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Gender Dysphoria and Asperger Syndrome: The Role of the Speech-Language Pathologist
Special interests are a well-known symptom of Asperger syndrome. But what if that interest centers around gender identification in which the individual identifies himself/herself as the opposite sex? In the field of mental health, the relationship between gender dysphoria and autism spectrum disorders is being discussed with greater regularity. However, a definitive statement as to the relationship of the two diagnoses remains controversial.
The process of gender identification is a complex developmental process eventually culminating with children determining their identified gender group by approximately three years of age in the neurotypical population (Berenbaum, et al., 2008). Gender concerns in neurotypical children may also be viewed as a developmental process as data is demonstrating plasticity of gender identification continues to approximately puberty (Drummond, et al., 2008). As a result of impaired social interaction and fewer opportunities to explore their sexual identity, the possibility exists that individuals with ASD may demonstrate a similar developmental pattern, but may use a different timeline than neurotypical individuals in determining gender identification. As a result, it may seem reasonable that complications may be present when one considers how to categorize gender concerns in the presence of ASD.
According to the DSM-5 (2013) “…a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months” is necessary for the diagnosis to be provided. Manifestation may be seen through “…strong desires to be treated as the other gender or to be rid of one’s sex characteristics, or a strong conviction that one has feelings and reactions typical of the other gender.” This change in definition from the previous DSM IV disputes the belief that being transgender is a mental illness and is strongly supported by the World Professional Association for Transgender Health (De Cuypere, et al., 2010).
When autism spectrum disorder is present, this concept of “strong desires” may significantly impact and contribute to gender identification. Two case histories support this concern. Both males sought hormonal and surgical treatment based on strong convictions. Both also presented with Asperger-like traits that were not previously identified. Treatment was withheld and both men eventually determined their transgender phase was transient. Had intervention proceeded, the consequences would have been significant.
The earliest report of this concern was reported by Williams and colleagues (1996), who described two males diagnosed with ASD, both of which presented with “feminine gender-stereotyped preoccupations.” This concept was further explored by Landen and Rasmussen (1997) who hypothesized that gender identity formation can be impacted by impaired social interaction.
Even though documentation of this situation is scanty, researchers have been offering hypotheses for the link between autism and gender dysphoria. The Extreme Male Brain (EMB) Theory of autism is based on an exaggeration of the typical male characteristic of systemizing while presenting with low levels of empathizing, a female characteristic.
The second theory is that the restricted range of interests and a lack of flexible thinking seen in autism may predispose some individuals to focus on aspects of gender dysphoria. One must proceed with caution when children reason as such: “I like soft clothes. Girls like soft clothes. Therefore I am a girl.”
The third theory is that since friendship and close relationships with members of their own sex remains difficult, it might be easier to focus on the opposite sex which they perceive as more accepting.
Ultimately, the problem of trying to understand the mind of one with autism is a complex task. When the possibility of gender dysphoria is present, it becomes even more crucial for clinicians to fully investigate the needs of the client. Doing so will likely allow clinicians to better advise individuals with ASD who seek assistance for gender-related concerns.
Speech-language pathologists have been working with the transgendered population for quite some time (Crutchley, et al., 2010; Freidenberg, 2002; Kowalski, 19 ). Formal training in the needs of this population is extremely limited and intervention is significantly more than just establishing a higher pitch. As such, finding qualified speech-language pathologists with experience in this population is difficult and when the possibility of Asperger syndrome is also present, the needs of the client become exponentially greater.
This presentation will discuss the link between gender dysphoria and Asperger syndrome. It will educate participants about the characteristics associated with both clinical labels and discuss the role speech-language pathologists may play in this issue.