Autism Spectrum Disorders In A Gender Identity Service: How Prevalent Is The Co-Occurrence And What Are Implications For Treatment?

Objective. Recent studies suggest higher rates of co-occurring gender dysphoria (GD) and autism spectrum disorder (ASD) than it would be expected by chance. This study provides information on the clinical prevalence of ASD in children and adolescents referred to a specialized German Gender Identity Service for children and adolescents (Hamburg GIS) and on features related to the individuals and their treatment in case of co-occurring GD and ASD. Method. We assessed information on birth-assigned sex, age, diagnosis (GD and ASS), and treatment status of 680 referred children and adolescents (time period: 2013-2018). The frequency of ASD diagnoses (ICD F84.0, F84.1, F84.5, F84.8 or F84.9, confirmed or suspected) was evaluated within the sample with GD diagnoses (confirmed diagnoses: ICD F64.0, F64.2; suspected: F64.8, F64.9; n = 579). The individual and treatment-related features of 18 children and adolescents with co-occurring GD and ASD and 40 children and adolescents with GD but without ASD diagnosis were compared. Results. The clinical prevalence of co-occurring ASD diagnoses, including suspected cases, was 3.1 %. Youth with co-occurring GD and ASD had significantly higher rates of suspected GD diagnoses and started significantly less often with gender-affirming medical interventions than youth without ASD diagnosis. Conclusions. Although the prevalence of ASD among children and adolescents with GD was lower than that reported from other international gender identity services, the present results suggest that the two phenomena do co-occur frequently. The results confirm that a diagnosis of ASD can challenge diagnostic procedures as well as decision-making regarding gender-affirming medical interventions.