Patel, Emily; (2019) Understanding Gender Identity Development in Gender Variant Birth-Assigned Female Adolescents with Autism Spectrum Conditions. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

This thesis focuses on understanding gender identity development in gender variant birthassigned female adolescents with Autism Spectrum Conditions (ASC), with the aim of elucidating the association between ASC and gender dysphoria identified by Gender Identity Development (GID) services worldwide. Part 1: This section presents a systematic review of the literature investigating the characteristics of children and adolescents referred to GIDs and other specialist services with gender dysphoria. The review focused specifically on demographics, psychiatric comorbidity and associated risks. There were 24 articles that met the criteria for review. The review indicates that there could be a notable delay between reported age of onset of gender dysphoric feeling and presentation to clinical services; shows that more birth-assigned females, compared to birth-assigned males, have been referred in recent years; more referrals come from white, compared to non-white, ethnic backgrounds proportional to what would be expected given the countries’ demographics; and the majority are sexually attracted to individuals of the same birth-assigned sex. There is also a high level of co-occurring mental health difficulties among gender dysphoric children and adolescents, and they are at elevated risk of self-harming and suicidal behaviour. Part 2: This section shows the results of a qualitative study using Constructivist Grounded Theory method. Interviews were conducted with ten clinically-referred gender variant adolescents aged between 15 and 18, who were birth-assigned female and had a diagnosis of ASC. Analysis of the semi-structured interviews identified a core category of ‘Journey Towards Understanding’, which consisted of three major categories that represent the consecutive stages of this journey: ‘Awareness of Difference’, ‘Experience of Incongruence’, and ‘Understanding Difference’. A final major category ‘Neurodiversity as a Facilitator of Change’ reflected the intrapersonal and interpersonal processes associated with having ASC that may have enabled the participants to make the transition towards living as (trans) males. Part 3: This section presents a critical appraisal outlining the political, socio-cultural and clinical context for the research, and how this influenced the researcher’s position. It also includes reflections on the conceptual and practical challenges faced by the researcher in designing and conducting qualitative research with gender variant young people with ASC. It demonstrates how specific methodological challenges, arising during four phases of the research process, were (or could have been) addressed: study design; recruitment; interviews with participants, and transcription and data analysis. Further implications for future research and clinical services are also considered.

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