Comorbid childhood gender identity disorder in a boy with Asperger syndrome – Review

This is a very short article, actually published as a letter to the editor.

The authors present a case of a boy who they diagnosed with both gender dysphoria and autism. (In a later follow-up study, they found that he no longer had gender dysphoria at age 16.)

They present this case study as a counter point to the “extreme male brain” theory of autism. As they say, with the extreme male brain theory, “gender dysphoria in female subjects with Asperger syndrome (AS) could be explained logically. But a literature search yielded no boys with AS and gender identity disorder (GID). Hereby we present such a case.”

The authors diagnosed the boy with gender dysphoria based on the following criteria: feminine behaviors and speech, preferring female playmates, preference for feminine activities, lack of interest in sterotypical boy toys, liking cute characters in cartoons, always painting cute girls surrounded with hearts and flowers, dressing in girls’ clothes at home, regretting being a boy, wishing he were a girl, and saying that he would grow up to be a woman.

The child was of average intelligence and had not had delays in developing motor skills or language. However, he had “limited interactions with others, difficulty in developing peer relationships and was underresponsive in social situations. He liked making his own rules and frequently lost his temper when there were broken.” He was also preoccupied with certain colors and figures.

The authors make a distinction between gender-related symptoms in autism and gender identity disorder:

“Most of the gender-related symptoms in autistic spectrum disorder (ASD) could be related to behavioral and psychological characteristics of autism. For example, a boy with ASD might have a sense of belonging to the female sex after being bullied by male peers. Tranvestism in ASD may arise from a preoccupation with specific clothes such as a flared skirt which satisfies their tactile sensation. In their youth, ASD subjects can sometimes develop a unique confusion of identity that occasionally expands to gender-related problems. But these views do not explain the present case. For the diagnosis of GID in ASD, sufficient language abilities and sufficient follow-up time are essential. The present case fulfills these requirements.”

The authors conclude by saying that if the GID persists, they would treat the patient following international standards – i.e. he would be allowed to transition following the same protocol as anyone else.

One thing I found interesting in this article was that one of the boy’s feminine behaviors was covering his mouth with his hand when he laughed. This is something women in Japan do, but not in the West. Clearly culture plays a role in how a child expresses their gender dysphoria.

Original Article:

Comorbid childhood gender identity disorder in a boy with Asperger syndrome by Masaru Tateno md , phdYukie Tateno md, Toshikazu Saito md , phd in Psychiatry and Clinical Neurosciences Volume 62, Issue 2, page 238April 2008