Jack Turban, MD, from Harvard Medical School argues that recent findings of overrepresentation of autism spectrum disorder (ASD) symptomology among transgender youth reflects social deficits related to social stress and deprivation rather than true ASD symptoms. In a letter to the editor published in the Journal of Autism and Developmental Disorders, Dr Turban argues that these symptoms and social deficits are likely reversible with improved social engagement, especially affirmation and support from peers and loved ones.
Transgender youth have high rates of peer and family rejection as well as anxiety and depression. Rates of internalizing psychopathology increase as patients age.
The rates of testing positive on scales for ASD also increase with age for transgender youth, contrary to the typical trends of ASD symptomology. The rate of social deficits resulting from internalizing psychopathology would be expected to increase, however. Research suggests that 80% of transgender youth report being bullied, 40% of transgender adults report a history of family rejection, and 10% of transgender people report family violence after revealing gender identity.
Recent research following transgender individuals from late childhood into young adulthood shows that gender-affirmative hormonal and surgical care results in normative global functioning. A TransYouth project demonstrated the prepubertal transgender children who had affirmation of their gender identities and were permitted to socially transition had developmentally normative rates of anxiety and depression. “These studies provide hope that future cohorts of transgender youth, if provided with acceptance, can develop normative mental health,” writes Dr Turban.
Dr Turban cites the recommendations from a recent Delphi consensus that it is necessary to establish a care team with expertise in gender dysphoria and ASD, provide psychoeducation, provide the structure for gender exploration and social transition, and emphasize that ASD is not a contraindication for gender-affirmative hormonal care. He concludes that future longitudinal studies should assess whether transgender youth are indeed protected from increased ASD symptomology when they have affirmative medical and family environments.
Turban JL. Potentially reversible social deficits among transgender youth [published online May 12, 2018]. J Autism Dev Disord. doi:10.1007/s10803-018-3603-0