Week 3 - Intersectionality and minority voices in autism research

Intersectionality

Defined by Crenshaw (1989), looks at how categories of a person’s identity overlap to create a distinct new identity. Social and political identities can intersect, combine and overlap, but identities are not additive - they interact multiplicatively

Systematic biases in autism research

• DSM criteria - diagnostic tools rely on observation, fail to account for masking, poor measurement validity (Lai et al., 2015)

• Racial and ethnic disparities - research not accounting for this; structural racism in healthcare access and stereotypes, clinician bias, mistrust in health system, language barriers (Mandell et al., 2002)

• Diagnosis - wait times and private care access

• LGBTQ+ and gender intersections

Intersectionality in autism

• Autism across cultures, ethnicities, socioeconomic status

• Multiple marginalised identities

• Barriers to diagnosis and support

Why does intersectionality matter for research?

• Construct validity

• Sampling bias

• Generalisability

How do we address issues of intersectionality in research?

• Recruitment sampling from underrepresented groups

• Participatory research

• Critical reflexivity - methodological transparency

• Challenge deficit models

• Consider intersectionality within methods sections and research planning - not just in theory or framework sections (e.g. as a link to social justice)

Sex

Biological aspects that related to our body’s function, appearance and reproductive capacity, is assigned at birth (SAAB)

Gender

Culturally determined, characteristics and expectations attributed to people based on the individual’s sexed body

Gender identity

Individual’s perceptions of their own gender as man, woman or else, not visible to others, has to do with individual’s sense of self and who they are

• Not determined by sex

• Not determined by sexual orientation

Transgender

Gender identity that does not align with their SAAB

Non-binary

Gender identity that disrupts/challenges gender binarism

Cisgender

Identifies with SAAB

Overlap between autism and gender diversity

• Autistic people more likely to identify as trans/non-binary

• High rates of gender dysphoria with autistic people and high autistic trait scores amongst minorities

• High % autism among gender diverse people

Pecora et al. (2020)

Autistic participants 1.68x more likely to be trans/other gender

Hisle-Gorman et al. (2019)

Autistic children 4x as likely to be diagnosed with gender dysphoria vs. matched controls

Warrier et al. (2020)

Gender-diverse individuals had higher autistic traits

Strauss et al. (2021)

22.5% of gender-diverse respondents diagnosed as autistic

Mastrantonio et al. (2025)

57.5% non-binary and 48% binary trans in autistic sample

Autigender

Autism shapes experience of gender

Neuroqueer

Queer identity and neurodivergent identity shape one another

Neuroqueering

Active process of challenging neuro/heteronormativity and social norms

Biological theories

• High birth weight - little theoretical underpinning or evidence

• Extreme male brain theory - Baron-Cohen, male brains more capable of systematising whereas female brains more capable of empathy

• Genetic link - not much research, unlikely that one gene is responsible

Psychological theories

• Atypical gender development/delayed gender consistency - autistic people may form gender consistency later than non-autistic people and because of this delay are more likely to develop a non-cis gender. Little research on this.

• Obsession - some autistic people develop obsession with identity/gender diversity which could contribute to their gender development

• Sexual orientation - if autistic people develop same-sex attraction, they may get confused and feel need to change own gender

• ToM impairment - autistic people struggle with ToM so may struggle to identify with SAAB

Social theories

• Minority stress - people part of minority group more likely to be stressed because of internal (internalised stigma, transphobia etc.) or external (harassment, violence, discrimination) stresses

• Feeling different - idea that autistic people may feel different in their early years, which trans people also experience

• Resistance to social norms - autistic people not as susceptible to social norms so may be more likely to explore their gender openly and come out as gender diverse

Walsh et al. (2018)

High rates of non-binary identities in gender-diverse autistic samples consistent with resistance to societal conditioning

Limitations of biological/psychological/social theories of the autism-gender diverse intersection

• Study quality not good - low quality gender dysphoria measures (single item, no focus on distress), if children protagonist of study, parental responses used, clinical samples (people seeking trans or autism support)

• Assumptions about identity - assumption that autistic people are just confused about their gender

• Medicalisation of gender diverse/autistic identities - research should not be limited to autistic traits and gender dysphoria, should focus on self-identification

• Diagnostic oversharing - harder to get diagnosis as gender diverse, but self-identification is dismissed

Unique barriers of autistic gender diverse people

• Multiple minoritised identities - unique forms of oppression and stress impacting health

• Poorer health in both autistic and gender diverse populations individually, potentially even poorer outcomes when these identities co-occur (Strauss et al., 2021; Kung, 2023)

Intersectional identities and inadequate healthcare access for autistic gender diverse people

• Fear of disclosing

• Lack of understanding by professionals

• Lack of training on this intersection so lots of people fall through the cracks/gp unrecognised

• Lack of clinical guidance

• Sensory and communication barriers - mismatch in understanding (double-empathy theory)

Adams et al. (2015)

• 3.7% formally diagnosed and 1.1% self-id autistic gender diverse reported being denied gender affirming care due to AS

• 25% formally diagnosed and 36% self-id decided not to share AS

Poorer outcomes of autistic gender diverse people

• Autistic gender diverse US college students had greater risk for suicidal thoughts/behaviours compared to cis non-autistic (Mournet et al., 2024)

• 2.3x more likely to report a physical health condition, 10.9x more likely to report a mental health condition, 5.8x more likely to report self-harm than cis non-autistic adults (Green et al., 2025)

• Autistic trans+ people had worse overall health, higher rates of unmet needs, and more mental health struggles compared to other gender diverse people (Adams et al., 2015)

Mastrantonio et al. (2025)

Being autistic in sample of non-binary people led to higher sexual wellbeing

Autistic pride

Understanding autism as a positive difference, being able to highlight strengths that relate to being autistic and developing a positive autistic identity

Davis et al. (2022)

Very little published research on autism in different ethnic groups, particularly black people

Autism in the media

Autistic people may see the autistic people represented on TV by non-autistic actors (often the “smart autistic”) and not identify with them, making them feel more alienated and different

What do diagnostic manuals say about difference in diagnosis?

• DSM-5 notes autism is late-diagnosed or underdiagnosed in Black children (American Psychiatric Association, 2013)

• DSM-5-TR notes that females are diagnosed later than males (American Psychiatric Association, 2022)

• DSM-5-TR explains late diagnosis happens “among socially oppressed ethnic and racialised children” (American Psychiatric Association, 2022, p. 66)

• ICD-11 notes there are different cultural behaviours e.g. eye contact (World Health Organization, 2022)

Rutherford et al. (2016)

Girls are still diagnosed later than boys, but as they get older the ratio reduced, suggesting that autism in older girls is more noticeable than in younger one - girls more likely to be picked up as autistic as they get older

Autism and ethnicity

• Bobb (2019) suggested under-diagnosis can happen if a black child is academically able and well-integrated into their community

• Individuals with high support needs are more likely to be diagnosed (Straiton & Sridhar, 2021)

• Underdiagnosis of autism in black people

• Not a lot of research on ethnicity in autism

Ethnicity in autism research

• Not all autism research includes demographics of race and ethnicity

• Only 25% of 1013 articles reported race or ethnicity data (Steinbrenner et al. 2022), of the articles that did report ethnicity data, only 7.7% were black

• Underrepresentation of black people in autism research

• Up to 30% of autistic participants reported discrimination for being both black and autistic (Davis et al., 2022)

Black autistic women and girls

• Black autistic women can be stereotyped as an “angry Black woman” when just trying to be assertive (Burkett, 2020)

• Lovelace et al. (2022) only found three academic papers centred on Black autistic women and girls over a 77-year period, which did not explore intersectionality

Autism strategy in England

Has six key focuses, one of which is “improving understanding and acceptance of autism within society” (Department of Health and Social Care, 2021). The plan is to include diversity, including autism in women and ethnicity, although this does not specify whether it will look at the intersectionality of any of these

What else should be considered in autism research?

• Representation - having professionals with whom autistic people and their families can identify

• More diversity and less stereotypically autistic or autistic-coded characters in fiction