Children with ASD and ADHD are more likely to exhibit gender variance

John F. Strang, PsyD, a pediatric neuropsychologist at Children's National Health System, and colleagues, found that children with autism spectrum disorders (ASD) or attention deficit hyperactivity disorder (ADHD) were more likely to exhibit gender variance, the wish to be the other gender, than children with no neurodevelopmental disorder, or a medical neurodevelopmental disorder such as epilepsy or neurofibromatosis.

The study, titled "Increased Gender Variance in Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder" was published in the Archives of Sexual Behavior. According to Springer, the journal's publisher, it is the first study to compare the occurrence of gender identity issues in children with specific neurodevelopmental disorders against typically developing children.

The study looked at children and adolescents, between the ages of 6 and 18, who have autism, ADHD, epilepsy, neurofibromatosis, or are typically developing. Results showed that gender variance was about 8 times more likely in participants with ASD, and approximately 7 times more likely in participants with ADHD, compared to the control group of typically developing children. There was no difference between children with epilepsy or neurofibromatosis, and the control group.

"From previous studies and clinical reports, we knew that children who presented with gender identity issues were more likely to have autism than would be expected just by chance, but we'd never looked at how common gender variance was in different developmental groups," says Dr. Strang. "What we saw was an over-representation of gender variance in kids with autism or ADHD. The next step for us is to understand what that might mean."

Strang and his colleagues suggest that the reasons for elevated gender variance in children with ADHD or ASD could be due to the primary symptoms of the disorders. For instance, with ADHD it may be harder to keep gender variant impulses hidden from the societal and/or interpersonal pressures against gender nonconformity. For children with autism, who have less awareness of social expectations, there may be less of an impulse to avoid expressing underlying gender variance.

The study also found children with neurodevelopmental disorders and gender variance had increased rates of anxiety and depressive symptoms compared to children with no reported gender variance. The authors suggest further research into examining gender variance and neurodevelopmental disorders is needed in order to best evaluate and provide support for these children.

"In our autism clinic we now ask questions regarding gender identity because we know it's not such an uncommon issue. We don't overemphasize it because it is a relatively small percentage of children overall, but we do want to make sure we're asking about it and providing children and families support when they need it," says Dr. Strang.