The anti-trans lie of “just autistic”

Zinnia JonesWhen it comes to media coverage of transgender topics, the Daily Mail reliably provides stark examples of what not to do. Fresh on the heels of a non-story about one person’s claims that numerous unnamed individuals regret their transitions but will not come forward for lack of bravery, the Mail on Sunday’s health correspondent Stephen Adams has offered his peculiar interpretation of the intersection between transness and autism: “A quarter of youngsters being treated at transgender clinics may just be autistic, new research claims”.

Does new research claim any such thing? Adams continues: “Those attending gender identity clinics are many times more likely to show signs of autism than the population at large, doctors found.”

These are two entirely distinct statements. “A quarter of trans people may be autistic” and “A quarter of trans people may just be autistic” are in no way synonymous or interchangeable claims. The former means that these people are both trans and autistic; the latter means that these people are not trans and are only autistic. The former claim does not support the latter in any way – it entirely contradicts it. Anti-trans campaigners Stephanie Davies-Arai of Transgender Trend and Heather Brunskell-Evans go on to predictably and embarrassingly cosign Adams’ line of illogic.

Consider the results of applying this reasoning in the context of other conditions and their comorbidities. For example, up to a quarter of people with cancer may have depression. Imagine then asserting on this basis that up to a quarter of people with cancer may just have depression. The gulf between those two claims is unbridgeable, yet the Mail is happy to pretend no such gap exists at all.

So what does the study in question actually claim: that a quarter of trans youth may be autistic, or a quarter of trans youth may just be autistic? According to Thrower et al. (2019) themselves, there is no “just”:

The few studies employing diagnostic criteria for ASD suggest a prevalence of 6–26% in transgender populations, higher than the general population, but no diferent from individuals attending psychiatry clinics. . . . Low-level evidence exists to suggest a link between ASD and GD.

In fact, if anything, the “just” might run the other way – trans youth could potentially be misdiagnosed as autistic:

In addition to compromised social skills and executive function, autism associated obsessional interests may potentially result in a misdiagnosis of autism if an individual demonstrates a strong interest in gendered items associated with the opposite sex (Parkinson 2016; Tateno et al. 2008; Williams et al. 1996).

The authors reach a conclusion opposite to that of Adams, Davies-Arai, and Brunskell-Evans – that a person being on the spectrum in no way means that they may not also require gender-supportive care:

From a practical clinical perspective for individuals who do have concurrent GD and ASD, guidelines have recently been published highlighting a need for potential extended assessment and decision-making periods (Strang et al. 2018). Most importantly, a diagnosis of ASD should not exclude people from gender-related medical supports. People with neurodevelopmental conditions and GD should be supported in the strengths of neurodiversity and gender diversity and reassured that these conditions do not preclude any forms of afrmative clinical care (Turban and van Schalkwyk 2018b).

Strang et al. (2018) offer a series of guidelines developed by expert consensus, recommending that due to the frequency with which gender dysphoria and autism co-occur, youth with gender dysphoria should be screened for autism – and those with autism should be screened for gender dysphoria. They continue, affirming that diagnoses of gender dysphoria and autism can indeed coexist:

The diagnosis of ASD should not exclude an adolescent from also receiving a GD diagnosis and, when indicated, appropriate GD-related treatment. However, clinicians and parents sometimes dismiss GD as a trait of ASD (e.g., as an overfocused or unusual interest). Although in some cases GD symptoms appear to stem from ASD symptoms, many adolescents have persistent GD independent of their ASD. Similarly, an undiagnosed ASD can be missed if a clinician and/or parents view an adolescent’s social difficulties as stemming from GD-related challenges alone. Parents and/ or clinicians may resist further assessments after receiving one diagnosis, whether it be ASD or GD, if they view all symptoms through the lens of the initial diagnosis.

The literature could not be more clear that the co-occurrence of gender dysphoria and autism is not a matter of “either/or”. And yet again, the Mail could not be more clear in their total lack of interest in providing accurate information about trans people’s lives to the cis public. 

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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