About Evidence Based Autism
“I believe in evidence. I believe in observation, measurement, and reasoning, confirmed by independent observers. I'll believe anything, no matter how wild and ridiculous, if there is evidence for it. The wilder and more ridiculous something is, however, the firmer and more solid the evidence will have to be.”
― Isaac Asimov, The Roving Mind
We are a group of autistic adults, some of us parents and all of us passionate about raising awareness and understanding of autism and creating a better fairer world for the autistic community. We are among the millions of people worldwide who are increasingly concerned about the replacement of sex as a quantifiable measure with Gender Identity.
Sex is the means via which we divide our population for the purposes of medicine and personal/intimate services, prison estates, schools, clubs and sports. Sex cannot be exchanged for the contested concept of 'gender identity' without doing harm to statistics and epidemiology, as well as significant harm to children and to girl's and women's sex based rights. 'Gender Identity' is supposed, by those who believe in it, to be an inner feeling based on a spectrum of how masculine or feminine someone feels and as such, has no standing in law.
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Currently, of all the children and young people adopting a gender identity which they believe is in opposition to their sex, 76% are adolescent girls and this trend has been replicated globally. Evidence indicates that the cohort of children and adolescents most likely to adopt a ‘trans’ identity are Autistic (approximately 35% of all referees to The Tavistock Gender Identity Development Service, with a further 13% demonstrating autistic traits), Gay or Lesbian , Looked After Children or children who have experienced some form of trauma or Adverse Childhood Experience (ACE).
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Autism
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Autism as a spectrum condition, is badly under-researched. The vast majority of research upon which current understanding of ASC is based, is historic and based entirely on cohorts consisting of boys.
What this means in practice, is that not only has research not kept up with differing presentations of autism, particularly of girls, but it lags behind the increasing numbers of girls and women who are diagnosed or suspected of being autistic each year. Autism is a complex condition that presents differently in each child or young person; support and understanding of autism and autistic people is still sorely lacking in many areas of society. The lack of understanding and diagnosis of autism in girls and young women also impacts on autistic boys and young men, by trapping them within sex-stereotypical assumptions about how their autism 'should' present.
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We believe that the social and medical model of supporting, affirming and treating transgender identities adopted by autistic children and adolescents, fits within a historical pattern of ableism and attempts to ‘cure’ autism. The autistic children having their identities medicalised, become life-long medical patients, reliant on cross sex hormones, undergoing hugely invasive double mastectomies and often major surgery to create the facsimile of a penis or a vagina. They are at serious risk of becoming infertile and losing sexual function as a result of the hormones and surgery prescribed.
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A therapeutic approach
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We advocate for a psychotherapeutic approach to autistic children with gender identity issues. This is because the wide range of co-morbidities and mental health issues that can accompany autism, make it difficult to identify the root of gender related distress.
It is vital that children are given the most appropriate support but the right form of support may not be immediately clear without building a therapeutic relationship first.
Given the lack of knowledge and scant research base surrounding the validity of both GnRH Analogue blockers and cross sex hormones, the actions of an increasing number of countries now refusing to prescribe them, is eminently sensible.
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With that in mind, any support offered to children and young people identifying away from their sex or adopting a 'gender identity', needs to be child centred and based solely on treatment with a robust evidence base. Safeguarding is key. Clinicians and therapists must develop a thorough knowledge base about autism and an in depth understanding of the differing profiles of each individual autistic child. An understanding of the numerous co-morbidities common alongside autism, not least of which is Body Dysmorphic Disorder, is vital as there are numerous physical and psychological issues inherent in autism that could lead a child to believe that their body is 'wrong' and they are therefore 'trans'.
The Cass Report has flagged up the risk of diagnostic overshadowing, wherein the affirming of a young person's gender identity clouds the presentation of other psychosocial issues or co-morbid conditions. Once affirmed on a gender dysphoria pathway, clinicians and therapists can find themselves in a difficult position; They are not allowed to approach 'gender dysphoria' (the DSM V diagnostic category under which most of these children will be treated) under the umbrella of mental illness, even if they know that the child has one or more comorbid mental health conditions which may predate their presentation.
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It is complicated by the lack of knowledge about autism and how it presents. It is also true that many autistic boys present in exactly the same way as autistic girls - so much so that in the far future we may cease to talk about male and female presentations and just simply refer to different phenotypes across the spectrum.
Effective therapeutic work with autistic children cannot take place with only a broad overview of what neurodiversity and autism actually mean. Each child must be seen as the incredible individual that they are. Every autistic child is different and every aspect of their personality is relevant when following a therapeutic pathway.​ It is vital to dig down and understand how autism affects each child, and to map their autistic profile so a clear picture of their strengths and difficulties can be built up.
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There also needs to be a solid understanding of the unique vulnerabilities of autistic girls and young women. They are statistically more likely than the general population to experience abuse and sexual assault. As young adults they are also more likely to experience domestic abuse, have difficulty with employment, housing and managing finances. ​ They are more likely to experience suicidal ideation that other groups, particularly if they are female, and even more so if they have co-morbid ADHD.
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Autistic girls struggle massively with puberty; such enormous change is very difficult to manage, on a sensory level as well as simply being the greatest period of transition (and therefore stress and anxiety) than at any other point in their lives.​ Autistic boys go through the same pressures when dealing with puberty; these factors may well contribute to an autistic child or young person developing issues with their sexed body, the roles they believe society or their peers expect them to play, or believing that their difficulties navigating puberty are the result of so-called 'gender dysphoria'.
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Why does this matter?
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Over the last ten years, ideas of social justice have been brought to the forefront of public policy in the UK and overseas. This is undoubtedly a good thing for a fairer and more equitable society. The value of lived experience has become increasingly recognised, across all marginalised groups, including the autistic community. It is vital to listen to the voices and experiences of the autistic community when forming policy and law, and planning public services. However, just as there is a saying 'If you've met one autistic person you've met one autistic person', so you might also say 'One autistic person's experience is only one autistic person's experience'.
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No one person's life can incorporate the multitude of complexities across the vast and varied autistic community. Neither should one person, or a handful of people's experiences define how support is provided to millions of people, young and old.
​Over the past ten years, there has been a vast increase across the autistic community for identification at odds with biological sex. This has manifested alongside a wider awareness of the transgender community.
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Once known as transexual, and numbering a handful of thousands in the UK, the expanded transgender community is a relatively new and quite different set of identities. Transgender now includes Transexuals, Transvestites and Cross Dressers. It also includes people – both children and adults – who identify as neither male or female or both and who crucially, want social structures and access to public services to reflect the fact ​that they wish to be perceived publicly and by other people as being a mix of both sexes or having neither sex.
A further cohort under the new transgender umbrella wish to be perceived as having a fluid identity, (Genderqueer, Genderfluid and all variations on this idea) moving from day to day between degrees of masculine or feminine behaviour. Again, they wish society to be reordered away from sex based divisions in terms of how it provides public services, to reflect their shifting internal feelings.
Unlike other protected groups under the Equality Act, the cohort protected under the characteristic of Gender Reassignment require the engagement of other people in order to bring their identities to life. This is achieved by demanding that other people ignore their innate and immediate perceptions of whether someone is male or female in order to accommodate that persons internal feelings. This is particularly dangerous for children and women as we rely on our finely developed and innate sense of sex recognition in order to assess whether we are safe.
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As so many autistic children and young people are adopting a 'trans' identity or reporting symptoms of body dysmorphia and experiencing confusion about their identity, we want to create a space where evidence based information and data can be accessed.
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It is vital that all autistic children and young people are supported with compassion and understanding, and that any therapies that are accessed should have a robust evidence base, and take account of the differences in information processing, communication and life experiences of the autistic community. We hope that with this website we can build a resource that will assist with that and help ensure that autistic children are treated with respect, understanding and with acknowledgement that their autistic worldview is something to be understood rather than corrected.