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.

中文翻译：

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除了污名：变性青少年心理健康的认知和自闭症相关预测因素

摘要

客观的

自闭症谱系障碍 (ASD) 在跨性别青少年中的比例明显偏高。独立地，自闭症谱系障碍和性别多样性与心理健康风险增加有关。然而，人们对自闭症跨性别青少年的心理健康知之甚少。这项研究调查了迄今为止使用金标准 ASD 诊断程序诊断出的自闭症跨性别者、非自闭症（同源性）跨性别者和自闭症顺性别青少年的最大匹配样本的心理健康状况。根据对性/性别相关自闭症表型的深入理解，对略低于阈值的自闭症诊断表现（常见于自闭症女孩/女性）进行了建模。

方法

这项研究包括 93 名 13-21 岁的青少年，平均分为自闭症跨性别者、自闭症顺性别者和同源性跨性别者群体；13 名跨性别青少年处于 ASD 诊断的边缘，并被纳入更大的“广泛 ASD”分组。心理和神经心理学评估包括评估心理健康、智商、LGBT 耻辱感、ASD 相关社会症状、执行功能 (EF) 以及实现性别相关需求的 EF 相关障碍。

结果

与自闭症跨性别者和自闭症顺性别者相比，自闭症跨性别青少年的内化症状明显更严重。除了与心理健康相关的耻辱感之外，ASD 相关的认知/神经发育因素（即较差的 EF 和较大的社会症状）与较差的心理健康相关：具体而言，社会症状和 EF 性别障碍与更大的内化和 EF 问题以及具有更高自杀倾向的 EF 性别障碍。比较所有 ASD 和性别相关群体，女性性别认同与更高的自杀率相关。

结论

分析跨性别青年心理健康风险的异质性对于制定有针对性的评估和干预措施至关重要。本研究将 ASD 诊断、ASD 表型特征和 EF 相关的性别障碍确定为变性青少年心理健康较差的潜在风险。