I once completed an amazing training on gender expansive therapy with a therapist who specializes in working with trans* folks and they noted that they didn’t think they had worked with any Autistic clients. My first thought was “Yes you have!”, followed by wondering if those clients hadn’t felt safe talking about their Autistic identity because they weren’t sure if their therapist would be affirming of this identity, regardless of their affirming approach towards their gender identity. There’s a lot of stigma and mis-information about Autistic people within the mental health field, and the best resources out there for allistic (non-autistic) therapists who want to be autism-affirming are completing trainings/workshops created by Autistic therapists and seeking professional consultation with Autistic therapists, such as myself. Nothing about us without us, please!

One of the things we wonder about within the Autistic community is why so many of us seem to question our gender and sexuality and land on something other than the societal-expected norm. Lydia X. Z. Brown, a disabled and queer policy advocate and attorney, as part of a panel presentation at the Out Leadership US Summit 2020, explained that if you are positioned to question norms (which, as my fellow Autists know, is something we love to do!) then you are automatically more willing to embrace a non-conforming gender identity.

Another interesting facet of this topic is that female and AFAB (assigned female at birth) Autists are more likely to identify as lesbian, bisexual, pansexual, asexual, bigender, non-binary, genderqueer, gender fluid, transgender, or agender compared to male or AMAB (assigned male at birth) Autists (Weir et al., 2021), although we don’t really know why this is. There’s also evidence to show that Autistic folks are more open to exploring non-traditional relationship structures, such as polyamory, consensual non-monogamy, or relationship anarchy (Gratton, 2020; Schöttle et. al., 2017).

Although there’s not yet a lot of formal research being done on the topic of autism and sexuality, the results of studies and surveys that have been conducted estimate that up to 35% of Autistic folks identify as non-heterosexual, which is a huge proportion compared to only 4.5% in the overall population (Sarris, 2020). In fact, another study that surveyed 630 adults found that 69.7% of the autistic respondents reported identifying as non-heterosexual (including homosexual, bisexual, and asexual), while only 30.3% of the non-autistic respondents reported non-heterosexual identities (George and Stokes, 2018). Notably, there is a difference in sexuality based on gender as well, with Autistic women being more likely to identify as non-heterosexual compared to Autistic men. In one study of Autistic adults in the Netherlands, 43% of female respondents and 18% percent of male respondents identified as non-heterosexual (Dewinter et al., 2017).

Expanding on this, Warrier et al. (2021) found that trans and gender-diverse adults were 3-6 times more likely to be diagnosed with autism compared to cisgender adults, estimating that 3-9% of all trans and gender-diverse adults are likely to also be Autistic. This study only examined those Autistic adults who had a formal diagnosis, but a more recent study that came out earlier this year found that including folks with subthreshold autistic diagnostic presentations within the broad autism group still showed that Autism was significantly over-represented among a group of 93 transgender adolescents (Strang et al., 2023).

Keep in mind that the research on sexuality and gender expression in Autistic adults is in its infancy due to autism being a fairly new diagnosis (the first person ever diagnosed as autistic, Donald Triplett, just passed earlier this year and was diagnosed in 1943), the vast majority of Autism research still being cure-based, and the assumption for many years that Autistic adults would not exist because they would all be cured as children or “grow out of it”. Further, it’s clear that many Autistic adults (especially women and AFAB folks) escaped diagnosis as children due to masking or camouflaging behaviours or having low support needs. It remains difficult for many adults to get a formal Autism diagnosis to this day because of the overwhelming prevalence of outdated beliefs and stereotypes. Notably, there is a stereotype that Autistic people are not interested in sex or relationships and that, in and of itself, has impeded a lot of the research into this area.

Importantly, being both Autistic and LGBT2SQIA+ comes with additional stigma of being multiply marginalized (even more so for BIPOC folks) and trouble finding inclusion in spaces meant for either community, including having to “come out” multiple times (O’Shea et al., 2020). So how do we do better moving forward? According to the Fenway Institute’s National LGBT Health Education Center, qualitative research studies and clinical experience provide insight into the unique experience of gender-diverse, neurodivergent youth, who are the first generation to feel more comfortable openly exploring both of these identities.

Young Autistics often experience a sense of urgency around affirming their gender identity and reduced stigma associated with neurodivergence. For some, sexuality and gender identity are areas of active exploration and fluidity. They may fluctuate in how they define, and how strongly they emphasize, their gender identity or sexual orientation. Their gender identity may be directly related to their Autism: “autigender”, or they may consider their neurodiversity a critical part of their queerness: “neuroqueer”. Non-binary experience is common and in clinical experience, many neurodivergent people feel most comfortable with non-binary gender identification. Doctors, parents, and therapists may confuse gender exploration as a special interest and assume it will be a passing phase, which can be harmful and dismissive as well as delay appropriate social and medical transition.

The answer to how to do better is, of course, working hard within our practices and clinical systems to be fully inclusive and non-discriminatory. The use of inclusive language when talking about sexuality and gender expression likely comes easily to most queer-affirming practitioners, but the language of disability and neurodiversity might be new to you. I guarantee, if you are working with queer or trans clients, you ARE working with Autistic clients. Take the time to learn about our unique community from those of us who are eager to teach. Neurodiversity-affirming therapists are ready to stop having to undo harm caused by therapists who have not done this work and are continuing to operate from a stigmatizing, stereotyped lens of autism and other neurodiversities. The time for change is now.

I’ll end with a quote from one of the participants in O’Shea et al. (2020): “I think often it’s easier to be one or the other, and you don’t often get to be both. You either get to be the person with a disability, and you don’t always disclose, as others have said; or you get to be the gay person, but you don’t get your disability side of you actually acknowledged, or sort of… I don’t know. I think you often get split between the two, or between however many there are.”

Additional resources for clinicians and clients:

Neuroqueer Heresies: Notes on the Neurodiversity Paradigm, Autistic Empowerment, and Postnormal Possibilities by Nick Walker

• Unmasking Autism: Discovering the New Faces of Neurodiversity by Devon Price

• Queerly Autistic: The Ultimate Guide For LGBTQIA+ Teens On The Spectrum by Erin Ekens

• Supporting Transgender Autistic Youth and Adults: A Guide for Professionals and Families by Finn V. Gratton

• The Awesome Autistic Guide for Trans Teens by Yenn Purkis and Sam Rose

References:

Dewinter J., De Graaf, H., & Begeer, S. (2017). Sexual Orientation, Gender Identity, and Romantic Relationships in Adolescents and Adults with Autism Spectrum Disorder. Journal of Autism and Developments Disorders. 47(9), 2927–2934.

• Fenway Institute’s National LGBT Health Education Center. Neurodiversity & Gender-Diverse Youth: An Affirming Approach to Care 2020. Retrieved on August 7, 2023. https://www.lgbtqiahealtheducation.org/wp-content/uploads/2020/08/Neurodiversity-and-Gender-Diverse-Youth_An-Affirming-Approach-to-Care_2020.pdf

• George, R., & Stokes, M. A. (2018). Sexual Orientation in Autism Spectrum Disorder. Autism Research, 11(1), 133–141.

• Gratton, Finn. (2020). Supporting Transgender Autistic Youth and Adults: A Guide for Professionals and Families. Jessica Kingsley Publishers. Philadelphia

• O’Shea, A., Latham, J.R., McNair, R., Despott, N., Rose, M., Mountford, R., & Frawley, P. (2020). Experiences of LGBTIQA+ People with Disability in Healthcare and Community Services: Towards Embracing Multiple Identities. International Journal of Environmental Research and Public Health, 17(21), 8080.

• Sarris, Marina (2020). Autistic People More Likely to Identify as LGBTQ. Discover Spark. Retrieved on July 19. 2023. https://sparkforautism.org/discover_article/autism-lgbtq-identity/

• Schöttle, D., Briken, P., Tüscher, O., & Turner, D. (2017). Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder. Dialogues in Clinical Neuroscience, 19(4), 381–393.

• Strang, J.F., Anthony, L.G., Song, A., Lai, M.C., Knauss, M., Sadikova, E., Graham, E., Zaks, Z., Wimms, H., Willing, L., Call, D., Mancilla, M., Shakin, S., Vilain, E., Kim, D.Y., Maisashvili, T., Khawaja, A., & Kenworthy, L.. In Addition to Stigma: Cognitive and Autism-Related Predictors of Mental Health in Transgender Adolescents. Journal of Clinical Child and Adolescent Psychology, 52(2), 212-229.

• Warrier, V., Greenberg, D.M., Weir, E., Buckingham, C., Smith, P., Lai, M.-C., Allison, C., & Baron-Cohen, S. (2020). Elevated Rates of Autism, Other Neurodevelopmental and Psychiatric Diagnoses, and Autistic Traits in Transgender and Gender-Diverse Individuals. Nature Communicatioons, 11, 3959.

• Weir, E., Allison, C., & Baron-Cohen, S. (2021). The sexual health, orientation, and activity of autistic adolescents and adults. Autism Research, 14, 2342-2354.