AS/ASD Special Interest and Gender Identity/Dysphoria

Categories: RECENT RESEARCH

Stephanie C. Holmes

MA, BCCC, Certified Autism Specialist

A Discussion with Dr. Tony Attwood, World Renowned AS/ASD Expert

This AS/ASD special interest article will address an issue of growing concern that we in the Christian counseling field can neither be ignorant or insensitive about in the world of Autism Spectrum Disorder. When I was in graduate school, the term Asperger’s Syndrome was a new word. It was even believed at the time that the likelihood of a person with AS in counseling would be considered rare, since it was a pervasive development disorder and not something a therapeutic situation would be able to change. We did not know then about the many complexities and layers that often accompany the Asperger/Autism diagnosis. As I have stated in many articles and blogs and in my seminars with tthe AACC, everything with AS is like adding an exponent to that issue. Dr. Attwood makes two important points, “Aspies never do things in halves” and “There are different paths to the same profile.” Much of what we learned in the therapeutic world of theories and modalities and resources assume the person in the counseling room would be for the most part neuro-typical (NT). Dr. Attwood has taught, and many in the autism community concur, that the best style of counseling to use with AS/ASD persons is cognitive-behavioral, as AS/ASD persons tend to stay cognitive.

When an Aspie comes to believe something, it becomes a “truth” to them, much like we in Christian counseling have come to a belief in God and believe in Scripture. We believe what we believe not out of proof but faith. When an Aspie locks their mind onto a belief system, it becomes a perception of truth that trying to argue logic or present them with what we believe to be facts does not usually dissuade them, but can instead almost entrench them into the position. Consequently, Dr. Attwood and I discussed the neural pathway in which AS persons can become entrenched into a belief that they should be the opposite gender. This is a different issue than what we think we know about Transgender or Transsexual issues. This combination of AS/ASD wiring and gender identity needs to be handled with care, since an argument simply of Christian beliefs or faith about gender is not usually effective with an Aspie struggling or considering a gender reassignment surgery. Because surgery is a permanent solution to what may be a 3-5 year phase, it is important to address the problem from more than a belief vs. belief stance. For those who come to us who espouse faith, faith can certainly be part of the discussion, but we need to understand the mindsight and belief system in place driving this interest or focus.

Those Dr. Attwood refers to as “genuinely feeling they are transgender” would state that since childhood they have had attraction or thoughts about feeling like the opposite gender. For those with AS/ASD, the beliefs that they are truly the opposite gender and that social issues would disappear if they could become the opposite gender stem from what he calls the Psychology of Archaeology. Children begin to form that concept of self in childhood. Dr. Attwood defined this as, “Do you like who you are, or are you comfortable with who you are or others perceive you to be.” For NT children, there is a wealth of knowledge that this concept is being built upon: family, community, peers, etc. A strong component of identity development is how peer groups and those closest to you in your community treat you and view you. Aspies tend to base this on the criticisms of peer and feelings of inferiority. Dr. Attwood said that, developmentally, children between the age of 6-8 years of age are beginning to pick up on differences and what being different means. At this age, children are picking up on being included or excluded and how others are treating them in light of perceived differences. AS/ASD persons may or may not be diagnosed at this age since the average age of milder autism or what was formerly called Asperger’s is ages 8-11. However, Dr. Attwood said that boys are finding at this young age that girls tend to be nicer and friendlier to them than boys in their peer group. So the seed is planted for a boy to think that perhaps if he was a girl, this would “fix” things. So he may befriend more girls and begin to adopt more feminine mannerisms. Once this occurs, boys in this peer group will begin to distance themselves further and exclude them for their lack of masculine qualities. The boys don’t accept me, but the girls do, maybe I was meant to be a girl.

Young AS/ASD girls may not be “girly girl”, and maybe not even “tom boy”, but they do not seem to fit in with what the other girls their age are doing. An AS/ASD girl may pick up that the girls are being mean to her and leaving her out or excluding her because she does not like the same things that they do. Some girls may be more tom boyish or masculine which is generally a little more accepted in society (a feminine boy usually gets a more derogative name like “gay” or “sissy”). The AS/ASD girls find that being with the NT girls is more stressful than being with the boys. The boys are more inclusive and I would rather be doing what they are doing anyway. As each approaches puberty, the thoughts can become that perhaps they are not their biological gender.

As both males and females age, their AS/ASD differences become more prominent to them and others. They may they feel like they do not seem to fit in anywhere. In adolescence the desire to belong and be accepted is strong. As AS/ASD persons enter middle and high school, peers begin to distance themselves and they wonder, Where do I fit? Where do I find acceptance? Aspies also tend to be 5-6 years behind their peers in developing romantic attraction and may believe they are asexual or bisexual because they have not had any experiences in the area of romantic type relationships. Celibacy is often seen as safe, and many on the spectrum live happy fulfilled lives celibate.

Dr. Attwood explained that in the teen years, the spectrum teen is basing their self-concept on the criticism and negatives verses compliments or strengths. “They have a sense of a fractured self, and begin to collect data about this difference. They become interested at an intellectual level about the opposite gender and that my differences must be because I am supposed to be the opposite gender.”

Add to this seed of thought an often lonely peer experience and lack of peer guidance. Feelings of isolation and rejection by the mainstream NT peer group water the seed that thinks, different means defective, and I need to change or do something to fix this to be accepted by my peers. The LGBTQA group, especially teens, understand rejection and isolation and they are accepting of differences. AS/ASD teens feel welcomed and supported into this group and feel that sense of belonging and acceptance they have been longing for in this culture. As an Aspie does “nothing in halves”. They do not see an alternate perspective about their AS/ASD (and many may not be diagnosed OR were diagnosed but their parents did not want to tell them). The seed of thought about being different, combined with a need for acceptance and belonging, becomes a powerful catalyst to pursue gender identity change. The belief becomes entrenched and dogmatic. Well-meaning parents may try to argue with them or dissuade them with facts or faith and tell them they cannot hang out with this group of friends, but this can feel like taking a life line from them. They pursue the knowledge of what it takes to become the opposite gender relentlessly. Just like any other special interest, they collect the data about hormones and surgeries in a knowledge based way and not an emotional way. Dr. Attwood says a special interest has a “use by date” of 3-5 years. Many studies, which will be noted below, caution allowing an AS/ASD person to have the gender reassignment surgery during this 3-5 year phase because permanent changes such as surgery will have remorse when the interest fades and passes.

Dr. Attwood said, “When other men pursue gender identity change they do so almost in a parody of femininity and become immersed in the make- up, fashion, and all things female. Aspie guys who have this as a special interest do not usually pursue the feminine role with such passion. They believe that if they have the package removed in their underpants, take hormones, dress more female, and then have the surgery they have become female, but usually they stand out as they have not thought about getting a female hair style or make up or feminine look.” As they make these changes and gain acceptance in the LGBTQA culture on websites and school and forums they may still feel entrenched on having the reassignment surgery.

I asked Dr. Attwood how he would address this in session with an AS/ASD person who is set on the belief that they are the opposite gender. This is where the Psychology Archeology comes into place.

TA: “I do not address the gender head on. They will argue in their belief that they should be the opposite gender. What I want to explore compassionately with them is where did this belief first begin? How did you come to believe this about yourself? Where do you place your feelings of acceptance? Do they see gender change as a solution to their social problems or challenges? I bypass the gender belief and go to the core questions of self- concept and how this was formed.”

As Christian counselors, we have a belief about where sense of self and our identity should stem from as a core belief. It is important to explore that with the client. In our culture of acceptance with no questions asked, we need to further research to explore this area of AS/ASD and Gender Identity/Dysphoria. As Christian clinicians, we can be ready to address the issue with compassion, understanding that what has been presented represents “a different path to the same profile.” This is why as a mother of an AS person and clinician, I advocate early diagnosis, early interventions, telling a child why they are different and explaining that different does not mean defective. Dr Attwood said, “By waiting until the teen years or hiding the diagnosis, it can denote something shameful about it when they can learn to embrace the AS/ASD as part of who they are and understand these differences.” If we can help these students understand their core self and more about the differences, maybe they can be spared the journey into gender identity confusion and dysphoria as an explanation for why they are different.

Resources and Studies for further examination:

Isabel Henault

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904453/

http://www.ncbi.nlm.nih.gov/pubmed/23897727

http://link.springer.com/article/10.1007/s10803-010-0935-9

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0087961

http://www.ncbi.nlm.nih.gov/pubmed/15981142

Parts of this blog have been published in Autism Parent Magazine and Autism/Asperger Digest May 2016 editions in the following articles:

Autism Parent Magazine Issue 47 “Developing a sense of self and relationships with ASD”

Autism/ Asperger Digest May/June/July issue “Overcoming a geocentric mindset in ASD”

Stephanie C. Holmes, M.A., is an ordained minister and Licensed Christian Counselor with the Board of Examiners for Georgia Christian Counselors and Therapists and was formerly an LPC in North Carolina. She is a Board Certified Christian Counselor through the AACC’s Board of Christian Professional and Pastoral Counselors and a Certified Autism Specialist. Stephanie’s career path changed when her oldest daughter was diagnosed with Asperger’s Syndrome in 2004. She began to change her focus to the world of IEPs and 504 educational plans and understand how to help special needs students in the classroom. In addition, she also helps families deal with their frustrations and challenges having a special needs child. Stephanie has practiced counseling at her home church, Calvary Atlanta. She currently advocates for special needs families through her business, Primarily on Skype: Autism Spectrum Resources for Marriage & Family, LCC, where she does Skype consultation, counseling, & coaching families concerning spectrum issues through the US & Internationally.