While Autism Spectrum Disorder (ASD) occurs in approximately 2% of the population, it is found more commonly in people who identify as LGBTQ+. Estimates of its prevalence in the LGBTQ+ population range between 15 and 35%. This post explores this and the implications for mental health outcomes for LGBTQ+ individuals who have ASD.
According to neuropsychologist Theresa Regan, PhD, correct identification of ASD in adults and children is still not as accurate and reliable as it could be. More clinicians need to be knowledgeable about the diagnostic criteria so that more people with ASD can be correctly identified or referred for psychological testing.
This is important because it influences what we can say for certain about folks on the spectrum. Nonetheless, one estimate for ASD people who don’t have an intellectual disability is that 15-35% are LGBTQ+. First, let’s establish what ASD is.
What is Autism Spectrum Disorder?
ASD is a neurological condition that affects people across the lifespan, but it is first present in early childhood. Males are four times more likely to be diagnosed with it than females, but part of that is that females with ASD tend to be overlooked. Their symptoms tend to be internalized and can be masked. Roughly 80% of the risk for having ASD is genetically based, and often there are many first-degree relatives with it in the same family (e.g., siblings, parents, children, etc.)
Autism is not the same as an intellectual disability, although a person can have both ASD and an intellectual disability. People often assume that they are one and the same, but a person can have average or above average intelligence and ASD. The main symptoms include impairment in social communication, sensory processing, and repetitive, stereotyped movements. It also affects emotional regulation (how you handle emotions), self-care (hygiene, seeking medical care, remembering to eat, drink or use the restroom, etc.), and independent functioning.
However, not all people with ASD have the same symptoms and don’t look or act the same. Some of their repetitive behaviors may be hidden because the person with ASD has learned to hide or mask the symptoms in public.
This is a very brief description, so for more information, I recommend getting reliable information about it rather than resorting to social media where everyone seems to diagnose themselves and others, regardless of expertise. If you believe you might have ASD, it’s best to get specialized testing by a neuropsychologist or neurologist with expertise in Autism.
There’s a myth that people on the spectrum want to be alone and don’t want friendships or romantic partnerships. However, many people with ASD are in romantic partnerships. The drive to connect with other people isn’t the same as neurotypical (non-ASD) people, and they might have unique challenges in expressing themselves or initiating or maintaining friendships. Nonetheless, they are perceived as not wanting other people around.
Why are there more LGBTQ+ people with Autism Spectrum Disorder?
This is an area that is still being explored scientifically. Part of the working hypotheses include the differing ways that ASD folks think about relationships and gender. There’s a new term called “autigender” that refers to how ASD affects gender identification. Some people on the spectrum identify as asexual as well.
Other researchers hypothesize that prenatal exposure to certain hormones might influence the greater number of people on the spectrum who identify as transgender or nonbinary. There’s a higher incidence of gender dysphoria in ASD folks, which can have poorer mental health outcomes for them.
Social and sexual development can be different for people with ASD. Because of challenges with social communication and establishing reciprocal relationships with others, may have different relationships with peers, including romantic connections. However, as noted above, we can’t assume that someone with ASD does not have a sex drive or romantic relationship.
Some people on the spectrum have a lack of proprioception (awareness of their own bodies), which might lead to a different awareness of gender identity. Also, there is a lack of access to sexuality and relationship education in many schools and families, also leading to a different (and sometimes misinformed) understanding of sexual orientation and gender identity for ASD kids.
What are the challenges of LGBTQ+ people having ASD?
In addition to the challenges listed above, LGBTQ+ folks on the spectrum are twice as likely to be bullied for being different. They also face discrimination in housing, employment, and are often misunderstood by their peers. Access to medical care can also be a challenge, especially since many people on the spectrum have difficulty initiating social contact – including making medical appointments. They might also have a hard time identifying their needs and communicating them successfully to medical problems because of under-sensitivity or other sensory differences.
There’s also pressure to pass for “normal” on both the ASD and the LGBTQ+ fronts. People on the spectrum try to hide or mask their different behavior (like repetitive movements or being emotionally dysregulated and “melting down”). Similarly, LGBTQ+ people may need to pretend they are cisgender or straight to avoid ridicule, bullying, or social exclusion. Masking (hiding who they are) can lead to exhaustion and a sense of isolation or shame.
What are the implications for mental health?
As mentioned above, a combination of factors can put LGBTQ+ teens and adults can put them at risk for depression, anxiety, general stress, and gender dysphoria. Additionally, they can be at higher risk for suicidality. Being bullied and ostracized for being different can be traumatizing for people as well.
Unfortunately, not all schools, universities or workplaces have good resources for addressing their mental and physical health needs. Having trouble advocating for themselves and/or pursuing mental health care can make it even harder to get their needs met.
If you are struggling with gender identity/sexual preference and ASD, please get the support you need in LGBTQ affirmative psychotherapy, or call 661-233-6771.
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