Gender dysphoria and gifted children

by Lisa Marchiano

Lisa Marchiano, LCSW, is a psychotherapist and certified Jungian analyst. She blogs on parenting at Big Picture Parenting, and on Jungian topics at www.theJungSoul.com. You can also find her at PSYCHED Magazine and @LisaMarchiano on Twitter. Lisa has contributed previously to 4thWaveNow (see “The Stories We Tell,”  “Layers of Meaning” and “Suicidality in trans-identified youth”).

Lisa is available to interact in the comments section of this post.


Rates of gender dysphoria in children and young people have increased dramatically in a short period of time. There is some evidence that significant numbers of those who experience dysphoria are gifted.

Since 2016, I have been consulting with families with teens or young adults who identify as transgender. Nearly all of these parents report that their child is bright or advanced, and a significant majority have shared that their transgender-identifying child was formally assessed as gifted. Four of these families report children who tested in the profoundly gifted range (verbal and/or full scale scores >150).

An investigator who presented as-yet unpublished research at the Society for Adolescent Health and Medicine conference this year described a population of adolescents and young adults presenting with a rapid onset of gender dysphoria (an abrupt onset of symptoms with no history of childhood gender dysphoria). Of the described population of 221 AYAs, nearly half (49.5%) had been formally diagnosed as academically gifted, 4.5% had a learning disability, 9.6% were both gifted and learning disabled, and 36.2% were neither.

This is a curious correlation. Could it be that gifted young people are more likely to experience dysphoria? Or is it rather that parents of gifted children are more likely to seek out my services or respond to surveys? My best guess is that it may be a little of both.

 

Possible Reasons for Increased Incidence of Gender Dysphoria Among the Gifted

  • Correlation with Autism Spectrum Disorders

Among those with Asperger’s, there is a higher proportion of giftedness than in the general population, and there are many overlapping traits between Asperger’s individuals and gifted individuals. This is especially true for the exceptionally or profoundly gifted. It has been suggested that as many as 7% of people with Asperger’s syndrome are gifted, compared with 2% of the general population who are gifted.

Those working with gender dysphoric youth have remarked on the significant proportion of those seeking treatment who carry a diagnosis of ASD. A 2010 Dutch study found that the incidence of ASD among children referred to a gender identity clinic was ten times higher than in the general population. At the UK’s only gender identity clinic for children, a full 50% of the children referred are on the autism spectrum.

A 2017 survey of 211 detransitioned women found that 15% were on the autism spectrum. This is 29 times higher than the rate of autism among females in the general population. Many of the survey responders felt that their autism contributed to their belief that they were transgender. For example:

I would absolutely not be trans if it were not for my autism spectrum features, which caused me to be grouped with boys in my youth because I was a “little professor” who lacked the ability to perform socially and emotionally in the way girls are supposed to.

And:

I think autism had something to do with my childhood difficulties relating to other girls and understanding/performing femininity. Traits like difficulty socialising, extreme focus on very specific interests etc seemed more acceptable once I framed myself as a boy.

  • Gender Atypical Preferences Among the Gifted

Research has shown that gifted children are more likely to exhibit gender atypical preferences. Gifted boys and girls may have wide and varying interests that do not conform to gender stereotypes. It is this author’s observation that most teens who self-diagnose as transgender do so on the basis of gender stereotypes. Liking video games rather than nail polish is interpreted as evidence that one is a boy, and so on.

  • Awareness of Difference; Bullying

Gifted children often have particular social needs and struggles. Even at a young age, gifted kids can have a sense of being different from everyone else without understanding the reasons for this difference. Feelings of isolation and loneliness can result. These feelings can be especially intense for profoundly gifted kids, or for kids who are both gifted and learning disabled (twice-exceptional). Because the experience of the gifted child can be so qualitatively different from those of his or her peers, gifted children may struggle with social isolation.

It seems plausible that some of the gifted transgender-identifying teens whose parents I have consulted with have come to understand themselves as trans, in part, as a way of explaining their pervasive sense of difference. “I was never like the other kids. I always knew I was different, I just didn’t know why.”

Being different can also bring with it negative social attention, including bullying. The blogger, detransitioner, and PhD psychology student ThirdWayTrans has shared his story on his blog. Diagnosed as profoundly gifted and radically accelerated in certain subjects, ThirdWayTrans found himself to be the victim of violent bullying throughout much of his childhood. He transitioned at 19 and lived as a woman for 20 years before coming to the realization that his gender dysphoria and desire to transition were linked to the traumatic bullying he experienced.

When I was a child I experienced trauma issues with bullying. When I was young I was physically the slowest boy but also very intellectually advanced like a child prodigy. By fourth grade I was going to the high school to take high school math, and on the other hand I was the weakest. So I was singled out for being a kind of super nerd. This didn’t make me popular at all. It made me popular with the adults actually but not my peers. So I suffered a lot of bullying and violence. It peaked in middle school where every day I would have some sort of violence directed at me.

When I was a child I started to have this fantasy of being a girl, because it meant I could be safe and not suffer from this violence due to being at the bottom of the male hierarchy. I could also be more soft. I used to cry a lot and that was also something that was not seen as good for a boy. I could be free of all of that and also still be intellectual because everyone was saying that girls can be smart too.

ThirdWayTrans notes that as an adult, he understood intellectually that it was okay for men to be vulnerable and “feminine,”  but that his internalized child perspective made it feel unsafe for him to let go of his trans identity.

  • Existential Questioning

Questioning one’s gender may go along with a predisposition to question one’s place in the world. Gifted children tend to question traditions critically, and to challenge things that others take for granted. Thinking about one’s identity may come more naturally to gifted kids.

  • Perfectionism and Anxiety

Gifted children may suffer from anxiety and perfectionism. Anxiety disorders were also well-represented among the comorbid issues reported in the detransitioners survey mentioned previously. It has been suggested by some that adopting a transgender identity may in some cases be an anxiety management strategy. I am familiar with one young man with dysphoria who is both gifted and learning disabled. His preoccupation with gender waxes and wanes, but is predictably worse during exam periods, when he tends to fall behind and become overwhelmed. The feelings of dysphoria seem to allow him to distract himself from his feelings of intense anxiety and insecurity, while alleviating some of the academic pressure. When he is suffering from increased distress over gender dysphoria, his teachers and parents are more focused on his mental well-being, and they place fewer demands on him.

Outcomes

Currently there is very little data on long-term outcomes for gender dysphoric youth. To date, there is only one study that examines outcomes for those who pursued medical transition as minors. The study followed 55 individuals who pursued medical transition as minors, and showed that at one year post operation, study subjects evidenced positive outcomes according to several measures of mental health. However, it is important to note that the individuals followed in this study were carefully chosen, screened, and followed according to a strict protocol. All of those in the study had histories of lifelong gender dysphoria. It is a big leap to generalize these findings to teens exhibiting sudden onset gender dysphoria, and who may receive minimal assessment and counseling before starting hormones or undertaking other interventions.

I am aware of young people transitioning whose families report a decrease in symptoms and an improvement in academic and vocational functioning post transition. However, in my experience, this is the exception rather than the rule. Of course, families seeking my assistance are doing so mostly because of poor outcomes, so I hardly see a representative sample. Nevertheless, certain patterns have emerged through my work with parents.

Most parents with whom I have consulted have teenage children with rapid onset gender dysphoria. (In other words, their child did not exhibit any dysphoria until adolescence.) Most parents supported a social transition, allowing their child to change names, pronouns, gender presentation, etc., but drew the line at medical intervention (hormones and surgery) until adulthood. Most of the parents I have worked with noted one or more of the following changes subsequent to their child’s social transition: worsening gender dysphoria as the child became increasingly preoccupied with passing; decreased academic or vocational functioning – declining grades, etc.; increased social isolation as child spent more time on transgender internet sites, or spent time exclusively with transgender friends; worsening overall mental health evidenced by increased anxiety, self-harming behaviors, and/or depression; constriction of interests as the young person ceased to pursue pastimes and activities that had once been important to him or her; and worsening family relationships, including increased tension and anger between parent and child.

I have also known of gifted young people who desisted from a transgender identity. These young people had parents who were loving, engaged, and supportive, but who assisted them in questioning their belief that they were the opposite sex. Though the sample size is small, those who desisted from identifying as trans appeared to benefit from improved family relationships, increased social and academic engagement, and overall better mental health than during the period of transgender identification.

Conclusion

Currently, there is very little research into long-term outcomes for gender dysphoric young people. My observations indicate that a disproportionate number of those families seeking consultation with me have a transgender-identifying teen who is also gifted. There are many possible reasons for this confluence. Assessment and treatment for gender dysphoria in teens should take into account the various motivations that might influence a young person to self-diagnose as transgender. Families should be encouraged to support their child in ways that feel most appropriate to them, taking into account that a one-size-fits-all treatment for gender dysphoria is likely not suitable at this time. Further research is needed into causes and treatments.

Social work professor speaks out on behalf of her FtM autistic daughter

UPDATE 5/24/16: The National Review (NRO) has published an article discussing Dr. Levinstein’s post here on 4thWaveNow. It was pointed out in the comments thread on the NRO piece that Dr. Levinstein’s bio on the U Michigan-Flint site includes a statement that she is the “proud mother of a trans son.” I asked her for a response, and she submitted the following for this update.

That bio was written two years ago, prior to all my daughter’s surgeries and the ensuing and now chronic health problems resulting from testosterone, at a time when I was trying my best to be supportive of my child’s choices.

I am indeed proud of my daughter, who has been a victim in this process.

Dr. Levinstein also stated that she is happy to discuss her situation further with the press.


Dr. Kathleen “Kelly” Levinstein, PhD, LCSW, LMSW is a Professor of Social Work at the University of Michigan, Flint.  Among many other accomplishments, Dr. Levinstein was a Heilbein Scholar at the NYU School of Social Work, where she also taught, and has directed and provided clinical services for people with disabilities for many years, primarily in New York and New Jersey. A clinical and research social worker for 40 years, Dr. Levinstein describes herself as “the only out autistic PhD level social worker” in the world. Her research and advocacy work includes human and civil rights violations against the autistic community.

In this post and accompanying short interview, Dr. Levinstein tells us about the ordeal currently being experienced by her daughter who has undergone transgender medical transition. Dr. Levinstein also shares her thoughts about the current increase in young women with autism being diagnosed as transgender.

A version of Dr. Levinstein’s account will be published in an anthology entitled Female Erasure: What You Need To Know About Gender Politics’ War on Women, the Female Sex and Human Rights, Tidal Time Publishing, Fall 2016. Ruth Barrett, editor, forward by Germaine Greer. www.femaleerasure.com.

For previous 4thWaveNow posts on the subject of autism and transgenderism, see here:

“Insistent, consistent, persistent”: Autism spectrum disorder seen as no barrier to child transition–or sterilization

Guest post: For teen girls with autistic traits — a plea for watchful waiting

New study out of Finland: Girls with gender dysphoria have many other mental health issues


by Kathleen “Kelly” Levinstein, PhD, LCSW, LMSW

My daughter, who is on the autism spectrum, as am I, is now 19 years old. She had felt (and told others) that she was a lesbian most of her life. When she was 16, she began watching a TV show called “Degrassi,” which featured an FtoM character. After a few weeks, she announced that she was not actually a butch lesbian, as she had previously said, but was in fact trans. She started attending a local PFLAG meeting, where she met many trans people, including a number of FtoM trans teenagers who were raving about a certain “gender therapist.” Although the APA recommends a minimum of one year of “gender counseling” before surgery, this gender therapist (whom I consented to, before really understanding what I was doing) gave my daughter the go-ahead to have a bilateral mastectomy after only two sessions. This gender specialist never reviewed any of the Special Ed records or spoke to my daughter’s previous therapist, who had known her for a decade. And, crucially, she never asked my daughter, “Might you be a lesbian?”

The gender therapist (whom I believe has an unholy financial alliance with the surgeon) gave my daughter (then 18 and one day) the go-ahead for the $30,000 surgery (covered for all university employees and their families where I work). My daughter is now on testosterone (which she clearly is unable to evaluate the risks and consequences of).

To give you some sense of my daughter’s level of understanding of what it means to transition, she told me recently that she believes that the testosterone “will grow her a penis.” I had to break the news to her that, although this is the mythology in the PFLAG meetings (where a number of the other young trans people are also autistic), this is not the case.

She has been taken advantage of. Healthy organs were amputated. This is insurance fraud, poor clinical practice, a violation of APA standards, unethical and unjust. It is a crime not just against women, but particularly against disabled women. So many of these young women who are “transitioning” are also autistic.

My daughter has a representative payee on her SSDI [disability] check, as it was felt that she was unable to handle her own money. This was of little concern to the gender therapist. I believe that once the therapist realized the “treatment” would be covered by the University of Michigan insurance, it was full speed ahead.


You mention that your daughter previously considered herself a lesbian, and this changed when she started watching the TV program “Degrassi.” Was that the only thing that influenced her to claim a trans identity? Was there anything else?

Other than Degrassi, the PFLAG meetings–which are now the cult of trans–sealed her fate. There were no young lesbians there. In fact, there are very few young lesbians left–they are all transitioning. If she had been able to have a lesbian relationship prior to transitioning I believe that things would have transpired differently. I attempted to get her in a support group for young lesbians when she was 12, but was informed that because of liability insurance reasons,  she was not welcome until age 18. By that time it was too late.

She had a legal name change in Dec of 2014, a bilateral mastectomy in April 2015, and started testosterone in Sept 2015.  My daughter has severe Crohn’s Disease, and currently, she is having grave reactions to the testosterone. She has been hospitalized three times now for complications.

Many professionals, as well as some autistic people themselves, have written about the fact that young people on the ASD spectrum are often “gender nonconforming” and have a less stable sense of identity. Can you speak to this regarding your daughter?

I DO believe that there is an overlap with the autistic and transgender populations.  Some studies show a higher level of testosterone in autistic human beings. For males a high enough level of testosterone converts to estrogen. This may explain the large number of autistic people of both sexes claiming that they are transgender.

In recent years, activists have agitated for disabled people to be treated as having the same “agency” to make medical decisions as non-disabled people. In fact, when anyone brings up concerns about young people with autism being questioned about their transgender identity, they are accused of “ableism.” Do you have any thoughts about this?

Yes, I agree–anyone asking for critical thinking about these issues with autistics is accused of ableism and transphobia. This is often an effective silencing tactic. I have found no allies in the autism community. Instead, there is a vilification of anyone daring to ask questions about these issues, including the evidence of MtoF physical, sexual and psychological violence against women. Women who publicly question receive death threats, threats to rape us and our children, burn us to death with gasoline, decapitate us, and so on. This all coming from people who claim they are our “sisters.”

Given that your daughter was recently hospitalized for health issues related to her use of testosterone, have you found any medical professionals who are willing to speak up about this?

I have found no health professionals willing to go on the record against this. Everyone is afraid of professional suicide and threats of violence. I am standing alone.

My daughter’s latest hospitalization has been described by doctors as due to “absorption issues.” She now has a full beard but still has her period. The testosterone is wreaking true havoc on her system.

Autistic women (again, I am one) frequently have a difficult time, sensory-wise with their periods. But rather than attempting to help us with this difficulty, our problems get labeled  “gender dysphoria” and the answer has become to remove our periods from us.

We will find out in 20 years the effects of testosterone on our young women. I am confident that it will not be a pretty picture.