When the right thing to do is at odds with the legal thing to do: affirming transgender and autistic minors in an oppressive legal, political, and social climate

Abstract

Transgender youth must confront an increasingly volatile cultural, social, and political environment where their gender identities are being policed via anti-transgender legislation and socially critiqued via public discourse. In the United States, human rights groups are tracking over 600 anti-transgender legislation targeting transgender and gender non-conforming youth to regulate healthcare, education, legal recognition, and the right to exist publicly. In the UK, the NHS in England has limited transgender minors from accessing gender affirming medical care. The closing of a well-established gender affirming clinic in London has increased affirming care waitlists to over four years. Further, legal restrictions which criminalize or significantly limit affirming care actions by parents, medical personnel, clinical practitioners, and educators of transgender youth are also on the increase in the United States and the United Kingdom. Research has highlighted that transphobic attitudes towards the LGBTQAI+ population are influential factors in the provision of heteronormative and cisnormative based, sexuality, gender and gender identity education for autistic youth – which is not appropriate. Research has documented a correlation between transgender identities and neurodiversity, and that transgender people are 3-6 times more likely to be diagnosed as autistic than their cisgender counterparts, placing those who live at this intersection at heightened risk to ableist and transphobically motivated clinical and educational practices.

Poor outcomes such as increased risk of depression, anxiety, and suicidality, in correlation with increased vitriol, decreased access to affirming environments, and public discourse surrounding the gender identity of transgender children have been reported. Societal norms and gender training which regulate the body autonomy of children, coupled with the over policing of disabled people, in a heighted legally oppressive climate, is calling for autistic inclusive, transgender affirming, youth toolkits, and affirming caregiver support recommendations which can be applied across varied levels of restrictive legal landscapes.

This research sought to provide practitioners, who by nature of their professional roles, are categorically positioned, to frequent contact with transgender and autistic youth (and their caregivers) with practice recommendations to affirm diverse gender identity across varied levels of legal pressure and restrictions. The research sought to provide both caregivers and practitioners with replicable and realistic steps to affirm the gender identity of the autistic and transgender child when the right and ethical thing to do is at odds with the legal thing to do. An initial quantitative research study was utilized to solicit the perceptions of parent attitudes of their child’s neurotype (autism) in relation to their gender identity (transgender, expansive gender, non-binary, non-cisgender). The findings were used to develop an applied study that would enable practitioners to use existing therapy modalities, to increase affirmation across home, community, and school environments. Using a telehealth modality, the applied study focused on three case studies of transgender and autistic teens and their parents across Georgia, USA, the United Kingdom, and Canada. A parent training program was developed to increase parental self-assessment of their implicit bias surrounding gender and disability and how their bias impacted their worldview and parenting.

As a result of this study, parents were able to identify gender dysphoria, the ways in which this impacted their child, and were able to act as agents of change across their home and community environments by limiting or removing transphobic barriers. Several unique and reproducible surveys and assessment tools have been created as a result of this research to measure teen feelings of overall worth and value, how affirming they believed their environments were to be, as well as parent surveys which offer a self-assessment on affirming caregiving behavior. Further, a gender, disability, and ethnic identity tool was developed to measure the unique experience of youth living at the intersection of diverse ethnicity, neurotype, and gender. All teen participants reported increases in their overall feelings of worth and value, and increased affirmation across frequented environments, despite added legislation barriers across the study duration. The teenage participants were also able to achieve self-identified goals across self-help, socialization, communication, and safety awareness that incorporated the nuance of gender and neurodiversity.

This study provided comprehensive and replicable recommendations for parents and practitioners working with the intersection of autistic and transgender identities while meeting quality standards to classify as evidence-based practice. This research demonstrates that parents of transgender youth are positioned to act as forces of affirmation and advocates for their children, despite the oppressive laws which create fear. Further, practitioners who frequent contact with the autistic community are uniquely situated to provide direction to parents via their existing roles. Guidance, however, must be realistic, swift, comprehensive, and flexible to the ever-changing legal landscape.

Date of Award	Dec 2024
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	Alison MacKenzie (Supervisor) & Nichola Booth (Supervisor)