This guest post by 4thWaveNow community member neverfallingforit is second in a series exploring the increasingly well known connection between autism spectrum disorder (ASD) and gender dysphoria (or other gender-related issues).

 Many of us have shared observations that our kids show signs of ASD. Unfortunately, the current treatment paradigm tends to view ASD as no barrier to “transitioning” kids and young adults.

 A word about the title of this post. The current approach fostered by WPATH is generally referred to as “watchful waiting” with regard to diagnosing younger children as transgender. While this sounds like a hands-off approach, in reality “watchful waiting,” to trans activists and many gender specialists,  often includes the use of “preferred pronouns,” “social transition,” and (frequently) puberty blockers. Once these kids reach adolescence, “watchful waiting” ends and the path to full medical transition becomes available.

There is much that is still unexplored (and unstudied) about the impact of these supposedly benign interventions on actually helping to create a persistent transgender identity in children and young people. I’ll have more to say about this in a future post.

by neverfallingforit

When my daughter first started identifying as transgender, I quickly and easily found articles online which posed a link between autism and gender identity issues. I bought the books Aspergirls by Rudy Simone and I am Aspiengirl by Tania A Marshall. At the back of each book there is a checklist of traits for girls with Asperger Syndrome, many of which I learned were different from those which appear in the male Asperger profile.

I also learned that formal research on the autistic female profile is relatively new, and as such, is years behind clinical and anecdotal observations. After reading the books, my daughter herself placed ticks next to a whole host of these traits, and I began to suspect that an autistic spectrum disorder (ASD) was in the mix here somewhere. Several traits particularly jumped out at me:

• may have androgynous traits despite an outwardly feminine appearance. Thinks of herself as half-male/half-female (well balanced anima/animus)
• may not have a strong sense of identity and can be very chameleon-like, especially before diagnosis
•  will not have many girlfriends and will not do “girly” things like shopping with them or have get-togethers to “hang out”
•  emotionally immature and emotionally sensitive
•  strong sensory issues – sounds, sights, smells, touch and prone to overload
•  will have obsessions but they are not as unusual as her male counterpart (less likely to be a “trainspotter”)

After finding 4thWaveNow, I read that gender identity clinics are seeing a higher number of natal girls in their referrals than they would expect from previous epidemiological knowledge, and also that it is very common to find that these girls had autism spectrum characteristics. Some of the studies alluded to the fact that cultural factors could also be at play in the increasing referral rates.

As I read the comments on many of 4thWaveNow’s posts, I could see a profile emerging of a subset of teenage girls who had come to believe that they were born in the wrong body. Most had never previously mentioned gender dysphoric feelings to their parents, although many had never been “girly girls.” They often seem to share the same personality traits; traits which fitted right into the female Asperger profile. 4thWaves’s comprehensive article on autism discusses how autistic spectrum traits could lead to a transgender presentation and I could clearly see how this applied to my daughter.

What really caught my attention was how these girls also seemed to share the same cultural traits. My parental antennae kicked in.

Then, I found an article on GenderTrender, and some more pennies began to drop. Way back in 2010, that blog was insightfully covering the transgender trend in ‘tween and teenage girls

 who believe that rejection of increasingly constrictive female norms means they must be male. These girls don’t want to act out a ‘female’ role in relationships with boys.

Here was an apt description of my daughter, who kept telling me that she must be a boy because she was a “rubbish girl,” that she wanted “to be the boy in the relationship, saying the lines and making the moves.”

She and her friends had recently been watching porn videos on their phones at school, and a letter had been sent home to parents. I wondered if the images she had seen had frightened her. Girls with ASD often have sensory issues which can mean they don’t like to be touched much, or hugged; a few in my daughter’s online social group describe themselves as asexual. Maybe she felt that taking on a male presentation would ensure that she wasn’t pressured into situations which she was uncomfortable with? She refuses to discuss it with me.

As the same article also observed,

 they don’t want to be marginalized as the gender non-conforming women that they are. Femininity rejecting females simply DO NOT EXIST in the media reflection that is so important to children and teens in western culture. These kids want to fit into social norms, wear the right brands, get the right haircuts, and look like the people in magazines. “Transgender” has a certain cachet, a certain alterna-cool about it for those in middle school and high school years. Declaring one’s trans status is like getting the ultimate cool tattoo or piercing body mod and provides girls with special status and treatment amongst their peers as well as school officials, employers, parents and other authorities.

This, too, has been my experience. My daughter’s social popularity rose on her transgender announcement, and what teenager wouldn’t rejoice in that–especially one who had previously had trouble maintaining friends? She attracted much encouragement and support.

I read all the statistics about suicide rates, the suffering of those with crippling dysphoria, about the bravery of coming out as trans in a hostile world — and yet my daughter displayed no such angst. She declared herself the happiest ever and demanded that we catch up with the rest of the world. Her anger and distress were only directed at us, her parents, when we questioned her transgender narrative.

One of the most heartbreaking parts of my story is the way my daughter has been encouraged to believe that we, her parents, don’t love and respect her because “we don’t want her to be happy.” Outside of our family, her friends, college teachers and the media are cheering and validating her male presentation. She is genuinely bewildered, disappointed and hurt by our inability to sign up to her self-diagnosis, without question, without due diligence. Not long ago, she reblogged a popular post on her Tumblr account. It is an illustration of a parent cutting the multicolored wings on the back of a “transgender” child.

It’s common knowledge that teenagers always run with their peer group. They try out identities and refute parental opposition. There’s nothing new in that. That’s healthy. But it’s the untested lifelong medical treatments and surgery involved here which frighten us, and make us cautious parents – not “transphobes.” And, if my daughter does have Asperger Syndrome, does she have the ‘theory of mind’ to understand the long-term implications of what she is proposing?

Back to GenderTrender:

 The trans tweener trenders bond and encourage online via YouTube groups and web forums which function much like pro-ana, pro mia and trans-abled communities, encouraging dysphoria and censoring questioning and dissent.

The online spaces my daughter visits have become saturated with transgenderism. Many 4thWaveNow parents mention that their girls spend a great deal of time on Tumblr in particular. During Trans Awareness Week recently Tumblr was described glowingly:

 Tumblr seems like a natural fit for young transgender people to gather online, with a thriving social justice community and fandom devotees advocating LGBTQ rights, Tumblr fosters a culture of reaching out for advice from caring, experienced strangers… Tumblr’s also important because through finding one person who is similar to you, you’ll find 10 more, because they’ll be following people like themselves. When I was first working out I was trans, I didn’t follow that many other girls, but now I follow loads… the most important thing Tumblr’s trans community can give its members may be a sense of affirmation.

How intoxicating must that be? A legion of like-minded girls, with similar interests – after so many years of feeling like you don’t fit in. And how normalizing!

In my daughter’s case, I would also add into the mix the androgyny, cosplay and cross-play associated with anime and manga, and the androgyny, parental estrangement, disassociation, and angst messages that she absorbed during her previous obsession with the “emo” scene too.

Not feeling either stereotypically male or female is fine. Androgyny is fine. Trying on many identities is fine. But how did these feelings become conflated with a transgender diagnosis, when they all fit firmly into the Asperger girls’ profile too?

Here are a few quotes from parents of girls with Asperger Syndrome, which feature in the  I am Aspiengirl  book:

 “She went from princess, to tomboy, to punk, to emo to goth. She is having trouble finding out just who she is and has gotten involved with the wrong types of people. She is not interested in dating and finds flirting very confusing. She also does not seem to have a solid gender identity.”

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“She has recently given up trying to fit in. She is going through very challenging teenage years, feeling even more outcast. We are now watching her embrace opposite conventions, despise femininity, social and gender rules. She is now a tomboy and a bit confused about her gender.”

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“We all thought she had gone to the “dark side”. She just didn’t fit in anywhere and had no idea who she was. She seemed to despise femininity and defined social and gender rules. When she has friends, she tends to naively and blindly follow wherever they go, their rules, taking on their traits, from the way they dress to the way they talk and act.” 

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“Just a few months ago, she was wearing frilly dresses and looked like a princess. Now she’s Goth and won’t let anyone call her by her new name. She has depression and panic attacks that sneak up on her from out of nowhere.”

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“She really struggles with sensory sensitivities, social anxiety, panic attacks and depression. She must have gone through at least three or four different lifestyle changes.”

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Do any of these anecdotes sound familiar to other parents in my position?

So what now? I strongly suspect that my daughter is on the autistic spectrum. I feel that she has Asperger-related issues which are impacting on her self-diagnosis of being trans. I feel transgenderism has become a special interest/ obsession that gives her relief from anxiety. All I want is to be reassured that clinicians will take care, be cautious, give her time to experience more life, to mature.

But will they?

Until I believe they will exercise proper caution, I am too scared to lead her into a therapist’s waiting room. Because I fear that, in some medical quarters, as soon as the word “transgender” is uttered, Asperger syndrome becomes downgraded to a mere co-existing condition.

In a recent small retrospective study of children presenting to a gender clinic in Boston, it was found that 23% of the patients potentially could be given an Asperger diagnosis but instead of urging caution, the researcher Daniel Shumer seemed to imply that it merely meant these kids may need to have the transition process explained more clearly.

 Given the growth of gender programs and general awareness of gender dysphoria in the U.S., Shumer said it helps to know that there’s a link between it and Asperger syndrome. He said he hopes his work will help persuade doctors to screen transgender patients for ASD and know that they may need to take more care to explain hormonal interventions to their patients on the autism spectrum.

Aron Janssen, MD, a child psychiatrist at NYU Langone Medical Center, who was not involved in the study had this to say,

It’s really about assessing what gender means to a population that may think of gender in a different way than the way most of us do,” Janssen said, explaining that thinking differently about gender shouldn’t limit treatment options for patients with ASD. In a way, people with ASD may express their gender more authentically because they’re not as swayed by social stereotypes, Janssen said.

Aron Janssen has recently taken part in an interview with The Ackerman Institute for the Family, which he has posted to the WPATH Facebook page. In it, he gives his view that gender dysphoria is a completely separate entity from autism spectrum disorder. He states that recent research has found an overlap between individuals who have gender dysphoria and individuals who have an autism spectrum disorder but we don’t really know why that is.

One of the implications for treatment, he says, can be that patients with autism who may have a “theory of mind” impairment could have difficulty in understanding how to communicate their internal gender identity to the outside world; in other words, they may not understand that how you speak, dress, act and appear are important to how people view your gender presentation. They may need help with that.

A Reddit commentator with Asperger’s would agree with that impairment, but reaches a different conclusion on the help needed:

 I can’t speak for all people with autism (I have Asperger’s), but I think a lot of people with autism spectrum disorder are confused by the messages that society puts out about how to act and how to perform gender. I always felt like I didn’t fit in with women when I was growing up. Had I been born later, I have to wonder if I’d be picking up this trans narrative and taking it to heart. This is not the kind of help that young people with autism need. They need appropriate services, help finding their way into jobs and meaningful social connections, not hormones.

Dr Janssen, however, appears to take a different perspective.

 For too long individuals with autism who have had gender dysphoria have had that gender dysphoria dismissed as filling category 2 of autism- that restricted or repetitive interests or behaviors – and their gender identity was thought of as a symptom of autism, as opposed to something that is genuine for each individual.

As such, he believes he needs to help patients express their own autonomy and give them access to the care they say they need.

Which all sounds great, if we weren’t talking about letting children with cognitive vulnerabilities make decisions about irreversible treatments before their brains reach full maturation!

My last point is this:  So much of the research available cites case studies of patients who have experienced gender dysphoria from a very young age. Information about the clinical management of SUDDEN, LATE ONSET gender dysphoria in YOUNG TEENAGE GIRLS has been impossible for me to find on the internet. 4thwave’s blog is the only place I have found where this particular path to transgender presentation is being discussed.

More importantly, parents are also beginning to come here to tell about desistance in their daughters. These stories are important. (These stories give me hope.) If you have a similar one to tell, please share it here. My plea to clinicians is that they read these accounts and adopt a WATCHFUL WAITING approach for this group of teens and young adults.