In Addition to Stigma: Cognitive and Autism-Related Predictors of Mental Health in Transgender Adolescents

John F. Strang, Gender Development Program, Children's National Hospital.
Laura G. Anthony, Department of Psychiatry, University of Colorado School of Medicine.
Amber Song, Gender Development Program, Children's National Hospital.
Meng-Chuan Lai, The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health.
Megan Knauss, Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital.
Eleonora Sadikova, Curry School of Education, University of Virginia.
Elizabeth Graham, The Arc of the United States National Council of Self-Advocates.
Zosia Zaks, Hussman Center for Adults with Autism, Towson University.
Harriette Wimms, Youth Gender Care Services, The Village Family Support Center of Baltimore.
Laura Willing, Gender Development Program, Children's National Hospital.
David Call, Gender Development Program, Children's National Hospital.
Michael Mancilla, Youth Pride Clinic, Adolescent and Young Adult Medicine, Children's National Hospital.
Sara Shakin, Department of Pediatrics, Sinai Hospital of Baltimore.
Eric Vilain, Center for Genetic Medicine Research, Children's National Hospital.
Da-Young Kim, Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital.
Tekla Maisashvili, Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital.
Ayesha Khawaja, Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital.
Lauren Kenworthy, Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53

Volume

52

Issue

2

DOI

10.1080/15374416.2021.1916940

Abstract

OBJECTIVE: Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date of autistic-transgender, non-autistic (allistic) transgender, and autistic-cisgender adolescents diagnosed using gold-standard ASD diagnostic procedures. In accordance with advancing understanding of sex/gender-related autism phenotypes, slightly subthreshold autistic diagnostic presentations (common in autistic girls/women) are modeled. METHOD: This study includes 93 adolescents aged 13-21, evenly divided between autistic-transgender, autistic-cisgender, and allistic-transgender groups; 13 transgender adolescents were at the margin of ASD diagnosis and included within a larger "broad-ASD" grouping. Psychological and neuropsychological evaluation included assessment of mental health, IQ, LGBT stigma, ASD-related social symptoms, executive functioning (EF), and EF-related barriers to achieving gender-related needs. RESULTS: Autistic-transgender adolescents experienced significantly greater internalizing symptoms compared to allistic-transgender and autistic-cisgender groups. In addition to stigma-related associations with mental health, ASD-related cognitive/neurodevelopmental factors (i.e., poorer EF and greater social symptoms) were associated with worse mental health: specifically, social symptoms and EF gender barriers with greater internalizing and EF problems and EF gender barriers with greater suicidality. Comparing across all ASD and gender-related groups, female gender identity was associated with greater suicidality. CONCLUSIONS: Parsing the heterogeneity of mental health risks among transgender youth is critical for developing targeted assessments and interventions. This study identifies ASD diagnosis, ASD phenotypic characteristics, and EF-related gender barriers as potential risks for poorer mental health in transgender adolescents.

Department

Psychiatry and Behavioral Sciences

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