Autistic people are over-represented at gender clinics, but there is limited research to guide clinical practice with this group, according to new research.

The study published in Autism investigated the perspectives of clinicians working with autistic patients who experience gender dysphoria, and whether they work differently with this patient group.

Existing research has generally focused on quantitative work investigating how specific autism traits could contribute to higher rates of gender diversity in autistic people, and qualitative research has investigated the perspectives of autistic and transgender young people and adults.

The study authors said that there is a dearth of evidence understanding the perspectives of clinicians. Given the crucial role that clinicians play in providing access to transgender healthcare, including in assessing gender dysphoria and its distinctiveness from other conditions including autism, it is important to understand their perspectives and clinical approaches to working with this group. Furthermore, in the absence of comprehensive guidance for working with autistic children, adolescents and adults experiencing gender dysphoria, thorough qualitative evidence is needed to begin to develop evidence-based clinical approaches.

Researchers recruited clinicians with a range of professional backgrounds and who worked with autistic and transgender people in various clinical settings. Participants needed to work in a setting where they had substantial contact with the patient group; for most clinicians, they were recruited from gender clinics (n = 14), but two were recruited from autism services to ensure a range of views were included. They then analysed the interview transcripts using interpretative phenomenological analysis (IPA). 

Autism adaptations should be made in gender settings

The study found that the first overarching theme was clinician understanding of the intertwined experiences of patients, with four subthemes: (a) coming to an individualised understanding of autism, gender dysphoria, and mental health; (b) different ways of thinking about gender; (c) social differences as barriers and facilitators to gender comfort; (d) the challenge of sensory sensitivities and puberty.

The second overarching theme was mismatch of patient and clinician communication styles and goals, with three subthemes: (a) different communication of gender needs; (b) changing clinical sessions to overcome barriers; (c) tension between clinician and patient aims and thinking styles.

The authors concluded that autism adaptations should be made in gender settings, by increasing clinician understanding of how autism and gender dysphoria can intersect, as well as by making adjustments to clinic processes.

They added: "We found that clinicians worked with patients to try and better understand their experiences of gender dysphoria. Clinicians identified features of autism that they believed were related to gender identity and dysphoria including different thinking styles, social differences, and sensory sensitivities. Clinicians noticed that autistic people spoke about their gender in different ways to non-autistic people. Clinicians tried to adapt their practice to better meet the needs of their autistic patients.

"These adaptations tended to focus on differences in the assessment process, for example, offering longer or shorter appointments and changing their communication style. We conclude that clinicians were offering an individualised approach to autistic patients experiencing gender dysphoria. However, these clinicians were particularly interested in working with autistic people, and so may not be representative of the wider clinician population. Clinicians working in this area should receive training on autism adaptations and the intersection of autism and gender dysphoria."