Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals

Abstract

It is unclear whether transgender and gender-diverse individuals have elevated rates of autism diagnosis or traits related to autism compared to cisgender individuals in large non-clinic-based cohorts. To investigate this, we use five independently recruited cross-sectional datasets consisting of 641,860 individuals who completed information on gender, neurodevelopmental and psychiatric diagnoses including autism, and measures of traits related to autism (self-report measures of autistic traits, empathy, systemizing, and sensory sensitivity). Compared to cisgender individuals, transgender and gender-diverse individuals have, on average, higher rates of autism, other neurodevelopmental and psychiatric diagnoses. For both autistic and non-autistic individuals, transgender and gender-diverse individuals score, on average, higher on self-report measures of autistic traits, systemizing, and sensory sensitivity, and, on average, lower on self-report measures of empathy. The results may have clinical implications for improving access to mental health care and tailoring adequate support for transgender and gender-diverse individuals.

Fig. 1. Schematic diagram of the study.

This figure provides a schematic overview of the study. In this study we investigated three questions, presented in the red boxes. For each question, the primary dataset was the Channel 4 dataset (pink box). We used four validation datasets to validate the results—Musical Universe (cyan box), LifeLines (orange box), IMAGE (yellow box), and APHS (purple box). Colored arrows from the dataset boxes to the questions indicate which questions were investigated in which datasets. AQ-10 (Autism Spectrum Quotient-10), SQ-10 (Systemizing Quotient-10), EQ-10 (Empathy Quotient-10), SPQ-10 (Sensory Perception Quotient-10), AQ-50 (Autism Spectrum Quotient-50), ADHD (Attention-Deficit/Hyperactivity Disorder), OCD (Obsessive-Compulsive Disorder).

Fig. 2. ORs and 95% CIs for autism in transgender and gender-diverse individuals compared to cisgender males, cisgender females, and cisgender individuals altogether.

a This figure provides the unadjusted Odds Ratios (ORs, point) and 95% CIs for autism in transgender and gender-diverse individuals compared to either cisgender males, cisgender females, or cisgender (cisgender males and cisgender females) individuals in five datasets (C4: N = 514,100; MU: N = 85,670; APHS: N = 2312; IMAGE: N = 1803; and LifeLines: N = 37,975). b This figure provides adjusted ORs (point) and 95% CIs for autism in transgender and gender-diverse individuals compared to cisgender males, cisgender females, or all cisgender individuals in five datasets (C4: N = 514,100; MU: N = 85,670; APHS: N = 2312; IMAGE: N = 1803; and LifeLines: N = 37,975). ORs have been adjusted for age, educational attainment, and in the case of IMAGE dataset, an additional dummy variable for study (see “Supplementary Methods”). The y-axis is on the same scale for both the panels. The differences in ORs for the IMAGE dataset between Models 1 and 2 is primarily due to the inclusion of “study” group as a covariate. Specifically, the IMAGE dataset consists of individuals recruited into a study of mathematics and autism (“Methods”). Whilst the mathematics group is predominantly male and have higher educational attainment (all have at least an undergraduate degree), the case–control group had a more balanced ratio and a wider range of educational attainment. Covarying for the study the participants have been recruited into (mathematics or autism case–control) changes the ORs.

Fig. 3. Kernel density plot of scores on the four self-report measures in the C4 Dataset for non-autistic individuals only.

This figure provides kernel density plots for scores on the four self-report measures (AQ-10, EQ-10, SQ-10, and SPQ-10) for non-autistic participants from the C4 dataset (N = 514,100) based on their gender (cisgender males, cisgender females, transgender and gender-diverse individuals). Scales on the axes are different between the panels. See Supplementary Fig. S1 which provides kernel density plots for all four measures for both autistic and non-autistic individuals. The non-autistic transgender and gender-diverse kernel density plots appear smoother due to the relatively low number of participants included, hence providing less resolution in the kernel density estimates when compared to the non-autistic cisgender males and non-autistic kernel density plots.

Fig. 4. ORs and 95% CIs for other neurodevelopmental and psychiatric conditions in transgender and gender-diverse individuals compared to cisgender individuals.

a This figure provides the Odds Ratios (ORs, point) and 95% CIs for diagnosis of autism and six other neurodevelopmental and psychiatric conditions in transgender and gender-diverse individuals compared to cisgender individuals in the C4 dataset (N = 514,100). We did not employ Model 3 for autism as it was conducted after excluding autistic individuals in the dataset. ORs have been calculated using three models (see Methods). ADHD = Attention-Deficit/Hyperactivity Disorder; OCD = Obsessive-Compulsive Disorder; LD = Learning Disorder. b This figure provides the same, but for the MU dataset (N = 85,670). Information on LD was not available in the MU dataset. The y-axis is on a different scale from the panel above.