Autism, Neurodiversity, and Gender Diversity

A growing body of evidence supports a potential link between autism spectrum disorder (ASD) and gender dysphoria, yet few studies have looked at sex differences in the co-occurrence of gender diversity and ASD. The aim of this study was to characterize sex differences in gender-diverse expressions and identities, as well as gender-related concerns, in youth with ASD. Parents of youth with ASD ages 6-21 (n = 163) completed an online questionnaire about their child's gender expression and identity. Sex-typed behaviors during childhood were measured using the Gender Identity Questionnaire (GIQ). Semi-partial Kendall correlations and chi-square tests were used to compare gender non-conformity, gender-diverse identities, and gender-related concerns between sexes. Sex-based differences in mean GIQ score and individual GIQ items were evaluated using a linear regression and semi-partial Kendall correlations, respectively. All regressions and correlations controlled for child age. Parents of girls were more likely to report child appearances and mannerisms that were less concordant with their child's birth sex. Based on parent-report, girls had lower mean GIQ scores, indicating greater cross-gendered/fewer same-gendered behaviors in childhood. Lastly, parents of girls with ASD were more likely to report that their daughters experienced anxiety due to gender-related concerns and discomfort during puberty than parents of boys. These findings suggest that girls with ASD seem more likely have gender-diverse preferences, mannerisms, and appearances that fall outside of traditional gender norms. Gender-related concerns appear to be a source of real distress in girls with ASD, highlighting the need for individualized support, especially during puberty. LAY SUMMARY: Despite evidence of a potential link between autism and gender diversity, few studies have explored differences in gender identity/expression between boys and girls with autism. Based on parent responses, we found that girls with autism are more likely than boys to have appearances and mannerisms, as well as behaviors during childhood, that fall outside of the traditional gender role. The unique profile of girls with autism and their elevated distress over gender-related concerns call for individualized support during adolescence.

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.

Objective: Mental health (MH) comorbidity is elevated in individuals who identify as gender-diverse (GD) and in individuals with an eating disorder (ED). GD individuals with an ED may have significantly higher MH comorbidity than individuals with just one of these conditions. Gender Minority Stress Theory suggests that experience of stressful events associated with gender minority status may increase risk of developing MH difficulties and may explain the elevated risk of ED diagnosis in GD populations. Method: This is a cross-sectional analysis of survey data. Using data from a sample of 334,957 American university and college students, we compared MH comorbidities of 1885 GD individuals with an ED to demographically matched samples of non-GD individuals with an ED and GD individuals with no ED diagnosis. Results: Even following stringent demographic matching, GD participants with an ED had significantly more comorbid MH diagnoses (M = 4.23, SD = 2.23) than non-GD individuals with an ED (M = 2.86, SD = 1.98). Similarly, GD participants with an ED had significantly higher MH comorbidity than demographically matched GD individuals without an ED (M = 1.96, SD = 1.84). In GD individuals, ED diagnosis was associated with increased odds of experiencing minority stress events (OR: 2.19 95% CI [1.91–2.51]) and associated distress (OR: 2.17 95% CI [1.89–2.50]). Conclusions: We find that GD individuals with an ED report significantly elevated MH comorbidity, including serious MH disorders. Prompt intervention and proactive screening have an important role to play in supporting young adults in this vulnerable population.

Differential diagnosis of autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) in adolescents is difficult due to similar behavioral topography. For instance, restrictive, repetitive behavior, cognitive rigidity, anxiety, and avoidance contribute to impairment in social relationships and daily living skills in both conditions. The diagnostic picture for youth with ASD and/or OCD may be further clouded by high rates of co-occurring gender-diverse clinical concerns, attention-deficit/hyperactivity disorder, tic disorder, depression, and anxiety disorders With increased prevalence and improved identification of ASD, OCD, and gender-identity-related distress, more adolescents are seeking treatment. It is vital that providers are knowledgeable about best practices for diagnosing and treating these overlapping symptoms. This review describes the state of the literature regarding presentation and prevalence of ASD, OCD, and gender-identity concerns separately and as co-occurring phenomena. Sex differences and gender-diversity among individuals with ASD and OCD are also reviewed. We briefly describe evidence-based behavioral treatments for ASD, OCD, gender-identity-related distress as separate and co-occurring considerations. Recommendations for tailoring within these therapies and family involvement are discussed.

In this chapter diverse sexual orientations and gender identities in Australia are introduced, and differences and intersections between gender, sex and sexuality are explored. A brief history of Australian gender and sexuality diverse communities, relevant legislation and human rights issues are provided. Changing language used to describe people from diverse sexual orientations and gender identities is addressed, with particular reference to the areas of medicine, health and human rights. The impact of stigma, discrimination and minority stress on people of diverse sexual orientations and gender identities in the Australian healthcare system is explored by showing how these experiences are key social determinants of health. Students are asked to consider their personal and professional roles in relation to cultural safety. Case studies are provided to assist students to understand the power imbalance between health provider and those accessing a health service, and to identify strategies to minimise it. This chapter also outlines ways that health professionals’ knowledge and attitudes about sexuality and gender diversity, and their conscious and unconscious bias, aids in the creation and reduction of stigma and discrimination. By the end of the chapter, students will have developed an understanding of current key principles for inclusive and respectful practices in healthcare settings for working with people of diverse sexual orientation and gender identity.

PurposeThis study aims to explore the relationship between gender diversity (GD) in leadership, green collaborations (GC) and firm financial success within FTSE 350 nonfinancial companies in the UK, shedding light on how GD moderates the impact of GC on firm financial success.Design/methodology/approachQuantitative methods are used to analyze data from 2,280 firm-year observations, offering insights into the correlation between GD, GC and firm financial success metrics such as returns on assets (ROA), returns on equity (ROE) and earnings per share (EPS).FindingsThe empirical analysis conducted in this study uncovers a compelling correlation between GD on the board and the financial success of firms involved in GC. The findings illuminate a positive association, indicating that companies boasting higher levels of GD among their leadership tend to outperform their counterparts with less diverse leadership teams regarding financial success (ROA, ROE and EPS). This suggests that including women in leadership roles can introduce fresh perspectives, innovative ideas and strategic priorities that prioritize sustainability and environmental stewardship by facilitating GC. Moreover, the study underscores the critical role of GD as a practical, valuable resource and a catalyst for driving financial success within sustainable business practices.Practical implicationsThese findings reinforce the strategic importance of cultivating GD as a pivotal resource for organizations aiming to excel in sustainability-driven initiatives, such as GC. By assembling diverse leadership teams, firms can benefit from broader perspectives, innovative thinking and a more profound commitment to environmental stewardship, ultimately enhancing their financial performance. Consequently, corporate leaders, policymakers and investors are encouraged to recognize GD as a moral obligation and a key driver of sustainable success and a competitive advantage in today’s marketplace.Social implicationsEmbracing GD and actively participating in GC carry profound social implications that extend beyond firm financial success metrics. By promoting GD, organizations signal a commitment to inclusivity, equality and diversity in corporate leadership, thereby fostering a more inclusive and equitable work environment. Furthermore, the engagement in GC underscores a dedication to social and environmental responsibility, aligning with the expectations of diverse stakeholders, including employees, customers, communities and regulatory bodies. Such initiatives contribute to broader societal goals by addressing pressing environmental challenges and promoting sustainable business practices that prioritize the well-being of both present and future generations. This highlights the pivotal role of GD as a crucial resource in driving positive social change and advancing sustainable business practices.Originality/valueThe study contributes to both academic research and practical understanding by empirically examining the relationship between GD in leadership and firm financial success within GC; it addresses a critical void in existing literature, offering insights valuable to scholars, practitioners, policymakers and investors. Moreover, the study implications extend beyond traditional GD studies by emphasizing its strategic importance in driving sustainable business practices and enhancing firm value. This underscores the need to recognize GD as a crucial resource for financial success in pursuing sustainability goals through GC.

Sleep problems are highly prevalent in ADHD and autism spectrum disorder (ASD). Better insight in the etiology is of clinical importance since intervention and prevention strategies of sleep problems are directed at underlying mechanisms. We evaluated the association of sleep problems and sleep patterns with sleep hygiene (behavioral/environmental practices that influence sleep quality, e.g. caffeine use), access to electronic media, chronotype, and anxiety/depression in children aged 6–12 years with ADHD, ASD, or typical development (TD) using parental questionnaires. ANOVA and linear regression analyses were adjusted for age and sex. Children with ADHD and ASD showed more sleep problems (63.6 and 64.7%, vs 25.1% in TD) and shorter sleep duration than controls, while differences between ADHD and ASD were not significant. Sleep hygiene was worse in ADHD and ASD compared to TD, however, the association of worse sleep hygiene with more sleep problems was only significant in ASD and TD. There was a significant association of access to electronic media with sleep problems only in typically developing controls. Chronotype did not differ significantly between groups, but evening types were associated with sleep problems in ADHD and TD. Associations of greater anxiety/depression with more sleep problems were shown in ADHD and TD; however, anxiety/depression did not moderate the effects of chronotype and sleep hygiene. We conclude that sleep problems are highly prevalent in ADHD and ASD, but are differentially related to chronotype and sleep hygiene. In ASD, sleep problems are related to inadequate sleep hygiene and in ADHD to evening chronotype, while in TD both factors are important. Clinical implications are discussed.

BackgroundThe diagnostic boundaries between autism spectrum disorder (ASD) and specific language impairment (SLI) are not clear‐cut. Evidence of the lack of distinct boundaries between these disorders comes from research identifying a group of children who have pragmatic language difficulties that can be distinguished from those in children with SLI and those with ASD. These findings have led to the inclusion of a new diagnostic category, social (pragmatic) communication disorder (SPCD), in the Diagnostic and Statistical Manual of Mental Disorders‐5th Edition DSM‐5. While this new diagnostic category appears to capture a subgroup of children who may not have been recognised in the DSM‐IV, SPCD has been criticised due to a lack of empirical evidence, showing that the disorder is distinct from ASD in terms of aetiology, intervention, and prognosis.ObjectiveThe purpose of this paper was to summarise the literature that has investigated overlaps in the phenotypes of SLI, ASD, and SPCD. A secondary objective was to present a framework for the assessment and diagnosis of these three conditions.Method and ResultsIn this paper, we review the research that has examined overlaps in the aetiologies and phenotypes of ASD, SPCD, and SLI. While the results highlighted overlaps in the language profiles and autistic symptomatology, these three conditions could also be distinguished based on the severity of the social communication deficits and the absence of rigid and repetitive behaviour in strictly defined cases of SPCD and SLI.ConclusionsStrictly defined cases of SPCD and SLI can be distinguished from ASD. However, there is a lack of assessment tools that can reliably distinguish these three conditions. We consider the clinical implications of the findings and present a model of assessment and diagnosis for ASD, SLI, and SPCD.

Transgender refugees are at risk of experiencing increased minority stress due to experiences of trauma in their country of origin, and the intersection of multiple marginalized identities in their host country. Adopting a transfeminist and decolonial approach, the present study aimed at exploring transgender refugees’ experiences of life and migration. A semi-structured interview protocol was developed, grounded in the perspectives of minority stress and intersectionality. Participants were five transgender refugees (four women and one non-binary) from different cultural/geographic contexts, professing different religions. Using thematic analysis, the researchers identified three themes: pre- and post-migration minority stress and transphobia; religion as a protective factor for gender affirmation; and individuation and the synthesis of social identities. Participants reported traumatic experiences and the inability to openly live out their gender identity in their country of origin as the main push factors to migration. They also reported feelings of isolation and experiences of victimization during interactions with the Italian asylum services, due to a lack of adequate training, racial prejudice, and transphobia. Participants demonstrated positive individuation, linked to gender affirmation treatments and religious protective factors. The interview protocol may be used by social operators to support the claims of transgender asylum seekers, and to clinically assess transgender people with an immigrant background.

Endocrine circuitry in autism spectrum disorders: A systematic review of mechanistic insights and clinical implications.

Autism is a neurodevelopmental disorder of complex etiology and is amongst the most heritable of neuropsychiatric disorders while sharing genetic liability with other neurodevelopmental disorders such as intellectual disability (ID). Autism spectrum disorders (ASDs) are defined more broadly and include autism, Asperger syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. Under the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Revised (DSM-IVTR), these disorders are grouped together with Rett syndrome (“Rett’s disorder”) as pervasive developmental disorders. However, Rett syndrome has a reportedly distinct pathophysiology, clinical course, and diagnostic strategy (Levy & Schultz, 2009) and will likely be removed in the impending publication of DSM-V (APA, 2010). The new diagnostic manual will formally adopt the single diagnostic category “ASDs”, which is used here. Reported prevalence rates for ASDs range from 20 (Newschaffer et al. 2007) to 116 (Baird et al., 2006) per 10,000 children, and vary in accordance with diagnostic, sampling, and screening criteria. The Centers for Disease Control and Prevention (CDC) suggest that in the United States, the prevalence of ASDs is 1 in 110 (1/70 in boys and 1/315 in girls) (ADDM, 2009). The three primary characteristics of ASDs are communication impairments, social impairments, and repetitive/stereotyped behaviors. The DSM-IVTR, ICD-10, and many other diagnostic instruments require impairment in each of these domains for a diagnosis of autistic disorder. Within the last decade, a number of major technological developments have transformed our understanding of the genetic causes of autism, and the field continues to evolve rapidly. In this chapter, we will review three approaches to identifying genetic factors that contribute to the pathogenesis of ASDs: 1) common variants and genome-wide association studies (GWAS); 2) rare variants and copy number variation (CNV) studies, and 3) familial forms of autism and the role of next-generation sequencing (NGS) methods. Data from all three approaches underscores the conclusion that autism is a highly complex and heterogeneous disorder, involving a multifactorial etiology. Moreover, it is becoming increasingly apparent that autism is not a unitary disorder, and that the spectrum may consist of any number of different autisms that share similar symptoms or phenotypes. This conclusion has important implications for evaluation and treatment, which are discussed in the conclusion.

To evaluate whether anti-glutamic acid decarboxylase (Anti-GAD) antibodies and selected biochemical parameters are associated with autism spectrum disorder (ASD), symptom severity, and autistic regression in a case-control design. We hypothesized that Anti-GAD titers would be higher in ASD and associated with greater symptom burden. Children aged 2-9 years with ASD diagnosed according to DSM-5 criteria and age- and sex-matched healthy controls were included. Laboratory analyses assessed Anti-GAD, ASO, ferritin, iron, vitamin D, vitamin B12, thyroid-stimulating hormone, and folate. Clinical evaluations included the Autism Behavior Checklist (ABC), Modified Checklist for Autism in Toddlers (M-CHAT), and Ankara Developmental Screening Inventory (AGTE). Autistic regression was defined as loss of previously acquired language and/or social communication skills lasting ≥3 months between 15 and 30 months of age. Ninety children participated (45 with ASD and 45 controls). Anti-GAD antibody levels were higher in the ASD group than in controls (p = 0.003). Although statistically significant, the absolute difference between groups was modest. Among ASD cases, 62% met criteria for regression; this relatively high proportion may reflect the clinic-based sampling and the operational definition applied. Compared with those without regression, children with regression had higher Anti-GAD titers and ABC scores but lower iron and ferritin levels (all p < 0.05). Anti-GAD levels correlated positively with ABC total scores (r = 0.724, p = 0.01). These findings reflect statistical associations and do not imply causality. Higher Anti-GAD antibody levels were statistically associated with ASD, autistic regression, and greater behavioral symptom severity in this sample. These results suggest possible immune-related contributions to ASD heterogeneity; however, larger longitudinal studies are needed before clinical or biomarker implications can be established.

Introduction Children with autism spectrum disorder (ASD) are reported to have atypical symmetry patterns and volumes of language-related brain areas. There is a dearth of evaluation of the significance of this finding clinically for children with ASD in India. Objective Perform brain morphometric analysis in children with ASD and evaluate the left–right asymmetry of primary and association areas of language and its clinical implications. Methodology Drug-naive children with ASD who visited developmental paediatrics, aged 3–12 years, were recruited for the study after informed consent. The diagnosis was by a multidisciplinary team. All children underwent assessments and MRI brain scan. Postprocessing included cortical reconstruction and volumetric segmentation of unimodal and higher order association areas related to language. The quantitative neuroimaging results were analysed with respect to both autism severity and ability test scores. Results Analysis included 10 children (8 males and 2 females) aged 36–99 months. Autism severity score ranged from 30.5 to 40 on CARS. The unimodal association areas of pars opercularis and planum temporale indicated left asymmetry, and in the higher association areas, supramarginal gyrus had left asymmetry, while pars triangularis displayed right asymmetry. The supramarginal gyrus indicated a left asymmetry in males, while it showed right asymmetry in females. Children who had higher autism symptoms had significantly lower left frontal opercular volume compared to those with lower autism symptom severity. Conclusion Asymmetry patterns of language areas of brain in children with ASD and low left frontal opercular volumes in children with higher autism symptomatology indicate anomalous fronto-temporal grey matter development.

Within cohorts of children with autism spectrum disorder (ASD) there is considerable variation in terms of language ability. In the past, it was believed that children with ASD either had delayed articulation and phonology skills or excelled in those areas compared to other language domains. Very little is known about speech sound ability in relation to language ability and non-verbal ability in Swedish preschool children with ASD. The current study aimed to describe language variation in a group of 4-6-year-old children with ASD, focusing on in-depth analyses of speech sound error patterns with and without non-phonological language disorder and concomitant non-verbal delays. We examined and analysed the speech sound skills (including consonant inventory, percentage of correct consonants and speech sound error patterns) in relation to receptive language skills in a sample of preschool children who had screened positive for ASD in a population-based screening at 2.5 years of age. Seventy-three children diagnosed with ASD participated and were divided into subgroups based on their receptive language (i.e., non-phonological language) and non-verbal abilities. The subgroup division revealed that 29 children (40%) had language delay/disorder without concurrent non-verbal general cognitive delay (ALD), 27 children (37%) had language delay/disorder with non-verbal general cognitive delay (AGD), and 17 children (23%) had language and non-verbal abilities within the normal range (ALN). Results revealed that children with ALD and children with AGD both had atypical speech sound error patterns significantly more often than the children with ALN. This study showed that many children who had screened positive for ASD before age 3 years - with or without non-verbal general cognitive delays - had deficits in language as well as in speech sound ability. However, individual differences were considerable. Our results point to speech sound error patterns as a potential clinical marker for language problems (disorder/delay) in preschool children with ASD. What is already known on the subject Children with autism spectrum disorder (ASD) have deficits in social communication, restricted interests and repetitive behaviour. They show very considerable variation in both receptive and expressive language abilities. Previously, articulation and phonology were viewed as either delayed in children with ASD or superior compared with other (non-phonological) language domains. What this paper adds to existing knowledge Children with ASD and language disorders also have problems with speech sound error patterns. What are the potential or actual clinical implications of this work? About 75% of children with ASD experience language delays/disorders, as well as speech sound problems, related to speech sound error patterns. Understanding/acknowledging these phonological patterns and their implications can help in the diagnosis and intervention of speech sound disorders in children with ASD. Direct intervention targeting phonology might lead to language gains, but more research is needed.

Recently, the American Psychiatric Association eliminated Asperger Syndrome (AS) and introduced the Autism Spectrum Disorder (ASD) diagnostic framework. This change in nosology socially implicates people who self-identify with and derive personal meaning from their AS diagnosis. The current study explored the opinions of adults with AS regarding their identity related to the diagnostic terminology of ASD. Twelve adults with AS completed a semi-structured interview that was transcribed and analyzed qualitatively using Thematic Analysis. The analysis revealed six themes: (a) Derived Meaning, (b) Knowledge and Understanding, (c) Perceptions and Labels, (d) Social Identity, (e) Opinions and Reactions to ASD, and (f) Barriers to Funding and Service Provision. Many participants socially identified and self-categorized as part of the AS community because their challenges matched those described by the DSM-IV. Importantly, many participants described the removal of AS as a threat to their identity, social status, and access to supports. Implications are discussed.