Gender and Autism Program: A novel clinical service model for gender-diverse/transgender autistic youth and young adults

Authors

John F. Strang, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Abigail L. Fischbach, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Sharanya Rao, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Ann Clawson, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Megan Knauss, Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA.
Sarah N. Bernstein, Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA.
Anna I. van der Miesen, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, the Netherlands.
Anne P. Inge, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Kenia Alonzo, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Julia Zeroth, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Lauren Kenworthy, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Colleen I. Morgan, Division of Hearing and Speech, Children's National Hospital, Washington, DC, USA.
Abigail Brandt, Division of Hearing and Speech, Children's National Hospital, Washington, DC, USA.
Christina C. Moore, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
Kaitlyn Ahlers, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
Mary K. Jankowski, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
Lucy S. McClellan, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Shane B. Henise, Pride Clinic, Adolescent and Young Adult Medicine, Children's National Hospital, Washington, DC, USA.
Caitlyn J. Cap, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Shannon L. Exley, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Amy Youmatz, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Minneh Song, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.
Jennifer L. McLaren, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
Benjamin Parchem, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA.

Document Type

Journal Article

Publication Date

4-25-2024

Journal

The Clinical neuropsychologist

DOI

10.1080/13854046.2024.2318155

Keywords

Transgender; autism spectrum disorder; autistic; gender-affirming care; neuropsychology

Abstract

Situated in Children's National Hospital (CNH)'s Neuropsychology Division, the Gender and Autism Program (GAP) is the first clinical service dedicated to the needs of autistic gender-diverse/transgender youth. This study describes GAP clinical assessment profiles and presents a multi-perspective programmatic review of GAP evaluation services. Seventy-five consecutive gender- and neuropsychologically-informed GAP evaluations were analyzed, including demographics, gender and autism characterization, and primary domains evaluated. Three program-based Delphi studies were conducted and identify: clinician priorities and challenges in providing care, program administrator lessons learned and ongoing barriers, and considerations adapting this model for a rural academic medical center. Nearly two-thirds of referrals were transfeminine. Most youth had existing autism diagnoses; of those undiagnosed, three-quarters were found to be autistic. Five goals of evaluations were identified: Mental health was always assessed, and most evaluations also assessed gender-related needs in the context of autism neurodiversity. Neuropsychological characterization of strengths and challenges informed personalized accommodations to support youth gender-related self-advocacy. Clinicians emphasized frequent youth safety concerns. Administrators emphasized the need for specialized training for working with families. Components for adaptation of the GAP in a rural academic medical center were identified. Since its founding, the GAP has proven a sustainable neuropsychology-based service with consistent referral flow and insurance authorizations. Capturing staff perspectives through rigorous Delphi methods, and addressing the GAP's feasibility and replicability, this study provides a road map for replicating this service. We also highlight GAP training of specialist clinicians, fundamental to addressing the desperate shortage of providers in this field.

APA Citation

Strang, John F.; Fischbach, Abigail L.; Rao, Sharanya; Clawson, Ann; Knauss, Megan; Bernstein, Sarah N.; van der Miesen, Anna I.; Inge, Anne P.; Alonzo, Kenia; Zeroth, Julia; Kenworthy, Lauren; Morgan, Colleen I.; Brandt, Abigail; Moore, Christina C.; Ahlers, Kaitlyn; Jankowski, Mary K.; McClellan, Lucy S.; Henise, Shane B.; Cap, Caitlyn J.; Exley, Shannon L.; Youmatz, Amy; Song, Minneh; McLaren, Jennifer L.; and Parchem, Benjamin, "Gender and Autism Program: A novel clinical service model for gender-diverse/transgender autistic youth and young adults" (2024). GW Authored Works. Paper 4673.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4673

Department

Psychiatry and Behavioral Sciences