Autism In “Trans”: A Meta-Review

A paper from 2022 covered a “systematic literature review and meta-analysis” of previous studies of the co-morbidity of autism/autistic traits and “gender dysphoria/incongruence”. It’s available online and not behind a paywall (link below). I’m always suspicious of such papers, as they can often turn out to be produced by paper mills for a hack that needs to “publish or perish” as they don’t contain any real new science research. But in this case, the review looks to be genuine and honest.

There are a few things in the review that came out very forcefully that support a point that I have been making for years about many of the papers that purport to be about gender dysphoria, the lack of consistent operational definitions. In this case, this lack is metaphorically “squared” in that both the definitions of autism / autistic traits and of gender dysphoria / incongruence interact to create a very “heterogeneous” pattern of data and conclusions when analyzing the papers,

“The high heterogeneity observed in the current meta-analyses was not surprising, as it is common in meta-analyses that focus on ASD or GD/GI (e.g., Arcelus et al., 2015; Lai et al., 2019; Loomes et al., 2017). It likely reflects some fundamental limitations of the literature pertaining to the prevalence of ASD diagnoses/ASD traits in GD/GI individuals. First, the targeted population cannot be considered homogeneous, as it includes transgender people, nonbinary individuals, people formally diagnosed with GD, and people who do not conform to the societal expectations of their birth-assigned sex and may or may not present GD feelings. Future studies might usefully apply stricter eligibility criteria to elucidate which of the aforementioned categories are most influenced by ASD. Of equal importance is another limitation identified through the current study. That is the paucity of studies that have employed standardized diagnostic measures of ASD to identify autistic GD/GI individuals.”

The paper also supported another issue I have long discussed concerning the use of surveys and self-report,

Results showed that the study design and participant type were the only significant moderators. The prevalence of ASD diagnoses was lower in clinical-based studies than in population-based studies. Also, the prevalence of ASD diagnoses was lower in people who met the diagnostic criteria or had a diagnosis of GD/GID/GID-NOS and people referred to gender clinics than in GI people. We should mention here that in clinical-based studies and studies that included people with a diagnosis or symptoms of GD information about the diagnosis of ASD was collected through medical records and in most of the studies the diagnosis was verified, whereas in studies that included GI people from the general population information was collected mainly through self-reports. This suggests that the prevalence of ASD diagnoses in GI people might be overestimated when ASD diagnosis is self-reported and that clinical-based studies might provide more precise estimates. 

Quite simply, we know that self-reported “gender incongruence” vastly over estimates the number of such individuals and that those very same individuals who falsely claim to be “trans” or “non-binary” are also prone to falsely claim to be on the ASD spectrum, so as to feel “special”.

Almost as a throw away comment by the authors, the type that actually can be the most enlightening as giving us insight into the behind the scenes thinking of the researchers (i.e. gossip) is this tidbit, discussing one of the best studies, not coincidentally from the Netherlands clinic,

“Interestingly, among adolescents diagnosed with GID, 6.5% received a co-occurring diagnosis of ASD, whereas 1.9% of children with GID were diagnosed with ASD. Turban and van Schalkwyk (2018) argued that since ASD is a neurodevelopmental disorder that is usually detected early in development, the high rates of clinically diagnosable ASD found in adolescents and not children with GID indicate that the diagnostic tool de Vries at al. (2010) used did not tap “true” ASD characteristics. Instead, psychosocial issues, such as anxiety and depression, that are particularly common in adolescents with GD/GI might have artificially inflated adolescents’ scores on DISCO-10.”

Here we can see that Turban, often lauded as a champion of the transkid community, is showing his denial of the two type taxonomy, as ASD comorbidity is far more common in “Late Onset” transsexuals than in “Early Onset”. “Late Onset” individuals would only show up at the clinics in adolescence or adulthood.

The final result of the meta-analysis supports the conclusion that there is a higher than expected (from the general population) comorbidity of ASD in the transsexual population. However, their estimate of 11% is very likely too high, having been pulled up by the studies that used self-report.

Further Reading:

How many “trans” people are there, really?

Falsely Claiming to be “trans” is Cool (NOT) !

Autistic Sky

Reference:

Kallitsounaki, A., Williams, D.M. Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis. J Autism Dev Disord 53, 3103–3117 (2023). https://doi.org/10.1007/s10803-022-05517-y