Theories on the Link Between Autism Spectrum Conditions and Trans Gender Modality: a Systematic Review.

While research on the prevalence of co-occurring autism spectrum conditions (ASC) and trans gender modality (TGM) is available, less is known about the underlying mechanism of this association. Insight is needed to improve treatment of trans autistic people. This review provides an overview of theories on the ASC-TGM link and the available evidence for/against them published between January 2016 and October 2020. A systematic search was performed in PubMed, PsycINFO, Web of Science, and Scopus. This resulted in 36 studies, in which 15 theories were identified. Results indicate all theories lack substantial empirical support. Unlikely and promising theories were identified. The most promising theories were those on resistance to social norms and weakened sex differences. Future directions are provided.

Rigorous science demands support of transgender scientists.

To build a just, equitable, and diverse academy, scientists and institutions must address systemic barriers that sex and gender minorities face. This Commentary summarizes (1) critical context informing the contemporary oppression of transgender people, (2) how this shapes extant research on sex and gender, and (3) actions to build an inclusive and rigorous academy for all.

The Effect of Relative Pubertal Maturation and Perceived Popularity on Symptoms of Depression and Social Anxiety in Adolescent Boys and Girls.

Research has shown that adolescents - particularly girls - who mature relatively early often experience more internalizing problems. This effect is thought to be partially driven by psychosocial mechanisms, but previous research based relative pubertal maturation on complete samples or population standards, instead of considering the adolescents' direct peer environment. In the current study the level of adolescents' pubertal development was assessed relative to their classmates in order to examine relative pubertal maturation. The effects of adolescents' relative pubertal status, and their perceived popularity, on symptoms of social anxiety and depression in adolescents were studied. All analyses were also performed for absolute pubertal maturation. Participants were 397 young adolescents (Mage = 13.06, SD = 0.36, 49.9% girls) at timepoint 1, and 307 (Mage = 14.08, SD = 0.36, 50.5% girls) at timepoint 2. A significant positive relationship was found between relative pubertal timing and symptoms of depression for girls but not boys. Social anxiety symptoms were not significantly related to relative pubertal timing in either sex. Relative pubertal maturation had no effect on change in or persistence of depressive and social anxiety symptoms one year later. The effects of the comparison with the immediate peer environment, did not seem to explain more variance in internalizing symptoms than the effects of early maturation.

"My whole life has been a process of finding labels that fit": A Thematic Analysis of Autistic LGBTQIA+ Identity and Inclusion in the LGBTQIA+ Community.

Background: Being nonheterosexual and noncisgender appears to be more common among autistic people. This intersection of identities is often stigmatized in research and society. However, we know that community involvement can protect against negative mental health outcomes associated with being a minority; researchers found this effect in separate studies examining participation in the autistic and Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual plus other gender and sexual orientation-based identity (LGBTQIA+) communities. This study examined how autistic LGBTQIA+ individuals navigate their multiple marginalized identities and the LGBTQIA+ community. Methods: Twelve autistic LGBTQIA+ people from the United Kingdom took part in semistructured interviews. Questions focused on identity and community. We analyzed the interviews using reflexive thematic analysis. Results: We identified four overarching themes-Identity (Re)Development, Navigating Authenticity, Exclusion from Community Spaces, and Creating Change. Participants viewed accessing a community of similar others as a means of increasing understanding, self-knowledge, and self-acceptance. We identified several barriers to inclusion, including accessibility and gatekeeping. Participants discussed strategies to combat these obstacles, such as the creation of intersectional community spaces and activism and representation as a means of increasing autism understanding. Conclusions: This study suggests that similar to other marginalized groups, autistic LGBTQIA+ individuals are motivated to engage in communities relevant to their identities. However, community spaces for autistic LGBTQIA+ are often inaccessible due to social, sensory, and identity-based barriers. Participants highlighted autism understanding as a barrier to coming out both in community and noncommunity settings. This suggests that improving autism acceptance and understanding is crucial to achieve accessible, intersectional, and inclusive community spaces.

Why is this an important issue?: Autistic people are more likely to be part of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual plus other gender- or sexual orientation-based identity (LGBTQIA+) communities. Being part of a community may boost well-being. Because of a history of viewing autistic and LGBTQIA+ identities in a negative medicalized way, we have limited understanding of autistic people's experiences of having both identities and being part of both communities. We think everyone could listen and learn more from autistic LGBTQIA+ people and think about ways of creating accessible spaces where autistic LGBTQIA+ people can flourish. What was the purpose of this study?: We looked at autistic LGBTQIA+ people's experiences of the LGBTQIA+ community. We were also interested in understanding how autistic LGBTQIA+ people experienced their different identities (e.g., being both autistic and LGBTQIA+, and how these connect). What did the researchers do?: We developed interview questions with a trans autistic collaborator. The questions were about experiences and identities as an autistic LGBTQIA+ person and getting involved in communities. We did interviews with 12 LGBTQIA+ autistic adults from the United Kingdom, who were diverse in age, gender identity, and sexuality. We then identified patterns in what the interviewees said. What were the results?: Interviewees talked about how they had made sense of "who they were" over time and tried to be true to themselves. However, they mentioned many barriers when trying to access the LGBTQIA+ community. These barriers included community spaces that were overwhelming in social and sensory ways. Although nonautistic LGBTQIA+ individuals might welcome autistic people into the community, they did not really understand autism. Interviewees were also concerned about "gatekeeping," which means that some LGBTQIA+ community members decided who belonged in the community. Despite these barriers, interviewees still wanted to be part of LGBTQIA+ communities and suggested solutions, such as flexible online spaces, more autistic LGBTQIA+ role models, and fighting for change in society. What do these findings add to what was already known?: These findings help us to better understand a topic there is not much research on­the experiences of autistic LGBTQIA+ people. Our findings tell us about how our interviewees came to appreciate their different identities, and the benefits and challenges of being included in LGBTQIA+ communities. What are potential weaknesses in the study?: Our findings reflect the experiences of a small group of people in the United Kingdom, so their experiences will not apply to everyone. Our group lacked diversity in some ways­all interviewees were White and no one reported having a co-occurring learning disability. We do not know how our findings would apply to people with other minority identities. How will these findings help autistic adults now or in the future?: This study helps us better understand the experiences of autistic LGBTQIA+ people and the barriers they face. Community spaces specifically for autistic LGBTQIA+ could be good, to help people explore their identities and find similar people. These spaces need funding, and we must make sure that they are accessible to everyone, regardless of how they identify.

Increased interference from conflicting perspectives and gender differences: A longitudinal study during adolescence.

Adolescents need to develop adequate perspective-taking skills to successfully navigate their increasingly complex social environments. This study investigated adolescents' development of the cognitive processes of egocentric and altercentric interference that influence perspective-taking abilities. Using the Dot Perspective Task, participants' (N = 803; 50.9% female) egocentric and altercentric interference was measured during 3 consecutive years from 12 to 14 years of age. Linear mixed model analyses showed that whereas overall task performance improved over time, egocentric and altercentric interference increased over time. These results suggest that perspective taking develops at slower rates when there are conflicting perspectives than in situations with no conflict. Moreover, we found that girls showed less egocentric interference than boys. This result provides task-based evidence that supports previous findings of higher self-reported perspective taking in adolescent girls than in adolescent boys.

A Few Close Friends? Adolescent Friendships' Effect on Internalizing Symptoms Is Serially Mediated by Desire for More Friends and Social Goal Orientation.

Interpersonal connection is a fundamental human motivation, and the extent to which it is fulfilled is a strong predictor of symptoms of internalizing disorders such as social anxiety and depression, perhaps especially during the "social reorienting" period of adolescence. However, little is known about the contribution to this effect of the individual's social motivations, which are intensified during adolescence. Furthermore, social goal orientation - an individual's priorities and intentions in social interactions - is an important predictor of vulnerability to internalizing symptoms. Adolescents spend most of their waking lives in classrooms, bounded social networks with a limited pool of candidates for befriending. This study investigated whether friendships within one's class protects against internalizing symptoms in part by reducing the desire for more classmate friendships, which may tend to promote maladaptive social goals. Participants were 423 young adolescents (M age = 13.2, sd = 0.52 years; 49.4% girls). As predicted, adolescents' number of reciprocated classroom friendships had a protective effect on internalizing symptoms which was serially mediated by desire for more such friendships, and social goal orientation. However, only demonstration-avoidance goals significantly predicted internalizing symptoms. Unreciprocated friendship nominations were unexpectedly associated with stronger desire and more social anxiety symptoms. The results suggest that the effect of number of friends is mediated by the individual's thoughts and feelings about their number of friendships, such that a strong desire for more friendships promotes maladaptive goals, oriented toward social status and consequently less oriented toward the cultivation of interpersonal intimacy with the friends they already have.

Social network position, trust behavior, and neural activity in young adolescents.

Our social interactions take place within numerous social networks, in which our relationships with others define our position within these networks. In this study, we examined how the centrality of positions within social networks was associated with trust behavior and neural activity in 49 adolescents (Mage = 12.8 years, SDage = 0.4 years). The participants played a trust game with a cartoon animation as a partner, which showed adaptive behavior in response to the participant and was generally untrustworthy. Social network positions were obtained in secondary school classrooms where the participants and their classmates reported on who their friends were. Using social network analysis, a score was calculated that indicated the centrality of everyone's position within the friendship network. The results showed that more central social network positions were associated with higher levels of initial trust behavior, although no evidence was found for a relationship between network position and the adaptation of trust behavior. The results of the functional MRI analyses showed that the centrality of the network positions was positively associated with caudate activity when making trust decisions. Furthermore, the adolescents with more central network positions also showed stronger increases of caudate activity when the partner's return was processed compared to the adolescents with less central network positions. The current study provides initial evidence that social network positions in friendship networks relate to socio-cognitive behavior and neural activity in adolescents.

Development of the neural correlates of self- and other-referential processing across adolescence.

During adolescence, major changes in brain mechanisms take place and differentiated representations of both the self and of others are developed. Although studies have investigated the neural mechanisms of self- and other-referential processing in adolescents, the development of these mechanisms remain largely unaddressed. Here, we report a three-year longitudinal study with annual measurements, and investigate the developmental trajectories of activity and connectivity underlying self- and other-referential processes in 34 participants from early to mid-adolescence (mean age timepoints 1, 2, 3 = 12.9, 13.9, 15.0 years). Moreover, we probe whether these correlates continue to develop from mid-adolescence to young adulthood by comparing neural correlates of the adolescents at the last measurement to an independent group of 42 young adults (mean age 22 years). Participants underwent functional MRI while performing a trait judgement task in which they indicated whether an adjective described themselves, a similar or a dissimilar peer. Brain activity within the dorsal medial prefrontal cortex (dMPFC) and right temporal parietal junction (TPJ) showed a quadratic change from early to mid-adolescence, with a peak in activity at the second measurement when evaluating the self, the similar and dissimilar peer. No differential activity was observed when comparing the adolescents to young adults. Functional connectivity did not change from early to mid-adolescence, however, connectivity of the dMPFC with a posterior midline region during self- and other-referential processing relative to the control condition reduced from mid-adolescence to young adulthood. Together, these findings provide insight in the developmental trajectories of brain activity and connectivity underlying the development of the self-concept and representations of peers in adolescence.

"Masculine" Describes Gender Expressions, Not Neurobiologies: Response to Dutton and Madison (2020).

This letter is a response to "Gender Dysphoria and Transgender Identity Is Associated with Physiological and Psychological Masculinization: a Theoretical Integration of Findings, Supported by Systematic Reviews" by Dutton and Madison (2020), which relies on theorisations for which substantial counter-evidence exists, fails to engage with these or other criticisms of the theories upon which it seeks to build, and reaches conclusions that contradict existing evidence. Furthermore, the original theorisations contained in Dutton and Madison (2020), and the conclusions drawn from those theorisations, risk causing serious harm to already-marginalised groups.

Considerations in genetic counseling of transgender patients: Cultural competencies and altered disease risk profiles.

Transgender people are a growing population with specific healthcare needs, barriers to care, and disease risk factors. Cultural competencies for working with transgender people in healthcare settings are essential to reduce barriers to care and combat the associated health disparities. Genetic counselors support their patients to understand and manage medically and personally complex life events and decisions. A genetic counselor caring for a transgender patient or a patient with a transgender relative will therefore require specific cultural competencies and medical knowledge that may not have been covered in their training. Transgender health is also a relatively young field in which new insights may quickly become fundamental. The present paper therefore provides an overview of current best practices for culturally sensitive working with transgender patients, and an introduction to the additional considerations for assessment of disease risk in transgender people. Guidance on how to ensure communication with patients and other stakeholders is inclusive and affirming of transgender identities, is offered. Medical interventions used for gender transitions are described, and their (potential) effects on cancer and cardiovascular disease risk are discussed. Furthermore, the effects of sociocultural risk factors such as minority stress are outlined. In sum, we invite the reader to consider the specific biological, psychological, and social context of the consultation. Finally, we explore culturally competent approaches to pedigree charting and physical examinations with transgender people and provide recommendations for practice.

Intrinsic network interactions explain individual differences in mentalizing ability in adolescents.

Mentalizing is an important aspect of social cognition and people vary in their ability to mentalize. Despite initial evidence that mentalizing continues to develop throughout adolescence, it is unclear which neural mechanisms underlie individual variability in mentalizing ability in adolescents. Interactions within and between the default-mode network (DMN), frontoparietal network (FPN) and cingulo-opercular/salience network (CO/SN) have been related to inter-individual differences in cognitive processes in both adults and adolescents. Here, we investigated whether intrinsic connectivity within and between these brain networks explained inter-individual differences in affective mentalizing ability in adolescents. Resting-state brain activity was measured using functional MRI and affective mentalizing ability was defined as correct performance on the Reading the Mind in the Eyes test performed outside the scanner. We identified the DMN, FPN and CO/SN, and within and between network connectivity values were submitted to a bootstrapping enhanced penalized multiple regression analysis to predict mentalizing in 66 young adolescents (11-14 years). We showed that stronger connectivity between the DMN and the FPN, together with lower within-network connectivity of the FPN and the CO/SN predicted better mentalizing performance. These novel findings provide insight into the normative developmental trajectory of the neural mechanisms underlying affective mentalizing in early adolescence.

Neural correlates of self- and other-referential processing in young adolescents and the effects of testosterone and peer similarity.

During adolescence, self-concept develops profoundly, accompanied by major changes in hormone levels. Self-evaluations become more complex, and peers and their opinions increasingly salient. Neuroimaging studies have investigated self- and other-related processing in adolescents, however, the influence of similarity of peers on these processes is still unclear, as well as functional connectivity underlying such processes. We investigated the effect of peer similarity on neural activity and connectivity underlying self- and other-referential processing, by distinguishing between a similar and dissimilar peer when making other-evaluations. Moreover, we explored the association between testosterone and brain activity during self-evaluations. Sixty-six young adolescents underwent functional MRI while performing a trait judgement task in which they indicated whether an adjective described themselves, a similar or a dissimilar classmate. The ventral medial prefrontal cortex (MPFC) showed increased engagement in self-referential processing, and the posterior cingulate cortex and right temporal parietal junction during other-evaluations. However, activity did not differ between the similar and dissimilar other conditions. Functional connectivity of the ventral MPFC included the striatum when evaluating the similar peer and frontoparietal regions when evaluating the dissimilar peer. Furthermore, inter-individual differences in testosterone levels were positively associated with dorsal MPFC activity in males. This study provides insight into the influence of peer similarity on activity and connectivity underlying other-referential processing in young adolescents, and suggests that testosterone affects neural correlates of self-referential processing.

Social Cognition and Friendships in Adolescents With Autistic-Like Experiences and Psychotic-Like Experiences.

Autism spectrum conditions (ASC) and schizophrenia spectrum conditions (SSC) are both characterized by changes in social-cognitive functioning. Less is known about the overlap and the differences in social-cognitive functioning when comparing individuals with subclinical levels of ASC and SSC, while studies in non-clinical samples have the benefit of avoiding confounds that are present in clinical groups. Therefore, we first examined how autistic-like experiences, positive psychotic-like experiences and the co-occurrence of both correlated with the performance on an extensive battery of social cognition tasks in young adolescents. Second, we examined the effect of autistic-like experiences, psychotic-like experiences and their co-occurrence on friendships in daily life. A total of 305 adolescents (Mage = 12.6, sd = 0.4, 147 boys) participated in the current study. A battery of social cognition tasks, comprising the Reading the Mind in the Eyes task, Dot perspective task and trust game were individually administered in a classroom setting, along with a friendship peer nomination questionnaire. Results indicated no evidence for a relationship between the performance on the social cognition battery and subclinical experiences of autism and/or psychosis. However, results did show that the amount of autistic-like experiences of adolescents were associated with being less often selected as a friend by their peers. By contrast, no relationship between self-reported friendships and autistic-like experiences was found. Neither a relationship between friendships and psychotic-like experiences was reported. This study provides initial evidence that information provided by peers may shed light on (altered) social behavior associated with autistic-like experiences that is not apparent on performance measures, as well as elucidate possible differences between autistic- and psychotic-like experiences.

Brief Report: Gender Identity Differences in Autistic Adults: Associations with Perceptual and Socio-cognitive Profiles.

Prior research has shown an elevation in autism traits and diagnoses in individuals seen for gender related consultation and in participants self-identifying as transgender. To investigate this relationship between autism and gender identity from a new angle, we compared the self-reported autism traits and sensory differences between participants with autism who did or did not identify with their assigned sex (i.e. cisgender or trans and non-binary, respectively). We found broad elevation of most cognitive autism traits in the trans and non-binary group (those who identified with a gender other than their assigned gender), and lower visual and auditory hypersensitivity. We contrast these data to existing hypotheses and propose a role for autistic resistance to social conditioning.