that popular culture and art would be improved if "there were more queer autistics out there," along with other groups that are marginalized. [59] She also criticized bad portrayals of autistic characters and expressed her desire to "deliberately write the most counter-stereotypical autistic character possible" in her novel, Exciting Times.
Occasionally, LGBTQ autistic characters appear in literature. For example, a 2015 novel, Carry the Ocean, by Heidi Cullinan, gay protagonist, Jeremey Samon, develops a romantic relationship with an autistic boy named Emmet Washington. [60] Ada Hoffman's 2019 debut novel, The Outside, has a lesbian and autistic protagonist, Yasira Shien, who once had a lover named Tiv. [61] The book's sequel, The Fallen, came out in July 2021, [62] with a reappearance of Yasira, and the book was praised for its "excellent neurodiverse representation." [63] Xan West's 2019 novella, "Their Troublesome Crush," has a character, Ernest, who is openly autistic and demiromantic. West said they wrote the character from their own experience as an autistic demiromantic person. [64] [65] Ernest has been described as "a show tunes–loving submissive," and has a metamour, the partner of his partner, named Nora. [66] Furthermore, Judith, the protagonist of Xan West's 2020 novel, Tenderness, is an "autistic Jewish bisexual midsize fat femme" who has chronic pain. [67] Zack Smedley's 2019 novel, Tonight We Rule the World, tells the story of Owen, a "bisexual high schooler...on the autism spectrum." [68]
Some creators and characters of animated series are autistic and part of the LGBTQ community. The creator of Dead End: Paranormal Park , Hamish Steele, a gay man who is autistic, [69] [70] has said that he incorporated his experiences into characters such as Norma Khan in the show of the same name, [69] who is bisexual and autistic. [71] [72] [73] [74] [75]
Live-action television series have LGBTQ autistic characters as well. For instance, in March 2020, it was announced that the series Everything's Gonna Be Okay was introducing a "queer storyline" for autistic protagonist Matilda, who explores her sexual identity as a pansexual woman, and her friend, Drea, becomes her girlfriend. The show's creator, Josh Thomas, told The Advocate that he likes "having queer people in my show", noted that autistic people have "an extreme emotional vulnerability", and said that is "exciting that people on the spectrum are boldly leading and as far as identity goes." [76] In the course of filming the first season, he realised that he is autistic himself and obtained a formal diagnosis. In the second season his character (a gay man) comes to realise he, too, is autistic. [77] The rebooted Australian series Heartbreak High also features a queer autistic character, Quinni, played by autistic actor Chloé Hayden and written with her input. [78]
Asperger syndrome (AS), also known as Asperger's syndrome, formerly described a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior, interests, and activities. The syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered milder than other diagnoses that were merged into ASD due to relatively unimpaired spoken language and intelligence.
Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder.
Gender identity is the personal sense of one's own gender. Gender identity can correlate with a person's assigned sex or can differ from it. In most individuals, the various biological determinants of sex are congruent, and consistent with the individual's gender identity. Gender expression typically reflects a person's gender identity, but this is not always the case. While a person may express behaviors, attitudes, and appearances consistent with a particular gender role, such expression may not necessarily reflect their gender identity. The term gender identity was coined by psychiatry professor Robert J. Stoller in 1964 and popularized by the controversial psychologist John Money.
Autism spectrum disorders (ASD) are neurodevelopmental disorders that begin in early childhood, persist throughout adulthood, and affect three crucial areas of development: communication, social interaction and restricted patterns of behavior. There are many conditions comorbid to autism spectrum disorders such as attention-deficit hyperactivity disorder and epilepsy.
Ray Milton Blanchard is an American-Canadian sexologist who researches pedophilia, sexual orientation and gender identity. He has found that men with more older brothers are more likely to be gay than men with fewer older brothers, a phenomenon he attributes to the reaction of the mother's immune system to male fetuses. Blanchard has also published research studies on phallometry and several paraphilias, including autoerotic asphyxia. Blanchard also proposed a typology of transsexualism.
Gender variance or gender nonconformity is behavior or gender expression by an individual that does not match masculine or feminine gender norms. A gender-nonconforming person may be variant in their gender identity, being transgender or non-binary, or they may be cisgender. In the case of transgender people, they may be perceived, or perceive themselves as, gender-nonconforming before transitioning, but might not be perceived as such after transitioning. Transgender adults who appear gender-nonconforming after transition are more likely to experience discrimination.
Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for children who experience significant discontent due to a mismatch between their assigned sex and gender identity. The diagnostic label gender identity disorder in children (GIDC) was used by the Diagnostic and Statistical Manual of Mental Disorders (DSM) until it was renamed gender dysphoria in children in 2013 with the release of the DSM-5. The diagnosis was renamed to remove the stigma associated with the term disorder.
The American-Canadian sexologist Ray Blanchard proposed a psychological typology of gender dysphoria, transsexualism, and fetishistic transvestism in a series of academic papers through the 1980s and 1990s. Building on the work of earlier researchers, including his colleague Kurt Freund, Blanchard categorized trans women into two groups: homosexual transsexuals who are attracted exclusively to men and are feminine in both behavior and appearance; and autogynephilic transsexuals who experience sexual arousal at the idea of having a female body. Blanchard and his supporters argue that the typology explains differences between the two groups in childhood gender nonconformity, sexual orientation, history of sexual fetishism, and age of transition.
Sexuality in transgender individuals encompasses all the issues of sexuality of other groups, including establishing a sexual identity, learning to deal with one's sexual needs, and finding a partner, but may be complicated by issues of gender dysphoria, side effects of surgery, physiological and emotional effects of hormone replacement therapy, psychological aspects of expressing sexuality after medical transition, or social aspects of expressing their gender.
The classification of transsexual and gender non-conforming people into distinct groups has been attempted since the mid-1960s.
The questioning of one's sexual orientation, sexual identity, gender, or all three is a process of exploration by people who may be unsure, still exploring, or concerned about applying a social label to themselves for various reasons. The letter "Q" is sometimes added to the end of the acronym LGBT ; the "Q" can refer to either queer or questioning.
Kenneth J. Zucker is an American-Canadian psychologist and sexologist. He was named editor-in-chief of Archives of Sexual Behavior in 2001. He was psychologist-in-chief at Toronto's Centre for Addiction and Mental Health (CAMH) and head of its Gender Identity Service until December 2015. Zucker is a professor in the departments of psychiatry and psychology at the University of Toronto.
A transgender person is someone whose gender identity differs from that typically associated with the sex they were assigned at birth. Some transgender people who desire medical assistance to transition from one sex to another identify as transsexual. Transgender is also an umbrella term; in addition to including people whose gender identity is the opposite of their assigned sex, it may also include people who are non-binary or genderqueer. Other definitions of transgender also include people who belong to a third gender, or else conceptualize transgender people as a third gender. The term may also include cross-dressers or drag kings and drag queens in some contexts. The term transgender does not have a universally accepted definition, including among researchers.
Various topics in medicine relate particularly to the health of lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) individuals as well as other sexual and gender minorities. According to the US National LGBTQIA+ Health Education Center, these areas include sexual and reproductive health, mental health, substance use disorders, HIV/AIDS, HIV-related cancers, intimate partner violence, issues surrounding marriage and family recognition, breast and cervical cancer, inequities in healthcare and access to care. In medicine, various nomenclature, including variants of the acronym LGBTQIA+, are used as an umbrella term to refer to individuals who are non-heterosexual, non-heteroromantic, or non-cis gendered. Specific groups within this community have their own distinct health concerns, however are often grouped together in research and discussions. This is primarily because these sexual and gender minorities groups share the effects of stigmatization based on their gender identity or expression, and/or sexual orientation or affection orientation. Furthermore, there are subpopulations among LGBTQIA+ groups based on factors such as race, ethnicity, socioeconomic status, geographic location, and age, all of which can impact healthcare outcomes.
Transgender youth are children or adolescents who do not identify with the sex they were assigned at birth. Because transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, they differ in challenges compared to adults. According to the World Professional Association for Transgender Health, the American Psychological Association, and the American Academy of Pediatrics, appropriate care for transgender youth may include supportive mental health care, social transition, and/or puberty blockers, which delay puberty and the development of secondary sex characteristics to allow children more time to explore their gender identity.
Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulties with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.
Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions, as well as gender-affirming care, for transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world.
Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.
LGBT psychology is a field of psychology of surrounding the lives of LGBTQ+ individuals, in the particular the diverse range of psychological perspectives and experiences of these individuals. It covers different aspects such as identity development including the coming out process, parenting and family practices and support for LGBTQ+ individuals, as well as issues of prejudice and discrimination involving the LGBT community.
Rapid-onset gender dysphoria (ROGD) is a controversial, scientifically unsupported hypothesis which claims that some adolescents identify as transgender and experience gender dysphoria due to peer influence and social contagion. ROGD is not recognized as a valid mental health diagnosis by any major professional association, which discourage its use due to a lack of reputable scientific evidence for the concept, major methodological issues in existing research, and its stigmatization of gender-affirming care for transgender youth. The paper initially proposing the concept was based on surveys of parents of transgender youth recruited from three anti-trans websites; following its publication, it was re-reviewed and a correction was issued highlighting that ROGD is not a clinically validated phenomenon. Since the paper's publication, the concept has frequently been cited in legislative attempts to restrict the rights of transgender youth.
Persons with [autism spectrum disorder] and/or other neurodevelopmental problems are more likely than the general population to have transgender identity, non-heterosexual sexual orientation, and other gender non-conformities.
A substantial proportion of autistic adolescents and adults are LGBTQIA+. Autistic people are more likely to be transgender or gender nonconforming compared with non-autistic people, and findings from a recent autism registry study suggest that among autistic people able to self-report on a survey, up to 18% of men and 43% of women may be sexual minorities.
Long story short, I was diagnosed with autism during the show's production, basically, thanks to Norma, because I was just writing my experiences...I think for a possible season two, the focus would shift a degree towards Norma and balance that out.
As a gay person working in the industry, it's hard to hear that and not think that you are inappropriate.
The graphic novels have been lauded for capturing the growing pains of early adulthood of characters...including...neurodiverse Norma