With the COVID-19 pandemic evolving rapidly across the globe, scarce medical resources have become centered around care for those who are infected with COVID-19, and so-called non-essential medical care has been set on hold. While there is general consensus about the prioritizing of COVID-19 care, a growing number of health care providers and patient representatives have expressed their concerns with the (long-term) consequences of deferring other medical care (Wang & Zhang, 2020). As this global outbreak continues to spread, inducing fear and anxiety without a clear perspective, this pandemic will especially impact those who depend on proper medical and mental health care. It is largely unknown what the (mental) health status is of the groups that remain out of scope during this COVID-19 crisis, especially those in vulnerable positions and with prior health problems. In this Guest Editorial, we express our concerns over the deferral of most gender-affirming (medical) treatments and the direct and indirect effects this might have on the public (mental) health of transgender and gender non-conforming (TGNC) people, and the health system that serves these individuals. We highlight the increased vulnerability of this group, underline the cumulative burden (e.g., physical, mental, socioeconomic) for many TGNC individuals, and argue why gender-affirming medical and mental health care should be prioritized when re-introducing nonessential medical care (see also Bowleg, 2020; Wang et al., 2020)

/pdf/you-have-to-wait-a-little-longer-transgender-mental-health-5axzs10fyt.pdf

"You Have to Wait a Little Longer": Transgender (Mental) Health at Risk as a Consequence of Deferring Gender-Affirming Treatments During COVID-19.

Recently, there has been increasing attention to key intersections between sex, gender and autism (Lai et al., 2015), including the so-called ‘female autism phenotype’ (Mandy et al., 2012), social ‘camouflaging’ (Hull et al., 2017) and experiences of gender diversity in autistic people (van der Miesen et al., 2016). This research and related clinical practice have increased awareness of the breadth of autistic experience. However, sex and gender often have been conflated in this work, and gender viewed through a binary lens. The term ‘gender’ refers to a range of experiences, both internal and external (Becker et al., 2017; Ehrtmann et al., 2019), and the intricate interplay between social gender and inner gender-related experiences has yet to be articulated in autism (Cooper et al., 2018). In this editorial, written as a collaboration between clinician researchers and autistic advocates (Fletcher-Watson et al., 2019), we explore key topics in the field and offer recommendations for advancing this work through more diversified, sexand gender-informed lenses, and with a focus on the lived experiences of autistic people.

https://journals.sagepub.com/doi/pdf/10.1177/1362361320913192

Both sex- and gender-related factors should be considered in autism research and clinical practice.

Not all people conform to what is socially construed as the norm and divergences should be expected. Neurodiversity is fundamental to the understanding of human behaviour and cognition. However, neurodivergent individuals are often stigmatised, devalued, and objectified. This position statement presents the perspectives of neurodivergent authors, the majority of whom have personal lived experiences of neurodivergence(s), and discusses how research and academia can and should be improved in terms of research integrity, inclusivity and diversity. The authors describe future directions that relate to lived experience and systematic barriers, disclosure, directions on prevalence, stigma, intersection of neurodiversity and open scholarship, and provide recommendations that can lead to personal and systematic changes to improve acceptance of neurodivergent individuals’ lived experiences within academia. 

/pdf/bridging-neurodiversity-and-open-scholarship-how-shared-2s6ukirz.pdf

Bridging Neurodiversity and Open Scholarship: How Shared Values Can Guide Best Practices for Research Integrity, Social Justice, and Principled Education

Objective: 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.Method: 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.Results: 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.Conclusions: 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.

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

Mental health difficulties among trans and gender diverse young people with an autism spectrum disorder (ASD): Findings from Trans Pathways.

Objective: Research addressing the co-occurrence of autism (and/or neurodiversity) and gender-diversity (A/ND-GD) has been conducted largely without the perspectives and voices of the A/ND-GD community. Including A/ND-GD community advocates as research partners may be a critical next step for advancing research initiatives on the co-occurrence given the apparent complexity and alterity of the A/ND-GD experience. Method: Consistent with the community-based participatory research (CBPR) model we propose herein, our authorship team includes a partnership between clinician researchers and diverse A/ND-GD community collaborators. Multiple facets of the A/ND-GD lived experience are examined, including through narratives provided by our A/ND-GD community partners. Results: Based on our experience conducting A/ND-GD-related research and our lived experience as A/ND-GD self-advocates, we highlight challenges in this line of research, including risks of conducting studies without the involvement of the A/ND-GD community. And given that many A/ND-GD youth present with gender-related urgency during the teen years, we provide a developmental framework for how CBPR-informed methods may enrich our understanding of the care needs of these young people and provide context for the apparent heterogeneity in their gender needs and trajectories over time. Conclusions: Integrating CBPR methodologies in A/ND-GD research initiatives has the potential to optimize the relevance of the research questions asked and the interpretation and contextualization of study findings.

Community-Based Participatory Design for Research that Impacts the Lives of Transgender and/or Gender-Diverse Autistic and/or Neurodiverse People.

Common Intersection of Autism and Gender Diversity in Youth

Background
Autistic transgender people face unique risks in society, including inequities in accessing needed care and related mental health disparities. Given the need for specific and culturally responsive accommodations/supports, the characterization of key experiences, challenges, needs, and resilience factors within this population is imperative. This study developed a structured self-report tool for autistic transgender young adults to communicate their experiences and needs in a report format attuned to common autistic thinking and communication styles.


Methods
This cross-nation project developed and refined the Gender-Diversity and Autism Questionnaire through an iterative community-based approach using Delphi panel methodology. This proof-of-principle project defined "expertise" broadly, employing a multi-input expert search approach to balance academic-, community-, and lived experience-based expertise.


Results
The expert collaborators (N = 24 respondents) completed a two-round Delphi study, which developed 85 mostly closed-ended items based on 90% consensus. Final item content falls within six topic areas: the experience of identities; the impact of experienced or anticipated discrimination, bias, and violence toward autistic people and transgender people; tasks and experiences of everyday life; gender diversity- or autism-related care needs and history; the experience of others doubting an individual's gender identity and/or autism; and the experience of community and connectedness. The majority of retained items relate to tasks and experiences of everyday life or the impact of experienced or anticipated discrimination, bias, and violence.


Conclusions
This study employed a multipronged multimodal search approach to maximize equity in representation of the expert measure development team. The resulting instrument, designed for clinical, research, and self-advocacy applications, has parallel Dutch and English versions and is available for immediate use. Future cross-cultural research with this instrument could help identify contextual risk and resilience factors to better understand and address inequities faced by this large intersectional population.

The Gender-Diversity and Autism Questionnaire: A Community-Developed Clinical, Research, and Self-Advocacy Tool for Autistic Transgender and Gender-Diverse Young Adults.

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Community-Based Participatory Design for Research that Impacts the Lives of Transgender and/or Gender-Diverse Autistic and/or Neurodiverse People.

Common Intersection of Autism and Gender Diversity in Youth

The Gender-Diversity and Autism Questionnaire: A Community-Developed Clinical, Research, and Self-Advocacy Tool for Autistic Transgender and Gender-Diverse Young Adults.