Gender dysphoria more prevalent among youth with autism, study finds

Key takeaways:

Youth with autism are three times as likely to have a co-occurring diagnosis of gender dysphoria than peers who do not have autism, according to findings from a study of more than 900,000 adolescents published in Pediatrics.

In a commentary accompanying the study, experts said the finding “must not be used to further stigmatize or discriminate against [transgender and gender diverse] youth, or to pathologize identifying as [transgender and gender diverse] because of its links with a neurodevelopmental condition.”

For the study, researchers at children’s hospitals across the United States joined to examine the prevalence of co-occurring autism spectrum disorder (ASD) and gender dysphoria (GD).

“[M]ost existing research on co-occurring ASD and GD in pediatric populations has used case studies and clinical convenience samples, limiting the generalizability of the findings and our ability to assess the unique service and support needs of this population,” they wrote.

The study used data derived from electronic medical records at Children’s Hospital Colorado, Children’s Hospital of Philadelphia, Cincinnati Children’s Hospital Medical Center, Nationwide Children’s Hospital, Nemours Children’s Health, Seattle Children’s Hospital, Stanford Children’s Health, and Lurie Children’s Hospital of Chicago.

It included 919,898 youth aged between 9 and 18 years (average age, 13.6 years) who had two or more inpatient or outpatient encounters at one of the facilities between 2009 and March 2022.

Overall, 4.4% had a diagnosis of ASD, 0.5% had a diagnosis of GD, and 0.05% had diagnoses for both. GD was more prevalent among youth with an ASD diagnosis (1.1%) than among their peers without autism (0.6%).

The researchers calculated that there was a threefold greater likelihood of a diagnosis of GD among youth with autism than without (adjusted OR = 3; 95% CI, 2.72-3.31).

Compared with other demographic characteristics, youth who were EMR-reported female and youth on private insurance were more likely to have co-occurring ASD and GD diagnoses, whereas youth of color — particularly Black and Asian youth — were less likely to have both diagnoses.

“Our study adds to the growing body of research on co-occurring ASD and GD and provides important evidence to support additional research, improved screening for ASD and GD, and care integration and coordination in specialty clinics and in underserved communities,” the authors wrote.

In the commentary Carly E. Guss, MD, MPH, and Scott E. Hadland, MD, MPH, MS, both of Harvard Medical School, and Eri D. Solomon, noted that because “the percentage of youth who identify as TGD is comparable across racial and ethnic groups (ie, 1% to 2%), future studies should carefully determine whether disparities in receipt of gender-affirming care exist by race, ethnicity, and insurance status among youth with ASD.”

“In some states, legislated bans on the use of state Medicaid funds to pay for gender-affirming care will almost certainly worsen health disparities, particularly since Medicaid is the primary insurer of youth of color in the United States,” they wrote.

They said the findings “should encourage pediatric clinicians to assume a central role in optimizing the health and well-being of youth who have ASD and/or identify as TGD, who are likely to thrive when they have the strong support of caring, affirming health care providers.”

“This research represents an important step toward building services and supports that reduce disparities in access to care and improve health outcomes for youth with co-occurring autism spectrum disorder and gender dysphoria and their families,” a spokesperson for Seattle Children’s Institute, which has five credited authors on the study, told Healio. “We believe we have a responsibility to provide equitable health care for all patients. Seattle Children’s is committed to supporting transgender and nonbinary patients and their families in accessing comprehensive gender-affirming care.”