Caring for Transgender and Gender Diverse Youth with Co-occurring Neurodiversity

Research points to an association between gender diversity and the clinical characteristics of autism spectrum disorder (ASD)/neurodiversity, and it has been suggested that gender dysphoria (GD) and ASD intersect more frequently than would be estimated by chance. Several hypotheses have been forwarded to explain this potential co-occurrence, but empirical evidence for these hypotheses is lacking. Co-occurring ASD might come with specific challenges in assessment of individuals with gender identity questions. However, there is a clinical consensus that GD and ASD can co-occur independently, and that an ASD diagnosis should not be an exclusion criterion for a GD diagnosis in children and adolescents, nor for gender-affirming medical treatment in adolescents. While exploring gender identity in youth with ASD, it is important to take ASD-specific challenges into account and to adjust the assessment process to their needs. With respect to gender affirmative interventions, a carefully evaluated stepwise approach that takes into account specific ASD characteristics is indicated.