Autistic Spectrum Disorders in a transgender population attending transgender health services: A comparative study between a large group of transgender and cisgender people

Studies and clinical reports suggest that there might be an over-representation of Autism Spectrum Disorders (ASD) and ASD traits among the Transgender population attending Transgender Health Services. These studies are... [ view full abstract ]

Studies and clinical reports suggest that there might be an over-representation of Autism Spectrum Disorders (ASD) and ASD traits among the Transgender population attending Transgender Health Services. These studies are limited by inadequate methodology, small numbers and lack of matched controls.

The aims of the study were to 1) investigate rates of ASD clinical caseness (described as features suggesting ASD diagnosis), as measured by the AQ-28, in the Transgender population and to compare these to a matched (by... [ view full abstract ]

The aims of the study were to 1) investigate rates of ASD clinical caseness (described as features suggesting ASD diagnosis), as measured by the AQ-28, in the Transgender population and to compare these to a matched (by assigned gender at birth and age) control Cisgender group from the general population; 2) compare the subscales of the AQ-28 between the Cisgender and Transgender groups; 3) test for differences in ASD scores between at birth assigned males and at birth assigned females in both groups.

In this case-control study participants in the Transgender group were selected from the database of a National Transgender Heath Service in the UK (total n=1020). Participants were selected for inclusion if they consented to... [ view full abstract ]

In this case-control study participants in the Transgender group were selected from the database of a National Transgender Heath Service in the UK (total n=1020). Participants were selected for inclusion if they consented to participate in the study and had complete data for a measure of autistic traits (the ASQ-28). The comparison group was selected from survey data from a non-clinical, community population from which Transgender people were removed (total n=3414). The 660 eligible participants in the Transgender group were matched 1:1 by age and assigned gender at birth to 656 Cisgender non-clinical participants from the community survey (total n=1312). Overall assigned males at birth represented 60.4% of the total sample, whilst assigned females at birth were 39.6%. Assigned gender at birth was used as 19.63% of the Transgender sample identified as non-binary.

Socio-demographic variables such as assigned gender at birth, employment status, and age were collected. The Autism Spectrum Quotient (AQ-28) (Hoekstra et al., 2011) was used. This is a 28 items questionnaire assessing traits... [ view full abstract ]

Socio-demographic variables such as assigned gender at birth, employment status, and age were collected. The Autism Spectrum Quotient (AQ-28) (Hoekstra et al., 2011) was used. This is a 28 items questionnaire assessing traits of ASD. The AQ-28 has 6 subscales that measure autistic traits; “Social Skills”, “Routine”, “Switching”, “Imagination”, “Numbers and Patterns” and “Social Interactions”. The AQ-28 subscales and total scores were utilised for this study. The clinical cut-off utilised for the AQ-28 is >70, which suggests the presence of clinically significant ASD traits, and presence of a possible ASD diagnosis.

People in the Transgender group were more likely to score above the cut-off for possibly clinically significant ASD traits (17.1%) compared to Cisgender people (14.2%) (OR=1.31; CI=1.04-1.66). Cisgender participants scored... [ view full abstract ]

People in the Transgender group were more likely to score above the cut-off for possibly clinically significant ASD traits (17.1%) compared to Cisgender people (14.2%) (OR=1.31; CI=1.04-1.66). Cisgender participants scored higher (p<.05) than the Transgender sample on total AQ-28 scores as well as on the “Imagination” and “Numbers-Patterns” subscales, whilst the Transgender sample scored higher on the remaining subscales. For both the “Imaginations” and “Numbers-Patterns” subscales, the Cisgender group had more difficulties than the Transgender group. For those assigned female at birth, participants in the Transgender group were twice as likely to score above the cut-off for possible clinically significant ASD traits (OR=2.2; CI=1.51-3.2). Birth assigned females in the Transgender group had higher total AQ28 and subscale scores (p<.001) except for the “Imagination” and “Numbers-Patterns” subscales were the Cisgender participants displayed more difficulties. For participants assigned male at birth there was no increase in the likelihood of scoring above the cut-off for clinically significant ASD traits (OR=0.92; CI=0.68-1.25). Those in the Transgender group assigned male at birth did score higher for problems on the “Routine” and “Attention Switching” subscales (p<.005) compared to Cisgender males but had fewer difficulties on the “Imagination” and “Numbers-Patterns” subscales (p<.001).

A Transgender population attending Transgender Health Services was more likely than matched Cisgender controls to have levels of ASD traits in the clinically significant range suggesting possible ASD. Although Cisgender people... [ view full abstract ]

A Transgender population attending Transgender Health Services was more likely than matched Cisgender controls to have levels of ASD traits in the clinically significant range suggesting possible ASD. Although Cisgender people presented with higher difficulties in the total AQ28, “Imagination” and “Numbers-Patterns” subscales, the Transgender group had higher scores for all other subscales. The increased risk of ASD traits in the Transgender group seemed mainly accounted for by those assigned female at birth. They were twice more likely than their matched controls to get an AQ28 score in the clinically significant range. For Transgender assigned males at birth there was no increased risk but their higher scores for “Social Skills”, “Routine” and “Attention Switching” suggest potential social difficulties. The overall clinical impression that Transgender people report more ASD traits than the Cisgender population is correct when investigating assigned females at birth. Further study needs to be undertaken to confirm if this increase in ASD traits means an increased prevalence of ASD in the Transgender population. Findings that Transgender assigned females at birth report similar AQ28 total scores to Cisgender males and higher scores than Cisgender females and Transgender assigned males at birth are of clinical interest and require further research.