Playing both sides: Trans people, autism, and the two-faced claims of Ken Zucker and Susan Bradley

In late 2015, the Child and Adolescent Gender Identity Clinic at Toronto’s Centre for Addiction and Mental Health was closed following a review of its practices in the treatment of gender-nonconforming children. The clinic, founded by Dr. Susan Bradley in the 1970s and later directed by her frequent collaborator Dr. Kenneth Zucker, was notable for its use of an approach focused on discouraging children from identifying with or expressing a gender other than the one they were assigned, with the intention of ensuring that they would grow up to be cisgender rather than transgender. This clinical goal does not reflect the contemporary professional consensus that gender-affirming therapy and watchful waiting are the healthiest approaches when treating children who are potentially transgender or gender-questioning.

The allegation that the closure of the Gender Identity Clinic was purely “politically motivated” has received extensive coverage in an investigation by New York magazine, a recent BBC Two documentary on transgender children, and several articles in the Globe and Mail. However, considerably less attention has been given to Zucker’s and Bradley’s lengthy history of inflammatory and self-promoting rhetoric which irresponsibly plays to popular prejudices. While these researchers have claimed to support transgender adolescents and adults in transitioning, they continue to issue statements which misinform the public about the nature of transgender identity and are scientifically unfounded – in some cases going so far as to offer their tacit approval to religiously-motivated transphobia and long-running malicious rumors about queer and trans “recruitment” of children. Their misleading claims in the media do a disservice to transgender youth and adults, as well as the wider public.

Gender-deprivation therapies are unproven, unethical, and professionally unsupported

The treatment protocol for gender-questioning children at the Gender Identity Clinic was of a clearly coercive nature, intended to deprive these youth of any gendered apparel, toys, or activities not stereotypically associated with their assigned sex, while encouraging their families to teach them that transitioning is impossible. This approach was described in J. Michael Bailey’s 2003 book, The Man Who Would Be Queen:

First, he thinks that family dynamics play a large role in childhood GID—not necessarily in the origins of cross-gendered behavior, but in their persistence. It is the disordered and chaotic family, according to Zucker, that can’t get its act together to present a consistent and sensible reaction to the child, which would be something like the following: “We love you, but you are a boy, not a girl. Wishing to be a girl will only make you unhappy in the long run, and pretending to be a girl will only make your life around others harder.” . . .

The second prong is therapy for the boy, to help him adjust to the idea that he cannot become a girl, and to help teach him how to minimize social ostracism. . . .

The third prong is key. Zucker says simply: “The Barbies have to go.” He has nothing against Barbie dolls, of course. He means something more general. Feminine toys and accoutrements—including Barbie dolls, girls’ shoes, dresses, purses, and princess gowns—are no longer to be tolerated at home, much less bought for the child. Zucker believes that toleration and encouragement of feminine play and dress prevents the child from accepting his maleness. (Bailey, 2003, pp. 30-31)

Suppose a similar “treatment” were imposed on a cisgender child, denying them the opportunity to engage with any interests that could conceivably be associated with their assigned sex, and pushing them to live as a gender with which they don’t identify. It’s obvious that such an attempt at gender conditioning would be not only unsuccessful, but unjustifiable and even traumatic for the child. Those trans and gender-questioning children who were subjected to this coercive protocol were at times very resistant to this as well:

So, to treat Bradley, Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. . . .

By the time Bradley started therapy he was almost 6 years old, and Carol had a house full of Barbie dolls and Polly Pockets. She now had to remove them. To cushion the blow, she didn’t take the toys away all at once; she told Bradley that he could choose one or two toys a day.

“In the beginning, he didn’t really care, because he’d picked stuff he didn’t play with,” Carol says. “But then it really got down to the last few.”

As his pile of toys dwindled, Carol realized Bradley was hoarding. She would find female action figures stashed between couch pillows. Rainbow unicorns were hidden in the back of Bradley’s closet. Bradley seemed at a loss, she said. They gave him male toys, but he chose not to play at all. . . .

“He was much more emotional. … He could be very clingy. He didn’t want to go to school anymore,” she says. “Just the smallest thing could, you know, send him into a major crying fit. And … he seemed to feel really heavy and really emotional.”

Bradley has been in therapy now for eight months, and Carol says still, on the rare occasions when she cannot avoid having him exposed to girl toys, like when they visit family, it doesn’t go well.

“It’s really hard for him. He’ll disappear and close a door, and we’ll find him playing with dolls and Polly Pockets and … the stuff that he’s drawn to,” she says.

While this attempt at behavioral modification is inflicted on children with the intention of preventing them from growing up to be transgender, there is no clear evidence that this distressing treatment changes the likelihood of that outcome. Zucker and Bradley themselves acknowledge this in their 1995 textbook, Gender Identity Disorder and Psychosexual Problems in Children and Adolescents:

At this point, formal outcome studies of cross-gender-identified children are needed to determine whether some types of treatment are better than others, and whether any type of treatment is significantly better than no treatment. Process studies are also needed to learn why, with or without intensive treatment, the vast majority of cross-gender-identified children eventually relinquish the desire to change sex. (Zucker & Bradley, 1995, p. 288)

In a 2012 summary of their treatment model, CAMH GIC clinicians, including Zucker and Bradley, appear to recognize that there is a lack of useful evidence to show that their approach makes a clear difference in children’s gender identity development (Zucker, Wood, Singh, & Bradley, 2012):

Because the treatment literature is lacking in terms of rigorous comparative evaluations (e.g., Treatment X vs. Treatment Y or Treatment X vs. no treatment, etc.), one has to rely on a patchwork of empirical evidence about natural history. . . .

Is there really such a thing as natural history for GID or does its developmental course vary as a function of contextual factors? If, as in our clinic, treatment is recommended to reduce the likelihood of GID persistence, perhaps the data can only be interpreted in that context. In any event, we require more comparative data to draw conclusions about the natural history of GID in children and its relation to contextual factors.

In three of four cases examined in the final section of their summary, the outcome is ambiguously described as “Success? Failure?” or “Success? Failure? In between?”

Other clinicians working with gender-questioning children have also noted that gender-disaffirming approaches are not supported by evidence (de Vries & Cohen-Kettenis, 2012):

There are, however, no controlled studies that have investigated psychological interventions aimed at influencing certain types of gender dysphoria. It remains for the most part unclear if “treated” children have been “cured” through interventions or just “grew out of” their gender variance.

Even if one were to accept that preventing transgender adults from existing is a valid clinical goal, it remains unclear whether this protocol can be said to achieve even that or provide any benefits that would justify the harm imposed on these children. Instead, professional organizations such as the American Academy of Pediatrics recommend an approach allowing transgender and gender-questioning children to live as their identified gender with the support of their family and community (Dreyer, 2016):

Both families stressed how important it is for home to be a safe and accepting space for the transgender child. When those children walk through the door of their homes at the end of a school day, they should be able to be themselves without any judgment. As one of the fathers passionately said, “I won’t be my child’s first bully!”

The pediatrician’s office, and the entire health care setting, should be a safe, accepting place as well. I was sad to receive an email from one of the parents telling of another family’s encounters with the health care system when they bring their 5-year-old transgender daughter in for care for her serious chronic disease. The doctors refuse to treat her as a girl until she is older, and some have even called child protective services claiming the mother is harming her child for allowing her to live as a girl.

This is done even though a study by Olson and colleagues, published in Pediatrics in March, showed socially transitioned transgender children who are supported in their gender identity have improved mental health outcomes. There appears to be no harm — and possible benefit — from such parent-supported early social transitions.

Much coverage of the CAMH GIC’s closure has misleadingly framed this controversy as a clash between “trans activists” who endorse an affirming approach in implied opposition to scientific evidence, and “researchers” like Zucker and Bradley who have supposedly been unjustly pushed aside by the overwhelming forces of “political correctness”. In reality, this is not a matter of undue influence by antiscientific activists as is commonly depicted. The gender-affirming position is endorsed by major organizations of medical professionals, whose recommendations are supported by decades of studies and clinical experience but counterintuitive to a largely uninformed public. It is opposed by a marginal fringe of researchers, whose approach is nowhere near as strongly backed by science but is much more heavily backed by the widespread public preference that trans people simply not exist at all. Appeals to the public’s naïve misconceptions by Zucker and Bradley are a recurring theme throughout their engagement with the media.

Claims of support for trans people are contradicted by facile and offensive comparisons

In medical literature, Zucker, Bradley, and other CAMH GIC clinicians voice their support of transitioning as an effective treatment for adolescent and adult trans people (Zucker, Wood, Singh, & Bradley, 2012):

But, if the clinical consensus is that a particular adolescent is very much likely to persist down a pathway toward hormonal and sex-reassignment surgery, then our therapeutic approach is one that supports this pathway on the grounds that it will lead to a better psychosocial adaptation and quality of life.

However, this support is rather badly compromised by Zucker’s frequent habit of comparing trans children’s genders to the hypothetical situations of individuals wishing to alter their race or species:

Zucker says the homosexuality metaphor is wrong. He proposes another metaphor: racial identity disorder.

“Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? … I don’t think we would,” Zucker says.

In the 2017 BBC Two documentary “Transgender Kids: Who Knows Best?”, Zucker offers another such analogy:

A four-year-old might say that he’s a dog – do you go out and buy dog food?

A four-year-old might say he’s a dog; does Zucker go out and open a “Species Identity Clinic” under the auspices of CAMH? No, because he clearly knows that there is a difference between the well-established clinical entity of gender dysphoria, and the uncritical false intuitions regarding race and species promoted to the public by such intellectual luminaries as the creators of South Park.

Again: He is a researcher with decades of experience with transgender and gender-questioning patients, who he claims to support in their transitions (at least in adolescence and adulthood). There is no question that he understands the very real distinction between this actual phenomenon and flashy irrelevant rhetorical distractions invented solely to attack the legitimacy of trans people’s identities. His willful and knowing conflation of our genders with absurd hypotheticals that only serve the purpose of deliberate mockery calls into question just how strongly he really supports transgender individuals. How are his patients to believe they’ll be taken seriously and treated with respect when he publicly ridicules their genders in such terms? “Support” does not consist of using one’s authority as a gender researcher to promote these nonsensical faux-analogies to a public that’s already all too eager to use this as an excuse to dismiss our existence. This is better described as simply irresponsible – and insulting.

Examining claims of autism “masquerading” as transness

In the wake of the BBC Two documentary prominently featuring Zucker, many news outlets have focused on one of his particularly notable claims:

Dr Kenneth Zucker believes autistic traits of “fixating” on issues could convince children they are the wrong sex. . . .

Dr Zucker says in the film: “It is possible that kids who have a tendency to get obsessed or fixated on something may latch on to gender. Just because kids are saying something doesn’t necessarily mean you accept it, or that it’s true, or that it could be in the best interests of the child.”

Zucker’s notions of “fixation” have been the subject of numerous headlines using language clearly intended to call into question whether transgender children are genuinely trans at all:

• “Children who believe they are transgender ‘could have autism’, says controversial expert” (The Telegraph, 12 Jan 2017)
• “Children who think they are transgender ‘could have autism’ and are ‘fixating’ on their sex, says expert” (The Daily Mail, 11 Jan 2017)
• “Are autistic children more likely to believe they’re transgender? Controversial Toronto expert backs link” (National Post, 12 Jan 2017)
• “Transgender children could actually be autistic, suggests psychologist” (Metro News, 12 Jan 2017)
• “Psychologist: Do Transgender Children Just Have Autism?” (The Daily Wire, 12 Jan 2017)
• “Children who think they are transgender could have autism” (IOL, 17 Jan 2017)

While Zucker’s statements have been interpreted by these publications as indicating that transgender children may not be trans at all but rather autistic and falsely appearing to be trans, this is not supported by existing literature on autism and gender dysphoria, including work by Zucker and others at the CAMH GIC. Instead, researchers have recognized that autism may occur more frequently among the transgender population, and gender dysphoria may occur more frequently among the autistic population (Strang et al., 2014). In such cases, gender dysphoria and autism are comorbid – meaning that both autism and gender dysphoria are present, not that only autism is present and gender dysphoria is absent as implied by these headlines.

Autistic trans children are still a minority of all trans youth: a 2010 study of youth referred to a gender identity clinic found that only 7.8% could be diagnosed as being on the autism spectrum (de Vries, Noens, Cohen-Kettenis, van Berckelaer-Onnes, & Doreleijers, 2010). Even if we were to accept the unsupported assumption that their autism “caused” their gender dysphoria and that this rules out a diagnosis of dysphoria, this still could not account for 92.2% of dysphoric children, who do not “just have autism”. In a 2016 review of published studies on co-occurring gender dysphoria and autism, researchers did not conclude that the presence of autism should warrant caution in treating dysphoria – instead, they raised the issue of trans youth with autism being undertreated by providers who are unfamiliar with these children’s particular needs (Glidden, Bouman, Jones, & Arcelus, 2016):

These difficulties become further compounded if the clinician has little experience of working with people with ASD. All of this can leave experienced and skilled clinicians feeling less confident about their assessment and treatment. This will have implications for the treatment of patients with gender dysphoria and ASD, ranging from an incomplete assessment to uncertainty about whether to commence potentially irreversible treatment with cross-sex hormones and gender-related surgical procedures to a fear of potential adverse outcomes. Risk-adverse clinicians could undertreat patients. In turn, this could leave the patient feeling misunderstood, under-supported, and not receiving necessary treatment. Further experience of assessing and treating the gender dysphoria of those with ASD could start to allay much of these difficulties.

Examinations of a proposed developmental link between autism and gender dysphoria in youth by researchers at the CAMH GIC tend to be highly speculative and lacking in specifics. In a 2015 paper on autistic traits in dysphoric children, coauthored by Zucker, the only clear finding was that a high birth weight was associated with autistic traits as well as gender dysphoria (VanderLaan, Leef, Wood, Hughes, & Zucker, 2015). The authors propose a diverse range of hypotheses for consideration, such as:

• “Intense/obsessional interests in cross-gender activities or objects” emerging as a result of autistic traits, leading to “a cross-gender self-schema and identity”
• “Social communication deficits” related to autism, making it “difficult for some children to acquire concepts regarding gender norms” and limiting “awareness of social cues in response to his or her gender role enactment”
• “traits of ASD lead to gender nonconformity in a stochastic fashion whereby children with ASD form intense preoccupations with cross-gender activities or objects due to chance” (in reply to the question of “why only a particular subset of children showing traits of ASD exhibit marked gender nonconformity”)
• “factors increasing the likelihood of GD are elevated among those ASD children who are gender nonconformity”, such as “a familial, possibly genetic component”, “excesses of older brothers in natal males and excesses of older sisters in natal females”, or “internalizing problems such as depression and anxiety”
• “high birth weight might be associated with ASD for reasons such as those noted above while its association with GD is due to some other circumstance(s)”, such as “lower levels of prenatal testosterone exposure” in natal males (however, the authors note that “it seems unlikely that the GD-ASD link in females would be similarly owing to prenatal testosterone exposure”, and that “some alternate explanation should be sought”)
• “a pattern of male-typical prenatal development” in natal females with higher birth weight, with masculinization potentially extending to “neural regions that underlie sexually dimorphic behavior”
• “Another possibility is that each of these hypotheses applies to some subset of children who exhibit traits of ASD and GD”
• “The processes related to these hypotheses may interact with one another”

Overall, even as recently as 2015, Zucker and others openly acknowledge they lack sufficient evidence to discriminate between an astonishingly wide array of hypotheses regarding the nature of this association – one of which literally posits that children with autism acquire cross-gender “interests”, so intensely and persistently as to develop an entire transgender identity, at random.

And while the authors note that clinicians “may wish to explore whether traits of ASD such as intense/obsessional interests or social communication deficits contribute to a child’s gender schema”, they go on to point out that “traits of ASD may have little or no impact on co-occurring GD” and acknowledge that “ASD may be a treatment consideration, but not necessarily the focus”. In another paper on “intense/obsessional interests” in children with dysphoria, coauthored by Zucker and Bradley (VanderLaan et al., 2014), the authors recognize the possibility that “Conversely, GD may give rise to such interests and obsessions, leading to a clinical presentation consistent with ASD”.

In her 2012 dissertation, Dr. Devita Singh, who worked with Zucker and Bradley at the GIC, also notes that any causal relation between autistic spectrum disorders and gender dysphoria in children has not been established (Singh, 2012):

It is not clear if children with GID who also have PDD or traits of PDD will be more likely to persist in gender dysphoria compared to children with GID who do not have PDD or traits of PDD. It is plausible that the presence of a PDD may increase the likelihood of persistent gender dysphoria if the fixation on cross-gender interests in these children is more intense compared to children with GID without a PDD. On the other hand, for some children with PDD, the nature of the intense interest does change over time and, therefore, comorbid PDD may not place children with GID at a greater risk for persistent gender dysphoria. This is an empirical question that will require further exploration.

To sum up: Zucker, Bradley, and affiliated researchers go to great lengths to explain that claims of autistic spectrum conditions “causing” gender dysphoria are speculative and unproven, and recognize that even if such a causal relationship did exist, this wouldn’t mean that a child’s gender dysphoria is not genuine. They further acknowledge that they cannot rule out the possibility of gender dysphoria itself producing the appearance of autistic traits, and recognize that autistic traits simply may not be a relevant factor at all for many dysphoric children.

Yet these major news outlets have nonetheless chosen to fixate on the idea that transgender children’s genders and dysphoric symptomatology are not “real” at all and can instead be explained away as entirely the product of another condition. Why is it that these publishers have chosen to offer headlines in the vein of “Transgender children could actually be autistic”, rather than “Autistic children could actually be transgender”? These choices reflect a deeply-rooted cultural desire to deny and erase the reality of transgender existence, encouraging readers to believe that trans children’s lives can be dismissed as a mere misdiagnosis.

Promotion of conservative religious allegations of transgender “recruitment”

Zucker and Bradley’s clinical model of childhood gender dysphoria, in which dysphoria can potentially be “cured” with a particular course of treatment, has a sinister corollary: It enables the claim that individuals are, in turn, being deliberately “made” transgender by others. In an op-ed for the National Post (released concurrently with the BBC documentary), Bradley makes exactly that claim, going beyond Zucker’s suggestion that gender-dysphoric children may be autistic rather than transgender, and directly asserting that “trans activists” are “unethically influencing autistic children to change genders”. This echoes the long-lived homophobic myth that queer people seek to “recruit” heterosexual children, and Bradley makes this assertion on just as flimsy a basis.

Citing an article posted on a conservative Catholic blog by Elise Ehrhard, Bradley alleges that there is an “aggressive approach by adult trans activists in recruiting adolescents with Asperger’s Syndrome or other types of Autism Spectrum Disorder (ASD) to their cause”. Ehrhard, a cisgender woman with autism, declares that “there needs to be greater awareness of transgenderism’s lies”, and describes being transgender as “a pseudo-religious movement” and a “left-wing cultural assault against human biology”. For a clinician who works with trans youth to cite such an article approvingly in a major publication, while claiming to be supportive of these youth, is baffling – how would a transgender child feel about being sent to see this doctor?

Bradley’s reason for referring to this article is just as confusing:

Ehrhard is not transgender — she doesn’t see herself as a male — but, citing a social media campaign featuring the hashtag #AutisticTransPride, she can see why Asperger’s and other ASD adolescents nowadays come to believe they are. This disturbs her. Adolescents struggling to deal with their quirky cerebral wiring do not need to be told they are “a girl trapped in a boy’s body” or vice versa, she says. Nevertheless, Ehrhard notes, many parents are buying into this completely unscientific hypothesis.

Ehrhard herself describes the hashtag campaign as follows:

A new campaign has sprung up on social media with the hashtag #AutisticTransPride. A movement telling young people on the spectrum that the identity issues they will struggle with as they grow-up can be solved through sex change or “gender questioning” is cruel. Surface changes in clothes and pronouns will solve nothing and only exacerbate their suffering. What they need is not biological alteration, but greater acceptance and understanding of their neurobiological differences.

Neither Bradley nor Ehrhard appear to acknowledge that the #AutisticTransPride campaign was a joint effort by the Autistic Self-Advocacy Network, the National LGBTQ Task Force, and the National Center for Transgender Equality. The campaign was launched to raise awareness of the particular challenges faced by transgender and gender-nonconforming autistic people, pointing out that they often face a lack of support from healthcare providers:

Everyone should be able to live as the gender they know themselves to be, and autistic people are no exception. But many trans and gender nonconforming autistic people find that their caregivers, healthcare providers or family members deny the validity of their gender identity and prevent them from living according to who they are. Many people mistakenly believe that autistic people can’t understand their gender or make decisions about how to express it. Some assume that if autistic person doesn’t identify with their gender identity, that’s just a “symptom” of their autism. Others assume that all autistic individuals are men or have “extreme male brains.”

Rejecting the reality of trans autistic people’s gender identities can be dangerous, even life threatening. These misperceptions have led many trans autistic people to be denied the right to determine how to express their gender in their day-to-day life, make legal changes to reflect their gender, and access affirming medical care, including transition-related care.

Contrary to Bradley’s claim that “trans activists are unethically influencing autistic children”, this campaign was spearheaded by an autistic advocacy group that is itself run by autistic people. The hashtag, meant as a nexus for autistic trans people and their allies to express solidarity and support for this community, has been deliberately misconstrued by Bradley in her portrayal of a marginalized group’s pride in themselves as a malignant and infectious effort to “influence” the wider cisgender population. Instead, Bradley goes on to promote the very same vein of prejudice and misunderstanding that this campaign sought to counteract:

To accept the thinking and wishes of those with ASD at face value, without understanding why they feel the way they do, is not a kindness, and may in fact be extremely damaging.

Given her outsized skepticism toward autistic individuals’ ability to grasp issues of gender identity, it’s unclear why she approvingly cites the transphobic opinions of cisgender autistic people such as Ehrhard while doubting transgender autistic people’s expressions of their own identities. Is an autistic trans person’s gender to be scrutinized, and an autistic cis person’s gender to be accepted outright? Are efforts merely to raise awareness of transness a malign, “unethical” “influence” being imposed on the autistic population, while Zucker and Bradley’s own treatment protocol of actively encouraging cisness in young autistic patients is just assumed to be inherently ethical and not at all predatory (to say nothing of Ehrhard’s wholesale dismissal of transness as an “assault against human biology”)? The distinction in play here appears to be less a matter of autism and more a matter of simple cissexism.

Moreover, Bradley and Ehrhard’s assertions that “Adolescents struggling to deal with their quirky cerebral wiring do not need to be told they are ‘a girl trapped in a boy’s body’ or vice versa” are incorrect. Some may need to be told exactly that. Just as transgender people are more likely to be autistic, autistic people are more likely to exhibit gender variance. Even if “trans activists” were “influencing” autistic youth to identify as transgender, there would not necessarily be anything unethical about it – this demographic experiences an elevated prevalence of gender variance, and even Zucker notes that autism may make it “difficult for some children to acquire concepts regarding gender norms”. This is a group that could explicitly benefit from deliberate efforts to raise awareness of the possibility of a transgender identity.

Bradley, however, chooses to disregard entirely how trans youth can benefit from earlier and easier access to information about transness, and appears to focus only on a supposed risk to cisgender youth who may wrongly believe themselves to be trans – a possible outgrowth of the GIC clinicians’ hypothesis that autistic children can “acquire” a trans identity at random merely by learning that transness exists. This red herring of supposed misdiagnosis and regret among dysphoric youth is not supported by literature, yet hypothetical harm to cis people is seen as outweighing real benefits to trans people. Once again, cissexism, rather than the actual needs of vulnerable autistic youth (particularly autistic transgender youth, who are doubly marginalized), is the guiding principle here.

Bradley contends that the CAMH GIC “did what is considered best practice in the field of ASD and gender discomfort”. However, a recent position paper by experts on co-occurring autism and gender dysphoria offers clinical guidelines explicitly contradicting Bradley’s attitude that knowledge of transness is potentially dangerous to autistic youth. Instead, the authors specifically recommend that adolescents diagnosed as being on the autism spectrum should be asked about their gender identity due to their increased likelihood of experiencing gender variance (Strang et al., 2016):

Given the increased incidence of gender issues among people diagnosed with ASD, youth with ASD should also be screened for gender issues. Screening may be accomplished by including a few questions about gender identity on an intake form and/or by including some content about gender issues in the clinical interview. If gender concerns are noted, a referral should be made to an appropriate gender specialist for assessment and supports.

The private and public faces of Zucker and Bradley

Zucker and Bradley often seem to want to eat their cake and have it too. They seek recognition for how helpful they believe their gender clinic was in providing proper treatment to trans and gender-questioning youth, but then choose to play to public prejudice by treating transness itself as a kind of dangerous knowledge that may infect those who merely come in contact with it. In scientific publications, they recognize the nuances of the relationship between autism and gender dysphoria and admit that the etiologies they propose are almost entirely speculative; in public, they make provocative statements suggesting that trans children are not trans at all, offer dismissive and inaccurate comparisons to species and race, and cast trans people themselves as preying on autistic youth.

These are not compatible stances. When clinicians claim to support and care for trans people in their practice, this should be reflected by their engagement with media. Zucker and Bradley have instead elected to spread messages that are not conducive to the health and well-being of the population they treated at the CAMH GIC. Telling cis people, and trans people themselves, that trans youth are like kids who pretend to be animals, does not encourage public understanding of trans people or help vulnerable trans youth feel validated in who they are. Misrepresenting autistic trans people’s pride in themselves as being some kind of nefarious “recruitment” plot is an unrepentant attack on this community’s public existence. And spreading the notion that autistic people are generally incapable of usefully understanding their own gender means creating unnecessary roadblocks of doubt and confusion on the already fraught path to self-discovery that all trans people walk. If Zucker and Bradley seek to defend the clinic they ran, their public approach leaves much to be desired.

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References

• Bailey, J. M. (2003). The man who would be queen: The science of gender-bending and transsexualism. Washington, DC: Joseph Henry Press.
• de Vries, A. L. C., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: the Dutch approach. Journal of Homosexuality, 59(3), 301–320.
• de Vries, A. L. C., Noens, I. L. J., Cohen-Kettenis, P. T., van Berckelaer-Onnes, I. A., & Doreleijers, T. A. (2010). Autism spectrum disorders in gender dysphoric children and adolescents. Journal of Autism and Developmental Disorders, 40(8), 930–936.
• Dreyer, B. P. (2016, August 3). Letter from the President: Pediatricians should not be transgender children’s first bully. AAP News. Retrieved from http://www.aappublications.org.
• Glidden, D., Bouman, W. P., Jones, B. A., & Arcelus, J. (2016). Gender dysphoria and autism spectrum disorder: a systematic review of the literature. Sexual Medicine Reviews, 4(1), 3–14.
• Singh, D. (2012). A follow-up study of boys with gender identity disorder (Doctoral dissertation).
• Strang, J. F., Kenworthy, L., Dominska, A., Sokoloff, J., Kenealy, L. E., Berl, M., . . . & Wallace, G. L. (2014). Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Archives of Sexual Behavior, 43(8), 1525–1533.
• Strang, J. F., Meagher, H., Kenworthy, L., de Vries, A. L. C., Menvielle, E., Leibowitz, S., . . . & Anthony, L. G. (2016). Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents. Journal of Clinical Child & Adolescent Psychology. Advance online publication. doi:10.1080/15374416.2016.1228462
• VanderLaan, D. P., Leef, J. H., Wood, H., Hughes, S. K., & Zucker, K. J. (2015). Autism spectrum disorder risk factors and autistic traits in gender dysphoric children. Journal of Autism and Developmental Disorders, 45(6), 1742–1750.
• VanderLaan, D. P., Postema, L., Wood, H., Singh, D., Fantus, S., Hyun, J., . . . & Zucker, K. J. (2014). Do children with gender dysphoria have intense/obsessional interests? Journal of Sex Research, 52(2), 213–219.
• Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press.
• Zucker, K. J., Wood, H., Singh, D., & Bradley, S. J. (2012). A developmental, biopsychosocial model for the treatment of children with gender identity disorder. Journal of Homosexuality, 59(3), 369–397.