Introduction
There is increasing awareness among parents, caregivers, clinicians and therapists that there is a clear link between gender identity issues and Autistic Spectrum Disorder (ASD).
We know that currently, 76% of referees to The Tavistock & Portman Gender Identity Service (GIDS) are adolescent girls, and we also know from The Tavistock’s statistics that 48% either have a diagnosis of, or show traits of Autism. 1
Altogether, this is an astonishing number of young people sharing characteristics that are usually only present in 1% of the population. While there is clear evidence that there is a link between the number of children and young people with gender dysphoria or identifying under the transgender umbrella, there is no research that looks at why. Part of the reason for this is that the exponential rise in children and young people experiencing gender dysphoria or identifying as trans has taken place very quickly – too fast in fact, for research to keep up.
There has been an unprecedented overall increase in referrals to the NHS Gender Identity Service (GIDS) of over 3263% over the ten years from 2009 to 2019, with an increase in referrals from adolescent girls over that period of 5337% . With the understanding that a significant proportion of all referrals indicate autistic traits, it may be many more years before we see the results of any research into the reason for this. This assumes of course, that such research is taking place at all.2
Both the transition and detransition process (for which there is historically very little support) can be extremely traumatic, both psychologically and physically. There is at present a lack of robust exploration of what causes gender dysphoria, due in part to lack of funding for both CAMHS (Children & Adolescent Mental Health Services) and adult mental health services generally, as well as ongoing cuts to health budgets impacting on service provision at GIDS. Instead, it is easier and cheaper to follow an affirmation model.
The social and political landscape in which children and adolescents are experiencing dysphoria moves and shifts quickly and as more light is cast upon the evidence or lack thereof underpinning treatment guidelines, more and more professional bodies, clinical experts and academics as well as therapists, educators, parents and politicians are speaking out.
In March of 2022 the National Academy of Medicine in France released a statement urging caution in the treatment of gender dysphoria as
‘There is no test to distinguish between persisting gender dysphoria and transient adolescent dysphoria. Moreover, the risk of over-diagnosis is real, as evidenced by the growing number of young adults wishing to detransition [c]. It is, therefore, appropriate to extend the phase of psychological care as much as possible’.
France has joined England, Finland, Denmark and Sweden in restricting or urging extreme caution in the use of puberty blockers and cross sex hormones to treat gender dysphoria in children and adolescents. In America, Dr Marci Bowers, president-elect of WPATH and Dr Erica Anderson, former president of the U.S. Professional Association for Transgender Health, who are among the most noted specialists in the country, have added their voices, expressing concern that children are being fast-tracked to a lifelong medical pathway.3
In 2020 the Council for Choices in Healthcare in Finland (COHERE) issued the following statement after stringently updating their guidelines on transition for minors, making clear that any other comorbid psychiatric issues must be addressed fully before any issues with gender dysphoria are tackled.
‘If a child or young person experiencing gender-related anxiety has other simultaneous psychiatric symptoms making specialised medical care, treatment according to the nature and severity of the disorder must be arranged within the services of their own region, as no conclusions can be drawn on the stability of gender identity during the period of disorder caused by a psychiatric illness with symptoms that hamper development.’
In 2021 the Karolinska Institute in Sweden, which houses the largest paediatric gender clinic in the country, restricted the use of puberty blockers and hormones to clinical trials only.4 There is an acknowledgement that the so called ‘Dutch Protocol’ research upon which the World P A Transgender Healthcare guidelines for treating dysphoric children are based, studied a small cohort of boys, all of whom had developed dysphoria as young children and remained deeply affected by it throughout childhood and adolescence.
The recent research paper Reconsidering Informed Consent for Children, Adolescents and Young Adults (Levine et al 2022)5 highlights the limitations of the Dutch protocol and interrogates the concept of informed consent from children and young people; the issue at the heart of the High Court challenge to the Tavistock GIDS brought by Keira Bell & Mrs A. The relevance of Mrs A’s petition is that she was concerned that her 15 year old autistic daughter may not be able to meaningfully consent to medical transition.
The recently published interim report in the Independent review of gender identity services for children and young people led by Dr Hilary Cass, noted the concerns raised about the number of neurodiverse children presenting at GIDS. 6
The current cohort of referees – the largest and fastest growing in history – is overwhemingly girls, all of whom developed dysphoria and/or adopted a transgender identity after commencing puberty and overwhelmingly in clusters of girls in schools and among friendship groups.
This cohort also appear to develop dysphoria very suddenly, and in tandem with binge watching social media channels such as YouTube or Tik Tok, and spending a significant amount of time in chat groups on websites Tumblr, Reddit and Discord. There, their dysphoria and/or identity will be swiftly validated by strangers who have no knowledge of their circumstances, medical history or any vulnerabilities that may be caused by neurological differences such as Autism or ADHD.
We are extremely concerned that autistic children and adolescents are not receiving optimal care; either in terms of their Autism being recognised, or taken into account when under the care of gender identity services. We have collated within this report all the research, studies, and media that make up our knowledge base for Autism and identity issues.
We hope that in pulling together all this information in one place, parents and caregivers – as well as professionals, can better understand autistic children and young people, support them more effectively, and engage with clinicians and therapists with greater confidence.
It is also to be hoped that researchers and advocacy organisations working in the field of Autism will see within this report a compelling basis for undertaking serious unbiased research into this unprecedented and fast moving phenomenon. The juvenile autistic community is vastly overrepresented among the current cohort of gender dysphoric children and adolescents. It is vital that we understand the reasons for this recent seismic shift in identity issues and investigate fully what it is about being an autistic youth in today’s society that makes identifying away from your fundamental core self, such an attractive proposition.
Jane Galloway – Autistic Advocate
Transgender Trend 2022
1‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties (icf-consultations.com)
2Referrals to the Gender Identity Development Service (GIDS) level off in 2018-19 (tavistockandportman.nhs.uk)
3Transgender Docs Warn About Gender-Affirmative Care for Youth (webmd.com)
4Sweden’s Karolinska Ends All Use of Puberty Blockers and Cross-Sex Hormones for Minors Outside of Clinical Studies | SEGM
5Full article: Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults (tandfonline.com)