People believe the combination of autism spectrum disorder (ASD) and gender dysphoria (GD) is a complicated one. In addition, clinicians can be reluctant to diagnose and treat this combination of problems. In scientific research, several researchers are currently debating the existence of a link between ASD and GD. Nevertheless, everyone agrees that there is more gender diversity among adolescents with ASD than previously thought. The current case study illustrates an example of a gender journey for an adolescent with ASD and the challenges faced by mental health service providers in guiding adolescents or young adults with ASD in this gender quest.
TopLiterature Review
In the last decades more research has been conducted on the psychosexual development of adolescents with ASD. The main focus of this research is on the needs and concerns of stakeholders, or the differences in psychosexual functioning compared with non-ASD adolescents. Many published papers conclude with emphasizing the need for specialized programs to guide adolescents with ASD in their psychosexual development (Dewinter, Vermeiren, Vanwesenbeeck, & Nieuwenhuizen, 2013; Ginevra, Nota, & Stokes, 2016; Nichols & Blakeley-Smith, 2009). Although more professionals address the psychosexual development of adolescents with ASD and work with (self-developed) materials, published specialized material for adolescents with ASD and research into the effectiveness of these programs remain scarce. In 2010, a training program was developed in the Netherlands targeting the psychosexual development of adolescents with ASD: the Tackling Teenage Training (TTT) program (Boudesteijn, Van der Vegt, Visser, Tick, & Maras, 2012). A pilot study of the effects of the TTT program on psychosexual knowledge among 30 adolescents with ASD showed that adolescents with ASD had increased knowledge of puberty and psychosexual topics after following the training program (Dekker, Van der Vegt, Visser, Tick, et al., 2014). The results of the following Randomized Controlled Trial, with 189 adolescents with ASD that were randomized to an intervention condition or a waiting-list control condition, indicated that the TTT program is effective as a psycho-educational program to provide adolescents with ASD with the knowledge and insight they need to prepare themselves for a healthy psychosexual development (Visser, Greaves-Lord, Tick, Verhulst, Maras, & van der Vegt, 2017).
With an increase in research on the psychosexual development of adolescents with ASD, there is also a growing interest in the co-occurrence of ASD and gender dysphoria (Van Der Miesen, Hurley, & De Vries, 2016; Øien, Cicchetti, & Nordahl-Hansen, 2018). Several possible explanations for this co-occurrence are presented, for instance rigidity in thinking in adolescents with ASD hinders flexibility in their gender development (de Vries, Noens, Cohen-Kettenis, van Berckelaer-Onnes, & Doreleijers, 2010), the role of pre-occupations, obsessions and unusual interests (Vanderlaan, Leef, Wood, Hughes, & Zucker, 2015), and a different development of gender identity in adolescents with ASD (van Schalkwyk, Klingensmith, & Volkmar, 2015). Multiple papers (i.e., case studies, scientific studies and reviews) describe that both the process of diagnosis and the treatment of adolescents with GD can be complicated by the co-occurrence of ASD. However, the optimal diagnostic procedure and treatment protocol and outcomes for adolescents with ASD and GD are currently unknown (van der Miessen et al., 2016).