L7: Gender Identity & Sexuality in ND Conditions

Understand how sexuality and gender identity are diverse, fluid, and influenced by cultural and societal norms ; Explain how gender identity differs in ADHD or Autism Identify ; Identify explanations for differences in gender identity in autism ; Understand the importance of tailored sex education in Down Syndrome

historical view of sexuality & nd ppl

individuals asexual, childlike

impact of historical view

• lack of research and clinical attention

• bias hindered early studies

- e.g. focus on victimisation

what limited sexuality/gender research for ND ppl

ethical concerns. e.g. informed consent, vulnerability, exploitation

esp regarding IDs

moving forwards in sexuality/gender research in ND

• focus on sexual education, consent, health rls

• studies on impact of nd conditions on sexual development and expression

• research on gender identity and sexual orientation w/in nd populations

• emphasis on need for tailored support

sexual development: childhood

• ages 0-12

• body awareness

• gender role exploration

• understanding of rls

sexual development: adolescence

• ages 13-19

• puberty

• sexual identity formation

• early romantic experiences

sexual development: adulthood

• ages 20+

• continued exploration

• intimacy and rls development

• lifelong learning abt sexual health and expression

when does sexual orientation typically emerge?

between middle childhood and early adolescence

UK 2021 Census: sexual orientation

• 89.4% heterosexual

• 3.2% LGB+

→ 1.5% gay/lesbian

→ 1.3% bisexual

→ 0.3% other

Weir et al., 2021: method

• anonymous, self report survey

• 1,183 autistic

• 1,203 non-autistic

• aged 16-90 years

Weir et al., 2021: findings

autistic ppl 8x more likely to identify as asexual and ‘other’ sexuality than non-autistic peers

Weir et al., 2021: sex differences in sexual orientation

• autistic men 3.5x more likely to identify as bisexual than non-autistic men

• autistic women 3x more likely to identify as homosexual than non-autistic women

ADHD & sexuality

• women with are more likely to have had homosexual experiences (Young & Cocallis, 2023)

• generally, ppl with do not differ from neurotypical peers in self-reported sexual orientation

• potential to show more hypersexual behaviours (Hertz et al., 2023; Soldati et al., 2021)

core four features of ADHD that relate to sexuality

1. impulsivity

2. inattention

3. sensory sensitivities

4. dopamine

ADHD & sexuality: impulsivity

risky sexual behaviour

ADHD & sexuality: inattention

distractibility

difficulty focussing

ADHD & sexuality: sensory sensitivities

repelled

discomfort

ADHD & sexuality: dopamine

sensation seeking

reward seeking

Kohlberg’s stages of gender development

1. stage 1: 2-3y/o: gender identity based on appearance

2. stage 2: 4-5y/o: gender stability over time, still appearance-based

3. stage 3: 6-7y/o: gender constancy across changes

nature: gender

biological factors

• hormones (androgens) influence development

• intersex conditions and transgender/twin studies relevant

nurture: gender

Social Cognitive Theory

• gender development involves personal, environmental, and behavioural factors

Gender Similarity Hypothesis

genders are more alike than different in most variables

gender-typing and gender expression

the processes by which children adopt observable behaviours in like with construction of gender

child development and gender

learn to perform behaviours associated w their gender

what do gender-typed preferences and behaviours result from? (Leaper, 2013)

combined influence of biological, psychological, and sociocultural processes

→ biopsychosocial model

gender-typed behaviours =/= gender identity

gender identity

individual’s internal sense of own gender

what is gender?

complex interplay of social, cultural, and personal factors, distrinct from the biological concept of sex

gender diversity

experiences of aspects of your gender as different from your assigned sex at birth

what can gender diversity result in?

gender incongruence

gender incongruence

gender identity that differs from sex assigned at birth

how many adolescents identify as gender diverse according to survey-based research? (Rider et al., 2018)

1-2%

2021 UK Census: how much of the gen pop indicated their gender differed from their sex?

0.5%

DSM-5-TR: gender dysphoria (children)

A marked incongruence between one’s experienced/expressed gender and assigned gender, lasting at least 6 months, as manifested by at least six of the following (one of which must be the first criterion):

1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender)

2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing

3. A strong preference for cross-gender roles in make-believe play or fantasy play

4. A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender

5. A strong preference for playmates of the other gender

6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities

7. A strong dislike of one’s sexual anatomy

8. A strong desire for the physical sex characteristics that match one’s experienced gender

DSM-5-TR: gender dysphoria (adolescents & adults)

A marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months, as manifested by at least two of the following:

1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)

2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)

3. A strong desire for the primary and/or secondary sex characteristics of the other gender

4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

the first systematic study regarding gender diversity and autism

• led by Vries et al. (2010)

• investigated the incidence of autism in children and adolescents referred for gender diversity services

Vries et al. (2010): findings

7.8% of the sample (children and adolescents referred to gender diversity services) met strict diagnostic criteria for autism

10x higher than prevalence of autism in gen pop at that time

Strang et al., (2018): what did they identify?

studies of gender diverse and transgender youth that included only clinical autism diagnoses or autism diagnosed through comprehensive methods

7 studies

Strang et al., (2018): findings

in all 7 studies, rates of clinical diagnoses were significantly greater compared to the general population

what has gender diversity research with autistic children typically relied on?

parent-report based on a single question

Corbett et al., (2023): method

• 244 children (140 autism, 104 neurotypical)

• used the Gender Diversity Screening Questionnaire (Self-Report and Parent-Report)

• two domains: 

1. Binary Gender Diversity

2. Nonbinary Gender Diversity

Corbett et al., (2023): self-report findings

autistic children showed higher Gender Diversity, both binary and nonbinary, than neurotypical children

Corbett et al., (2023): parent-report findings

a significant difference in gender diversity between the groups on body incongruence

Corbett et al., (2023): what does this underscore?

the need to better understand and support the unique and complex needs of autistic children who experience gender diversity

what is this?

findings of Corbett et al., (2023)

describe studies on gender diversity and ADHD

• very limited

• very few studies look at this condition specifically

Warrier et al., 2020

transgender and gender diverse individuals had elevated rates of ADHD

Holt et al., 2016

prevalence rate of ADHD of 8.3% in children and adolescents referred to gender care

Cheung et al., 2018

prevalence rate of ADHD of 4.3% in TGD adults

Ignatova et al., 2025: method

• 10,277 ADHD & Transgender early adolescents (12-13y/o)

• data taken from the longitudinal Adolescent Brain Cognitive Development (ABCD) study (based in US)

• methods: “Are you transgender?” Yes (TG), no (CG), or maybe (GQ)

Ignatova et al., 2025: results

• gender diverse individuals showed higher levels of ADHD traits

• results reduced when controlling for stress

Ignatova et al., 2025: what did authors link results reducing when controlling for stress to?

current US climate

lived experience study: autistic & transgender

Cooper et al., 2022

Cooper et al., 2022: method

21 autistic adults took part in semi-structured interviews

all Ps identified as transgender and/or nonbinary

Cooper et al., 2022: main findings

• distress due to their bodies not matching their gender identity, whilst managing complex intersecting needs

• societal acceptance of gender and neurodiversity → barriers in accessing healthcare for their gender needs

• tension between need to undergo physical gender transition vs a need for sameness and routine

Cooper et al., 2022: positive experiences

• “we see the world differently” ; being autistic allows one to deny social norms and follow own path→ P 22

• have never/rarely tried to fit in, so don’t care that gender presentation is sterotypically male whilst intentionally doing more feminine things → P 12

• autism diagnosis made experiences come to light; realised do things that find uncomfortable/ don’t suit them that they edited to ignore; diagnosis was comforting and allowed new coping strategies to be implemented → P17

DSM-V-TR: autism- what does the criteria say about sensory issues?

“Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)”

DSM-V-TR: autism and sensory issues

• hypo or hyperactivity to sensory input

• unusual interests in sensory stimuli

‘sensory dysphoria’

• described in Cooper et al., 2022

• distress linked to sensory experiences intersecting with gender

evaluate Ignatova et al., 2025 study

• not good at all

• only one question

• results disappear when controlled for stress

• stress a way too big confounding variable

• measures traits not diagnosis

• WEIRD

• ethnocentric

• no info abt type etc

• social sensitivity

examples of sensory dysphoric experiences described in Cooper et al., 2022

• wearing uncomfortable fabrics and shapes associated w girls clothes

• sensory challenges of puberty like periods, facial hear

how does one P explain sensory dysphoria in Cooper et al., 2022?

“I was stuck between having really bad gender dysphoria not wearing a binder or feeling really uncomfortable sensory wise.”

why might more autistic people be gender diverse? three explanations (Warrier et al., 2022)

1. biological explanations

2. increased self-identification

3. cognition and sensory differences

biological theories: autism and gender (Warrier et al., 2022)

1. prenatal hormone exposure

2. brain structure and function

prenatal hormone exposure: autism and gender (Warrier et al., 2022)

• variations in …. cld contribute to differences in how individuals perceive and experience gender

• higher exposure to foetal testosterone → autistic traits in animal models

• BUT not simple cause and effect rls

brain structure and function: autism and gender (Warrier et al., 2022)

• differences in …. cld influence  how individuals process and internalise social constructs like gender

• differences in brain regions involved in social cognition and self-perception might play a role

limitation of prenatal hormone exposure explaining autism and gender

there are autistic ppl who have not have higher exposure to foetal testosterone and also ppl w differing levels of exposure to differing prenatal hormones who r not autistic

increased self-identification: autism and gender (Warrier et al., 2022)

• autistic individuals may be less influenced by societal norms generally, including re expectations surrounding gender and sexuality

• → leading to greater likelihood of expressing authentic gender/sexual identity, even if deviates from societal norms

• may be less likely to suppress or conform to traditional gender roles/sexual identities due to social pressures

differences in social cognition and sensory processing: autism and gender (Warrier et al., 2022)

1. systemising and pattern recognition

2. intense focus and special interests

3. sensory sensitivities/sensation seeking 

systemising and pattern recognition: autism and gender (Warrier et al., 2022)

have a more analytical approach to gender, breaking down its components and questioning traditional norms

intense focus and special interests: autism and gender (Warrier et al., 2022)

increased depth, leading to a more profound understanding of own identity and less influence from outside sources

sensory sensitivities/sensation seeking: autism and gender (Warrier et al., 2022)

• certain clothing textures or social environments associated with specific genders might be intensely uncomfortable

• preference for certain gendered presentations due to sensory input it provides

gender identity & sexuality in Down Syndrome: research

• limited to no studies investigating gender diversity in DS

• parent-report regarding more general views of sexuality in DS

• no studies speaking directly to ppl w DS

• focus on need for/improvement of sexual education

issues w sex ed

WHO advocates for SE as a human right

adolescents/YAs w IDs or DDs frequently excluded

SE in DS: focus

on safety and abuse prevention rather than holistic approach

• healthy rls, consent, sexual fulfilment

what needs to happen re SE and DS

work w individuals w DS to develop and implement more accessible and effective SE programs

Schmidt et al., 2021: aim

improving accessibility of sexuality education for individuals w intellectual or developmental disabilities

Schmidt et al., 2021: data

qualitative, collected through interviews and focus groups

from individuals, parents, healthcare providers, and educators

Schmidt et al., 2021: beneficial modalities

• educational guides

• visuals

• videos

• universal design for learning

• direct, explicit instructions

Schmidt et al., 2021: beneficial settings

• one-to-one

• small groups

• combination

Schmidt et al., 2021: additional important things

• role-playing and modelling

• open communication

• importance of parental support and education

Universal Design for Learning (UDL): what?

adapts education to fit diverse learner needs

the 3 UDL principles

1. representation (the ‘what’)

2. action/expression (the ‘how’)

3. engagement (the ‘why’)

UDL: representation

offer information in varied formats, e.g. visual, auditory

UDL: action/expression

provide different ways for learners to interact and express themselves

UDL: engagement

increase motivation through choice, relevance, and collaboration

UDL in SE

makes it accessible and engaging for all