Episode 10: Autism & Gender
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No AI is used at any point in this podcast.
This podcast explores recently published research on a number of different neurodivergent types. This season I am talking about autism, and in this episode I will go over some recent research on autism and gender. Unless otherwise specified, the research I have done for this and all episodes do not include those with intellectual challenges in conjunction with autism characteristics. While I will describe autism characteristics in this episode, I also recognise that every autistic person will experience autism differently, and these are not specific to every person who identifies as autistic.
Suicide comes up in the research here, so if you don’t want to hear about that right now, please wait until the next episode comes out, and mind yourself in the best way that suits you. Some support services will be listed in the show notes.
Terminology
In the last episode on autism and sexuality, I outlined the definitions of sexuality and gender. I will offer a brief overview of what I said: As some literature appears to conflate both these words, gender and sexuality, I feel it’s important to elaborate on their meanings. Sexuality is the identity a person holds regarding sexual practices, what they find to be sexual, who, and in what capacity. Gender is just as varied and is socially constructed, including the widely accepted binary of masculine and feminine, as well as Transgender, gender neutral, non-binary, genderqueer, no gender at all, a combination of identities, and more. For some, identifying their gender or sexuality is vitally important to their sense of self, and for others not claiming their exact identity in this regard works for them. The purpose of outlining the confusion some researchers appear to express between sexuality and gender is to highlight a possible identity injustice to their participants, that by not taking time to understand unique differences their results will become inaccurate at best. I go into all this more at the start of the last episode, but I will leave it there for now and get into the research. This is an overview rather than an extensive coverage of autism and gender, so let this be a starting place for you if you want to know more.
I’m exploring autism and gender in research because there are some fascinating intersections between the two identities that affect autistic people in very specific ways. Those of you with an interest in autism characteristics have likely come across the concept of gendered autism characteristics, namely that those who present socially as female will probably be missed as autistic by healthcare professionals, or will have an assessment in later life rather than childhood. This is because the social stereotype of what autism looks like is deeply biased towards masculine presentations, with female characteristics being realised only in recent years. As I said before, gender is socially constructed. So when an autistic person behaves and thinks in their unique way, and if those ways are contrary to what is the social stereotype for their gender presentation, they will experience a social backlash in the form of isolation, bullying, lack of social opportunities, and more. That autistic person then learns to camouflage their authentic thoughts and behaviours so those things don’t happen as much, but the consequences of doing this regularly, for years or a whole lifetime, is increased meltdowns, shutdowns, burnout, self-harm and suicide. As healthcare professionals are more used to autistic expressions in boys and men, as those are the ones who express themselves without as much fear of social recrimination, the characteristics often found in boys and men became the default that describes autism for all gender expressions. They had less to lose from expressing their autism because society excuses particular behaviours in boys and men that they don’t in girls and women, for example, self-isolation, hyper fixation on a subject, lack of sociability, anger, frustration, and sometimes lashing out. Girls and women who expressed themselves in so-called ‘anti-social ways’ like this are less likely to be assessed for autism, and more likely to be scolded as children for their assumed ‘bad behaviour’, and to learn to mask their characteristics to fit in, due to the extremely high standard of behaviour and gender presentation afforded to those who present as feminine. The situation is compounded by minority stigma if the girl or woman happens to also be from a racial, religious, or ethnic background as well. This leads to very difficult mental health patterns of social anxiety, self-worth, social confusion, etc. I hope this brief outline has highlighted some reasons why autism is gendered, and it’s my belief that it’s not true that more men and boys are autistic, but instead autism crops up as a normal differentiation in human mental processing in all humans, but it gets complicated when society steps in and decides to divide people up into neat gendered packages. Maybe one day scientists and society won’t be as concerned by how a person identifies in their personal life, and be more interested in learning how to accommodate people who are forced to live false lives because of unreasonable social standards.
While this concept describes a binary gender system, there are those who are autistic and whose gender is outside of this normative system. Hillier and others (2020) investigated the experiences and challenges of autistic and LGBTQ+ people. Some papers don’t include the full acronym, so I’ll use what they used, but I recognise people who are intersex and asexual and will include specific references in the research when I find them. There isn’t enough data to know the full experiences of transgender adults who are also autistic, but for perspective, Hillier and others (2020) found a survey of 6,450 neurotypical transgender adults, 63% of whom reported serious discrimination, with financial, emotional, mental and physical threats to stability. Suicide rates were higher at 41% than the general population from the discrimination which is 1.6%. Unemployment rates were doubled, and all members of the LBG, transgender, and gender diverse community had less access to social resources and networks (ibid).
When it comes to the intersection of autism and gender identity, it is very important that each individual person is taken in consideration without generalisations. Their holistic experiences will impact how their autism and gender identity experiences are felt by them, including their family situation, social connections and supports, their age and education, everything. Some recent research goes into how there appears to be a connection between autism and gender identity, and studies have shown many children who identify as a gender other than the one assigned at birth also show characteristics of autism (Dewinter et al, 2024). Hillier and others (2020) found research that showed autistic people express higher rates of gender identity diversity. Their own participants rejected the idea that autistic people may be confused about their sexual orientation and/or gender identity, and that those around them, including their parents, often rejected their non-binary gender identity or minority sexual orientation status, or questioned their ability to really know who they are and what they want. We have seen in other episodes how disabled people, or those perceived as disabled, are desexualised, treated like children, or sometimes, hypersexualised, and can be prevented from exploring their own sexuality. When in college, the participants noted the difficulties finding a group to connect with, that the LGBTQ communities rejected them because of their autism traits, and from the autism community because of their sexuality or gender identity.
The World Health Organisation (2006) states that gender can refer to a range of experiences including identities, gender-related expressions, and culturally driven associations, such as gender roles. Human rights apply to sexual and gender diversity rights, including the right to freedom of thought and expression, equality, non-discrimination, privacy, autonomy, integrity, information, education, and health (Dewinter and others, 2024).
A paper from Gagnon et al. (2023) reviewed the challenges experienced by health professionals when treating autistic and gender incongruent people, and it’s a challenging read as the language is very pathologising of both autism and gender non-conformity. However, there are some interesting take-aways. The term ‘gender dysphoric’ is not an accurate one for all people who do not identify with their given gender, as it is a highly medicalised term and insinuates there might be a sickness to ‘cure’, and it doesn’t describe accurately those who aren’t distressed by their gender fluidity and find it doesn’t resonate with their perspective of gender identity (Gagnon et al, 2023). Gagnon and others (2023) say as much, in their paper. But they then tie themselves up in knots over whether gender can be found in brain scans (it’s a social concept, so unless there’s a pink bow tied to someone’s brain stem, you won’t find identity in an imaging machine). They cite the hypothesis that because autism is a development disorder, that all areas of development might be disordered, including gender. This hypothesis assumes that both autism and non-cis gender identities are not ‘normal’ parts of human diversity. The paper (Gagnon et al, 2023) mentions how autistic gender non-conforming people have great difficulty in the workplace, in getting hired, experiencing stigmatisation, harassment, violence, and abuse. Unsurprisingly, these people have higher rates of anxiety and depression than those with either autism or gender incongruence. Parents of autistic children who express gender incongruence find it difficult to believe that their child has two distinct identities, believing instead that autism is informing the gender incongruence. The children and adult participants in many papers express how hard it is to be believed by family in this regard. An associated hurdle for those looking for gender-affirming care is that they must declare psychological distress to qualify for that care, and those who are questioning their identity but are not very distressed about it may not have access to the answers they are looking for. This is an example of the ways that the medical profession gatekeep information about gender-affirming care, a paternalistic attitude masquerading as protecting people from themselves. If you want to read an incredible and detailed book about transgender issues, please take a look at The Trans-Gender Issue: An Argument for Justice by Shon Faye. Gagnon and others (2023) cite research that states two approaches should be favoured by health professionals, the first being to encourage parents to provide sufficient space for their child to explore their feelings associated with gender identity, and the second being to facilitate the affirmation of gender identification in the child and to help them build resilience and a positive gender identity (ibid). Where the child is autistic and gender-questioning, both identities should be explored simultaneously.
A paper from Kallitsounaki and Williams (2023) reported that academic publications have doubled over the last two years that explore the intersection of autism and gender identity. We have already found in other research from Dewinter and others (2024) and Hillier and others (2020) that many academics believe there to be a link between autistic people and gender incongruence due to the high figures of autistic people who identify as a gender they weren’t assigned at birth. However, another theory put forward by Fortunato and others (2022) is that instead of gender incongruence being an autistic characteristic, it is the autism characteristics themselves that are being mistaken for gender incongruence. Bear with me while I try to explain what they mean, and I appreciate we must be wary of adding to the disbelief and invalidation already felt by gender incongruent or transitioning people. I am explaining the academic literature on this while firmly believing that if an individual identifies as gender-incongruent then they must be believed. The point Fortunato and others (2022) want to make is that the consequences of being gender incongruent in an unforgiving and ignorant society can also present to outsiders (family, friends, healthcare workers) as autism characteristics, and vice versa. For example, they cite that the often-found intensity and focus of autistic people is also present in social anxiety disorder which is common to transgender people. This may be why healthcare professionals seem to find such a high number of gender incongruent people in autistics, and also why parents refuse to believe their autistic child is also gender incongruent. But there isn’t enough research to prove this either way, and these are potentially very harmful assumptions. We must always remember that every person is at liberty to identify however they want in terms of gender, and that every autistic person has their own set of distinct characteristics and autism cannot be over-generalised. I point these theories out because it’s important to be aware of what is being written about autism and autistic people, even if only to be forewarned. If all the research is being shared only to other researchers then the voice of the people being studied will be lost. This is a big reason behind why I’m doing this work because it’s important to understand the framework you are living in when you visit a doctor, or gender-affirming healthcare professional, or even someone you just met who read an article on gender once or saw a reel about someone like you. Knowledge is power, and understanding what you’re walking into and how you’re being perceived by those who have more power than you is vital. Before extensive research is completed, with autistic gender non-conforming people as both participants and researchers, theories and assumptions will be put forward instead of what is really going on.
If you want to know more or need to follow up with some self-care after listening to this podcast, please check the show notes for some great websites created by and for autistic gender-incongruent people.
Thank you for listening. Join me next episode where I will talk about autism in a global context and intersectionality. I will be posting these episodes every fortnight to allow more time for my own research and college studies. Please review the podcast on the platform you listen from and share it with someone you think might be interested. The research I have used in this episode can be found cited in the show notes, and a full transcript will be available at www.theneurogenderpodcast.com. To receive updates on the podcast please join the mailing list in the show notes. I am Alexa and this has been The Neurogender Podcast.
Show Notes
Samaritans Ireland and UK – 116 123
Papyrus (people under 35) – 0800 068 4141
Autistica suicide help page - https://www.autistica.org.uk/what-is-autism/signs-and-symptoms/suicide-and-autism
BelongTo Ireland: https://www.belongto.org/
LGBT.IE Ireland: https://lgbt.ie/
National Autistic Society (LBGTQ Branch): https://www.autism.org.uk/what-we-do/branches/lgbtq-online-branch
Podcast Mailing List: https://mailchi.mp/e1e4c4603d1c/sign-up-for-new-episode-email-alerts
TENI - Transgender Equality Network Ireland: https://teni.ie/
The Transgender Issue: An Argument for Justice by Shon Faye: https://www.amazon.co.uk/Transgender-Issue-Argument-Justice/dp/0241423147
Twainbow (US): https://www.twainbow.org/
Webinar – ‘Neurodivergent & LGBTQIA+: The ‘double-rainbow’ intersection’: https://www.youtube.com/watch?v=Jny3KPoxXIc&ab_channel=NeurodiversityWeek
References
Dewinter, J. et al. (2024) 'Short report: Recommendations for education, clinical practice, research, and policy on promoting well-being in autistic youth and adults through a positive focus on sexuality and gender diversity', Autism : the international journal of research and practice, 28(3), pp. 770-779.
Fortunato, A. et al. (2022) 'Is It Autism? A Critical Commentary on the Co-Occurrence of Gender Dysphoria and Autism Spectrum Disorder', Journal of homosexuality, 69(7), pp. 1204-1221.
Gagnon, D. et al. (2023) 'ASD and Gender Dysphoria: A Review of Challenges and Facilitators for Health Professionals', Sexuality and disability, 41(3), pp. 691-706.
Hillier, A. et al. (2020) 'LGBTQ + and autism spectrum disorder: Experiences and challenges', International journal of transgender health, 21(1), pp. 98-110.
Kallitsounaki, A. and Williams, D. M. (2023) 'Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis', Journal of autism and developmental disorders, 53(8), pp. 3103-3117.
World Health Organization. (2006). Defining sexual health: Report of a technical consultation on sexual health 28–31 January 2002, Geneva.