Category Archives: 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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Most Autistic People Have Normal Brain Anatomy – Neuroskeptic | DiscoverMagazine.com

Neurosceptic has a good article up about an important new study of brain structure and autism.

The study found very few differences between the brain anatomy of people with autism and people without it. It was a large study and calls into question earlier studies that found differences.

A troubling finding was that when they made the sample size smaller, they found more differences.

Since brain studies of gender identity involve small samples, this raises an important question: are we seeing real differences, or would they disappear with a larger study like this one?

There are some questions for this new study of autism, of course. A few points from the blog and comments:

There may still be other differences in the brain, either smaller brain structures or differences in function.

It could be that there is more than one type of autism and they look different in brain scans.

The study only looked at people with autism who were high-functioning; perhaps that made a difference.

Anyhow, enjoy Neurosceptic’s article:

Most Autistic People Have Normal Brain Anatomy – Neuroskeptic | DiscoverMagazine.com.

Exploring gender identity within the context of Asperger’s syndrome – Review

This is a thesis from 2012.

According to the abstract, the author interviewed adult men with Aspergers about their “perceptions of masculinity, gender-typed behaviours, relationships, and societal influences.”

She found that “for participants, identifying with male gender provides a platform for fitting in by allowing them to learn from societal stereotypes and rehearse playing ‘male’ roles. Participants displayed ambivalence in their feelings of being drawn to the perceived safety of females but resenting the ‘feminine’ side of themselves.”

Based on her study and the literature on gender identity, she makes recommendations for professionals and parents of children with Aspergers about potential gender identity confusion.

Unfortunately, I am not able to read it online. Perhaps someone else can find out what the author is recommending for parents!

Exploring gender identity within the context of Asperger’s syndrome by Victoria Elliott.

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

Psychiatric comorbidity among patients with gender identity disorder – Partial Review

This study looked at the patients at a Japanese clinic for gender identity disorder to see if they had any other mental health issues. They did not find a high rate of autism spectrum disorders (ASDs).

This is not a review of the full study, just the information related to ASD.

Out of 579 patients that they treated, only 4 were diagnosed with Asperger’s disorder and there were no other cases of autism spectrum disorders.

In other words, less than 1% of this group had an ASD.

All of the patients with Asperger’s were born male.

This data is worth noting because it is so different from results in other countries. Are patients with autism not referred to the GID clinic in Japan? Is autism being diagnosed the same way in the different studies? Are adult patients less likely to have ASD than children and teenagers with gender dysphoria?

This data also highlights the fact the gender dysphoria and autism spectrum disorders are connected in males, not just females – in fact, in this case, they were connected only in males.

There is a theory that having an “extreme male brain” makes some girls with autism develop gender dysphoria. While that could still be true, it does not explain why males with autism would feel that they are females.

Instead of an “extreme male brain,” there might be some other mechanism that connects autism and gender dysphoria in both trans women (born male) and trans men (born female).

Another interesting aspect of the data was that they diagnosed 96% of the patients they saw with GID. Of the 24 patients who were not diagnosed with GID, half had severe psychological disorders like schizophrenia. Eight were excluded for homosexuality and four were excluded for transvestic fetishism.

I am not sure why they diagnosed such a high percentage of their patients with GID. Perhaps by the time people are referred to their clinic, they have been diagnosed by other doctors. It might also be somehow related to the definition of GID or the process of diagnosis.

I am assuming they excluded the gay patients because the patients discovered that they did not have GID and that the clinic is not excluding all gay patients. Most people with GID are attracted to people of their birth sex.

Other important results from the abstact:

“Using DSM-IV criteria, 579 patients (96.0%) were diagnosed with GID. Among the GID patients, 349 (60.3%) were the female-to-male (FTM) type, and 230 (39.7%) were the male-to-female (MTF) type. Current psychiatric comorbidity was 19.1% (44/230) among MTF patients and 12.0% (42/349) among FTM patients. The lifetime positive history of suicidal ideation and self mutilation was 76.1% and 31.7% among MTF patients, and 71.9% and 32.7% among FTM patients. Among current psychiatric diagnoses, adjustment disorder (6.7%, 38/579) and anxiety disorder (3.6%, 21/579) were relatively frequent. Mood disorder was the third most frequent (1.4%, 8/579).”

The horrifying part has been bolded. I’m putting off talking about it until another day when I can deal with it.

I’ll just add that the authors suggested that “the harsh circumstances in which most GID patients have lived in Japan might influence the high rate of suicidal ideation or self mutilation in GID patients.”

Original Article:

Psychiatric comorbidity among patients with gender identity disorder by Masahiko Hoshiai MDYosuke Matsumoto MD, PhDToshiki Sato MD, PhDMasaru Ohnishi MD, PhDNobuyuki Okabe MDYuki Kishimoto MDSeishi Terada MD, PhD, and Shigetoshi Kuroda MD, PhD in Psychiatry and Clinical Neurosciences Volume 64, Issue 5, pages 514–519, October 2010.