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J Clin Child Adolesc Psychol. 2018 Jan-Feb;47(1):105-115. doi: 10.1080/15374416.2016.1228462. Epub 2016 Oct 24.

Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents.

Author information

a Division of Pediatric Neuropsychology , Children's National Health System.
b Department of Child and Adolescent Psychiatry , VU University Medical Center.
c Division of Psychiatry and Behavioral Sciences , Children's National Health System.
d Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine.
e Department of Child and Adolescent Psychiatry , New York University School of Medicine.
f Department of Medical Psychology , VU University Medical Center.
g Division of Pediatric Endocrinology , University of Michigan Health System.
h School of Professional Psychology , Pacific University.
i Division of Child & Adolescent Psychiatry , Hofstra Northwell School of Medicine.
j Division of Endocrinology , Boston Children's Hospital.
k Department of Psychiatry , University of California San Francisco School of Medicine.
l Department of Psychiatry , University of California San Francisco-Benioff-Children's Hospital Oakland.
m Departments of Psychiatry , Endocrinology and Urology, Boston Children's Hospital and Harvard Medical School.
n Child and Adolescent Gender Center , Department of Pediatrics, University of California San Francisco Benioff Children's Hospital.
o Division of Psychiatry and Behavioral Sciences, Children's National Health System.
p Department of Radiology and Center for Autism Research , The Children's Hospital of Philadelphia.
q Divisions of Endocrinology and Social Work , Boston Children's Hospital.
r Private Practice , Farmington Hills , MI.
s Division of Psychiatry and Pediatrics , University of Colorado.
t Division of Pediatric Neuropsychology , Children's National Health System.


Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD. There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements. The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment; guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/blurring of treatment and assessment.

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