Episode 17

Published on:

2nd Apr 2021

17 - Autism and Gender Dysphoria

The startling links between ASD and Gender Dysphoria are raising plenty of questions as clinicians wonder why children on the spectrum tend to struggle with gender. Also, which comes first: ASD or gender nonconformity? In this episode, we explore how autistic traits may cause youth to question their gender and become attached to identity labels. And we wonder if this has implications for the trans movement.


Far From the Tree: Parents, Children and the Search for Identity, by Andrew Solomon



NeuroTribes: The Legacy of Autism and the Future of Neurodiversity, by Steve Silberman



Scientific American Article: “Autism — It’s Different in Girls”



13 YO girl with social struggles:




Thrower, E., Bretherton, I., Pang, K. C., Zajac, J. D., & Cheung, A. S. (2019). Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review. Journal of Autism and Developmental Disorders, 50(3), 695–706. Doi.org/10.1007/s10803-019-04298-1 

Hisle-Gorman, E., Landis, C. A., Susi, A., Schvey, N. A., Gorman, G. H., Nylund, C. M., & Klein, D. A. (2019). Gender Dysphoria in Children with Autism Spectrum Disorder. LGBT Health, 6(3), 95-100. doi:10.1089/lgbt.2018.0252 

Butler G, De Graaf N, Wren B, et al 

Assessment and support of children and adolescents with gender dysphoria 

Archives of Disease in Childhood 2018;103:631-636. 

Extended Notes

  • Sasha worked with autistic children early in her career and it really shaped a lot of her training today.
  • How do you define autism?
  • Stella thinks girls who have autism are getting missed at a younger age compared to boys.
  • How are gender and autism related?
  • Some children are just getting misdiagnosed as children and it’s showing up as anxiety or depression, instead of being on the spectrum.
  • Can’t figure out why a child might not be making progress? They’re on the wrong meds.
  • Autistic kids in general don’t really conform to gender norms.
  • Parents spend so much time with their autistic children just so they can live somewhat of a normal life. It’s painful and heartbreaking.
  • It’s cute when you’re five when it comes to not picking up on the gender roles, but as you get older, it can be difficult to integrate into a normal life.
  • Are there more autistic people now than there were before?
  • Technology and being overly glued to it can accelerate the social deficit traits.
  • Are you comfortable in your own body? A lot of times the answer is no.
  • One of the signs of autism is sensory issues. Both Sasha and Stella have noticed with their gender dysphoric children that they have an overfixation on the new changes their body is giving them during puberty, and how they hate it.
  • You don’t want to deny that children on the spectrum do have legitimate challenges, but there is a balance between blaming it on their autism vs. not enough real-life training.
  • “If you’re not supporting me, you must be transphobic.”
  • Should you assess your kid for autism?
  • Tread carefully when it comes to testing your teen. Your teen is going to take it as you trying to fix what’s “not fixable.”

This podcast is partially sponsored by ReIME, Rethink Identity Medicine Ethics:


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About the Podcast

Gender: A Wider Lens Podcast
Two therapists explore the expanding concept of "gender" from a psychological depth perspective.
Gender dysphoria has become a minefield for public discussion, with many afraid to express their views or question the narrative. Our mission is to examine this important and complex topic from a range of perspectives, but always through a psychological lens. By openly considering and examining gender identity, transition, and the transgender umbrella, we hope to give all interested parties permission to engage these fascinating topics with less fear and more honesty. Interviews and discussions will involve clinicians, medical professionals, academics, transgender people, parents, detransitioners and other interesting individuals whose lives have been touched by the concept of gender.

Conversations between two practicing therapists give listeners an opportunity to contemplate gender from a depth perspective not currently taken up in most of today’s accessible debates. As a result of their work with gender dysphoric therapy clients as well as their personal divergent experiences with gender, Stella and Sasha hold a refreshing and informed perspective.

Is gender identity a facilitation of development and expression of creativity, or can it be a defense against painful existential realities of living in a human body? What can we discover about masculinity, femininity, identity, gender performance, and sexuality when we peer beneath the surface and dive into a deeper psychological exploration? What is the relationship between body, mind, identity, culture, and psyche?

This podcast engages listeners in an intimate and fascinating behind-the-scenes inquiry about a topic as taboo as it is salient today.

* We are sponsored by ReIME and Genspect.
Rethink Identity Medicine Ethics (ReIME) is a non-profit organization dedicated to improving long term care for gender variant individuals. To learn more, visit https://rethinkime.org/

Genspect is an international alliance of parent and professional groups whose aim is to advocate for parents of gender-questioning children and young people. Parents are concerned that their kids are not receiving appropriate treatment and support; many do not feel free to speak out about their concerns.
To learn more, visit https://genspect.org/
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About your hosts

Stella O'Malley

Profile picture for Stella O'Malley
Stella O’Malley is a psychotherapist and author who works in private practice in Ireland. Her work focuses on parenting, family dynamics and working with teenagers.

Much of Stella’s counselling and writing focuses on mental health and the importance of well-being and she is a regular contributor to the media. She is also the resident psychotherapist for the current TV series, Raised by the Village, a family programme that helps troubled teenagers reconnect with themselves and their families.

Stella's first book, Cotton Wool Kids, was released in 2015 while Bully-Proof Kids: Practical tools to help kids grow up confident, resilient and strong was released in 2017. Stella’s latest book Fragile, was released in 2019 and focuses on overcoming anxiety and stress.

Stella was the presenter of the documentary Trans - Kids: It’s Time To Talk broadcast on Channel 4 in November 2018 and she contributed a chapter to the 2019 book, Inventing Transgender Children and Young People.

The Jungian analyst, Lisa Marchiano, and Stella launched Secrets of the Motherworld in September 2019, offering thoughtful exploration of the most intimate aspects of motherhood in a bid to help mothers feel less alone.

Stella is a Clinical Advisor for the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners. She is also the lead facilitator for the Gender Dysphoria Support Network.

Stella holds a B.A. in Counselling and Psychotherapy and a M.A. in Cognitive Behavioural Therapy.

Sasha Ayad

Profile picture for Sasha Ayad
Sasha Ayad is a Licensed Professional Counselor who works in private practice, and has treated adolescents for over 10 years. Her work focuses on teens and young adults struggling with issues of gender dysphoria and gender identity.

She became interested in the sharp rise in teenagers who declare a trans identity for the first time during adolescence. She discovered, through working with hundreds of families, that many teens were developing gender dysphoria only after adopting a transgender identity. She questions the practice of medical transition for children and teenagers, and her clinical work focuses on developmentally appropriate, least-invasive-first talk therapy.

Sasha is also a founding member and Clinical Advisor in the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners.

Sasha’s previous work experience includes:
- School counselor for middle and high school students at a charter school for underserved communities

- Behavioral therapy with children on the autism spectrum

- Individual and group counseling for women and children impacted by domestic abuse and sexual violence

- Developed and ran the first counseling program at a large state supported living facility for adults with intellectual disability

Sasha holds a B.S. in Psychology and an M.Ed. in Counseling Psychology.