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

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Strang, J. F., Anthony, L. G., Song, A., Lai, M. C., Knauss, M., Sadikova, E., Graham, E. K., Zaks, Z., Wimms, H., Willing, L., Call, D., Mancilla, M., Shakin, S., Vilain, E., Kim, D. Y., Maisashvili, T., Khawaja, A., & Kenworthy, L. (2021). In Addition to Stigma: Cognitive and Autism-Related Predictors of Mental Health in Transgender Adolescents. Journal of Clinical Child & Adolescent Psychology, 52(2), 212-229. https://doi.org/10.1080/15374416.2021.1916940

Publication date: 14 Jun 2021 Added to AutiHub: 29 Aug 2026 Type: Article Article language: English
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Authors

Publication authors
18
Publication authors identified as autistic
1 / 18 (5.6%)
  1. John F. Strang
  2. Laura G. Anthony
  3. Amber Song
  4. Meng-Chuan Lai
  5. Megan Knauss
  6. Eleonora Sadikova
  1. Elizabeth K. Graham *
  2. Zosia Zaks
  3. Harriette Wimms
  4. Laura Willing
  5. David Call
  6. Michael Mancilla
  1. Sara Shakin
  2. Eric Vilain
  3. Da-Young Kim
  4. Tekla Maisashvili
  5. Ayesha Khawaja
  6. Lauren Kenworthy

Abstract

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.

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Cited references
69
With a DOI
63
Without a DOI, from raw bibliography text
6
6 / 69 (8.7%) cited references include at least one author identified as autistic.
References with data to complete
0 / 69 (0.0%)
References with detected author names
69 / 69 (100.0%)
Without detected author names
0
Without a structured title
0
Without a stable identifier
5
References with raw author names still to review
0
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
407
From DOI or external metadata
407
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
156 / 407 (38.3%) names are linked to an author already present in AutiHub. 251 / 407 (61.7%) names are not yet linked.
Names linked to a person identified as autistic
12 / 407 (2.9%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 12 / 156 (7.7%). Distinct people identified as autistic: 8 / 341 (2.3%).
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