Date Published: June 22, 2020
One day, Riley Smith learned from some former co-workers that an acquaintance had come out as transgender. Smith felt happy for the acquaintance, but she also felt something else. “Afterward, in the days and weeks that followed, I felt a different emotion that I recognized as envy. It led to me to ask myself increasingly difficult questions about who I was.”
Assigned male at birth, Smith eventually came to realize that she is a transgender woman. As an autistic person, she is not alone. A higher percentage of autistic people identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) than the general population, according to research studies.1-5 A 2017 Gallup poll found that 4.5 percent of Americans identify as LGBT.
Studies vary widely on the percentage of people with autism who are gay, lesbian, or bisexual. One analysis suggested the rate is 15 to 35 percent among autistic people who do not have intellectual disability. 2
“Most of the data that we’re seeing is that [the LGB rate] is two to three times higher,” says clinical psychologist Eileen T. Crehan, Ph.D., an assistant professor at Tufts University. But larger studies need to be done before the true rate is known, she says.
Several studies also suggest that autistic men are more likely than autistic women to be heterosexual.3, 5 In a Dutch study, for example, only 57 percent of autistic women reported being straight compared to 82 percent of autistic men. The women were more likely to be attracted to both sexes, and also to neither sex.5
Research suggests that people who have an autism diagnosis or autism traits are more likely to be transgender than the general population. One study found the rate to be two to three times higher in people who have autism. Also, a larger percentage of autistic people reported their gender as being something other than strictly male or female, compared to other people. Examples of gender identities included in that study were bigender, genderqueer, and “other.” 3
Sex Education for Students with Autism
Eileen Crehan studies sexuality, gender identity, and sex education experiences in adults who have autism. She asks, “How do we prepare youth, particularly those with autism, to navigate sexual relationships and their own identity?” She discusses sexual orientation, gender identity, and autism in a recorded webinar for SPARK, the largest study of autism.
In an interview, Crehan says access to appropriate sex education is “an area of need” across the autism community, especially for those with minimal verbal skills. U.S. schools often teach sex education differently from state to state, and many such classes do not address LGBTQ issues, she says.
Crehan wonders about the timing of sex education for some youth who have autism. Students often take sex education classes in the pre-teen to early teen years, when most children reach puberty. But those on the spectrum may develop socially on a different timeline, Crehan says. Do they take an interest in dating and become aware of sexual orientation and gender identity at the same ages as their typically developing classmates, she asks. “Is the timeline similar in autism? There are a lot of questions to answer.”
Autism and Self-Awareness in the Teen Years
Riley Smith, 26, wonders if being on the autism spectrum delayed her recognition of her gender identity when she was younger. “That [autism] diagnosis may have made it more difficult to figure out that I was transgender, mainly because I had issues with not being fully in touch with my own feelings and desires,” explains Smith, a participant in the SPARK autism study.
Smith was diagnosed with an autism spectrum disorder in childhood, and received help with social skills. “A comparatively large part of my time at that age was spent just learning how to socially interact with people. So I guess I wasn’t doing as much active introspection. I was too focused on the performative aspect of social situations.”
Justin, who did not want his last name used, discovered in high school that he was both autistic and gay. “I knew what being gay was, but I personally lacked the emotional self-awareness for a while until I realized that’s what I was feeling toward other guys,” he explains. He only told a few trusted people. “I wasn’t openly gay in high school because I suspected very strongly I would be attacked,” he says.
Bullying is a particular risk for students like Smith and Justin. According to research, students with autism are at higher risk of being bullied.6 The same is true for LGBT youth. A 2017 survey of U.S. high school students found that those who are gay, lesbian, and bisexual are almost twice as likely to be bullied at school and online as heterosexual students are.7
Justin, who is in his 20s, did not escape bullying in high school. “I was bullied for being autistic. It’s just that no one involved knew that’s what I was. They just saw me as this awkward nerd. My differences offended them so they wanted to be mean.”
Smith says she was “mildly bullied” in high school. “It was not due to anything LGBT-related. I don’t think they knew I have autism, but they knew I was unusual.”
Shortly after high school, Smith came out to her family as a gay man. Then in her 20s, after she realized she was transgender, she began the process of transitioning to female.
She knew she was on the right path, she says, when she asked herself a question: “If there was a button you could push that automatically switches your gender, would you push it?” And she knew that she would.
The road she is traveling is a long one, she says. “Not only is transitioning difficult and entails a lot of emotional and physical changes, but it’s also a very long process that involves a lot of minor steps.”
Finding Support, Information for Gender and Sexuality Questions in Autism
Smith began attending an online support group for people who are transitioning.
Her mother, Lisa St. John, started a group for parents of transgender adults on the spectrum. Apart from gender identity issues, the transition to adulthood alone can be difficult for anyone on the spectrum, St. John says. Adding in a gender transition “compounds the difficulty,” she says. Her group members want to help support their children through their transitions.
When her daughter was growing up, she says, no one told her that people on the spectrum are more likely to be LGBTQ. She was surprised when Smith came out to her, and she struggled to find a doctor who was knowledgeable about autism and transgender concerns.
Crehan says many adults, both with and without autism, say they wish they had received more education about sexuality when they were younger. “We hear it more strongly from the autistic group,” she says. That’s because their social and communication differences may pose challenges for dating and relationships. And if they are LGBTQ, those differences may cause challenges with the process of coming out to family and friends. She says the Organization for Autism Research has sex education resources online for straight and LGBTQ people ages 15 and older.
Justin says that understanding and accepting his autism made it easier to understand and accept his sexuality, and vice versa. Autistic people and LGBTQ people often face negative stereotypes, discrimination, and pressure to conform or “pass for ‘normal,'” he says. “The intersection between being queer and being autistic is that we don’t want to be altered. We don’t want to be cured of who we are. Our worth doesn’t derive from seeming ‘normal.'”
Briella Baer Chen, formerly of the Interactive Autism Network, provided information for this article.
- View “Sexual Orientation, Gender Identity, and Autism Spectrum Disorder,” Eileen Crehan’s SPARK webinar.
- The Organization for Autism Research publishes Sex Ed for Self-Advocates, for ages 15 and older.
- View a recording of another SPARK webinar by Crehan, “Talking about the Birds and the Bees in ASD.”
- George R. and Stokes M.A. Autism Res. 11, 133-141 (2018) PubMed
- Pecora L.A. et al. J. Autism Dev. Disord. 46, 3519-3556 (2016) PubMed
- George R. and Stokes M.A. Autism 22, 970-982 (2018) PubMed
- Strang J.F. et al. Arch. Sex. Behav. 43, 1525–1533 (2014) PubMed
- Dewinter J. et al. J Autism Dev Disord. 47, 2927–2934 (2017) PubMed
- Zablotsky B. et al. Autism 18, 419-427 (2014) PubMed
- U.S. StopBullying.gov. Accessed June 10, 2020