In Addition to Stigma: Cognitive and Autism-Related Predictors of Mental Health in Transgender Adolescents.

Researchers studied 93 teenagers who were either autistic, transgender, or both. They found that autistic transgender teens had more anxiety and depression than other groups. Problems with thinking skills and social difficulties made mental health worse. When executive functioning problems got in the way of gender-related needs, suicide risk increased. The study shows that autistic transgender youth face unique mental health challenges that need special attention.

This study examined mental health outcomes in 93 adolescents (ages 13-21) across three groups: autistic-transgender, non-autistic transgender, and autistic-cisgender youth. Using gold-standard diagnostic procedures, researchers found that autistic-transgender adolescents experienced significantly greater internalizing symptoms than both comparison groups. Beyond stigma effects, autism-related cognitive factors including executive functioning difficulties and social symptoms were associated with worse mental health outcomes. Executive functioning barriers to achieving gender-related needs were linked to greater suicidality.

Female gender identity across all groups was associated with increased suicidal risk. The study highlights the complex intersection of autism and gender identity in mental health outcomes.

Autistic-transgender youth require targeted mental health screening and intervention. Executive functioning support may be particularly important for gender-related needs. Clinicians should assess both stigma-related and autism-specific risk factors. Female-identifying transgender youth may need enhanced suicide risk assessment and intervention strategies.

Single study design limits generalizability. Sample size of 93 across three groups is relatively small for subgroup analyses. Study type not specified in metadata. Cross-sectional design prevents causal inferences about relationships between autism characteristics and mental health outcomes.

Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date of autistic-transgender, non-autistic (allistic) transgender, and autistic-cisgender adolescents diagnosed using gold-standard ASD diagnostic procedures.

In accordance with advancing understanding of sex/gender-related autism phenotypes, slightly subthreshold autistic diagnostic presentations (common in autistic girls/women) are modeled. This study includes 93 adolescents aged 13-21, evenly divided between autistic-transgender, autistic-cisgender, and allistic-transgender groups; 13 transgender adolescents were at the margin of ASD diagnosis and included within a larger "broad-ASD" grouping. Psychological and neuropsychological evaluation included assessment of mental health, IQ, LGBT stigma, ASD-related social symptoms, executive functioning (EF), and EF-related barriers to achieving gender-related needs. Autistic-transgender adolescents experienced significantly greater internalizing symptoms compared to allistic-transgender and autistic-cisgender groups.

In addition to stigma-related associations with mental health, ASD-related cognitive/neurodevelopmental factors (i.e., poorer EF and greater social symptoms) were associated with worse mental health: specifically, social symptoms and EF gender barriers with greater internalizing and EF problems and EF gender barriers with greater suicidality. Comparing across all ASD and gender-related groups, female gender identity was associated with greater suicidality. Parsing the heterogeneity of mental health risks among transgender youth is critical for developing targeted assessments and interventions. This study identifies ASD diagnosis, ASD phenotypic characteristics, and EF-related gender barriers as potential risks for poorer mental health in transgender adolescents.