Skip to main content

Advertisement

SpringerLink
Log in

Increased Gender Variance in Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Evidence suggests over-representation of autism spectrum disorders (ASDs) and behavioral difficulties among people referred for gender issues, but rates of the wish to be the other gender (gender variance) among different neurodevelopmental disorders are unknown. This chart review study explored rates of gender variance as reported by parents on the Child Behavior Checklist (CBCL) in children with different neurodevelopmental disorders: ASD (N = 147, 24 females and 123 males), attention deficit hyperactivity disorder (ADHD; N = 126, 38 females and 88 males), or a medical neurodevelopmental disorder (N = 116, 57 females and 59 males), were compared with two non-referred groups [control sample (N = 165, 61 females and 104 males) and non-referred participants in the CBCL standardization sample (N = 1,605, 754 females and 851 males)]. Significantly greater proportions of participants with ASD (5.4 %) or ADHD (4.8 %) had parent reported gender variance than in the combined medical group (1.7 %) or non-referred comparison groups (0–0.7 %). As compared to non-referred comparisons, participants with ASD were 7.59 times more likely to express gender variance; participants with ADHD were 6.64 times more likely to express gender variance. The medical neurodevelopmental disorder group did not differ from non-referred samples in likelihood to express gender variance. Gender variance was related to elevated emotional symptoms in ADHD, but not in ASD. After accounting for sex ratio differences between the neurodevelopmental disorder and non-referred comparison groups, gender variance occurred equally in females and males.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for ASEBA School-Age Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

    Google Scholar 

  • Arnold, S. D. (1996). Sex differences in ADHD: Conference summary. Journal of Abnormal Child Psychology, 24, 555–569.

    Article  PubMed  Google Scholar 

  • Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., et al. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The Special Needs and Autism Project (SNAP). Lancet, 368, 210–215.

    Article  PubMed  Google Scholar 

  • Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in Cognitive Sciences, 6, 248–254.

    Article  PubMed  Google Scholar 

  • Baron-Cohen, S. (2009). Autism: The empathizing-systemizing (E-S) theory. Annals of the New York Academy of Sciences, 1156, 68–80.

    Article  PubMed  Google Scholar 

  • Beacher, F. D. C. C., Radulescu, E., Minati, L., Baron-Cohen, S., Lombardo, M. V., Lai, M., et al. (2012). Sex differences and autism: Brain function during verbal fluency and mental rotation. PLoS ONE, 7. doi:10.1371/journal.pone.0038355.

  • Bedard, C., Zhang, H. L., & Zucker, K. J. (2010). Gender identity and sexual orientation in people with developmental disabilities. Sexuality and Disability, 28, 165–175.

    Article  Google Scholar 

  • Bejerot, S., Eriksson, J. M., Bonde, S., Carlström, K., Humble, M. B., & Eriksson, E. (2012). The extreme male brain revisited: Gender coherence in adults with autism spectrum disorder. British Journal of Psychiatry, 201, 116–123.

    Article  PubMed  Google Scholar 

  • Biddle, D. A., & Morris, S. B. (2011). Using Lancaster’s mid-P correction to the Fisher’s exact test for adverse impact analyses. Journal of Applied Psychology, 96, 956–965.

    Article  PubMed  Google Scholar 

  • Bland, J. M., & Altman, D. G. (2000). Statistics notes: The odds ratio. British Medical Journal, 320, 1468.

    Article  PubMed Central  PubMed  Google Scholar 

  • Center for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, fourteen sites, United States, 2008. Surveillance Summaries, 61, 1–19.

    Google Scholar 

  • Coates, S., & Person, E. S. (1985). Extreme boyhood femininity: Isolated behavior or pervasive disorder? Journal of the American Academy of Child Psychiatry, 24, 702–709.

    Article  PubMed  Google Scholar 

  • Cohen-Kettenis, P. T., Owen, A., Kaijser, V. G., Bradley, S. J., & Zucker, K. J. (2003). Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis. Journal of Abnormal Child Psychology, 31, 41–53.

    Article  PubMed  Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2005). Social Responsiveness Scale. Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • de Vries, A. L. C., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality, 59, 301–320.

    Article  PubMed  Google Scholar 

  • de Vries, A. L. C., Doreleijers, T. A. H., Steensma, T. D., & Cohen-Kettenis, P. T. (2011). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52, 1195–1202.

    Article  PubMed  Google Scholar 

  • de Vries, A. L. C., Noens, I. L., Cohen-Kettenis, P. T., Van Berckelaer-Onnes, I. A., & Doreleijers, T. A. (2010). Autism spectrum disorders in gender dysphoric children and adolescents. Journal of Autism and Developmental Disorders, 40, 930–936.

    Article  PubMed Central  PubMed  Google Scholar 

  • Dreger, A. (2009). Gender identity disorder in childhood: Inconclusive advice to parents. Hastings Center Report, 39, 26–29.

    Article  PubMed  Google Scholar 

  • Drescher, J., & Byne, W. (2012). Introduction to the Special Issue on “The Treatment of Gender Dysphoric/Gender Variant Children and Adolescents.” Journal of Homosexuality, 59, 295–300.

    Google Scholar 

  • Edwards-Leeper, L., & Spack, N. P. (2012). Psychological evaluation and medical treatment of transgender youth in an interdisciplinary “Gender Management Service” (GeMS) in a major pediatric center. Journal of Homosexuality, 59, 321–336.

    Article  PubMed  Google Scholar 

  • Fombonne, E. (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. Journal of Clinical Psychiatry, 66, 3–8.

    PubMed  Google Scholar 

  • Gallucci, G., Hackerman, F., & Schmidt, C. W. (2005). Gender identity disorder in an adult male with Asperger’s syndrome. Sexuality and Disability, 23, 35–40.

    Article  Google Scholar 

  • Gutmann, D. H., Aylsworth, A., Carey, J. C., Korf, B., Marks, J., Pyeritz, R. E., et al. (1997). The diagnostic evaluation and multidisciplinary management of neurofibromatosis 1 and neurofibromatosis 2. Journal of the American Medical Association, 278, 51–57.

    Article  PubMed  Google Scholar 

  • Happé, F., & Frith, U. (2006). The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36, 5–25.

    Article  PubMed  Google Scholar 

  • Jackson, L. K., & Atance, C. M. (2008). Future thinking in children with autism spectrum disorders: A pilot study. Journal on Developmental Disabilities, 14, 40–45.

    Google Scholar 

  • Kenworthy, L., Case, L., Harms, M. B., Martin, A., & Wallace, G. L. (2010). Adaptive behavior ratings correlate with symptomatology and IQ among individuals with high-functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, 416–423.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kenworthy, L., Yerys, B. E., Anthony, L. G., & Wallace, G. L. (2008). Understanding executive control in autism spectrum disorders in the lab and in the real world. Neuropsychology Review, 18, 320–338.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kraemer, B., Delsignore, A., Gundelfinger, R., Schnyder, U., & Hepp, U. (2005). Comorbidity of asperger syndrome and gender identity disorder. European Child and Adolescent Psychiatry, 14, 292–296.

    Article  PubMed  Google Scholar 

  • Lai, M., Chiu, Y., Gadow, K. D., Gau, S. S., & Hwu, H. (2010). Correlates of gender dysphoria in Taiwanese university students. Archives of Sexual Behavior, 39, 1415–1428.

    Article  PubMed  Google Scholar 

  • Lainhart, J. E., Bigler, E. D., Bocian, M., Coon, H., Dinh, E., Dawson, G., et al. (2006). Head circumference and height in autism: A study by the Collaborative Program of Excellence in Autism. American Journal of Medical Genetics Part A, 140, 2257–2274.

    Article  PubMed  Google Scholar 

  • Landen, M., & Rasmussen, P. (1997). Gender identity disorder in a girl with autism: A case report. European Child and Adolescent Psychiatry, 6, 170–173.

    Article  PubMed  Google Scholar 

  • Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., et al. (1989). Autism Diagnostic Interview: A standardized investigator-based instrument. Journal of Autism and Developmental Disorders, 19, 363–387.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2000). Autism Diagnostic Observation Schedule (ADOS). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of the Autism Diagnostic Interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.

    Article  PubMed  Google Scholar 

  • Menvielle, E. (2012). A comprehensive program for children with gender variant behaviors and gender identity disorders. Journal of Homosexuality, 59, 357–368.

    Article  PubMed  Google Scholar 

  • Mukaddes, N. M. (2002). Gender identity problems in autistic children. Child: Care. Health and Development, 28, 529–532.

    Article  Google Scholar 

  • Perera, H., Gadambanathan, T., & Weerasiri, S. (2003). Gender identity disorder presenting in a girl with Asperger’s disorder and obsessive compulsive disorder. Ceylon Medical Journal, 48, 57–58.

    PubMed  Google Scholar 

  • Rodrigue, J. R., Morgan, S. B., & Geffken, G. R. (1991). A comparative evaluation of adaptive behavior in children and adolescents with autism, Down syndrome, and normal development. Journal of Autism and Developmental Disorders, 21, 187–196.

    Article  PubMed  Google Scholar 

  • Tateno, M., Tateno, Y., & Saito, T. (2008). Comorbid childhood gender identity disorder in a boy with Asperger syndrome. Psychiatry and Clinical Neurosciences, 62, 238.

    Article  PubMed  Google Scholar 

  • Van Beijsterveldt, C. E. M., Hudziak, J. J., & Boomsma, D. I. (2006). Genetic and environmental influence on cross-gender behavior and relation to behavior problems: A study of Dutch twins at ages 7 and 10 years. Archives of Sexual Behavior, 35, 647–658.

    Article  PubMed  Google Scholar 

  • VanderLaan, D. P., Postema, L., Wood, H., Singh, D., Fantus, S., Hyun, J., et al. (2014). Do children with gender dysphoria have intense/obsessional interests? Journal of Sex Research. doi:10.1080/00224499.2013.860073.

    Google Scholar 

  • Wallien, M. S. C., Swaab, H., & Cohen-Kettenis, P. T. (2007a). Psychiatric comorbidity among children with gender identity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1307–1314.

    Article  PubMed  Google Scholar 

  • Wallien, M. S. C., van Goozen, S. H. M., & Cohen-Kettenis, P. T. (2007b). Physiological correlates of anxiety in children with gender identity disorder. European Child and Adolescent Psychiatry, 16, 309–315.

    Article  PubMed  Google Scholar 

  • Williams, P. G., Allard, A. M., & Sears, L. (1996). Case study: Cross-gender preoccupations with two male children with autism. Journal of Autism and Developmental Disorders, 26, 635–642.

    Article  PubMed  Google Scholar 

  • Wolkenstein, P., Freche, B., Zeller, J., & Revuz, J. (1996). Usefulness of screening investigations in neurofibromatosis type 1: A study of 152 patients. Archives of Dermatology, 132, 1333–1336.

    Article  PubMed  Google Scholar 

  • Wood, H. (2011, October). The relationship between gender identity disorder and autism spectrum disorder. In K. J. Zucker (Chair), Gender identity disorder in children and adolescents: Theoretical and empirical advances. Symposium presented at the joint meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry, Toronto.

  • Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guildford Press.

    Google Scholar 

  • Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Kibblewhite, S. J., Wood, H., Singh, D., et al. (2012). Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex and Marital Therapy, 38, 151–189.

    Article  PubMed  Google Scholar 

  • Zucker, K. J., Owen, A., Bradley, S. J., & Ameeriar, L. (2002). Gender-dysphoric children and adolescents: A comparative analysis of demographic characteristics and behavioral problems. Clinical Child Psychology and Psychiatry, 7, 398–411.

    Article  Google Scholar 

  • Zucker, K. J., Wood, H., & VanderLaan, D. P. (2014). Models of psychopathology in children and adolescents with gender dysphoria. In B. P. C. Kreukels, T. D. Steensma, & A. L. C. de Vries (Eds.), Gender dysphoria and disorders of sex development: Progress in care and knowledge (pp. 171–192). New York: Springer.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Autism Spectrum Disorders, Children’s National Medical Center, 15245 Shady Grove Road, Suite 350, Rockville, MD, 20850, USA

    John F. Strang, Lauren Kenworthy, Jennifer Sokoloff, Caroline Luong-Tran & Haley Meagher

  2. Division of Neuropsychology, Children’s National Medical Center, Rockville, MD, USA

    Aleksandra Dominska, Laura E. Kenealy, Madison Berl & Karin Walsh

  3. Department of Psychiatry, Children’s National Medical Center, Washington, DC, USA

    Edgardo Menvielle & Kyung-Eun Kim

  4. School of Education, Arcadia University, Glenside, PA, USA

    Graciela Slesaransky-Poe

  5. Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA

    Gregory L. Wallace

Authors
  1. John F. Strang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren Kenworthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aleksandra Dominska
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Sokoloff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura E. Kenealy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Madison Berl
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karin Walsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Edgardo Menvielle
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Graciela Slesaransky-Poe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kyung-Eun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Caroline Luong-Tran
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Haley Meagher
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Gregory L. Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John F. Strang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Strang, J.F., Kenworthy, L., Dominska, A. et al. Increased Gender Variance in Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder. Arch Sex Behav 43, 1525–1533 (2014). https://doi.org/10.1007/s10508-014-0285-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-014-0285-3

Keywords

Search

Navigation