Kübra Bercem KAHRAMAN, Zilan TOPCU, Duygu YAVUZ, Erten DİRENC, Ayşe Burcu ERDOĞDU

Autistic traits, emotional recognition and empathy in adolescents with gender dysphoria

Objective: Gender dysphoria (GD) is defined as an apparent incongruence between the sex assigned at birth and the experienced gender. The aim of this study is to evaluate the basic milestones of autistic symptoms in adolescents diagnosed with GD and to compare them with the control group. Method: The Sociodemographic Information Form, the Reading the Mind in the Eyes Test (RMET) and DANVA (Non-Verbal Diagnostic Accuracy Test), the Ka-Si Empathy Scale, and the Social Response Scale (SRS) were used. The psychiatric symptoms were evaluated using the Child Behavior Checklist (CBCL). Results: A total of 36 adolescents, diagnosed with GD (n=17) and a control group (n=19), included to the study. The GD group and control group were similar in terms of mean age. Of the GD group, 29.4% had a CBCL total score, 35.3% had a CBCL internalization score and 11.8% had a CBCL externalization score above their respective cut-off points. The GD group had significantly higher scores in the SRS social subscale than the control group (t=2.227, p=0.033). SRS social score was found to be predicted by group and gender variables (df=3, F=5.064). Conclusion: Having male biological sex and having GD increased the SRS social subscale score. It was found that internalizing problems such as depression and anxiety were common in adolescents with GD and their social skills were impaired compared to the control group.

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1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edition. Washington DC: American Psychological Association; 2013.

2. Van der Miesen AIR, de Vries ALC, Steensma TD, Hartman CA. Autistic symptoms in children and adolescents with gender dysphoria. J Autism Dev Disord 2018; 48:1537-1548.

3. Van Der Miesen AI, Hurley H, De Vries AL. Gender dysphoria and autism spectrum disorder: A narrative review. Int Rev Psychiatry 2016; 28:70-80.

4. Baird G, Simonoff E, Pickles A, Chandler S, Loucas T, Meldrum D, et al. Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The special needs and autism project (SNAP). Lancet 2006; 368:210-215.

5. Steensma TD, Zucker KJ, Kreukels BP, Vanderlaan DP, Wood H, Fuentes A, et al. Behavioral and emotional problems on the Teacher’s report form: A cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. J Abnorm Child Psychol 2014; 42:635-647.

6. Skagerberg E, Di Ceglie D, Carmichael P. Brief Report: Autistic features in children and adolescents with gender dysphoria. J Autism Dev Disord 2015; 45:2628-2632.

7. Hisle-Gorman E, Landis CA, Susi A, Schvey NA, Gorman GH, Nylund CM, et al. Gender dysphoria in children with autism spectrum disorder. LGBT health 2019; 6:95-100.

8. Strang JF, Meagher H, Kenworthy L, de Vries ALC, Menvielle E, Leibowitz S, et al. Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents. J Clin Child Adolesc Psychol 2016; 47:105-115.

9. Akgul GY, Ayaz AB, Yildirim B, Fis NP. Autistic traits and executive functions in children and adolescents with gender dysphoria. J Sex Marital Ther 2018; 44:619-626.

10. Soleman RS, Schagen SE, Veltman DJ, Kreukels BP, Cohen-Kettenis PT, Lambalk CB, et al. Sex differences in verbal fluency during adolescence: A functional magnetic resonance imaging study in gender dysphoric and control boys and girls. J Sex Med 2013; 10:1969-1977.

11. Glidden D, Bouman WP, Jones BA, Arcelus J. Gender dysphoria and autism spectrum disorder: A systematic review of the literature. Sex Med Rev 2016; 4:3-14.

12. Jacobs LA, Rachlin K, Erickson-Schroth L, Janssen A. Gender dysphoria and co-occurring autism spectrum disorders: Review, case examples, and treatment considerations. LGBT Health 2014; 1:277-282.

13. Tateno M, Tateno Y, Saito T. Comorbid childhood gender identity disorder in a boy with Asperger syndrome. Psychiatry Clin Neurosci 2008; 62:238.

14. Williams PG, Allard AM, Sears L. Case Study: Cross-gender preoccupations in two male children with autism. J Autism Dev Disord 1996; 26:635-642.

15. Unal F, Oktem F, Cetin FÇ, Cengel SEK, Akdemir D, Cak HT, et al. Reliability and validity of schedule for affective disorders and schizophrenia for school age children-present and lifetime version-Turkish version (K-SADS-PL-T). Turk Psikiyatri Derg 2019; 30:42-50.

16. Baum KM, Nowicki S. Perception of emotion: Measuring decoding accuracy of adult prosodic cues varying in intensity. J Nonverbal Behav 1998; 22:89-107.

17. Nowicki S, Duke M. Individual differences in the nonverbal communication of affect: The diagnostic analysis of nonverbal accuracy scale. J Nonverbal Behav 1994; 18:9-35.

18. Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I. The “Reading the Mind in the Eyes” test revised version: A study with normal adults, and adults with Asperger syndrome or highfunctioning autism. J Child Psychol Psychiatry 2001; 42:241-251.

19. Girli A. Psychometric properties of the Turkish child and adult form of “Reading the Mind in the Eyes Test”. Psychology 2014; 5:1321-1337.

20. Constantino JN, Przybeck T, Friesen D, Todd RD. Reciprocal social behavior in children with and without pervasive developmental disorders. J Dev Behav Pediatr 2000; 21:2-11.

21. Constantino JN, Davis SA, Todd RD, Schindler MK, Gross MM, Brophy SL, et al. Validation of a brief quantitative measure of autistic traits: Comparison of the social responsiveness scale with the autism diagnostic interview-revised. J Autism Dev Disord 2003; 33:427-433.

22. Unal S, Guler AS, Dedeoglu C, Taskın B, Yazgan Y. Social reciprocity in the clinical sample diagnosed with Attention Deficit Hyperactivity Disorder: Comparison with the control group obtained from the school sample. Poster presentation, 19th National Congress of Child and Adolescent Psychiatry and Diseases, 2009.

23. Kaya A, Siyez DM. Child and adolescent KA-SI empathic tendency scale: Development, validity and reliability study. Egitim ve Bilim 2010; 35:110-125.

24. Jackman KB, Dolezal C, Levin B, Honig JC, Bockting WO. Stigma, gender dysphoria, and nonsuicidal self-injury in a community sample of transgender individuals. Psychiatry Res 2018; 269:602-609.

25. à Campo J, Nijman H, Merckelbach H, Evers C. Psychiatric comorbidity of gender identity disorders: A survey among Dutch psychiatrists. Am J Psychiatry 2013; 160:1332-1336.

26. VanderLaan DP, Postema L, Wood H, Singh D, Fantus S, Hyun J, et al. Do children with gender dysphoria have intense/ obsessional interests? J Sex Res 2015; 52:213-219.

27. George R, Stokes MA. Sexual orientation in autism spectrum disorder. Autism Res 2018; 11:133-141.

28. VanderLaan DP, Leef JH, Wood H, Hughes SK, Zucker KJ. Autism spectrum disorder risk factors and autistic traits in gender dysphoric children. J Autism Dev Disord 2015; 45:1742- 1750.

29. Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS. Prevalence of autism spectrum disorder and attention-deficit hyperactivity disorder amongst individuals with gender dysphoria: A systematic review. J Autism Dev Disord 2020; 50:695-706.

30. Øien RA, Cicchetti DV, Nordahl-Hansen, A. Gender dysphoria, sexuality and autism spectrum disorders: A systematic map review. J Autism Dev Disord 2018; 48:4028-4037.

31. Warrier V, Greenberg DM, Weir E, Buckingham C, Smith P, Lai MC, et al. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nat Commun 2020; 11:3959.

32. Davis J, McKone E, Zirnsak M, Moore T, O'Kearney R, Apthorp D, et al. Social and attention‐to‐detail subclusters of autistic traits differentially predict looking at eyes and face identity recognition ability. Br J Psychol 2017; 108:191-219.

33. Turban JL, van Schalkwyk GI. “Gender dysphoria” and autism spectrum disorder: Is the link real? J Am Acad Child Adolesc Psychiatry 2018; 57:8-9.e2.

34. Mukaddes NM. Gender identity problems in autistic children. Child Care Health Dev 2002; 28:529-532.

35. Bellini S. Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus Autism Other Dev Disabl 2004; 19:78-86.

36. Rosenthal SM. Transgender youth: Current concepts. Ann Pediatr Endocrinol Metab 2016; 21:185-192.

37. Richard DA, More W, Joy SP. Recognizing emotions: Testing an intervention for children with autism spectrum disorders. Art Therapy 2015; 32:13-19.

38. Castelli, F. Understanding emotions from standardized facial expressions in autism and normal development. Autism 2005; 9:428-449.

39. Dawson G, Webb SJ, Wijsman E, Schellenberg G, Estes A, Munson J, et al. Neurocognitive and electrophysiological evidence of altered face processing in parents of children with autism: Implications for a model of abnormal development of social brain circuitry in autism. Dev Psychopathol 2005; 17:679-697.

40. Van Der Geest JN, Kemner C, Verbaten MN, Van Engeland H. Gaze behavior of children with pervasive developmental disorder toward human faces: A fixation time study. J Child Psychol Psychiatry 2002; 43:669-678.

41. Wright B, Clarke N, Jordan J, Young AW, Clarke P, Miles J, et al. Emotion recognition in faces and the use of visual context in young people with high-functioning autism spectrum disorders. Autism 2008; 12:607-626.

42. Pelphrey KA, Sasson NJ, Reznick JS, Paul G, Goldman BD, Piven, J. Visual scanning of faces in autism. J Autism Dev Disord 2002; 32:249-261.

43. Adolphs R, Spezio ML, Parlier M, Piven J. Distinct faceprocessing strategies in parents of autistic children. Curr Biol 2008; 18:1090-1093.

44. Gumustas F, Yilmaz I, Yulaf Y, Gokce S, Sabuncuoglu O. Empathy and facial expression recognition in children with and without attention-deficit/hyperactivity disorder: Effects of stimulant medication on empathic skills in children with attentiondeficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2017;27:433-439