Gender Identity and Autism: Strategies for Supporting Autistic Transgender, Nonbinary, and Gender Diverse Individuals

About the Author

Meredith Maroney, PhD (she/her/hers) is an Assistant Professor of Counselling Psychology at the University of Calgary, and will be moving to the University of Massachusetts Boston beginning in September 2023. She is a Licensed Psychologist in New York and Alberta. Dr. Maroney directs the Double Rainbow Lab, which is focused on LGBTQ mental health and the intersection of autism and LGBTQ+ identities. She is passionate about conducting social justice-oriented research in partnership with communities and individuals with lived experience.

The higher likelihood of being transgender, nonbinary, or gender diverse among autistic individuals (and vice versa) has been a growing area of study in recent years (see Sala et al., 2020; Warrier et al., 2020), which has prompted much needed discussions about how professionals can better serve autistic transgender/nonbinary people in their respective settings. As a psychologist and researcher in this area, I am often asked 1) about literature on co-occurrence, followed by 2) what does this mean for my practice? Before getting into some areas of action and critical self-reflection, it is important to begin this blog by naming my own positionality: I am a neurotypical, white, sexual minority, cisgender woman, with a great deal of education privilege. Whether you are just starting out, or have been working clinically for many years, here are some considerations for professionals who want to be a better ally for transgender, nonbinary, and gender diverse autistic people.

1. Interrogate your own assumptions about gender. This is an important step, one that I can’t emphasize enough as a starting point. As practitioners, so much of our work is informed by who we are and how we show up with clients or students. Professionals who are cisgender (not transgender or nonbinary) have the privilege to not think critically about gender norms, roles, and language. Such biases may manifest by failing to think about gender beyond the binary, not using gender inclusive terminology, or viewing fluidity as confusion. These misconceptions may show up in our interactions with autistic gender diverse people by making assumptions that being cisgender is the norm, misgendering people after they have clearly stated their pronouns, or using one identity to invalidate or minimize another.

For those of us who are cisgender, I recommend these questions for reflection, which were articulated in an article by McGeorge and colleagues (2021): “What is my initial reaction when I see someone whose gender expression does not fit societal expectations for masculinity and femininity?” or “If a nonbinary person’s gender expression does not fit my expectations, do I wonder about the validity of this gender identity?” These questions (and many others) can help to start the self-reflection process of how we feel about gender beyond the binary.

2. Find a balance between acknowledging and empowering identity, without fixating. Autistic gender diverse folks may show up to providers with different needs — and gender may not be an area they need direct support. For instance, one autistic client may be in the early stages of exploring their gender identity and may wish to talk about this, while another may just need support accessing additional services (e.g., trans-identified provider, autistic-LGBTQ+ community, gender affirming care). It is important to know that there is a lot of diversity with how people experience, label, express, and affirm their identities. The process of coming out to self, others, and starting to live authentically can vary greatly based on positionality and context.

It is also important that professionals avoid overfocusing on gender when it is not a presenting concern for the client. This can happen if providers are uncomfortable or worried about making a mistake, typically in relation to gender identity. Clients may not be seeking out providers to provide support beyond respecting identity, and may have other areas they would like to focus on. In fact, in most of the research I have done, autistic-LGBTQ+ people have felt most supported by those with shared identities (Maroney & Horne, 2022; Mendes & Maroney, 2019). Be sure to start by using your client’s language regarding their identity, pronouns, name, and inquire how you can be most helpful in your time together.

3. Listen to autistic gender diverse people. There are many barriers to finding providers who have knowledge in supporting both gender and autism (Maroney & Horne, 2022; Mendes & Maroney, 2019). Once in the room with us, it is important to avoid creating a space where people feel the need to justify their identity or to tell a specific narrative (e.g., binary gender) that may not fit for them to access the care that they need. Truly listening is something we should already be doing well (especially those of us trained as clinicians), but can be an issue when we assume we are the ‘experts’ that ‘know better.’ Maintaining a stance of openness and viewing autistic people as “experts” on themselves are a few recommendations I’ve received from autistic transgender people (Maroney & Horne, 2022). Pay attention to the language that autistic transgender people are using to talk about their identities (e.g., nonbinary, they/them, identity-first), and prioritize using this language when speaking with them. Rather than assuming it’s ok to use their pronouns or chosen name when writing a clinical note or talking to others (e.g., parents, team members), be sure to have a conversation about outness and safety to ensure you are respecting their privacy.
   
4. Work alongside communities to challenge oppressive systems. Take a critical perspective to systems that may be silencing autistic gender diverse people and look for ways you can support and empower folks in navigating these systems. Professionals who are interested in getting more involved in advocacy efforts supporting autistic transgender communities should look to autistic-led organizations such as the Autistic Self-Advocacy Network (ASAN) or the Autistic Women & Nonbinary Network (AWN). ASAN regularly updates action alerts to inform allies about important policy level changes. In addition to the self-reflection, critically examine ways that your organization can be more inclusive and attuned to the needs of a broad range of autistic gender diverse people. ​​

This is an emerging area of research and practice, and there is always more to learn. For those who are less familiar with gender identity, it can be uncomfortable to interrogate privilege and take steps to self-educate. Don’t let worry about ‘getting it wrong’ prevent you from learning more about this intersection. Finally, when you are seeking out training or resources, prioritize work that centers autistic transgender people (e.g., includes an autistic transgender presenter, author, community input).

References

Maroney, M. R. & Horne, S. G. (2022). “Living in a world that doesn’t seem set up right for me:” Intersectional stigma and experiences of resistance of transgender, nonbinary, and gender diverse autistic adults. Manuscript under review.

McGeorge, C. R., Coburn, K. O., & Walsdorf, A. A. (2021). Deconstructing cissexism: The journey of becoming an affirmative family therapist for transgender and nonbinary clients. Journal of Marital and Family Therapy, 47(3), 785-802.

Mendes, E. A., & Maroney, M. R. (2019). Gender, Identity, Sexuality, and Autism: Voices from Across the Spectrum. Jessica Kingsely Publishers.

Sala, G., Pecora, L., Hooley, M., & Stokes, M. A. (2020). As diverse as the spectrum itself: trends in sexuality, gender and autism. Current Developmental Disorders Reports, 7(2), 59-68.

Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., … & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature communications, 11(1), 1-12.