Children and teenagers with an autism spectrum disorder or those who have attention deficit and hyperactivity problems are much more likely to wish to be another gender. So says John Strang of the Children's National Medical Center in Washington, DC, USA, leader of the first study to compare the occurrence of such gender identity issues among children and adolescents with and without specific neurodevelopmental disorders. The paper is published in Springer's journal Archives of Sexual Behavior.
Children between 6 and 18 years old were part of the study. They either had no neurodevelopmental disorder, or they were diagnosed with an autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), a medical neurodevelopmental disorder such as epilepsy, or neurofibromatosis. The wish to be the other gender, known as gender variance, was assessed with the Child Behavior Checklist, one of the most commonly used behavioral report inventories for children and adolescents.
Compared to the control group, gender variance was found to be 7.59 times more common in participants with ASD. It was also found 6.64 times more often in participants with ADHD. No difference was noted between the control group and participants in the other two neurodevelopmental groups.
Participants who wished to be another gender had elevated rates of anxiety and depression symptoms. However, these were lower among participants with autism spectrum disorders. This is possibly due to their impaired social reasoning which makes them unaware of the societal pressures against gender nonconformity.
Strang and his co-workers' study is the first to report on the overlap between ADHD diagnosis and coinciding gender variance. It supports previous studies that have shown increased levels of behavioral problems and/or disruptive disorders among young people with gender variance.
Navigating a child's gender variance is often complex for children and families. The presence of neurodevelopmental disorders makes diagnostics, coping, and adaptation even more challenging.
"In ADHD, difficulties inhibiting impulses are central to the disorder and could result in difficulty keeping gender impulses 'under wraps' in spite of internal and external pressures against cross-gender expression," says Strang, who suggests that the coincidence of gender variance with ADHD and ASD could be related to the underlying symptoms of these neurodevelopmental disorders.
Strang continued, "Children and adolescents with autism spectrum disorders may be less aware of the social restrictions against expressions of gender variance and therefore less likely to avoid expressing these inclinations. It could also be theorized that excessively rigid or 'black and white' thinking could result in such a child's rigidly interpreting mild or moderate gender nonconforming inclinations as more intense or absolute."