What Next?

This section provides recommendations for action aimed at each of the following groups, education staff, therapeutic and health practitioners, and parents.

7.1 Education

  • Schools should take into account the Schools Guidance on the Transgender Trend website, in conjunction with the Children’s Rights Impact Assessment also available on the website.
  • All RSE curriculum resources provided by outside agencies or organisations should be checked – are they evidenced and based on fact? Are they respectful of the competing needs of all protected groups under the Equality Act?
  • Schools should make sure that pupils are allowed to openly question during the lessons and be given appropriate, evidence-based answers, whilst respecting the viewpoints of others. It should be made clear that identities are personal, they are the product of more than just personal inner feelings, but are also shaped by other factors such as upbringing, faith, access to education, and socio-economic factors.
  • Are LGB identities respected and taught as same sex attraction, alongside teaching respect for the trans community?
  • In primary and early years settings, is child development taken into account when talking about identity-based issues? Is the social, emotional and cognitive level of the children taken into account when discussing LGBT issues?
  • Are staff trained in Autism – not just at a basic level, but do they understand how presentations of autism vary from child to child – do they understand what is meant by autism being a spectrum and how this fits in to an individual child’s sensory, emotional and psychological developmental profile?
  • Is any curriculum learning around RSE and PHSE adapted for SEND pupils, including those with autism and/or ADHD?
  • Is the importance of clear, unambiguous, and evidence-based teaching of RSE subjects to autistic children understood and factored in to lesson plans? Is the importance of ensuring this from a safeguarding point of view understood?
  • Are teachers incorporating differing ways of communicating with autistic children, to ensure that they are understood – and checking that the child understands complex areas?
  • In terms of safeguarding – it is important to recognise the issues around gender identity that apply to autistic pupils, for example trauma response, a wish to escape gender stereotyping, and the pressures from peers in response to the fast moving and unregulated online landscape in which they are immersed.

7.2 Therapeutic and Health Practitioners

  • Make sure you are up-to-date with current issues that may affect autistic children, as well as an awareness of how autism may present. Although we talk broadly about the female phenotype, there are autistic boys whose presentation is missed as it more closely resembles the presentation associated with girls and women.
  • Do you have training in autism and how it presents? Are you aware of the conditions that often accompany an autism diagnosis – like anxiety, ADHD, OCD conditions, eating disorders, etc.
  • Are you aware of the communications differences that might be present in autistic children, and mindful of signs that might suggest an autistic profile?
  • Therapy practitioners should take into account the issues discussed in the online podcast – ‘Gender : A wider lens.’
  • Make sure you take into account the young person’s requirements and make reasonable adjustments for them, such as being able to request an appointment at a quieter time of day, being able to wait in a quiet room, extending the length of time of the appointment so that they feel less rushed, being informed if appointments are running to time or running late and being told if you will be seeing a different doctor. See NHS England’s guidance on reasonable adjustments for more suggestions.

7.3 Parents

  • Don’t panic!
  • Read as widely as possible, including published research papers.
  • You know your child – trust in that. You know them better than anyone else.
  • Don’t be afraid to challenge, ask questions and ask for research to back up what you are being told.
  • Bear in mind the need for many children to have boundaries around them. It is possible that rather than immediate affirmation, some children will feel more secure and more protected if offered support from parents, whilst holding space for them to change their minds. They may not want to embark on any transition process, and they may not want to be referred to GIDS.
  • Remember that adopting a trans identity is not necessarily evidence of dysphoria, and gender dysphoria in and of itself is not evidence of a transgender identity.
  • A child presenting with gender dysphoria may be struggling to reconcile their biological sex with the expectations placed upon them, or struggling to reconcile stereotypes that may sit in opposition to their interests or passions.
  • It is important to demonstrate – as well as explain – that stereotypes that are applied to the sexes don’t need to be a barrier to interests, hobbies and skills. If you can, model for your children that gender stereotypes are just that, and can easily be ignored.
  • If you suspect that your child might be autistic, it is useful to use strategies to communicate with them that you would use with autistic children. Be clear, open and try to avoid using ambiguous language. Give them time to process what you are saying.
  • Check back with them their understanding of what you are saying.
  • Allow them space to decompress and process the day’s events, if they have come home from school, college or work. They may feel overloaded and need time alone to be quiet.
  • Be aware that Gender Identity Clinics are not necessarily experts in autism. Many clinicians, unless they are specialists, will have a broad overview of autism but not necessarily the in-depth knowledge that would allow them to differentiate between differing presentations or recognise the elements that may be confused with or cause gender dysphoria.
  • This article was written for the support group Our Duty by members of the Detransition Advocacy Network, giving advice about how to best support a child or adolescent with gender dysphoria. Advice for parents by detransitioners | Our Duty

7.4 Autistic Girls; Gender’s silent frontier

This article was originally published in Transgender Trend.

Jane Galloway is an Autistic woman with ADHD. Like so many autistic females, she was only diagnosed in her 40’s, after a lifetime struggling to understand why she felt so ‘other’. She is a passionate advocate for autistic women and girls and supports families like hers, in her local area, and writes about Autism in her spare time.

A new conversation is starting to emerge around the whole issue of transgender children and young people. A new question; What about Autism?

We know from research released by the Tavistock & Portman GIDS, that since 2011 there has been a phenomenal rise in young people accessing their services, and the group that has increased exponentially across this period, is adolescent girls.[1] We also know that that 48% of all referees to the Tavistock, have autistic characteristics.[2]

If this was any other issue that had such stratospheric increases in referral numbers and that potentially led to a lifelong, life-changing medicalised pathway for children; if there was any other connective factor affecting nearly 50% of all children referred to a particular service, there would be huge national interest and attendant press coverage. In fact, there is actually hardly any interest and even less research into why this is happening. It is unclear whether this is because to question gender is hugely discouraged, or because Autism is seen as an irrelevance, of no particular import. But it is important to ask; is this because this is overwhelmingly affecting girls?

There is some research that acknowledges that there is a link, but nothing that explores why. And it is the why that is so incredibly important. In making sure that anyone who goes down a medicalised pathway is doing so because they are dysphoric and that all other differential diagnoses have been ruled out first. We heard from the whistleblowers from the Tavistock that clinicians observed young people coming to the clinic from all over the country, and repeating the same words and phrases, as if learned by rote.[3]

Polly Carmichael, Head of the Tavistock, speaking at the 2018 Westminster Social Policy Forum ‘Next steps for Trans equality’ conference, admitted that they know that young people are spending time online, looking up symptoms and signs of dysphoria. She said “It’s not exceptionally difficult for young people to fulfil the diagnosis, in the sense they can go online and see what it is”. Within this context, it is essential to understand whether gender non-conforming girls at the Tavistock are there for the right reasons.

I must admit to having a very personal interest in all of this; I was diagnosed this year as Autistic.

I am an autistic woman who grew up as an autistic girl, I just wasn’t aware of it. At 13 I had my first suicidal thoughts, which persisted on and off, until I was in my late twenties. I had no idea why I felt so disconnected from the world. I felt as though there was another planet that I was supposed to be on; that this one was just too small, too impossible, too wrong. Nothing made sense and I longed for something or somewhere else, where I could exist in a way that made sense. I couldn’t understand why everyone around me seemed to know exactly what to do, how to talk, how to think, how they just seemed to know how to operate in the world, when I had no idea at all.

All I did was hide in my room, listen to music, lie down on my bed and rock from side to side. It allowed me a space to escape, decompress and to practice every conversation, argument, scenario, trying out different endings. I still do this now.

I was obsessed with music. I developed an encyclopaedic knowledge of every band, song, genre. As I hit my late teens, I hung out with the boys in school who were in bands, because they ‘got’ me, or at least didn’t care so much that I was so damn weird all the time. I felt so completely ‘other’; I hated myself, I hated my body and I didn’t know why. I genuinely felt that I belonged nowhere.

If my school had told me, or taught me, that I might have a different identity, a reason why I felt so utterly different to everyone else, a way of making sense of some of the pain and utter self-loathing and suicidality that I felt, I would have grabbed at it with both hands.

As it was, I hung out with the goths and the heavy metal boys and the alternative indie kids. I displayed my self -hatred with black hair dye, piercings, Doc Martens and hiding my face with eyeliner. You could do that in the 1980’s. You could scream at the world through youth culture and music.

Nowadays kids don’t have that option. We now live in a world driven by capitalism and neoliberalism, where each individual is a canvas onto which corporations project their wares. The extension of advertising to children (where previously this was understood to have ethical implications) has turned them into a generation of consumers.

Youth culture has been captured by this trend and has repackaged rebellion and sold it to young people as a product to be selected. Young people who feel disaffected now have no safe avenue through which to psychologically separate and experiment with their identity.

Instead we have a toxic mess where individual identity is held aloft as more important than society. So, if you are young and lost among this landscape, what do you do? You grab at the first thing that comes along that helps you make sense of your world.

Feeling utterly lost and disenfranchised, I spent decades launching myself at everything that crossed my path and thinking ‘This! This is who I am!’ until it wasn’t any more, and all the same feelings came flooding back (because they had only been temporarily buried) and I was forced to move on to the next thing, in my search for a sense of self.

Because it turned out that I was neurodiverse. Autistic with ADHD. But it took until my 40s to discover that. If I had been told as an adolescent that the reason I felt so permanently ‘other’ was because I might be trans, or non-binary, then yes, I absolutely would have grabbed that too, and thrown myself in without looking. And embraced the new community that would have made me feel less lonely, less other, less damn weird. Less like an oddity, and more like a girl that belonged somewhere.

The only reason I didn’t, was because it simply wasn’t presented as a viable option to the average teenager in the 1980’s. Pre the 2004 Gender Recognition Act, pre the mainstream idea of children identifying away from their sex, and before the expanded Stonewall Trans Umbrella, at a time when the number of transsexuals in the UK was a steady 5,000 or so.

And by the time I realised that I wasn’t trans at all, it would have been too late. You see, adolescents by definition, have very little filter, no long-term outlook, and a need to have their desires indulged right now; not because they are spoilt, but because impulse control and delayed gratification are far off distant concepts when you are a teenager. And intentionally so, because our brains can’t mature all in one go, and so it happens gradually and these are parts of the brain that develop later.

So yes, I would have decided I was trans if it had been an option.

The thing is, I genuinely didn’t feel female, I didn’t feel male, I had no internal sense of gender at all (back in the 1980’s this was so self-evidently normal, that it wasn’t even a ‘thing’ and the music scene was all the better for it – the likes of Marilyn, Boy George, and Annie Lennox all rocked androgyny and no- one questioned their sex). But now, this entirely pedestrian feeling of not identifying with, or feeling, male or female, has been pathologised beyond belief, to the point where singer Sam Smith, the latest of a notable line of celebrities embracing trans identities, has been lauded by the media for his bravery in announcing he is non-binary and feels like he has a fabulous woman inside him.

Meanwhile, back in 1986, I was stuck, with no internal sense of gender, no coherent feeling of being male or female but a crashing feeling of suicidality. If I had been told that this *meant* something, and I belonged somewhere because of it, I’d have grabbed at it with both hands. If it meant taking medication, no matter the side effects, even better, because with my particular sense of the world, medication meant that whatever I was experiencing was real.

I would know that the cacophony in my head was so important, so relevant, that a doctor somewhere had given me something to take to make it all better. It would give it meaning and leave no room for doubt; there was something wrong with me. It would have provided a sense of validation for my internal torment, and dare I say it, to my adolescent mind, a certain glamour (‘I’m on drugs. This is serious’).

It wouldn’t have been real though. The feelings were real, but It would have been Autism and ADHD; all the stuff in my brain that I didn’t know about yet, because back in the 1980’s, far too many neurodiverse girls weren’t diagnosed.

But we know now that we can be and are neurodiverse and we know that at the moment, these girls are vastly overrepresented at GIDS. And no one is saying ‘slow down’.

We are letting this happen because it is easier than asking difficult questions. But these girls need us to speak out and say ‘I felt like that too, and it’s okay. Maybe it’s Autism. Or maybe you’re a Lesbian. Maybe that’s why you feel different; hate puberty, hate girlhood. It’s complicated isn’t it? But it’s okay’.

We need to be the grown-ups again because these girls, who are lonely and lost and frightened, need to know that we’re in charge and that we know what we are doing. That they can rely on us to act only on robust research and keep them safe, while they work out who they are.

They need to know that as they grow and experiment and change, and flirt with identity as the main driver of rebellion among teenage girls at the moment, that we are wise enough to tell the difference between a child genuinely troubled with dysphoria, and the girls who are making a youthful attempt to separate from their parents, through the medium of identity.

The price that is being paid by these girls though, is too high. The increasing number of detransitioner voices that are emerging in droves in the UK and US, examples including the Pique Resiliance Project,[4] and Detransition Advocacy Network, and Post Trans[5] should give us pause. Because while we are told by lobby groups that detransitioners are irrelevant, as they were never really trans in the first place, they certainly felt something strongly enough to take Testosterone and have a double mastectomy, and those are things from which you can never come back.

And if those autistic and/or lesbian girls made a mistake, you can bet that some of the current cohort of girls going through this now, are making a mistake too. All of this needs careful thought and consideration but we are told that this is not possible. We are told that this makes us bigots.

James Caspian at Bath Spa University attempted to base a research project on his work with the trans community, as he was interested in tracking the pathways of the increasing number of trans people he was counselling, who were detransitioning. But the research was blocked by the university as too controversial. A great pity, as I suspect the research could have told us something we badly need to know.[6]

In the meanwhile, we need robust research investigating the link between Autism and gender ID issues. This movement has escalated so quickly, and managed regulatory capture across all of the organisations and public services in the UK, including schools, the NHS, the Police, and even government, with such unchallenged success, that there simply hasn’t been time to do any research.

So the autistic girls who are reliant on us to act based on what we know to be true, as opposed to what we are being told to believe, are being held aloft in front of us, like canaries in a coal mine. They represent an experiment in a new social justice movement that is moving so fast that we’ve hardly had time to catch our breath and see what is actually happening.

But to sound a word of warning, sometimes when things move too fast, things get missed.

We have no way of knowing whether the autistic brain processes ideas about masculinity and femininity (the social roles attached to the two sexes) differently and how that might impact on understanding of identity. Respected Autistic advocate and author Alis Rowe, writes eloquently and compassionately about autistic girls and gender on her blog,[7] but acknowledges, from her own experience, that not all girls who identify as boys will turn out to be trans.

There is also a false equivalence with LGB culture in the current narrative, driven by the lingering shame of Section 28, that states that anyone asking questions is part of a long shadow of historic bigotry. However, experimenting with or accepting a sexual orientation other than heterosexual does not involve making medical decisions with lifelong irreversible side effects, including mastectomies and the risk of sterility, loss of sexual function, and inability to orgasm.

The sudden influx of girls has come recently, alongside a rise in the diagnosis of Autism in females and a societal shift in access to online porn. This is informing a type of masochistic, violent, sex education which girls are, understandably, rejecting. The sudden meteoric rise in girls identifying away from their natal sex, with no previous indications, but after an intense period of time spent online or watching youtube videos of transitioning teens, has been named Rapid Onset Gender Dysphoria (ROGD) and the statistics demonstrate the link with autistic girls.[8]

As the mother of teenagers, I also know, from conversations I have with them, that there is a culture among autistic girls that has completely normalised all of this. In playgrounds and over lunch, they are talking about mastectomies and puberty blockers, not as a way of dealing with dysphoria, but as a practical solution to the troubling process of going through puberty; something that is exponentially harder for autistic children than for neurotypicals, as they find any kind of change very hard to process.

I am also aware, as an adult, that children have very little understanding of the long-term impact that either of these actions would have on their bodies, or their still developing sense of self. Or even that hating their bodies and themselves are dreadful feelings, but actually entirely normal for adolescent girls.

With such a huge number of autistic girls identifying as trans, whether that be as a boy or as non-binary (a feeling that they identify as neither male or female, although they will biologically be female or in rare cases, intersex) we have to ask questions about why this is.

Growing up in a culture soaked by internet porn, in which women are expected to conform to highly sexualised, performative femininity, young girls are often facing impossible beauty standards. They are seeing a world of toxic gender roles that speak neither for nor to them and for young lesbians and autistic girls, the temptation to reject it outright, is overwhelming. Add in the differentiated theory of mind and social understanding of many girls who are autistic, and many of them will assume ‘Because I am not this, I must therefore be that’.

We know that schools cannot afford to cascade down robust training in SEN/Autism across all staff, but statistically, each class now will have at least one ASC pupil in it. Factor in the nationwide lack of differentiated knowledge around autistic girls, and we have a crisis waiting to happen in terms of how gender variance within Autism is supported. None of the schools guidance that I have looked at makes any reference to autistic girls as the group that are overwhelmingly affected by this.

The guidance from the Equality and Human Rights Commission (EHRC) for the new RSE curriculum in schools, doesn’t mention autistic girls either. None of the guidance offers advice about differentiating between an autistic or neurotypical child identifying as trans, beyond stating that they may need to have transition options explained to them more clearly.

There is nothing in any of the guides to advise teachers about supporting a child with competing protected characteristics under the Equality Act (EA2010). For an autistic girl, she would be covered under Sex, Disability and Gender Reassignment but there is no guidance around how to navigate these often competing needs and rights. Is this ablism, or the refusal to acknowledge that each protected characteristic of the EA2010 isn’t an individual protected box? That many children will present in a Venn diagram of characteristics and it is this, among other things that, is so sorely missing from schools guidance or indeed, any other kind of guidance around transitioning children.

If the medical community is slow to action research into why these girls are identifying this way, the schools guidance provided by various organisations, simply neglects to acknowledge them as a group at all.

In January 2017, the National Association of Head Teachers launched new research into autistic girls, but this has not yet filtered down to classroom level. Autistic girls are not being given the space to find out who they are, and many of them are yet to be diagnosed. Some will be on the pathway, but many more will be struggling, as I did, with no idea that they are autistic at all.

New research from Sweden, also indicates that autistic females have a risk of suicide that is ten times that of neurotypical females. Our girls with Autism/GID deserve robust levels of support before they reach that point.[9]

We must invest in robust research and investigate thoroughly and impartially, why this sudden, unprecedented rise in girls identifying away from girlhood and womanhood has happened. How much is due to the neurodiverse brain? How much is down to cultural and emotional issues and how much, is down to feelings of dysphoria around one’s sexed body?

Given that the most obvious differential diagnosis for sex dysphoria is trauma and sexual abuse, it is vital that on that basis alone, we call for a slowing down of pathways for children and young people, and invest in resources to allow psychologists and therapists the space and time to engage in genuine psychological exploration with the young referees. The recently expanded Memorandum of Understanding inhibits this, on the basis that all exploratory therapy is considered equivalent to conversion therapy.

For autistic girls, lack of robust support and the intense desire to ‘fit in’, leaves them vulnerable to online communities, ready to affirm their identity, or worse, exposes them to online doctors and unscrupulous overseas pharmacies, who are all too eager to encourage them to buy hormone blockers or cross-sex hormones. With their differentiated theory of mind, they may therefore find themselves entering territory from which they cannot return.

  1. Assessment and support of children and adolescents with gender dysphoria | Archives of Disease in Childhood (bmj.com)
  2. Clarke 2019 extened clinical assessment.pdf | DocDroid
  3. NHS transgender clinic accused of covering up negative impacts of puberty blockers on children by Oxford professor (telegraph.co.uk)
  4. Home (piqueresproject.com)
  5. Post Trans – Detransition Stories (post-trans.com)
  6. Bath Spa university bars research into transgender surgery regrets | News | The Times
  7. Are autistic people more likely to have gender dysphoria? – The Girl with the Curly Hair
  8. Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria (plos.org)
  9. New Study Finds Autistic Women More Likely to Attempt Suicide | The Mighty