Category Archives: Children with Aspergers/Autism

At the Intersection of Gender and Autism – Part I

“At five, I wanted to be a boy” – the viewpoint of a woman with Aspergers.

This is a great essay with interesting insights into gender and autism.
The essay is featured in the book Ultraviolet Voices: Stories of Women on the Autism Spectrum.

The only bad thing about this essay; it’s part 1 of 3. We’re going to have to wait to read the rest.

Musings of an Aspie

Note: This is my contribution to the Ultraviolet Voices anthology. It’s nearly 5000 words long, so I’m going to serialize it here over the next 3 weeks.  

At five, I wanted to be a boy. I don’t know what I thought being a boy meant. Maybe I thought it meant playing outside in the summer, shirtless and barefoot. Maybe I thought it meant not wearing dresses.

Dresses were all scratchy lace trim and tight elastic sleeves. Stiff patent leather shoes pinched my sensitive feet. Perfume tickled my nose. Tights made my legs itch and had maddening seams at the toes.

Too young to understand sensory sensitivities, I followed my instincts. While other girls favored frilly clothes, I gravitated toward the soft comfort of cotton shirts and worn corduroys.

Somehow, comfort got mixed up with gender in my head. For decades, “dressing like a girl” meant being uncomfortable. And…

View original post 1,120 more words

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Gender and Autism – an article

This is an excellent article reviewing research on gender and autism. I highly recommend it.

Gender and Autism: a Preliminary Survey Post on the blog “Musings of an Aspie.”

The author discusses the “extreme male brain” theory of autism and suggests some alternatives.

She also talks about factors that might influence how people with autism spectrum disorders experience gender:

“This raises the question of what role being autistic might play in the formation of our personal experience of gender. For example, autistic children are less sensitive to social cues than typical children and may not make friends with or become part of groups of same-gender peers. If we’re not tuned in to what the social norms for children of our gender are, we’re less likely to adopt them early in life.

There may also be an aspect of autistic-related body dysmorphia in general that factors into gender dysphoria for some autistic individuals. Many autistic people have difficulty feeling connected to their physical selves or being physically comfortable with their body.

Finally, there is the issue of sensory sensitivities. Dressing or presenting androgynously may be a result of gender dysphoria or it may be related to avoiding sensory triggers associated with certain types, textures or styles of clothing.”

Enjoy the article!

Brains of Children with Autism Fail to Trim Synapses – NY Times article and a Question

A fascinating article in the NYTimes about a new study of children with autism.

A few interesting points:

Babies grow many synapses connecting the neurons in their brain. As they grow up, they prune these synapses.

It looks like autistic children may not prune these synapses as well as other children and teenagers do. Their problems with social learning may be due to having too many connections in the brain.

They may also have a problem clearing out old and degraded cells.

From the NYT article:

“‘Impairments that we see in autism seem to be partly due to different parts of the brain talking too much to each other,” he said. “You need to lose connections in order to develop a fine-tuned system of brain networks, because if all parts of the brain talk to all parts of the brain, all you get is noise.'”

This overconnectivity in the brain could explain “symptoms like oversensitivity to noise or social experiences, as well as why many people with autism also have epileptic seizures.”

More than a third of people with autism have epilepsy!!!!

Is there any connection between this and gender dysphoria?

Probably not, but it is interesting to speculate. What if gender dysphoria is also caused by overconnectivity in the brain, just less of it? Perhaps gender dysphoria is caused by too many connections in just one part of the brain. That might explain why there are more people than you would expect with both ASDs and gender dysphoria. Something for someone to research, perhaps.

It might also be interesting to find out if people with gender dysphoria have a higher rate of epilepsy than expected.

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

The Kids Who Beat Autism – NYT Article

There’s a fascinating article in the NYT about children who are diagnosed with autism, but outgrow it.

The author, Ruth Padawer, discusses two studies of this phenomenon:

Intervention for optimal outcomes in children and adolescents in a history with autism,

and

Predicting young adult outcomes among more and less cognitively able individuals with autism spectrum disorders.

The experts do not know yet what caused the autism or how to cure it. They have just shown that about 10% of kids can overcome it.

Factors that increase the chance of outgrowing autism include: earlier parental concern, earlier referral to therapists, and earlier and more intense intervention. Applied Behavior Analysis (ABA) may increase the chances of a good outcome. (ABA is not appropriate therapy for gender dysphoria; there is a famous case of it being used with a gender non-conforming boy with disastrous results.)

In addition, children who start with better scores on IQ tests are more likely to do well. Presumably their autism is not as severe to start with.

The children who overcome autism may still have some symptoms, including “social awkwardness, attention deficit hyperactivity disorder, repetitive movement, mild perseverative interests and subtle difficulties in explaining cause and effect.” One of the people interviewed in the article also mentions sensory issues such as feeling that omelets are slimy or disliking the texture of paper.

However, for the group of children whose autism faded, we can’t be sure if their brains changed due to treatment, if their brains changed on their own, or if their brains were never the same as the brains of other children with autism,

Another study found that therapy could change the brain activity of children with autism.

Early Behavioral Intervention is Associated With Normalized Brain Activity in Children with Autism.

According to the New York Times, “Prior studies determined that autistic children show more brain engagement when they look at color photos of toys than at color photos of women’s faces — even if the photo is of the child’s mother. Typically developing children show the reverse, and the parts of their brain responsible for language and social interaction are more developed than those of autistic children.”

Toddlers who received “25 hours a week of a behavioral therapy designed to increase social engagement” had brain patterns like typically developing children after two years; toddler who received the regular community intervention did not.

This article is not directly related to gender dysphoria, but it is an interesting look at a condition that may be somehow linked to gender dysphoria.

Original Article:

The Kids Who Beat Autism by  Ruth Padawer in The New York Times.

Gender dysphoria in pervasive developmental disorders – Review

This article is in Japanese, so I have only seen the abstract.

In the abstract, the authors suggest that people with autism spectrum disorders (ASD) “often have identity crises which sometimes include gender dysphoria.” They speculate that when people with ASD become teenagers, they “realize their uniqueness and differences compared to others, and, as a result, they may develop confusion of identity which could be exhibited as gender identity disorder.”

They talk about a recent study that found that “amongst 204 children and adolescents who visited a GID clinic in the Netherlands, 7.8% were diagnosed with autism spectrum disorders after a careful diagnostic procedure by a multi-disciplinary team.”

The paper looks at four cases of young people with both ASD and either gender dysphoria or “related symptoms.” Their study included:

“1) a girl with PDD (pervasive developmental disorders=autism/ASD) who repeatedly asserted gender identity disorder (GID) symptoms in response to social isolation at school,

2) a junior high school boy with PDD and transvestism,

3) a boy diagnosed with Asperger’s disorder who developed a disturbance of sexual orientation, and

4) a boy with Asperger’s disorder and comorbid childhood GID.”

They believe that “Many of the clinical symptoms related to gender dysphoria might be explained by the cognitive characteristics and psychopathology of PDD.”

Without seeing more, it is hard to evaluate this study.

Nevertheless, they do not seem to have proven their case very well. Two of the four people they discuss do not sound like they have gender dysphoria.

For the other two children, it would help to know more details – did they outgrow the gender dysphoria? do they now believe that they were wrong about their gender? could they have gender dysphoria and ASD?

The authors conclude by saying that gender dysphoria has become more well-known in Japan and they are seeing more patients complaining of it.

They believe that it is important to consider an underlying diagnosis of ASD for patients with gender dysphoria; I can agree with that conclusion at least.

Original Article:

Gender dysphoria in pervasive developmental disorders by Tateno M, Ikeda H, Saito T in Seishin Shinkeigaku Zasshi. 2011;113(12):1173-83.