Poster #46 - Intellectual Abilities and Executive Functioning in Youth with Co-Occurring Autism Spectrum Disorder and Gender Dysphoria

• In Event: 3-003 - Poster Session 09
  In Poster Session: PS 09 Section - Developmental Disabilities

Integrative Statement

Objective: Recently, much attention has been paid to the co-occurrence of Autism Spectrum Disorder (ASD) and Gender Dysphoria (GD). A 2016 narrative review by Van Der Miesen and colleagues suggests that gender variance is present in 5-7% of youth with ASD compared to approximately 1% in the general population. However, some have questioned whether gender-diverse youth with co-occurring ASD truly have ASD, or whether apparent ASD characteristics are derived from social anxiety. ASD is characterized by a profile of difficulties and relative strengths in executive functioning. No study thus far has examined the cognitive (i.e., executive and intellectual functioning) profile of youth with clinically diagnosed ASD and GD as compared to those with ASD alone.
Methods and Participants: We investigated intellectual abilities and executive functioning in well-characterized sample of youth referred for gender-related consultations in an outpatient ASD neuropsychology clinic in a metropolitan area. Participants include 35 clinically diagnosed ASD+GD youth and 32 age-matched (within 1 year) youth diagnosed with ASD without GD. Measures of intellectual abilities included verbal (vocabulary) and visual (matrix reasoning) subtests of the Wechsler Intelligence Scales. Executive functioning was assessed using parent report of the Behavior Rating Inventory of Executive Function (BRIEF), BRIEF-Second Version (BRIEF-2), and BRIEF-Adult Version (BRIEF-A).
Results: Independent t-tests revealed individuals with co-occurring ASD+GD display superior intellectual functioning compared to individuals with ASD alone (Table 1). Because previous work has identified a strong correlation between verbal ability and executive functioning (e.g., Duff et al., 2004), we assessed executive functioning before and after controlling for verbal ability (Table 2). Before controlling for verbal ability, individuals with co-occurring ASD+GD display less impaired executive functioning overall, and less impaired working memory. After controlling for verbal ability, individuals with co-occurring GD and individuals with ASD alone no longer differed in their executive functioning deficits.
Conclusions: These findings suggest that youth who are referred for gender consultations with co-occuring ASD display executive functioning profiles concordant with typical ASD. At the same time, autistic youth with co-occuring GD show above average intellectual and verbal skills. This suggests the possibility that greater intellectual abilities allow autistic youth to better self-advocate for their gender dysphoria-related needs. Autistic youth with less exceptional verbal and broader thinking skills may struggle to self-advocate for, or may have reduced awareness of gender needs during the adolescent years.

Authors

• Kelsey Csumitta, National Institutes of Health
  Presenting Author

• Eleonora Sadikova, Children's National Health System
  Non-Presenting Author

• Sara Shakin, Children's National Medical Center
  Non-Presenting Author

• Allison B. Ratto, Children's National Medical Center
  Non-Presenting Author

• A. Chelsea Armour, Children's National Medical Center
  Non-Presenting Author

• Lauren Kenworthy, Children's National Medical Center
  Non-Presenting Author

• Gregory L Wallace, The George Washington University
  Non-Presenting Author

• Alex Martin, National Institute of Mental Health
  Non-Presenting Author

• John F Strang, Children's National Health System
  Non-Presenting Author