Inextricably tied: Nonbinary autistic individuals' views on how their gender identity and autism are connected.

LAY ABSTRACT: This study explores the experiences and identities of nonbinary autistic people. The relationship between autistic and nonbinary identities has not been researched in detail. Few studies focus specifically on nonbinary autistic adults. We interviewed 44 nonbinary individuals for this study. Participants had thought-out opinions on gender identity and emphasized identifying with fluidity rather than traditional gender roles. Participants discussed the connection of their autistic and nonbinary identities and how it affected how people saw them and how they saw themselves. We have recommendations for programming, policy, and research from these findings.

What Category Best Fits: Understanding Transgender Identity in a Survey of Autistic Individuals.

Introduction: Calls for improved measures of gender identity to understand the experience of transgender individuals have grown rapidly in the past 5 years. The need for methodological innovation in this topic area has particular importance for the autistic population since a higher co-occurrence of transgender identities among autistic people has been documented but is not well understood. We use a survey with questions that reflect standards in 2018 to demonstrate how binary conceptualizations of gender did not adequately capture gender identities of transgender autistic individuals. Methods: Using descriptive statistics from a statewide survey of 1527 autistic adults (mean age 27.5 years), this study compared self-reported survey responses to close-ended standard questions at the time about gender identity to understand shortcomings in capturing this population authentically. Results: We found a mismatch between respondents answering that they were transgender, the sex assigned at birth, and gender identity on separate questions. We postulate that transgender men and women were likely selecting binary responses when asked about gender identity. Furthermore, we found that many qualitative responses reported in the self-selected "other" category reflected nonbinary identities and utilized specific terminology that revealed nuance in how they understood gender identities. Conclusions: We urge researchers to provide multiple flexible options when measuring gender identity in autistic populations as they are likely to encompass many identities. We endorse best practices for measuring gender identity for autistic research.

Why is this an important issue?: Autistic people may be more likely to identify as transgender, or a gender identity different from their sex assigned at birth. Transgender autistic people may identify with binary gender identities, as men or women. Some transgender autistic people have nonbinary gender identities or identities that are different from these binary gender identities. If standard measures do not work well for transgender autistic people, their use may result in less accurate research. We present better ways to ask gender identity questions in autism research surveys. What was the purpose of this study?: This study explored how accurately standard questions about sex and gender measure gender identity for transgender autistic people. We looked at how autistic people responded to sex and gender questions in a statewide survey completed in 2018. We suggest improvements in gender identity questions to include diverse gender identities reported by autistic people. What did the researchers do?: We collected 1527 responses from autistic adults using the Pennsylvania Autism Needs Assessment completed in 2018. We examined descriptive statistics for how respondents answered one question about current gender identity, one question about transgender identity, and one question about sex assigned at birth. What were the results of the study?: We found that these three standard questions did not reflect the gender identities of autistic people who took the survey. In response to the transgender identity question, 4% of autistic adults reported that they were transgender or nonbinary. Most (93.9%) of the sample reported binary identities, as male or female. Some autistic adults (2.3%) chose the "other" category on the current gender identity question. They reported a variety of binary gender identities or nonbinary identities. Many autistic adults did not answer questions about sex assigned at birth (26.7%) or transgender identity (27.1%). What do these findings add to what was already known?: We did not know if standard gender identity questions measured transgender identities in autistic people correctly. These findings show that they do not, but also that current measures may not fully address a variety of gender identities, including nonbinary identities. What are potential weaknesses in the study?: We use three survey questions from a survey that had already been used. The measures we used might not have captured how transgender autistic adults see themselves. Autistic adults who had support in completing the survey might have felt pressure from other people, such as caregivers, to answer a certain way. How will these findings help autistic adults now or in the future?: Transgender autistic people have not been studied or supported extensively in the past. Better gender measures could help us learn more about transgender autistic people and possible unmet needs within this population. We suggest best practices that autism researchers can implement in surveys. This will ensure that research more accurately reflects transgender autistic adults' gender identities. Respectful and appropriate methods will improve autism research and translate into better understanding, support, and quality of life for transgender autistic adults.

Evidence from the Autism Transitions Research Project (2017-2022): Capstone review and services research recommendations.

Few funding sources have explicitly supported systems-wide research to identify mechanisms for improving access, service delivery, outcomes and wellbeing for autistic transition-age youth and young adults. We aimed to integrate findings from research produced through a five-year federal Autism Transition Research Project (ATRP) cooperative agreement. This capstone review sought to: (1) map the body of scientific evidence that emerged from this federal award, and (2) identify remaining evidence gaps to inform future autism transition services research. We used scoping review methods to assess 31 ATRP-funded published scientific studies. We charted study characteristics, topical domains, socio-ecological levels of variables, focus on equity, and inclusion of autistic participants. We evaluated how these topics were addressed across studies to identify continued gaps in the evidence base. Compared to prior published reviews and research agendas, we found improvements in characterization of study participants, broader examination of socio-ecological correlates, and examination of multiple outcome domains. However, we also identified continued deficits in inclusion of autistic study participants, use of multisectoral data, and research with a strong focus on equity. Our recommended priorities for autism transition services research to facilitate healthy life outcomes and wellbeing included: continued analysis of population-level data and improved data infrastructure; development of service delivery methods and interventions that target marginalized groups; expanded research to inform improvements in the performance and coordination of complex service ecosystems that interface with autistic youth; and bolstering the roles of autistic research participants.

Youth Mask-Wearing and Social-Distancing Behavior at In-Person High School Graduations During the COVID-19 Pandemic.

PURPOSE: Reopening schools during the COVID-19 pandemic is a challenging policy issue that requires mitigation strategies, such as mask-wearing and social distancing. Whether youth will conform to these strategies is unclear. METHODS: We leverage data on 1,152 youth's mask-wearing and social-distancing behaviors from observations of five in-person live-streamed high school graduations from one U.S. public school district in July 2020. Multiple researchers took ethnographic field notes and systematically recorded public health behaviors for each graduation. We also use data from the local public health department, school district, newspapers, community observations, and the National Center for Education Statistics. We then conducted a descriptive quantitative analysis of mask-wearing status by gender, ethnicity, and school, along with a qualitative thematic analysis. RESULTS: Nearly 70% of students wore their masks properly while receiving their diploma, although 9.6% wore no mask and 18.7% struggled with mask fit. Almost all students removed masks for graduation photos after adults suggested they should, although 80% of them were wearing their mask properly before the photo. We found significant school variation, but no gender or ethnic variation in student mask-wearing. School variation aligned with political themes of student speeches and in adult commitment to safety measures. Student speakers at all schools mentioned altruistic concern about COVID-19. All schools struggled with social distancing throughout the ceremony, except when students were seated in socially distanced chairs. CONCLUSIONS: This study provides important insights into youth conformity to COVID-19 guidelines and strategies to protect public health during in-person schooling.

Distance and acceptance: Identity formation in young adults with chronic health conditions.

Health has long been a chief concern of life course researchers, especially in examining early life. Research on chronic conditions and their impact on individual identity often center on biographical disruption or the idea of a bifurcation of "before and after" identities. This research examines identity formation in young adults with chronic health conditions that began in childhood, a population that continues to grow. This study focuses on young adults' narrative identities, both regarding how young adults describe the transition to adulthood and how cultural ideals of young adulthood and actors from institutions influence how they describe themselves. This study uses 22 in-depth qualitative interviews to reveal how young adults distance themselves from their conditions or move to acceptance through the narratives they tell about their health, feelings, and behaviors. This research suggests that identity confirmation by others forms an integral part of the nexus of health and the life course, shaping how adolescents make the transition into young adulthood. Social support from actors in institutions gives room to some young adults with chronic conditions to integrate their conditions into their narrative identities. This study reveals the social nature of young adult identities, and how cultural ideals guide them, precisely because it uses cases of young adults who must transition to adulthood in alternative ways.