Traits of Autism Spectrum Disorder in School-Aged Children With Gender Dysphoria: A Comparison to Clinical Controls

Objective: Studies of children with gender dysphoria (GD) have reported an overrepresentation of autism spectrum disorder (ASD) or traits. One limitation of these studies has been the absence of a concurrent comparison group of children referred for other clinical problems. The present study addressed this gap by comparing 61 children referred for GD with 40 children referred for other clinical concerns (age range, 4-12 years). Method: ASD caseness was measured in 2 ways: (a) a Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of ASD or cut-off scores for caseness or (b) dimensionally on 2 standardized measures. Results: Children with GD had a higher proportion with a co-occurring DSM diagnosis of ASD and a higher proportion who met the criterion for caseness on the Social Communications Questionnaire than the clinical controls. In contrast, on the Social Responsiveness Scale, the 2 groups were similar with regard to caseness and traits of ASD. Conclusions: The results of our study showed evidence of both specificity and nonspecificity with regard to ASD traits and caseness. Future research can adopt the principle of multifinality to understand better why only a minority of children with GD have a co-occurring diagnosis of ASD, but the majority does not. Implications for Impact Statement The present study draws specific attention to the overrepresentation of autism spectrum disorder traits among children referred for gender dysphoria. Children with gender dysphoria should be screened for a possible autism spectrum disorder (ASD) and, when warranted, receive a more comprehensive ASD diagnostic assessment to facilitate more holistic clinical care.