Greetings Earthlings!

Leading on from my previous post about gender identity and autism, this week I’d like to discuss NHS proposed guidelines in the UK where children who are referred to gender clinics will also be assessed for neurodevelopmental conditions like autism and ADHD.

But is this a good thing?

While some people believe that this is part of the growing anti-trans agenda in the UK, the majority feel that this is a positive step for the autistic community as experts estimate that trans patients could be 3-6 times more likely to be diagnosed as autistic. As such, it’s important that gender dysphoric patients are properly assessed so that they can be fully supported. This is especially important given the long term ramifications if a patient transitions but their dysphoria was a temporary product of their autism.

I have read many stories over the years from families with undiagnosed autistic kids who identified with trans ideology as they did not feel like they fit in. These children then began the transitioning process, only to find that after an autism diagnosis, they no longer felt at odds with their birth gender. Statistics among de-transitioning patients are difficult to estimate, but studies have found that as many as 15-20% of these are autistic.

It’s actually quite common for neurodiverse children to temporarily disassociate from their bodies as they naturally approach puberty. In my own case, I often felt that life would be so much easier if I could just click a button around 9 years of age (after having the dress up experience of one’s first holy communion of course 😂🙈) to switch genders as being a man seemed so much better than the realities of womanhood. Other than these passing thoughts as an undiagnosed kid, I have never ever felt at odds with my gender. Despite being quite tomboyish in my younger days, my friends describe me as quite feminine in my 30s with a wardrobe that’s bursting with dresses. Were 9 year old Aoife to express such thoughts today, I would likely be landed in a gender clinic being assessed for gender dysphoria, when what I really needed was an autism assessment.

Whilst many autists may be genuinely transgender, we need to do due diligence in gender assessments to ensure that no decisions are rushed. In my opinion, this is an excellent plan from the NHS to ensure that autists and people with gender dysphoria are getting the best care possible.

On the other hand, this proposal begs the question as to why similar guidelines have not been recommended for other conditions that are often co-morbid with autism. Many people who are assessed for ADHD are receiving subsequent autism diagnoses. Overlap is estimated to be as high as 80%, yet an autism assessment is not always considered during ADHD assessment. Moreover, it’s thought that 23-32% of patients with eating disorders are also autistic, an issue that is quite common for undiagnosed women, yet autism assessments are not factored into treatment. These co-morbid issues impact an arguably higher number of autists than gender dysphoria, yet patients are generally not co-screened for autism.

A larger conversation is clearly needed around co-occurring mental health and neurodiversity if we want to properly support the autistic community.

Hope you enjoyed my post dear Earthlings!

Have a lovely weekend!

Aoife